Objective To investigate the hepatic hemodynamic characteristics of cirrhotic patients with splenectomy using iodine map of dual-source computed tomography(DSCT).Methods Twenty-four cirrhotic patients with splenectomy were selected as a study group,41 cirrhotic patients without splenectomy as a cirrhosis group and other 32 patients with normal liver as a control group.The iodine concentration(IC)in hepatic arterial and venous phases was measured on the iodine map,and the arterial iodine fraction(AIF)and portal venous iodine concentration(PVIC)were calculated.Receiver operating characteristic(ROC)curves were plotted and the area under the curve(AUC)was recorded to evaluate the diagnostic efficacy of each parameter using the DeLong test.Results IC in arterial phase and AIF were significantly higher,and IC in venous phase and PVIC were significantly lower in study group(P<0.05).The AUC values of the four parameters between study group and cirrhosis group were 0.735,0.992,0.943,and 0.994,respectively.Conclusion DSCT iodine map is helpful for clinical quantitative assessment of hepatic hemodynamic characteristics in cirrhotic patients with splenectomy,and the PVIC has optimal independent diagnostic performance.

Scoliosis is a common deformity in neuromuscular disease, which usually has the characteristics of early onset age, severe degree of deformity, and rapid progression.Neuromuscular scoliosis often leads to serious damages to the quality of life, and results in the loss of walking, standing and sitting, and cardiopulmonary insufficiency.Surgical treatment can improve the quality of life for children with neuromuscular scoliosis, but surgical treatment is still challenging due to the complex surgery and many complicated diseases.The complications are much higher than those of idiopathic scoliosis.A multidisciplinary team is necessary in the surgical treatment of neuromuscular scoliosis to promptly and effectively reduce the complications.

It is still at the initial stage for basic-level military doctors to participate in the standardized residency training. While, their professional backgrounds and training objectives are significantly different from those civilian residents, it is necessary to explore the standardized training methods in line with the military career demands for those basic-level military doctors. Based on the actual needs of grass-roots troops and military medicine, this study makes significant progress in the integration of standardized residency training and field surgery training methods, making the basic-level military doctors achieve the goal of field surgery training in the course of clinical practice of residents. Not only the surgical capability of basic-level military doctors, but also the medical support capability in grass-roots troops has been improved. This article summarizes the application methods and experience of field surgery teaching in the standardized residency training of military medical residents at the grass-roots level.

Objective:To investigate the clinical efficacy of zoledronic acid combined with calcium in the treatment of primary osteoporosis (OP).Methods:A total of 180 patients with OP were selected and randomly divided into study group and control group. The two groups of patients were given oral calcium carbonate D3 tablets (Ⅱ), on this basis, the patients in the study group were given zoledronic acid injection. The clinical efficacy was observed after 12 months of the treatment, and the total effective rate was calculated. The bone mineral density, visual analog scale (VAS) of pain, and bone biochemical indexes, including blood calcium (Ca), blood phosphorus (P), bone γ-carboxyglutamate protein (BGP), calcitonin (hCT), collagen type I amino-terminal peptide (P1NP) and collagen type I cross-linked carboxy-terminal peptide (β-specific sequence) (β-CTX) were collected before and after the treatment.Results:The clinical efficacy of the study group was better than that of the control group ( P<0.05). After the treatment, the bone mineral density in the study group was higher ( P<0.05), and the VAS score was lower than that in the control group ( P<0.05). After the treatment, there was no significant difference in serum calcium, serum phosphorus and BGP between the control group and the study group (all P>0.05), the hCT and P1NP levels in the study group were significantly higher than those before the treatment (all P<0.01), and the β-CTX level was significantly lower than that before the treatment ( P<0.01). Conclusions:Zoledronic acid combined with calcium has a good therapeutic effect on OP.

Objective:To perform 3D modeling based on CT images of human stomach-esophagus structure and provide 3D models of normal and reflux forms of gastroesophagus.Methods:Based on CT images of stomach-esophagus structure, 3D models was established using Mimics 10.01, Geomagic Studio 2012 and SolidWorks 2018 software. In the modeling process, the Mimics software was used to coarsely and finely divide the model to export stomach-esophageal point cloud data. On the basis of the point cloud data, Geomagic Studio software was used to simplify and repair the model, and complete the operations of filling holes and smooth surfaces. SolidWorks software was used to process the structure of the cardia and establish a normal model of stomach-esophagus and a model of cardiac disease. Finally, the model was replicated using soft 3D printing technology.Results:The geometric parameters of the established stomach-esophagus model were within the actual range, which proved that the model has certain practicality.Conclusions:The model can be used as a basic material for gastric surgery simulation training, to help doctors or medical students to be proficient and improve the operation skills and surgical level of gastric surgery.

Objective To analyze the influence of different geometric parameters on flexibility of the commonly used Z-shaped stent-grafts for treating thoracic aortic aneurysm, as well as the primary and secondary order of such influence. Methods The three-dimensional models of the stent-grafts with different strut numbers, wire diameters, crest height, bending radius were established by SolidWorks and imported to ANSYS software for finite element analysis．The 60° rotation of X-axis was applied to the stent-grafts, and the flexibility of the stent-grafts was evaluated according to 3 evaluation parameters (Von Mises stress, reaction force and bending torque)． Results After bending of the stent-grafts, the maximum stress was concentrated on the inside of the bend；reducing the wire diameter, crest height and strut number of the stent-grafts, the flexibility of the stent-grafts would increase; increasing the bending radius， the flexibility of the stent grafts would increase; the effect of the wire diameter and strut number on flexibility of the stent-grafts was stronger than that from the bending radius and crest height． Conclusions The strut number, wire diameter, crest height, bending radius had a significant impact on flexibility of the stent-grafts. The research findings can provide theoretical references for the selection and optimal design of the stent-grafts in clinic, and have a positive influence on reducing the incidence rate of complications such as new entry.

Simulations can mimic the environment that refers to the surgery operation to improve the technical skills of the trainees. In this paper, we designed a new cardiac surgery simulative training system. The isolated pig heart was selected as the heart model. A mechanical device was designed to achieve the beating of heart model. At the same time, adjusting frequencies of mechanical movement could change the rating of heartbeat. In order to validate the rationality of the system, 12 non-medical specialty students and 12 medical specialty students were divided into two groups, which consecutively accepted seven-days of training for off-pump coronary artery bypass grafting using the cardiac surgery simulative training system. The time for completing bypass grafting before and after training were recorded. And the bridging outcomes of each trainee were assessed by 3 surgery cardiac surgeons using the object structured assessments of technical skill (OSATS) criteria. After training, each trainee could finish the bypass suturing in a shorter time than before training, and the scores of each trainee assessed by OSATS criteria were also improved. The results showed that the cardiac surgery simulative training system had better training effect in improving the surgical techniques, operation skills and proficiency of surgical instruments of trainees.

Objective To summarize the method of forearm skin flap with dorsal interosseous artery placed by turning the proximal end of the flap to the distal side of the wound to repair skin and soft tissue defect of palm and thumb of hand,and put forward the key points of operation.Methods From 2008 to 2013,the forearm skin flap with interosseous dorsal artery to repair skin and soft tissue defect of palm and the part between thumb and index finger in 20 cases.Dorsal interosseous artery in the forearm is passing through between superficial and deep layers of extensor muscles and sends out 5-13 cutaneous branches to dorsal antebrachium skin.The large skin flap has good blood supply with high survival rate.Results All flaps survived,and good results were achieved in all 20 cases.Conclusion The flap preserved two main arteries from upper limb with good blood supply,and the amount of blood supply of the flap depended on the size of flap,and the wound of donor site can be directly sutured up or covered with free skin graft,thus minimizing the alteration of appearance and function of donor area.

Objective To investigate relationship among Brachial-ankle pulse Wave Velocity (baPWV),Homocysteine (Hcy),Serum Matrix Metallopro Teinases-9 (MMP-9) and coronary heart disease.Methods Sixty-six cases of patients diagnosed as coronary heart disease according to the coronary angiography showed any one of the main coronary arteries (left main,left anterior descending,left circumflex artery,right coronary artery) diameter stenosis≥ 50％ were selected into coronary heart disease from June 2009to March 2011 hospitalized in the Second Affiliated Hospital of Ningxia Medical Cardiology.And 40 cases of healthy people who had medical examination over the same period were selected into the normal control group.The 66 cases of patients were further divided into single-branch-affected group (n =18),two-branchaffected group(n =25) and multi-branch-affected group (n =23) according to the branches of coronary artery pathological changes shown in coronary angiography.Detected and compared baPWV,Hcy and MMP-9 among these groups.Results The baPWV,Hcy and MMP-9 in coronary heart disease group were significantly higher than those in the control group (baPWV:(2132 ±240) cm/s vs (1360 ±81) cm/s,t =23.97,P ＜0.01 ;Hcy:(14.32 ± 5.20) μmol/L vs (6.50 ± 1.40) μmol/L,t =11.54,P ＜ 0.01 ; MMP-9:(768.0 ± 95.3) μg/L vs (228.0 ±56.2) μg/L,t =36.69,P ＜0.01) ;The baPWV,Hcy and MMP-9 in multi-branch-affected group were significantly higher than those in single-branch-affected and two-branch-affected group; The baPWV,Hcy and MMP-9 in two-branch-affected group were higher than those in single-branch-affected group (baPWV (2041 ±168) cm/s vs (1873 ± 150) cm/s vs (1560 ± 172) cm/s,F =45.36,P ＜0.01 ;Hcy:(21.31 ±6.30) μmol/L vs (15.32 ± 5.80) μmol/L vs (10.50 ± 3.20) μmol/L,F =36.18,P ＜ 0.01 ;MMP-9:(1042.0 ± 180.2) μg/L vs (940.0 ± 175.8) μg/L vs (723.0 ± 102.2) μg/L,F =41.06,P ＜ 0.01).The serum MMP-9 was significantly positive correlated with baPWV and Hcy (r =0.630,P ＜0.01 ;r =0.351,P ＜0.05) ;The Hcy was significantly positive correlated with baPWV (r =0.475,P ＜ 0.05) in the coronary heart disease group.Conclusion The baPWV,Hey and MMP-9 were related with the degree of artery stenosis in coronary heart disease.Combined detection of these three markers can be used to assess the risk of coronary heart disease.

Objective To investigate the clinical characteristics and analyze prognostic risk factors of combined hepatocellular-cholangiocarcinoma. Methods The clinical data of 19 cases of combined hepatocellular-cholangiocarcinoma admitted in our hospital from January 1999 to December 2009 were analyzed retrospectively. The survival function was analyzed by Kaplan-Meier. The possible prognostic risk factors were tested by χ2-test. Results Hepatocellular-cholangiocarcinoma was diagnosed by pathology in the 19 patients, among which hepatic tunic was infiltrated in 13 cases, peritoneum involved in 1 case, intravascular cancer embolus in 1 case. At that time lymphocyte nodes metastasis in 2 cases were found by regional lymphadenectomy in 7cases. The 1-year and 3-year survival rates were 61% and 42%,respectively. Prognosis of patients with tumor size ＞ 5 cm ( χ2 = 4. 392, P = 0. 036 ), history of heavy drinking ( χ2 = 11.010, P = 0.001 ) or intraoperative blood transfusion ( χ2 = 4. 645,P = 0. 031 ) were worse than others. Conclusion It was difficult to get correct preoperative diagnosis of combined hepatocellularcholangiocarcinoma. Tumor size, history of heavy drinking and blood transfusion were all prognostic related risk factors.