Objective:To explore the clinical teaching effect of case-based learning combined with diagnosis and treatment guidelines in standardized residency training in the department of rheumatology and immunology.Methods:Forty standardized trainees were randomized into two groups. One was the observation group, which adopted case-based learning combined with diagnosis and treatment guidelines. The other one was the control group, which performed the traditional clinical teaching mode. After 4 weeks, the assessment and satisfaction evaluation were carried out among the two groups. SPSS 19.0 was used for t test and Mann-Whitney test. Results:Students in observation group showed significantly better ability of physical examination and case analysis than those in the control group. The satisfaction degree of the students in the observation group was significantly higher in terms of diagnosis and treatment standard, clinical thinking, problem solving ability, self-learning ability and personal profession benefits than that in the control group.Conclusion:Case-based learning with diagnosis and treatment guidelines is an ideal teaching method combining theory with practice perfectly, which can significantly improve the effect of clinical teaching of standardized residency training in the department of rheumatology and immunology.

Objectives To investigate the value of oral glucose tolerance (OGTT)-insulin/C peptide release test in early diagnosis of chronic pancreatitis (CP)-associated abnormal glucose tolerance.Methods Sixty patients with CP who were admitted to the Department of Gastroenterology,Changhai Hospital from June 2017 to February 2018 were divided into CP with normal glucose tolerance (CP-NGT),CP with impaired glucose tolerance (CP-IGT),CP with newly diagnosed diabetes(CP-new-DM) and CP with the previous history of diabetes (CP-history-DM) according to previous medical records and data from OGTT-insulin/C peptide release test.The characteristics of glucose metabolism,the changes of blood glucose,insulin and C peptide released among the four groups were compared.Results In 43 cases of patients with CP without diabetes,the abnormal glucose metabolism was detected in 6 cases (14.0％) by fasting blood glucose or glycosylated hemoglobin,and in 30 cases (69.8％) by OGTT-insulin/C-peptide release test.The detection rate of abnormal glucose metabolism was increased by 55.8％.In the group of CP-history-DM,the peak secretion of blood glucose,insulin,C peptide was all at 120 min,and the multiplication of increased release of C peptide (peak/baseline) [4.1 (3.4,4.4) vs (6.1 ± 2.2) 、(6.4 ± 2.5)、(6.8 ± 3.8)],the C peptide area under curve (C-PAUC) [(3.6 ± 1.4)]μg · h-1 · L-1 vs 8.6(7.1,9.7),(8.1 ±3.1),(6.9 ±2.7) μg · h-1 L-1] and the homeostasis model of assessment for β cell (HOMA-β) [24.4 (11.4,37.4) vs 52.4 (44.6,92.1),(89.8 ± 57.2),(72.4 ± 57.0)] were all significantly lower,and the difference was statistically significant(all P＜0.05).In the group of CP-new-DM,the peak of blood glucose was at 60 min,while the peak of insulin,C peptide was at 1 20 min,the early insulin secretion index (/ I30/A G30) [2.2 (0.8,4.2)vs (11.4 ± 9.4)] and insulin secretion sensitivity index-2 (ISSI-2) [256.1 (160.1,340.7) vs (548.5 ± 173.2)] in group of CP-new-DM were significantly lower than those in the group of CP-NGT,and the difference was statistically significant (all P ＜0.05).Conclusions The insulin /C peptide secretion was insufficient in the early stage of CP-related diabetes mellitus.Routine OGTT-insulin / C peptide release test for patients with CP can increase the detection rate of abnormal glucose metabolism.

Objective To explore the application of the evidence-based case report method in the standardization training of resident physicians in the department of endocrinology. Methods Fifty-one resi-dents recruited from the endocrinology department were randomly divided into the experiment group (26 cases) and control group (25 cases). The evidence-based case report method was conducted in the ex-peri-mental group, while the traditional clinical teaching mode was applied in the control group. The re-sults of the examination of two groups including the theoretical test and skill test were compared and the question-naire survey was conducted to find out the differences of students' interest in learning, clinical skills and satisfaction. All data were compared using t test. Results There was no significant difference in theoretical test between the two groups (P>0.05). The total score of the skill test in the experimental group was (85.13 ±4.63) and the control group was (76.79 ±3.11) (P=0.000). The students in the experimental group showed that the teaching method had more significant effects on improving their learning interest and initiative, clinical thinking ability, clinical work ability, literature review ability and medical article writing ability. Scores of satisfaction with teaching methods (total score was 10) for experimental group were (9.69 ±0.34), which was also significantly higher than those in the control group (8.01 ±0.39) (P=0.000). Conclusion The application of evidence-based case report teaching method in the standardized training of resident physicians in department of endocrinology is worthy of being perfected and further popularized in clinical teaching work.

Objective to determine the basal levels of several pancreas-related endocrine hormones in patients with chronic pancreatitis.Methods according to inclusion and exclusion criteria,consecutive patients from February 2016 to August 2016 in Department of Gastroenterology,Changhai Hospital,Second Military Medical University and ten healthy control (matched for age and gender) were included.Basal levels of glucagon-like peptide 1,pancreatic polypeptide,Secretin,glucagon,somatostatin between groups of CP vs healthy control,CP with abnormal glycometabolism vs CP with normal glycometabolism and alcoholic CP vs non-alcoholic CP were compared.Results a total of 53 patients with chronic pancreatitis and 8 healthy subjects were included in this study.(1) CP vs healthy controls:the level of secretin in healthy control patients is significant lower than that in CP patients;(2) CP with abnormal glycometabolism vs CP with normal glycometabolism:the level of triglyceride and somatostatin is significant lower than that in CP patients;the prevalence of patients with chronic alcohol consumption and the level of glucagon-like peptide 1 in CP with abnormal glycometabolism is significant higher than that in CP with normal glycometabolism;(3) the prevalence of abnormal glycometabolism in alcoholic CP group is significant higher than that in non-alcoholic CP.The results above are all of statistical significance.Conclusions in addition to dysfunction of islets/3-cells,CP also easily affects the level of other pancreas-related hormones such as secretin,somatostatin and glucagon-like peptide 1.Otherwise,chronic alcohol consumption is also strongly related with abnormal glycometabolism,the mechanism deserves further researches.

Objective To analyze the clinical features of recurrent acute pancreatitis (RAP).Methods The clinical data of patients diagnosed as RAP were collected in Changhai Hospital, the Second Military Medical University between January 2016 to July 2016, and chronic pancreatitis(CP) patients and RAP patients to matching, as control group.A prospective cohort study about the clinical features of RAP and CP was set.The survival analysis model was established by Kaplan-Meier′s method, to calculate the cumulative rate of RAP which progressed into CP.Results The morbidity of male patients was 69.0% in the RAP group(n=100) and 60% in the CP group(n=100).The average first onset age of RAP and CP was 38 and 21 years old, respectively;and the teenagers accounted for 12% and 38.6%.The incidence of diabetes was 49.5% and 9%;and the incidence of fatty diarrhea was 46.6% and 19% of the two groups.The cumulative incidence of CP was 2% within 1 year, 4.6% in 3 years, and 12.4% in 5 years.Conclusions Men has higher morbidity in both RAP group and CP group.RAP patients′ first onset age was older than that of CP.Teenagers had a low incidence in RAP group.The risk of diabetes and fatty diarrhea was lower in RAP group than CP group.A certain proportion of RAP patients can progress to CP.

Objective To analysis the clinical features of dorsal pancreas agenesis ( DPA) and the associated diabetes, pancreatitis and other congenital organ malformations.Methods Chinese databases of Sinomed, CQVIP and CNKI using the term of short pancreas, pancreas agenesis, bulbar pancreas and dorsal pancreas, and English databases of PubMed using the term of dorsal pancreas agenesis, short pancreas and pancreas hypoplasia were searched.The clinical manifestation, pancreatic head characteristics and associations with diabetes, pancreatitis and other congenital organ malformations were analyzed.Results Six related publications from Chinese databases were searched and 21 patients were included with 2 cases excluded.Sixty-one publications from English database were searched and 71 patients were included.Thus, a total of 91 patients with DPA were analyzed.Abdominal pain was the most common manifestation, which was reported by 61.5% of the patients. 15.3% patients were identified during regular physical examination. Other manifestations including jaundice, fatigue, abdominal discomfort and diabetes were rare.After removing cases with insufficient information, 39 patients (61.9%) carried abnormal pancreatic head.Prevalence of diabetes or impaired glucose tolerance was 56.7% and the percentage of insulin-dependent diabetes in patients with abnormal glycaemia was 47.3%(n=18).20 patients (26.7%) were associated with pancreatitis, including 15 patients (75.0%) with acute pancreatitis, 1 patient (5.0%) with recurrent pancreatitis, and 4 patients (20.0%) with chronic pancreatitis. Thirty-three patients ( 36.2%) suffered other congenital organ malformations, including 21 patients (63.6%) with splenic malformation, 8 patients (24.2%) with heart malformation, and 17 patients (51.5%) with multi-organs malformations like gastrointestinal malformation, azygos vein and inferior cava vena fusion, duodenal and biliary atresia and renal absence.Conclusions The main diagnostic criteria of DPA was the absence of dorsal pancreatic duct.Diabetes was the most common complication followed by pancreatitis.

Objective To investigate the clinical application of scalp skin grafts in reconstruction of external auditory meatus in congenital aural atresia.Methods We conducted a retrospective study on 85 patients of congenital aural atresia,all of whom were unilateral,operated from March of 2008 to December of 2010 in ENT department of the Sun Yat-Sen Memorial Hospital.The patients enrolled in the study were between 6 to 37 years old (median age 12 years),55 male and 30 female.Scalp surface graft in ipsilateral temporal region was harvested to cover the bony external auditory meatus.Results All of these scalp split-thickness skin grafts survived without necrosis,no restenosis was found in these external auditory meatus.Neither scar nor alopecia was found in the skin-harvesting region,and hairs grew well.Granulations occurred in 27 cases in the first to sixth month posteroperatively,20 cases recovered after local treatment.In the first year,30 cases obtained hearing improvement more than 15 dB,36 cases gained more than 25 dB and 19 cases gained more than 35 dB.Totally 8 patients were lost in the 4 to 5 years of follow-up,70 cases (70/77,90.9％) developed new external auditory meatus,7 cases (7/77,9.1％) suffered from stenosis in different degrees,but no atresia was found in these patients.Conclusion Scalp split-thickness skin grafts has significant clinical advantage in meatoplasty of congenital aural atresia.

[ABSTRACT]OBJECTIVETo evaluate the short-term efficacy of Eustachian tube balloon dilation (ETBD) in the treatment of symptomatic Eustachian tube dysfunction (SETD) by subjective and objective analysis.METHODS Forty patients who underwent ETBD were included. Subjects’ inclusion criteria were as followed: symptoms of ETD (aural fullness predominantly, with or without otalgia, muffle hearing and tinnitus), normal tympanic membrane, type A or C tympanograms, and without a history of any middle ear diseases. Main outcomes including subjective improvement, otoscopy, pure-tone audiometry, impedance audiometry, R-value in tubomanometry (TMM) and Eustachian Tube Score (ETS) were assessed 1 week and 6 months postoperatively.RESULTSAll cases were dilated successfully. A significant effect of treatment was documented when measuring subjective improvement, impedance audiometry, R-value in TMM and ETS 1 week and 6 month postoperatively. Subjective symptoms were not relieved only in one patient. The overall success rate for all patients was 98%.CONCLUSIONETBD can provide short-term benefits to those who are diagnosed with SETD and refractory to medical management. SETD might be an optimal indication for ETBD in the treatment of ETD.

Objective To explore the comparative advantage of Team based learning (TBL) in common diseases teaching among pre-selected trainees for medical non-commissioned officer. Methods 200 trainees were randomly divided into two groups of equal size (each having 100 trainees), one TBL group and another lecture based learning (LBL) group as the control group. The teaching content was both Chapters of High Altitude Illness and Hypertension. In the LBL control group, the traditional lec-ture based teaching and learning manner was followed. In contrast, the trainees in the TBL group were assigned pre-lecture self-learning outline and questions to discuss in advance, team-based group dis-cussion was conducted, and scene simulation with typical disease case analysis were adopted in class. In both groups, the teaching effectiveness were evaluated by both exam test and questionnaire manner. Results It turned out the team based learning model resulted in significantly improved overall trainee assessment scores (88.90 ± 5.28 vs. 76.10 ± 5.12, P<0.05) and higher overall teacher satisfaction scores (8.63 ± 0.85 vs 7.18 ± 0.72, P<0.05), compared to the LBL group. Conclusion TBL model is more effective in improving trainees' capabilities of cultivating team work spirit, self-confidence, learn-ing enthusiasm, problem analysis and knowledge application. TBL model significantly brings more advantage in teaching pre-selected trainees for medical non-commissioned officer.

Purpose To investigate the expression of VEGF, NRP1 and the cancer stem cell marker CD44 in gastric carcinoma and their correlations. Methods High throughput technology of tissue microarray and immunohistochemical SP method were employed to investigate the expression of VEGF, NRP1 and CD44 proteins in 72 gastric carcinoma specimens and 52 normal gastric tissues. Immu-nohistochemistry records were reviewed, their correlations and the clinicopathological characteristics were evaluated. Results ( 1 ) The positive rates of VEGF, NRP1 and CD44 proteins were 76. 4%, 66. 7%, and 83. 3% in gastric carcinoma, respectively, with sig-nificant differences from normal gastric tissues (P<0. 01). (2) The positive expression of VEGF and NRP1 were closely correlated with infiltration depth, lymph node metastasis and TNM stage (P<0. 05). The positive expression of CD44 was closely correlated with Lauren type, differentiation degree, lymph node metastasis and TNM stage (P<0. 05). (3) In addition, the expression of CD44 was significantly correlated with VEGF and NRP1 in gastric carcinoma (rs =0. 578, rs =0. 278, rs =0. 316, P<0. 05). Conclusions VEGF, NRP1 and the cancer stem cell marker CD44 are highly expressed in gastric cancer, which are closely related to the biological behaviors of gastric cancer. Synergistic effects are observed between VEGF and NRP1, and they are closely related to the expression of the cancer stem cell marker CD44, which remains to be further studied.