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Medical virtual simulation experimental teaching platform has the characteristics of high openness and sharing, overcoming resource constraints, diversified teaching methods and so on. Applying the virtual simulation platform to general surgery teaching, students can break through the constraints of the textbooks, and perform immersive practical operations on the network by watching experimental videos, and simulating virtual instrument, and experimental materials online, so as to improve their hands-on skills and increase their interest in learning.
ABSTRACT
Objective To investigate the effects of Buyang Huanwu decoction and its decomposed recipes on neurological function and angiogenesis after focal cerebral ischemia in rats and its mechanism. Methods Fifty-two clean grade SD male rats were randomly divided into sham-operation,model,whole prescription,invigorating qi,and promoting blood circulation groups (n = 8 in each group)according to the random number table. In addition to the sham-operation group,the middle cerebral artery occlusion models of the rats in other groups were induced by the suture method. The patients with the first Longa nerve function scores 1 to 3 were used as successful modeling. The whole Buyang Huanwu decoction included dried root of Astragalus membranaceus 120. 0 g,dried root of angelica sinensis 6. 0 g,dried root of Paeonia lactiflora 4. 5 g, dried rhizome Ligusticum chuanxiong 3. 0 g,dried body of Pheretima aspergillum 3. 0 g,dried flowers of Carthamus tinctorius 3. 0 g,and seed of Prunus persica 3. 0 g;the invigorating qi prescription included dried root of Astragalus membranaceus 120. 0 g;the promoting blood circulation prescription included dried root of angelica sinensis 6. 0 g,dried root of Paeonia lactiflora 4. 5 g,dried rhizome Ligusticum chuanxiong 3. 0 g, dried body of Pheretima aspergillum 3. 0 g,dried flowers of Carthamus tinctorius 3. 0 g,and seed of Prunus persica 3.0 g. On the first day after procedure,the rats began to be administered intragastrically. The intragastric doses of the whole prescription group,invigorating qi group,and promoting blood circulation group were 13. 1,10. 8,and 2. 2 g/ kg,respectively. The sham-operation group and the model group were given equal volume of isotonic saline,once a day for 14 days. 5-bromodeoxyuridine (BrdU,50 mg/ kg)were injected intraperitoneally,once a day for 14 days. The modified neurological severity score (mNSS)and the corner test were used to evaluate sensorimotor function at day 1,7 and 14 after procedure. BrdU and rat von Willebrand factor (vWF)double immunofluorescent staining were used to detect the angiogenesis in ischemic peripheral region;Western Blot was used to detect the protein expression of vascular endothelial growth factor (VEGF). Results (1)Compared with the model group,the mNSS score in rats in the whole prescription group was lower at day 7 and 14 after procedure (6. 8 ±1. 0 vs. 8. 5 ±1. 1,6. 1 ± 0. 8 vs. 8. 0 ± 1. 4;all P < 0. 01). The number of turning right in the whole prescription group was reduced (7. 1 ±0. 6 vs. 8. 6 ±1. 2 and 6. 1 ± 0. 8 vs. 7. 9 ±1. 1;all P < 0. 01). The number of turning right in the invigorating qi group was reduced (7. 5 ± 0. 5 vs. 8. 6 ± 1. 2 and 6. 2 ± 1. 0 vs. 7. 9 ± 1. 1;all P < 0. 01). At day 14 after procedure,the number of BrdU / vWF co-labeled immunopositive cells in ischemic peripheral zone of the whole prescription group was increased significantly. There was significant difference between the groups (30 ± 8 / mm2 vs. 24 ± 7 / mm2;P < 0. 01). The VEGF protein expression was increased (0. 33 ±0. 01 vs. 0. 30 ±0. 01;P <0. 01). (2)Compared with the invigorating qi group,the rat mNSS scores of the whole prescription group were lower at day 7 and 14 after procedure (the invigorating qi group 8.2 ±1.3 and 7.5 ±0.9 respectively;all P <0. 05). The number of BrdU/ vWF immunopositive cells in the whole prescription group was increased at day 14 after procedure (26 ±5/ mm2 in the invigorating qi group;P < 0. 05). The VEGF protein expression was increased (0.31 ±0.01 in the invigorating qi group;P <0.01). (3)Compared with the promoting blood circulation group, the mNSS scores of the whole prescription group were lower at day 7 and 14 after procedure (the promoting blood circulation group 8.5 ±0.9 and 7.6 ±0.7 respectively;all P <0. 05). The number of turning right was reduced (8.5 ±0. 8 and 7. 6 ± 0. 9 respectively in the promoting blood circulation group;all P < 0. 05). The number of BrdU/ vWF immunopositive cells in ischemic peripheral zone of the whole prescription group at day 14 after procedure was increased (26 ± 6 / mm2 ,P < 0. 05). The relative expression level of VEGF was increased (0. 31 ±0. 01 in the promoting blood circulation group,P <0. 05). Conclusion Buyang Huanwu decoction can promote angiogenesis and recovery of neurological function after cerebral ischemia. Its mechanism may be associated with the up-regulation of the VEGF protein. The traditional Chinese medicines for invigorating qi and invigorating the circulation of blood in the prescription have synergistic effect.
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The anatomy and position of choledocho-pancreatico-duodenal junction are unique,so choledocho-pancreatico-duodenal junction is easily be injured during operation,and thus it needs further investigation.Anatomical,pathological and iatrogenic factors are the 3 main causes of choledocho-pancreatico-duodenal junction injury.The diagnosis of choledocho-pancreatico-duodenal junction injury includes intraoperative and postoperative diagnosis; and the treatment methods include intraoperative repaire and suture,T tube drainage,postoperative debridement and drainage,biliopancreatic shunt,duodenal diverticulum,jejunum stoma,gastrointestinal and biliary reconstruction.Precise operation,T tube cholangiography,choledochoscopy can effectively prevent the choledocho-pancreatico-duodenal junction injury.The principle of early discovery,early management,avoiding over-management,and promoting damage control surgery should be awared to reduce the mortality.
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Hepatocellular carcinoma (HCC) in nonimpaired livers are a type of HCCs arising in non-cirrhotic,non-fibrotic livers without viral hepatitis or alcohol abuse.Liver resection is the major form of treatment.Factors considered when developing a prognostis include R0 liver resection,hepatocellular function,recurrence,vascular invasion,transfusion,tumor size,tumor number,tumor capsule,and daughter nodules.So the prognosis can be predicted through the analysis of these factors during preoperative and perioperative period. The curative effects of the operation can be enhanced by optimizing treatment based on the analysis of these prognostic factors.