目的:探讨经脐入路行腹腔镜胆囊切除术的可行性。方法:对6例患者采用仅在脐部切开一个切口进行腹腔镜胆囊切除术。结果:6例患者手术均获成功,无中转常规腹腔镜手术或开腹手术。手术时间80～130min,无出血、胆管损伤等并发症发生。术后1d出院,术后1月门诊随访,患者恢复顺利,除脐部外,腹壁无手术瘢痕。结论:经脐入路腹腔镜胆囊切除术技术上是可行的,但难度较大,在开展手术初期应慎重选择病例。
ObjectiveTo analyze the research status of mini-clinical evaluation exercise (Mini-CEX) in medical and nursing education in the mainland of China, so as to provide a basis for optimizing medical and nursing teaching evaluation tools and promoting the reform of medical and nursing personnel training mode.MethodsPubMed, Embase, Wanfang, CQVIP, China National Knowledge Infrastructure, and China Biomedical Literature Database were searched. The key words were “mini-clinical evaluation exercise” or “mini-CEX” or “CEX” or “mini clinical exercise evaluation”. The languages were limited to Chinese and English. The address of the first author was in the mainland of China. The retrieval time was from the establishment of the databases to December 31st, 2020. The literature was analyzed bibliometrically after screening and duplicate removal.ResultsA total of 536 articles were included for analysis and summary. The articles originated from 28 provincial-level administrative divisions in China, among which Shanghai, Xinjiang, Guangxi, Liaoning, and Guangdong were the top five in terms of the number of papers published. The annual number of papers published exceeded 60 in 2017, and reached 112 in 2019 and 113 in 2020, respectively. A total of 397 hospitals and universities contributed to the literature, among which 49 institutions published more than 2 papers. The maximum number of articles published by a same author was 5. There were 530 journal papers published in 169 journals. Only 228 articles (42.54%) were supported by funds, and the research type was mainly experimental and quasi experimental research (56.71%). Under the key words co-occurrence network analysis, a total of 321 nodes and 1 013 connections were obtained, with an average of 3.21 connections per node. In addition to “mini-CEX” and “mini-clinical exercise evaluation”, the most prominent research directions were “clinical teaching” “standardized training” “resident” “scenario simulation” and “clinical ability”.ConclusionsThe number of mini-CEX-related medical and nursing articles is increasing year by year, but the distribution of research areas and institutions is uneven, the research quality needs to be improved, the application scope and research types need to be enriched, and the research content needs to be expanded. In the future, teachers and research teams of medical colleges and universities should be mobilized to apply Mini-CEX teaching method to the cultivation of medical and nursing talents in a whole and continuous way, so as to further standardize the localization application of mini-CEX in the mainland of China, and promote the in-depth development of formative evaluation of medical education.
ObjectiveTo investigate the effectiveness of epidermal growth factor receptor antagonist (AG-1478) on chronic proliferative cholangitis (CPC), so as to investigate new treatment approach for hepatolithiasis associated with CPC. MethodsForty-six SD rats were divided into 5 groups: CPC model group (n=10), only made models. AG-1478 treatment group (divided into 3 mg/kg， 6 mg/kg， and 12 mg/kg groups, n=10 per group), the common bile ducts in CPC animal model received an intralumenal administration of AG-1478 at the meantime of modeling, followed by intraperitoneal AG-1478 injection of 1.5 mg/(kg·d) for 7 days. Sham operation group (SO group, n=6). Subsequently, histopathological observation, immunohistochemistry, real time PCR， and Western blot were used to evaluate the mRNA expression and influence of AG-1478 on the hyperplasia （EGFR， ki-67， BrdU， collagen Ⅰ protein） and lithogenic potential (Mucin 5AC) of CPC. ResultsCompared with CPC model group, the expressions of EGFR, ki-67， and BrdU were obviously decreased in the AG-1478 treatment group. Also, the inhibition of hyperplasia of biliary epithelium and collagen fibers were confirmed by histopathological observation. Additionally, the expressions of Mucin 5AC mRNA and collagen Ⅰ protein remarkable decreased in the AG-1478 treatment group (Plt;0.05). Conclusions EGFR inhibitor (AG-1478) could shows inhibitory effectivenss on the CPC-mediated hyperplasia and lithogenic potential, and therefore holds promise as the new treatment approach for CPC.