Clinical practice is a key step that students take to become doctors.This paper does research in clinical teaching methods for ophthalmology through analyzing current problem of clinical practice in ophthalmology.In the clinical teaching,we should strength the building up of clinical teachers,stimulate students' interest and activity,take PBL(problem-based learning) into teaching method,make use of the principle of optimization medical care and the evidence-based medicine in clinical practice teaching,strength medical students' legal consciousness and cultivate capability of building up cooperative doctor-patient relationship,and improve quality of clinical teaching.

objective To investigate the ability of insulin sensitivity index HOMA2-%S and secretion function index HOMA2-%B calculated by HOMA2,the new homeostasis model assessment,in clinical application. Methods Eighty female volunteers with polycystic ovary syndrome in Chongqing area [50 subjects with normal glucose tolerance(NGT group)and 30 subjects with impaired glucose regulation(IGR group)]were involved in this study.Thev underwent a 75 g oral glucose tolerance test(OGTF)and the Botnia clamp test. From the data of faming blood samples in OGTF,insulin sensitivity index HOMAI-ISI,secretion function index HOMAl-β and disposal index DI-HOMA1 were calculated by the old homeostasis model assessment(HOMA I),meanwhile insulin sensitivity index HOMA2-%S,secretion function index HOMA2-%B and disposal index(DI-HOMA2) were caleulated by the new homeostasis model assessment (HOMA2).Correlation coefficients between insulin sensitivity index and GIR (the glucose infusion rate at steady state of Botnia clamp test),and between insulin secretion function index and AIR(the acute insulin response in Botnia clamp test),were studied.Results The Pearson's linear correlation coefficient between HOMA2-%S and GIR(r=0.503),HOMA1-ISI and HOMA2-%S (r= 0.990).HOMA2-%B and AIR(r=0.382),HOMA1-B and HOMA2-%B(r=0.976) were all statistically significant(a11 P<0.01).The glucose disposal indexes calculated from the HOMA2 and HOMA1 of 1GR group were significantly lower than those from the NGT group(t=2.825,P<0.Ol;t=2.222,P<0.05). Conclusion The HOMA2 is a better model in evaluating the insulin sensitivity and secretion function and is recommended to be widely used in clinical evaluation.

Objective To investigate the correlation between the psychological capital and humanistic practice ability in ICU nurses. Methods In this convenience study, a total of 168 nurses from ICU were enrolled. The self-designed basic information questionnaire, psychological capital questionnaire and nurse humanistic practice ability scale were used in the study. Results The total score on psychological capital and the score on the humanistic practice ability were (4.23 ± 0.41), was (3.68 ± 0.65). The psychological capital was positively correlated with humanistic practice ability in ICU nurses (P<0.01, r=0.498). Conclusions The psychological capital and humanistic practice ability of the nurses in ICU are both in the medium level. Nursing managers should take measures to improve the psychological capital of ICU nurses and create a good cultural practice environment to enhance the humanistic practice ability.

Objective To observe the clilnical effect of treatment of chill by butorphanol after epidural anesthesthia. Methods One hundred patients under going epidural anesthesia , divided into two groups randomly, 50 in butorphanol group(B)were injected intravenously through upper limbs with 0. 04% butorphanol (diluted with normal saline)20 μg/kg; 50 in pethidine group(P) were injected intravenously through upper limbs with 1% pethidine ( diluted with normal saline )0. 75 mg/kg. The speed of the two injection was30 ml/min, after five minutes the patients who were still chilling were injected with midazolam 0. 05 mg/kg. Observe the effect and complications after one minute, three minutes and five minutes. Results After one minute and five minutes the effect of treating chill was no statistically difference ( P ＞ 0. 05 ).However, after three minutes the effect of the butorphanol group was obviously superior to the pethidine group ( P ＜0. 05) ,And the complications of butorphanol group was also less than pethidine group ( P ＜0. 01) . Conclusion Butorphanol display good effect on treating the chill after epidural anesthesia.

Sixty-six volunteers,including 24 subjects with normal glucose tolerance(NGT),18 patients with impaired glucose regulation (IGR),and 24 patients with type 2 diabetes mellitus ( T2DM ),underwent a test of continuous glucose monitoring.The data of continuous glucose monitoring were embedded into two-dimension Euclid space by Takens' embedding theory.Glycemic phase diagram was drawn by MATLAB.The area and center distance of glycemic phase diagram were calculated by computer.The distinction of glycemic variability and average glycemic level among different glucose regulation populations were analyzed.The results showed that there existed significant differences in body mass index,systolic blood pressure,diastolic blood pressure,low density lipoprotein-cholesterol,high density lipoprotein-cholesterol,triglyceride,total cholesterol,creatinine,and alanine aminotransferase among three groups( all P＜0.05 ).The levels of HbAIC,fasting plasma glucose( FPG ),postprandial 2 h plasma glucse (2hPG),area and center distance of glycemic phase diagram in T2DM group were higher than those in NGT and IGR groups( P＜0.01 ),and the levels of FPG,2hPG,area and center distance of glycemic phase diagram in IGR group were higher than those in NGT group( P＜0.01 ).The levels of FPG and 2hPG were correlated with area and center distance of glycemic phase diagram ( all P＜0.01 ).These results suggest that measuring the area and center distance of glycemic phase diagram is a good method to assess glycemic variability and average glycemic level during continuous glucose monitoring.

Objective To evaluate the efficacy and safety of cardiac shock wave therapy(CSWT) in coronary heart disease in elderly patients.Methods Eleven patients with refractory angina pectoris were enrolled.The ischemic area was determined by the 99mTechnetium-MIBI single-photon emission computed tomography (SPECT) and coronary angiography,and treated with CSWT.The CSWT were performed during treatment of 3 months,with 9 times totally.The clinical evaluations included the clinical symptoms,Canadian Cardiovascular Society (CCS) class scores,New York Heart Association class (NYHA),Seattle angina questionnaire (SAQ),6-min walking distance and the use of dosage of nitroglycerin,left ventricular end diastolic diameter (LVEDD) and left ventricular ejection fraction (LVEF).The amelioration of ischemic myocardial was analyzed by SPECT.The safety of CSWT was evaluated by changes in clinical symptoms,ECG monitoring,blood pressure and oxygen saturation,blood levels of creatine kinase,creatine kinase myocardial band isoenzymes (CK-MB),troponin T (TnT),alanine transfer enzyme (ALT),creatinine (CR),brain natriuretic peptide and high sensitive C reactive protein (hs CRP).Results The CCS class scores,NYHA,6-min walking distance and the dosage of nitroglycerin were significantly improved at 4 and 12 months after treatment as compared with pretreatment.The steady state of angina pectoris and the frequency score in SAQ were significantly improved.The 21 cardio-vessel segments were treated,and the improvement rate of resting myocardial perfusion was 46.2％ (6/13),the effective rate was 38.5％ (5/13),and the obvious effective rate was 7.8％ (1/13) after treatment.The improvement rate of loaded myocardial perfusion was 57.1％ (12/21),the effective rate was 47.6％ (10/21),and the obvious effective rate after treatment was 9.5％ (2/21).There were no significant changes in levels of CK,CK-MB,TNT,ALT,Cr,BNP and hs CRP,heart rate,systolic blood pressure,diastolic blood pressure and oxygen saturation after treatment as compared with pretreatment.Conclusions The CSWT is a safe and effective treatment for coronary heart disease in the elderly,and the curative effect could maintain at least one year.

Objective:To investigate the clinical effect of the transverse rectus abdominismuscle (TRAM) on reconstruction of the breast.Methods:The clinical data of 23 patients receiving TRAM breast reconstruction in our department from Jan. 2018 to Dec. 2019 were retrospectively analyzed.Results:The operation time of 23 patients ranged from 240 to 360 mins, andthe average time was about 300 mins. Intraoperative bleeding was about 120 to 200 ml, with an average of 170 ml. All the flaps survived successfully, but 2 cases were complicated with local fat necrosis. The postoperative period was between 6 and 12 months. No local tumor recurrence or metastasis was found inall patients during postoperative follow-up, and the breast shape was maintained in good condition.Conclusion:TRAM can make up for the regret of breast loss caused by breast cancer in female patients. It can bring confidence in life and work to female patients, and the technology is safe and reliable, which is worthy of promotion.

This study evaluated the effects of electric pulses combined with antitumor drugs on S180 tumor cells. It was found that the growth of S180 sarcoma was inhibited with a maximum inhibition ratio of 95.5% after the use of electric pulses in combination with the injection of bleomycin (BLM), and the blood vessels of tumor were obviously fewer than those of the untreated tumor in vivo. The mitochondria of S180 tumor cells were swollen after the use of electric pulses in combination with adriamycin. The results showed that electrochemotherapy has evident inhibitory effect on the growth of S180 sarcoma and the mechanism may involve the suppression of tumor angiogenesis and changes in the ultrastructures of tumor cells.
Animals ; Antimetabolites, Antineoplastic ; administration & dosage ; Bleomycin ; administration & dosage ; Combined Modality Therapy ; Electric Stimulation Therapy ; methods ; Electrochemistry ; Mice ; Neovascularization, Pathologic ; prevention & control ; Sarcoma 180 ; blood supply ; therapy

Objective:To investigate the risk factors and treatment of postpancreatico-duodenectomy hemorrhage(PPH).Methods:The retrospective case-control study was conducted. The clinical data of 712 patients who underwent pancreaticoduodenectomy in Peking University First Hospital from January 2012 to November 2021 were collected. There were 392 males and 320 females, aged from 16 to 89 years, with a median age of 62 years. Observation indicators: (1) diagnosis of PPH; (2) analysis of influencing factors for PPH; (3) treatment of PPH. Measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers or percentages. Univariate analysis was performed using the chi-square test or Fisher exact probability, and multivariate analysis was performed using the Logistic regression model. Results:(1) Diagnosis of PPH. Of the 712 patients, 72 cases had PPH and 7 cases died. The incidence of PPH was 10.11%(72/712), and PPH related mortality was 9.72%(7/72). There were 7 cases of early PPH and 65 cases of delayed PPH. There were 23 cases of mild PPH and 49 cases of severe PPH. (2) Analysis of influencing factors for PPH. Results of univariate analysis showed that preoperative serum total bilirubin (TBil), extended surgery, postoperative pancreatic fistula, postoperative biliary fistula, postoperative abdominal infection were related factors for delayed PPH ( χ2=13.17, 3.93, 87.89, 22.77, 36.13, P<0.05). Results of multivariate analysis showed that preoperative serum TBil ≥171 μmol/L, postoperative grade B or C pancreatic fistula, postoperative biliary fistula, postoperative abdominal infection were independent risk factors for delayed PPH ( odds ratio=1.91, 8.10, 2.11, 2.42, 95% confidence interval as 1.09-3.33, 4.62-14.20, 1.06-4.23,1.35-4.31, P<0.05). (3) Treatment of PPH. ① Treatment of early PPH. Of the 7 cases with early PPH, 4 cases had mild PPH and 3 cases had severe PPH. The 4 cases with mild PPH were stanched by conservative treatment. The bleeding location of the 3 cases with severe PPH were the posterior wall of pancreatoenteric anastomosis, the pancreatic uncinate stump and the unintentional puncture of the jejunostomy tube of the left upper abdominal wall vessels and the 3 cases were stanched by reoperation. All the 7 cases were discharged without other complications. ② Treatment of delayed PPH. Of the 65 cases with delayed PPH, 19 cases had mild PPH and 46 cases had severe PPH. Of the 19 cases with mild PPH, 18 cases were stanched by conservative treatment including 2 cases died of pancreatic fistula and abdominal infection, 1 case were stanched by endoscope therapy. Of the 46 cases with severe PPH, 18 cases with stable vital signs and slow bleeding were stanched by conservative treatment including 1 case died of infectious toxic shock and the other 28 cases underwent invasive treatment, including 2 cases undergoing gastroscopy, 20 cases undergoing interventional treatment and 6 cases under-going reoperation as the initial treatment. Of the 22 cases taking endoscope or interventional treatment as the initial treatment, 5 cases underwent rebleeding and 2 cases died, with the reblee-ding rate and mortality as 22.7%(5/22) and 9.1%(2/22), respectively. Of the 6 cases taking reopera-tion as the initial treatment, 3 cases underwent rebleeding and 2 cases died, with the rebleeding rate and mortality as 3/6 and 2/6, respectively. There was no significant difference in the rebleeding rate and mortality in patients taking endoscope or interventional treatment as the initial treatment and patients taking reoperation as the initial treatment ( P>0.05). Of the 28 cases undergoing invasive treatment, 10 cases underwent secondary surgical treatment, including 6 cases taking reoperation and 4 cases taking interventional treatment as the initial treatment for hemorrhage, and 4 cases died with the mortality as 4/10, and the other 18 cases who did not receive secondary surgical treatment survived. There was a significant difference in the mortality between patients with or without secondary surgical treatment ( P<0.05). Conclusions:Preoperative serum TBil ≥171 μmol/L, post-operative grade B or C pancreatic fistula, postoperative biliary fistula, postoperative abdominal infection are independent risk factors for delayed PPH. Surgical treatment should be performed decisively for early severe PPH. For delayed severe PPH patients who undergoing conservative treat-ment without effect, endoscope therapy and interventional treatment should be the first choice, and surgical treatment should be performed if those above procedures not working.

Pancreatic cancer is the fourth leading cause of cancer-related death in the world.Most patients are diagnosed as locally advanced or metastatic disease at initial visit,losing the opportunity of surgery.Conversion therapy aims to give unresectable tumors the opportunity to receive radical surgery through comprehensive treatment.For unresectable pancreatic cancer,chemotherapy based on AG(abraxane+gemcitabine)or FOLFIRINOX(5-fluorouracil+leucovorin+irinotecan+oxaliplatin),radiotherapy combined with chemotherapy as well as other regimens have shown conversion potential.Targeted therapy and immunotherapy have also become new frontiers of conversion therapy for pancreatic cancer.Focusing on new drugs and new regimens,this review has summarized the latest research progress of conversion therapy for pancreatic cancer.