Objective To evaluate the effect of esophagofundostomy combined with devascularization for the treatment of portal hypertension.Methods From February 2009 to August 2013,30 cases (research group) underwent esophagofundostomy combined with devascularization,while 56 cases (control group) were treated by devascularization only.Splenectomy was performed in all patients.Results There was no perioperative mortality in either group.The difference of postoperative serum bilirubin,albumin and blood platelet was not statistically significant (t =1.13、0.23、1.53,all P ＞ 0.05) ; The incidence of hepatic encephalopathy in research group and control group was 3％ and 11％,respectively,three years mortality was 14％ and 24％,respectively (x2 =0.61、1.22,all P ＞0.05).The rebleeding rate in research group was lower than control group,there was a significant difference (x2 =4.61,P ＜ 0.05).Research group was superior to control group in improving esophageal-gastric varices and there was a significant difference (P ＜ 0.05).Conclusions Compared with devascularization,esophagofundostomy combined with devascularization is more effective in reducing esophageal-gastric varices and prevention of rebleeding.

In recent years,liver transplantation donor shortage as one of world medical problems is paid more attention by domestic and overseas scholars.In view of that,heterotopic auxiliary liver transplantation emerges which transplants the whole or some parts of a donor liver outside the original liver position on the condition that some parts or the whole of the original liver were retained.As for the liver transplantation with poor conditions on portal vein,reconstruction of portal vein has become an aporia.Based on this,some scholars put forward the theory——arterialization of portal vein(PVA),namely a method to increase arterial blood supply or replace portal vein blood perfusion of liver by establishing some pathes among artery and portal vein or its branches.The research background and current situation of heterotopic auxiliary liver transplantation with portal vein arterialization,the transplanting position of donor liver,vessel reconstruction,dynamics mechanism after reconstruction and liver regene-ration are summarized in this review.

Basic surgical skills tralning which belongs to the basic course of surgery, is clini-cal basis for the medical students. The teaching practice of basic surgical skills tralning was explored by the Affiliated Hospital of Inner Mongolia Medical University, the theoretical teaching was combined with skills tralning practice, three kinds of means which contalned the model, animal tissues and or-gans in vitro and animal experiment were used to carry out systemic and standardized tralning. Finally, the basic surgical skills of postgraduate in surgery were improved, and the expected alm of teaching was achieved.

Radiological evaluation is a key step for donor's preoperative evaluation in living donor liver transplantation(LDLT).There are many powerful functions in multi-slice computed tomography (MSCT)which can suit all-in-one radiological evaluation before donor's operation.By referring to the articles from home and abroad in recent years,from viewpoint of surgeon,this artical reviews the application status of multi-slice CT for preoperative assessment in LDLT,which can help to provide theory support for choice of radiological examination in LDLT donor.

Objective To discuss the diagnostic value of peritoneal effusion detection by emergency-ultrasound in patients with closed abdominal injury. Method From August 2006 to June 2009,212 patients with closed abdominal injury were studied to evaluate peritoneal effusion detection by emergency ultrasound. Results of 212 patients,peritoneal effusion frequency rate was 78.8%( 167/212), meanwhile,abdominal paracentesis confirmation ratio was only 46.2%(98/212). In the follow-up, 13 patients with injuried hollow viscera and 1 patient with rupture of kidney showed peritoneal effusion. The volume of abdominal fluid was increasing in 17 patients,which needed to be managed by surgery. The accuracy rates were respectively 78.3%( 112/143) and 36.1%(13/36) in the solid organs and the hollow organs. Conclusion During the course of diagnosis and treatment in closed abdominal injury,peritoneal effusion monitoring by ultrasound should be used routinely, which can help to decrease the rate of misdiagnosis and avoid delayed treatment.

Objective:To explore the application of formative assessment in clinical skills simulated training course.Method:s The clinical skills simulated training course for excellent doctors in our school was selected as the research focus, students of Grade 2014 adopted traditional summative evaluation (control group), and the multi-station examination was used as evaluation method. Students of Grade 2015 adopted the formative evaluation on the basis of summative evaluation (experimental group), a diversified evaluation system was established, including inter-group evaluation by students, random evaluation by teachers, feedback of operation videos of different stages and real-time feedback of students' opinions after class. Questionnaires were conducted among students and teachers at the end of the course.Result:s The scores of the experimental group were higher than those of the control group, with differences being statistically significant ( P<0.05). Questionnaires showed that the proportion of "good" selected by teachers and students in the feedback of formative assessment was markedly higher than that of "just so-so" and "bad", indicating that formative assessment is conducive to increasing students' initiative for self-studying, improving students' learning effect, comprehensively and accurately evaluating students' clinical operational skills, as well as improving the teaching level of clinical practice skills. Conclusion:The diversified evaluation system, which combines formative evaluation with summative evaluation, has achieved good teaching results in clinical skills simulated training course and it is worth to be widely applied.

By formulating the standard operating procedures for clinical skills, and standardizing the operation steps, the Affiliated Hospital of Inner Mongolia Medical University further refines and quantifies the scoring criteria, and this is also applied in the teaching practice of medical students' clinical skills. The two operations of clean wound dressing and diagnostic peritoneal puncture are taken as an example for description. The assessment results shows that the level of medical students' clinical skills has improved significantly. Questionnaire survey also shows that teachers' training efficiency and students' learning effi-ciency have been improved , indicating that clinical skills standard operation procedures have achieved good teaching results in clinical skills teaching practice.

Objective To investigate the teaching effect of standardized patient teaching model in the practice teaching of emergency medicine. Methods A total of 50 standardized training residents were randomly divided into experimental group and control group during the process of medical history collection and special physical examination. The residents in the experimental group were taught with the standardized patient teaching model, and those in the control group were taught with the model of traditional theory teaching followed by clinical practice. Assessment was performed after the course was completed. Results Compared with the control group, the experimental group had significantly higher scores of medical history collection and physical examination (P<0.05). The experimental group also had significantly higher scores of communication and humanistic concern than the control group (P<0.05). The questionnaire survey showed that the medical students preferred the standardized patient teaching model, and they thought such model could improve doctor-patient communication ability and clinical practice ( P<0 . 05 ) . Conclusion The standardized patient teaching model can significantly improve the effect of practice teaching of emergency medicine and plays an important role in improving the clinical skills of medical students in emergency.

Objective:To explore the application effect of modified direct observation of procedural skills (DOPS) as a formative assessment tool in clinical skills training of professional graduate students.Methods:A total of 130 professional graduate students of Batch 2019 were selected as the experimental group, and 127 graduate students of Batch 2018 were selected as the control group. Two groups of students received clinical general skills training after enrollment, the control group adopted the traditional skills teaching method, and the experimental group added DOPS as formative assessment on the basis of traditional teaching. The teaching effect of DOPS was evaluated by means of scores analysis and student self-assessment. SPSS 23.0 was used for t-test. Results:The score of the experimental group (84.35±3.41) was higher than that of the control group (77.58±2.68), which showed a statistically significant difference ( t=2.63, P<0.05). The scores of "skill operation ability" and "communication ability" were the lowest single indexes in the assessment of DOPS. The results of self-assessment showed that the scores of autonomous learning ability, clinical thinking ability, clinical practice ability and professional accomplishment of students in the experimental group were all higher than those in the control group ( P<0.05). Conclusion:Modified DOPS is helpful to improve clinical core ability, which is worth promoting for application.

Objective:To explore an ideal method for establishing a mouse model of chronic atrophic gastritis (CAG).Methods:CAG mouse models were established with five different modeling methods ( N-methyl- N′-nitro- N-nitrosoguanide (MNNG), sodium salicylate, sodium deoxycholate, Helicobacter pylori infection, and combinations of them) in BALB/c and C57 mice. The effect of each modeling method was evaluated by histological observation of gastric mucosa, plasma biochemical parameters, inflammatory response score, and the expression of anti-inflammatory factors. Results:The results of histological observation of gastric mucosa showed that all of the 5 methods could successfully establish CAG mouse models. In BALB/c mice, compared with the healthy control group, significant features of CAG accompanied with intestinal metaplasia was found in the model group established by combination of MNNG-free drinking, 2% sodium salicylate and 20 mmol sodium deoxycholate. From the results of serological detection, compared with the normal control group, the mRNA expression levels of related anti-inflammatory factors interleukin-2, interleukin-10, interleukin-13 and growth differentiation factor-15 of each model group decreased, which indicated that the mice of each CAG model group had different degrees of inflammation. The results of plasma biochemical parameters indicated that plasma gastrin of each group decreased and the ratio of pepsinogen Ⅰ and pepsinogen Ⅱ significantly dropped. The above results demonstrated that in BLAB/c mice, MNNG-free drinking, 2% sodium salicylate and 20 mmol sodium deoxycholate was better than other four modeling methods. For C57 mice, it was also found that simple chemical drug mutagenesis and Helicobacter pylori replication method both could successfully establish CAG models. No matter from pathological observation, relative expression of anti-inflammatory factors and analysis of plasma biochemical parameters, the effects of combination of the two methods was better. Conclusion:The CAG mouse model established by MNNG-free drinking, 2% sodium salicylate and 20 mmol sodium deoxycholate can provide a certain reference for the establishment and application of mouse model in CAG experiments in the future for pharmacological research.