Objective To investigate the levels of serum soluble CD14 subtype(Presepsin)and serum amyloid protein A(SAA)in patients with colorectal cancer after laparoscopic surgery,and their predictive value for early anastomotic leakage.Methods From October 2021 to April 2024,126 patients with laparoscopic colorectal cancer were divided into the non-anastomotic leakage group(control group,n=103)and the anastomotic leakage group(observation group,n=23)based on whether anastomotic leakage occurred within 3 days after the operation.Clinical information was collected from both groups and compared between groups.Enzyme linked immunosorbent assay(ELISA)was applied to detect the postoperative serum levels of Presepsin and SAA in two groups.Pearson method was applied to investigate the correlation between postoperative serum levels of Presepsin and SAA in patients with colorectal cancer after laparoscopic surgery.The multivariate Logistic regression model was applied to analyze the key factors influencing the occurrence of anastomotic leakage in the early postoperative period in patients with colorectal cancer after laparoscopic surgery.The receiver operating characteristic curve(ROC curve)was applied to evaluate the predictive value of serum Presepsin and SAA levels for early anastomotic leakage in colorectal cancer patients after laparoscopic surgery.Results Compared with the control group,the proportion of patients with tumours≥7 cm from the anus was significantly reduced and intraoperative bleeding was significantly increased in the observation group,the differences were statistically significant(P<0.05).The postoperative levels of serum Presepsin and SAA in the observation group were obviously higher than those in the control group,the differences were statistically significant(P<0.05).There was an obvious positive correlation between serum levels of Presepsin and SAA in patients with colorectal cancer after laparoscopic surgery(r=0.749,P=0.016).Serum Presepsin levels higher than 389.23 pg/mL and SAA expression levels higher than 25.10 mg/L were independent risk factors for the occurrence of early anastomotic leakage after surgery in patients with colorectal cancer after laparoscopic surgery.A tumor distance from the anus of≥7 cm was a protective factor.The area under the curve(AUC)of serum Presepsin and SAA alone and in combination for detecting early anastomotic leakage in patients with colorectal cancer after laparoscopic surgery was 0.834(95%CI:0.757～0.894),0.801(95%CI:0.720～0.866),and 0.897(95%CI:0.830～0.944).The combined detection was superior to the separate detection of Presepsin and SAA(Zcombination-Presepsin=2.085,Zcombination-SAA=2.010,both P<0.05).Conclusion Serum levels of Presepsin and SAA are elevated in patients with colorectal cancer after laparoscopic surgery,and their combined detection has high predictive value for early anastomotic leakage.

Objective:To explore and evaluate the optimization and application of case-based learning (CBL) in the reform practice for integrated curriculum of the digestive system.Methods:The 174 undergraduate students majoring in eight-year clinical medicine enrolled in 2019 at the Peking University Health Science Center were selected as research objects. CBL was used in the integration and optimization of the digestive system curriculum. These included increasing class hours, selecting disease modules, lesson preparation involving multi-disciplinary teachers, and joint teaching. Upon completion of teaching, a comprehensive evaluation of teaching effectiveness was conducted through questionnaires administrated to teachers and students, feedback from supervision experts, and scores of students. SPSS 21.0 was used for the t-test and a reliability analysis was conducted on the questionnaire results. Results:Teachers, students, and supervision experts were highly satisfied with CBL. More than 95% of teachers believed that joint teaching facilitated the sharing of diverse professional knowledge among teachers, enhanced the in-depth instruction of imaging knowledge, promoted the transformation of teaching ideas, and improved teaching ability. More than 70% of students agreed that joint teaching deepened their understanding of diseases, stimulated learning interest, and established a theoretical foundation for clinical practice. The average score of class performance was (47.60±2.41) points (a total score of 50 points). The answers of students to case-based questions in final exams were satisfactory. The average score of final evaluation was (82.24±8.82) points.Conclusions:The optimization and application of CBL in the integrated curriculum of the digestive system is highly accepted by teachers and students. This method improves the interest of learning and facilitates the establishment of overall medical thinking and clinical thinking in students.

Objective To investigate the levels of serum soluble CD14 subtype(Presepsin)and serum amyloid protein A(SAA)in patients with colorectal cancer after laparoscopic surgery,and their predictive value for early anastomotic leakage.Methods From October 2021 to April 2024,126 patients with laparoscopic colorectal cancer were divided into the non-anastomotic leakage group(control group,n=103)and the anastomotic leakage group(observation group,n=23)based on whether anastomotic leakage occurred within 3 days after the operation.Clinical information was collected from both groups and compared between groups.Enzyme linked immunosorbent assay(ELISA)was applied to detect the postoperative serum levels of Presepsin and SAA in two groups.Pearson method was applied to investigate the correlation between postoperative serum levels of Presepsin and SAA in patients with colorectal cancer after laparoscopic surgery.The multivariate Logistic regression model was applied to analyze the key factors influencing the occurrence of anastomotic leakage in the early postoperative period in patients with colorectal cancer after laparoscopic surgery.The receiver operating characteristic curve(ROC curve)was applied to evaluate the predictive value of serum Presepsin and SAA levels for early anastomotic leakage in colorectal cancer patients after laparoscopic surgery.Results Compared with the control group,the proportion of patients with tumours≥7 cm from the anus was significantly reduced and intraoperative bleeding was significantly increased in the observation group,the differences were statistically significant(P<0.05).The postoperative levels of serum Presepsin and SAA in the observation group were obviously higher than those in the control group,the differences were statistically significant(P<0.05).There was an obvious positive correlation between serum levels of Presepsin and SAA in patients with colorectal cancer after laparoscopic surgery(r=0.749,P=0.016).Serum Presepsin levels higher than 389.23 pg/mL and SAA expression levels higher than 25.10 mg/L were independent risk factors for the occurrence of early anastomotic leakage after surgery in patients with colorectal cancer after laparoscopic surgery.A tumor distance from the anus of≥7 cm was a protective factor.The area under the curve(AUC)of serum Presepsin and SAA alone and in combination for detecting early anastomotic leakage in patients with colorectal cancer after laparoscopic surgery was 0.834(95%CI:0.757～0.894),0.801(95%CI:0.720～0.866),and 0.897(95%CI:0.830～0.944).The combined detection was superior to the separate detection of Presepsin and SAA(Zcombination-Presepsin=2.085,Zcombination-SAA=2.010,both P<0.05).Conclusion Serum levels of Presepsin and SAA are elevated in patients with colorectal cancer after laparoscopic surgery,and their combined detection has high predictive value for early anastomotic leakage.

Objective:To explore and evaluate the optimization and application of case-based learning (CBL) in the reform practice for integrated curriculum of the digestive system.Methods:The 174 undergraduate students majoring in eight-year clinical medicine enrolled in 2019 at the Peking University Health Science Center were selected as research objects. CBL was used in the integration and optimization of the digestive system curriculum. These included increasing class hours, selecting disease modules, lesson preparation involving multi-disciplinary teachers, and joint teaching. Upon completion of teaching, a comprehensive evaluation of teaching effectiveness was conducted through questionnaires administrated to teachers and students, feedback from supervision experts, and scores of students. SPSS 21.0 was used for the t-test and a reliability analysis was conducted on the questionnaire results. Results:Teachers, students, and supervision experts were highly satisfied with CBL. More than 95% of teachers believed that joint teaching facilitated the sharing of diverse professional knowledge among teachers, enhanced the in-depth instruction of imaging knowledge, promoted the transformation of teaching ideas, and improved teaching ability. More than 70% of students agreed that joint teaching deepened their understanding of diseases, stimulated learning interest, and established a theoretical foundation for clinical practice. The average score of class performance was (47.60±2.41) points (a total score of 50 points). The answers of students to case-based questions in final exams were satisfactory. The average score of final evaluation was (82.24±8.82) points.Conclusions:The optimization and application of CBL in the integrated curriculum of the digestive system is highly accepted by teachers and students. This method improves the interest of learning and facilitates the establishment of overall medical thinking and clinical thinking in students.

Objective:To explore the feasibility and effect of remote medical education model using online film reading training to improve the ability of ophthalmologists in the Xinjiang Uygur Autonomous Region (hereinafter referred to as "Xinjiang Region" ) in diagnosing fundus diseases.Methods:The three-level film reading training system of Xinjiang Production and Construction Corps system division hospital-Corps Hospital-Peking Union Medical College Hospital was established. From June 2022 to January 2023, 4 159 posterior color fundus images were continuously collected from Department of Ophthalmology of Xinjiang Corps Hospital and 4 divisional hospitals in the Corps medical system. Among them, hypertensive retinopathy, diabetic retinopathy, exudative age-related macular degeneration (AMD), atrophic AMD and retinal vein occlusion were 3 073, 651, 43, 186 and 206 cases, respectively. The images were divided into 3 rounds (first, second and last) according to the proportion of diseases. The doctors who participated in the training (hereinafter referred to as the "training") were 15 ophthalmologists from the Corps Hospital of Xinjiang Region and the division hospital of the Corps system. There were 7 male and 8 female. Age was (38.1±4.0) years. The titles of senior, deputy senior, intermediate and junior are 1, 6, 5 and 3 respectively; Bachelor's degree and master's degree are 13 and 2 respectively. The working time of fundus disease specialty was (9.6±3.3) years. The film reading system training was conducted before the first round of labeling, and after each round of film reading, the doctors of Peking Union Medical College Hospital gave feedback and explanation on the film reading results. The diagnostic consistency, sensitivity and specificity were compared by paired sample t test. Spearman or Pearson correlation analysis was conducted between the improvement of diagnostic level and professional title, education, age and working hours of ocular fundus disease. Results:All the participating doctors completed the first, second and last reading. After each round of film reading, the film reading summary was carried out for 2 hours. The average diagnostic agreement rates of participating physicians were 53.0%, 67.0% and 75.0%, respectively. The sensitivity and specificity were 0.38, 0.69, 054 and 0.66, 0.85, 0.96, respectively. There was significant difference between the first and last examination ( P<0.001). The sensitivity of the second reading was significantly higher than that of the first reading, and the sensitivity of the last reading was significantly lower than that of the second reading, with statistical significance ( P<0.05). The specificity of the second reading was significantly higher than that of the first reading, and the last reading was significantly higher than that of the second reading, with statistical significance ( P<0.05). There was no significant correlation ( P>0.05) between the improvement of diagnostic level of participating physicians and educational background ( Rho=0.07), professional title ( Rho=0.13), age ( r=0.20), and working time of ophthalmofundus disease specialty ( r=0.26). Conclusions:Relying on the three-level online telemedicine training, it can improve the ability of ophthalmologists in Xinjiang region to diagnose fundus diseases. The preliminary telemedicine education model has demonstrated potential for feasibility and effectiveness in remote areas with inadequate medical resources.

Objective:To explore the feasibility and effect of remote medical education model using online film reading training to improve the ability of ophthalmologists in the Xinjiang Uygur Autonomous Region (hereinafter referred to as "Xinjiang Region" ) in diagnosing fundus diseases.Methods:The three-level film reading training system of Xinjiang Production and Construction Corps system division hospital-Corps Hospital-Peking Union Medical College Hospital was established. From June 2022 to January 2023, 4 159 posterior color fundus images were continuously collected from Department of Ophthalmology of Xinjiang Corps Hospital and 4 divisional hospitals in the Corps medical system. Among them, hypertensive retinopathy, diabetic retinopathy, exudative age-related macular degeneration (AMD), atrophic AMD and retinal vein occlusion were 3 073, 651, 43, 186 and 206 cases, respectively. The images were divided into 3 rounds (first, second and last) according to the proportion of diseases. The doctors who participated in the training (hereinafter referred to as the "training") were 15 ophthalmologists from the Corps Hospital of Xinjiang Region and the division hospital of the Corps system. There were 7 male and 8 female. Age was (38.1±4.0) years. The titles of senior, deputy senior, intermediate and junior are 1, 6, 5 and 3 respectively; Bachelor's degree and master's degree are 13 and 2 respectively. The working time of fundus disease specialty was (9.6±3.3) years. The film reading system training was conducted before the first round of labeling, and after each round of film reading, the doctors of Peking Union Medical College Hospital gave feedback and explanation on the film reading results. The diagnostic consistency, sensitivity and specificity were compared by paired sample t test. Spearman or Pearson correlation analysis was conducted between the improvement of diagnostic level and professional title, education, age and working hours of ocular fundus disease. Results:All the participating doctors completed the first, second and last reading. After each round of film reading, the film reading summary was carried out for 2 hours. The average diagnostic agreement rates of participating physicians were 53.0%, 67.0% and 75.0%, respectively. The sensitivity and specificity were 0.38, 0.69, 054 and 0.66, 0.85, 0.96, respectively. There was significant difference between the first and last examination ( P<0.001). The sensitivity of the second reading was significantly higher than that of the first reading, and the sensitivity of the last reading was significantly lower than that of the second reading, with statistical significance ( P<0.05). The specificity of the second reading was significantly higher than that of the first reading, and the last reading was significantly higher than that of the second reading, with statistical significance ( P<0.05). There was no significant correlation ( P>0.05) between the improvement of diagnostic level of participating physicians and educational background ( Rho=0.07), professional title ( Rho=0.13), age ( r=0.20), and working time of ophthalmofundus disease specialty ( r=0.26). Conclusions:Relying on the three-level online telemedicine training, it can improve the ability of ophthalmologists in Xinjiang region to diagnose fundus diseases. The preliminary telemedicine education model has demonstrated potential for feasibility and effectiveness in remote areas with inadequate medical resources.