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简介：AbstractTic disorders (TD) is a neurodevelopmental disorder that is often first recognized in children and adolescents and is characterized mainly by motor and phonic tics. Drug treatment of TD has been criticized because of serious side effects, and TD treatment emphasizes behavioral psychotherapy. This study reviewed the most common behavioral psychotherapy for TD: habit reversal training (HRT). We examined the contents, variation, curative effects, and premonitory urge control of HRT and other behavioral psychotherapies. The findings suggest that current understanding of HRT is insufficient and further studies are needed. First, studies of online guidance training are needed to implement technology that can help more patients. Second, the future integration of HRT and other technologies is important. Third, imaging techniques could be used to further explore the brain mechanisms underlying HRT. Research on HRT for TD in China is insufficient. We call on more Chinese researchers to study, investigate, and develop technology to promote the development of behavioral psychotherapy for TD in China.

简介：在美国，尽管许多慢性病的治愈率已有所提高，但公众对慢性病有效治疗的需求仍很急迫，传统中医（TCM）用草药治疗各种疾病已有两千多年的历史，有些中药在临床上已表现抗肿瘤和增强免疫活性的功能，因此，我们更需要努力工作，以便成功地发现新型治疗药物。1990年－1997年，包括中医药及天然草药（TCM－NH）的替代药物在美国的使用率从30％增至40％，目前每年约600万病人寻求替代医疗，1997年替代医疗的消费总额已经达到210亿美元，其中120亿美元白白浪费，寻找替代医疗服务的花费已经超过了美国常用和药和住院的费用。然而不幸的是，替代药物与生物医学研究领域研究和应用研究及发展获得传统医学知识，所以他们常常不知道临床前试验和临床试验的重要性，这对替代医学是一个冲击，病人和医师在缺权威的有关添加剂及其相互作用方面的指导的情况下，使用替代药物尤其是草药方剂，已经引起了需要特别关注的法律和道德问题。来自国家研究所，国防部以及其它国际上私人及商业组织对生物医学研究及规范化的资助，必将加强TCM－NH的知识基础，对疾病过程有更深的认识，从而取得能与常规治疗组相结合的有效研究资料，为未来的商业运作的成功打下知识基础。

简介：THEURGENCYOFtheHIVepidemicinChinahascreatedsubstantialinterestintheprevention,treatment,care,andadvocacyofHIVandAIDS.ChinahasinvestedlargeportionsofitspublichealthstructuretocurbthespreadoftheHIVepidemicwithinitsborders.however,trainingandeducationofphysicianshasbeentraditionallylessemphasized,stalledattheintersectionbetweenhealtheducation,clinicalscience,andpublichealth.^2TheemergingHIV/AIDScliniciantrainingneedsmustberevisitedinlightofthehistoricalandbiologicalcontextofHIVinChina.ThisbriefreviewofthecliniciantrainingneedsinChinawillexaminethehistoryofSTDsinChina,thebiologicalcorollariesimportanttotraining,andtheendpointsofrecentstudiesassessingChineseHIVandsexuallytransmitteddisease(STI)cliniciantraining.

简介：ＴＨＥＴＲＡＩＮＩＮＧＰＲＯＢＬＥＭＯＦＴＨＥＮＵＲＳＩＮＧＳＴＡＦＦＩＮＩＣＵＯＦＯＵＲＣＯＵＮＴＲＹＴＨＥＴＲＡＩＮＩＮＧＰＲＯＢＬＥＭＯＦＴＨＥＮＵＲＳＩＮＧＳＴＡＦＦＩＮＩＣＵＯＦＯＵＲＣＯＵＮＴＲＹＪｕａｎＤｕ；ＤｏｎｇｓｈｅｎｇＴａｎｇ（...

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简介：AbstractObjective:Proficiency in endoscopic endonasal skull base surgery requires both substantial baseline training and progressive lifelong learning. Endoscopic simulation models continue to evolve in an effort to optimize trainee education and preoperative preparation and improve surgical outcomes. The current scoping review systematically reviews all available literature and synthesizes the current paradigms of simulation models for endoscopic skull base surgery training and skill enhancement.Methods:In accordance with Preferred Reporting Items for Systemic Review and Meta-Analyses guidelines, we systematically searched PubMed, Embase, CINAHL, and Cochrane databases. Studies were categorized according to the type of simulation models investigated.Results:We identified 238 unique references, with 55 studies ultimately meeting inclusion criteria. Of these, 19 studies described cadaveric dissection models, 17 discussed three-dimensional (3D) printed models, 14 examined virtual surgical planning and augmented reality-based models, and five 5 articles described task trainers.Conclusions:There are a wide variety of simulation models for endoscopic skull base surgery, including high-fidelity cadaveric, virtual reality, and 3D-printed models. These models are an asset for trainee development and preoperative surgical preparation.

简介：将中风偏瘫患者分为针灸结合康复训练组(n=50),针灸组(n=32),康复训练组(n=31),采用针刺治疗和康复训练.在治疗前后对患者偏瘫肢体的运动功能和日常生活能力进行评定.总有效率针灸结合康复训练组明显高于针灸组和康复训练组(P＜0.01),而针刺组和康复组的总有效率比较无明显差异(P＞0.05).针灸结合康复训练是治疗中风偏瘫的有效方法.

简介：瞄准：评估基于万维网的技术的使用估计学习曲线并且为胃的放大多彩石印版内视镜检查法(MC)重估一个分类的一个简化版本的重制度。方法：作为部分一多集中试用，一条混合途径用CDROM被采取，与持续5s各个和“汽车跑”的MC的20部电影，触发一个本地HTML框架的文件设定通过一个因特网连接引用了到一张遥远的问询表。三endoscopists被问到有希望地并且独立地分类随机分开与至少3d选择的10部这些电影。答案集中地被存储并且与正确答案和足够的反馈回到了参加者。结果：为在3个组的分类，两内[科恩的kappa(kappa)=0.79-1.00到0.89-1.00]并且内部观察员的同意增加了从第一(中等)到第6观察(kappa=0.94)。另外，对参考的同意在最后观察增加了(0.90，1.00和1.00为观察员A，B和C，分别地)。100%的有效性被所有观察员在他们的第4观察获得。当第4(潜水艇)组被考虑的、内部观察员的协议是时，几乎完善(kappa=0.92)在第6观察。有参考的关系清楚地在他们的第6观察改善了进kappa(0.93-1.00)和敏感(75%100%)。结论：这个MC分类是由优秀intra观察员和内部观察员的同意出现，并且与参考改进同意似乎容易可解说、可学会。象在这研究使用的那个那样的一个网系统可能是有用的为内视镜或另外的图象关于定义，教育和传播基于诊断过程。

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简介：AbstractBackground:Minimally invasive pancreatic surgery (MIPS) has developed over the last 3 decades and is nowadays experiencing an increased interest from the surgical community. With increasing awareness of both the public and the surgical community on patient safety, optimization of training has gained importance. For implementation of MIPS we propose 3 training phases. The first phase focuses on developing basic skills and procedure specific skills with the help of simulation, biotissue drills, video libraries, live case observations, and training courses. The second phase consists of index procedures, fellowships, and proctoring programs to ensure patient safety during the first procedures. During the third phase the surgeons aim is to safely implement the procedure into standard practice while minimizing learning curve related excess morbidity and mortality. Case selection, skills assessment, feedback, and mentoring are important methods to optimize this phase. The residual learning curve can reach up to 100 cases depending on the surgeons’ previous experience, selection of cases, and definition of the parameters used to assess the learning curve. Adequate training and high procedural volume are key to implementing MIPS safely.

简介：AbstractMilitary training is intense, difficult and often dangerous, so all kinds of injuries or diseases frequently occur during training. Most of the previous studies and reviews on military training-related injuries focused on musculoskeletal system, whereas there are no reviews of abdominal injuries and diseases. Although the incidence of military training-related abdominal injuries and diseases is relatively low, the patients’ condition is often critical especially in the presence of abdominal organ injury, leading to multi-organ dysfunction syndrome and even death. This paper elaborates on common types of military training-related abdominal injuries and diseases as well as the prevention and treatment measures, which provides some basis for scientific and reasonable training and improvement of medical security.

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简介：AbstractPurpose:It is challenging to prepare military surgeons with the skills of combat damage control surgery (CDCS). The current study aimed to establish a damage control surgery (DCS) training platform for explosive combined thoraco-abdominal injuries.Methods:The training platform established in this study consisted of 3 main components: (1) A 50 m × 50 m square yard was constructed as the explosion site. Safety was assessed through cameras. (2) Sixteen pigs were injured by an explosion of trinitrotoluene attached with steel balls and were randomly divided into the DCS group (accepted DCS) and the control group (have not accepted DCS). The mortality rate was observed. (3) The literature was reviewed to identify the key factors for assessing CDCS, and testing standards for CDCS were then established. Expert questionnaires were employed to evaluate the scientificity and feasibility of the testing standards. Then, a 5-day training course with incorporated tests was used to test the efficacy of the established platform. In total, 30 teams attended the first training course. The scores that the trainees received before and after the training were compared. SPSS 11.0 was employed to analyze the results.Results:The high-speed video playback confirmed the safety of the explosion site as no explosion fragments projected beyond the wall. No pig died within 24 h when DCS was performed, while 7 pigs died in the control group. After a literature review, assessment criteria for CDCS were established that had a total score of 100 points and had 4 major parts: leadership and team cooperation, resuscitation, surgical procedure, and final outcome. Expert questionnaire results showed that the scientific score was 8.6 ± 1.25, and the feasibility score was 8.74 ± 1.19. When compared with the basic level, the trainees' score improved significantly after training.Conclusion:The platform established in this study was useful for CDCS training.

简介：AbstractPurpose:To develop animal models of penetrating thoracic injuries and to observe the effects of the animal model-based training on improving the trainees’ performance for emergent and urgent thoracic surgeries.Methods:With a homemade machine, animal models of lung injuries and penetrating heart injuries were produced in porcine and used for training of chest tube drainage, urgent sternotomy, and emergent thoracotomy. Coefficient of variation of abbreviated injury scale and blood loss was calculated to judge the reproducibility of animal models. Five operation teams from basic-level hospitals (group A) and five operation teams from level III hospitals (group B) were included to be trained and tested. Testing standards for the operations were established after thorough literature review, and expert questionnaires were employed to evaluate the scientificity and feasibility of the testing standards. Tests were carried out after the training. Pre- and post-training performances were compared. Post-training survey using 7-point Likert scale was taken to evaluate the feelings of the trainees to these training approaches.Results:Animal models of the three kinds of penetrating chest injuries were successfully established and the coefficient of variation of abbreviated injury scale and blood loss were all less than 25%. After literature review, testing standards were established, and expert questionnaire results showed that the scientific score was 7.30 ± 1.49, and the feasibility score was 7.50 ± 0.89. Post-training performance was significantly higher in both group A and group B than pre-training performance. Post-training survey showed that all the trainees felt confident in applying the operations and were generally agreed that the training procedure were very helpful in improving operation skills for thoracic penetrating injury.Conclusions:Animal model-based simulation training established in the current study could improve the trainees’ performance for emergent and urgent thoracic surgeries, especially of the surgical teams from basic-level hospitals.

简介：AbstractIntroduction:Currently, interventions for children with autism spectrum disorders (ASD) in China are mainly carried out by professionals in rehabilitation institutions and special schools. However, when autistic children are older, they do not receive effective training and treatment, and there is no specific place in society to accommodate autistic adults. Mental hospitals are usually their ultimate home.Case presentation:We report a 22-year-old male with ASD. The manifestation and/or intervention from the age of 3 years to now were recorded. He has been hospitalized in the closed ward of a mental hospital since 2015.Conclusion:This report typically present the current problems in treatment and training of autistic children growing up in China. Life-long rehabilitation training is important for every patient with ASD. Relevant policies and resources in China should be optimized in terms of medical treatment and health care, education and training, social assistance, social security, labor employment, and social culture.

简介：AbstractHypothesis:Three-dimensional (3D) printed temporal bones are comparable to cadaveric temporal bones as a training tool for otologic surgery.Background:Cadaveric temporal bone dissection is an integral part of otology surgical training. Unfortunately, availability of cadaveric temporal bones is becoming much more limited and concern regarding chemical and biological risks persist. In this study, we examine the validity of 3D-printed temporal bone model as an alternative training tool for otologic surgery.Methods:Seventeen otolaryngology trainees participated in the study. They were asked to complete a series of otologic procedures using 3D-printed temporal bones. A semi-structured questionnaire was used to evaluate their dissection experience on the 3D-printed temporal bones.Results:Participants found that the 3D-printed temporal bones were anatomically realistic compared to cadaveric temporal bones. They found that the 3D-printed temporal bones were useful as a surgical training tool in general and also for specific otologic procedures. Overall, participants were enthusiastic about incorporation of 3D-printed temporal bones in temporal bone dissection training courses and would recommend them to other trainees.Conclusion:3D-printed temporal bone model is a viable alternative to human cadaveric temporal bones as a teaching tool for otologic surgery.

简介：摘要ObjectiveThis study aimed to evaluate the effect of different combinations of rTMS and cognitive training (rTMS-COG) on PSCI and identify the optimal combination protocol.MethodsA cerebral infarction rat model was established by transient middle cerebral artery occlusion (tMCAO). The Morris water maze test was conducted to assess the cognitive function of rats. RNA sequencing and bioinformatics analysis were employed to study the underlying mechanisms.ResultsrTMS, COG and rTMS-COG all had beneficial effects on PSCI, while cognitive training immediately after rTMS (rTMS-COG0h) achieved a better effect than cognitive training 1 h and 4 h after rTMS, rTMS and COG. We identified 179 differentially expressed genes (DEGs), including 24 upregulated and 155 downregulated genes, between the rTMS-COG0h and rTMS groups. GO analysis revealed that the major categories associated with the DEGs were antigen procession and presentation, regulation of protein phosphorylation and axoneme assembly. KEGG analysis showed that the DEGs were enriched in processes related to phagosome, circadian entrainment, dopaminergic synapse, apelin signaling pathway, long-term depression, neuroactive ligand-receptor interaction, axon guidance and glucagon signaling pathway. PPI analysis identified Calb2, Rsph1, Ccdc114, Acta2, Ttll9, Dnah1, Dlx2, Dlx1, Ccdc40 and Ccdc113 as related genes.ConclusionsThese findings prompt exploration of the potential mechanisms and key genes involved in the effect of rTMS-COG0h on PSCI.

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