Creating an effective PBL case in oral and maxillofacial surgery at a Chinese dental school: a dental education primer

Problem-based learning (PBL) is a widely accepted educational method centered on the discussion and learning that emerge from a clinically based problem; however, little has been reported on the details of PBL case-writing in the dental education literature. This article outlines some principles of writing a PBL case as it is practiced at a Chinese dental school and presents, as an example, an actual case based on a clinical problem (ameloblastoma of the jaw) intended to provide a learning focus for predoctoral dental students. A good PBL case should allow for progressive, interdependent actions to be taken in the evaluation and overall management of the patient in context and should trigger inquiry and discussion among students in both the basic sciences (anatomy, physiology, biochemistry, pharmacology, pathophysiology, etc.) and related clinical sciences. The epidemiological, sociological, and ethical considerations related to each problem should also be emphasized as an essential component of effective health care provision.     

Intermediate filaments in the medial rectus muscles in patients with concomitant exotropia

International Ophthalmology - Distribution of intermediate filament (IF) proteins in normal extraocular muscles (EOMs) showed that the EOMs differ significantly from the other muscles in the body...     

活体肝移植供体术中出血量的准确测算

为探讨准确测算术中出血量，减少不必要的输血、输液。对2例活体肝移植术中出血量进行统计，对劈肝前、劈肝中及劈肝后的纱布分别计数称重。保证了供体的安全，为合理输血、输液提供了参考。     

Therapeutic experience with primary liposarcoma from the sigmoid mesocolon accompanied with well-differentiated liposarcomas in the pelvis

Multifocal liposarcoma with different histological types is rare, especially that originating from the mesentery. We herein report a case of primary myxoid liposarcoma from the sigmoid mesocolon that was accompanied with well-differentiated liposarcomas in the pelvis. The location, the fat signal and the relationship with adjacent organs of the liposarcomas were well shown in the axial, coronal and sagittal dimensions of MRI, giving a comprehensive and specific image before surgery. To alleviate the patient’s symptoms and mental stress, a laparotomy was performed. The tumors were all completely excised with macroscopic free margins. The final histopathological report showed that the tumor in the sigmoid mesocolon was a pure myxoid liposarcoma, while the pelvic tumors were spindle cell liposarcomas, a special type of well-differentiated liposarcoma. According to the AJCC staging system, they were all stage IIB. No further adjuvant therapy was performed. Close follow-up after the surgery has been performed, and the patient has remained healthy without any evidence of recurrence or metastasis for 17 months after the surgery.     

The early and mid-term results of mitral valve repair for mitral regurgitation in children

Purpose

To review the surgical techniques and mid-term results of mitral valve repair in children with moderate or severe mitral regurgitation (MR).

Methods

One hundred and seven children with moderate or severe MR, aged 19.6 ± 8.5 months, were enrolled in this study. The surgical techniques used for mitral valve repair varied according to the mitral valve morphology, and included annuloplasty, annuloplasty ring, cleft closure, reconstruction of the posterior leaflet, etc. The concomitant cardiac anomalies were treated simultaneously. The results of repair were evaluated by transesophageal echocardiography performed during the operation and by serial transthoracic echocardiography performed during the follow-up.

Results

One hundred and six cases had no more than mild regurgitation intraoperatively, whereas only one case had moderate regurgitation. This patient underwent redo repair immediately, and the subsequent regurgitation was trivial. The in-hospital mortality rate was 0.9 % (1/107). The average follow-up was 46.5 ± 8.2 months. One patient died of heart failure 10 months postoperatively. The freedom from moderate or severe regurgitation after mitral valve repair was 92.3 ± 3.3 %.

Conclusion

Pediatric patients with moderate or severe MR require early surgical treatment. The early and mid-term results of mitral valve repair in pediatric patients were satisfactory.     

Surveying quality of life in patients with Fabry disease by the SF-36 scale

Objective To test the availability of the SF-36 scale for the Chinese patient with Fabry disease (FD), the quality of life(QOL) and its probable influence factors were analyzed. Methods The data were obtained from 50 healthy volunteers and 57 patients with FD enrolled in nephrology department of Ruijin hospital from Jan, 2003 to Jan, 2013. The SF-36 scale was used to evaluate the QOL of patients and to compare the difference between the patientsandcontrols. Furthermore, the influencing factors were estimated by multiple linear regressions. Results Between the patientsandcontrols, the differences of 8 dimensionalitiy's scores had statistical significance, which claimed that the reaction was sensitive. Especially, in the patient group, the Pearson correlation coefficient among each domain of the SF-36 was lower than its Cronbach's α coefficient (0.934), which indicated good internal consistency reliability. The two common factors were much the same to the theory assume, which illustrated the construct validity was available. Even the acceptability of the patient’ group at 100% proved the scale was appropriate for patients with FD. In addition, in role-physical (RP) and bodily pain (BP) , the scores of the male patients were less than the females (P﹤0.01), declared that the QOL of the males was inferior to the females. In the physical function (PF) and the mental health (MH), the scores of the patients with angiokeratoma were less than the group without it, so the patients who had evident clinical symptoms more likely contributed to depression. Using multiple linear regression, age, gender and clinical types were chosen into regression equation by stepwise regression, and the main potential predictor was age. Conclusions The SF-36 scale applies to evaluate the QOL of patients with FD. It is critical to concern and manage the QOL of FD patients, especially in their mental health aspect.     

Disposable circumcision suture device： clinical effect and patient satisfaction

In our experience patients undergoing circumcision are mostly concerned about pain and penile appearances. We conducted a prospective randomized trial to assess the benefits of a new disposable circumcision suture device （DCSD）. A total of 942 patients were equally divided into three groups （conventional circumcision, Shang ring and disposable suture device group）. Patients in the DCSD group were anesthetized with compound 5% lidocaine cream, the others with a 2% lidocaine penile block. Operation time, intra-operative blood loss, incision healing time, intra-operative and post-operative pain, the penile appearance and overall satisfaction degree were measured. Operation time and intra-operative blood loss were significantly lower in the Shang ring and suture device groups compared to the conventional group （P 〈 0.001）. Intra-operative pain was less in the suture device group compared With the other two groups （P 〈 0.001）; whereas post-operative pain was higher in the conventional group compared to the other two groups （P 〈 0.001）. Patients in the suture device （80.57%） and Shang ring （73,57%） groups were more satisfied with penile appearances compared with the conventional circumcision group （20.06%, P 〈 0.05）. Patients in suture device group also healed markedly faster than the conventional group （P 〈 0.01）. The overall satisfaction rate was better in the suture device group （78.66%） compared with the conventional （47.13%） and Shang ring （50.00%） groups （P 〈 0.05）. The combination of DCSD and lidocaine cream resulted in shorter operation and incision healing times, reduced intra-operative and post-operative pain and improved patient satisfaction with the cosmetic appearances.     

基层医院开展TST治疗重度混合痔临床疗效与价值

【摘要】〓目的〓探讨选择性痔上粘膜切除术(TST)治疗重度混合痔在基层医院的临床应用效果及价值。方法〓对我院2011年1月~2012年6月收治的102例重度混合痔患者进行回顾性分析,102例患者根据意愿中,48例施行TST术,54例行传统外剥内扎术(M-M术),观察并比较两组患者的临床疗效。结果〓TST组的术中出血量及住院时间均少于M-M组,差异有统计学意义(P<0.01);TST组在术后疼痛、伤口水肿、排尿困难及复发率方面均优于M-M组;两组手术时间差异无统计学意义。结论〓由于TST是治疗重度混合痔的安全、有效、微创等特点,在基层医院开展患者能够接受。     

X-刀治疗颅内肿瘤56例临床分析

目的探讨X-刀治疗颅内肿瘤的疗效及并发症。方法自2001年元月至2001年12月，共收治颅内肿瘤病人56例，其中男性30例，女性26例，年龄9—68岁，平均45．6岁。病变位于大脑半球深部者32例，鞍区16例，脑干肿瘤8例；肿瘤直径1—5cm。影像学或病理分类：脑转移瘤29例，脑胶质瘤12例，垂体瘤11例，脑膜瘤4例。全部病例均采用德国siemens直线加速器和Bmi。LAB X-刀治疗计划系统，进行立体定向分次放疗，5—8Gy／次，2—3次／周，共3-8次／1-3周，剂量范围相当于常规分割50～72Gy。结果全部56例患者中，有效率达85．7％（48／56）；颅内高压为最常见的副反应，占46.4％（26／56）。结论X-刀是治疗颅内肿瘤的一种安全有效的方法。