The standardized training of residents is an important stage for medical students to transition from medical theory to clinical practice,and the only way to become a qualified clinician.In recent years,the development of standardized resident training in China has changed from system construction to quality connotation construction.Medical simulation education,as an important bridge between medical theoretical teaching and practical teaching,has been recognized to a higher degree for its appropriate safety and high repeatability.However,there are still many restrictions in the practical application,so that the actual effect is difficult to reach the expectation.This review discussed the application and practice of medical simulation in the standardized training of residents.

Objective:To investigate the necessity of adaptive re-planning during radiotherapy for nasopharyngeal carcinoma (NPC) and its impact on dose improvement.Methods:Clinical data of 89 NPC patients admitted to Sun Yat-sen University Cancer Center from July 2014 to December 2017 were retrospectively analyzed. All patients received 25+7 rounds of adaptive re-planning during radiotherapy. Plan-A was defined as the initial CT scan-based 25-fraction radiotherapy plan, while plan-B was defined as the re-planned 7-fraction radiotherapy plan based on a subsequent CT scan. The changes in the target and parotid gland volumes were compared between plan-A and plan-B. Plan-I was a one-time simulation of plan-A extended to 32 fraction radiotherapy plan, and plan-II was generated through registration and fusion of the plan-A and plan-B for adaptive re-planning. The differences in dose metrics, homogeneity index (HI), conformity index (CI), and dose to organs at risk (OAR) were compared between plan-I and plan-II. Statistical analysis was performed by using paired t-test. Results:Compared with plan-A, the gross tumor volume of massive bleeding lesions (GTV nx) and parotid gland volume of plan-B were decreased by 13.14% and 11.12%, respectively (both P<0.001). While planning clinical target volume of metastatic lymph nodes (PCTV nd) of plan-B was increased by 7.75%( P<0.001). There were significant changes in the lymph nodes of plan-A and plan-B. The D mean, D 5%, D 95% of massive bleeding lesions planning target volume (PTV nx) and D 5% of high risk planning target volume (PTV1) in plan-II were all significantly higher than those in plan-I (all P<0.05). The CI of PTV nx and PTV1 in plan-II was closer to 1 than that in plan-I. In all assessed OAR, the D mean, D 50%, and D max of plan-II were significantly lower than those of plan-I (all P<0.05). Conclusions:During radiotherapy, NPC patients may experience varying degrees of primary tumor shrinkage, parotid gland atrophy, and lymph node changes. It is necessary to deliver re-planning and significantly improve the dose of target areas and OAR.

Bone Transplantation/adverse effects* ; Transplantation, Autologous/adverse effects*

Objective:To determine the median effective dose (ED 50) of remimazolam for preoperative sedation in pediatric patients of different ages. Methods:This was a prospective study. American Society of Anesthesiologists Physical Status classification I or Ⅱ pediatric patients, aged 1-6 yr, scheduled for elective surgery in our hospital from July to December 2023, in whom the preoperative anxiety was still not relieved after non-drug intervention (preoperative separation anxiety score [PSAS]≥3), were selected. According to the age, the children were divided into 1-<2 yr group, 2-<3 yr group, 3-<4 yr group, 4-<5 yr group and 5-6 yr group. A child's PSAS score = 1 at the time of separation from parents was classified as satisfactory sedation, and a PSAS score ≥ 2 was classified as unsatisfactory sedation. The initial dose of remimazolam in each group was 0.3 mg/kg, dose ratio 1.15. If the child was satisfactorily sedated, the next patient received a lower dose of remimazolam, or conversely if the child was not satisfactorily sedated, a higher dose was given in the next patient. The test was ended when 7 alternating waveforms appeared. The Dixon-Massey method was used to calculate the ED 50 and 95% confidence interval. Results:In 1-<2 yr group, 2-<3 yr group, 3-<4 yr group, 4-<5 yr group and 5-6 yr group, a total of 120 children were included in this study, with 26, 23, 21, 27 and 23 cases, respectively, and the ED 50 (95% confidence interval) of remimazolam for preoperative sedation was 0.152 (0.126-0.178), 0.159 (0.135-0.183), 0.171 (0.147-0.196), 0.150 (0.126-0.174), and 0.146 (0.121-0.170) mg/kg, respectively. There was no significant difference between the groups ( P>0.05). Conclusions:The ED 50 of remimazolam for preoperative sedation is 0.152, 0.159, 0.171, 0.150 and 0.146 mg/kg for every 1 yr in children aged 1-6 yr, and the age factor does not affect the preoperative sedative effect of remimazolam in children of this age group.

Objective:To observe the clinical efficacy of manual therapy based on the Discovery of Posture Secret (DPS) in treating adolescent idiopathic scoliosis (AIS).Methods:Thirty-six AIS patients were randomly divided into an observation group of 17 and a control group of 16. In addition to 10 minutes of side-shift training each week, the control group was given 20 minutes of sling exercise training (SET), while the observation group underwent weekly 20-minute manual therapy sessions based on DPS on the days without SET. Before and after the 4 weeks of treatment spine curvature (Cobb angle), clavicular angle (CA), angle of trunk rotation (ATR) and vertebral rotation (VR) were measured, and the Scoliosis Research Society′s patient questionnaire 22 (SRS-22) was administered.Results:After the treatment the average Cobb angle, CA, ATR and SRS-22 score of the observation group had improved significantly compared with before the treatment. The average Cobb angle, ATR and SRS-22 score of the control group were also significantly higher, but the improvements were not as great as in the observation group. There was no significant difference in VR improvement between the two groups.Conclusion:Manual therapy based on the DPS can effectively ameliorate the scoliosis and shoulder imbalance of AIS patients.

Objective:To investigate the expression of PRMT5 protein in colorectal cancer tissues and its relationship with recurrence after curative resection.Methods:The clinical data of 154 patients with colorectal cancer who underwent radical resection in Zigong Fourth People′s Hospital from February 2016 to April 2018 were retrospectively reviewed, the colorectal cancer tissues and adjacent tissues samples of them were retained at the time of surgery. The PRMT5 protein expressions in each specimen were determined by immunohistochemistry. The recurrence status of patients during the 3-year postoperative follow-up period was counted, and they were divided into recurrence group and no recurrence group.The positive expression rates of PRMT5 protein in colorectal cancer tissues between the two group was compared, and Cox regression model analysis was used to analyze the influencing factors of recurrence after radical resection of colorectal cancer.Results:The positive expression rate of PRMT5 protein in the colorectal cancer tissues was higher than that in the adjacent tissues: 70.13%(108/154) vs. 16.23%(25/154), there was statistical difference ( χ2 = 91.16, P<0.01). Within 3 years after surgery, the recurrence rate was 20.13%(31/154), and the positive expression rate of PRMT5 protein in the recurrence group was higher than that in the no recurrence group: 93.55%(29/31) vs. 64.23%(79/123), there was statistical difference ( χ2 = 10.16, P<0.05). The results of Cox regression model analysis showed that the tumor stage, lymph node metastasis and positive expression of PRMT5 protein in colorectal cancer tissues were independent risk factors for recurrence after radical resection of colorectal cancer ( P<0.05). Conclusions:The PRMT5 protein shows high expression in colorectal cancer tissues, and it is closely related to postoperative recurrence, and its positive expression can increase the risk of postoperative recurrence in patients with colorectal cancer.

Objective:To compare Da-vinci robotic surgical system with laparoscopic surgery for the repair of hiatal hernia.Methods:The clinical data of 115 patients undergoing minimally invasive Nissen fundoplication at the Department of Hernia and Abdominal Wall Surgery, the Affiliated Hospital,Xuzhou Medical University from Dec 2019 to May 2022 were retrospectively studied. After propensity score matching (PSM), 46 cases in each group were included:Robot-assisted surgery (RS group) and laparoscopic surgery (LS group). Postoperative complications were collected and GERD Questionnaire (GERDQ) were used as the standard in evaluation of the results.Results:Patients in RS group had less intraoperative bleeding ( P<0.001), shorter postoperative gastrointestinal recovery time ( P<0.001), and shorter postoperative hospital stay ( P=0.002). The LS group had a shorter operative time ( P<0.001) and lower total hospital cost ( P<0.001). GERD-Q scores decreased significantly in both groups at 3 and 6 months postoperatively compared with preoperative scores ( P<0.001). There was no statistically significant difference between the two groups in the incidence of postoperative complications ( P>0.05). No recurrence was seen in both groups during postoperative follow-up. Conclusion:Da-vinci robot-assisted repair of hiatal hernia is as safe and feasible as laparoscopic procedures, with less intraoperative trauma and quicker, earlier recovery.

Objective:To investigate the application value of jigsaw puzzle flap based on free-style perforator in repairing the defect on groin and adjacent organ after tumor extended resection.Methods:From December 2013 to August 2019, the data was focused on the patients who underwent soft tissue defect repair of groin and adjacent areas in the Second Affiliated Hospital of Chengdu Medical College. After the defect was predetermined preoperatively, portable ultrasound Doppler was used to map multiple perforators adjacent to the defect. The large defect was divided into several small parts, based on the location of perforators, the intensity of the Doppler, the safety size of flap that can be perfused by a single free-style perforator, and the donor sites can be closed primarily. Each component part corresponds to a free-style perforator flap. The perforator vessels were reversely dissected, and small flaps of V-Y advancement, rotation and propeller pedicled with perforator vessels were formed (appropriate modification of flaps can be made according to actual anatomical perforator vessels). All flaps were transferred to the defect site and reassembled according to the preoperative design (film simulation) to repair the large wound or deep space after the extended resection of the tumor in the groin and adjacent organs. Meanwhile, the donor site was closed and sutured primarily. The color, temperature, capillary reaction of the skin flap were observed during the first 3 days after procedure, and appearance and function after repair were observed after long-term follow-up.Results:A total of 31 patients were enrolled, including 18 males and 13 females. The ages of the patients ranged from 48 to 82 years with an average of 66 years. The defect area of skin and soft tissue was 8.0 cm×10.0 cm-15.5 cm×20.0 cm, with an average of 12.0 cm×15.0 cm. A total of 65 flaps were harvested, including 32 propeller flaps, 18 rotating flaps and 15 V-Y advancement flaps. There were 3 cases with 3 flaps and 28 cases with 2 flaps. The average skin flap area was 12.0 cm×20.0 cm-5.0 cm×10.0 cm, with an average of 8.0 cm×13.0 cm, and the diameter of the pedicle perforator vessel was 0.5 mm-4.0 mm. The color, temperature and capillary reaction of the skin flap were normal during the first 3 days after operation. Too much tension resulted in congestion of the flap in one case and poor wound healing. The wound was treated with dressing change, and healed in two weeks. The patients were followed up for 3 months to 5 years, with an average of 1.5 years. 30 patients survived primarily. The postoperative appearance was good.Conclusions:The combination of multiple small free-style perforator flaps can repair the large skin and soft tissue defects of malignant tumors after extensive resection on the groin and its adjacent area, and the donor site can be closed primarily. This method is easy to operate and avoids micro anastomosis and skin grafting. It is a kind of repair approach for clinical reference.

Objective:To compare surgery-related indicators, patient recovery status, perioperative complications and risk factors affecting the occurrence of postoperative grade Ⅲ or higher complications in patients undergoing laparoscopic gastric mesenchymal tumor surgery with different visceral fat areas.Methods:Clinical data of 116 patients with gastric interstitial tumor in Shaanxi Provincial People′s Hospital from April 2014 to June 2020 were retrospectively analyzed, including 44 male patients and 72 female patients, with patient aged from 25 to 88 years old and the mean age was (61.8±10.7) years, including 54 patients in the high VFA group and 62 patients in the low VFA group. SPSS 23.0 was used for statistical analysis, and t-test and χ2 test were applied to compare and analyze the patients′ surgery-related indexes, postoperative recovery status, complications within 30 d after surgery and differences in Clavien-Dindo classification of complications, while univariate and multifactorial analyses were used to study the factors affecting the occurrence of postoperative grade Ⅲ or higher complications. Results:Patients in the high VFA group had a higher body mass index than in the low VFA group, and the difference was statistically significant ( t=4.48, P<0.001); patients in the high VFA group had longer operative time ( t=2.88, P=0.005), more intraoperative bleeding ( t=2.17, P=0.032), longer period of fasting ( t=2.73, P=0.008), longer time for defecation ( t=4.46, P<0.001) and bowel movement ( t=4.62, P<0.001), and longer postoperative hospital stay ( t=3.43) compared with those in the low VFA group ( t=2.73, P=0.001), prolonged defecation ( t=4.46), prolonged bowel movement ( t=4.62), and prolonged postoperative hospitalization ( t=3.43), with statistically significant differences ( P<0.05); the incidence of postoperative complications was significantly higher in the high VFA group (31.4%) compared with the low VFA group (14.5%) ( χ2=4.78, P=0.029); among them, the incidence of postoperative pulmonary infection was significantly higher in patients in the high VFA group (12.9%) compared with those in the low VFA group (1.6%), and the difference between them was statistically significant ( χ2=4.16, P<0.05); while the differences in postoperative incision-related complications, anastomotic fistula, lower limb venous thrombosis, and intestinal obstruction were not statistically significant ( P>0.05). The incidence of postoperative complications above grade Ⅲ of the Clavien-Dindo complication classification was significantly higher in patients in the high VFA group (16.7%) compared with those in the low VFA group (4.8%), and the difference between the two was statistically significant ( χ2=4.35, P<0.05); univariate analysis revealed that operative time ≥300 min and increased VFA were the risk factors for postoperative grade Ⅲ or higher complications, while VFA was not an independent risk factor. Conclusion:Larger visceral fat area increases the difficulty of laparoscopic gastric mesenchymal tumor surgery operation, and also affects patients′ postoperative recovery, leading to increased postoperative complications, but VFA is not an independent risk factor affecting the occurrence of postoperative grade Ⅲ or higher complications in patients with gastric mesenchymal tumor.