The ideological and political education in standardized residency training plays an important role in cultivating medical talents with noble medical ethics and exquisite medical skills. Teaching evaluation is an important method to promote teaching improvement and optimization. However, there are still some problems and challenges in the evaluation of ideological and political education for standardized residency training. This article proposes the ideological and political education of standardized residency training can be comprehensively evaluated by the context-input-process-product evaluation model from four aspects: background, input, process, and result evaluation. The aim is to provide solid support and guidance for the ideological and political education route in standardized residency training.
Objective To compare the therapeutic effects between endoscopic thyroidectomy by anterior chest approach and modified Miccoli thyroidectomy. Methods Sixty patients with thyroid goiter were performed endoscopic thyroidectomy by anterior chest approach (endoscopic thyroidectomy by anterior chest approach group, n=30) and modified Miccoli thyroidectomy (modified Miccoli group, n=30) respectively. The operative time, the drainage volume, cosmetic benefit, the postoperative hospitalization time, the expenses of hospitalization and postoperative complications of two groups were compared. Results The operative time and the drainage volume after operation of endoscopic thyoidectomy by anterior chest approach group were significantly more than modified Miccoli group 〔(99.9±23.4) min vs. (74.0±29.6) min; (68.6±8.7) ml vs. (40.9±6.1) ml, respectively〕, Plt;0.05. The cosmetic benefit score of endoscopic thyoidectomy by anterior chest approach group was higher than that of modified Miccoli group 〔(4.7±0.2) points vs. (3.7±0.1) points〕, Plt;0.05. The postoperative hospitalization time and expenses of hospitalization were no significant differences between the two groups 〔(6.5±1.7) d vs. (5.5±0.9) d; (9 328.3±1 107.1) yuan vs. (8 568.2±1 032.3) yuan, respectively〕, Pgt;0.05. One case had transient hoarseness in 2 groups respectively, no other complications happened. Conclusions Modified Miccoli operation is both minimally invasive and cosmetic, but endoscopic thyroidectomy by anterior chest approach has better cosmetic benefit, which can release patients’ psychological trauma. The patients with specific cosmetic demand may choose endoscopic thyroidectomy by anterior chest approach.
Objective To investigate the effectiveness of modified percutaneous suture in repairing acute closed Achilles tendon rupture by comparing with conventional open suture. Methods Between January 2006 and October 2009, 50 patients with acute closed Achilles tendon rupture were treated with modified percutaneous suture by making 5 small incisions at both sides of Achilles tendon and zigzag suture (improved group, n=22) and with Kessler suture (conventional group, n=28), respectively. No significant difference was found in gender, age, time from injury to operation between 2 groups (P gt; 0.05). Results In improved group, the patients achieved healing of incisions by first intention after operation and nocomplication occurred; however, incision infection occurred in 1 case, Achilles tendon re-rupture in 1 case, and incision scar contracture in 2 cases in conventional group. The operation time of improved group [(38.7 ± 6.6) minutes] was significantly shorter (t= —12.29, P=0.00) than that of conventional group [(52.3 ± 6.9) minutes]; the blood loss of improved group [(4.9 ± 2.0) mL] was significantly less (t= —25.20, P=0.00) than that of conventional group [(40.7 ± 7.1) mL]. The patients were followed up 2-3 years (mean, 29.9 months). The American Orthopaedic Foot and Ankle Society (AOFAS) score was 99.6 ± 1.0 in improved group and was 98.4 ± 3.0 in conventional group, showing no significant difference between 2 groups (t=1.66, P=0.10). Conclusion Comparison with conventional open suture, modified percutaneous suture has some advantages, such as easy operation, less complications, rapid recovery of limb function, and so on. Modified percutaneous suture is one of the best choices for the treatment of acute closed Achilles tendon rupture.
Objective To evaluate the effect of the modified extended iliofemoral approach on treatingcomplex acetabular fractures. Methods Thirty-six cases of complex acetabular fractures were treated by the open reposition and internal fixation by a modified extended iliofemoral approach. Results Thirty-sixcases were followed up for 7-46 months, with an average of 23.8 months. According to the Matta standard, anatomical reposition was performed in 24 cases, perfect reposition in 8 cases, and unsatisfactory reposition in 4 cases. By the modified d’Aubignepostel score, among the 36 cases, 22 had an excellent result, 9 had a good result, and 5 had a poor result. Conclusion Themodified extended iliofemoral approach facilitates the operative exposure of the anterior and posterior walls and both columns of the acetabulum in the surgically-treated acetabular fractures by the open reposition and internal fixation.Because of the reconstruction, the functions of the abductor muscle mass managed by the lagscrew-fixed osteotomies of the iliac crest, and greater trochanter, the patients can achieve a rapid rehabilitation of the joint.
目的 探讨乳腺癌改良根治术后影响局部复发与远处转移的相关因素。方法 对陕西省汉中市铁路中心医院略阳医院2000年3月至2007年3月期间行乳腺癌改良根治术且资料完整的637例原发性乳腺癌患者的临床资料进行回顾性分析。结果 66例（10.36%）患者术后发生局部复发和远处转移，其中局部复发50例（7.85%），远处转移16例（2.51%）；术后3～4年内发生复发与远处转移者47例（71.21%）。术后复发和远处转移与患者年龄、肿瘤大小、腋窝淋巴结转移情况、TNM分期、激素受体（ER/PR）表达情况及术后是否接受正规的辅助治疗有关，与患者有无家族史无关。结论 肿瘤大小、腋窝淋巴结转移情况、TNM分期、ER/PR表达情况及术后是否接受正规的辅助治疗是影响乳腺癌改良根治术后复发与远处转移的危险因素，重视乳腺癌术后随访，规范乳腺癌的手术方式，强化乳腺癌的综合治疗是降低乳腺癌改良根治术后复发与远处转移率的主要措施。
Objective To compare the clinical effect between high flow rate modified ultrafiltration （HMUF） and conventional modified ultrafiltration（CMUF）, and the effect on hemodynamic data and inflammatory mediators. Methods Forty children were divided into two groups with random number table, HMUF group and CMUF group, 20 cases each group. Hematocrit （HCT） and hemodynamic changes were recorded and the concentration of tumor necrosis factor （TNF） and interleukin 6 （IL-6） were measured. Results The operations were done uneventfully with moderate hypothermia cardiopulmonary bypass in 40 patients. Duration of ultrafiltration of HMUF group （7.83±0. 75 min） was less than that of CMUF group （13.86±1.95 min, P〈0.01）. The volumes ultrafiltrated of HMUF group （440.00±91.86ml） was more than that of CMUF group （372.22±56.52ml, P〈0.01）. There are no significant differences about the hemodynamic data, HCT, TNF and IL-6 between two groups. Conclusion The HMUF is safe and efficient,when it was used after pediatric cardiopulmonary bypass, the duration of ultrafiltration can be shortened significantly.
ObjectiveTo explore the clinical efficacy of modified polytetrafluoroethylene (PTFE) prosthesis rhinoplasty for correction of low nose and short columella. MethodsBetween August 2012 and August 2015, modified PTFE prosthesis rhinoplasty was used to correct low nose and short columella in 52 patients. There were 4 males and 48 females, aged 19 to 45 years (mean, 27 years). Primary rhinoplasty was performed in 47 cases; secondary rhinoplasty was performed in 5 cases, and it was 12-18 months from the first operation (mean, 15 months). During operation, a scaly sag ventral side was made by carving and moving cap shaped nose prosthesis was prepared, and nasal dorsumnasal columella prosthesis covered by tension-free flap was designed. At pre-operation and last follow-up, Image ProPlus 6.0 software was used to measure the nose length, nose depth, nose tip width, nostril/nose tip, nasolabial angle, and nasal tip rotation for evaluation of external nose shape correction; and ultrasound was used to measure the alar cartilage angle, alar two vertex distance, and nose tip to vertex distance for evaluation of internal soft tissue changes; the prosthesis position was observed by CT scan at 12 months. ResultsAll incisions healed by first intention, with no complications. All patients were followed up 7-36 months (mean, 20.4 months). At 12 months after operation, CT scans showed that prosthesis located in the middle of the nose and above nasal bone, septal cartilage and crus mediale cartilaginis alaris majoris in 45 patients; no prosthesis displacement was observed. At last follow-up, image measurement and ultrasound results showed external nose shape parameters (except nostril/nose tip) and internal soft tissue structures were significantly improved when compared with preoperative values (P < 0.05). ConclusionModified PTFE prosthesis rhinoplasty can effectively correct low nose and short columella, with small surgical trauma and good appearance.