Background The incidence of acute ischemic stroke (AIS) remains high, and a timely restoration of cerebral blood flow is crucial for its prognosis. There are less therapeutic approaches to promote recovery of cerebral blood flow in AIS patients treated beyond a limited time window. The analysis of remote ischemic postconditioning (RIPostC) on the efficacy, complications and prognosis of AIS patients beyond the time window is of great significance. Objective To investigate the role of RIPostC on the prognosis of AIS beyond time window, thus providing a safe and effective cerebral blood flow restoration way for AIS beyond time window. Methods It was a randomized, parallel group, placebo-controlled trial involving AIS patients beyond time window (onset time > 6 h) of thrombolysis who were hospitalized in the Department of Neurology, Beijing Aerospace General Hospital from September 2, 2021 to August 31, 2022. They were randomly assigned into the control group and experimental group, and treated and followed up for 90 days. General treatment and conventional treatment of cerebrovascular disease were performed in both groups. RIPostC and simulated RIPostC were respectively given 28 times within 14 days in the experimental group and control group, respectively. Before the intervention, and 30 days and 90 days after the intervention, neurological function was assessed using the modified Rankin Scale (mRS) and the National Institutes of Health Stroke Scale (NIHSS). Cognitive function was assessed by the Mini-mental Status Examination (MMSE) and Montreal Cognitive Assessment (MoCA). Daily living ability was assessed by the Instrumental Activity of Daily Living (IADL). Mental status was assessed by the Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS). Cerebral blood flow velocity was assessed by the transcranial Doppler ultrasound (TCD). Inflammatory response was assessed by measuring interleukin 6 (IL-6) levels. Results Ninety-nine out of 122 AIS patients finally completed the trial and follow-up, including 49 patients in the experimental group and 50 in the control group. There were no significant differences in gender, age, underlying diseases (hypertension, diabetes, coronary heart disease) and baseline NIHSS scores between the two groups (P>0.05). Repeated measures analysis of variance showed that there was an interaction between time and group on MMSE, MoCA, mRS, NIHSS, cerebral blood flow velocity, and IL-6 (P<0.05). Specifically, the main effects of time and group on MMSE, MoCA, NIHSS, cerebral blood flow velocity, and IL-6 were significant (P<0.05), and the main effects of time on mRS, SAS, SDS, and IADL were significant (P<0.05). The MMSE and MoCA scores and cerebral blood flow velocity on 30 days and 90 days after the intervention were significantly higher in the experimental group than those of the control group, while the mRS and NIHSS scores were significantly lower (P<0.05). The SDS and IADL scores on 30, 90 days after the intervention were significantly lower than those of control group (P<0.05). On 30 days after the intervention, AIS patients in the experimental group had significantly higher SAS score and lower IL-6 level than those of control group (P<0.05). Adverse events were reported in 23 AIS patients, including 17 in the experimental group and 6 in the control group. There was no significant difference in the incidence of skin petechiae, dizziness, palpitation, chest tightness between the two groups (P>0.05). The incidence of skin ecchymosis [4.00% (2/50) vs. 12.24% (6/49) ] and the overall incidence of adverse events [12.00% (6/50) vs. 34.69% (17/49) ] in the control group were significantly lower than those of the experimental group (P<0.05) . Conclusion RIPostC can reduce the inflammatory response in AIS patients, and protect neurological function, cognitive function, depression and intracranial blood flow velocity.

目的 观察多巴丝肼片和盐酸普拉克索片联合用药对帕金森病(PD)患者治疗的效果.方法 入选PD患者分为A组、B组及C组.B组PD患者使用多巴丝肼片进行治疗;C组PD患者使用盐酸普拉克索片进行治疗;A组PD患者同时使用多巴丝肼片和盐酸普拉克索片进行联合用药治疗.评价治疗前后患者的日常活动和运动功能、非运动症状(NMS)情况、生活质量以及临床疗效,记录和统计药物不良反应发生情况.结果 治疗后,A组(88.00％)有效率显著高于B组(44.00％)和C组(40.00％)(均P＜0.05).治疗后,A、B和C组帕金森病综合评分量表(UPDRS)第Ⅱ量表评分分别为(6.78±1.16)、(13.45±1.31)、和(13.32±1.23)分,第 Ⅲ 量表的评分分别为(7.69±1.27)、(14.78±1.45)和(14.54±1.67)分,汉密顿抑郁量表(HAMD)评分分别为为(10.96±2.25)、(18.76±2.47)和(15.54±2.67)分,汉密顿焦虑量表(HAMA)评分分别为(8.62±2.27)、(15.78±2.45)和(18.65±2.56)分,蒙特利尔认知评估量表(MOCA)评分分别为(28.26±2.16)、(17.98±2.13)和(17.67±2.15)分,PDQ-39 总得分分别为(25.24±4.61)、(50.68±5.66)和(49.78±5.64)分,A 组上述指标与B、C组比较,差异均有统计学意义(均P＞0.05).A、B和C组药物不良反应发生率分别为4％、8％和4％,组间比较差异均无统计学意义(均P＞0.05).结论 多巴丝肼联合普拉克索可有效促进PD患者NMS改善,提升患者生活质量.

Background Virtual reality (VR) surgery training has become a trend in clinical education. Many research papers validate the effectiveness of VR-based surgical simulators in training medical students. However, most existing articles employ subjective methods to study the residents’ surgical skills improvement. Few of them investigate how to improve the surgery skills on specific dimensions substantially. Methods Our paper resorts to physiological approaches to objectively study the quantitative influence and performance analysis of VR laparoscopic surgical training system for medical students. Fifty-one participants were recruited from a pool of medical students. They conducted four pre and post experiments in the training box. They were trained on VR-based laparoscopic surgery simulators (VRLS) in the middle of pre and post experiments. Their operation and physiological data (heart rate and electroencephalogram) are recorded during the pre and post experiments. The physiological data is used to compute cognitive load and flow experience quantitatively. Senior surgeons graded their performance using newly designed hybrid standards for fundamental tasks and Global operative assessment of laparoscopic skills (GOALS) standards for colon resection tasks. Finally, the participants were required to fill the questionnaires about their cognitive load and flow experience. Results After training on VRLS, the time of the experimental group to complete the same task could drop sharply ( p < 0.01). The performance scores are enhanced significantly ( p < 0.01). The performance and cognitive load computed from EEG are negatively correlated ( p < 0.05). Conclusion The results show that the VRLS could highly improve medical students' performance and enable the participants to obtain flow experience with a lower cognitive load. Participants' performance is negatively correlated with cognitive load through quantitative physiological analysis. This might provide a new way of assessing skill acquirement.

目的 探讨美金刚联合多奈哌齐对阿尔茨海默病(AD)患者认知功能及神经递质的影响.方法 选取北京航天总医院收治的AD患者100例,随机分为试验组(n=50)、对照组(n=50),对照组予以多奈哌齐治疗,试验组在此基础上予以盐酸美金刚治疗,比较2组临床疗效、AD评定量表的认知分量表(ADAS-Cog)评分、神经精神科问卷(NPI)评分、日常生活能力量表(ADL)评分及血浆神经递质(Ach、5-HT、GABA、Glu)、血清免疫炎性因子(IL-6、TNF-α、CRP)、不良反应发生率.结果 试验组治疗有效率90.00％(45/50例)高于对照组74.00％(37/50例),差异有统计学意义(P＜0.05);治疗后试验组ADAS-Cog评分、NPI评分分别为(25.31±2.69)分、(16.78±1.85)分,均低于对照组(26.65±2.78)分、(20.49±2.18)分,治疗后试验组ADL评分为(55.43±5.63)分,高于对照组(47.08±4.79)分,差异有统计学意义(P＜0.05);治疗后试验组治疗后Ach、5-HT、GABA、Glu分别为(41.25±4.38)nmol·L-1、(68.74±6.93)ng·mL-1、(31.20±3.26)μmol·L-1、(90.41±9.1)μmol·L-1,均高于对照组(32.14±3.36)nmol·L-1、(57.12±5.88)ng·mL-1、(25.78±2.64)μ mol·L-1、(82.36±8.37)μ mol·L-1,试验组血清IL-6、TNF-α、CRP 水平分别为(13.12±1.37)ng·L-1、(4.75±0.49)mg·mL-1、(2.57±0.28)mg·L-1,均低于对照组(15.67±1.55)ng·L-1、(5.42±0.56)mg·mL-1、(2.79±0.31)mg·L-1,差异有统计学意义(P＜0.05).2组不良反应发生率8.00％(4/50例)、4.00％(2/50例)比较差异无统计学意义(P＞0.05).结论 美金刚联合多奈哌齐治疗AD疗效较好,可明显改善患者认知功能、精神症状、神经递质水平,下调炎性因子,提高患者生活质量水平,安全性可靠,有临床推广价值.

目的 确定脑静脉窦血栓形成(CVT)患者院内恶化的影响因素.方法 分析2017年1月至2019年6月期间在北京航天总医院和首都医科大学宣武医院住院治疗的成人初次CVT患者.收集一般人口学资料、入院时临床和影像特征以及院内恶化的信息.院内恶化定义为入院后出现任何新的或恶化的神经系统症状和体征.以出院后1年随访时的mRS来评估功能预后,预后不良定义为残疾或死亡(mRS＞2).通过多因素Logistic逻辑回归分析来确定院内恶化的影响因素以及院内恶化对远期功能预后的影响.结果 共纳入了 138例CVT患者,中位年龄为34岁,81例患者(58.7％)为女性.入院后43例患者(31.2％)出现病情恶化.发病时间是唯一与院内恶化独立相关的因素(OR,0.932;95％CI,0.874-0.993;P=0.029).院内恶化与残疾或死亡独立相关(OR,3.733;95％CI,1.013-13.755;P=0.048).结论 大约30％的CVT患者出现院内病情恶化,入院时发病时间较短的患者可能具有更高的病情恶化的风险,因此需要更密切的病情监护.院内恶化可能与长期预后不良有关.

目的 系统评价我国内地应用达芬奇机器人手术系统与腹腔镜治疗直肠癌的安全性和近期疗效.方法 计算机检索PubMed、Cochrane Library、Embase、Geenmedical、Springer、中国知网、万方等数据库,检索收集我国内地应用达芬奇机器人手术系统与腹腔镜治疗直肠癌的随机对照试验和非随机对照试验.检索时间从各数据库建立至2020年12月,并提取数据资料利用RevMan5.3软件进行Meta分析.结果 共纳入13篇文献,共2060例,其中达芬奇机器人组1001例,腹腔镜组1059例.Meta分析结果表明,与腹腔镜手术比较,达芬奇机器人手术出血量少[MD=-24.92,95％CI(-42.07,-7.77),P＜0.05],获得淋巴结数目多[MD=0.94,95％CI(0.29,1.58),P＜0.05],首次排气时间短[MD=-0.89,95％CI(-1.29,-0.49),P＜0.05],首次进食时间短[MD=-0.85,95％CI(-1.23,-0.46),P＜0.05],术后住院时间短[MD=-0.33,95％CI(-0.65,-0.02),P＜0.05],术后总并发症少[OR=0.70,95％ CI(0.52,0.93),P＜0.05],低位直肠癌保肛率高[OR=3.10,95％CI(2.01,4.77),P＜0.05],中转开腹率低[OR=0.25,95％CI(0.09,0.71),P＜0.05];但住院总费用高[MD=1.51,95％CI(0.91,2.11),P＜0.05];在手术时间、环周切缘阳性率、肿瘤下切缘长度、术后各并发症等结局指标方面两者之间差异均无统计学意义(均P＞0.05).结论 我国内地应用达芬奇机器人手术系统治疗直肠癌安全、可行,且在手术出血量、获得淋巴结数目、首次排气时间、首次进食时间、术后住院时间、术后总并发症、低位直肠癌保肛率、中转开腹率等方面要优于腹腔镜,但住院总费用高.在手术时间、环周切缘阳性率、肿瘤下切缘长度、术后各并发症等方面,机器人并没有表现出明显优势.

目的:探究结直肠癌KRAS基因突变与分化程度及组织类型的相关性研究.方法:选取结直肠癌患者89例,其中26例KRAS突变阳性患者纳入突变组,63例KRAS突变阴性且无其他突变患者纳入未突变组.采用荧光定量PCR Taqman-ARMS探针法测定KRAS基因突变,比较组间的差异性与相关性.结果:结直肠癌患者KRAS突变阳性率的分析结果显示,结直肠癌KRAS阳性率为29.21％;KRAS基因突变在普通腺癌的检出率高于黏液性腺癌,高分化、中分化和低分化的程度与突变与否有统计学差异(P<0.05),在突变组中中分化的比例较高.结论:结直肠癌患者KRAS突变组织学类型和分化程度有明显相关性.

近年来研究发现B族维生素参与了很多重要的生物反应过程,除了在人体代谢中发挥传统的作用外,还可以通过抑制细胞增殖、促进细胞自噬、诱导细胞凋亡等作用机制达到抗结肠癌的作用.临床研究结果提示B族维生素在辅助治疗结肠癌方面起到一定的作用,未来仍需进一步开展B族维生素药理机制研究,并将其逐步应用到结肠癌的治疗中,有望成为更新、更有效的抗结肠癌药物.

Background. Virtual reality-based surgery training has become a promising trend in the sector of clinical education. Prior studies have confirmed the effectiveness of VR-based surgical simulators on training surgeons. Most existing papers employing subjective methods explored the students’ overall perceptions of surgical skills. However, few studies, from the multidimension perspective of learning performance, investigate how VR improves surgery skills. Participants. 37 college students were recruited in comparative experimental research. The experimental group was equipped with a VR + haptic surgical simulator, while the VR simulator without haptic feedback was used for the control group. Method. The study resorted to physiological approaches to investigate the influence of the VR laparoscopic surgical training system on students’ performance. Results. The experimental group scored higher than the control group in flow experience and has better performance in the four dimensions of operation evaluation skills. Conclusion. The study deposited that learners are more likely to exert to flow experience in a learning situation with haptic feedback, which will further improve medical students’ performance.

Objective:To investigate the effect of the adaptive computerized cognitive training(ACCT) on patients with mild cognitive impairment(MCI).Methods:A total of 114 patients with mild cognitive impairment (53 cases in the treatment group and 61 cases in the observation group) were selected.In the treatment group, routine treatment combined with ACCT were given for 24 weeks, then routine treatment only for 24 weeks, 48 weeks altogether. In the observation group, routine treatment was given for 48 weeks.At week 0, 24, 48, both groups were assessed by scales including: mini-mental state examination (MMSE), Montreal cognitive assessment(MoCA), numerical memory span test, activities of daily living, Hamilton depression scale(HAMD)and Hamilton anxiety scale(HAMA). SAS 9.4 was used for statistical analysis.The data were analyzed by χ 2 test, rank sum test and multi-level model analysis. Results:Interactions between group and time on MMSE( treatment group: 0 week 22.0 (21.0, 23.0), 24 weeks 24.0 (24.0, 25.0), 48 weeks 25.0 (24.0, 26.0); observation group: 0 week 23.0 (21.0, 24.0), 24 weeks 23.0 (21.0, 24.0), 48 weeks 23.0 (21.0, 24.0)), MoCA( treatment group: 0 week 18.0 (17.0, 20.0), 24 weeks 22.0 (20.0, 23.0), 48 weeks 22.0 (20.0, 24.0); observation group: 0 week 19.0 (17.0, 20.0), 24 weeks 19.0 (18.0, 20.0), 48 weeks 19.0 (18.0, 20.0)), IADL( treatment group: 0 week 11.0 (10.0, 13.0), 24 weeks 12.0 (10.0, 12.0), 48 weeks 12.0 (10.0, 12.0); observation group: 0 week 12.0 (11.0, 13.0), 24 weeks 11.0 (10.0, 12.0), 48 weeks 11.0 (10.0, 12.0)), DST-forwards and HAMD scores were significant(all P<0.05), and DST-backwards had significant group main effect ( P<0.05). Further simple effect analysis showed that the influence of group and time on MMSE, MoCA and DST-forwards were statistically significant (all P<0.05), and the influence of time on IADL and HAMD were statistically significant (both P<0.05). Further comparison of the difference between the two groups at each time point: D-value of MMSE, MoCA, DST-forwards, and DST-backwards score in the treatment group were higher than those in the observation group, while D-value of HAMD score was lower than that in the observation group, and the differences were statistically significant (all P<0.05). Conclusion:ACCT may have long term effect on improving the cognitive function and depression of MCI patients.

目的 研究旨在识别腹腔感染的危险因素,建立一种能准确预测直肠癌前切除术后腹腔感染的模型.方法 回顾性收集某院胃肠外科2017年12月—2020年9月行直肠癌前切除术患者的临床及病理资料,采用单因素分析及多因素logistic回归分析筛选出直肠癌前切除术后独立危险因素.基于独立危险因素建立列线图风险预测模型,并对其性能进行评价.结果 共纳入247例直肠癌前切除术患者,32例发生腹腔感染,发病率为13.0％.经单因素和多因素logistic回归分析,筛选出糖尿病(OR=4.430,95％CI:1.177～16.668,P<0.05)、手术时间≥180 min(OR=5.502,95％CI:1.459～20.752,P<0.05),以及术后发生吻合口瘘(OR=18.171,95％CI:4.756～69.416,P<0.05)、肺部感染(OR=7.689,95％CI:2.143～27.593,P<0.05)是直肠癌前切除术后发生腹腔感染的独立危险因素.基于此结果建立列线图预测模型,校准曲线显示该列线图模型的预测发生概率和实际发生概率之间一致性较好,Bootstrap法计算出C-index值为0.945,区分度较好,受试者工作特征曲线下面积为0.945(95％CI:0.871～0.971),决策分析曲线显示价值性高.结论 基于直肠癌前切除术后患者发生腹腔感染的独立危险因素建立的列线图预测模型,能直观预测术后发生腹腔感染的概率.

VR based laparoscopic surgical simulators (VRLS) are increasingly popular in training surgeons. However, they are validated by subjective methods in most research. In this paper, we resort to physiological approaches to objectively research quantitative influence and performance analysis of VRLS training system. The results show that the VRLS could highly improve medical students’ performance (p < 0.01) and enable the participants to obtain flow experience with a lower cognitive load. The performance of participants is negatively correlated with cognitive load through quantitatively physiological analysis.

Background VR surgery training becomes a trend in clinical education. Many research papers validate the effectiveness of VR based surgical simulators in training surgeons. However, most existing papers employ subjective methods to study the residents’ surgical skills improvement. Few of them investigates how to substantially improve the surgery skills on specific dimensions.Methods In this paper, we resort to physiological approaches to objectively research quantitative influence and performance analysis of VR laparoscopic surgical training system for medical students. 41 participants were recruited from a pool of medical students. They conducted four pre and post experiments in the training box. In the middle of pre and post experiments, they were trained on VR laparoscopic surgery simulators (VRLS). When conducting pre and post experiments, their operation process and physiological data (heart rate and electroencephalogram) are recorded. Their performance is graded by senior surgeons using newly designed hybrid standards for fundamental tasks and GOALS standards for colon resection tasks. Finally, the participants were required to fill the questionnaires about their cognitive load and flow experience.Results The results show that the VRLS could highly improve medical students' performance (p < 0.01) especially in depth perception and enable the participants to obtain flow experience with a lower cognitive load.Conclusion The performance of participants is negatively correlated with cognitive load through quantitatively physiological analysis. This might provide a new way of assessing skill acquirement.

目的 研究糖化血红蛋白(HbA1c)、25-羟基维生素D[25(OH)D]、尿酸(UA)与急性缺血性脑卒中(AIS)合并脑微出血(CMBs)患者认知功能障碍的关系.方法 选取2017年8月至2020年8月本院接收140例AIS患者临床资料作为研究对象,根据是否合并CMBs进行分组,将合并CMBs者设为研究组(n=76),未合并CMBs者设为对照组(n=64).比较两组患者HbA1c、25(OH)D及UA水平,采用蒙特利尔认知评价量表(MOCA)比较两组患者认知功能情况,采用多元Logistic回归分析影响AIS合并CMBs患者认知功能障碍的危险因素.结果 研究组患者HbA1c、UA水平明显高于对照组,25(OH)D明显低于对照组,差异均有统计学意义(P＜0.05).研究组患者延迟回忆、语言能力、抽象思维、定向力、注意力与计算力、视空间及执行能力评分明显低于对照组,差异有统计学意义(P＜0.05).根据研究组患者认知功能情况进行分组,认知功能良好组34例,认知功能障碍组42例,经多元Logistic回归显示:脑微出血数量(2级)、HbA1c(异常)、25(OH)D(异常)及UA(异常)为影响AIS合并CMBs患者认知功能障碍的独立危险因素(P＜0.05).结论 HbA1c、25(OH)D及UA水平与急性缺血性脑卒中合并脑微出血患者认知功能障碍密切相关,临床上检测其水平对监测患者认知功能障碍具有重要意义.

目的:探讨腹腔镜手术治疗完全性直肠脱垂的术式选择及临床疗效.方法:回顾分析2015年6月至2019年12月为16例完全性直肠脱垂患者行腹腔镜直肠悬吊术及联合其他术式治疗的临床资料,其中5例单纯行腹腔镜直肠悬吊术,6例行腹腔镜直肠悬吊+冗长结肠切除术,3例行腹腔镜直肠悬吊+吻合器痔上黏膜环切术,2例行腹腔镜直肠悬吊+冗长结肠切除+肛门环缩术.结果:16例手术均顺利完成,无中转开腹,术后患者恢复顺利,无并发症发生,术后2～3 d肛门排气,住院6～12 d,平均(8.0±1.8)d.术后随访8～60个月,均未见复发,16例患者术后排便情况良好,生活质量改善.结论:以腹腔镜直肠悬吊术为基础的个体化方案治疗完全性直肠脱垂是安全、可行的,临床疗效满意,值得推广.

目的 探究结直肠癌KRAS基因突变阳性与P53基因及MCC基因的相关性研究.方法 回顾性研究2017年3月至2020年7月于桂林医学院第二附属医院确诊为结直肠癌患者89例,将其中26例KRAS突变阳性患者纳入突变组,63例KRAS突变阴性且无其他突变患者纳入未突变组.采用荧光定量PCR Taqman-ARMS探针法测定KRA S基因突变;免疫组织化学方法对P53基因、MCC基因表达进行检测,比较组间的差异性与相关性.结果 通过对89例结直肠癌患者KRA S突变阳性率的分析,结果显示26(29.21％)KRAS突变阳性,未突变患者为63(70.79％);结直肠癌KRAS阳性率为29.21％;KRAS突变组MCC突变阳性效率6(23.08％)显著低于未突变组27(42.86％)差异有统计学意义(P<0.05);KRAS突变组P53突变阳性效率8(30.77％)著低于未突变组40(63.49％)差异有统计学意义(P<0.05);KRAS突变与P53、MCC呈负相关.结论 结直肠癌KRAS突变与P53、MCC呈显著的负相关关系.

特发性大网膜节段性梗死(idiopathic segmental greater omental infarction,ISGOI)是一种原因不明的大网膜急性血液循环障碍疾病[1],临床表现缺乏特异性,极易误诊为急性阑尾炎等其他急腹症[2].本病很少见,我们以"idiopathic segmental greater omental infarction"为检索词在PubMed检索出文献仅64篇,绝大多数为1例报道.我院2020年9月收治1例ISGOI,报道如下.

目的:探讨洛铂腹腔灌注化疗对进展期结直肠癌裸鼠动物模型的治疗效果,从而为进展期结直肠癌的临床多途径治疗及预后等提供有效的实验依据.方法:将结直肠癌细胞株lovo种植于balb/c裸鼠腹腔中,将成瘤成功且符合实验标准的balb/c裸鼠再随机分为对照组(10只)、实验组(10只),对照组腹腔注射0.9％氯化钠溶液,实验组腹腔注射洛铂溶液(洛铂10mg/kg+5％GS).两组每隔7d给药1次,每隔4d称量并记录裸鼠重量、观察并记录两组裸鼠存活情况,最后剥瘤称重并计算抑癌率.实验时间为50d.结果:经分析数据,对照组裸鼠肿瘤重量高于实验组(P<0.05),实验组抑癌率高于对照组(P<0.05),实验组裸鼠重量高于对照组(P<0.05);实验组平均生存时间高于对照组(P<0.05).结论:洛铂腹腔灌注化疗对裸鼠进展期结直肠癌生长具有明显抑制作用并延长成瘤裸鼠的存活时间.

目的 探讨急性脑梗死(acute cerebralinfarctio,ACI)患者脑微出血(cerebral microbleeds,CMBs)相关因素及其对认知功能、预后的影响.方法 选取北京航天总医院2016年7月至2020年7月收治的182例ACI患者,根据合并CMBs情况分为CMBs组(64例)和非CMBs组(118例).比较两组患者的临床治疗、认知功能及预后,探讨引起ACI患者CMBs的危险因素,分析CMBs对ACI患者认知功能及预后的影响.结果 CMBs组年龄>65岁、高血压、高胆固醇血症、腔隙性脑梗死、脑白质疏松症、高同型半胱氨酸血症的患者比例均高于非CMBs组(P<0.05);多因素logistic回归分析显示,年龄>65岁、高血压、高胆固醇血症、腔隙性脑梗死、脑白质疏松症、高同型半胱氨酸血症是影响ACI患者发生CMBs的独立危险因素(P<0.05);CMBs组语言功能、注意力、记忆力、命名、定向力、抽象思维、视空间与执行功能等维度评分均低于非CMBs组(P<0.05);CMBs组预后不良发生率为34.38％高于非CMBs组的16.10％(P<0.05).结论 年龄>65岁、高血压、高胆固醇血症、腔隙性脑梗死、脑白质疏松症、高同型半胱氨酸血症等因素会增加ACI患者CMBs的风险,CMBs会损伤ACI患者的认知功能,影响预后.

In recent years, virtual reality (VR) based training has greatly changed surgeons learning mode. It can simulate the surgery from the visual, auditory, and tactile aspects. VR medical simulator can greatly reduce the risk of the real patient and the cost of hospitals. Laparoscopic cholecystectomy is one of the typical representatives in minimal invasive surgery (MIS). Due to the large incidence of cholecystectomy, the application of its VR-based simulation is vital and necessary for the residents' surgical training. In this paper, we present a VR simulation framework based on position-based dynamics (PBD) for cholecystectomy. To further accelerate the deformation of organs, PBD constraints are solved in parallel by a graph coloring algorithm. We introduce a bio-thermal conduction model to improve the realism of the fat tissue electrocautery. Finally, we design a hybrid multi-model connection method to handle the interaction and simulation of the liver-gallbladder separation. This simulation system has been applied to laparoscopic cholecystectomy training in several hospitals. From the experimental results, users can operate in real-time with high stability and fidelity. The simulator is also evaluated by a number of digestive surgeons through preliminary studies. They believed that the system can offer great help to the improvement of surgical skills.