Objective To explore the effectiveness of an integrated laparoscopic simulation training course (best essential surgical technique training, BEST) in enhancing laparoscopic peritoneal suturing techniques in surgical residents.Methods As an integrated two-stage program, the BEST course applied basic laparoscopic training system with simple molds in phase Ⅰ training, and then adopted advanced laparoscopic training system, 3D Laparoscope and ex-vivo animal models in phase Ⅱ training. The laparoscopic suturing techniques were practiced in phase Ⅱ training. From August 2021 to July 2024, surgical residents in the second year of the national standardized training program were divided into pilot and control groups based on whether they had undergone the BEST course. Two cases of laparoscopic peritoneal suture were performed by the surgical residents under supervision in the department of gastrointestinal surgery. The operative time, quality of suture, and independent completion rate were compared between the two groups.Results A total of 33 surgical residents (19 in pilot group and 14 in control group) were included in this study, and a total of 66 cases of laparoscopic peritoneal suture were performed (38 in pilot group and 28 in control group). The operative time was significantly shorter in pilot group than that in control group (15.7 min vs. 17.5 min, P=0.025). The quality of suture was significantly better in pilot group compared to control group (P=0.023). In pilot group, all peritoneal sutures were performed by residents independently, whereas in control group, 3 cases (10.7%) were assisted by the supervisor, and the independent completion rate was different significantly (P=0.039).Conclusions The BEST course can help improve surgical residents′ laparoscopic peritoneal suturing techniques and could be promoted in the national standardized training program for surgical residents.

Objective:To analyze and summarize the implementation effect of basic essential surgical training (BEST) course of laparoscopic skills over the past 10 years and the practical experience in updating course content and models.Methods:The pre-class assessment questionnaires, basic laparoscopic operation assessment results, and post-class assessment questionnaires of the students who participated in the BEST course of laparoscopic skills were collected. According to the period of the course construction, the students were divided into two groups, namely students who used the course of single training system in the early stage (traditional group) and students who used the course integrating a variety of training systems after the course model was updated in the later stage (test group). The two groups were compared for the scores of track circle moving, tunnel crossing, and high and low columns, as well as their subjective evaluation of course setting and implementation effect. The t-test, Wilcoxon test, or chi-square test was conducted according to the data type using SPSS 13.0. Results:The time for 150 traditional group students to complete track circle moving, tunnel crossing, and high and low columns was 1.08 min (0.81 min, 1.60 min), 2.20 min (1.60 min, 3.27 min), and 4.86 min (3.28 min, 6.36 min), respectively, while the time for 75 test group students to complete the three operations was 1.27 min (0.87 min, 1.83 min), 2.57 min (1.58 min, 4.07 min), and 4.35 min (2.90 min, 6.42 min), respectively, with no significant difference between the two groups ( P>0.05). In terms of students' subjective evaluation of the course, a higher percentage of the test group students were satisfied with classroom environment, teaching method arrangement, training equipment, training opportunities, helping clinical work, and meeting pre-class expectations than those in the traditional group. Conclusion:The constantly updated BEST course can ensure the training quality of trainees and obtain their higher satisfaction. The benefits of this course in clinical practice can be further verified through long-term follow-up of these trainees.

Virtual reality (VR) is a technology that interacts computer-generated three-dimensional scenes with the user′s senses and has been gradually applied in the real medical field. Since the first time of successful attempt in 3D laparoscopic gastrointestinal surgery VR living video broadcast in 2016, the authors have experienced the exploration of the application of this technology (2016-2017) as well as the in-depth research phase (2018-2019). Nowadays, the VR application in our center has entered into the application practice phase (2020 to present). With the technology iteration and more and more application experience acquisition, our current VR application mainly focuses on two practice settings, including the clinical teaching scenarios for early exposure to acute appendicitis for medical undergraduate students and the preoperative communication to give pati-ents an early sense of the process in the operating theatre, and has achieved good application results. With continuous breakthroughs and innovations in software and hardware, we believe that more clinical VR scenarios and the course audience will be expanded to a wider group. The integration of some new hotspots such as Meta-Universe and ChatGPT will make up for the shortcomings in VR content scenarios and interactivity, and its application prospects are infinite.

Objective:To explore the curative effect of synchronous bionic electrical stimulation in hyperbaric oxygen chamber on patients with sudden deafness（SD）and the changes in hemorheological indicators.Methods:A total of 128 SD outpatients and inpatients treated at the Hyperbaric Oxygen Department of the Sixth Medical Center of the Chinese PLA General Hospital from June 2020 to June 2021 were randomly divided into study group（70 cases treated with synchronous brain bionic electrical stimulator in hyperbaric oxygen chamber）and control group（58 cases given conventional hyperbaric oxygen therapy），respectively. The curative effects of the two groups were evaluated，and the hemorheological indicators，such as the whole blood（high-shear and low-shear）viscosity，plasma viscosity，and red blood cell aggregation，were analyzed by the automatic biochemical analyzer before and after treatment.Results:After two courses of treatments，the overall effective rate of the study group（88.57%）was significantly higher than that of the control group（79.31%），and the difference was statistically significant（ P<0.05）. After treatment，the whole blood（high-shear and low-shear）viscosities，plasma viscosity，and erythrocyte aggregation indicators of the two groups were significantly decreased compared with those before treatment（ P<0.05），and the above indicators in the study group were significantly lower than those in the control group（ P<0.05）. Conclusions:Synchronous brain bionic electrical stimulation in the hyperbaric oxygen chamber can improve the hemorheological indicators of the SD patients，reduce their blood hypercoagulability，and improve their hearing level and treatment effect. Hence，it is worth of clinical promotion.

Objective:To explore the curative effect of synchronous bionic electrical stimulation in hyperbaric oxygen chamber on patients with sudden deafness（SD）and the changes in hemorheological indicators.Methods:A total of 128 SD outpatients and inpatients treated at the Hyperbaric Oxygen Department of the Sixth Medical Center of the Chinese PLA General Hospital from June 2020 to June 2021 were randomly divided into study group（70 cases treated with synchronous brain bionic electrical stimulator in hyperbaric oxygen chamber）and control group（58 cases given conventional hyperbaric oxygen therapy），respectively. The curative effects of the two groups were evaluated，and the hemorheological indicators，such as the whole blood（high-shear and low-shear）viscosity，plasma viscosity，and red blood cell aggregation，were analyzed by the automatic biochemical analyzer before and after treatment.Results:After two courses of treatments，the overall effective rate of the study group（88.57%）was significantly higher than that of the control group（79.31%），and the difference was statistically significant（ P<0.05）. After treatment，the whole blood（high-shear and low-shear）viscosities，plasma viscosity，and erythrocyte aggregation indicators of the two groups were significantly decreased compared with those before treatment（ P<0.05），and the above indicators in the study group were significantly lower than those in the control group（ P<0.05）. Conclusions:Synchronous brain bionic electrical stimulation in the hyperbaric oxygen chamber can improve the hemorheological indicators of the SD patients，reduce their blood hypercoagulability，and improve their hearing level and treatment effect. Hence，it is worth of clinical promotion.

Objective:To explore the pathogenic variants of a family with syndromic deafness by high-throughput sequencing.Methods:The family was from Puyang City, Henan Province, and had four members, including two with syndromic deafness. The proband and his sister had congenital deafness, and their parents had normal phenotypes. The clinical phenotype of the family was characterized using clinical examinations and pedigree analysis. The clinical examinations included imaging examination, audiometry (pure tone audiometry, acoustic immittance, brainstem auditory evoked potential, and otoacoustic emission), vestibular function test, and ophthalmic examination (visual acuity test, visual field test, fundus examination, visual evoked potential, and electroretinogram). Target exome sequencing of 129 known deafness genes and bioinformatics analysis were used to screen suspected pathogenic variants. Sanger sequencing and minigene assay were used to verify and functionally investigate the mutation detected, respectively. According to the standards and guidelines for interpreting genetic variants proposed by the American College of Medical Genetics and Genomics, the variants c.6049G>A and c.8699A>G were classified as pathogenic/likely pathogenic, and the variant c.9856C>G was classified as variants of uncertain significance.Results:The probands and his sister had severe sensorineural hearing loss with decreased binocular vision, night blindness, decreased peripheral visual field sensitivity and partial visual field defect, and normal vestibular function. Both of them had three CDH23 mutations, including CDH23 (NM_022124.5) c.6049G>A (p.Gly2017Ser),c.9856C>G (p.His3286Asp), and c.8699A>G (p. Asp2900Gly), The first two were inherited from the father, and the last one was from the mother. The missense variants c.9856C>G and c.8699A>G were not included in the gnomad database. The missense mutation c.6049G>A was located in the last position of exon 46 and was predicted to affect splicing by bioinformatics software. The minigene experiment showed that the mutation cause exon skipping of exon 46, resulting in an abnormal protein. Conclusions:Compound heterozygous variations of the CDH23 are the leading cause of USH1D in the family. This study confirms that the compound heterozygosity of splicing and missense variants of the CDH23 gene could lead to USH1D.

Objective To investigate the clinical efficacy of hyperbaric oxygen (HBO) combined with transcranial electrical stimulation (tDCS) and memantine tablets on cognitive impairment in the patients with moderate to severe craniocerebral injury.Methods Forty-nine patients with moderate or severe cognitive impairment induced by trauma brain injury (TBI) who were admitted into the Rehabilitation Department and Neurosurgery Department of Shanxi University Hospital from May 2017 to May 2018 were enrolled for the study.The patients were divided into the HBO group (or group A,n =16),the HBO + tDCS group (or group B,n =16) and the HBO + tDCS + memantine group (or group C,n =17) in accordance with different treatment methods.The total scores of Montreal Cognitive Assessment Scale (MoCA) and the scores of each item before and 4 weeks after treatment,the Simple Mental State Examination Scale (MMSE) and Barthel Index (BI) were analyzed to determine improvement of cognitive impairment in the TBI patients.Results After 3 courses of treatment,MoCA comprehensive scores and sub-item scores were all significantly higher than those before treatment,with statistical significance (P ＜ 0.01).In sub-items,the comprehensive scores of VS-EF,ATT,LANG,D-MEM and MoCA in group B were significantly higher than those in group A after treatment,also with statistical significance (P ＜ 0.05).Following treatment,the scores of VS-EF,ATT,LANG and D-MEM in group C were all significantly higher than those in group B after treatment,also with statistical significance (P ＜0.05).The comprehensive scores of MMSE and ADL in group B and C after treatment were all significantly higher than those in group A,and statistical significance could be seen when comparisons were made between them (P ＜ 0.01).The comprehensive scores of MMSE (21.23 ± 6.53) and ADL(64.38 ±12.80) in group C were all obviously higher than those in group B(17.61 ±6.35,5.39 ± 10.22),also with statistical significance (P ＜ 0.05).Conclusion Comprehensive treatment with HBO + tDCS + memantine could achieve obvious better therapeutic effects on cognitive impairment of the patients with severe TBI.For this reason,it is worth further clinical application.

Objective To investigate the clinical efficacy of hyperbaric oxygen (HBO) combined with transcranial electrical stimulation (tDCS) and memantine tablets on cognitive impairment in the patients with moderate to severe craniocerebral injury.Methods Forty-nine patients with moderate or severe cognitive impairment induced by trauma brain injury (TBI) who were admitted into the Rehabilitation Department and Neurosurgery Department of Shanxi University Hospital from May 2017 to May 2018 were enrolled for the study.The patients were divided into the HBO group (or group A,n =16),the HBO + tDCS group (or group B,n =16) and the HBO + tDCS + memantine group (or group C,n =17) in accordance with different treatment methods.The total scores of Montreal Cognitive Assessment Scale (MoCA) and the scores of each item before and 4 weeks after treatment,the Simple Mental State Examination Scale (MMSE) and Barthel Index (BI) were analyzed to determine improvement of cognitive impairment in the TBI patients.Results After 3 courses of treatment,MoCA comprehensive scores and sub-item scores were all significantly higher than those before treatment,with statistical significance (P ＜ 0.01).In sub-items,the comprehensive scores of VS-EF,ATT,LANG,D-MEM and MoCA in group B were significantly higher than those in group A after treatment,also with statistical significance (P ＜ 0.05).Following treatment,the scores of VS-EF,ATT,LANG and D-MEM in group C were all significantly higher than those in group B after treatment,also with statistical significance (P ＜0.05).The comprehensive scores of MMSE and ADL in group B and C after treatment were all significantly higher than those in group A,and statistical significance could be seen when comparisons were made between them (P ＜ 0.01).The comprehensive scores of MMSE (21.23 ± 6.53) and ADL(64.38 ±12.80) in group C were all obviously higher than those in group B(17.61 ±6.35,5.39 ± 10.22),also with statistical significance (P ＜ 0.05).Conclusion Comprehensive treatment with HBO + tDCS + memantine could achieve obvious better therapeutic effects on cognitive impairment of the patients with severe TBI.For this reason,it is worth further clinical application.

Objective To investigate the effects of sensorimotor therapy on patients with knee osteoarthritis.Methods Ninety-two patients with knee osteoarthritis were divided into a treatment group and a control group by using random digits table. Both groups received conventional rehabilitation therapy, including knee isometric and isotonic contraction training, ultrashort wave diathermy as well as aerobic exercise. The treatment group was also administered with sensorimotor training, in addition to the conventional training,including the muscle strengthening and control training of quadriceps and hamstring muscle using sling exercise therapy system and on the Thera-band mattress. The visual analogue scale (VAS) for pain, manual muscle testing and knee range of motion as well as the Japanese Orthopedic Association knee function evaluation form were used to evaluate the patients. Results There was no statistic difference between the 2 groups before treatment, with regard to the evaluation parameters used in this study. After 2 months of treatment, both groups improved significantly (P ＜0.05),with the treatment group improved to a significantly greater extent (P ＜0.05). Conclusions Sensorimotor training in addition to the conventional rehabilitation treatment can further relieve the pain of patients with knee osteoarthritis joints arthritis and improve the function of patients with knee osteoarthritis.