Objective To systematically review the effectiveness and safety of flexible ureteroscope lithtripsy (fURL) and percutaneous nephrolithotomy (PCNL) in treating renal calculus. Methods Such databases as MEDLINE, EMbase, The Cochrane Library, CNKI, CBM, VIP, and WanFang Data from January, 1990 to August, 2012 were searched to comprehensively collect the clinical trials that compared fURL and PCNL in treating renal calculus. Two reviewers independently screened studies according to exclusion and inclusion criteria, extracted data, and assessed the methodological quality. Then, meta-analysis was performed using RevMan 5.1 software. Results Eight non-randomized controlled trials involving 536 patients were included. The results of meta-analysis showed that, PCNL was better than fURL in stone clearance (OR=0.26, 95%CI 0.15 to 0.46), but fURL was better than PCNL in postoperative pyrexia (OR=0.1, 95%CI 0.42 to 3.35), the incidence of blood transfusion (OR=0.17, 95%CI 0.03 to 1.00), and the duration of hospitalization (P=0.45, I2=0%). Conclusion Current evidence has proved that PCNL is better than fURL in decreasing stone clearance, fURL is better than PCNL in complication, the duration of hospitalization, and medical costs.
Objective To comprehensively evaluate the association between TNF-α gene −308 G/A polymorphism and the risk of prostate cancer. Methods A meta-analysis was performed to analyze the association between −308 G/A polymorphism and the risk of prostate cancer risk. Results A total of 11 case-control studies (4 919 cases and 5 210 controls) were included in this meta-analysis. The result showed no statistically significant differences in all genotype distribution between prostate cancer cases and controls: dominant model (OR=1.11, 95%CI 0.90 to 1.36, P=0.33), recessive model (OR=0.91, 95%CI 0.70 to 1.18, P=0.47), GA versus GG (OR=1.11, 95%CI 0.90 to 1.37, P=0.33), AA versus GG (OR=0.92, 95%CI 0.71 to 1.20, P=0.55), A versus G (OR=1.07, 95%CI 0.91 to 1.26, P=0.39). In the subgroup analysis by ethnicity, no statistically differences were found between prostate cancer cases and controls. Conclusion This results of meta-analysis suggests that TNF-α gene –308G/A polymorphism may not be a risk factor of prostate cancer. Due to the limited quantity of the includied studies, further studies are needed to validate the above conclusion.
Objective To further strengthen the understanding of the genesis of thyroid tumors through the analysis of thyroid nodules in the clonal origin. Method The related literatures which discussed the clonality of thyroid nodules were reviewed and analyzed. Results About the clonal origin of thyroid nodules， the X chromosome inactivation detection and single gene mutation detection were the most widely chosen one at present. Most of the materials available at present related to X chromosome inactivation proposed that major part of the thyroid nodules were monoclonal and the malignant cells spreaded by means of the inner lymphatic vessel net，whereas polyclonal and monoclonal thyroid nodules coexisted occasionally. Only BRAF mutation was found of certain importance in clonal origin identification in the thyroid nodules. Conclusions Thyroid nodule is prevalent in clinical practice，while the clonality of thyroid nodules especially the thyroid tumor is not clear. And for the time being the commonly used methods to identify the clonal origin of thyroid nodule are X chromosome inactivation and single gene mutation detection. Published results confirm the finding of X chromosome inactivation methods that the majority of thyroid nodules are monoclonally originated.
Objective To study the current situation of doctor-patient communication education for medical undergraduates, and meanwhile to analyze the students’ satisfactory degree to communication education and its influencing factors, so as to provide sound suggestions to promote the students’ clinical communication abilities. Methods Using simple sampling, 50% of the students who majored in clinical medicine in grade 2006-2009 in West China Medical School of Sichuan University were selected as respondents. The investigation was conducted by face to face talk with a self-designed questionnaire. The data were input using EpiData 3.0 software and the results were analyzed by SPSS 13.0 software. Results A total of 450 questionnaires were distributed, and 404 were validly retrieved (89.78%). Among the respondents, 74.3% of them were satisfied with the current situation of doctor-patient communication education; 75.7% of them begun to know doctor-patient communication education since the stage of learning basic knowledge; 49.8% of them were trained by means of problem-based-learning (PBL); and 65.5% of them were trained with auxiliary standardized patient (SP). “Grade”, “Gender”, “SP used” and “PBL used” were the main factors affecting the satisfactory degree to current doctor-patient communication education (P=0.029, 0.023, 0.012, and 0.029, respectively). Conclusion The medical undergraduates’ satisfactory degree to current doctor-patient communication education is generally high, but it is also affected by various factors. Although doctor-patient communication education has started early, the training system is still problematic and the teaching resources coverage is limited. So in order to make a further systematic, standardized, overall designed education for students’ cognition and communication skills, the medical colleges should open integrated doctor-patient communication curriculum that combines with both PBL and SP auxiliary teaching methods, and covers all the undergraduate learning stage.
Objective To investigate the rebuilding status of community health service (CHS) system after Wenchuan earthquake in Mianzhu, improve service ability and provide data for better reconstruction of CHS system after natural disaster. Methods The interview was conducted with local health system officials, and self-designed questionnaire for face-to-face interview was distributed to 508 community residents in Mianzhu who were selected by convenience sampling. Data entry and statistical analysis were completed using Microsoft Office Excel 2007 and SPSS 16.0 respectively. Results A total of 508 questionnaires were distributed, and then 486 questionnaires were retrieved effectively (response rate 95.7%). The analysis on 486 respondents in CHS after rebuilding showed the rate of respondents with health files rose from 20.1% to 43.8%, the rate of having regular health check-up rose from 7.4% to 46.7%, the rate of health education rose from 20.1% to 39.7%, the rate of chronic disease monitoring rose from 0.9% to 35.4%, the rate of knowing referral pattern rose from 15.7% to 51.2%, the rate of propaganda for disaster relief rose from 33.6% to 58.6%, and the rate of doing disaster emergency response exercise was 21.8% currently. 62.3% of residents chose CHS on the first visit. The satisfactory degree to CHS rose from 45.4% to 76.1% after earthquake. Both popularization of regular health check-up and propaganda for disaster relief were major factors with influence on residents’ satisfaction to CHS (Plt;0.001, P=0.010, respectively). Conclusion The residents’ satisfactory degree to the rebuilding status of CHS system is encouraging. It is necessary to strengthen the popularization of regular health check-up and propaganda for disaster relief in order to improve the quality of community health service.
【摘要】 目的 了解科研志愿者参与科研活动的现状及满意度，为促进本科生科研能力培养提供决策建议。 方法 以参与四川大学华西临床医学院循证医学中心及多学科综合治疗（MCQ）两项科研志愿者活动的407名同学为调查研究对象，采用自制问卷表进行调查。对数据进行描述性分析和Logistic回归分析。 结果 发放问卷407份，回收有效问卷351份，有效回收率86.24%。80.6%的受访对象对目前参与科研活动现状表示满意。认为限制工作进展的主要因素是缺乏相关基础知识和基本技能（占34.7%）以及缺乏时间（占31.6%）。21.1%的科研活动无固定的组织模式。96.2%的受访对象表示有必要进行活动成果展示。是否有导师指导、是否有知识传授和技能培训以及对活动组织模式是否满意是影响科研志愿者对科研活动满意度的主要因素（P值分别为0.027、0.011和0.000）。 结论 志愿者参与科研活动的满意度总体较高;满意度受到多种因素影响。建立科研志愿者招募体系、完善科研能力培养层次、加强科研团队组织建设、规范管理运作机制、嵌入科研课程并加强科研成果展示有助于提升本科生科研活动的参与率及满意度，对医学本科生科研能力培养具有积极作用。【Abstract】 Objective To study the current status and satisfactory degree of student volunteers’’ participation in scientific research, so as to provide suggestion for improving the scientific research capability of medical undergraduates. Methods Carried out a survey on 407 student volunteers from EBM (Evidence-Based Medicine) and MCQ (Matrix clinical quality) research program in West China Medical School, Sichuan University with self-designed questionnaires.The data was described and analyzed with logistic regression. Results A total of 351 (86.24%) valid questionnaires were retrieved among all the 407 questionnaires assigned.80.6% of the respondents were contented with the current situation of scientific volunteers’ program.34.7% of respondents thought that lack of basic knowledge and skill was the main factor that limited the progress of their research work.While for another 31.6% respondents, the main limited factor was lack of extracurricular time.21.1% of research activities were not operated in a standardized organizational mode.96.2% of the respondents emphasized on the necessity of exhibiting their works and achievements in public.“Tutor’s instructions”, “training on basic knowledge and skills” and “organizational mode” were the main factors which affect the satisfactory degree on scientific volunteer programs (P=0.027, 0.011, and 0.000, respectively) . Conclusion The satisfactory degree of students who participated in scientific volunteer programs is generally satisfying, however affected by various factors. Increase of participation rate in scientific research program can be attributed to factors such as establishment of a scientific volunteer recruitment system, improvement of students’ research capability, standard organizational modes, standard managing and operating mechanism, embed training lessons into courses
Objective To investigate the differences in characteristics and susceptibility factors between infectious stones and calcium oxalate stones, and provide reference value for screening infectious stones in clinical work. Methods According to the results of analysis of stone components in the extracorporeal shock wave lithotripsy center of West China Hospital of Sichuan University between June 2014 and April 2017, 392 patients with infectious stones (including 56 patients with magnesium ammonium phosphate stones in group A and 336 patients with calcium carbonate apatite in group B) and 392 patients with calcium oxalate stone (group C) were selected to discuss the difference of clinical features by retrospectively analyzing the clinical data. Results The proportion of females, the long diameter of stones and the proportion of staghorn stones in group A [75.0%, (3.9±2.5) cm, 41.1%] were higher than those in group B [39.3%, (2.4±1.3) cm, 6.0%], and the proportion of females and the long diameter of stones in group A and B were larger than those in group C [30.1%, (1.9±0.7) cm]; the differences above were statistically significant (P<0.05). There was no significant difference among the three groups in surgically history or complicated factors of urinary tract such as ureteral stricture (P>0.05). The prevalences of diabetes, renal tubular acidosis and hyperlipidemia in patients with infectious stones were higher than those in group C. The prevalences of renal tubular acidosis and hyperlipidemia in group A (16.1%, 39.3%) were higher than those in group B (0.6%, 21.1%), the positive rate of urine culture in group A (58.9%) was higher than that in group B (20.5%), which were both higher than that in group C (8.9%); these differences were statistically significant (P<0.017). The bacteria cultured from urine were mainlyProteus mirabilis and Escherichia coli in group A, and Escherichia coli in group B and group C. Conclusion Patients with large volume of stones, complicated with diabetes, renal tubular acidosis, hyperlipidemia and positive urine culture are more likely to have infectious stones.
Objective To investigate the awareness of rational use of drug (RUD) on medical workers in hospitals of different ranks, the establishment and execution of relevant strategies in hospitals of different ranks, and the main factors affecting RUD on medical workers, so as to provide references for the generalization of RUD. Methods A certain number of different ranks of hospitals in Chengdu and Zigong were randomly selected by the convenience sample method. Medical workers in each hospital were selected through face-to-face interviews with a self-designed questionnaire. Monte Carlo Chi-square analysis was applied on the hospital ranks and formulation of RUD guidelines, and logistic regression analysis was performed on the awareness of RUD knowledge of the respondents. Results Among 700 questionnaires distributed, 672 were retrieved (response rate 96.0%). The numbers of respondents who were familiar with the Pharmaceutical Affairs Councils (PACs) as well as the Pharmacy and Therapeutics Committees (PTCs) were 217 (32.29%) and 83 (12.35%), respectively. The number of respondents who understood the concept of essential medicine was 502 (74.71%). A total of 441 (61.16%) medical workers had been trained on RUD, 199 (29.61%) medical workers denied there were PTCs in their hospitals, and 60.71% of the medical workers mentioned that the use of drug was monitored and controlled with the feedback in their hospitals. The result of logistic regression analysis indicated that the professional title (P=0.038), awareness of essential medicine (Plt;0.001) and participation of RUD training (P=0.008) were the factors influencing the awareness of RUD. Conclusion Both management and education should be executed at the same time to elevate the level of rational use of drug. In order to increase the level of RUD we should complete monitoring institution and improving RUD awareness of workers. Additionally enhancing the rationality of medication should be performed by establishing guidelines of treatment or medication. Improving personal knowledge, scientific information and medication custom should be performed by standardizing regulations, strengthening management, emphasizing education and promoting communication between doctors and patients.
Objective To investigate the construction and services of the community health service system in Shifang, as well as the satisfaction of community residents with the community health services and the post-disaster emergency response capability of the community hospital, so as to provide decision-making suggestions on better reconstruction of the community health service system and improvement of its post-disaster emergency response capability. Methods There were 4‰ of community residents in Fangting town were selected by convenience sampling for a face-to-face interview using a questionnaire. Logistic regression was used to identify the influencing factors of residents’ satisfaction with community health services. Results A total of 250 questionnaires were conducted for face-to-face interviews, and 246 ones were retrieved (response rate 98.4%). Residents’ understanding and satisfactory degree of the community health service were 41.1% and 36.6%, respectively. Health education, medical expenses and medical insurance were the main factors influencing the residents’ satisfactory degree of community health services (P=0.050, 0.001, and 0.001). The proportions of disaster / disaster prevention education, exercises of post-disaster contingency plans, and psychological intervention as well as rehabilitation for residents were 37.4%, 10.6%, and 12.6%, respectively. Conclusion Community health services have not been widely accepted by community residents, and the satisfactory degree is low. The residents’ understanding and adaptation can be improved by strengthening the community health service propaganda. Strengthening health education, improving the quality of services, controlling costs, and introducing medical insurance reimbursement mechanism can increase the residents’ satisfactory degree. Including disaster emergencies into basic tasks can strengthen the emergency response capability and then provide guarantee for the residents’ health.