应用智能控压负压吸引输尿管软镜治疗肾铸型结石的临床研究

目的：　比较智能控压负压吸引输尿管软镜碎石术与普通输尿管软镜碎石术治疗肾铸型结石的临床疗效。方法：　回顾性分析2017年9月至2021年8月于重庆医科大学附属第一医院及赣州市人民医院行输尿管软镜碎石术的64名肾铸型结石患者临床资料。其中男性42例,女性22例,平均年龄50.9岁。41例行智能控压负压吸引输尿管软镜碎石术（控压组）,23例行普通输尿管软镜碎石术（非控压组）。运用t检验、χ²检验或Fisher确切概率法检验对2组患者的一期结石清除率、并发症发生率、术后血白细胞、手术时间、住院时间、住院总费用等进行比较。结果：　控压组手术时间长于对照组[（78.9±29.8）min vs.（60.7±32.1）min,t=2.278,P=0.026],一期结石清除率高于对照组（73.1% vs. 0%,χ²=28.808,P=0.000）,住院总费用低于对照组[（24 215.9±3 848.8）元 vs.（26 497.9±4 230.2）元,t=2.196,P=0.032]。2组并发症发生率（19.5% vs. 17.3%,χ²=0.044,P=0.835）、住院时间[（8.22±2.94）d vs.（6.87±1.79）d,t=1.997,P=0.05]、术后血白细胞[（9.83±5.72）×10⁹/L vs.（9.06±2.49）×10⁹/L,t=0.067,P=0.546]差异均无统计学意义。结论：　对于肾铸型结石,智能控压输尿管软镜吸引取石术较普通输尿管软镜一期结石清除率高、住院总费用少、患者获益更高。     

虚拟现实模拟培训在青年医师腹腔镜技能培训中的作用

目的 通过分析郑州大学附属郑州中心医院参加过腹腔镜技能培训的普外科青年医师的腹腔镜胆囊切除术学习曲线,探讨腹腔镜虚拟现实模拟培训的意义。方法 将青年外科医师50人分为两组,干预组参加虚拟现实模拟培训,对照组参加传统腹腔镜临床培训。培训完成后,在高年资拥有丰富腹腔镜手术经验医师的监督下完成30例腹腔镜胆囊切除术。应用CUSUM分析法,根据完成率、手术评分和手术时间绘制学员的手术学习曲线。x为手术例数,k为斜率。计算k=0时的x值,比较两组学员的手术学习曲线和术中评分。采用SPSS 23.00进行t检验和卡方检验。结果 干预组与对照组分别在x=19.24±0.39、x=21.72±0.73时跨过手术学习曲线,差异有统计学意义（P<0.01）;干预组与对照组显露胆囊部分得分分别为（10.82±2.73）、（9.71±2.69）（t=4.61,P<0.01）;解剖胆囊三角得分分别为（12.59±3.12）、（8.87±2.99）（t=6.21,P<0.01）;剥离胆囊得分分别为（10.69±3.38）、（8.80±3.55）（t=3.10,P<0.01）。结论 虚拟现实模拟培训可以促进腹腔镜培训的基本技能转化为临床操作技能,可促进普外科青年医师成长。     

人工智能辅助系统结合CBL教学在眼科住院医师斜视专业教学中的应用

目的　探讨人工智能（artificial intelligence,AI）辅助系统结合病例教学法（case-based learning,CBL）在眼科住院医师斜视专业教学中的应用。方法　将2020年1月至2021年12月在北京大学人民医院眼科规培的40名眼科住院医师作为研究对象,将其分为对照组和试验组,每组20人。对照组采用传统教学,试验组采用AI辅助系统结合CBL教学。专科培训结束时对两组学生进行理论知识、临床技能、临床思维考核,用问卷调查来评估教学效果。采用SPSS 26.0对数据进行卡方检验、单因素方差分析和独立样本t检验。结果　试验组理论知识考核成绩[（34.10±1.33）分]高于对照组成绩[（33.15±1.35）分]（t=2.24,P=0.031）,临床技能考核成绩[（24.75±1.02）分]高于对照组成绩[（23.60±0.82）分]（t=3.93,P<0.001）,临床思维考核成绩[（24.80±0.77）分]高于对照组成绩[（24.20±0.83）分]（t=2.37,P=0.023）。对教学效果的评估,试验组在提升学习兴趣（t=11.47,P<0.001）,提升临床思维能力（t=9.36,P<0.001）,提升知识与技能水平（t=17.71,P<0.001）,加大知识共享程度（t=31.17,P<0.001）,整体满意度（t=10.60,P<0.001）5方面评分均高于对照组。结论　AI辅助系统结合CBL教学能提高眼科住院医师对斜视疾病的独立诊疗能力,建立正确的临床思维路径,教学效果良好。     

解剖系膜法在胸腔镜食管癌左喉返神经链淋巴结清扫中的应用

目的：对比解剖系膜法和传统方法在胸腔镜食管癌左喉返神经链淋巴结清扫中的效果、并发症及愈合。方法：收集 2017年1月—2018年6月在南京医科大学第一附属医院行胸腔镜联合食管癌根治术（Mckeown术式）患者168例,其中解剖系膜法行左喉返神经链淋巴结清扫100例,传统手术方法68例,对比2种淋巴结清扫方法患者手术资料、围手术期并发症等,Cox 回归分析左喉返神经链淋巴结清扫方式是否为影响食管癌患者无病生存期（disease-free survival,DFS）的独立危险因素。结果：两组患者手术时间［（191.5±19.6）min vs.（197.2±16.7）min］、平均住院时间［（12.5±2.4）d vs.（12.1±2.1）d］、术中出血量 ［（138.8±52.4）mL vs.（132.7±43.3）mL］等差异无统计学意义,改良组左喉返神经链淋巴结清扫数量较传统方式明显增多 ［（2.93±1.19）个vs.（2.57±0.98）个,P=0.036］,而喉返神经损伤比例明显降低（2% vs. 13%,P=0.010）。多因素Cox回归分析提示,左侧喉返神经链淋巴结清扫方式、TNM分期、肿瘤分化程度是影响食管癌生存期的独立危险因素（P=0.012、0.037、0.045）。结论：解剖系膜法清扫左喉返神经链淋巴结可明显降低食管癌手术后并发症,有效提高食管癌术后无病生存期,解剖系膜法在左喉返神经链淋巴结清扫中具有较大应用价值。     

机器人辅助腹腔镜与传统腹腔镜治疗复杂肾上腺肿瘤的手术效果比较

目的 比较达芬奇机器人辅助腹腔镜和传统腹腔镜治疗复杂肾上腺肿瘤的手术效果,探讨达芬奇机器人辅助腹腔镜切除复杂肾上腺肿瘤的临床应用前景。方法 收集上海交通大学医学院附属瑞金医院2016年3月至2019年3月收治的47例复杂肾上腺肿瘤患者资料,其中机器人辅助腹腔镜组25例,传统腹腔镜组22例。比较两组手术中转开放手术情况、手术时间、术中出血量、术后引流管留置时间、术后住院时间及住院费用。结果 机器人辅助腹腔镜组手术均获成功,传统腹腔镜组有2例手术中转开放手术。机器人辅助腹腔镜组手术时间与传统腹腔镜组相比差异无统计学意义[159（149,168）min vs 165（155,194）min,P>0.05];机器人辅助腹腔镜组术中出血量少于传统腹腔镜组[350（250,475）mL vs 550（285,615）mL,P<0.05],术后引流管留置时间和术后住院时间短于传统腹腔镜组[3（3,4）d vs 4（3,4）d,P<0.05;6（6,7）d vs 7（7,8）d,P<0.05],而住院费用高于传统腹腔镜组[72 874.30（72 398.60,73 651.60）元vs 48 933.50（43 978.60,50 254.90）元,P<0.05]。结论 对于复杂性的肾上腺肿瘤,达芬奇机器人辅助腹腔镜手术存在一定的优势,在患者经济条件允许的情况下值得推广。     

子宫肌瘤腹腔镜剥除术中止血药物效果分析

目的 探讨垂体后叶素与缩宫素在腹腔镜下肌壁间子宫肌瘤剥除术的临床效果。方法 选取2015年10月~2016年12月行腹腔镜下子宫肌瘤剥除术的患者60例,分成两组各30例。治疗组注射6IU垂体后叶素+10ml生理盐水,对照组注射20U缩宫素+10ml生理盐水,按照两组的用药情况,观察比较血压变化和其他情况。结果 治疗组与对照组比较,手术时间明显减少（98.13±5.07min vs 110.83±8.03min,t=-7.324,P=0.000）,术中出血量明显减少（67.50±10.24ml vs 97.83±16.10ml,t=-8.705,P=0.000）,血红蛋白术前术后变化（9.67±2.09g/L vs 11.53±2.21g/L,t=-3.362,P=0.001）。术中用药后15min,治疗组收缩压上升,显著高于对照组（150.77±5.57mmHg vs 142.03±5.21mmHg,t=6.273,P=0.000）。结论 腹腔镜下肌壁间子宫肌瘤剥除术应用垂体后叶素止血效果明显优于缩宫素,但会引起短暂性血压升高,临床使用应结合患者病情个性化选择。     

过表达细胞因子信号转导抑制因子2调控JAK2/STAT3通路抑制直肠癌细胞活性和移植瘤生长

目的：　探究细胞因子信号转导抑制因子2（suppressor of cytokine signaling 2,SOCS2）过表达对直肠癌细胞生长、运动和JAK2/STAT3通路的影响。方法：　HCT8细胞分为对照组、pcDNA组和pcDNA-SOCS2组,根据组别转染pcDNA空载体或pcDNA-SOCS2重组表达载体,RT-PCR检测SOCS2基因表达,BrdU染色检测细胞增殖,流式细胞术检测细胞凋亡,Transwell检测细胞侵袭,Western blot检测细胞SOCS2、上皮钙黏蛋白、波形蛋白、纤连蛋白表达以及JAK2和STAT3的磷酸化。另设BALB/c nu/nu裸鼠分为对照组、pcDNA-SOCS2组,建立HCT8皮下移植瘤模型,称取移植瘤质量,免疫组化检测Ki-67和血管内皮生长因子（vascular endothelial growth factor,VEGF）平均光密度,Western blot检测瘤组织JAK2和DTAT3磷酸化。结果：　离体实验中,RT-PCR结果显示,与对照组（1.00±0.00）比较,pcDNA-SOCS2组细胞SOCS2 mRNA水平（4.70±0.27）明显升高（P=0.000）。Western blot结果显示,pcDNA-SOCS2组细胞SOCS2蛋白表达（0.130±0.020）较对照组（0.010±0.005）明显上调（P=0.000）。BrdU阳性百分比明显降低（P=0.000）;流式细胞术结果显示,pcDNA-SOCS2组[（35.0±5.0）%]HCT8细胞凋亡率较对照组[（6.0±3.4）%]明显升高（P=0.000）。Transwell分析结果显示,pcDNA-SOCS2组（89.0±10.0）HCT8细胞侵袭数目较对照组（87.0±13.0）明显减少（P=0.000）。Western blot结果显示,pcDNA-SOCS2组HCT8细胞中上皮钙黏蛋白水平（0.120±0.030）较对照组（0.010±0.004）明显升高（P=0.000）,同时波形蛋白水平（0.008±0.004）和纤连蛋白水平（0.010±0.005）较对照组（0.170±0.024,0.070±0.020）明显降低（P=0.000）,JAK2和STAT3磷酸化水平降低（P=0.000）。在体实验中,pcDNA-SOCS2组瘤体质量（0.14±0.06）较对照组（0.45±0.08）明显减轻（P=0.000）。免疫组化结果显示,pcDNA-SOCS2组Ki-67和VEGF平均光密度（17.0±6.0,7.0±6.0）较对照组（52.0±9.0,43.0±9.0）明显降低（P=0.000）,瘤体JAK2和STAT3磷酸化水平明显下调（P=0.000）。结论：　SOCS2过表达可抑制直肠癌HCT8细胞的增殖和运动能力并促进其凋亡,这一作用与JAK2/STAT3通路有关。     

有生育要求的Ⅲ型CSP手术治疗效果临床研究

目的：　探讨有生育要求的Ⅲ型瘢痕妊娠（cesarean scar pregnancy,CSP）阴式及腹腔镜病灶切除修补术（focal excision repair,FER）手术方式的临床价值。方法：　回顾分析2017年1月至2019年12月重庆市妇幼保健院收治的有生育要求的Ⅲ型CSP并行非介入辅助下阴式FER 55例及腹腔镜FER 36例。结果：　88例手术顺利,阴式FER术中出血（116.6±33.3）mL,手术时间（68.0±13.3）min,腹腔镜FER术中出血（150.6±31.6）mL,手术时间（107.0±13.3）min;2种手术出血量和手术时间统计学差异明显（P<0.05）,阴式FER住院费用明显低于腹腔镜FER（P<0.05）,术后1年超声随访阴式FER切口瘢痕厚度[（4.66±0.30）mm]较腹腔镜FER[（4.06±0.37）mm]厚（P<0.05）,术后18个月后妊娠情况无统计学差异（P>0.05）。结论：　2种手术方式治疗Ⅲ型CSP各有利弊,非紧急情况下可以避免使用子宫动脉栓塞术（uterus artery embolization,UAE）。     

人文管理对进修医师焦虑、抑郁倾向干预效果的研究

目的 探讨人文管理对进修医生焦虑、抑郁倾向的干预效果。方法 选择2016年1月至2018年12月开始在首都医科大学附属北京安贞医院进修学习的进修医生进行人文管理,并以2013年4月至2015年12月的进修医师为参照,应用医院焦虑抑郁量表于进修前、后进行问卷调查。所有进修医生均采用常规进修管理模式,干预组在此基础上建立个体化进修学习日程表、配备进修医生导师、定期对进修医生进行走访并组织进修医生座谈会、协助进修医生加入科室学术群、组织协调进修医生参与多学科专病学术查房、通过巴林特小组方式进行负面情绪疏导、将进修医生文化生活融入医院文化建设和对进修结束的进修医生进行随访。应用SPSS 16.0进行t检验和方差分析。结果 两组医生进修前测评数据按照性别、进修科室类别、来源医院级别和进修时长的不同比较,焦虑和抑郁评分差异无统计学意义（P>0.05）。干预组两次测评比较,焦虑第2次评分男女进修医生[（5.90±1.37） vs. （6.48±1.87）,（5.92±1.45） vs. （6.73±2.12）]、进修各科室医生[（5.50±1.23） vs. （6.76±2.35）,（6.03±1.36） vs. （6.64±1.75）,（5.98±1.50） vs. （6.64±2.15）]、来自二、三级医院医生[（5.85±1.29） vs. （6.64±2.02）,（6.00±1.50） vs. （6.78±2.14）]、各进修时长医生[（5.92±1.37） vs. （6.64±2.15）,（5.92±1.47） vs. （6.68±1.98）]和总分[（5.92±1.42） vs. （6.66±2.05）]低于第1次测评评分（P<0.05）;抑郁第2次评分女性进修医生[（6.15±1.37） vs. （6.68±2.06）]、进修医技科室医生[（6.02±1.40） vs. （6.69±1.88）]、来自三级医院医生[（6.13±1.41） vs. （6.51±1.90）]、各时长进修医生[（6.04±1.42） vs. （6.50±2.02）,（6.12±1.34） vs. （6.57±1.97）]和总分[（6.09±1.37） vs. （6.54±1.99）]低于第1次测评评分（P<0.05）。对照组第2次测评焦虑评分,男性进修医生评分[（6.63±1.15） vs. （6.11±1.76）]高于第1次测评评分（P<0.05）。两组医生第2次测评数据比较,焦虑评分方面,干预组各分层医生评分和总分评分低于对照组（P<0.05）;抑郁评分方面,女性进修医生、来自三级医院医生、进修时长6个月医生和总分评分低于对照组（P<0.05）。结论 应用人文管理方式加强对进修医生进行管理,可以在一定程度上改善进修医生的心理状态,特别是缓解焦虑状态,是一种值得推广的进修管理模式。     

创客教学在消化内镜教学中的应用研究

目的　在消化内镜检查教学中应用创客教学法,以期拓展学生的思维,激发其创新意识,从而获得较好的教学效果,达到提高学生成绩、教学满意度及学习兴趣的目的。方法　选取2020年1月到2021年9月于首都医科大学宣武医院进行临床见习的2个长学制班级的全体学生作为研究对象。1个班全体学生为试验组（SCS创客教学班）,共计55人;另外一个班全体学生为对照组（传统教学组）,共计56人。两组学生于教学前进行摸底考试并进行威廉斯创造力倾向测量表评分;于教学后再进行闭卷考试,并进行威廉斯创造力倾向测量表评分;最后以问卷形式对两组学生进行满意度评分及学习兴趣调查。应用SPSS 23.0软件对数据进行t检验和卡方检验。结果　试验组教学后考试成绩,理论总分（68.11±9.27 vs. 58.66±6.55,t=-6.19,P<0.001）、选择题（21.85±3.94 vs. 18.96±4.59,t=-3.56,P=0.001）、简答题（13.55±3.67 vs. 11.18±3.23,t=-3.61,P<0.001）、简单病例分析（12.67±3.82 vs. 11.14±2.82,t=-2.40,P=0.018）、复杂病例分析（20.04±5.62 vs. 17.38±5.30,t=-2.57,P=0.012）、阅片考试（36.53±7.59 vs. 33.14±7.82,t=-2.31,P=0.023）均高于对照组,差异有统计学意义。试验组威廉斯创造力倾向测量表评分（98.91±9.81 vs. 91.09±10.60,t=-4.03,P<0.001）、满意度评分（6.76±1.78 vs. 5.66±1.91,t=-3.14,P=0.002）、学习兴趣评分（6.49±2.00 vs. 5.41±1.82,t=-2.98,P=0.004）均高于对照组,差异有统计学意义。结论　创客教学法在消化内镜检查教学中的应用,可以培养学生的创新思维,提高医学生对消化内镜检查的理解,诱发他们对消化内镜的学习欲望,还可以提升学生对教学的满意程度。     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

Acupuncture Treatment of Vomiting

CASE HISTORY A female patient, 46 years old, head of the foreign affairs department of a certain university in Beijing, paid her first visit on October 9, 2006, with the chief complaint of vomiting for one month. She got vomiting after meals in early September. Before that, she had discomfortable sensation in the stomach due to angry with others, but she didn't pay much attention. Later, it developed into vomiting after eating. After the vomiting, the discomfort would be relieved, but with slight hypodynamia. She was once diagnosed as having 'neurogenic vomiting'. Having taken some western and Chinese drugs, the above symptoms were a little bit improved, but she would have nausea upon eating and with regurgitation. Because of the fear for vomiting, she did not dare to have food intake, with body weight reduction of 6 kilos in one month.     

Qiu Baoguo''''s Experience in Treating Consumptive Syndromes after Radio-Chemotherapies

Radiotherapy and chemotherapy are the important modern medical therapies for malignant tumors,yet they can also bring about serious local and systemic toxic side reactions so to decrease the patient;'s life quality,manifested by a series of consumptive symptoms.Having engaged in the combined work of Chinese and western medicine for nearly 50 years,the research fellow Qiu Baoguo in Henan Provincial Academy of TCM has developed his unique views on the TCM study of consumptive syndromes.The author of this essay had once the fortune tO follow Dr.Qiu in clinic,and specially would like to introduce in the following Dr.Qiu's experience in treating consumptive syndromes after radio-chemotherapies for patients with malignant tumor.     

Insomnia Due to Deficiency of Both the Heart and Spleen Treated by Acupuncture-Moxibustion and Chinese Tuina

OBJECTIVE: To observe therapeutic effects of the comprehensive therapy of acupuncture-moxibustion and Chinese Tuina for treatment of insomnia due to deficiency of both the heart and spleen. METHODS: 92 cases were divided randomly into the treatment group (treated by acupuncture-moxibustion and Chinese Tuina) and the control group (treated by acupuncture-moxibustion). RESULTS: The therapeutic effect of the treatment group was obviously superior to that of the control group (the CHI2 test showed P < 0.01). CONCLUSIONS: The comprehensive therapy of acupuncture-moxibustion and Chinese Tuina can give marked therapeutic effects for treatment of insomnia due to deficiency of both the heart and spleen.     

Analysis of CK-19,PDX-1,Nestin,Ngn3 in different donor islet purity in rats

Objective: To investigate if there are the CK-19, PDX-1, Nestin, Ngn3 positive cells in the donor islets of different purity in rats. Methods: Thirty male adult SD rats were randomly divided into 3 groups. Islets were isolated using digestion by ductal injection of collagenase. Group Ⅰ (n=10): Separating cell preparations were not purified, Group Ⅱ(n=10): Islet sediment was purified with 25% Ficoll400 ,Group Ⅲ (n=10): Islet sediment was purified with 25% and 11% Ficoll-400. The levels of protein of CK-19, PDX-1, Nestin and Ngn3 were detected by immunohistochemistry and the mRNA of CK-19, PDX-1, Nestin, Ngn3 was amplified by RT-PCR. Results: After two different purification methods applied, three islet preparations of different purities were obtained. The difference of islet purity was significant among various groups (P＜0.05). Compared with group Ⅱ and group Ⅲ,the protein and mRNA of CK-19, PDX-1, Nestin,Ngn3 were both higher in group Ⅰ; group Ⅲ was poorly expressed. Conclusions: The three different islet purity donor islet have different CK-19, PDX-1, Nestin, Ngn3 positive cells within them, indicating that there are some islet stem cells in the purified donor islet.     

Dr.Zhang Ren''''s Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

Luo Lingjie''''s Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.