Within the context of the "Healthy China Strategy" and the "Biology-Psychology-Society" medical model, the goals, content and methods of medical education have undergone tremendous changes. To keep up with the pace of development of medical technology and medical concepts, medical education requires major reforms, and medical teaching models requires reconstruction. Based on previous investigations and discussions and considering the West China medical education as an example, this paper summarizes the difficulties that will be faced in the transformation and reform of modern medical education and discusses and analyzes the future direction of medical education reform.
Laparoscopic hepatectomy is routinely used in the surgical treatment of hepatocellular carcinoma, and has formed a standardized operating procedure. Tumors located in the segments Ⅶ and Ⅷ of liver as well as the paracaval subsegment of caudate lobe are considered to be difficult sites for laparoscopic hepatectomy due to the deep anatomical location, proximity to important vascular structures, difficulty in exposing the visual field under laparoscopy, and limited operating space. Based on the experience of our team and related research reports, the authors analyzed and summarized countermeasures for the difficulties of laparoscopic hepatectomy in the treatment of hepatocellular carcinoma in difficult sites. Adhering to the tumor-centered and margin-based principles, accurate preoperative assessment, selection of the correct surgical approach, designing liver resection plane guided by hepatic vena while taking into account portal vein territory, and giving preference to ananatomical hepatectomy while preserving functional liver parenchyma as much as possible are the prerequisites for ensuring minimally invasive and oncology benefits for patients with hepatocellular carcinoma in difficult sites.
Accurate segmentation of pulmonary nodules is an important basis for doctors to determine lung cancer. Aiming at the problem of incorrect segmentation of pulmonary nodules, especially the problem that it is difficult to separate adhesive pulmonary nodules connected with chest wall or blood vessels, an improved random walk method is proposed to segment difficult pulmonary nodules accurately in this paper. The innovation of this paper is to introduce geodesic distance to redefine the weights in random walk combining the coordinates of the nodes and seed points in the image with the space distance. The improved algorithm is used to achieve the accurate segmentation of pulmonary nodules. The computed tomography (CT) images of 17 patients with different types of pulmonary nodules were selected for segmentation experiments. The experimental results are compared with the traditional random walk method and those of several literatures. Experiments show that the proposed method has good accuracy in the segmentation of pulmonary nodule, and the accuracy can reach more than 88% with segmentation time is less than 4 seconds. The results could be used to assist doctors in the diagnosis of benign and malignant pulmonary nodules and improve clinical efficiency.
Objective To evaluate the diagnostic value of brain natriuretic peptide (BNP) for cardiac dyspnea.Methods Plasma BNP levels were measured by radioimmunoassay in dyspnea patients with chronic heart failure (CHF) (n=52) or without CHF (n=30) and normal control group (n=28).Results The BNP level in dyspnea patients with CHF was significantly higher than that of dyspnea patients without CHF and normal control group [(649.80±141.72) pg/mL vs (59.08±18.60) pg/mL and (65.20±16.32) pg/mL，respectively,Plt;0.05].There was no significant difference of BNP level between dyspnea patients without CHF and normal group (Pgt;0.05).The plasma BNP level elevated with the worsening of heart failure (NYHA Classiffication).The BNP level in dyspnea patients with CHF was negatively correlated with left ventricle ejection fraction (r=－0.673，Plt;0.001).The receiver operating characteristic (ROC) curve analysis showed that the area under the ROC curve (AUC) is 0.91(0.88-0.98，Plt;0.001) with a sensitivity of 87.2% and a specificity of 86.8% at the cutoff value of 206 pg/mL.Conclusion Measurement of plasma BNP is a rapid diagnostic method for cardiac dyspnea.
Objective To explore the clinical effect of occipital-cervical fusion and its impact on cervical curvature, and preliminarily study the causes of postoperative dysphagia. Methods The data of 24 patients who underwent occipito-cervical fusion in the Fourth People’s Hospital of Zigong between January 2014 and December 2018 were retrospectively analyzed, including 13 males and 11 females, aged 33-82 years, with an average age of (58.3±13.3) years. Among them, there were 14 cases of atlas fractures, 6 cases of atlantoaxial fractures, 1 case of intraspinal canal space-occupying lesion, 2 cases of chronic atlantoaxial dislocation with spinal cord compression, and 1 case of instability caused by inflammatory diseases. Japanese Orthopedic Association (JOA) score and Visual Analogue Scale (VAS) score were used to evaluate neurological function and pain of patients preoperatively and postoperatively. Occipito-cervical angle (O-C2) and lower cervical angle (C2-C7) were measured to evaluate the preoperative and postoperative angle changes in patients. The causes of postoperative dysphagia were analyzed. Results All the 24 patients were followed up for 8-50 months (26.3 months on average). The mean JOA score increased from 11.6±1.5 before surgery to 15.4±1.2 at the last follow-up, and the mean VAS score decreased from 6.4±1.1 before surgery to 2.0±0.6 at the last follow-up; the differences between the two time points were statistically significant (P<0.001). The bone graft fusion rate was 95.8% (23/24). The mean O-C2 angle decreased from (16.5±7.6)° before surgery to (14.7±4.5)° at the last follow-up, with no statistical significance (P=0.395). The mean angle of C2-C7 increased from (9.4±5.5)° before surgery to (16.3±3.5)° at the last follow-up, and the difference was statistically significant (P<0.001). Two patients developed postoperative dysphagia, possibly due to fusion in a flexion position. Conclusion Occipito-cervical fusion has reliable efficacy in treating occipito-cervical instability, with a high fusion rate and a low incidence of complications, but it will change the physiological curvature of upper and lower cervical vertebra, and fusion in a flexion position may cause postoperative dysphagia.
目的 了解5.12汶川大地震24个月后震区小学生的心理健康状况，为进行震后长期心理危机干预提供依据。 方法 于2010年5月即汶川大地震发生后24个月，分别使用创伤应激量表儿童版（CRIES-13）、儿童抑郁障碍自评量表（DSRSC）、长处与困难问卷（SDQ）学生版，调查了553名来自于彭州灾区的小学生的心理健康状况及其影响因素。 结果 ① 灾区小学生CRIES-13总分为（22.98 ± 12.29）分，其中大于划界分（30分）者为143人，占总人数的25.9%；女性总分高于男性（Z=?2.031，P=0.042）；震后被转移至安全地点的时间越长（OR=1.025，P=0.012）、家人伤亡越严重（OR=1.141，P=0.021），其CRIES-13总分大于划界分的可能性越高。② 灾区小学生DSRSC总分为（11.07 ± 5.78）分，其中总分大于划界分（15分）者为120人，占总人数的21.7%；女性总分高于男性（Z=?2.508，P=0.012）；灾区小学生的年龄（r=0.098，P=0.021）、震后被转移至安全地点的时间（r=0.117，P=0.004）与DSRSC总分呈正相关。③ 灾区小学生SDQ总困难因子得分为（14.97 ± 5.44）分，62.9%的人报告自身存在主观困难；女性的情绪因子、亲社会因子得分高于男性（Z=?3.123，P=0.002；Z=?2.243，P=0.025）；年龄越大，品行因子（χ2=7.604，P=0.023）、亲社会因子（χ2=8.102；P=0.017）得分增加。 结论 震后灾区小学生的心理健康状况受到性别、年龄、震后被转移至安全地点的时间、家人伤亡程度的影响，震后长期心理危机干预应综合考虑这些相关因素以确定高危人群。
目的:探讨5·12地震灾区11～16岁少年儿童的心理健康状况及其影响因素，为下一步开展创伤后心理危机干预提供依据。方法:在地震发生后一个月，使用长处与困难问卷（SDQ）学生版，调查了1268名来自于灾区的少年儿童（平均年龄14.20±1.02岁，男女比例1:1.02）的心理健康状况及其影响因素。结果:（1）灾区少年儿童SDQ总困难因子平均得分为13.66±5.75，74.9%的人报告自身存在主观困难；（2）女性的总困难因子、情绪因子、亲社会因子得分高于男性（z=-4.317，-7.963，-3.717；Pslt;0.001）；（3）困难对少年儿童社会功能的影响程度随年龄增加（χ2=7.684，P=0.021）。年龄越大，多动因子得分有增加的趋势（χ2=13.881，P=0.001）；（4）重度暴露组其总困难因子、情绪因子、影响因子得分高于轻度暴露组（z=-2.374，-4.279，-2.114；Pslt;0.05），困难造成的主观精神困扰程度前组高于后组（z=-2.920，P=0.004）；（5）女性、高年龄者、教师/同学伤亡较重者、震后被转移至安全的帐篷或房屋的间隔时间越长者，SDQ总困难因子异常的危险性越高。结论:震后灾区少年儿童的心理健康状况受到暴露水平、性别、年龄以及震后被转移至安全地点的时间的影响，心理干预应综合考虑相关因素。