Objective To investigate clinical competence assessment in the graduation examination for surgical professional degree postgraduates and surgical residents in Beijing. Methods Data of clinical competence assessment of graduation examination for surgical postgraduates from Capital Medical University (CMU) and residents from Beijing surgical residency training programs in 2013 were summarized and ana-lyzed. SPSS 11.5 software was used to do t test and chi square test to the corresponding data line. Results There were 118 surgical postgraduates in clinical medicine from CMU and 274 residents from Beijing surgi-cal residency training programs, who attended final clinical competence assessment. There were significant differences between the postgraduate and resident clinical competence assessment system. The differences included their organization in charge of examination and the contents of assessment system. The assessment system of clinical competence for the surgical postgraduates did not involved communication skills, reading and analysis of laboratory tests and imaging investigation. The score of case analysis in the postgraduate group was higher than that in the resident group [(84.6±1.1) vs. (82.2±10.2), P=0.039], however the score of surgical skill assessment in postgraduate group was significantly lower than that of the resident group [(78.2 ±14.0) vs. (90.5 ±6.3), P=0.000]. In addition, the rate in the score being higher or equal to 70 of case note, case analysis and surgical skill assessment between postgraduates and residents was significantly different (P<0.05). Conclusion Clinical competence assessment system for the surgical postgraduates should be adapted to their training goal. In addition to the process assessment, the objective structured clinical skills examination (OSCE) can be as a reasonable postgraduate graduation examination mode.

Objective To explore the extent of axillary lymph node dissection in breast cancer patients with positive sentinel lymph nodes.Methods In this series,95 patients underwent complete axillary lymph node dissection (CALND) following positive sentinel lymph nodes identified and 97 patients underwent partial axillary lymph node dissection (PALND) at the absence of positive sentinel lymph nodes.The influence of different extent of axillary lymph node dissection was evaluated.Results The positive rate of level(Ⅰ + Ⅱ) non-sentinel lymph nodes (NSLN) and level Ⅲ lymph nodes was 68.4％ and 29.5％,respectively,in CALND group.In PALND situation,57.9％ CALND cases would have changed pathologic stage from pN1 to pN2 or pN3.But with level Ⅲ lymph node dissection followed PALND,only 2.1％ cases had changed pathologic stage from pN2 to pN3.Multivariate logistic regression showed that the number of positive SLNs (OR =2.157) and positive rate of SLNs (OR =10.374) were risk factors for having positive level Ⅲ lymph nodes.CALND needed longer operation time and larger postoperative drainage volume.Conclusions In cases of breast cancer with ≥ 3 positive sentinel lymph nodes,complete axillary lymph node dissection should be considered.

Objective To study conventional laparoscopic instruments line single hole peritoneoscope gallbladder excision and three hole laparoscopic cholecystectomy surgery efficacy and safety.Methods 140 cases patients with gallbladder stones in our hospital from January 2014 to June 2015 were selected as the research subjects.All patients need to be treated with cholecystectomy.All the patients according to the random number table were randomly divided into two groups,respectively for single hole group and three group.Single hole group using a single hole peritoneoscope gallbladder excision,triplex group use three hole laparoscopic gallbladder resection.The surgical effect,hospitalization costs and complications were compared between the two groups after treatment.Results Hole group operation time (87.89 ± 12.81) min,longer than the three-hole group (53.89 ± 8.91) min,but the hospital stay was (1.28 ± 0.21) d and total hospital costs (11 241.21 ± 23.91) yuan,were lower than three-hole group,P ＜ 0.05,the difference was statistical significance in the amount of bleeding in the two groups were not statistical significance,P ＞ 0.05;two groups of patients had complicatiom,but have been treated better,and two concurrent disease (1.43％ vs 2.86％) incidence was no significant difference,P ＞ 0.05.Conclusion Single hole laparoscopic cholecystectomy reduce the hospitalization time and hospitalization expenses,surgical trauma is smaller,postoperative recovery is faster,and the safety is high,it is worthy of clinical application.

Objective To examine the clinical effect and learning curve of endoscopic thyroidectomy via chest-areolar approach in the treatment of benign thyroid nodules. Methods From January 2012 to May 2016,49 patients underwent endoscopic thyroidectomies via chest-areolar approach in Xuanwu Hospital ,Capital medical university. The clinical characteristics ,prognosis and operation time were retrospectively analyzed. The patients were divided into 9 groups according to the surgical sequence ,and the learning curves were analyzed by using moving average method. Results 49 endoscopic thyroidectomies via chest-areolar approach were performed successfully. The average size of the nodules was(2.80 ± 0.62)cm. 10 patients underwent bilateral thyroidectomy and 39 underwent unilateral thyroidectomy. The average operation time was(157.49 ± 21.23)min. 2 cases received re-operation due to postoperative pathology of malignancy. There were no postoperative recurrent laryngeal nerve injuries. 11 patients suffered from asymptomatic hypocalcemia with parathyroid hormone in the normal range. All of the patients were satisfied with the cosmetic results. The learning curves indicated that 35 endoscopic thyroidectomies were needed to be performed in the early study stage. Conclusions For surgeons with experience of conventional thyroidectomies,endoscopic thyroidectomy via chest-areolar approach is feasible and safe for selected patients. There is a significant learning curve in the application of endoscopic thyroidectomy. In the early study stage of endo-scopic thyroidectomy,35 cases are basically required for beginning surgeons to practice the surgical operation.

ABSTRACT:Objective To investigate the prevalence of thyroid nodules in Xi’an City by ultrasonography and study the correlation between thyroid nodules and the components of metabolic syndrome.Methods We recruited 4 527 subjects in this cross-sectional study and divided them into thyroid nodules (TN)group and non-thyroid nodules (NTN)group.The height,weight,blood pressure,blood sugar,lipid,and serum uric acid were measured and analyzed.The relationship between thyroid nodules and thyroid function was assessed in the subjects who received TT3,TT4,TSH,TGAB,and TPOAB tests.Results ① The prevalence of thyroid nodules was 31.8% and was significantly higher in the female patients (38.4% vs.27.1%,χ2=64.44,P<0.001).However,the prevalence of metabolic syndrome was 9.1% and was significantly higher in the male ones (11.4% vs.5.9%,χ2=40.39,P<0.001).② Compared with that in NTN group,TT3 in TN group was significantly increased (t=6.04,P<0.001), but the other indexes did not obviously change in the two groups (P>0.05).③ Age,systolic blood pressure,and TG,LDL-C and serum uric acid levels were remarkably higher in TN group than in NTN group (P<0.001 ). Conclusion The prevalence of thyroid nodules in Xi’an City is noticeably high.High systolic blood pressure level, dyslipidemia and elevated uric acid are associated with thyroid nodules.Therefore,screening and management of the individuals with aforementioned characteristics deserve more attention.

Objective To investigate the diagnosis and treatment of idiopathicgranulomatous mastitis.MethodsThis study was to retrospectively review the clinical presentation,radiological investigation,histopathological features,treatment and outcome of idiopatbic granulomatoos mastitis of women presenting to Xuanwu Hospital between January 2002 and June 2010.ResultsTwenty-four patients with a mean age of 34.5 years presented with a diagnosis of idiopathic granulomatous mastitis.Patients presented with a palpable breast lump,breast abscess,fistula formation in different periods of the disease; the role of radiological imagings was found to be limited in differentiating idiopathic granulomatous mastitis from other inflammatory and maliguant conditions of the breast.All patients underwent a surgical procedure as the main treatment; in the form of excision or incision and drainage of the breast lesions. Mean follow-up was 47.38 ( range 6-96 ) months with recurrence in 3(12.5％) patients.ConclusionsIdiopathic granulomatous mastitis presents clinically with a palpable breast lump.The diagnosis is often only made histopathologically after surgical excision or core biopsy.Wide excision of the lesions or incision and drainage of the lesion are the main treatment modalities.

Nine hundred and forty nine general physicians in Beijing urban area received surgical skill assessment in 2008.The assessment results of five surgical skills (taking out stitches,changing dressings,skin suture,knot with gloves and wearing isolation gown) were analyzed with the relations of different gender,age,educational background,professional title,specialty,hospital grade,length of service and times of test taking.The average score of the total assessment was 71.The score was lower in the practitioners who were male,older than 50 years,higher educational background,lower professional tide,more than 2 times of test taking,and who were specialized in traditional Chinese medicine,ophthalmology and otorhinolaryngology and emergency medicine.Results suggest that the levels of surgical skills in general practitioners are generally low and periodical training is needed.

: Objective To evaluate the value of rehabilitation direction for the treatment of the children with spastic cerebral palsy. Methods 116 children with spastic cerebral palsy were investigated. 56 children who accepted rehabilitation direction and training in family participated in study group and 60 children who wouldn't accept rehabilitation direction participated in control group. All the children received comprehensive rehabilitation treatment in hospital, including physical therapy, acupuncture, low frequency electrotherapy and occupational therapy. All the children were assessed with Gross Motor Function Measure-88 (GMFM) before and 3 months after treatment. Results There was a significant difference before and after treatment in scores of GMFM in each dimension and total in both groups (P<0.01), and the treatment group improved more than control group(P<0.05). Conclusion Rehabilitation direction can facilitate the recovery of spastic cerebral palsy children.

Objective:To observe the effect of emotional stimulation on the formation process of atherosclerosis ( AS) ,and explain the role of hydrogen sulfide ( H2 S) in atherosclerotic lesions. Methods:Twenty-four Sprague-Dawley rats were randomly divided into AS group, qi-stagnation and blood-stasis AS group and the control group. The AS group was fed with special diets, the qi-stagnation and blood-stasis AS group was fed with special diets and emotional stimulation, and the control group was fed with normal diets. During the experiment, the indicators including the characterization score, H2 S content, four items of the natural bleeding and blood coagula-tion, tissue blood flow and blood lipid were respectively detected in the 4 th, 8 th and 12 th week. Results:Compared with those in the AS group, since the 4 th week, the rats in qi-stagnation and blood-stasis AS group were with significantly decreased activity, slow re-sponse, lackluster fur and dark purple tongue (P<0. 01);the level of plasma lipid increased significantly, and increased further with time extension(P<0. 05 or P<0. 01);since the 8 th week, APTT and FIB changed significantly (P<0. 05),the blood flow to skin, liver and kidney decreased significantly (P<0. 05);the content of H2S was significantly higher in the 12 th week (P<0. 01). Con-clusion:Emotional stimulation promotes the formation of AS model,and the gas molecule system of H2 S plays a regulatory role in the qi-stagnation and blood-stasis AS animal model.

Objective:To compare the efficacy and prognosis of elective nodal irradiation (ENI) combined with nedaplatin chemotherapy and involved field irradiation (IFI) combined with nedaplatin chemotherapy in the radical radiotherapy treatment of patients with cervical or upper thoracic esophageal cancer.Methods:Seventy-eight patients with cervical or upper thoracic esophageal cancer in Hai'an Traditional Chinese Medicine Hospital from February 2017 to February 2020 were selected and divided into ENI group and IFI group according to random number table method, with 39 cases in each group. The ENI group was treated with ENI combined with nedaplatin chemotherapy, while the IFI group was treated with IFI combined with nedaplatin chemotherapy. After 2 months of treatment, the therapeutic effect and the dose of lung irradiation were compared between the two groups, and the occurrence of adverse reactions and prognosis were compared.Results:The total effective rate and disease control rate were 69.23% (27/39) and 82.05% (32/39) in IFI group, and 64.10% (25/39) and 74.36% (29/39) in ENI group, there was no significant difference between the two groups ( χ2 = 0.23, P = 0.631; χ2 = 0.68, P = 0.411). The lung irradiation doses of V 5 Gy and V 20 Gy in IFI group were lower than those in ENI group (both P < 0.05). The incidence rates of bone marrow suppression and radiation lung injury in IFI group were lower than those in ENI group (all P < 0.05). By the end of follow-up, the survival rates of IFI group and ENI group were 76.92% (30/39) and 66.67% (26/39), respectively. There was no significant difference in overall survival between the two groups ( χ2 = 1.06, P = 0.300). Conclusions:ENI and IFI combined with nedaplatin chemotherapy in the radical radiotherapy treatment of cervical and upper thoracic esophageal cancer have similar efficacy and prognosis, but IFI can reduce the lung radiation dose and the incidence of adverse reactions.