OBJECTIVETo investigate the clinical efficacy and safety of modified stapled transanal rectal resection (STARR) combined with perioperative pelvic floor biofeedback therapy (POPFBFT) in treating obstructed defecation syndrome (ODS).

METHODSThirty female ODS patients underwent modified STARR (resection and suture was performed in rectocele with one staple) combined with POPFBFT in Department of Colorectal and Anal Surgery, The First Hospital of Jilin university from October 2013 to March 2015. Before the modified STARR, patients received a course of POPFBFT (20 min/time, 2 times/d, 10 times as a course), and another 2 courses were carried out in clinic after discharge. Efficacy evaluation included general conditions of patients, morbidity of postoperative complication, overall subjective satisfaction (excellent: without any symptoms; good: 1 to 2 times of laxatives per month and without the need of any other auxiliary defecation; fairly good: more than 3 times of laxatives per month ; poor: with no improvement; excellent, good, fairly good are defined as effective), Longo ODS score (range 0 to 40 points, the higher the score, the more severe the symptoms), gastrointestinal quality of life index(GIQLI)(range 0 to 144 points, the lower the score, the more severe the symptoms), anorectal manometry and defecography examination. The follow-up lasted 12 months after operation (ended at April 2016).

RESULTSAverage age of 30 patients was 57(46 to 72) years and Longo ODS score of every patient was ≥9 before operation. The modified STARR was completed successfully in all the 30 patients with average operation time of 25 (18 to 34) min and average hospital stay of 6(4 to 9) d. Postoperative complications included pain(20%, 6/30), urinary retention (16.7%, 5/30), anorectal heaviness (6.7%, 2/30), and fecal urgency(26.7%, 8/30). Anaorectal heaviness and fecal urgency disappeared within 3 months. No severe complications, such as postoperative bleeding, infection, rectovaginal fistula, anastomotic dehiscence and anal incontinence were observed. The effective rate of overall subjective satisfaction was 93.3%(28/30) during the follow-up of 12 months. There was no significant difference in Longo ODS score between pre- POPFBFT and pre-operation (pre- POPFBFT: 32.95±3.22, pre-operation: 32.85±3.62, t=1.472, P=0.163). Compared with pre-POPFBFT, Longo ODS score at 1 week after operation decreased (t=4.306, P=0.000), moreover, score at 1 month after operation was lower than that at 1 week (13.05±7.49 vs. 15.00±7.17, t=7.322, P=0.000), while no significant differences were found among 1, 3, 6, 12 months after operation (F=2.111, P=0.107). Likewise, there was no significant difference in GIQLI score between pre-POPFBFT and pre-operation (pre-POPFBFT: 79.39±17.14, pre-operation: 76.65±17.56, t=1.735, P=0.096). Compared with the pre-POPFBFT, GIQLI score at 1 week after operation increased (t=4.714, P=0.000), moreover, GIQLI score at 1 month after operation was higher than that at 1 week (102.26±19.24 vs 91.31±21.35, t=5.628, P=0.000), while no significant differences were found among 1, 3, 6, 12 months after operation(F=1.211, P=0.313). In comparison with pre- POPFBFT, parameters of defecography examination at 12 months after operation showed obvious improvement: the rectocele decreased from (34.1±0.4) mm to (3.1±0.3) mm (t=6.847, P=0.000), anorectal angle during defecation increased from (123.8±6.7)degree to (134.7±8.5)degree, enlargement of anorectal angle during defecation increased from (29.1±3.5)degree to (37.1±5.3)degree, while no significant differences in descend of perineum, anorectal angles at rest as well as parameters of anorectal manometry were found (all P>0.05).

CONCLUSIONModified STARR combined with POPFBFT is safe and effective for ODS patients.

Aged ; Anal Canal ; surgery ; Biofeedback, Psychology ; physiology ; Constipation ; rehabilitation ; surgery ; Defecation ; Defecography ; Digestive System Surgical Procedures ; methods ; rehabilitation ; Female ; Humans ; Length of Stay ; Middle Aged ; Operative Time ; Pain, Postoperative ; etiology ; Pelvic Floor ; physiology ; Postoperative Complications ; Quality of Life ; Rectocele ; Surgical Stapling ; Suture Techniques ; Treatment Outcome ; Urinary Retention ; etiology

Objective:To explore the effectiveness of situational simulation teaching in the clinical clerkship education of endodontics.Methods:Stomatology students from Batch 2015 of Xinjiang Medical University were selected and randomly divided into two groups, experimental group ( n=28), taking situational simulation teaching and control group ( n=27), taking traditional teaching. The SEGUE scale was used to evaluate the effectiveness of the teaching methods. SPSS 21.0 software was used for independent samples t-test. Results:The theoretical results of the experimental group [(91.31±3.37) points] were higher than those of the control group [(87.93±4.28) points], with significant differences ( P < 0.05). According to the scores of SEGUE scale, the communication ability scores before and after teaching in the experimental group were (9.07±3.37) points and (21.86±2.47) points, respectively, and the difference was statistically significant ( P < 0.05); the control group were (8.85±3.43) points and (15.67±2.87) points, respectively; the teaching effect of the experimental group was significantly better than that of the control group, and the difference was statistically significant ( P < 0.05). Conclusion:The application of situational simulation teaching can effectively improve doctor-patient communication skills of medical students, thereby promoting the combination of theory and practice, and has a positive impact on improving students' clinical practice communication skills in the future.

Objective To assess the effects of low-dose esketamine on the median effective dose(ED50)of ciprofol for anesthesia induction in painless gastrointestinal endoscopy.Methods Fifty-nine pa-tients underwent elective painless gastrointestinal endoscopy,26 males and 33 females,aged 18-64 years,BMI 18-30 kg/m2,ASA physical status Ⅰ or Ⅱ,were divided into two groups by random number table method:esketamine combined with ciprofol group(group EC,n = 29)and ciprofol group(group C,n = 30).Group EC received intravenous injection of esketamine 0.3 mg/kg and group C received the same amount of normal saline 2 minutes before administration of ciprofol.The initial anesthesia induction dose of ciprofol was 0.4 mg/kg.If a positive reaction occurs during the examination,the next patient will receive an increase dose of propofol 0.04 mg/kg,otherwise will decrease by propofol 0.04 mg/kg.The positive reaction was defined that the patient's BIS can not be decreased to 60 2 minutes after anesthesia induction,or the cough or body movement reaction occur at level 2 or above when entering the mirror.The dosage of ciprofol,recovery time,discharge time,the occurrence of intraoperative and postoperative adverse reactions were recorded.The ED50,95%effective dose(ED95)and 95%confidence interval(CI)of the two groups were calculated by Probit probability regression analysis.Results Compared with group C,the dosage of ciprofol,the incidence of hypotension and frequency of administration of vasoactive drugs during the exami-nation process in group EC were significantly reduced(P＜0.05).The ED50 of ciprofol for anesthesia in-duction in painless gastrointestinal endoscopy in group EC was 0.21 mg/kg(95%CI 0.12-0.25 mg/kg)and the ED95 was 0.32 mg/kg(95%CI 0.26-0.39 mg/kg).The ED50 of ciprofol for anesthesia induction in painless gastrointestinal endoscopy in group C was 0.37 mg/kg(95%CI 0.32-0.40 mg/kg)and the ED95 was 0.48 mg/kg(95%CI 0.43-0.54 mg/kg).The ED50 and ED95 of ciprofol for anesthesia induction in painless gastrointestinal endoscopy in group EC was significantly lower than that in group C(P＜0.05).There was no significant difference in other frequency of adverse events between the two groups.Conclusion Esketamine 0.3 mg/kg can reduce the ED50 of ciprofol in painless gastrointestinal endoscopy and reduce the dosage of ciprofol during the examination process,which is safe for painless gastrointestinal endoscopy with stable intraoperative circulation.

Objective:To assess the efficacy of a novel spatial-temporal polyp detection system in colonoscopy.Methods:This research was a retrospective comparative study. Eight hundred and thirty-three participants who underwent computer-aided detection (CADe) colonoscopy at the First Medical Center of Chinese PLA General Hospital between March and June 2023 were enrolled to the experimental group, while 770 individuals who received conventional colonoscopy from March to June 2022, in the identical operation room were to the control group. The primary outcome was the adenoma detection rate (ADR), and the secondary outcomes were the polyp detection rate (PDR), adenomas per colonoscopy (APC), and polyps per colonoscopy (PPC).Results:The ADR [29.3% (244/833) VS 21.7% (167/770), χ2=12.133, P<0.001] and PDR [47.9% (399/833) VS 37.9% (292/770), χ2=16.241, P<0.001] were significantly higher in the experimental group than those in the control group. Adenomas ≤5 mm [23.5% (196/833) VS 16.1% (124/770), χ2=13.808, P<0.001] and flat-type adenomas [15.1% (126/833) VS 7.3% (56/770), χ2=24.519, P<0.001] were detected in a significantly higher proportion of subjects in the experimental group than those in the control group. There were significant difference in APC [0 (0,1) VS 0 (0,1), Z=-3.698, P<0.001] and PPC [0 (0,1) VS 0 (0,1), Z=-4.424, P<0.001] between the experimental and control groups. The use of CADe system significantly increased both ADR [29.5% (167/566) VS 18.9% (89/472), χ2=15.709, P<0.001] and PDR [47.3% (268/566) VS 33.3% (157/472), χ2=21.123, P<0.001] in junior endoscopists. However, in senior endoscopists, there was no statistical significant difference in ADR [28.8% (77/267) VS 26.2% (78/298), χ2=0.502, P=0.479] or PDR [49.1% (131/267) VS 45.3% (135/298), χ2=0.800, P=0.371] with or without CADe system. Conclusion:The use of CADe system significantly increases overall polyp and adenoma detection in clinical practice, especially in the detection of diminutive and flat-type lesions. Junior endoscopists gain greater advantages from the use of CADe system than their senior peers.

Objective : To explore dental caries-related factors among children aged 3-5 years in Urumqi City and to provide evidence for the etiological study and primary prevention of caries among local children. Methods : A multistage stratified cluster sampling method was used to randomly select children aged 3-5 years in Urumqi City for oral examination, physical examination and questionnaire survey. Data were collected and analyzed by principal component logistic regression using SPSS 23.0 software. Results: Principal component analysis showed that there were seven risk factors whose characteristic root value was greater than 1: oral hygiene habits, family education level, sugar intake, bedtime eating habits, age, gestational age, feeding mode, and cumulative contribution were 66.486% of the total variance. Principal component logistic regression analysis indicated that five factors, namely, oral hygiene habits (OR = 0.795, P = 0.044), family education level (OR = 0.667, P = 0.019), sugar intake (OR = 1.260, P = 0.006), bedtime eating habits (OR = 5.432, P<0.001) and age (OR = 0.676, P = 0.015), were closely related to early childhood caries, and they were statistically significant (P<0.05). Conclusion According to the principal component analysis, oral hygiene habits factor, family education level factor, sugar intake factor, bedtime eating habits factor and age factor were dental caries related factors among 3- to 5-year-old children in Urumqi City.