Objective:To investigate the effect of virtual-simulation laparoscopic training system in the training of basic skills of endoscopic surgery in trainees with different clinical experience.Method:s Eight refresher physicians, eight residents who received standardized residency training, and eight undergraduate interns in five-year clinical medicine were selected. All of them received the training of endoscopic operations with the laparoscopic training box and the virtual-simulation laparoscopic training system for 30 minutes every day for 4 weeks. Data analyses were performed using SPSS 19.0 and t-test was adopted to compare the scores before and after training among the three groups.Result:s Before training, there were significant differences in endoscopic operations between the undergraduate intern group and the other two groups ( P<0.05); after 4 weeks of training, all three groups had significant increases in the scores and spent less time on training items ( P<0.05). There was no significant difference in simple operations among the three groups ( P>0.05), and the undergraduate intern group had a significantly higher score of complex operations than did the standardized residency training group and the refresher physician group ( P<0.05). Conclusion:The virtual-simulation laparoscopic training system can improve the laparoscopic skills of clinical trainees at different levels, therefore, it is worth being promoted in the teaching of clinical skills.

目的 分析尿路造影(CTU)三维重建技术在上尿路疾病中的诊断价值.方法 对2017年1月至2019年1月临床140例疑似上尿路病变患者进行CTU扫描,由2名放射学医师分别行最大密度投影(MIP)、多平面重建(MPR)和曲面重建(CPR),并与临床及病理结果对照分析.结果 CTU三维重建技术对上尿路病变的诊断敏感度为98.32％、特异度76.19％、准确度95.68％、阳性预测值为95.90％、阴性预测值88.89％、阳性似然比4.13、 阴性似然比0.02.主要为输尿管结石47.01％,尿路上皮癌23.93％,炎性病变占9.40％,肿瘤侵犯占9.40％.结论 CTU三维重建技术全面显示上尿路整体情况、准确显示病变形态、范围及其CT表现,有很好的临床诊断价值.

目的 探讨乳腺癌钼靶X线恶性钙化征象与雌激素受体(ER)、孕激素受体(PR)、人表皮生长因子受体2 (HER-2)、增殖细胞核抗原Ki-67表达的关系.方法 选择初诊乳腺癌患者81例,术前均接受乳腺钼靶X线检查,根据有无恶性钙化征象分为有恶性钙化组36例、无恶性钙化组45例.取两组手术切除的乳腺癌组织,采用免疫组化SP法检测ER、PR、HER-2、Ki-67表达.结果 有恶性钙化组ER、PR阳性表达率均低于无恶性钙化组,而HER-2、Ki-67阳性表达率均高于无恶性钙化组(P均＜0.05).结论 乳腺癌钼靶X线恶性钙化征象可在一定程度上反映肿瘤ER、PR、HER-2、Ki-67表达情况,这为乳腺癌术前辅助内分泌治疗和预后判断提供了更多有价值的参考信息.

医务人员的专业素质在我国医疗卫生事业的发展中起到了重要的作用,各级医院为提高医务人员素质,加强人才开发,积极开展各类继续医学教育项目.该文基于实际工作经验,总结了作者所在单位的继续医学教育开展情况,并针对存在的问题在继续医学教育项目开展中采用新模式,充分利用现代化信息技术高质量地完成各类项目,提高学员主动学习的积极性,达到项目既定的培训效果,提升医护人员的诊疗水平.

全国高等医学院校大学生临床技能竞赛由教育部、财政部、卫生部主办,教育部医学教育临床教学中心承办,旨在培养医学生临床专业技能操作的规范性及运用能力,倡导相互协作的团队精神及创新意识,培养其科学精神及人文素养.芜湖市第二人民医院是皖南医学院非直属附属医院,从2001年起承担皖南医学院的临床理论教学与临床实习带教工作.笔者为芜湖市第二人民医院科研教学处专职临床教学工作管理人员,本文主要探讨临床技能竞赛对非直属医院临床教学改革的作用.

国家对住院医师规范化培训项目越来越重视,芜湖市第二人民医院积极响应国家政策,开展住院医师规范化培训工作.通过以芜湖市第二人民医院住院医师规范化培训应用"导师制"培训模式为例,阐述导师制的内涵、起源和特点,以及实行导师制的必要性,并探讨应用"导师制"模式实施方案.

Objectives Since a genome-wide association study revealed that Interleukin-23 receptor (IL-23R) gene is a candidate gene for Ulcerative Colitis (UC), many studies have investigated the association between the IL-23R polymorphisms and UC. However, the results were controversial. The aim of the study was to determine whether the IL-23R polymorphisms confer susceptibility to UC. Methods A systematic literature search was carried out to identify all potentially relevant studies. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were used to estimate the strength of association. Results A total of 33 studies in 32 articles, including 10,527 UC cases and 15,142 healthy controls, were finally involved in the meta-analysis. Overall, a significant association was found between all UC cases and the rs11209026A allele (OR = 0.665, 95% CI = 0.604~0.733, P < 0.001). Similarly, meta-analyses of the rs7517847, rs1004819, rs10889677, rs2201841, rs11209032, rs1495965, rs1343151 and rs11465804 polymorphisms also indicated significant association with all UC (all P < 0.05). Stratification by ethnicity revealed that the rs11209026, rs7517847, rs10889677, rs2201841 andrs11465804 polymorphisms were associated with UC in the Caucasian group, but not in Asians, while the rs1004819 and rs11209032 polymorphisms were found to be related to UC for both Caucasian and Asian groups. However, subgroup analysis failed to unveil any association between the rs1495965 and rs1343151 polymorphisms and UC in Caucasians or Asians. Conclusions The meta-analysis suggests significant association between IL-23R polymorphisms and UC, especially in Caucasians.

为进一步探索医学教学改革,促进学校与医院联合办学,强化联合培养医学生的力度,实现应用型人才培养目标,南通大学杏林学院与芜湖市第二人民医院于2013年起联合实行见习实习一贯制的教学模式.

China has paid more and more attention to the standardized training management on resident doctors in the hospital. The Second Peopleu0027s Hospital of Wuhu City followed the policy guidance, and carried out standardized residency training. Through taking The Second Peopleu0027s Hospital of Wuhu City as an example, the background and present situation of the standardized training of resident doctors and the management for the trainees were introduced to provide reference for the sustainable improvement in the training management.

Objective:To explore the effect of a comprehensive hospital with the help of doctor-patient communication skills training for medical personnel doctor-patient communication skills in modern psychoso-matic medicine mode.Method:In 2012 and 2013 a hospital clinicians were recruited physicians and medi-cal technology as the experimental group of 42 people to the hospital clinical work as a doctor in the control group 40 cases, according to"occupational physicians standardized training rules"requirement, the Court of this science physician clinicians and medical technology approved all of the new posts of occupational physi-cians standardized training, relevant scale surveys before and after the training results of two doctors differ-ences.Result:Before training the experimental group and the control group of physicians coping style com-parison of six factor questionnaire showed no significant differences ( P>0.05) .Factor after receiving training experimental group physicians to solve the problem is obviously higher than that of the control group, the difference was statistically significant (P <0.05).reflect the other five factors:.Fantasy coping style, self blame, withdrawal, rationalization factor for help, the difference between the two groups was not statistically significant (P>0.05).Conclusion: The results of the study show that the lack of medical knowledge and current clinicians do exist doctor-patient communication ability of psychosomatic, my courtyard through the training of doctor-patient communication skills model of psychosomatic medicine, the training is helpful to improve the doctor-patient communication skills, occupation accomplishment, reduce the occupation burn-out, coping ability, alleviate depression.It is worth of popularization in hospitals of all levels.

住院医师规范化培训是毕业后医学教育的重要组成部分,住院医师在规范化培训阶段加强沟通能力的培养,对今后适应临床工作及形成和谐医患关系至关重要. 从加强医患沟通技能培训的重要性入手,对医患沟通技能培训方法、机制及考核进行总结,为持续改进培训工作提供参考.

Objective:To analyze CT features and pathologic findings of cystic renal cell carcinoma( CRCC ). Methods:Nine cases were confirmed by operation and pathology and the clinical and imaging data of cystic renal cell carcinoma were retrospectively analyzed. Results:Of the 9 patients,2 cases of female,7 cases of male,lesions were solitary,mostly exophytic growth. CT plain scan in 2 cases,cystic solid in 7 cases,debris or floc in 5 cases of cystic contents in 2 cases,cystic wall nodular calcification. After enhancement,cystic wall separating and mural nodule showed thickness ranging from false tumors all around,see section cavitysingle or with different sizes,including serous or bloody fluid. Cystic epithelial tumor cells coated with transparent microscopically. Conclusion:Cystic renal cell car-cinoma CT showed solitary,cystic wall,partition and mural nodule showed varying degrees of enhancement,has certain characteristics.

Objective To evaluate the value of renasons for hematuria with 16-multiple slice spiral CT Urography.Methods 62 cases with hematuria confirmed by operotion or clinical.All patients underwent CT urography.The image of CT urography were obtanined by different three dimensional reconstruction.Reconstructed images including curved planar reconstruction(CPR),maximum intensity projection(MIP),multiplanar reconstruction(MPR) and volume endering(VR).Results In 62 cases,16-multiple slice spiral CT Urography detected neoplasm of urinary system in 19;stone of urinary in 26;renal and uretal tuberculosis or inflammation in 5;renal and uretal congenital malformation in 3.Conclusion 16-multiple slice spiral CT urography is of significant applied value in diagnosis in patients with hematuria.It may serve as one of the primary imaging method to evaluation of renasons for hematuria.

Objective To evaluate the utility of multislice spiral CT with volume rendering technique(VRT) in cranioplasty of patients with skull defect and to study the applied technic of computer aided personalized titanium mesh.Methods Thirty patients with skull defect underwent MSCT scans and then CT data were transferred into workstation and reconstructed by using computer aided design(CAD) and computer aided manufacture(CAM) technique for personalized skull defect prefabricated prosthesis and clinical application.Results Three-dimensional model acquired from CT data accurately showed the structures of skull defect region,chimeric prosthesis satisfaction without complications.Conclusion Multislice spiral CT with three-dimensional reconstruction technique plays important role in the cranioplasty of patients with skull defect.

目的应用CT脑血管造影(CTA)减影技术来研究脑底动脉环的结构显示情况。方法对所选的39例患者分别进行平扫和增强扫描,利用减影法CT血管造影技术将初始数据运用容积再现和最大密度投影方法来进行后处理,最后统计各支血管结构的显示状况。结果所有39例患者造影图像中,分别检出大脑前动脉发育不良4例;大脑后动脉发育不良4例。结论减影法CTA结合常规的CTA血管造影技术对脑底动脉环结构及其解剖变异能够良好地显示。

目的评价共轴针法在胸部病变穿刺活检中的临床意义.方法联合应用17G、18G切割针和21G抽吸针、PTC针对139例胸部病变进行CT导引下穿刺活检,病灶直径1.2～7.8cm,其中直径＜3cm者32例.结果139个病灶共取材291次.活检总阳性率90.7%(126/139),细胞学阳性率和组织学阳性率分别为61.2%(80/130)和84.8%(117/138).穿刺后发生气胸11例,轻度咯血6例.结论CT导引下胸部病变的穿刺活检是一种安全、有效的检查方法,影响并发症发生率的原因主要取决于患者的体质状况和穿刺次数,细针抽吸和粗针切割活检联合应用可以提高诊断率.