Objective To explore the feasibility and rationality of advanced integrated two-stage laparoscopic simulation training course in standardized training of surgical residents.Methods From December 2019 to December 2021,the advanced integrated two-stage laparoscopic simulation training course was carried out among 2019-2020 surgical residents who received standardized training in our hospital.The course was divided into two stages.In the first stage,BEST(best essential surgical technology training)course,adopted Darwin? endoscopic training system,Tianyan? endoscopic training system,Microport? 3D laparoscopic training system and simple simulative models were used.The second stage,BEST PLUS course,same platform as that in BEST course and in vitro animal models were used.The questionnaire survey method(before and after class questionnaire)was adopted to evaluate the curriculum setting,such as curriculum form,simulators,teaching method,time arrangement,curriculum difficulty,training effect,curriculum satisfaction and so on.Results A total of 37 surgical residents completed the two-stage course training and the questionnaire survey.The overall satisfaction rate with the curriculum setting was 100%.There were 32 residents(86.5%)thought that first stage training course could significantly improve their clinical skills,35 residents(94.6%)thought that second stage training course could significantly improve their clinical skills,and 36 resident(97.3%)thought that the first stage curriculum could significantly help them improve performance in the second stage curriculum.Conclusions The trainees had a high degree of recognition and satisfaction for the advanced integrated two-stage laparoscopic simulation training course.The overall design of course was reasonable and feasible,and was attractive to trainees.

Objective To explore the efficiency and safety of trans-sheath intraluminal forceps biopsy under digital subtraction angiography(DSA)guidance for assisting diagnosis of pulmonary artery obstructive diseases.Methods Data of 16 patients who underwent trans-sheath intraluminal forceps biopsy for pulmonary artery obstructive diseases were retrospectively analyzed,and the clinical manifestations were recorded.The technical success of biopsy was defined as tissue obtained met the needs of pathology diagnosis.For patients with malignant pathology results,the final diagnosis was malignant,for those with benign pathology results after biopsy and no obvious changes after 6-month or longer follow-up,or benign pathology results after surgical resection,the final diagnosis was benign,otherwise was no clear diagnosis.The operation time,technical success rate,diagnostic efficiency,complications and changes of pulmonary artery pressure before and after the biopsy were observed.Results Among 16 patients,9 complained of intermittent chest tightness,4 complained of chest pain with chest tightness,2 complained of chest pain but 1 denied any symptoms.The lesions located in the left lung in 10 cases and in the right lung in 6 cases,all with enhanced CT showed filling defects of the involved branch of pulmonary artery.Totally 16 trans-sheath intraluminal forceps biopsies were performed in 16 patients,with an average operation time of(31.02±6.02)min and technical success rate of 100%.Malignant tumors were finally diagnosed in 10 cases,including 1 case of lung cancer with false-negative biopsy result,while biopsy correctly diagnosed benign lesions in the other 6 cases.Transient worsening chest pain with chest tightness occurred in 2 cases and relieved after symptomatic treatments.No statistically significant difference of pulmonary artery pressure was found before([53.38±14.28]mmHg)and after([53.69±14.15]mmHg)biopsy(P＞0.05).Conclusion DSA-guided trans-sheath intraluminal forceps biopsy was relatively safe and valuable for assisting diagnosis of pulmonary artery obstructive diseases.

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.

Objective:To evaluate the fluoroscopy-guided percutaneous transhepatic forceps biopsy (PTFB) in the diagnosis of biliary strictures.Methods:Literatures on diagnosis of biliary strictures by PTFB published from January 2001 to August 2022 were obtained by searching the databases of PubMed, Embase, Web of Science, the Cochrane Library, China National Knowledge Infrastructure (CKNI), Wanfang, VIP, and China Biology Medicine disc (CBM). Literature inclusion and exclusion criteria were established and the retrieved literature was screened. The quality of the included literature was evaluated using the quality assessment of diagnostic accuracy studies (QUADAS-2). Statistical analysis was performed by using Meta-disc software and Stata software.Results:Eighteen articles involving 1 935 patients were finally included. The heterogeneity test suggested no threshold effect, but there was non-threshold heterogeneity in sensitivity and negative likelihood ratio due to other reasons, so a random-effects model was used, and a fixed-effects model were used for the remaining outcome indexes used due to low heterogeneity. The results showed that the pooled sensitivity of fluoroscopy-guided PTFB for the diagnosis of biliary strictures was 0.796 (95% CI: 0.776-0.814), the pooled specificity was 1.000 (95% CI: 0.985-1.000), the pooled positive likelihood ratio was 21.532 (95% CI: 11.281-41.098), the pooled negative likelihood ratio was 0.234(95% CI: 0.169-0.323), the pooled diagnostic odds ratio was 94.321(95% CI: 46.744-190.320), and the area under the summary receiver operating characteristic curve was 0.929. The pooled complication rate was 9.2% (95% CI: 6.4%-12.0%). Conclusion:Fluoroscopy-guided PTFB may be a superior diagnostic tool for biliary strictures.

Objective:To investigate the distribution of allergens in patients with allergic rhinitis （AR） in Ningxia, and provide theoretical data for the prevention and treatment of AR in this region. Methods:A total of 1664 patients diagnosed with AR in the Otorhinolaryngology Head and Neck Surgery Department of Yinchuan First People's Hospital Outpatient Clinic from January 2018 to December 2021 were retrospectively collected. Use the allergen sIgE antibody detection kit （immunoblotting method） to detect inhalation and ingestion allergens in patients.Results: ①Among all AR patients, 1 158 cases were detected positive, resulting in the detection rate was 69.59%; ②The detection rate of inhalation allergen was 65.87%, and the detection rate of ingestion allergen was 19.83%; ③Mugwort was the most sensitive allergen, and 76.32% of the patients having a positive grade ≥3; ④Out of the patients, 294 cases （25.39%） were allergic to only one allergen, 244 cases （21.07%） were allergic to two allergens, and 620 cases （53.54%） were allergic to three or more allergens; ⑤During different seasons, the highest number of positive allergens detected was in the summer, with 968 cases （83.59%）. Mugwort was the main allergen during this season （69.01%）. After the COVID-19 epidemic, the total positive rate of sIgE tests in AR patients decreased compared to before, and the difference was statistically significant （P<0.001）; ⑥Mugwort, dog epithelium, mold combination, egg, peanut, soybean, Marine fish combination and fruit combination all showed statistically significant differences between different gender groups （P<0.05）; ⑦Common ragweed, mugwort, dust mite combination, cockroach, egg, milk, Marine fish combination, shrimp, fruit combination and nut combination all showed statistically significant differences among different age groups （P<0.05）; ⑧There were statistically significant differences in hay dust among different ethnic groups （P<0.05）. Conclusion:Artemisia argyi is the main allergen in Ningxia, and the distribution characteristics of different allergens are influenced by treatment season, the COVID-19 epidemic, gender, age, ethnicity, and other factors, showing certain distribution patterns and rules.
Allergens ; Artemisia ; COVID-19 ; Retrospective Studies ; Rhinitis, Allergic ; Skin Tests ; Humans ; Male ; Female

Objective:To explore the medium-long term efficacy of transjugular intrahepatic portosystemic shunt (TIPS) for gastrointestinal hemorrhage in patients with idiopathic non-cirrhotic portal hypertension (INCPH).Methods:From March 2013 to July 2018, clinical data of 13 INCPH patients, including 5 males, 8 females,with gastrointestinal hemorrhage were retrospectively analyzed, who were diagnosed at the First Affiliated Hospital of Zhengzhou University, Anyang Fifth People′ s Hospital and Yuncheng Central Hospital. All patients received TIPS treatment. The general information, postoperative survival rate, the incidence of rebleeding, shunt dysfunction rate, and incidence of hepatic encephalopathy were analyzed.Results:All 13 patients with INCPH completed TIPS successfully with an average age of 45±8 (33 to 59) years. The hepatic venous pressure gradient (HVPG) decreased from 20.0-26.0 (22.6±1.9) mmHg before procedure to 8.0-14.0 (9.4±3.2) mmHg after. The median follow-up time was 44±7 (31 to 53) months. One patient died of liver failure 27 months after TIPS. Hepatic encephalopathy occurred cumulatively in 1 case (1/13), 1 case (1/13) and 1 case (1/13) in 12, 24 and 36 months after TIPS. Stent restenosis occurred cumulatively in 2 cases (2/13), 3 cases (3/13) and 3 cases (3/13) in 12, 24 and 36 months after TIPS. Portal vein thrombosis occurred cumulatively in 2 cases (2/13), and no primary liver cancer developed.Conclusions:TIPS is safe and effective in the treatment of INCPH with gastrointestinal bleeding with favorable medium-long term outcome.

Objective:To investigate the clinical value of transjugular liver biopsy (TJLB) in patients with unexplained liver disease complicated with massive ascites or coagulopathy.Methods:A retrospective analysis was performed from patients underwent TJLB in the First Affiliated Hospital of Zhengzhou University, Zhoukou Central Hospital, Shangqiu First People's Hospital and Jincheng People's Hospital from March 2015 to January 2022 due to unexplained liver disease complicated with massive ascites or coagulopathy. A total of 37 patients were included, including 21 males and 16 females, aged (53.5±11.9) years. According to different puncture points, the patients were divided into two groups: transhepatic right vein TJBL and transhepatic middle vein TJBL. The obtained liver tissue sampling effect, puncture times, complications were analyzed.Results:The success rate of TJLB was 97.3%(36/37). Thirty-six patients were able to obtain more than three segments of liver tissue and obtain histological diagnosis, and the pathological diagnosis rate was 100.0%(36/36). The number of puncture times, the amount of hepatic tissue and the number of portal areas in the right hepatic vein group (21 cases) were (3.7±0.9), (3.7±0.7) and (6.5±0.9) respectively, and those in the middle hepatic vein group (15 cases) were (3.7±0.7), (3.7±0.7) and (6.3±0.8) respectively. There were no significant differences between the two groups (all P>0.05). Conclusion:TJLB is safe and feasible for patients with unexplained liver disease complicated with massive peritoneal effusion and coagulopathy. Good liver tissue specimens can be obtained by TJLB from both right hepatic vein and middle hepatic vein.

ObjectiveObjective To systematically evaluate the efficacy and safety of antiviral therapy in patients with chronic hepatitis B (CHB) in the immune-tolerant phase. MethodsPubMed, Embase, Cochrane Library, CNKI, and Wanfang Data were searched for clinical trials of antiviral therapy for CHB patients in the immune-tolerant phase published up to September 2020. Related data were extracted after quality assessment for systematic review. HBV DNA clearance rate was the primary outcome. ResultsA total of 9 studies involving 821 patients were included. Eight studies reported HBV DNA clearance rate in the treatment group, among which 6 studies had an HBV DNA clearance rate of ＞60%, which was significantly higher than that in the untreated patients (0%-29.1%), and the combination therapy group had a better clearance rate than the monotherapy group. However, virologic recurrence was more common in the long term. Eight studies reported HBeAg seroconversion, and only 2 studies of the treatment of children with interferon-α (IFN-α) reported a seroconversion rate of ＞20% in the treatment group, which was higher than that in the untreated group. HBsAg clearance was observed in 2 studies of IFN-α treatment, while HBsAg seroconversion was not observed. One study reported the risk of liver cirrhosis and hepatocellular carcinoma (HCC) and showed that antiviral therapy could reduce the risk of liver cirrhosis and HCC in patients. The incidence rate of adverse events ranged from 4.1%-13.0% in the treatment with nucleos(t)ide analogues and reached 100% in the treatment with IFN-α, and serious adverse events were rare. ConclusionThe majority of CHB patients in the immune-tolerant phase show satisfactory virologic response after antiviral therapy, but they tend to experience recurrence after drug withdrawal and have a low seroconversion rate. Antiviral therapy has good safety. Current evidence suggests that such patients can be dynamically observed if there is no clear evidence for disease progression.

Objective:To analyze the clinical and endoscopic characteristics of gastric low-grade intraepithelial neoplasia (LGIN), and to explore the risk factors related to the progression of LGIN.Methods:The clinical, endoscopic and pathological data of 411 patients with LGIN diagnosed by initial pathological biopsy in the Department of Gastroenterology, the First People′s Hospital of Yichang (the People′s Hospital of China Three Gorges University) from January 1, 2012 to December 30, 2020 were retrospectively analyzed, and were followed up every three to six months and endoscopy and pathological biopsy were performed. The clinical data of patients were collected, which included age, gender, lesion location, lesion size, lesion type, lesion color, lesion appearance, family history of gastric cancer, history of smoking and alcohol intake, history of pickled food, whether complicated with intestinal metaplasia or gastric atrophy and the degree, whether there was Helicobacter pylori infection. According to the results of last follow up, the differences in above factors between progressive and non-progressive patients, and the risk factors for the progression of LGIN were analyzed. Indenpendent sample t test, chi square test, and univariate and multivariate logistic regression were used for statistical analysis. Results:Among the 411 patients with LGIN, there were 261 males and 150 females, the ratio of male to female was 1.74 ∶1; the mean age was (57.5±10.3) years old (30 to 86 years old). The most common clinical symptoms were abdominal pain, abdominal discomfort and abdominal distension, which accounted for 30.7% (126/411), 25.8% (106/411) and 20.9% (86/411), respectively. The lesions of 245 cases (59.6%) located in gastric antrum; the maximum diameter of lesions of 344 cases (83.7%) was 0.5 to less than 2.0 cm; the lesion types of 232 cases (56.4%), 104 cases (25.3%) and 75 cases (18.2%) were prominent type, flat type and depressed type, respectively. The lesion color of 298 cases (72.5%) was red, and that of 113 cases (27.5%) was normal or white. One hundred and seventy-one cases (41.6%) had surface erosion and 61 cases (14.8%) had surface ulcer. Two hundred and seventy-two cases (66.2%) of LGIN were complicated with intestinal metaplasia, and the proportions of mild, moderate and severe intestinal metaplasia were 50.4% (137/272), 33.8% (92/272) and 15.8% (43/272), respectively; 196 cases (47.7%) of LGIN were with gastric atrophy, and the proportions of mild, moderate and severe degree of gastric atrophy were 58.2% (114/196), 29.1% (57/196) and 12.7% (25/196), respectively. Rapid urease test or 14C urea breath test were carried out in 368 cases (89.5%), the positive rate of Helicobacter pylori infection was 45.1% (166/368), and the proportion of male was higher than that of female (59.6%, 99/166 vs. 40.4%, 67/166), and the difference was statistically significant ( χ2=4.537, P<0.05). All 174 patients with LGIN were successfully followed up, and the LGIN lesion of 11.5% (20/174) patients was progressive. The results of univariate analysis indicated that there were statistically significant differences in the lesion location, lesion size, lesion type, lesion appearance, atrophy, family gastric cancer history, history of alcohol intake, and history of pickled food between the patients with progressive lesions (20 cases) and the patients with non-progressive lesions (154 cases) ( χ2=11.950, 22.370, 8.964, 8.552, 10.362, 7.139, 5.913 and 4.668, all P<0.05). The results of multivariate logistic regression analysis showed that lesions in gastric corpus, maximum diameter of the lesion ≥2.0 cm, depressed lesions, ulcer lesions, atrophy, family gastric cancer, history of alcohol intake, history of pickled foods were independent risk factors of the progression of LGIN (odds ratio=4.796, 5.457, 4.431, 3.521, 1.380, 21.405, 3.294 and 1.832, 95% confidence interval 2.028 to 6.431, 3.256 to 8.943, 1.356 to 6.410, 1.305 to 5.706, 1.013 to 2.805, 5.062 to 25.391, 2.012 to 5.826, 1.072 to 3.790, all P<0.05). Conclusions:The lesions located in gastric corpus, maximum diameter of the lesion ≥2.0 cm, depressed lesions, ulcer lesions, atrophy, family gastric cancer history, history of alcohol intake, history of pickled foods are independent risk factors of the progression of LGIN. When the patients with LGIN have these characteristics, endoscopic resection should be considered.

Animals ; Biological Transport, Active/physiology* ; Centrioles/metabolism* ; Cilia/metabolism* ; Mice ; Mice, Mutant Strains ; N-Acetylglucosaminyltransferases/metabolism*