In order to further strengthen the training and management of clinical teachers, broaden the career development channels of clinical teachers, and truly stimulate their teaching enthusiasm and initiative, this study further classifies clinical teachers according to the principle of the Snell model, focuses on the training of educational clinicians, and explores the training mechanism of teaching talents in line with the actual development needs of hospitals affiliated to universities from the aspects of selection, training, incentive, and assessment. The results of practice show that related practices have a good effect, and the mean number of teaching achievements was 1.98 for the 56 educational physicians, which was 3.9 times that for non-educational physicians. The per capita teaching achievements of educational physicians tended to increase every year compared with those of non-educational physicians. The training path for educational physicians provides useful experience for the construction of clinical teaching team and the high-quality development of education and teaching, and at the same time, it is necessary to further strengthen the dynamic adjustment of talent echelon, the improvement of operating mechanism, and the introduction of new technology.

Objective:To evaluate the effect of different options of preoperative biliary drainage (PBD) on perioperative complications of patients undergoing pancreaticoduodenectomy (PD).Methods:The clinical data of patients undergoing PD for periampullary carcinoma from January 2016 to November 2021 at Third Affiliated Hospital of Naval Medical University (Shanghai Eastern Hepatobiliary Surgery Hospital) were retrospectively analyzed. The 303 patients including 199 males and 104 females, aged (64.2±8.8) years. According to PBD, the patients were divided into two groups: percutaneous transhepatic biliary drainage (PTBD) group ( n=228) and endoscopic retrograde cholangiopancreatography (ERCP) group ( n=75). PBD operation-related complications (including bleeding, biliary leakage, etc.), postoperative complications of PD (including pancreatic fistula, biliary leakage, surgical site infection, etc.) and perioperative complications (PBD operation-related complications + postoperative complications of PD) were compared between the two groups. Univariate and multivariate logistic regression analysis were used to analyze factors influencing perioperative complications of PD. Results:The incidence of PBD operation-related complications in PTBD group was 10.1% (23/228), lower than that in ERCP group 25.3%(19/228), and the difference was statistically significant (χ 2=10.99, P=0.001). The incidence of postoperative complications of PD in PTBD group was 38.2%(87/228), lower than that in ERCP group 69.3%(52/75), the difference was statistically significant (χ 2=22.09, P<0.001). The incidence of total perioperative complications in PTBD group was 44.3% (101/228), lower than that in ERCP group 73.3%(55/75), the difference was statistically significant (χ 2=19.05, P<0.001). Multivariate logistic regression analysis showed that patients with periampullary carcinoma undergoing ERCP biliary drainage and PD had increased risk of surgical site infection ( OR=2.86, 95% CI: 1.59-5.16, P<0.001) and pancreatic fistula ( OR=3.06, 95% CI: 1.21-7.74, P=0.018). Conclusion:ERCP biliary drainage is a risk factor for postoperative pancreatic fistula and surgical site infection in patients with periampullary carcinoma undergoing PD. PTBD should be recommended as the first choice for the patients underwent PD.

Objective:To investigate the application value of three-dimensional visualization technology in management of middle hepatic vein (MHV) processing in associating liver partition and portal vein ligation for staged hepatectomy(ALPPS).Methods:The retrospective and descriptive study was conducted. The clinical data of 40 patients with right massive liver cancer or multiple right liver lesions who underwent ALPPS in the First Affiliated Hospital of Guangxi Medical University from November 2017 to August 2019 were collected. There were 34 males and 6 females, aged (44±9)years, with a range from 26 to 64 years. All patients underwent multi-slice computed tomography (CT) plain and enhanced scan of superior abdominal region before operation, and the data were transmitted to the liver visualization analysis software IQQA system with 1.5 mm thin-layer images to complete the three-dimensional reconstruction of the liver and its blood vessels. Patients were performed ALPPS based on results of three-dimensional reconstruction and intraoperative findings. Observation indicators: (1) results of preoperative three-dimensional reconstruction; (2) surgical situations; (3) follow-up. Follow-up was conducted using outpatient examinations and telephone interview to detect postopeartive survival of patients up to March 2020. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were described as M (range). Count data were represented as absolute numbers. Results:(1) Results of preoperative three-dimensional reconstruction: 40 patients underwent three-dimensional reconstruction successfully, of which 37 clearly showed MHV, tumor location and relationship between them, 3 patients showed unclearly MHV and were classified based on two-dimensional images. Of the 40 patients, 12 had MHV classified as type A, 13 as type B, 9 as type C, and 6 as type D. Three-dimensional reconstruction of vessels showed 22 with umbilical veins and 9 with anterior veins. Of the 40 patients, 35 were predicted to preserve MHV, and 5 were predicted to resect MHV. Total estimated liver volume, tumor volume, and reserved liver volume were (1 012±119)cm 3, 600 cm 3(8-2 055 cm 3), (346±80)cm 3. The ratio of future liver remnant to standard liver volume was 34%±8%. (2) Surgical situations : 40 patients underwent the first-stage ALPPS, including 35 with preservation of MHV and 5 with resection of MHV, which was accorded with preoperative prediction. Thirty-four patients underwent the second-stage ALPPS, and 6 patients had failure to receive the second-stage ALPPS due to undificiency future liver remnant. The operation time and volume of intraoperative blood loss for 40 patients undergoing first-stage ALPPS were (350±79)minutes and 300 mL(range, 100-2 600 mL). Three patients received blood transfusion and no perioperative death occurred. There were 24 patients with grade A heptic insufficiency according to criteria of International StudyGroup of Liver Surgery (ISGLS) and 16 patients with grade B heptic insufficiency after the first-stage ALPPS. Twenty-eight patients had grade Ⅰ complications of Clavien-Dindo classification, including 17 with a small pleural effusion, 10 with a small pleural and abdominal effusion, 1 with hypoproteinemia; 8 patients had grade Ⅱ complications of Clavien-Dindo classification, including 5 with pneumonia, 1 with pneumonia combined with pleural and abdominal effusion, 1 with coagulation disorders, 1 with biliary fistula; 3 patients had grade Ⅲ complications of Clavien-Dindo classification, including 2 with pneumothorax and pneumonia, 1 with pneumothorax, pneumonia and coagulation disorders; 1 patient had grade Ⅳ complications of Clavien-Dindo classification as systemic inflammatory response syndrome. All patients with complications were improved after symptomatic treatment, anti infection, transfusion of fresh frozen plasma or drainage. For the 34 patients undergoing the second-stage ALPPS, the operation time and volume of intraoperative blood loss were (320±83)minutes and 500 mL(range, 200-6 000 mL). Twelve patients received blood transfusion. There were 12 patients with grade A heptic insufficiency according to criteria of ISGLS and 22 with grade B heptic insufficiency after the second-stage ALPPS. Eighteen patients had grade Ⅰ complications of Clavien-Dindo classification, including 11 with a small pleural effusion, 7 with a small pleural and abdominal effusion; 12 patients had grade Ⅱ complications of Clavien-Dindo classification, including 4 with pneumonia, 4 with coagulation disorders, 3 with massive abdominal effusion, 1 with biliary fistula; 3 patients had grade Ⅲ complications of Clavien-Dindo classification, including 1 with pneumothorax and pneumonia, 1 with massive pleural effusion, 1 with obstructive jaundice; 1 patient had grade Ⅳ complications of Clavien-Dindo classification as pneumonia and anemia. All patients with complications were improved after symptomatic treatment, anti infection, transfusion of fresh frozen plasma or drainage. (3) Follow-up: 40 patients were followed up for 2-35 months, with a median follow-up time of 17 months. The 6-month, 1-, and 2-year survival cases were 35, 26, 21 cases. Conclusion:Three-dimensional visualization technology can clearly show the MHV classification and its relationship with tumor location, which has an important guiding significance in the decision-making of MHV management in ALPPS.

Peritoneal adhesions are fibrous tissues that tether organs to one another or to the peritoneal wall and represent the major cause of postsurgical morbidity. Enterolysis at repeat surgeries induces adhesion reformation that is more difficult to prevent than primary adhesion. Here we studied the preventive effects of different approaches of berberine treatment for primary adhesion, and its effects on adhesion reformation compared to Interceed. We found the primary adhesion was remarkably prevented by berberine through intraperitoneal injection 30 min before abrasive surgery (pre-berberine) or direct addition into injured cecum immediately after the surgery (inter-berberine). Rats with adhesion reformation had a more deteriorative collagen accumulation and tissue injury in abrasive sites than rats with primary adhesion. The dysregulated TIMP-1/MMP balance was observed in patients after surgery, as well as adhesion tissues from primary adhesion or adhesion reformation rats. Inter-berberine treatment had a better effect for adhesion reformation prevention than Interceed. Berberine promoted the activation of MMP-3 and MMP-8 by directly blocking TIMP-1 activation core, which was reversed by TIMP-1 overexpression in fibroblasts. In conclusion, this study suggests berberine as a reasonable approach for preventing primary adhesion formation and adhesion reformation.

This paper was aimed to analyze the theoretical connotation with liver bodyyin with function yang, and to explain the physiological and pathological mechanism of body yin and function yang, respectively. The mechanism of its corresponding syndrome and symptoms were described and the composing principle of classical prescription for liver regulation was analyzed. The clinical significance of liver body yin with function yangwas confirmed by clinical cases. This paper argued that the liver ascending characteristics, which is a necessary guarantee for ascendingqi in the human body to adapt to the ascending gas of the world, is the key point to maintain balance of qi ascending and descending in the body. The liver ascending disorder mainly manifested for the excessive ascending and ascending deficiency, which analyzed the pathogenesis characteristic and clinical manifestation of the liver qi ascending disorder. This paper put forward a new view that the liver storing blood referred to the convergence and the conservation properties of the liver, which demonstrated the relationship between liver storing blood and controlling dispersion. It suggested that liver blood convergences liverqi so as not to make liverqi too excessive. The liver storing blood can raise spirit. Liver blood is the source of menstruation, and etc. This paper finally put forward the clinical prescription viewpoint of soothing liver and dropping inverse should raiseyin and gentle liver necessarily, releasing liver should raise liver and nourish blood and clearing away the liver-fire should cool blood and nourishyin. This research had certain clinical value.

This article was aimed to study the factors associated with sleep quality of anger-out and anger-in population based on the frequent pattern-tree (FP-Tree) growing algorithm with data mining. The algorithm of structuring frequent model FP-tree and mining frequent itemsets were designed. The database information scanned was recorded by using FP-Tree growing algorithm through state-trees. The frequent itemsets met minimum support required was generated through reducing the search space of project sets and scanning database only one. The data mining of all factors associated with emotional diseases was actualized. The results showed that factors associated with sleep quality of anger-out and anger-in population were disturbance in respiration, cough or snoring, feeling cold, hot or nightmares. The total time for program analysis was 2 seconds. It was concluded that data mining algorithm based on FP-Tree frequent itemsets can effectively realize the useful information receiving from factors associated with emotional diseases.

This study was aimed to investigate the effect of Radix Bupleuri extract (RBE) on 5-HT3R channel currents of primarily cultured hippocampal neurons in depression emotion rats.Depression emotion model ratswere duplicated.RBE was used for drug intervention.And then,the rats were evaluated by the open-field test (OFT) and the sucrose preference test.Serum of rats in each group was collected and then added into the primary cultured hippocampal neurons for 24 h.The 5-HT3R channel currents were recorded by the whole-cell patch clamp.The results showed that compared with the normal group,the total score of OFT in the model group was significantly decreased (P < 0.01); the sucrose preference ratio decreased obviously (P < 0.01); and the current density value of primary cultured hippocampal neurons in serum of the model group was significantly higher (P <0.01).Compared with the model group,the total scores of OFT in the RBE group and fluoxetine group increased significantly (P < 0.05,P < 0.01); the sucrose preference ratio also increased obviously (P < 0.05,P < 0.05); and current density value of the primary cultured hippocampal neurons in serum of the RBE group and fluoxetine group decreased significantly (P < 0.01,P < 0.01).It was concluded that RBE can effectively correct the abnormal 5-HT3R channel currents of rats with depression emotion,which may be one of the central mechanisms in the treatment of depression emotion.

This study was aimed to elucidate the 5-HT3R molecular mechanism of Radix Paeoniae Albaextract (RPAE) as drug intervention in the treatment of premenstrual syndrome (PMS) model rats with liver-qi depression pattern.PMS model rats with liver-qi depression pattern were prepared.And then,the model was treated with RPAE.The protein distribution of 5-HT3AR and 5-HT3BR in the frontal lobe was evaluated by the immune fluorescence technology and western blot.The results showed that there were positive expressions of 5-HT3AR and 5-HT3BR in frontal lobe of rats in each group.Compared with the normal group,the 5-HT3AR and 5-HT3BR protein expression levels of the frontal lobe in the model group increased significantly (P < 0.05).Compared with the model group,the 5-HT3AR protein expression level in the frontal lobe decreased significantly after RPAE treatment (P < 0.05).In conclusion,RPAE regulated the protein expressions of 5-HT3AR and 5-HT3BR in frontal lobe,which may be one of the mechanisms for its treatment of PMS with liver-qi depression pattern.

The modernization of Traditional Chinese Medicine (TCM) is urgent need of the modern theory of TCM, is a consensus. But, How to establish and what kind of modern TCM theory, is far from a consensus. Based on the summarization of the common law in the construction of scientific theory, we are trying to give a answer that are expected to form a consensus. Firstly, we have illustrated the trend that the development of TCM theory should learn from the life and medical sciences theory function and value; Secondly, we have proven that TCM and TCM theory belongs to the traditional medicine and theory and pointed out the limitation of the traditional medicine, TCM and its theory. And then we have revealed the inevitable trend of traditional medicine, TCM and its theory development at home and abroad, logically obtained the inevitable choice of constructing the modern TCM basic theory; Lastly, we have analyzed the different discipline new theory construction process and method at home and abroad and discovered the common five steps rule, put forward three principles and five steps of constructing modern TCM basic theory, demonstrated its important role during the theoretical revolution promoting Chinese Medicine theory from phenomenon description to mechanism clarification and the scientific value of Chinese Medicine theory in the domestic and foreign development trend.

This study was aimed to solve the problem of overall syndrome differentiation information collection on patient’s main complain of traditional Chinese medicine (TCM) four diagnostic methods, in order to make syndrome differentiation standard of premenstrual syndrome (PMS) with liver-qi invasion pattern. The method of cluster sampling was applied in the investigation. The appropriate structural equation modeling (SEM) was established according to multi-dimension indexes of case features and TCM theories. The results of the “information acquisition form for doctor” structural equation showed that emotion dimension, body-symptom dimension, organism condition dimension load coefficients were 0.715, 0.574 and 0.904, respectively. The results of the “information acquisition form for patient” structural equation showed that emotion dimension, body-symptom dimension, organism condition dimension load coefficients were 0.705, 0.945 and 0.848, respectively. There were strong relativities among all dimensions. Combined with TCM theories, the main symptom of identified PMS with liver-qi invasion pattern was “irritable and angry”. And the secondary symptoms contained headache, breast tenderness, distention and pain of lower abdomen and stomach. The combining symptoms were insomnia, dreaminess, swelling of extremities, fatigue, inefficiency for work and housework, hard to focus the attention. It was concluded that the combination of information acquisition method from both the doctor and patient established a relative comprehensive information acquisition system. It established the syndrome differentiation standard of PMS with liver-qi invasion pattern for the first time based on epidemiologic investigation. It provided important reference for the study of PMS subtype.