Since the enrollment in 2002, the cultivation model of "4+4" program of clinical medicine in Shanghai Jiao Tong University School of Medicine has been continuously explored and practiced. With the goal of cultivating high-level compound outstanding medical innovative talents with multi-disciplinary cross-capacity, through strengthening the heuristic teaching, establishing the medical-engineering cross-course, emphasizing the training of scientific research ability, and taking teaching reform in the basic clinical single-circulation organ system integration course, we have established a talent training system with the characteristics of Shanghai Jiao Tong University School of Medicine, which is characterized by "thick foundation, strong practice, re-transformation, shaping norms, and international integration", and intend to make further exploration in the field of post-graduation education convergence.

Objective:To investigate the clinical effect of posterior fossa decompression combined with dural reconstruction in the treatment of Chiari malformation-Ⅰ(CM-Ⅰ) complicated with syringomyelia (SM).Methods:The clinical data of 50 patients with CM-Ⅰ complicated with SM who were treated in Yan′an University Xianyang Hospital from June 2019 to January 2021 were analyzed. They were divided into the study group (27 cases) and the control group (23 cases) according to the surgical methods. The former received posterior fossa decompression combined with dural reconstruction, while the latter received posterior fossa decompression alone. The clinical symptom improvement, neurological function, cerebrospinal fluid dynamics and syringomyelia changes were compared between the two groups before and after the surgery, and postoperative complications were compared.Results:The overall clinical symptom improvement rate between the two groups had no significant difference ( P> 0.05). After the surgery, the scores of pain, sensory disturbance, dyskinesia and ataxia in the study group were higher than those in the control group: (4.56 ± 0.35) points vs. (4.28 ± 0.43) points, (3.61 ± 0.82) points vs. (3.15 ± 0.73) points, (3.81 ± 0.44) points vs. (3.59 ± 0.50) points, (4.43 ± 0.41) points vs. (4.09 ± 0.53) points, there were statistical significant ( P<0.05). After the surgery, the cerebrospinal fluid stroke volume (SV) and mean flow (MF) in the study group were higher than those in the control group: (0.05 ± 0.02) ml vs. (0.04 ± 0.01) ml, (0.05 ± 0.01) ml/s vs. (0.04 ± 0.01) ml/s; the maximum peak flow velocity (V max) of the head and tail in the study group were lower than those in the control group: (3.14 ± 1.05) mm/s vs. (3.87 ± 1.13) mm/s, (5.56 ± 1.38) mm/s vs. (6.43 ± 1.22) mm/s, there were statistical significant ( P<0.05). There were no significant differences in the rate of reduction or disappearance of syringomyelia, the rate of no change and the rate of increase of syringomyelia after the surgery between the two groups ( P>0.05). There was no significant difference in the incidence of postoperative complications between the two groups ( P>0.05). Conclusions:Posterior fossa decompression combined with dural reconstruction in CM-Ⅰ complicated with SM can better improve cerebrospinal fluid dynamics, and promote the reduction of syringomyelia without increasing postoperative complications.

Objective:To investigate the risk factors of postoperative acute respiratory distress syndrome (ARDS) in patients with esophageal cancer.Methods:The clinical data of patients with esophageal cancer who underwent surgery in the Affiliated Huai'an No. 1 People's Hospital of Nanjing Medical University from January 2020 to April 2021 were retrospectively analyzed, 223 patients were enrolled. The patients were divided into ARDS group (28 cases) and non-ARDS group (195 cases) according to whether ARDS occurred after surgery. The clinicopathological features of the two groups were compared, and the risk factors of postoperative ARDS were analyzed by univariate and multivariate logistic regression.Results:The age of patients in the ARDS group was higher than that in the non-ARDS group [(70±4) years old vs. (66±7) years old, P = 0.024]. The proportion of patients with history of chronic obstructive pulmonary disease (COPD) in the ARDS group was higher than that in the non-ARDS group [25.0% (7/28) vs. 4.6% (9/195), P < 0.001]. There were no statistical differences in gender, systolic pressure, body mass index, left ventricular ejection fraction, laboratory related examinations, history of smoking, history of diabetes, history of hypertension, history of cardiovascular disease, history of cerebrovascular disease, pathological type, tumor location, tumor stage and postoperative complications between the two groups (all P > 0.05). After further adjusting for gender, multivariate logistic regression analysis showed that the old age (≥65 years old) ( OR = 4.581, 95% CI 1.299-16.154, P = 0.018) and the history of COPD ( OR= 5.493, 95% CI 1.644-18.358, P = 0.006) were independent risk factors for postoperative ARDS in patients with esophageal cancer. Conclusions:Esophageal cancer patients with an age of ≥65 years old or history of COPD have a high risk of postoperative ARDS. Age and history of COPD may have certain significances in judging the occurrence of postoperative ARDS in patients with esophageal cancer.

Objective : To investigate the clinical effect of polidocanol sclerotherapy in the treatment of giant venular malformations of the lips and cheeks in adults. Methods: From September 2019 to September 2020, 5 patients with huge venular malformations of the lips and cheeks (4 males, 1 female) admitted to Xuzhou Central Hospital were included in the study. All the patients were treated with local injection of polidocanol foam scleroagent, and all patients were followed up with a 3-week treatment course. If the clinical symptoms were not alleviated and the MRI examination showed that > 25% of the lesion remained, or it relapsed again after symptoms are stable, the patient needed to be treated again. The endpoints of treatment were: ①subsidence of clinical symptoms and MRI showing residual lesions < 25% in size; ②continuous treatment for 4 times without relief or aggravation of symptoms; ③a discontinuation of treatment. Results: All 5 patients successfully completed the treatment and were injected 2 to 4 times during treatment. The curative effect was evaluated according to the Achauer standard, including grade Ⅰcurative effects in 1 patient, grade Ⅱ in 2 patients, grade Ⅲ in 2 patients. Among them, one patient suffered from erosion and bleeding in the lesion before the operation, and the symptoms were significantly improved postoperatively. No serious side effects were found except skin pigmentation in 1 case. Conclusion Local injection of polidocanol foam scleroagent is a safe and effective treatment method for adult giant venular malformations of the lips and cheeks, and it has a hemostatic effect on spontaneous bleeding invenular malformations.

Objective To investigate the recovery of affected side kidney function after upper urinary tract obstruction was relieved Methods 78 patients who had been diagnosed with upper urinary tract obstruction were enrolled from January to December of 2015 in our hospital.All patients received the surgery to relieve the obstruction.GFR of the affected side kidney was done after one months of the surgery.The average age was(51.3 ± 12.8)years old.The reason of obstruction was upper urinary tract calculi (72 cases) and upper urinary tract stenosis (6 cases) respectively.All the patients received CT and ECT before and after operation.All the patients was divided into 3 groups by the decreased degree of affected side kidney function,including moderately decreased group [15 rnl/min ≤ GFR ＜ 30 ml/min,n =43,mean value =(23.1 ±5.0) mL/min],severely decreased group [7.5 rnL/min≤ GFR ＜ 15 ml/min,n =23,mean value =(11.2 ± 2.3) ml/min],and extreme severely decreased group [GFR ＜ 7.5 ml/min,n =12,mean value =(4.3 ± 2.9)ml/min].Linear correlation analysis was used to analysis the relationship analysis between the GFR value (pre-operation,post-operation) and the renal cortical thickness.The follow up time of extreme severely decreased group extended to 8-12 months.Results The GFR of moderate decreased group recovered to(30.6 ± 8.5) ml/min,regained averagely (7.56 ± 7.62) ml/min;the severely decreased group recovered to (13.1 ± 4.5) ml/min,regain (1.94 ± 3.38) ml/min.Extreme severely decreased group recovered to (11.1 ± 3.4) ml/min,regained averagely (6.75 ± 4.76) rnl/min,the GFR mean value after operation 8-12 months recovered to (12.7 ± 3.6) ml/min.All groups got significant recovery of kidney function of the affected side.The correlation coefficient between GFR value and the renal cortical thickness was 0.59 (before the surgery) and 0.70 (after the surgery) respectively (P ＜ 0.05).Conclusions Most of affected side kidneys got different degree of recovery.Obstruction influenced the accuracy of ECT at the time of evaluating the actual renal function before operation.The kidneys which had been supposed should be resected in presurgical evaluation could recover to the level of kidney reserve after the surgery.

Objective To evaluate the diagnostic accuracy of CMS50F for screening in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). Methods Sixty-four volunteers with suspected OSAHS underwent simultaneous noc?turnal polysomnography (PSG), micromovement sensitive mattress sleep monitoring system(MSMSMS)and CMS50F. The ap?nea-hypopnea index (AHI) detected by PSG and MSMSMS was used as the diagnostic standard for OSAHS. The reliability of CMS50F for monitoring sleep was assessed. Results There was no statistic difference in CMS50F-ODI3 and PSG-AHI be?tween normal, mild and moderate OSAHS groups(P>0.05). The CMS50F-ODI3 was smaller than the PSG-AHI in severe OSAHS patients(P < 0.05). There was a positive correlation between CMS50F-ODI3 and PSG-AHI(r=0.855, P < 0.05). PSG-AHI≥5 events per hour was used as the threshold value to diagnose OSAHS, the sensitivity and specificity of CMS50F were 94.5%and 88.9%. There were no significant differences in CMS50F-ODI3 and MSMSMS-AHI between normal, mild and moderate OSAHS patients(P>0.05). The value of CMS50F-ODI3 was smaller than MSMSMS-AHI in severe OSAHS patients (P < 0.05). There was also a significant correlation between CMS50F- ODI3 and MSMSMS-AHI (r=0.867,P <0.05). MSMSMS-AHI≥5 events per hour was used as the threshold value to diagnose OSAHS, the sensitivity and specificity of CMS50F were 94.5%and 88.9%. Conclusion CMS50F can be used as a portable and reliable device for screening of pa?tients suspected OSAHS.

Objective To summarise and analyze the clinical effecacy of endovascular treatment(internal holmium laser incision,bal-loon dilation,ureter dilator,rigid ureter dilation)for ureteral stricture.Methods The clinical data of 628 patients from January 2010 to Jan-uary 2015 in our hospital were analyzed.The relevant operation indicators,postoperative complications and recovery condition were recorded and analyzed.Results The operation time was 5.5 to 29 minutes,with average time of 16.5 minutes,no ureteral avulsion,ureteral fragmen-tation and massive haemorrhage happened.All patients were followed up for 6 to 36 months,591 cases(94.1%)were cured,29 cases (4.6%)of postoperative stricture recurrence received endovascular treatment again,8 patients(1.3%)conversion to open ureterolithotomy. Conclusion Endovascular treatment of ureteral stricture is diversified within holmium laser incision,it has the advantages of shorter opera-tion time,fewer complications,less trauma,repeatability and so on,which is an effective and safe treatment method.

Objective To compare the clinical effects of proximal femoral nail antirotation (PFNA) and proximal femoral nail antirotation-Ⅱ (PFNA-Ⅱ) in the internal fixation of femoral intertrochanteric fracture.Methods A retrospective study was conducted of the 54 patients with femoral intertrochanteric fracture who had been treated at our department from May 2009 through July 2014.During May 2009 and November 2011,27 of them were treated with PFNA;during December 2011 and July 2014,the other 27 of them were treated with PFNA-Ⅱ.The 2 groups were compared in terms of operation time,intraoperative blood loss volume,hidden blood loss volume,intraoperative and postoperative complications,fracture healing time and Harris hip score at the last follow-up.Results In the PFNA group,27 patients were followed up for an average time of 22.6 ± 4.8 months.In the PFNA-Ⅱ group,27 patients were followed up for an average time of 19.5 ± 4.6 months.The PFNA group had significantly more intraoperative blood loss volume (130.1 ± 74.3 mL),and significantly higher rates of intraoperative lateral wall fracture of the proximal femur (18.5％,5/27),postoperative lateral thigh soft tissue irritation (22.2％,6/27) and postoperative thigh pain (22.2％,6/27) than the PFNA-Ⅱ group [46.3 ± 23.1 mL,0,3.7％ (1/27),3.7％ (1/27),respectively] (P ＜ 0.05).There were no significant differences between the 2 groups in operation time,hidden blood loss,postoperative complications of internal diseases,fracture healing time,or Harris hip score of last follow-up (P ＞ 0.05).Conclusion Compared with PFNA,PFNA-Ⅱ may lead to a smaller volume of intraoperative blood loss and a lower incidence of complications related to internal fixation.

Objective To investigate the metabolic profile of uric acid and the significance of the altered renal expression of urate trans-porter 1(URAT1) in patients with uric acid nephrolithiasis. Methods The data of 24 patients in our hospital from January 2012 to October 2013 were analyzed retrospectively. Participants in the research were divided into three groups:patients with uric acid nephrolithiasis,other patients with nephrolithiasis and normal participants. The basic clinical data and the related data of uric acid metabolition of participants were collected,URAT1 gene expression in renal tissures of three groups was detected by Real-time PCR technique. All data were statistically ana-lyzed and compared between these groups. Results Uric acid levels in plasma,body mass index and age were significantly higher in patients with uric acid nephrolithiasis than other two groups (P<0. 05),but urine PH value was significantly reduced in patients with uric acid neph-rolithiasis. Urine and uric acid output of 24 hours urine were no significant difference among the three groups (P>0. 05). The result of Real-time PCR suggested that the URAT1 renal expression was significantly higher in patients with uric acid nephrolithiasis than other two groups (P<0. 05). Conculusion Patients with uric acid nephrolithiasis are closely related with hyperuricemia,but unrelated with renal over-ex-cretion of uric acid. The upregulated URAT1 expression in the kidney may be an important molecular mechanism of the clinical features.