A comprehensive indicator system and empirical study for evaluating the teaching effect of laparoscopic simulation training / 中华医学教育探索杂志

We reviewed and developed an indicator system framework for assessing teaching effect of laparoscopic simulation training through literature research, expert consultation, analytic hierarchy process and factor analysis. We also made an empirical study on the constructed index system. The system included 3 domains (A1: evaluation of laparoscopic simulator; A2: operation evaluation of experimental animals; A3: evaluation of clinical practice), 10 second-level indicators and 23 third-level indicators for assessing teaching effect of laparoscopic simulation training. The indicator system framework has good internal consistency (Cronbach α= 0.968) and external consistency (>0.72). The empirical study found that: in the results of A1-A3 in the first level indicator, the score of the experienced group was significantly higher than that of the inexperienced group ( P<0.05). In the evaluation results of the 10 secondary indicators in the secondary indicators B1-B10, the score of the experienced group was significantly higher than that of the inexperienced group ( P<0.01). For the first time, we have established and evaluated a comprehensive evaluation indicator system which is reliable and effective and can be used for further evaluation of teaching effect of laparoscopic simulation training. The following empirical studies have verified the effectiveness and practicability of the evaluation system.

Application of the original laparoscopic simulator in the laparoscopy simulation training / 中华医学教育探索杂志

Objective:To make an empirical study on verifying whether the self-developed simple laparoscopic simulator can play a good role in the training of laparoscopic skills.Methods:Twenty-four Batch 2018 and Batch 2019 undergraduates of five-year clinical medicine of the Army Medical University were recruited in this study, and they were randomly divided into a research group and a control group for 4 weeks of simulation training, 3 times a week, 1 class hour each time. The training content was fundamental laparoscopic skills (FLSs). Before and after the training, the assessment was performed and the results and completion time were recorded. After the training, a satisfaction questionnaire was conducted among all trainees. SPSS 22.0 was used for data statistical analysis.Results:There was no statistical difference between the completion time and assessment results of the two groups before training ( P > 0.05). After four weeks of training, the completion time of the research group was shortened by 10.03% and the training performance increased by 35.17%; the completion time of the control group was shortened by 2.09%, and the training performance improved 12.34%. The comparison between groups found that the research group was superior than the control group, and the performance of the two groups were all improved after training. Most trainees recognized the simulator and were willing to promote it to other trainees according to the questionnaire feedback. Conclusion:The original laparoscopic simulator has a better training effect on simulation training than the traditional apprenticeship teaching has, which is of great significance for the promotion and optimization of laparoscopic skills teaching.

Endovascular treatment of ureteral stenosis:a report of 628 cases / 局解手术学杂志

Objective To summarise and analyze the clinical effecacy of endovascular treatment(internal holmium laser incision,bal-loon dilation,ureter dilator,rigid ureter dilation)for ureteral stricture.Methods The clinical data of 628 patients from January 2010 to Jan-uary 2015 in our hospital were analyzed.The relevant operation indicators,postoperative complications and recovery condition were recorded and analyzed.Results The operation time was 5.5 to 29 minutes,with average time of 16.5 minutes,no ureteral avulsion,ureteral fragmen-tation and massive haemorrhage happened.All patients were followed up for 6 to 36 months,591 cases(94.1%)were cured,29 cases (4.6%)of postoperative stricture recurrence received endovascular treatment again,8 patients(1.3%)conversion to open ureterolithotomy. Conclusion Endovascular treatment of ureteral stricture is diversified within holmium laser incision,it has the advantages of shorter opera-tion time,fewer complications,less trauma,repeatability and so on,which is an effective and safe treatment method.

Retrospective study of the safety and effectiveness of transurethral resection of the prostate for be-nigh prostatic hyperplasia in large prostates / 中华泌尿外科杂志

Objective To discuss the safety and effectiveness of transurethral resection of the prostate (TURP) on large-size (≥ 80 ml) benign prostatic hyperplasia (BPH).Methods Retrospective analysis of 958 BPH patients in Southwest Hospital during January 2010 to January 2013 was conducted.The patients were grouped into ≥80 ml prostate group (Group A) and ＜80 ml prostate group (Group B) according to the volume of prostate.Comparison was made between the 2 groups on the safety and effectiveness of TURP.Results There were 276 patients in Group A and 682 in Group B.No significant differences were shown in average age and preoperative American society of anesthesiology score of Group A and B.Compared with Group B,decrement in hemoglobin level and blood Na+ concentration of Group A was more significant (P＜0.01).There were more prostate tissues excised and duration of the operations was longer (P＜0.01).No significant difference was observed in peri-operative complications graded by the modified Clavien classification system,catheter durations and durations of hospital stay between the 2 groups (P＞0.05).At 6 months after the surgery,average maximum urinary flow rate (Qmax) increased from 5.9±2.9 ml/s to 17.1±8.2 ml/s for Group A and 6.1±3.0 ml/s to 17.5±6.4 ml/s for Group B,both groups showed significant increase in Qmax after surgery(P＜0.01).Six months after surgery,international prostate symptom score (IPSS) of Group A decreased from 23.7±6.1 to 5.9±4.9 while IPSS of Group B decreased from 23.1±5.5 to 6.2±4.4,both groups showed a significant decrease (P＜0.01).No significant difference was shown in IPSS,quality of life,Qmax,postvoid residual urine volume and occurrence rate of long-term complications after 6 months between the 2 groups (P＞0.05).Conclusion TURP is as safe and effective in treating large-size BPH as treating medium and small-size BPH.

Curative observation of polyscope modular flexible ureteroscope combined with Holmium laser lithotripsy in the treatment of renal calculi / 局解手术学杂志

Objective To evaluate the curative effect of polyscope modular flexible ureteroscope combined with Holmium laser lithotrip-sy in the treatment of renal calculi. Methods 53 patients with renal calculi were performed CTU to detect the position of renal calculi before operation. The patients were treated with polyscope modular flexible ureteroscope combined with Holmium laser, and the double J tube were routinely indwelled 4 to 12 weeks after surgery. Results All the 52 patients has successfully completed the operation in the frist stage. The mean operative time was about 38 minutes. 6 patients were treated with flexible ureteroscope for second stage operation. One week after oper-ation, the review showed that there were residual calculi existed in 24 cases and there were 56 cases of post-operative infection, including 17 cases of sepsis or sepsis shock. Conclusion Polyscope modular flexible ureteroscope can be used for all kinds of kidney stones surgery and is characterized by safety and mild tissue injury. But we should pay more attention to the post-operative infection especially urosepsis.

Clinical efficacy of physical vibration lithecbole / 局解手术学杂志

Objective To analyze the clinical efficacy of physical vibration lithecbole in treatment of urinary calculi. Methods Ana-lysed the efficacy of 80 patients who underwent physical vibration lithecbole only or combination therapy with surgery in urinary calculi in our hospital from February 2014 to July 2014. Result There were 1 to 4 times calculi discharge among the 80 patients. One month after the sur-gery, the calculi discharge rate was 33. 3% and the calculi clean rate was 22. 2% in the upper ureteral; the calculi discharge rate was 16. 7%and the calculi clean rate was 50. 0% in the distal ureteral; the calculi discharge rate was 40. 0% and the calculi clean rate was 23. 3% in the upper renal calyx;the calculi discharge rate was 27. 7% and the calculi clean rate was 38. 8% in the middle renal calyx;the calculi discharge rate was 60. 0% and the calculi clean rate was 20. 0% in the lower renal calyx. One month after the surgery of physical vi-bration lithecbole combined with Holium laser lithotripsy, the calculi discharge rate was 52. 1% and the calculi clean rate was 39. 1%. Con-clusion Physical vibration lithecbole is a noninvasive treatment for urinary calculi. It has good efficacy in calculi discharge and it can relieve the pain caused by calculi.

Holmium laser incision under ureteroscopy for refractory hemospermia / 局解手术学杂志

Objective To analyse the effect of holmium laser incision through ureteroscopy and simple ureteroscopy treatment for refrac-tory hemospermia. Methods From December 2003 to April 2013,the data of 67 cases with refractory hemospermia were retrospectively ana-lyzed. All the patients underwent semen analysis,transrectal ultrasonography,seminal vesicle ultrasonography,some patients underwent pelvic CT or MRI. Results Simple ureteroscopy were done for 24 cases,holmium laser incision through ureteroscopy were done for 43 cases. Var-ying degrees of ejaculatory duct stenosis or obstruction were observed. Postoperative follow-up was from 6 months to 8 years,in 24 cases of simple ureteroscopy,2 cases experienced recurrence 6 or 8 months later. The ejaculatory duct narrow were found when they received reopera-tion,with holmium laser incision,hemospermia disappeared. No complications such as retrograde ejaculation,urinary incontinence or rectal injury occurred postoperatively. Conclusion The effect of holmium laser incision through ureteroscopy for refractory hemospermia is better than simple ureteroscopy,which is worthy of clinical application needs further observation and summary.

Relationship between medical students' non-intelligence factors and academic records / 中华医学教育探索杂志

ObjectiveTo clarify the effect of medical students' non-intelligence factors on their academic records.MethodsTotally 104 medical students' non-intelligence factors and surgical academic records were collected and relationship between them was studied.Results① There were significant differences in academic records between students with different non-intelligence levels( F =4.21,P＜0.05 );better academic records were achieved in those with higher non-intelligence level than in those with good and poor non-intelligence level ( P ＜ 0.05 ).② There were significant differences in post clinical internship academic records between students with different non-intelligence levels ( F =8.65,P ＜0.01 ),better academic records were achieved in those with higher and good non-intelligence level( P ＜0.01,P ＜ 0.05 ).③ Medical students with higher and good non-intelligence level got obvious improvements in academic records after clinical internship,while students with medium non-intelligence level showed no difference ( P ＞ 0.05).ConclusionsMedical students' non-intelligence factors have obvious effect on their academic records.Keeping students' non-intelligence factors properly could improve their academic records.

High bladder pressure during urine storage is a main reason of upper urinary tract damage by voiding dysfunction diseases

Upper urinary tract damage secondary to voiding dysfunction is an important reason for the end stage of renal diseases. We evaluated clinical manifestations and outcomes of various treatments, and analyzed underlying mechanism in order to improve guidance for their therapy. Two hundred seventy one patients suffering from upper urinary tract damage caused by voiding dysfunction diseases from Jan. 1999 to Oct. 2009 were enrolled and data of urodynamics, urinary imaging and renal functions before and after treatments were retrospectively analyzed. Bladder pressure was over 40 cm H[2]O in 78.2% of the patients, and among them, the average pressures for the first voiding desire was 42.3 +/- 6.0 cm H[2]O with the maximum bladder pressure of 67.3 +/- 5.8cmH[2]O in 271 patients. In 157 patients the residual urine bladder volume was 100ml, but smaller and moderate residual urine volume was occurring in 37.9% of the upper urinary tract damage patients, which implied that residual urine is not an appropriate indicator. 89.3% of the patients exhibited bladder outlet obstruction and 95.2% of those suffered moderate to severe LUTS. After the relief of obstruction treatment and resulting intravesical pressure reduction, 264 patients showed a good recovery and in 202 of them hydronephrosis have disappeared and their renal function returned to normal, due to reduced bladder pressure. We found that high bladder pressure is the main reason of upper urinary tract damage caused by voiding dysfunction. Thus, attention should be paid in order to achieve and maintain reduced bladder pressure below the safety line

ERp44 C160S/C212S mutants regulate IP3R1 channel activity

Previous studies have indicated that ERp44 inhibits inositol 1,4,5-trisphosphate (IP(3))-induced Ca(2+) release (IICR) via IP(3)R(1), but the mechanism remains largely unexplored. Using extracellular ATP to induce intracellular calcium transient as an IICR model, Ca(2+) image, pull down assay, and Western blotting experiments were carried out in the present study. We found that extracellular ATP induced calcium transient via IP(3)Rs (IICR) and the IICR were markedly decreased in ERp44 overexpressed Hela cells. The inhibitory effect of C160S/C212S but not C29S/T396A/ΔT(331-377) mutants of ERp44 on IICR were significantly decreased compared with ERp44. However, the binding capacity of ERp44 to L3V domain of IP(3)R(1) (1L3V) was enhanced by ERp44 C160S/C212S mutation. Taken together, these results suggest that the mutants of ERp44, C160/C212, can more tightly bind to IP(3)R(1) but exhibit a weak inhibition of IP(3)R(1) channel activity in Hela cells.

Surgical treatment of post-traumatic complex posterior urethral stricture in male patients / 中华创伤杂志

Objective To investigate the therapeutic effect of post-traumatic complex posterior urethral stricture in the male patients.Methods Clinical data of 479 male patients with post-traumatic complex posterior urethral stricture were reviewed.One-stage resection of the stenosis and end-to-end anastomosis was performed in 422 patients and scrotal flap with blood pedicle posterior urethroplasty in 57.Results The mean operation time was 115 minutes(range,90-140 minutes).The mean blood loss was 225 ml(range,100-300 ml).No intraoperative blood transfusion was needed.The mean follow-up time was 15 months(range,12-24 months).Among the 422 patients performed end-to-end anastomosis,386 patients had good voiding and 36 had dysuria because of the formation of anastomotic stoma valve(21 patients)or stricture ring(15 patients).The problem was resolved by transurethral valve/stricture ring resection.Among 57 patients undergone posterior urethroplasty,45 patients had good voiding nine patients were found with anterior urethra-skin tube anastomotic stoma stricture,of which four patients were treated by urethral dilatation and five by endourethrotomy; three patients were found with posterior urethra-skin tube anastomotic stoma stricture,of which one patient was treated by urethral dilation and two by endourethrotomy.Conclusions One-stage resection of the stenosis and end-to-end anastomosis is the main treatment for post-traumatic complex posterior urethral stricture.If the condition of the patients does not allow the end-to-end anastomosis,posterior urethroplasty can be an alternative.

Identification of the nanobacteria in prostatic fluid of CPPS / 中华泌尿外科杂志

Objective To identify the nanobaeteria in prostate fluid of patients with CPPS.Methods Expressed prostatic secretion(EPS)and urine specimens were collected by Meares-Stamey way from CPPS patients(n=100)and normal controls(n=100).The specimens were cultured and nanobacteria was identified by indirect immunofluoreseenee staining with rnonoelonal antibody.The morphological features were observed by using transmission electron microscopy(TEM). Results The positive rate of nanobaeteria in the EPS cdture of CPPS patients and controls were 43% and 5% respectively,with significant statistical difference(X2=39.58,P＜0.01).By TEM,the sizes of NB ranged from 100 to 500 nm and appeared eoccoid-ccccobacillary shape. Conclusion Nanobaeteria infection may exist in EPS of CPPS patients.

Effect of Ca2+-almodulin on contraction of M3R-mediated detrusor muscle cell / 中国组织工程研究

BACKGROUND: Muscarine receptor plays a key role in adjusting contraction of detrusor muscle cell, and M3R, isoforms of its receptor, can mediate contraction of detrusor muscle cell directly. Ca2+ is the direct factor in stimulating contraction of detrusor muscle cell. Of several 10 kinds of Ca2+conjugable receptors protein, Ca2+ conjugated with different receptor proteins can adjust various reactions.OBJECTIVE: To investigate the effect of Ca2+-calmodulin (Ca2+-CaM) on contraction of M3R-mediated detrusor muscle cell.DESIGN: Compared observation .on the basis of detrusor muscle cell.SETTING: Ourological Center of Southwest Hospital of the Third Military Medical University of Chinese PLA.MATERIALS: The experiment was completed at Central Laboratory of Southwest Hospital of the Third Military Medical University of Chinese PLA. Healthy Wistar rats were selected in this study.METHODS: The primary cultured detrusor muscle cells were divided into experimental group and control group. Cells were inoculated in 6-well plate, and 10-4 mmol/L carbachol and M2R antagonist were added to cells of the experimental group during 70% confluence to block M3R and M2R respectively. Ca2+ concentration and CaM activity were detected by Ca2+ test kit and CaM test kit respectively.MAIN OUTCOME MEASURES: Changes of [Ca2+]I concentration and CaM activity of cells in both groups.RESULTS: The mean channel fluorescence values (log) of [Ca2+]I and CaM were higher in the experimental group than those in the control group(3.26±0.38, 2.06±0.12; 2.87±0.34, 2.14±0.24, P ＜ 0.05).CONCLUSION: Results in this study suggest that Ca2+-CaM participates in adjusting contraction of M3R-mediated detrusor muscle cells through signal transduction.

Nanobacteria induces Type Ⅲ prostatitis in rats / 第三军医大学学报

Objective To investigate the chronic inflammation causing effect of nanobacteria(NB) on the prostates of SD rats,and to provide experiment evidence for etiology of type Ⅲ prostatitis.Methods Forty adult,male rats were divided into model group(16 rats),treatment group(8 rats) and control group(16 rats) at random.The rats in model group and treatment group were reproduced by infusing NB suspension transurethrally,and the animals of control group received an infusion of normal saline.After 4 weeks,WBC,lecithine and pathological changes of prostates were observed in model group(8 rats) and control group(8 rats).Tetracycline(100 mg?kg-1?d-1) was administered to treatment group,and distilled water were given to other groups respectively for 4 weeks.Then all rats were sacrificed,and the same detections were done as before.NB from prostates of animal were re-isolated,cultured and identified.Results After 4 weeks,chronic inflammation were observed in model group.WBC became significantly higher and lecithine of prostates were lower in model group than in control group(P0.05).The positive cases of NB were 16 in model group,and none in control group.Conclusion Nanobacteria causes chronic inflammation in SD rat prostates.NB maybe the etiological agent of type Ⅲ prostatitis.Anti-NB treatment by tetracycline is effective for this inflammation.

Excitability changes of DRG neurons and expression of P2X_3 receptor in DRG neurons affected by prostatitis induced by CFA / 第三军医大学学报

Objective To explore excitability change of P2X receptor-mediated DRG neurons and expression of P2X_(3) receptor in the DRG neurons affected by prostatic inflammation.Methods ATP-evoked spontaneous firing and the expression of P2X_(3)receptor in the DRG neurons in the L6-S1 spinal cord were investigated by whole-cell patch clamp techniques,Western blotting on day 3,10 after Complete Freund's adjuvant(CFA) irritation of the rat prostate.Results Membrane potential of DRG neurons fluctuated spontaneously under current clamp.Membrane potential of neurons of control group and 3-day CFA irritation group were under threshold potential, and all recorded neurons had not action potential.However,4 of 39 neurons(10.26%) showed spontaneous action potential at membrane potential on day 10 after CFA irritation of prostate.Expression of P2X_(3) receptor increased significantly on day 10 after CFA irritation of the prostate by Western blotting.Conclusion The increase of expression and sensitivity of P2X_(3) receptor may play important roles in the development and maintenance of the pain owing to prostatic inflammation.

Prophylaxis and treatment of severe complications due to transurethral electrovaporization of the prostate / 第三军医大学学报

Objective To study the causes, prophylaxis, and treatment of the severe complications due to transurethral electrovaporization of the prostate (TVP). Methods We analyzed the complications found in 1 910 men with moderate and severe symptoms of prostatism treated with TVP from August 1997 to February 2003 and studied the causes, prophylaxis, and treatment of the severe complications due to TVP. Results Severe complications were found in 78 cases (4.1%). Late mass bleeding in 35 cases (0.18%) was resulted from the abscission of coagulated necrotic tissue of the prostate after TVP. Extraperitoneal water extravasation (hydrocele) in 27 cases (0.14%) was caused by the early incision of the peritoneum in TVP and could be prevented by avoiding early incision of the peritoneum and stopping operation in time. Severe urethral stricture in 9 cases (0.05%) was caused by using thick sheath of cystoscope and cutting the neck of urinary bladder improperly. Urinary bladder explosion in 2 cases (0.01%) was caused by accumulation of air during the process of TVP, but could be protected by removing the air and water in urinary bladder at intervals. Incontinence in 2 cases (0.01%) was resulted from the injured urinary sphincter muscle. Acute renal failure in 3 cases (0.015%) was caused by hypotension. Conclusion Severe complications due to TVP can be prevented and treated. The occurrence rate of severe complications can be decreased by the proper preventive measures and skilled techniques of the operators.

Study of the neurological mechanisms of referred pain of chronic prostatitis and its relationship with the bladder and the pelvic floor / 解放军医学杂志

Objective To look for the neurological evidence of the referred pain of the chronic prostatitis and the relationship between the pain of the chronic prostatitis, bladder, and pelvic floor. Methods The distribution of plasma extravasation was determined with Evans blue dye after irritation of the prostate and bladder of the SD rat with capsaisin, and the distribution of dye extravasation was analyzed. Substance P expression within the dorsal horn of the spinal cord was determined by hybridization in situ after irritation of the prostate, bladder and superficial somatic region of the pelvic floor with formalin. Results Pain irritation of the prostate resulted in plasma extravasation in L_5 to S_2 dermatomes (mainly in L_6 to S_1). In rats receiving bladder irritation, the distribution of plasma extravasation showed a similar pattern to that observed in rats receiving prostatic irritation. Irritation of the prostate, bladder and pelvic floor resulted in similar substance P expression within the dorsal horn of the spinal cord (L_6 to S_1). Conclusions Our results strongly suggest that referred pain status in inflammation of the bladder and prostate is neurogenically mediated. There are significant overlaps of nociceptive neurons within the spinal cord, which receive nociceptive inputs from the prostate, bladder and pelvic floor. Pathological changes in the prostate, bladder and pelvic floor can result in similar pain sensations.

Transurethral resection of bladder tumor under block anesthesia of bilateral obturator nerves / 中国微创外科杂志

Objective To study the safety and efficacy of transurethral resection of bladder tumor(TURBt)under block anesthesia of bilateral obturator nerves.Methods Seventy-seven patients were chronologically divided into two groups.Forty-six of patients with lateral,bilateral or multiple tumors in the bladder,which underwent transurethral resection of bladder tumor under epidural anesthesia from April 2003 to October 2004,were chosen as the Control Group.Thirty-one patients whom were administrated with epidural anesthesia plus bilateral block of the obturator nerve from October 2004 to July 2005 served as the Study Group.Incidences of bladder perforation and obturator nerve reflex were compared between the two groups.Results In the Control Group,obturator nerve reflex occurred in 25 patients(including intense reflex in 11 patients),giving an incidence of 54.3%(25/46),and bladder perforation resulted from the reflex was observed in 8 patients,with an incidence of 17.3%(8/46).In the Study Group,slight obturator nerve reflex happened in 3 patients(9.9%,3/31)and bladder perforation was found in 1 patient(3.2%,1/31).A significant higher rate of obturator nerve reflex was noted in the Control Group than in the Study Group(?2=15.970,P=0.000),but no statistical difference was seen in bladder perforation rate between the two groups(?2=2.359,P=0.125).Conclusions Bilateral block of the obturator nerve can improve the safety remarkably during transurethral resection of bladder tumor,especially when the tumor was located in the lateral bladder wall.

Role of gliocyte activation in change of excitatory amino acid in spinal cord from chronic prostatitis rats / 第三军医大学学报

Objective To explore the relationship between the activation of glial cells and the change of excitatory amino acids (EAA) in the cornu dorsal medullae spinalis induced by pain due to chronic prostatitis. Methods The pain models of chronic prostatitis were induced by injecting complete Freund’s adjuvant and 3% carrageenan into the prostate of 40 rats. Another 20 rats served as normal control. Propentofylline was given with PE-10 in spinal cord of 20 rat models. The activation of astrocyte and microglia and Glu in the spinal cord was detected with immunohistochemistry and the change of excitatory amino acids was observed by amino acids analyzer. Results Activation of astrocyte and microglia was significantly increased in the models and significantly reduced in interfered groups. Glu was significantly expressed in cornu dorsal medullae spinalis, and Glu and aspartic acid (Asp) was significantly increased in the models and significantly reduced in interfered groups. Conclusion The activation of glial cells is an important reason for the change of excitatory amino acids in cornu dorsal medullae spinalis induced by pain due to chronic prostatitis of rats. Inhibitor of gliocyte activation will be a new way to treat the pain of chronic prostatitis.

Nanobacteria: isolation from prostatic calculus and identification of its 16S rRNA gene / 第三军医大学学报

ObjectiveTo explore the distribution of nanobacteria in prostatic calculus and investigate its role in the formation of prostatic calculus. MethodsThe stones of 40 patients with prostatic calculus was used to isolate and culture the possible bacteria. The genomes of obtained bacteria were extracted, and the 16S rRNA was amplified by PCR followed by sequencing. ResultsThe obtained specific fragment had a 98% resemblance with 16S rRNA of nanobacteria: Score=2 480 bits (1 290), Expect=0.0; Identities=1 387/1 409 (98%), Gaps=4/1 409 (0%); Strand=Plus/Plus. ConclusionNanobacteria is proved existing in the stones of prostatic calculus patients by PCR and sequencing.