Application of "three-step teaching model" for minimally invasive simulation training in urologic clinical teaching / 基础医学与临床

Objective To explore the effectiveness of applying minimally invasive simulation training in urologic clinical teaching .Methods Interns, training clinicians and junior doctors in our hospital, each group of six people, participating in the newthree-step teaching model of "theory learning +simulation training +clinical practice".The score before and after training on their theoretical knowledge , simulation training skills and clinical practice were assessed and the results were analyzed .Results The test scores of minimal invasive techniques theoretical knowl-edge and clinical practice assessment were significantly enhanced before training and after training ( P<0.05 ) .We have established a standardized minimally invasive simulation training in urologic clinical teaching .Conclusions Minimally invasive simulation training provides an effective and safe learning cultivation method for clinician and medical students , which could improve the clinical practice skills of young doctors in minimally invasive surgery as well as shorten the learning curve .

Diagnosis and treatment of micro-paragangliomas in urinary bladdler / 基础医学与临床

Objective To develope the diagnostic criteria and surgical methods to treat micro-paraganagliomas (<1 cm) of urinary bladder ( PUB) , we now report a case series study including 5 individual cases .Methods Clinical data of 5 patients with micro-PUBs who underwent surgical treatment were obtained and analyzed retrospectively . Two male patients and three female patients were included in our study with the mean age of 51 ( range from 41 to 65 years) .4 patients were reported as symptomatic due to hypercatecholaminemia , while the other was free of symptoms.24-hour urine catecholamine ( CA) examination was utilized to qualitatively diagnose PUB , positive in 75%patients.Ultrasonography(USG), CT, MRI, 111In-DTPA-Octreotide scintigraphy (OctreoScan) and 131 I-MIBG scintigraphy were used to locate the tumor , positive in 80%, 20%, 75%, 25%and 33%patients respectively .What's more, all 5 patients underwent transurethral resection of tumor .Overfilling of bladder and puncture following ultra-sonography guidance were performed to locate the tumors , when tumors were absent in surgical vision .Results All tumors were located and resected completely with no open conversions .It took 0.5 to 26 minutes to locate the tumor and another 3 to 10 minutes to resect the tumors .All lesions were diagnosed by histopathological confirma-tion, especially by immunohistochemical staining.Blood pressure return to normal level after the procedures.No local recurrence or distal metastasis were observed by performing 24-hour urine CA test , USG, cystoscopy and MRI within adequate follow-up.The mean follow-up duration was 38.6 months, ranging from 6 to 120 months.Conclu-sions USG and MRI examination were considered better in detecting micro PUB than CT-scan.Overfilling of blad-der and puncture following USG guidance may support more accurate tumor location intraoperatively if the tumors were not found in transurethral resection procedures .

Timing of operation and therapeutic effect of endoscopic optic nerve decompression for traumatic optic neuropathy / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To observe the optimal timing of operation and the therapeutic effect of endoscopic optic nerve decompression for traumatic optic neuropathy (TON).</p><p><b>METHODS</b>The clinical records of 90 consecutive patients with TON (93 eyes) after head and/or maxillofacial trauma from April 1998 to March 2007 were reviewed and analyzed. All patients were either unresponsive or intolerant to medication before they underwent intranasal endoscopic optic nerve decompression. The time interval between the injury and operation ranged from one day to 97 days (median 5.5 days). Among the 93 eyes, there were 71 eyes with no visual acuity before operation and 22 eyes with residue visual acuity, including light perception in 1 eye, hand movement in 5 eyes, counting fingers in 13 eyes, 0.04 in 1 eye, and 0.1 in 2 eyes. Duration of follow-up ranged from 6 days to two years (median 8 days).</p><p><b>RESULTS</b>After decompression, 35 patients (36/93 eyes, 38.7%) showed improvement of visual acuity, 53 patients (55 eyes, 59.1%) remained the same as before operation, while 2 patients (2 eyes, 2.2%) showed decreased visual acuity. Among patients with visual acuity beyond light perception before decompression, 68.2% of them (15/22 eyes) experienced visual improvement, whereas only 22.9% (8/35 eyes, 0.02 in two eyes) among patients who lost visual acuity immediately after injury, and 36.1% (13/36 eyes, 0.02 in five eyes) among those who lost visual acuity gradually after injury. There was a significant difference in visual improvement between group with visual acuity and group with no visual acuity (chi(2) = 11.864, P < 0.01). Among patients with no visual acuity, 41.2% of those (7/17 eyes) who underwent operation within 3 days of injury, experienced improvement in visual acuity, compared with 25.9% (14/54 eyes) for those who underwent the operation more than 3 days after injury. It was indicated that no significant difference in visual improvement between these two groups (chi(2) = 1.46, P > 0.05). When comparing different sites of fracture, the effect of surgery was the most desirable (55.6%, 10/18 eyes improved) if the fracture occurred simultaneously in both exterior and interior walls of optic canal, followed by the interior wall fracture (45.7%, 21/46 eyes). The operation was less effective if there was no fraction (20%, 4/20 eyes) or if the fracture occurred in exterior wall alone (11.1%, 1/9 eyes).</p><p><b>CONCLUSIONS</b>Endoscopic optic nerve decompression is a minimally invasive procedure with no adverse cosmetic effects. Early operation is recommended for saving vision, even though visual acuity is lost immediately after injury. However, the satisfactory clinical effects of endoscopic optic nerve decompression require further study.</p>

Glucocorticoid receptor subunit expression in adenoid tissue of children with obstructive sleep apnea hypopnea syndrome / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>The expression of glucocorticoid receptor (GR) expression in obstructive sleep apnea hypopnea syndrome (OSAHS) in children is currently unknown. The aim of this study was to determine the GR-alpha and GR-beta status in the adenoidal tissues in children with OSAHS.</p><p><b>METHODS</b>Thirty-four pediatric patients (aged 3-14 years, median 7.8 years) had sleep study with polysomnography before adenoidectomy. According to the criteria of apnea hypopnea index (AHI) > or = 5 /h or/and apnea index (AI) > or = 1/h, they were divided into OSAHS and non-OSAHS sub groups. The study was based on fluorescent quantitative PCR (FQ-RT-PCR) for the mRNA expression of GR-alpha and GR-beta in the adenoidal tissues in children.</p><p><b>RESULTS</b>GR isoforms mRNA encoding for expression of both GR-alpha and GR-beta were detected in the adenoids of all children. GR-alpha mRNA level [(9.40 +/- 3.06) x 10(5) cDNA copies/microg total RNA] in the adenoidal tissues in OSAHS was lower than those in the non-OSAHS [(1.60 +/- 0.26) x 10(6) cDNA copies/microg total RNA] (F = 40.285, P < 0.001), whereas no differences found for GR-beta [(1.57 +/- 0.35) x 10(4) cDNA copies/microg total RNA, (1.52 +/- 0.18) x 10(4) cDNA copies/microg total RNA]. GR-alpha/GR-beta ratio was 62.3 +/- 20. 3 in OSAHS and 107.4 +/- 24.4 in non-OSAHS. AHI or AI was not related to the mRNA levels of GR-alpha and GR-beta in OSAHS or non-OSAHS.</p><p><b>CONCLUSIONS</b>GR-alpha and GR-beta were detectable in the adenoidal tissues in children. These data indicated that the relationship between the expressions of GR and the clinical significance in OSAHS need further and profound investigation.</p>

Retrospective analysis of the effect of intranasal endoscopic resection of olfactory neuroblastoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the effectiveness of intranasal endoscopic resection of olfactory neuroblastoma and the significance of assistant radiotherapy.</p><p><b>METHODS</b>Six patients (4 men and 2 women) ranging in age from 9-68 years (median age, 48 years) with olfactory neuroblastoma treated endoscopically at the Third Affiliated Hospital of SUN Yat-sen University between August 2001 and September 2005 were retrospectively analyzed. The Kadish clinical stage was determined for all six cases, two cases with stage B, and 4 with stage C. The duration of endoscopic follow-up ranged from fourteen months to sixty three months.</p><p><b>RESULTS</b>The tumor in five patients was completely excised including one case underwent craniotomy firstly and one case underwent neck dissection and the another case had her tumor subtotally resected. Five cases underwent assistant radiotherapy after operation without any evidence of recurrence so far, while the other one (Kadish stage B, tumor totally resection), who had no radiotherapy after first procedure, died from local recurrence and cerebellar metastasis 31 months after operation. The medium survival duration was 44.5 months.</p><p><b>CONCLUSIONS</b>With simple approach, excellent visualization, a less operative invasiveness and no scar on face, the endoscopic approach appears to be the method of choice for the treatment of olfactory neuroblastoma. But it was necessary for good prognosis to combine with radiotherapy after operation.</p>