案例中心教学法结合客观结构化临床考试在肝胆外科实习中的应用

目的探讨实行案例中心教学法(CBL)结合客观结构化临床考试(OSCE)培训在肝胆外科临床带教中的实施效果。方法将我科实习的36名肝胆外科实习生随机分为2组,实验组18名学生采用实行案例中心教学法结合客观结构化临床考试培训,对照组18名学生采用传统教学方法。3个月临床实习后进行考试。考试内容包括:病史采集、查体和病历书写;临床病例分析;临床操作技能考试;理论考试。结果实验组临床病例分析和临床操作技能考试成绩较对照组高,有统计学意义;病史采集、查体和病历书写、理论考试成绩两组差别无统计学意义。结论实行案例中心教学法结合客观结构化临床考试培训方法,有利于增加临床思维和工作能力。     

Utility of 3D magnetic resonance imaging in preoperative evaluation of hepatobiliary diseases

Three-dimensional (3D) imaging is playing an increasingly important role in modern diagnostic radiology. The recent improvements in magnetic resonance (MR) hardware, scanning protocols and 3D volumetric reconstruction software have facilitated great expansion of the role of 3D imaging for use in hepatobiliary surgery. In this review, we address the various 3D reconstruction techniques used in MRI and demonstrate the value of 3D imaging in preoperative evaluation of hepatobiliary diseases.     

Pharmacokinetics of gefitinib,an epidermal growth factor receptor tyrosine kinase inhibitor,in rat and dog

1.?The pharmacokinetics of gefitinib and its metabolites in rat and dog were investigated in preclinical studies conducted to support the safety evaluation and clinical development of gefitinib, the first EGFR tyrosine kinase inhibitor approved for the treatment of non-small-cell lung cancer.

2.?Following intravenous dosing (5?mg?kg^?1), gefitinib plasma half-life was 3–6?h in rats and dogs, although studies using a more sensitive HPLC-MS assay produced longer estimates of half-life (7–14?h).

3.?In these studies, plasma clearance was high (male rat: 25?ml?min^?1?kg^?1; female rat: 16?ml?min^?1?kg^?1; male dog: 16?ml?min^?1?kg^?1), as was the volume of distribution (8.0–10.4?l?kg^?1 in rat; 6.3?l?kg^?1 in dog), and exposure in female rats was double that in males.

4.?Following administration of [¹⁴C]-gefitinib, concentrations of radioactivity in plasma exceeded gefitinib throughout the profile, indicating the presence of circulating metabolites in both rat and dog.

5.?An HPLC-MS assay was developed to measure concentrations of gefitinib and five potential metabolites in plasma. All five metabolites were detected in the rat, but at levels much lower than gefitinib. In the dog, exposure to gefitinib and M523595 was similar, with much lower concentrations of M537194 and only trace levels of the other metabolites. This profile of metabolites is similar to that observed in man.     

王国三治疗肝胆疾病的经验总结

王国三老师是当代著名中医学家岳美中先生的得意门生,学识渊博,德高技精,在临床工作中积累了丰富的用药经验,对肝胆疾病的治疗更是有其独特的心得体会,临床效果显著。为了更好继承和发扬名老中医的学术思想,我们通过临床观察、跟师学习等方式对其治疗肝胆病的学术经验进行总结。     

Part 1: MRI features of focal nodular hyperplasia with an emphasis on hepatobiliary contrast agents

Focal nodular hyperplasia (FNH) is the second most common benign liver tumour and typically do not require any treatment. An accurate non‐invasive diagnosis is therefore vital to avoid unnecessary intervention and to reassure patients. This article discusses the demographics and pathology of FNH and reviews the appearance of FNH at MRI using liver‐specific contrast agents.     

Optimized high-resolution contrast-enhanced hepatobiliary imaging at 3 tesla: a cross-over comparison of gadobenate dimeglumine and gadoxetic acid

Purpose:

To evaluate the signal to noise ratio (SNR) and contrast to noise ratio (CNR) performance of 0.05 mmol/kg gadoxetic acid and 0.1 mmol/kg gadobenate dimeglumine for dynamic and hepatobiliary phase imaging. In addition, flip angles (FA) that maximize relative contrast‐to‐noise performance for hepatobiliary phase imaging were determined.

Materials and Methods:

A cross‐over study in 10 volunteers was performed using each agent. Imaging was performed at 3 Tesla (T) with a 32‐channel phased‐array coil using breathheld 3D spoiled gradient echo sequences for SNR and CNR analysis, and for FA optimization of hepatobiliary phase imaging.

Results:

Gadobenate dimeglumine (0.1 mmol/kg) had superior SNR performance during the dynamic phase, statistically significant for portal vein and hepatic vein in the portal venous and venous phase (for all, P < 0.05) despite twice the approved dose of gadoxetic acid (0.05 mmol/kg), while gadoxetic acid had superior SNR performance during the hepatobiliary phase. Optimal FAs for hepatobiliary phase imaging using gadoxetic acid and gadobenate dimeglumine were 25–30° and 20–30° for relative contrast liver versus muscle (surrogate for nonhepatocellular tissues), and 45° and 20° (relative contrast liver versus biliary structures), respectively.

Conclusion:

Gadobenate dimeglumine may be preferable for applications that require dynamic phase imaging only, while gadoxetic acid may be preferable when the hepatobiliary phase is clinically important. Hepatobiliary phase imaging with both agents benefits from flip angle optimization. J. Magn. Reson. Imaging 2011;. © 2011 Wiley‐Liss, Inc.     

北京某医院肝胆系统及胰腺疾病的疾病诊断相关分组研究

目的:建立北京市某传染病医院肝胆系统及胰腺疾病的疾病诊断相关分组(DRGs)方案,为相关政策提供依据。方法:依照美国AP-DRG18.0的分组轴线,对22 214例肝胆系统及胰腺疾病的病例进行分组,再以国际疾病编码ICD-10和手术操作编码ICD-9-CM3作为分类节点,对分组结果进行调整。结果:美国AP-DRG18.0的分组方法对该医院肝胆系统及胰腺疾病的病例分组具有可行性;节点调整后的疾病DRGs,组内同质性更好、组间异质性更强。结论:节点调整后的分组方法可以建立适合该医院的肝胆系统及胰腺疾病病例的DRG分组方案。     

基于零缺陷管理理论构建肝胆外科加速康复评价指标体系

目的构建适用于肝胆外科的加速康复评价指标体系,为加速康复外科实施效果提供评价工具。方法在零缺陷管理理论基础上,通过文献查阅、德尔菲专家咨询法构建肝胆外科加速康复评价指标体系。结果 2轮问卷回收率均为100%,专家权威系数分别为0.920、0.919。经过2轮专家咨询,最终构建的肝胆外科加速康复评价指标体系包括3个一级指标,8个二级指标,39个三级指标;指标重要性评分均4分,变异系数0～0.166;并确定各级指标权重。结论肝胆外科加速康复评价指标体系构建合理,有较好的可信度,经验证后可作为肝胆外科加速康复质量评价工具。     

贵州省黔南州20岁及以上农村居民慢性肝胆疾病患病率调查

目的 了解黔南州20岁及以上农村居民慢性肝胆疾病(CHD)的患病情况,为开展防治提供依据。方法 于2018年1月—2019年12月采取整群随机抽样方法对49 387名贵州省黔南州20岁及以上农村居民采用自行编制《黔南州CHD流行病学调查表》进行问卷调查,依据《临床肝胆病学》中有关标准进行诊断,采用SPSS 19.0软件进行分析。结果 49 387名黔南州20岁及以上农村居民中,CHD现患人数为7 245例,患病率为14.67%。其中男性患病率为16.69%（4 898/29 354）。女性为11.72%（2 347/20 033）,男性患病率高于女性（χ2 = 234.983,P = 0.001)。20岁～、30岁～、40岁～、50岁～、60岁～、70岁～、80岁～年龄段患病率分别为2.53%、5.09%、20.99%、23.49%、17.79%、16.75%、14.66%,不同年龄CHD患病率差异有统计学意义（χ2 = 67.823,P = 0.003）。汉族、布依族、苗族、水族、毛南族、瑶族、其他民族患病率分别为17.53%、18.06%、18.73%、21.64%、14.08%、3.07%、2.63%,不同民族CHD患病率差异有统计学意义（χ2 = 42.751,P = 0.005）。三都县、荔波县、罗甸县、平塘县、惠水县、长顺县、贵定县、龙里县、瓮安县、福泉市、独山县、都匀市CHD患病率分别为16.61%、15.99%、15.03%、14.13%、16.55%、11.98%、15.89%、13.54%、13.86%、13.99%、14.72%、13.74%。不同县市CHD患病率差异有统计学意义（χ2 = 27.253,P = 0.007）。各类型CHD患病率分别为:慢性胆囊炎（5.74%）、胆囊结石（4.48%）、脂肪肝（2.05%）、肝硬化（1.29%）、慢性病毒性肝炎（0.72%）、肝血管瘤（0.38%）。结论 黔南州20岁及以上农村居民CHD患病率处于低水平,病例类型以胆囊炎和胆囊结石为主,男性、水族居民是该地区防治的重点人群。