Objective:To investigate the current situation of the use of transjugular intrahepatic portosystemic shunt (TIPS) for portal hypertension, which should aid the development of TIPS in China.Methods:The China Portal Hypertension Alliance (CHESS) initiated this study that comprehensively investigated the basic situation of TIPS for portal hypertension in China through network research. The survey included the following: the number of surgical cases, main indications, the development of Early-TIPS, TIPS for portal vein cavernous transformation, collateral circulation embolization, intraoperative portal pressure gradient measurement, commonly used stent types, conventional anticoagulation and time, postoperative follow-up, obstacles, and the application of domestic instruments.Results:According to the survey, a total of 13 527 TIPS operations were carried out in 545 hospitals participating in the survey in 2021, and 94.1% of the hospital had the habit of routine follow-up after TIPS. Most hospitals believed that the main indications of TIPS were the control of acute bleeding (42.6%) and the prevention of rebleeding (40.7%). 48.1% of the teams carried out early or priority TIPS, 53.0% of the teams carried out TIPS for the cavernous transformation of the portal vein, and 81.0% chose routine embolization of collateral circulation during operation. Most of them used coils and biological glue as embolic materials, and 78.5% of the team routinely performed intraoperative portal pressure gradient measurements. In selecting TIPS stents, 57.1% of the hospitals woulel choose Viator-specific stents, 57.2% woulel choose conventional anticoagulation after TIPS, and the duration of anticoagulation was between 3-6 months (55.4%). The limitation of TIPS surgery was mainly due to cost (72.3%) and insufficient understanding of doctors in related departments (77.4%). Most teams accepted the domestic instruments used in TIPS (92.7%).Conclusions:This survey shows that TIPS treatment is an essential part of treating portal hypertension in China. The total number of TIPS cases is far from that of patients with portal hypertension. In the future, it is still necessary to popularize TIPS technology and further standardize surgical indications, routine operations, and instrument application.

We strive to explore a student-centered evaluation system focused on improving students' learning efficiency and learning effect. Through classroom questioning, discussion of difficult cases, new progress report, question bank test, writing of clerkship notes, simulated inquiry between students with bedside inquiry, physical examination between students with bedside physical examination, operation training of basic clinical skills, direct observation and evaluation of clinical skills, mini-clinical exercise evaluation, graduation examination and other measures, an evaluation system for promoting learning by class evaluation, clerkship evaluation and practice evaluation has been established to cultivate the connotation construction of medical moral quality and clinical practice ability of medical students, and further promote the mastery of basic theoretical knowledge and clinical operation skills. By comparing the results of the phased examination for medical practitioners, the passing rate of 2018 is significantly higher than that of 2017, with 23.31% increased passing rate of theoretical results, and 0.79% increased passing rate of skills operation results. It can be seen that the evaluation system for promoting learning has played a guiding role in the teaching practice of clinical courses in our hospital.

Objective To evaluate the effect of radiotherapy on the swallowing ability of persons with nasopharyngeal carcinoma (NPC) when swallowing food with different consistencies.Methods Twenty NPC patients were monitored fluoroscopically while swallowing materials with three different consistencies after radiotherapy.The oral transit time,oral residue,pharyngeal residue,penetration-aspiration and cricopharyngeal muscle function were observed.Results There were significant differences in all of the measurements when swallowing the three different foods.There were significant differences in all of the measurements between swallowing paste and liquids,but only in the oral transit time,oral residue and pharyngeal residue between swallowing thin and thick liquids.Conclusions The severity of swallowing dysfunction varies in NPC patients after radiotherapy.Foods with different consistencies have different effects on swallowing ability.Videofluoroscopy can evaluate swallowing objectively and provide an objective basis for food preparation.

Objective: To compare a new agar thickener with xanthan gum as a thickener in treating dysphagia patients with nasopharyngeal carcinoma after radiotherapy. Methods: Twenty nasopharyngeal carcinoma patients with dysphagia after radiotherapy were asked to swallow moderately and extremely thick liquids thickened with the agar and xanthan gum, and their swallowing was recorded with a videofluoroscope. Results: The average pharyngeal constriction ratio when swallowing agar thickener was significantly lower than when swallowing the traditional thickener. The average oral transit time, the initiation of pharyngeal swallowing were both significantly quicker. There was no significant difference in the average penetration aspiration scale scores between the two thickeners. In the subjective evaluation, the agar thickener was adjudged smoother and with better residual mouthfeel than the xanthan gum, but the scent of the xanthan gum was preferred. Conclusion The new agar thickener is smooth and not sticky. It produces faster transport with less oropharyngeal residue. It can be widely used among nasopharyngeal carcinoma patients with dysphagia after radiotherapy.

Objective To evaluate the characteristics of dysphagia after brain stem infarction,and to determine the mechanism of aspiration.Methods The fluoroscopic videos of 12 dysphagia patients who had suffered brain stem infarction and 10 healthy counterparts were analyzed quantitatively using a digital analysis system.Each participant was requested to twice swallow 5ml of thick liquid.The observations included the oral transit time (OTT),the swallow response time (SRT),the hyoid movement time (HMT),the upper esophageal sphincter opening time (UOT) and the laryngeal closure time (LCT).An 8-point penetration-aspiration scale (PAS) was used to evaluate the severity of aspiration,and the results were correlated with the other 5 quantitative observations.Results The average OTT [(3.091±1.803)s],HMT [(1.498±0.550)s] and LCT [(0.651±0.186)s] of the brain stem infarction patients were all significantly longer than those of the healthy controls.However,no significant differences were found between the patients and the healthy volunteers in terms of SRT or UOT.Aspiration severity was significantly correlated with SRT but not with LCT.Conclusion Dysphagia after brain stem infarction involves both the oral and pharyngeal phases.OTT,HMT and LCT can be used to quantify dysphagia after brain stem infarction,while SRT is a predictor of aspiration.

Objective To evaluate the relationship between muscle fibrosis and the displacement of the hyoid bone while swallowing among patients with nasopharyngeal carcinoma (NPC) after radiation therapy.Methods Twenty-six NPC patients with dysphagia were recruited.Shear wave elastography was performed to assess the fibrosis of the mylohyoid muscle.The horizontal and vertical displacement of the hyoid bone were measured based on the videofluoroscopic swallowing study,and the severity of dysphagia was determined using the penetration-aspiration scale (PAS).The correlation between the modulus value of the mylohyoid muscle and the horizontal and vertical displacement of the hyoid bone were analyzed,respectively.Receiver-operating characteristic (ROC) curve were constructed to assess the diagnostic ability of modulus value for the severity of dysphagia above grade 5 of PAS.Results For patients whose PAS was higher than grade 5,the modulus value of mylohyoid muscle was negatively correlated with the displacement of hyoid bone,while such correlation was absent for patients whose PAS grading were less than or equal to 5.Sensitivity and specificity by modulus value to detect dysphagia were 80％ and 81.8％,respectively,with the best cut-off value of 14.37 kPa.Conclusion The reduction of hyoid bone displacement can be partially attributed to muscle fibrosis for post-radiation NPC patients with severe dysphagia.The modulus value measured by Shear wave elastography could be used as a supplementary way to monitor the development of dysphagia.

Objective To monitor the immediate effect of Passi-Muir speaking valve (PMV) on patients with tracheostomy after acquired brain damage.Methods Twelve patients with tracheostomy after acquired brain damage were recruited.All of them underwent the high resolution manometry to measure the pressure in pharynx and upper esophagus during swallowing before and immediately after wearing PMV.The parameters including the pharyngeal peak pressure,increasing rate of the pharyngeal pressure,pharyngeal pressure duration,upper esophageal sphincter (UES) residual pressure and UES relaxation duration were recorded.Results No significant differences were found in all the measurements before and immediately after wearing PMV (P＞0.05).Conclusion PMV has no instant impact on the swallowing function of patients with tracheostomy after acquired brain damage.

By taking the course of laboratory hematology in Curtin University in Australia as an ex-ample, this paper introduced the characteristics of its teaching mode, teaching contents, teaching methods, assessment methods and laboratory practice. The advantages and disadvantages of education characteristics between Australia and China were compared and analyzed on the training methods and the training objec-tives, respectively. The education characteristics of laboratory hematology in Curtin University provided an important inspiration for our education reform in the field of medical laboratory in the future.

Objective To analyze temporal and kinematic parameters of video fluoroscopic images of swallowing using a digital acquisition and analysis system and to verify the reliability of this method.Methods Eighteen patients with dysphagia were requested to completed six swallows (3 ml and 5 ml of thin liquid, thick liquid, and paste mixed with 600 kg/m3 barium sulfate suspension) in the natural sitting position.Video fluoroscopy was used to measure the oral transit times, soft palate elevation times, hyoid movement times, laryngeal closure times, cricopharyngeal muscle opening times, hyoid anterior movement (HAM) , hyoid superior movement (HSM) , cricopharyngeal muscle opening diameter and pharyngeal constriction rate.Each was extracted from the videos four times by two raters working separately with an interval of 4 weeks between the sets of evaluations.Results Reliability varied among the different observations.HAM and HSM showed inter-rater reliability between 0.41 and 0.60 and intra-rater reliability between 0.61 and 0.80.The other observations all demonstrated acceptable reliability.Conclusion The self-designed digital acquisition and analysis system tested showed acceptable reliability and could be applied to analyze swallowing function clinically.

BACKGROUND:There are several reports about the application of fresh bone marrow aspirate being injected directly to repair partial ligament injury, but the application about fresh bone marrow aspirate directly being planted on scaffolds to build tissue-engineered ligament is rarely mentioned.
OBJECTIVE:To evaluate the feasibility of applying fresh bone marrow aspirate planted directly on scaffolds to construct tissue-engineered ligament
METHODS:We constructed fibroin fiber/smal intestinal submucosa composite scaffold, then planting fresh bone marrow directly to built bone marrow seeding group and planting seed cel s (bone marrow mesenchymal stem cel s) on the scaffold to built cel seeding group. The control group had no treatment. After that, we detected the density of cel adhesion, cel proliferation ability and extracel ular matrix secretion. Then, the composite in the bone marrow seeding group was implanted into the broken anterior cruciate ligament in rabbits, and material biocompatibility in vivo was evaluated after 12 weeks.
RESULTS AND CONCLUSION:After 4 hours of incubation, bone marrow seeding group was significantly higher than the cel seeding group in cel adhesion density and proliferation rate (P<0.05). Bone marrow seeding group and cel seeding group showed higher type I, III col agen secretion compared with the control group (P<0.05), but the col agen secretion of bone marrow seeding group and cel seeding group showed no significant difference. Composite cel scaffold implantation in vivo did not cause fatal immune rejection and severe inflammatory reaction, and no significant ligament regeneration and vascularization occurred. These findings indicate that fresh bone marrow aspirate can be seeded directly on scaffolds to construct tissue-engineered ligament, and the short-term biocompatibility in vivo is good.