Objective:To systematically evaluate the teaching effect of problem-based learning (PBL) plus case-based learning (CBL) versus lecture-based learning (LBL) in surgical internships in Chinese medical students.Methods:We searched PubMed, the Cochrane Library, Embase, China National Knowledge Infrastructure, VIP, and WanFang Data for randomized controlled studies evaluating PBL+CBL versus LBL in surgical internships in Chinese medical students. The retrieval time was from database establishment to June 2019. Data analysis was performed using RevMan 5.2 software.Results:Seventeen randomized controlled trials were included, involving a total of 1161 students, including 581 in the PBL+CBL group and 580 in the LBL group. Meta-analysis results showed that the PBL+CBL group had significantly higher scores of theory examination [mean difference ( MD)=6.15, 95%CI=4.14-8.15, P<0.001], skill examination ( MD=7.67, 95%CI=3.66-11.69, P<0.001), and case analysis ( MD=6.06, 95%CI=2.89-9.23, P=0.000 2) compared with the control group. The PBL+CBL group had a significantly higher percentage of satisfaction with the teaching results than the LBL group [odds ratio( OR)=2.98, 95%CI=1.88-4.73, P<0.001]. Conclusion:PBL+CBL is superior to LBL in medical students' surgical internships, which needs verification by more high-quality studies due to limitations in the number and quality of the included studies.

OBJECTIVE To evaluate the safety of fondaparinux in pregnancy and provide reference for its rational clinical application. METHODS A search was conducted in databases including CNKI， Wanfang， PubMed， Embase， and Elsevier （the search time was from the construction of the database to December 17， 2024） to collect case report literature on fondaparinux use during pregnancy. Patient demographic information， fondaparinux use during pregnancy， concomitant medications， clinical manifestations， and treatment details were extracted for descriptive statistical analysis. RESULTS A total of 17 case reports regarding the use of fondaparinux during pregnancy were collected， involving 42 patients from 11 countries and 47 pregnancy records. Among these， 20 cases involved the use of fondaparinux for the prevention of pregnancy-related venous thromboembolism （VTE）， while 27 cases were fondaparinux treatment due to related conditions. A total of 29 occurrences of the patients were treated with fondaparinux due to a （family） history of VTE. Nine occurrences of complicated pregnancies were reported， and 35 patients had records of comorbidities or relevant medical histories. The adverse events that occurred during pregnancy with the use of fondaparinux include postpartum hemorrhage （7 cases） and excessive anticoagulation caused by inappropriate dosage （1 case）. Among the 7 cases of postpartum hemorrhage， 3 cases had a blood loss of no less than 1 000 mL （including 2 cases with uterine atony）， 3 cases had a drug discontinuation time of ≤12 h. CONCLUSIONS Based on the existing literature， the safety of fondaparinux during pregnancy is generally manageable， with the main adverse event being postpartum hemorrhage. The dosage， interval between discontinuation，comorbidities/medical history， and concomitant medications of fondaparinux may be the main causes of its adverse events.