ObjectiveTo briefly describe the specific contents and analyze the implementation effects of the information-based training system on neurology residents.MethodsSince February 2020, an information-based training system was carried out in the standardized training center for residents in the Department of Neurology, Xuanwu Hospital of Capital Medical University. The effect of the information-based training system was measured by comparing the numbers of training lessions and examinations, participation rates of training lessions and examinations, and mock examination results after 4 months of training of the resident trainees in Grade 2017 under the information-based training mode (n=35) with those of the resident trainees in Grade 2016 under regular face-to-face training mode (n=35). Chi-square test was used for comparison between training groups.ResultsCompared with those in Grade 2016, the number of lessons in Grade 2017 increased by 87.0% (43 vs. 23), the participation rate of lessons in Grade 2017 was higher (100.0% vs. 87.0%, P<0.001), the number of examinations in Grade 2017 increased by 87.5% (15 vs. 8), the participation rates of examinations were both 100.0%, and the pass rate of the mock examination in Grade 2017 was higher (94.3% vs. 77.1%, P=0.040).ConclusionThe training method and effect of the standardized training model of the information-based training system for resident doctors are worthy of recognition, providing a reference for medical teaching, especially for the standardized training of resident physicians.
ObjectiveTo briefly describe the specific contents of the “four-dimensional integration” standardized training model for neurology residents and analyze the implementation effects.MethodsSince September 2019, the Standard Training Center for Residents in Department of Neurology, Xuanwu Hospital of Capital Medical University trained residents under “four-dimensional integration” standardized training model, including primary knowledge teaching, basic skill training, clinical thinking training, and student group learning. The effect of the “four-dimensional integration” model was measured by comparing the midterm assessment results after four months of training of the resident trainees in Grade 2019 under the “four-dimensional integration” training mode (n=37) with those of the resident trainees in Grade 2018 under regular training mode (n=32). The midterm assessment was conducted through standardized and objective clinical examinations, including three evaluations (theory, skills, and clinical drills), and the pass rate of tests was evaluated through Fisher’s exact probability method for comparison between training groups.ResultsThere was no significant difference in the pass rate of theoretical assessment (100.0% vs. 96.9%, P=0.464) or the pass rate of Mini-Clinical Evaluation Exercise (100.0% vs. 90.6%, P=0.095) between the two groups. The pass rate of skill assessment in Grade 2019 was significantly higher than that of the students in Grade 2018 (94.6% vs. 71.9%, P=0.018).ConclusionThe “four-dimensional integration” standardized training model for neurology residents and it effect are worthy of recognition, which can provide a reference for medical teaching, especially for the standardized training of resident physicians.
ObjectiveTo investigate the feasibility of hand-assisted laparoscopic surgery in radical gastrectomy for gastric cancer. MethodsThe data of two cases undergoing hand-assisted laparoscopic radical gastrectomy for gastric cancer, including operative time, operation related complications, intraoperative bleeding volumes, number of harvested lymph nodes, postoperative complications, time to restoration of bowel function, and length of postoperative hospital stay, etc, were retrospectively analyzed. ResultsTwo patients had undergone the successful hand-assisted laparoscopic radical total gastrectomy and distal gastrectomy without operation related complications. The operative time was 310 min and 220 min, respectively. While, the intraoperative bleeding volume was 120 ml and 80 ml with the number of harvested lymph node being 38 and 52, respectively. There were no postoperative bleeding, intestinal fistula, and anastomotic leakage， etc. The patients were discharged with smooth and fully recovery. ConclusionThe application of hand-assisted laparoscopic surgery in radical gastrectomy for gastric cancer is feasible and safe. However, the effectiveness needs further exploring.
ObjectiveTo explore the value on excision of subpyloric (No.6 group) lymph nodes of stomach by detection of metastatic rate and metastasis of lymph nodes of No.6 group and its subgroups. MethodsThe clinical data including complete information on No.6 group and its subgroups lymph nodes in 80 patients underwent gastrectomy and subpyloric lymph nodes dissection for gastric cancer from January 2006 to December 2009 were retrospectively analyzed. Referring to the right gastroepiploic vein, the No.6 lymph nodes were divided into three subgroups (No.6a, No.6b, and No.6c subgroup), and the relationship between the metastasis of No.6 lymph nodes and clinicopathologic features as well as the metastasis of No.7, No.8a， and No.9 lymph nodes were analyzed by logistic regression analysis. ResultsThe metastatic rate of No.6 group lymph nodes was 41.3% (33/80) and with 26.0% (108/415) of the resected lymph nodes involved. The metastatic rate of lymph nodes in No.6a subgroup (7.5%, 6/80) was significantly lower than that in No.6b (16.3%, 13/80) and No.6c subgroup (36.3%, 29/80), Plt;0.001. The metastasis of the resected lymph nodes in No.6a, No.6b, and No.6c subgroup was 25.0% (8/32), 17.6% (13/74), and 28.2% (87/309), respectively, and the difference was not significant (P=0.292). The metastasis of lymph nodes in No.6a subgroup was correlated to T stage (P=0.042) and N stage (P=0.006). The metastasis of lymph nodes in No.6b subgroup was correlated to N stage (P=0.002) and TNM stage (P=0.013). The metastasis of lymph nodes in No.6c subgroup was correlated to differentiation degree of tumor (P=0.008), T stage (P=0.003), N stage (P=0.000), and TNM stage (P=0.000). The logistic regression analysis showed that the metastasis of lymph nodes was correlated to the metastasis of No.8a lymph nodes (P=0.023) and N stage (P=0.002) in No.6 group, the metastasis of No.8a lymph nodes (P=0.018) in No.6a subgroup, N stage (P=0.005) in No.6b subgroup, and the metastasis of No.8a lymph nodes (P=0.016) and N stage (P=0.004) in No.6c subgroup. ConclusionAttentions should be paid to the complete dissection of subpyloric lymph nodes in gastric cancer surgery, especially for the lymph nodes of No.6a and No.6b subgroups.
Objective To investigate the application of abdominal aorta and bilateral abdominal perineal artery ligation in a hindlimb ischemia model of rats for research. Methods According to the random digits table, 38 SD rats were divided into 3 groups randomly, sham operation group (SO group, n=12), abdominal aorta ligation group (AAL group, n=12) and abdominal aorta and bilateral abdominal perineal artery ligation group (AAL+BAPA group, n=14). Rats were anesthetized by 6 mg/100 g ketamine via intraperitoneal injection. Blood vessels were ligated via laparotomy according to different procedures. Movement and pale skin color of rat’s hindlimb were observed on 2 and 4 weeks after operation, meanwhile venous blood from unilateral iliac vein was obtained for blood gas analysis and hindlimb skeletal muscle for HE stain. Results Two rats were dead during 3 d after operation in AAL+BAPA group, other rats survived. Rats in SO group had no obviously abnormal appearance. AAL group and AAL+BAPA group immediately presented hindlimbs pale, lower skin temperature, hypofrontality of limb motion after procedure. Symptoms above mentioned had improved gradually after 2 weeks and completely recuperated 4 weeks after operation in AAL group. Ischemia symptoms were still remained obviously such as cold, dried and thin on the 4th weekend in AAL+BAPA group. Each group had no hindlimbs necrosis. Two weeks after operation, pale limbs and muscle strength in AAL+BAPA group were more severe than those of SO group (Plt;0.05); Pale limbs was still worse than that of AAL group on 4 weeks after operation (Plt;0.05). There were no significant differences on different time in each group (Pgt;0.05). Venous blood partial pressure of oxygen of AAL+PABA group was significantly lower than that of the other two groups on 2 and 4 weeks after operation (Plt;0.05). Normal striated muscle structure was presented in SO group pathologically. AAL group revealed coloretur unevenness, swelling and distension, muscle cellular transverse striation elimination, skeletal muscle cell nucleolus deeply stained on the 2nd weekend and no difference with the SO group on the 4th weekend. AAL+BAPA group presented skeletal muscles decoration unevenness, cells swelling and distension, muscle cellular transverse striation elimination, skeletal muscle cell nucleolus stained deeply and intensively, intercellular space widening until the 4th weekend， but no obviously necrocytosis. Conclusion The method of ligating abdominal aorta and bilateral abdominal perineal artery can make a stable SD rat model of hindlimb ischemia
Objective To investigate the effect and surgical skill of ultracision harmonic scalpel in curative gastrectomy for patients with gastric carcinoma. Methods From January 2007 to May 2008, the data of 152 patients who were treated by curative gastrectomy with ultracision harmonic scalpel were analyzed retrospectively. Results The mean operative time was (189.5±24.2) min. Compared with the conventional operation, the number of harvested lymph nodes (mean: 30.4±11.6) in patients treated with ultracision harmonic scalpel was increased. The application of ultracision harmonic scalpel could shorten the operation time, decrease the intraoperative blood loss and make the operation field clear. There were no postoperative complications, such as anastomotic leakage, lymphatic leakage and massive hemorrhage. And there was no death in this series. Conclusion The usage of ultracision harmonic scalpel which could improve the curative degree of lymphadenectomy is safe in curative gastrectomy for patients with gastric carcinoma.
Objective To develop a new type of tail cap for closing the tail of the central hole of the interlocking intramedullary nail so as to reduce difficulty in implantation of the tail cap into intramedullary nail, and ensure the accuracy of implantation, as well as reduce unnecessary operation time. Methods In 2014, the new type of intramedullary nail tail cap (" new tail cap” for short) was successfully developed, and has been granted national utility model patent. A randomized controlled clinical trial was conducted in 34 patients with non pathological femoral shaft fractures treated between August 2014 and March 2016. The patients were randomly divided into groups A and B, 17 patients each group. There was no significant difference in gender, age, side, body mass index, cause of injury, injury to operation time, and fracture AO classification between groups (P>0.05), with comparability. All patients underwent fixation with interlocking intramedullary nail, and the new tail cap and original tail cap were used in groups A and B respectively. The blood loss and operation time during tail cap implantation, fracture healing time, and complications were recorded and compared between 2 groups; the limb function was evaluated by Klemm function evaluation standard. Results The blood loss and operation time during tail cap implantation of group A [(3.5±0.8) mL and (10.57±3.15) s] were significantly less than those of group B [(5.5±1.7) mL and (21.99±6.90) s] (t=–8.281,P=0.010;t=–10.743,P=0.009). All new tail caps were successfully implanted by one-time in group A, and the one-time success rate was 100%; the original tail cap exfoliation occurred in 3 cases of group B, and the one-time success rate was 82.4%. All the patients were followed up 6-16 months (mean, 9.7 months); there was no deep infection, loosening or breakage of internal fixation, and other serious complications. The time of fracture healing was (16.4±3.2) weeks in group A and (15.8±3.5) weeks in group B, showing no significant difference (t=0.514,P=0.611). At last follow-up, according to the Klemm function evaluation standard, the results were excellent in 14 cases and good in 3 cases in group A, and were excellent in 11 cases and good in 6 cases in group B, showing no significant difference between 2 groups (χ2=0.142,P=0.707). Conclusion The new type of femoral intramedullary nail tail cap can simplify operation, shorten operation time, and reduce blood loss, and it has satisfactory effectiveness.
ObjectiveTo report a new type of anatomical locking plate for sternocalvicular joint, and investigate its effectiveness in treatment of sternoclavicular joint fracture and dislocation.MethodsA new type of anatomical locking plate for sternoclavicular joint was developed, which accorded with the anatomical features and biomechanical characteristics of Chinese sternoclavicular joint. By adopting the method of clinical randomized controlled study, 32 patients with the sternoclavicular joint fracture and dislocation who met the selection criteria between June 2008 and May 2015 were randomly divided into groups A and B (n=16), and the patients were treated with new anatomic locking plate and distal radial T locking plate internal fixation, respectively. There was no significant difference between 2 groups in gender, age, injured side, body mass index, cause of injury, type of injury, the time from injury to operation, and preoperative Rockwood grading score (P>0.05). The operation time, intraoperative blood loss, incision length, hospitalization time, and postoperative complications in 2 groups were recorded, and the effectiveness was evaluated by Rockwood grading score.ResultsThe operations of 2 groups completed successfully. The operation time, intraoperative blood loss, and hospitalization time in group A were significantly less than those in group B (P<0.05), but there was no significant difference in the incision length between 2 groups (t=0.672, P=0.507). All the patients were followed up 18-30 months (mean, 24 months). In group A, there were 1 case of sternoclavicular joint pain and 2 cases of wound infection; in group B, there were 1 case of sternoclavicular joint pain, 1 case of internal fixation loosening, and 1 case of sternoclavicular joint re-dislocation; there was no significant difference in complication incidence between 2 groups (P=1.000). The Rockwood grading scores at each time point after operation in 2 groups were significantly higher than those before operation. At 1 month after operation, the Rockwood grading score in group A was significantly higher than that in group B (t=2.270, P=0.031); but there was no significant difference in the Rockwood grading scores between the 2 groups at 6 months and at last follow-up (P>0.05). At last follow-up, according to the Rockwood scoring standard, the results of group A were excellent in 13 cases, good in 2 cases, poor in 1 case, the excellent and good rate was 93.75%; the results of group B were excellent in 11 cases, good in 4 cases, poor in 1 case, and the excellent and good rate was 93.75%; there was no significant difference between 2 groups (Z=–0.748, P=0.455).ConclusionThe new type of anatomic locking plate accords with the Chinese anatomical characteristics. It has the advantages of easy operative procedure, less surgical trauma, shorter operation time, less intraoperative blood loss, shorter hospitalization time, and it can achieve better results in the treatment of sternoclavicular joint fracture and dislocation.
ObjectiveTo investigate the effectiveness of arthroscopic GraftLink technique reconstruction combined with suture anchor fixation in treatment of anterior cruciate ligament (ACL) rupture and medial collateral ligament (MCL) grade Ⅲ injury.MethodsBetween June 2015 and February 2018, 28 patients with ACL rupture and MCL grade Ⅲ injury were treated. Arthroscopic GraftLink technique was used to reconstruct ACL with autologous peroneus longus tendon (PLT), and suture anchor fixation was used to repair MCL. There were 22 males and 6 females, aged 21-47 years, with an average age of 30.4 years. The cause of injury included traffic accident in 18 cases, falling from height in 7 cases, and sports injury in 3 cases. The time from injury to admission was 1-2 weeks, with an average of 1.3 weeks. The preoperative Lysholm score of knee joint was 46.8±3.0 and the International Knee Documentation Commission (IKDC) score was 49.2±2.7. The American Orthopaedic Foot and Ankle Society (AOFAS) score of ankle joint was 98.29±0.72. Both Lachman test and valgus stress test were positive. There were 8 cases of meniscus injury and 2 cases of cartilage injury.ResultsThe operation time ranged from 55 to 90 minutes, with an average of 72.5 minutes. All incisions healed by first intention after operation, and no complications related to operation occurred. All patients were followed up 6-38 months, with an average of 20.7 months. At 3 months after operation, the range of motion of the knee joint was 116- 132°, with an average of 122°. Lachman test showed that the anterior translation more than 5 mm in 2 cases, and the others were negative; while the valgus stress test showed that all patients were positive. At 6 months after operation, the Lysholm score and IKDC score of knee joint were 90.2±1.8 and 93.5±2.3, respectively, which were significantly higher than preoperative scores (t=31.60, P=0.00; t=29.91, P=0.01); AOFAS score of ankle joint was 97.86±0.68, with no significant difference compared with preoperative score (t=2.89, P=0.08). KT-1000 test showed that the difference of anterior relaxation between bilateral knee joints was less than 2 mm in 25 cases and 3 to 5 mm in 3 cases.ConclusionThe method of ACL reconstruction via arthroscopic GraftLink technique with PLT and MCL repair via suture anchor fixation has the advantages of less knee injury and faster recovery, and there is no significant impact on ankle function after tendon removal.
To study how to repair the cartilage defect according to the principles of tissue engineering with acellular cartilage matrix as scaffold material. Methods The ear cartilage was obtained from a New Zealand white rabbit(weighing 2.4 kg )and then treated by a modified Courtman’s four-step method to produce the acellular cartilage matrix. Eighteen New Zealand white rabbits (aged 6 months, weighing 2.4-2.6 kg) with no sex l imit were divided into three groups. Forevery rabbit, two pieces of ear cartilage measured 1 cm × 1 cm were excised in each ear. Defects were repaired as follows: group A with the combined graft of acellular cartilage matrix and perichondium, group B with acellular cartilage matrix and group C with perichondium. Three animals in each group were killed 4 and 12 weeks postoperatively, respectively. Tissue samples obtained were analyzed with gross observation, hematoxyl in-eosin stain, Safranine O-alcian blue stain and type II collagen messenger RNA in situ hybridization respectively. Results In gross observation, the repaired sites in groups A and B were not change meaningfully in their shape 4 weeks postoperatively; but they felt a bit of thicker and harder 12 weeks postoperatively. In group C two repaired sites formed scabs at 2 weeks and perforated at 5 weeks. In histological observation, there was a sl ight inflammatory reaction surrounding the acellular cartilage matrix 4 weeks after it was implanted in groups A and B. The inflammatory cells were mainly lymphocytes. The perichondrium graft in group C was collapsed in the defects in HE stain. The defect sites were negative for Safranine O-alcian blue stain and type II collagen mRNA in situ hybridization in all groups. At 12 weeks cells were found in the acellular matrix which arranged in irregular manner in group A in HE stain and was positive for Safranine O-alcian blue stain and type II collagen mRNA in site hybridization. In groups B and C, no new cell was found in HE stain and the repaired sites were negative for Safranine O-alcian blue stain and type II collagen mRNA in situ hybridization. Conclusion Acellular