Application of Student Standardized Patient in the Clinical Teaching of Acute Abdomen

Background:In recent years,with the gradual expansion of the scale of medical education,the shortage of medical teaching resources and the reluctance of patients to cooperate with teaching have become increasingly prominent.Objective:To explore the application effect of student standardized patient(SSP)in the clinical teaching of acute abdomen.Methods:Fifty-four fifth-year general medical students from class 1826 of the general department of The First Affiliated Hospital of Xi’an Medical University were selected as the research subjects and randomly divided into two groups,with 27 students in the experimental teaching group,and the remaining 27 students in the conventional teaching group.The experimental teaching group adopted the SSP teaching approach.The SSPs were generated from the training students of the hospital through the recruitment and training process of SSP.In this study,seven qualified SSPs were selected for the clinical teaching of acute abdomen.At the end of the course,a periodic assessment was held.The rank sum test was used to compare the excellent and good rates between the two groups,while t-test was used to compare the difference between the two groups.Results:The results showed that the excellent and good rate of the experimental teaching group was significantly higher than that of the conventional group,in which the difference between the two groups was statistically significant(p<0.05).In terms of the assessment results,the theoretical scores and skills scores of the experimental teaching group were better than those of the conventional teaching group,in which the differences between the two groups were statistically significant(p<0.05).Conclusion:Through the training of SSP for acute abdomen and its application in surgical teaching and examination,the superiority of SSP is emphasized.Although there are still some shortcomings in the application of SSP in clinical teaching,it is a relatively new and effective teaching method,and it will play an increasingly critical role in clinical skills training pertaining to the medical specialty.

Combination of anti-PD-1 antibody with P-GEMOX as a potentially effective immunochemotherapy for advanced natural killer/T cell lymphoma

Advanced natural killer/T cell lymphoma(NKTL)has demonstrated poor prognosis with currently available therapies.Here,we report the efficacy of anti-programmed death 1(PD-1)antibody with the P-GEMOX(pegaspargase,gemcitabine,and oxaliplatin)regimen in advanced NKTL.Nine patients underwent six 21-day cycles of anti-PD-1 antibody(day 1),pegaspargase 2000 U/m^(2)(day 1),gemcitabine 1 g/m^(2)(days 1 and 8)and oxaliplatin 130 mg/m^(2)(day 1),followed by anti-PD-1 antibody maintenance every 3 weeks.Programmed death-ligand 1(PD-L1)expression and genetic alterations were determined in paraffin-embedded pretreatment tissue samples using immunohistochemistry and next-generation sequencing(NGS)analysis.Responses were assessed using 18F-fluorodeoxyglucose positron emission tomography(18FDG-PET)and computed tomography or magnetic resonance imaging.Eight patients exhibited significant responses,comprising of seven complete remissions and one partial remission(overall response rate:88.9%).After a median follow-up of 10.6 months,6/9 patients(66.7%)remained in complete remission.The most common grade 3/4 adverse events were anemia(33.3%),neutropenia(33.3%),and thrombocytopenia(33.3%);all of which were manageable and resolved.Immunochemotherapy produced a high response rate in patients with positive PD-L1 expression(5/6,83.3%).NGS analysis suggested that STAT3/JAK3/PD-L1 alterations and ARID1A mutation were associated with immunochemotherapy efficacy.Mutation in DDX3X and alteration in epigenetic modifiers of KMT2D,TET2,and BCORL1 might indicate a poor response to immunochemotherapy.In conclusion,the anti-PD-1 antibody plus P-GEMOX regimen demonstrated promising efficacy in advanced NKTL.PD-L1 expression combined with specific genetic alterations could be used as potential biomarkers to predict therapeutic responses to immunochemotherapy.

Comprehensive view on genetic features, therapeutic modalities and prognostic models in adult T-cell lymphoblastic lymphoma

Adult T-cell lymphoblastic lymphoma(T-LBL)is a rare and aggressive subtype of non-Hodgkin’s lymphoma that differs from pediatric T-LBL and has a worse prognosis.Due to its rarity,little is known about the genetic and molecular characteristics,optimal treatment modalities,and prognostic factors of adult T-LBL.Therefore,we summarized the existing studies to comprehensively discuss the above issues in this review.Genetic mutations of NOTCH1/FBXW7,PTEN,RAS,and KMT2D,together with abnormal activation of signaling pathways,such as the JAK-STAT signaling pathway were described.We also discussed the therapeutic modalities.Once diagnosed,adult T-LBL patients should receive intensive or pediatric acute lymphoblastic leukemia regimen and central nervous system prophylaxis as soon as possible,and cranial radiation-free protocols are appropriate.Mediastinal radiotherapy improves clinical outcomes,but adverse events are of concern.Hematopoietic stem cell transplantation may be considered for adult T-LBL patients with high-risk factors or those with relapsed/refractory disease.Besides,several novel prognostic models have been constructed,such as the 5-miRNAs-based classifier,11-gene-based classifier,and 4-CpG-based classifier,which have presented significant prognostic value in adult T-LBL.

Combination of anti-PD-1 antibody with P-GEMOX as apotentially effective immunochemotherapy for advancednatural killer/T cell lymphoma

Advanced natural killer/T cell lymphoma(NKTL)has demonstrated poor prognosis with currently available therapies.Here,we report the efficacy of anti-programmed death 1(PD-1)antibody with the P-GEMOX(pegaspargase,gemcitabine,and oxaliplatin)regimen in advanced NKTL.Nine patients underwent six 21-day cycles of anti-PD-1 antibody(day 1),pegaspargase 2000 U/m^(2)(day 1),gemcitabine 1 g/m^(2)(days 1 and 8)and oxaliplatin 130 mg/m^(2)(day 1),followed by anti-PD-1 antibody maintenance every 3 weeks.Programmed death-ligand 1(PD-L1)expression and genetic alterations were determined in paraffin-embedded pretreatment tissue samples using immunohistochemistry and next-generation sequencing(NGS)analysis.Responses were assessed using ^(18)F-fluorodeoxyglucose positron emission tomography(^(18)FDG-PET)and computed tomography or magnetic resonance imaging.Eight patients exhibited significant responses,comprising of seven complete remissions and one partial remission(overall response rate:88.9%).After a median follow-up of 10.6 months,6/9 patients(66.7%)remained in complete remission.The most common grade 3/4 adverse events were anemia(33.3%),neutropenia(33.3%),and thrombocytopenia(33.3%);all of which were manageable and resolved.Immunochemotherapy produced a high response rate in patients with positive PD-L1 expression(5/6,83.3%).NGS analysis suggested that STAT3/JAK3/PD-L1 alterations and ARID1A mutation were associated with immunochemotherapy efficacy.Mutation in DDX3X and alteration in epigenetic modifiers of KMT2D,TET2,and BCORL1 might indicate a poor response to immunochemotherapy.In conclusion,the anti-PD-1 antibody plus P-GEMOX regimen demonstrated promising efficacy in advanced NKTL.PD-L1 expression combined with specific genetic alterations could be used as potential biomarkers to predict therapeutic responses to immunochemotherapy.