Hainan Medical University Research Articles

Efficacy comparison of erlotinib and pemetrexed in treatment of advanced non-small cell lung cancer

Objective To compare the efficacy of erlotinib and pemetrexed in treatment of advanced non-small cell lung cancer (NSCLC) and its effect on the immunity of patients. Methods A total of 82 patients with NSCLC at the First Affiliated Hospital of Hainan Medical College from June 2014 to May 2018 were retrospectively analyzed. According to the different treatment methods, the patients were divided into erlotinib group (150 mg/d, oral administration, 2 hours after the meal) and pemetrexed group (500 mg/m2, intravenous drip, 21-day each cycle). There were 41 cases in each group. The clinical effects of the two groups were analyzed. Flow cytometry was used to detect the immune index. Results The objective effective rate in pemetrexed group was lower than that in erlotinib group [34.2% (14/41) vs. 39.0% (16/41), χ2 = 0.210, P = 0.647). There was no significant difference in T lymphocyte subsets between the two groups before and after treatment (both P > 0.05). The values of CD3+ T cells, CD4+ T cells, CD4+/CD8+ in both groups after the treatment were decreased compared with the values before the treatment; CD8+ T cells was increased after the treatment compared with the value before the treatment (all P < 0.05). Quality of life questionnaire-C30 (QLQ-C30) score in erlotinib group was higher than that in pemetrexed group [(75.1±13.5) vs. (68.9±12.9), t = 2.158, P = 0.017]. Myelosuppression and gastrointestinal reactions were the main adverse events in pemetrexed group; rashes and diarrhoea were the main adverse reactions in erlotinib group. Grade Ⅰ-Ⅱ side effects occurred in both groups. There were statistical differences in the incidence of myelosuppression, gastrointestinal reactions, rashes and diarrhoea of both groups (all P < 0.05). Conclusions The efficacy of erlotinib and pemetrexed in treatment of advanced NSCLC is similar, and both of them could regulate the immune response. Erlotinib has a significant advantage in improving the quality of life. Key words: Carcinoma, non-small cell lung; Erlotinib; Pemetrexed; T-lymphocyte subsets; Adverse reactions

Small interfering RNA targeting paul-like kinase 1 gene silencing inhibits colon cancer invasion and proliferation in clinical, cellular and mouse studies

Objective To investigate the clinical, cellular and mouse studies of small interfering RNA (siRNA) targeting silencing of paul-like kinase 1 (PLK1) on colon cancer invasion and proliferation. Methods Sixty-eight patients with colon cancer admitted to the Second Affiliated Hospital of Hainan Medical College from July 2013 to September 2018 were enrolled, including 40 males and 28 females. The average age was (47.5±6.2) years. Western blotting and real-time quantitative PCR (RT-qPCR) were used to detect PLK1 protein and mRNA levels, respectively. In vitro invasion assay (Transwell) and cell proliferation and toxicity (CCK-8) assays detect cell invasion and proliferation. A subcutaneous xenograft nude mouse colon cancer model was constructed for animal experiments. The F-test was used to compare the measurement data among groups, and the t-test was used for the comparison between the two groups. The rate was compared using the χ2 test. Correlation analysis was performed using the Spearman method. Results Compared with adjacent tissues (8.72±2.19), the mRNA level of PLK1 in colon cancer tissues (15.34±3.86) was significantly increased (t=12.593, P<0.05). The level of PLK1 was positively correlated with tumor invasion depth (r=0.368, P<0.05) and TNM stage (r=0.403, P<0.05). Compared with the siRNA negative control [invasion: (37.20±4.50)], the invasive ability of SW480 cells was significantly decreased after PLK1-siRNA-1 [invasion: (15.00±3.75)] and PLK1-siRNA-2 [invasion: (14.60±3.40)] treatments (t=5.073, t=4.985, P<0.05). At 24 h, 48 h, and 72 h, compared to the siRNA negative control [absorbance (A) values: 0.53±0.12, 0.73±0.16, 0.86±0.18], the proliferation of PLK1-siRNA-1 (0.32±0.10, 0.40±0.08, 0.53±0.10) and PLK1-siRNA-2 (0.34±0.08, 0.41±0.09, 0.54±0.11) decreased significantly (t=4.167, t=4.990, t=4.833, t=4.001, t=4.708, t=4.665, P<0.05). Compared with the siRNA negative control [tumor volume: (849.12±65.37) mm3; number of nodules: (9.35±2.15)], the mean tumor volume and the number of tumor nodules in nude mice treated with PLK1-siRNA-1 [tumor volume: (135.06±9.11) mm3; number of nodules: 1.46±0.20] and PLK1-siRNA-2 [tumor volume: (127.45±8.86) mm3; number of nodules: (1.30±0.15)] were significantly lower (t=19.168, t=7.004, t=20.365, t=7.659, P<0.05). Conclusion Targeted silencing of PLK1 can inhibit the invasion and proliferation of colon cancer, and provide a theoretical basis for the targeted prevention and treatment of colon cancer. Key words: Colon cancer; Paul-like kinase 1; Invasion; Proliferation

Effects of Clinical Characteristics, Laboratory Parameters and Treatment Regimens on Prognosis of Patients with Multiple Myeloma

To study the effects of clinicopathological features, laboratory parameters and treatment regimens on the prognosis of patients with multiple myeloma. The clinical data of 97 patients with multiple myeloma treated with chemotherapy in Department of Hematology, the 1st Hospital of Hainan Medical College were analyzed retrospectively. The clinicopathological features (age, sex, severe anemia, light chain type, hypoproteinemia, paraplegia, renal injury, amyloidosis, complex karyotype, bone disease classification, Eastern Cooperative Oncology Group (ECOG) physical status score, complete remission, etc.), laboratory parameters (C-reactive protein, lactate dehydrogenase, blood calcium, serum β2 microglobulin, etc.), and treatment schemes (thalidomide maintenance treatment) were recorded. The patients were followed up for 1-60 months, and their total survival time were recorded. A single factor and multiple factors were used to analyze the factors affecting the total and early mortality of the patients. The survival curves were plotted by the Kaplan-Meier method and the survival analysis was carried out by Log-rank test. Among 97 patients, 29 cases (29.90%) achieved complete remission, and 56 cases (57.73%) achineved partial remission. The total effective rate was 87.63% (85/97). At the end of the follow-up, 19 cases (19.59%) died, and 1, 3 and 5 year survival rates were 80.41%, 71.13% and 37.11% respectively. The median overall survival time was 29 (1-60) months. The results of single factor analysis showed that age, hypoproteinemia, severe anemia, paraplegia, renal injury, amyloidosis, complex karyotype, complete remission and thalidomide maintenance therapy were the factors affecting the prognosis of the patients (all P＜0.05). Further multiple factor Logistic regression analysis showed that age and hypoproteinemia, severe anemia, paraplegia, amyloidosis, complex karyotype and thalidomide maintenance treatment were factors affecting the prognosis (P＜0.05). Of the 97 patients, 8 cases died early. The results of single factor analysis showed that amyloidosis and severe anemia were risk factors for early death (all P＜0.05), and further multivariate Logistic regression analysis showed that amyloidosis was an independent risk factor for early death (P＜0.05). There are many adverse factors affecting the prognosis of patients with multiple myeloma, such as age, hypoproteinemia, severe anemia, paraplegia, amyloidosis, complex karyotype and so on. The risk of early death in the patients with amyloidosis is higher, and salidomide maintenance therapy can help to prolong the life span of the patient.

Impact of extranodal tumor deposits on prognosis and N stage in gastric cancer

BackgroundExtranodal tumor deposits have been reported to be associated with a poor prognosis in many malignancies and are also included in the tumor, node, and metastasis staging system for colorectal cancer. MethodsWe reviewed retrospectively a total of 2,344 gastric cancer patients who underwent gastrectomy with curative intent at the Tianjin Medical University Cancer Institute and Hospital (Hexi District, Tianjin, China) and the First Affiliated Hospital of Hainan Medical University (Longhua District, Haikou, China). Patients were categorized into 2 groups based on extranodal tumor deposit status: a positive group, including those with extranodal tumor deposits, and a negative group composed of those with no extranodal tumor deposits. Clinicopathologic factors were correlated with extranodal tumor deposits, and their individual prognoses were analyzed. In addition, a pathologically modified node classification system was proposed by incorporating the extranodal tumor deposit status into the 8th ed of the N staging system. The superiority of prognostic prediction between the modified node classification and node stage was compared. ResultsA total of 645 (27.5%) patients had extranodal tumor deposits. The presence of extranodal tumor deposits was associated with a larger tumor size, Borrmann type III and IV, a deeper depth of invasion, and an advanced node stage. In the multivariate analysis, extranodal tumor deposits were an independent prognostic factor for gastric cancer patients after curative resection. Gastric cancer patients with extranodal tumor deposits demonstrated a lesser 5-year overall survival than those with no extranodal tumor deposits (31.9% vs 61.4%, P < .001). With the strata analysis, statistically significant prognostic differences between the two groups were only observed in patients at the N0-N2 stage. The modified node classification was found to be more appropriate for predicting the overall survival of gastric cancer patients after curative resection than node stage, and the –2 log likelihood of the modified node classification (16,042.890) was smaller than the value of node stage (16,150.811). ConclusionExtranodal tumor deposits in gastric cancer patients indicate aggressive characteristics and a poorer prognosis of gastric cancer. We maintain that extranodal tumor deposits should be incorporated into the N staging system to enhance the accuracy of the prognostic prediction of patients with gastric cancer.

Observation of efficacy of paclitaxel with concurrent radiotherapy in the treatment for nasopharyngeal carcinoma patients with liver metastasis

Objective To investigate the efficacy, prognosis and safety of weekly paclitaxel with concurrent radiotherapy in nasopharyngeal carcinoma (NPC) patients with multiple liver metastases. Methods A total of 64 NPC patients with multiple liver metastases in First Affiliated Hospital of Hainan Medical University between January 2016 and January 2018 were recruited and randomly divided into experimental group (n=32) and control group (n=32) by the method of random number table. The patients in the two groups were given palliative radiotherapy with a median dose of 30 Gy. The experimental group used weekly paclitaxel (40 mg/m2) concurrent chemotherapy, cisplatin (40 mg/m2) in the control group. Paclitaxel and cisplatin were used weekly until the end of radiotherapy. The clinical efficacy and adverse effects between the two groups were compared. Results During the follow-up, 1 patient was lost to follow-up in the experimental group, complete remission (CR) in 6 cases (19.4%), partial remission (PR) in 9 cases (29.0%), stable disease (SD) in 7 cases (22.6%) and progressive disease (PD) in 9 cases (29.0%); 2 patients were lost to follow-up in the control group, CR in 4 cases (13.4%), PR in 10 cases (33.3%), SD in 9 cases (30.0%) and PD in 7 cases (23.3%). There was no significant difference between the two groups (Z=-0.060, P=0.952). The effective rates of the experimental group and the control group were 48.4% (15/31) and 46.7% (14/30) respectively, and the difference was not statistically significant (χ2=0.018, P=0.893); the tumor control rates were 71.0% (22/31) and 76.7% (23/30), with no statistically significant difference (χ2=0.256, P=0.613). The median survival time of the experimental group and the control group were 9.4 months and 8.9 months respectively, and the 1-year survival rates were 14.5% and 10.0%, with no significant difference (χ2=1.136, P=0.286). Among the adverse effects, the incidence rates of allergic reaction, neurotoxicity and cardiovascular toxicity in the experimental group were higher than those in the control group [18.8% (6/32) vs. 3.1% (1/32), 28.1% (9/32) vs. 15.6% (5/32), 31.3% (10/32) vs. 15.6% (5/32)], with no significant differences (χ2=2.566, P=0.109; χ2=1.463, P=0.226; χ2=2.177, P=0.140). The incidence rates of granulocyte decline, platelet decline, red blood cell decline, and impaired liver and kidney function in the experimental group were lower than those in the control group [56.3% (18/32) vs. 68.8% (22/32), 12.5% (4/32) vs. 21.9% (7/32), 15.6% (5/32) vs. 25.0% (8/32), 21.9% (7/32) vs. 28.1% (9/32)], with no significant differences (χ2=1.067, P=0.302; χ2=0.988, P=0.320; χ2=0.868, P=0.351; χ2=0.333, P=0.564). The incidence rates of nausea and vomiting was lower than that in the control group [(40.6% (13/32) vs. 78.1% (25/32)], with a significant difference (χ2=9.328, P=0.002). Conclusion Weekly paclitaxel with concurrent radiotherapy has equivalent efficacy to cisplatin and the adverse effects can be tolerated. Key words: Nasopharyngeal neoplasms; Neoplasm metastasis; Radiotherapy; Paclitaxel

Application of individualized health education on limb function recovery in patients with intracranial tumor

Objective To explore the value of individualized health education in early rehabilitation therapy after surgery in patients with intracranial tumor and its effects on patients' limb function recovery. Methods Totally 88 patients with intracranial tumor treated in the First Affiliated Hospital of Hainan Medical University from June 2015 to November 2017 were selected by cross-sectional sampling and divided into the treatment group (n=44) and the control group (n=44) according to the random number table. All the patients received surgery. Patients in the control group received conventional nursing intervention, while patients in the treatment group received individualized health education. Short Form 36 Questionnaire (SF-36) and Simplified Fugl-Meyer Assessment of Motor Recovery (SFMA) were used to evaluate the quality of life and limb function recovery of the two groups after nursing care. Results The quality of life score of the treatment group was (90.47±5.67) , better than that of the control group, which was (79.84±4.77) , and there was statistically significant difference between the two groups (P<0.05) after nursing care. The limb function score of the treatment group was (89.68±5.77) , better than that of the control group, which was (80.10±4.02) , and there was statistically significant difference between the two groups (P<0.05) after nursing care. Conclusions Individualized health education provided as early as possible for patients with intracranial tumor is of great significance in improving patients' quality of life and limb function recovery, which is worth promoting in clinical practice. Key words: Intracranial neoplasms; Quality of life; Individualized health education; Limb function

Survival analysis of 198 patients with pancreatic cancer in Hainan, China: A multi-institution prospective study

Objective: To explore the survival status and prognostic factors of patients with pancreatic cancer in Hainan.Methods: Clinical data of patients who were diagnosed as pancreatic cancer and visited the First and Second Affiliated Hospital of Hainan Medical University and Haikou People’s Hospital from 2013 to 2017 were collected based on electronic medical records. Basic information was collected by a self-designed questionnaire. Data about admission examinations including blood routine examination, blood biochemistry tests, tumour markers tests, imaging examination and other clinical tests were also collected. The date of follow-up via telephone was 30 June 2018. The survival rate was analyzed by the Kaplan–Meier method and the logrank test. Univariate and multivariate analyses were performed with COX regression model.Results: A total of 198 patients were included in the study. Kaplan–Meier results showed that the overall survival (OS) in 6 months and 1, 2, 3 and 5 years was 47.4%, 26.8%, 16.4%, 13.2%, and 8.7%, respectively. The median OS was 5.8 months. Log-rank test analysis found that there were significant differences in OS among patients with different age, surgery status, distant metastasis or absolute number of neutrophils, percentage of neutrophils, absolute number of lymphocytes, neutrophil-to-lymphocyte ratio (NLR), CA199 and carcino-embryonic antigen (P<0.1). COX multivariate analysis showed that age, surgical presence, presence or absence of distant metastasis and NLR were significantly associated OS (P<0.05).Conclusions: Older age, higher NLR and liver or lung metastasis are independent risk factors, while surgical treatment is an independent protective factor for patients with pancreatic cancer.

Complete Genome Sequence of a Rodent Torque Teno Virus in Hainan Island, China.

Torque teno virus (TTV) has been reported in a wide range of mammals. In this study, we sequenced and analyzed the complete genome of a genetic variant of a rodent TTV, RoTTV3-HMU1 (Hainan Medical University 1). The virus was found in a rat (Rattus norvegicus) in a residential area of Hainan Island, China.

Neurological manifestations of atrial myxoma: A retrospective analysis.

Atrial myxoma is the most common type of primary cardiac tumor and it is closely associated with stroke in adults. Early diagnosis and treatment of atrial myxomas is essential for the prevention of embolic events. The aim of the present study was to assess neurological complications associated with atrial myxoma. The neurological signs of atrial myxoma were retrospectively assessed in individuals who underwent treatment at West China Hospital (Chengdu, China) and The Affiliated Hospital of Hainan Medical University (Haikou, China), between March 2003 and February 2015. A total of 130 patients with atrial myxoma were included and 22 (17%) exhibited neurologic signs. These patients were aged 39.9±12.6 years (range, 13-78 years) and there were 13 female and 9 male patients. Ischemic cerebral infarct constituted the dominant clinical symptom (68.2%) and 3 patients exhibited concomitant cardiac manifestations. Atrial myxoma was diagnosed by echocardiography in all patients. Irregular surface of atrial myxomas was associated with a high risk of embolic events. The patients with myxoma successfully underwent surgery with no mortality recorded. In conclusion, atrial myxomas frequently manifest as cerebral infarction in individuals without cardiovascular risk factors. These tumors more commonly affect the middle cerebral artery. Irregular surface of myxomas appears to be associated with embolic events. Echocardiography may improve the diagnosis and early treatment of atrial myxomas.

Efficacy analysis of radical intensity-modulated radiotherapy combined with concurrent chemotherapy for treatment of metastatic nasopharyngeal carcinoma

Objective To investigate the clinical effects of radical intensity-modulated radiotherapy (IMRT) combined with concurrent chemotherapy in the treatment of metastatic nasopharyngeal carcinoma. Methods Ninety patients with metastatic nasopharyngeal carcinoma in the First Affiliated Hospital of Hainan Medical University from August 2010 to April 2015 were selected as the research objects. All the patients were randomly divided into the observation group (45 cases) and the control group (45 cases) according to the random lottery envelope. The control group was treated with conventional chemotherapy treatment, and the observation group was treated with radical IMRT based on the treatment of the control group. The efficacy of the patients in both groups was evaluated after the treatment for 4 periods. Results The effective rate in the observation group was higher than that in the control group [66.7% (30/45) vs. 33.3% (15/45); χ2=4.552, P 0.05). All the patients were followed up. 1 yeas and 2 year survival rates in the observation group were 95.6% (43/45) and 86.7% (39/45) respectively, while the control group were respectively 75.6% (34/45) and 64.4% (29/45) (χ 2 values were 6.393 and 5.309, both P < 0.05). Conclusion Radical IMRT combined with concurrent chemotherapy for metastatic nasopharyngeal carcinoma can improve the therapeutic effect and show good safety, and the radiation damage would not affect the treatment process. Key words: Nasopharyngeal neoplasms; Neoplasm metastasis; Radiotherapy, intensity-modulated; Drug therapy, combination; Radiation injury

Complete Genome Sequence of a Mammarenavirus Harbored by Rodents on Hainan Island, China.

ABSTRACTWenzhou virus (WENV) is a rodent-borne mammarenavirus that was recently found to infect humans. In this study, we sequenced and analyzed the complete genome of a genetic variant of WENV, HMU (Hainan Medical University) virus. The virus was harbored by a Rattus norvegicus individual in the residential areas of Hainan Province in southern China.

Complete genome sequence of a rodent torque teno virus in Hainan Island, China

Objective: Torque teno virus(TTV), are reported in a wide range of mammals. In this study, we sequenced and analyzed the complete genome of a genetic variant of Rodent TTV, RoTTV3-HMU1 (Hainan Medical University). The virus was harbored by a Rattus norvegicus in the residential areas of Hainan Island, China. Methods: Torque Teno virus (TTV) was found widely distributed throughout the world infecting an extensively wide range of mammals .We extracted the viral DNA from a Rattus norvegicus liver which was caught from the residential areas of Hainan Island. Purifying the amplicons in the range of 250-500 bp. Then Five hundred nanograms DNA was subjected to high-throughput sequencing. The contigs were compared with the NCBI nucleiotide database, designed the primers to cover the genome by PCR amplification and amplicons of each PCR which have been cloned and sequenced. Finally the genome was annotated by using NCBI ORF finder and FGENESV0. Phylogenetic analysis was implemented by the neighbor-joining method in the MEGA6 software package. Results: We sequenced the complete genome of a genetic variant of Rodent TTV, RoTTV3- HMU1. The genomic sequence of RoTTV3-HMU1 has been deposited in GenBank under accession number MF688246.1. The complete genome of RoTTV3-HMU1 is 2 570 nucleotides (nt) in length with a G+C content of 46.93%. RoTTV3-HMU1 encoded 3 unidirectional overlapping open reading frames (ORF). Sequence analysis indicated that the genome of RoTTV3-HMU1 virus was most closely related to RN_2_15 (GenBank accession no. KM668486.1). Phylogenetic analysis based on both ORF1 and the total genome sequence placed RoTTV3-HMU1 in to the clad RoTTV3 of the RoTTV. Conclusions: Hainan Island faces mainland across the sea, however, the same genotype of RoTTV was identified in both Hainan Island and the other part of China. The detection of RoTTV3-HMU1 contributed to a better understanding about the origin and evolution of RoTTV.

A retrospective study of diabetes in middle-aged and elderly urban population in Hainan, south China

Objective: To investigate the distribution characteristics and epidemic trends of diabetes in middle-aged and elderly urban Hainanese, and to explore the correlations between diabetes and hypertension or hyperlipidemia in this kind of people. Methods: Middle-aged and elderly urban Hainanese (35–74 years old) were examined at the Medical Center of the Second Affiliated Hospital of Hainan Medical University from 2013 to 2017. According to the World Health Organiza-tion (WHO) Diabetes Diagnostic Criteria 1999, subjects with fasting blood glucose (FBG) level ⩾7.0 mmol/L (126 mg/dL) were diagnosed as diabetes. The retrospective analysis of the collected cleared data was conducted by using chi-square test, single factor correlation analysis and multiple linear regression analysis methods [gender: X1 (male=1, female=2); age: X2 (35–44=1, 45–54=2, 55–64=3, 65–74=4). The test level was set as 0.05. All data were standardized by age according to the 6th National Census Data 2010. Results: A total of 69 077 middle-aged and elderly observations’ data in 2013–2017 were collected. The detection rates of diabetes were 8.28%, 8.89%, 10.71%, 8.29%, and 9.21% respectively by year (χ2=41.850, P

Evaluation of teaching-in-English reform in five-year clinical tropical medicine program – Case analysis of curriculum reform of clinical medicine in Hainan Medical University

ObjectiveTo investigate the model, quality as well as effect of teaching-in-English in five-year clinical medicine program of Hainan Medical University. MethodsThe questionnaire was carried out among clinical medicine undergraduates of 2012–2015 grades in Hainan Medical University, to investigate studying time, studying habits and the impact of teaching in English. Additionally results of CET-4, CET-6 and overseas internship from undergraduates of 2012–2015 grade, as well as the result of phased medical licensing examination and post-graduate entrance examination from undergraduates of 2012 were accordingly collected from the Teaching Management Department. ResultsFor the Chinese students in international classes, the average time of self-study was 161.49 min, 58.3% had preview before classes, and 90.7% had habit of review after classes. Thus the first time pass rate, total pass rate, first time excellent rate and total excellent rate of CET-4 and CET-6 of international classes were significantly higher than those of regular classes. The result of post-graduate entrance examination in 2016 showed that the score, pass rate and acceptance rate of international classes of 2012 grade were significantly higher those of regular classes (P < 0.01). ConclusionsTeaching-in-English reform in Hainan Medical University has achieved initial success. Chinese students from international classes are superior to those from regular classes in many aspects. However, there are still many problems, and effective measures should be implemented to promote teaching quality continuously.

Observation of the clinical effect of ERCP biliary metal stent implantation and PTCD in the treatment of malignant obstructive jaundice

Objective To observe the clinical effect of endoscopic retrograde cholangiopancreatography (ERCP) biliary stent implantation and percutaneous transhepatic cholangiography (PTCD) in the treatment of malignant obstructive jaundice (MOJ). Methods Eighty-eight patients with MOJ treated in the Second Affiliated Hospital of Hainan Medical University from January 2013 to March 2016 were selected and then randomly divided into ERCP group and PTCD group, 44 cases in each group.ERCP group received biliary tract stent implantation via ERCP pathway, and PTCD group underwent percutaneous transhepatic biliary puncture.The success rate, clinical efficacy, liver function and complication rate of the two groups were compared. Results The success rate of ERCP group was 93.18% (41/44), and the success rate of PTCD group was 90.91% (40/44). There was no significant difference between the two groups (P>0.05). In terms of the clinical curative effect, the total effective rate of ERCP group was 92.68% (38/41), the total effective rate of PTCD group was 90.00% (36/40), there was no significant difference between the two groups (P>0.05); the low obstruction efficiency in ERCP group was significantly higher than that of PTCD group (100.00% vs.75%), the high obstruction efficiency in ERCP group was significantly higher than that of PTCD group (96.43% vs.83.33%), the differences between the groups were statistically significant (χ2=3.503, 2.771, P 0.05). Conclusion The ERCP pathway and PTCD pathway implantation of biliary metal stent have great clinical efficacy, while in comparison, ERCP pathway performs better in low obstruction and PTCD pathway was more suitable in high obstruction.In the course of clinical treatment, the selection of surgical approach should be based on the different obstruction sites of the patients, so as to obtain the best therapeutic effect. Key words: ERCP; PTCD; Malignant Obstructive Jaundice; Stent Implantation; Effect comparison

The Effects of Reflective Training on the Disposition of Critical Thinking for Nursing Students in China: A Controlled Trial

The aim of this study was to evaluate the effects of reflective trainings for nursing students on their critical thinking disposition. A total of 157 senior undergraduate nursing students sampled from Hainan Medical University in China participated in this study in 2014. They were randomly divided into experimental and control groups. The experimental group students were provided the reflective training during their entire 12-month clinical internship, whereas students in the control group were requested to keep their reflective diaries but without a formal training. Before and after the intervention, nursing students' critical thinking disposition was rated using the Chinese version of Critical Thinking Disposition Inventory (CTDI-CV). Before the start of the intervention, the critical thinking disposition scores of the two groups had no significant differences. At the end of the intervention, it was found that the experimental students performed better in each subscale of CTDI-CV. These include the search for truth, open mind, analytical ability, systematic ability, critical thinking, self-confidence, curiosity, and cognitive maturity. By summing the scores of all categories, the results showed that the experimental group had a significantly higher total score than that of the control group (p≤.044). Evaluating the score difference in each function indicated that there was a range of improvements on the critical thinking disposition because of the reflective training intervention. Reflective training during the internship period improves nursing students' disposition of critical thinking and promotes their readiness for their clinical practices in the rapidly increasing demands of the healthcare field.

Analysis of the disease spectra in patients seeking emergency medical treatment in Haikou, China

Objective: To explore the characteristics of medical emergency disease spectra in Emergency Department of Haikou, China; and to provide clinical data for emergent disease treatment as well as emergency department personnel and equipment management. Methods: A total of 11 870 patients (over 16 years old) who visited Emergency Departments of the First Affiliated Hospital of Hainan Medical University, Haikou city from January 1, 2015, through December 31, 2015 were selected. Data on patients' age, sex, diagnosis, treatment duration, and treatment month were analyzed with Microsoft Excel. Results: Peak treatment times were from 18:00 to 24:00. The top four diseases were involved with respiratory, digestive, nervous, and cardiovascular systems, respectively. Respiratory problems peaked from November to February and digestive problems peaked from February to August. Temperatures ranging from >22.5 °C to 26 °C and high humidity exacerbated respiratory and digestive system diseases. Conclusion: The frequency of specific diseases that require emergency room care are affected by the local climate of Hainan Province.

Retracted Publications Within Journals: Further Causes for Concern.

AJR 2016; 207:W6 0361–803X/16/2071–W6 © American Roentgen Ray Society Retracted Publications Within Journals: Further Causes for Concern We read with interest the recent article by Rosenkrantz [1] on retracted publications within radiology journals, in which the author concludes that “retraction represents an uncommon, yet potentially increasing, issue within radiology journals that publishers have inconsistently and insufficiently addressed” [1]. Aside from the practical process of retraction that journals perform when misconduct is detected, additional actions subsequent to the actual retraction are necessary. Routinely, journals contact the institution or institutions of the authors of the article to report the misconduct and retraction [2]. Some journals may sanction authors and report the problem to the World Association of Medical Editors. Although corrective and punitive measures are an important part of the process, preventive action is critical [3]. Finally, as Rosenkrantz noted, preventing citation of the retracted articles by authors who are unaware of the retraction is an important issue that needs to be addressed. A novel approach to this problem recently suggested by Cosentino and Verissimo [4] warrants attention. Beuy Joob Sanitation 1 Medical Academic Center, Bangkok, Thailand Viroj Wiwanitkit Hainan Medical University, Hainan, China; Joseph Ayo Babalola University, Ikeji-Arakeji, Nigeria

Vitamin D and Blood Pressure Homeostasis

Wiwanitkit House, Bangkhae, Bangkok 10160, Thailand; visiting professor, Hainan Medical College, China E-mail: [email protected]

Acute organo-phosphorus pesticide poisoning, oxidative damage, haemoglobin level and total leukocyte.

Sir, the recent report on acute organo-phosphorus pesticide poisoning, oxidative damage, haemoglobin level and total leukocyte is very interesting [1]. Hundekari et al. noted that “cholinesterase inhibition may initiate cellular dysfunction leading to acetylcholine induced oxidative damage [1].” This work is very useful information in clinical toxicology. However, there are many points to be considered. First, there is no control group in this report and it is not possible to tell whether the observed finding is significantly different from general population in the same area. In many rural areas in developing countries, the exposure to organo-phosphorus pesticide is common and the abnormal cholinesterase activity can be seen [2]. Focusing on the present study, the question is on whether there is any underlying disease affecting haemoglobin among the subjects. It should be reminded that the hemoglobinopathy can affect haemoglobin level and show the figure of abnormal oxidative status [3]. Viroj Wiwanitkit Joseph Ayobabalola Hainan Medical University, China, Faculty of Medicine, University of Nis, Serbia; adjunct University, Nigeria; Chulalongkorn University, Bangkok Thailand