ObjectiveTo investigate whether the eight- year program students retain the skills from the endoscopy simulator gastroscopy training.Methods4 trainees accepted virtual reality simulator gastroscopy training and performed a standardized VR gastroscopy scenario at the end of training,and after a median 12 months without practice ( retention ).The intensified training was done by trainees based on the differences between the training end and the retention for a median 12 months and the number of intensified training times was found.ResultsThe significant differences existed in the overinsufflation and opeirational force and time.The score at the training end was better than after retention.Through the average 5.5 times intensified trainings the original levels could be reached.ConclusionThrough Endoscopy Simulator the key skills could be retained well and through a litde training the original levels could also be reached.

Objective To explore the therapeutic effects of small bone flap craniotomy and traditional craniotomy in patients with hypertensive cerebral hemorrhage. Methods Fifty-six patients with hypertensive cerebral hemorrhage, admitted to our hospital from June 2008 to June 2010, were randomly divided into experimental group (treated with small bone flap craniotomy, n=28) and control group (treated with traditional craniotomy, n=28). The operative time, hospital stays, case fatality rate,re-bleeding and complications and Glasgow outcome scale scores after 6 months treatment were analyzed and compared between the 2 groups. Results Operation time and hospital stays of the patients in the experimental group were significantly shorter than those in the control group (P＜0.05). The case fatality rate was 14.3％ and 25.0％ in the experimental group and control group, respectively, without significant differences (P＜0.05); the incidence of complications was 25.0 ％ and 46.4 ％ in the 2 groups without significant differences (P＜0.05); the scores of Glasgow outcome scale in the experimental group were superior to those in the control group (P＜0.05); the rate of re-bleeding was 10.7 ％ and 14.3 ％ in the 2groups without significant difference (P＞0.05). Conclusion As compared with traditional craniotomy,small bone flap craniotomy can decrease the rate of case fatality and complications, and improve the prognosis in patients with hypertensive cerebral hemorrhage.

Objective To investigate the Relationship between blood pressure variability rate and extent of critically in ill patients with sepsis. Methods From May 2012 to April 2013 in our hospital, 60 cases of sepsis patients for the study were divided into APACHE-II≥20 points(critical group)and APACHE-II<20 minutes(non-critical group), selected the same period to our hospital for medical examination of 30 cases of healthy subjects (control group). The risk and non-risk reorganization reorganization patients 24 h SBP-CV,24 h DBP-CV,dSBP-CV,dDBP-CV,nSBP-CV, nDBP-CV mutation rate, mutation rate and blood pressure APACHE-II score correlation analysis. Comparison of the three groups of patients with high-density protein cholesterol (HDL-C), low-density protein cholesterol (LDL-C), inter-leukin-6(IL-6),interleukin-18(IL-18)were compared. Results The danger of recombinant APACHE-II score was(29.56±0.79), non dangerous recombinant APACHE-II score was (13.15±0.58). Two groups of SBP mutation rate comparison, with statistically significant difference(P<0.05). Spearman analysis showed that 24 h SBP-CV,dSBP-CV,nSBP-CV,related to the mutation rate and APACHE-IIscore was positively(r=0.762,P=0.003). Critical group,non criti-cal group,control group HDL-C, LDL-C gradually increased, IL-6, IL-18 were lower, with statistically significant difference between the two groups (P<0.05). Conclusion The rate and blood pressure variability in the degree of sep-sis in critically ill patients was positively correlated, the mechanism may be the promotion of IL-6, inflammatory kookiness such as IL-18 secretion,and expand the inflammatory response.

Objective To explore the clinical value of tests of plasma type B natriuretic peptide (BNP) and troponin I (TnI) for elderly patients with sepsis. Methods A total of 108 elderly patients with sepsis who were admitted and treated in our department from January 2011 to January 2014 were selected. They were assigned to three groups according to the disease severity, 64 patients with common sepsis were as group A, 32 patients with severe sepsis were as group B, and 12 patients with septic shock were as group C. After being admitted to our department, mass concentration of plas-ma BNP and TnI for all patients were tested immediately. LVEF value of patients was tested by ultrasonic cardiogram, and APACHE II score was calculated. 28-day survival conditions for patients in group B and group C were followed up, each index between surviving patients and dead patients and connections between scores of BNP, TnI and APACHEIIwere compared. Results TnI and BNP for patients in group A were (0.08±0.01)μg/L and (206.42±76.15) pg/mL re spectively, in group B were (0.53±0.01) μg/L and (386.38±84.96) pg/mL respectively, in group C were (1.94±0.04) μg/L and (958.84±135.23) pg/mL respectively. The differences of mass concentrations of plasma BNP and TnI among the three groups were statistically significant (P<0.05). The more severe the disease conditions, the higher the mass con-centrations of plasma BNP and TnI. TnI and BNP for patients in the survival group were (0.47±0.08) μg/L and (692.59±22.17) pg/mL respectively, APACHEII was scored as (19.5±5.2), and LVEF was (52.1±13.9)%, while in the dead group were (1.23±0.05) μg/L, (986.25±22.65) pg/mL, (23.1±6.1) Scores, (41.5±11.5)%. The scores of BNP, TnI and APACHEII in dead group were significantly higher than those in the surviving group, and LVEF in dead patients was significantly lower than that in the survival group, the differences were statistically significant (P<0.05). Conclusion Mass concentration of plasma BNP and TnI can be used as effective indices for disease evaluation and prognosis for el-derly patients with sepsis.