Objective To evaluate the effects of percutaneous cholecystostomy (PCT) for the treatment of acute cholecystitis (AC) in poor-risk patients.Methods A retrospective clinical analysis was undertaken in poor-risk AC patients receiving PCT or emergency cholecystectomy (CCY) from April 2007 to December 2012.The success rate,complications,hospital stay and mortality,and readmission rate were compared between PCT and CCY groups.Results Of the 51 poor-risk acute cholecystitis patients,25 underwent PCT drainages and 26 received emergency CCY at an average age of 75 and 74 years respectively.The average intensive care unit length of stay was 13 days in PCT group and 5 days in CCY group (t =5.175,P =0.001).The mean hospital length of stay in PCT patients (21.3 days) was longer than that in CCY patients (9.8 days) (t =3.213,P =0.002).However,there was no significant difference in the overall hospital mortality,complications and successful rate between the two groups.No recurrence was observed in 19 out of 25 PCT cases after removing PCT catheter.The remaining six patients were readmitted for recurrent AC.Three of them were conservatively treated,while another 3 patients had PCT drainage anew and one of the three underwent delayed CCY 4 weeks after PCT replacement.The overall successful rate of PCT treatment was 76％.Conclusions Compared with emergency CCY,PCT has similar treatment effects in the successful rate of surgical management,morbidity,and overall hospital mortality although it is associated with longer hospital stays and higher readmission rate,which indicated that PCT is a convenient,safe and effective treatment option for poor-risk AC patients.

Objective To explore the effects of upper limb robot-assisted therapy on motor function and activities of daily living in con-valescent stroke patients. Methods From June to September, 2016, 12 chronic stroke patients at their first-ever stroke were enrolled and ran-domized into experimental group (n=6) and control group (n=6). Both groups received routine rehabilitation. Additional robot-assisted thera-py was provided to the experimental group, and additional repetitive movement training was provided to the control group, 20 minutes a day, five days a week for four weeks. Fugl-Meyer Assessment-Upper Extremities (FMA-UE), modified Ashworth Scale (MAS) and Func-tional Independent Measure (FIM) were used to assess the motor function of the upper limbs and hands, the muscular tension of shoulder and elbow, and activities of daily living (ADL) before and after treatment. Results After treatment, the scores of FMA-UE and FIM were bet-ter in both groups (Z>2.032, P<0.05), and no significant difference was found between two groups (t<0.723, P>0.05), however, the scores were a little bit higher in the experimental group than in the control group. After treatment, for the experimental group, the MAS scores of shoulder abduction/adduction and elbow flexion/extension improved (Z>2.121, P<0.05);for the control group, the MAS scores of shoulder abduction/adduction improved (Z>2.000, P<0.05), but the MAS scores of elbow flexion/extension were not significantly different (Z<1.890,P>0.05). There was no significant difference in the MAS scores of shoulder abduction/adduction and elbow flexion/extension between two group (Z<1.734, P>0.05). The moving trail recorded by the computer, gradually became a regular pattern from the mass, saying the motor control ability became better. Conclusion Upper limb robot-assisted therapy can promote the recovery of the motor function of upper limbs and ADL in convalescent stroke patient, similar to the repetitive movement training.

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This paper systematically discusses the construction of clinical skills information platform, including the goal, function design, module, content analysis of practical skills training and management system. The information platform for clinical skills training has played a significant role in innovating the teaching and management mode of clinical practice skills training, establishing a scientific assessment system, improving the clinical practice skills training system and enriching the teaching contents and means. At the same time, it has also promoted the communication between teachers and students during the clinical practice skills training, improved teachers' information-based teaching ability, and speeded up the construction of high-quality teachers.

Standardized residency training is the only way for medical students to grow into clin-icians. At present, the number of under training residents in China has reached 190000 (excluding special-ized degree graduate students). It is very important to manage each stage of this training well, which is an guarantee for improving the effect of standardized training. The residents who attend the training are com-posed of "unit personnel" and "intra-industry social personnel", and after standardized and homogenized training, the two types of students have officially become the new force in the medical industry after passing the final examination. In order to do a good job in the management of standardized residency training, to achieve fine management at all stages , this paper focuses on the differences between the two types of students, analyzes in detail the characteristics of these two types of students in the recruitment, training and welfare guarantee stages. "Unit personnel" are given the security, supervision and containment of the origi-nal unit, while due to the pressure of job-hunting and the uncertainty of future welfare, "intra-industry so-cial personnel" are equipped with more initiative. Based on advanced management experience in Beijing,Shanghai, Sichuan and Tianjin, this paper aims to summarize the key points in management of the two types of students in training, propose countermeasures to the difficulties in management, innovative management solutions, and provide reference for the optimization management of standardized residency training.

The contents recorded in the rotation registration manual is not only the quantitative indicators for evaluating the quality of residency training, but also the important basis for training assessment and issuance of training certificates. In order to solve the problems of data authenticity, information delay, and repeated entry in the rotation registration manual for residency training, Shanghai East Hospital, Tongji University, launched a project to dock the electronic rotation registration manual with the hospital information system. Through the establishment of the project team, the development of working mechanisms, and the implementation of the project, data analysis was used for process reformation and system optimization, so as to continuously improve management efficiency and medical safety while solving problems and form a set of implementation system with reference significance in practice.

Early accurate detection of inferior myocardial infarction is an important way to reduce the mortality from inferior myocardial infarction. Regrading the existing problems in the detection of inferior myocardial infarction, complex model structures and redundant features, this paper proposed a novel inferior myocardial infarction detection algorithm. Firstly, based on the clinic pathological information, the peak and area features of QRS and ST-T wavebands as well as the slope feature of ST waveband were extracted from electrocardiogram (ECG) signals leads Ⅱ, Ⅲ and aVF. In addition, according to individual features and the dispersion between them, we applied genetic algorithm to make judgement and then input the feature with larger degree into support vector machine (SVM) to realize the accurate detection of inferior myocardial infarction. The proposed method in this paper was verified by Physikalisch-Technische Bundesanstalt (PTB) diagnostic electrocardio signal database and the accuracy rate was up to 98.33%. Conforming to the clinical diagnosis and the characteristics of specific changes in inferior myocardial infarction ECG signal, the proposed method can effectively make precise detection of inferior myocardial infarction by morphological features, and therefore is suitable to be applied in portable devices development for clinical promotion.
Algorithms ; Databases, Factual ; Electrocardiography ; Humans ; Inferior Wall Myocardial Infarction ; Support Vector Machine