Objective:To construct and validate a competency-oriented entrustable professional activities (EPAs)-Competency-Milestones system for assessment of laparoscopic skills (ESALS).Methods:A research team composed of 15 members from five medical institutions was established. Taking the Staged Training and Assessment of Laparoscopic Skills program as the basis for EPAs, ESALS was constructed through scoping review and behavioral event interviews and the use of the Kawakita Jiro method. ESALS was applied to evaluate 49 trainees and 10 specialists (including 5 novices and 5 experts) on basic and advanced laparoscopic skills, respectively, in comparison with two other assessment tools—the Training and Assessment of Basic Laparoscopic Techniques (TABLT) and the Global Operative Assessment of Laparoscopic Skills (GOALS). Perform Mann Whitney U test using SPSS 23.0 software, and use Spearman coefficient for correlation analysis.Results:Through reviewing 13 literuature articles and interviewing 10 senior surgeons, the ESALS was developed, comprising 10 EPAs, 8 dimensions of competency characteristics, and 5 entrustable levels. In the basic skills evaluation, the ESALS score was significantly positively correlated with the TABLT score ( R=0.881, P<0.001). In the advanced skills evaluation, significant differences were observed between the novice and expert groups in all the ESALS competency scores (all P<0.05), while no difference was detected in the GOALS score of tissue handling ability. Conclusions:ESALS provides comprehensive evaluation, detailed standards, and precise feedback, with comparable efficacy to conventional tools. Future work should focus on expanding sample size to verify its generalizability and developing an electronic tool to enhance application efficiency.

Objective:To construct and validate a competency-oriented entrustable professional activities (EPAs)-Competency-Milestones system for assessment of laparoscopic skills (ESALS).Methods:A research team composed of 15 members from five medical institutions was established. Taking the Staged Training and Assessment of Laparoscopic Skills program as the basis for EPAs, ESALS was constructed through scoping review and behavioral event interviews and the use of the Kawakita Jiro method. ESALS was applied to evaluate 49 trainees and 10 specialists (including 5 novices and 5 experts) on basic and advanced laparoscopic skills, respectively, in comparison with two other assessment tools—the Training and Assessment of Basic Laparoscopic Techniques (TABLT) and the Global Operative Assessment of Laparoscopic Skills (GOALS). Perform Mann Whitney U test using SPSS 23.0 software, and use Spearman coefficient for correlation analysis.Results:Through reviewing 13 literuature articles and interviewing 10 senior surgeons, the ESALS was developed, comprising 10 EPAs, 8 dimensions of competency characteristics, and 5 entrustable levels. In the basic skills evaluation, the ESALS score was significantly positively correlated with the TABLT score ( R=0.881, P<0.001). In the advanced skills evaluation, significant differences were observed between the novice and expert groups in all the ESALS competency scores (all P<0.05), while no difference was detected in the GOALS score of tissue handling ability. Conclusions:ESALS provides comprehensive evaluation, detailed standards, and precise feedback, with comparable efficacy to conventional tools. Future work should focus on expanding sample size to verify its generalizability and developing an electronic tool to enhance application efficiency.

Objective To investigate the standard supplement of a certain dose of vitamin D for blood pressure control in pa-tients with essential hypertension.Methods 100 cases of patients with essential hypertension were randomly divided into 2 groups voluntarily,50 cases in each group.One group were set as control group,in which patients underwent a standard treatment.The other group was experimental group,in which 25 μg/d vitamin D was administrated in addition to standard treatment.Serum 25-hydroxyvitamin D[25 (OH)D]concentrations were measured by enzyme-linked immunosorbent assay(ELISA)and patients were followed up for one year to observe the situation of blood pressure controll.Mean and variable coefficient(CV)of systolic and dias-tolic blood pressure were calculated and compared between groups.Results In experiment group,the serum 25 (OH)D concentra-tion was (110.3±24.5)μg/L,systolic pressure was (144±16)mm Hg,variable coefficient of systolic pressure(CV1)was 11.1%, diastolic pressure was (87±9)mm Hg,variable coefficient of diastolic pressure(CV2)was 10.3%.While in control group,the 25 (OH)D concentration was (30.1±14.9)μg/L,systolic pressure was (145 ±26)mm Hg,CV1 was 17.9%,diastolic pressure was (87±10)mm Hg,CV2 was 12.4%.Serum 25(OH)D concentration and CV1 were statistically different between the two groups(P<0.01),CV2 was not statistically different(P >0.05).Conclusion Administrate quantitative vitamin D in addition to standard treat-ment is helpful for systolic pressure control in patients with essential hypertension but is meaningless for diastolic pressure control.

Objective To survey birth defects of neonates conceived by using various types of in vitro fertilization and embryo transfer (IVF-ET) between 1998 and 2007 in Shanghai. Methods From 1998 to 2007, 8507 neonates from 6551 pregnancies conceived through assistant reproductive technology (ART) from 7 reproductive medicine center in Shanghai were enrolled in this retrospective study, including Shanghai Ji-Ai Genetics and IVF Institute, Shanghai Jiaotong University School of Medicine affiliated Renji Hospital,Buijin Hospital, China Welfare Institute International Maternal and Infant Health Hospital, Shanghai First Maternity and Infant Health Hospital, Shanghai the Ninth People's Hospital and the Second Military Medical University affiliated Changhal Hospital. The clinical data about the type and incidence of birth defect were analyzed. Meanwhile, the factors associated with birth defect were investigated, such as various ART,gender, mother age, numbers of gestational sac, the source and quality of sperm. Results The birth defect rate was 1.08% (92/8507) and the most remarkable malformation occurred in circulation system [34% (31/92)]. The rates of major congenital malformations were 1.21% (34/2799) in fresh conventional IVF-ET, 1.07% (20/1871) in IVF-frozen-thawed embryo transfer(IVF-FET), 1.04% (23/2212) in fresh intracyto plasmic sperm injection (ICSI)-ET and 0.92% (15/1625) in ICSI-FET, which did not show statistical difference (P>0.05). There was also no significantly different incidence of malformations between 1.12% (49/4371) in male neonates and 1.02% (42/4136) in female neonates (P >0.05).However, the occurrence of congenital malformation is positively related with maternal age, the rates were 0.84% (41/4884) in mother's age less than 30 years and 1.77% (16/902) in mother' age more than 35 years, which reached statistical difference (P < 0.05). It also showed remarkable different incidence among 0.53% (25/4679) in singletons, 1.59% (57/3576) in twins and 3.97% (10/252) in triplets (P< 0.05). No remarkable difference of malformation rate among sperm sources used in fertilization were observed, including 1.09% (81/7419)in ejaculated sperm, 1.21% (7/579)in percutaneous epididymal aspiration (PESA) and 0. 79% (4/509) in donor sperm (P>0.05). Conclusions The overall incidence of birth defect in neonates from ART is similar to those conceived naturally and is not associated with different types of IVF-ET, embryo cryopreservation, sperm sources. However, maternal age and multiple pregnancies coder the higher possibility of birth defect.