The application of feedback debriefing in simulation-based clinical training

Disease Control and Voice Outcomes Following Treatment With PRGN-2012 in Adults With Recurrent Respiratory Papillomatosis.

Although the extreme tails of the distributions of equity returns tend to exhibit more negative than positive returns, very few studies have analysed how pervasive is skewness across entire distributions. We use daily returns on 6 international stock market indices from Britain, France, Germany, Italy, Japan and the United States over 24 years from January 1978 to February 2002 to search for skewness in the tails, in different intervals, and in the entire distributions using binomial distribution tests and two distribution free tests, the Wilcoxon Rank Sum Test and the Siegel-Tukey test. We find limited evidence of asymmetry in the tails, with more asymmetry close to the means. However, we find that the asymmetries closer to the means are statistically significant and consistent in a way that the asymmetry in the tails is not. We show via a Monte Carlo study that the Wilcoxon Rank Sum and Binomial Distribution test have good power inferring that the data are independent and identically distributed.

This paper conducts a validate analysis on surge and slump stock market's relative strength index (RSI) golden cross principle by using Chen 's (2005)n-parametric Bootstrap method, combine with Wilcox on rank sum test method to test conditional yield relative to non-conditional yield mean's statistical significance. Ultimately concluded that in null market the relative strength index golden cross shape is more effective than bear market. In those relative mature markets, such as United kingdom and United States, the relative strength index golden cross shape is more significant than emerging markets. Issue transaction instructions according to it, In 15 days is the best effective holding period.

IntroductionSimulation is an effective educational tool increasingly being utilized in medical education globally and across East Africa. Globally, pediatric patients often present with low frequency, high acuity disease and simulation-based training in pediatric emergencies can equip physicians with the skills to recognize and intervene. Northwestern University (NU) in Chicago, IL, USA, and Maseno University (MU), in Kisumu, Kenya launched a predominantly virtual partnership in 2020 to utilize the Jaramogi Oginga Odinga Teaching & Referral Hospital (JOOTRH) simulation center for MU faculty development in simulation based medical education (SBME) for medical students.Materials and methodsEducational goals, learning objectives, and educational content were collaboratively developed between MU and NU faculty. Virtual sessions were held for didactic education on simulation pedagogy, case development, and debriefing. Mixed educational methods were used including virtual mentored sessions for deliberate practice, piloted case facilitation with medical students, and mentored development of MU identified cases. Trained faculty had the summative experience of an intensive simulation facilitation with graduating MU students. MU faculty and students were surveyed on their experiences with SBME and MU faculty were scored on facilitation technique with a validated tool.ResultsThere were four didactic sessions during the training. Seven cases were developed to reflect targeted educational content for MU students. Six virtually mentored sessions were held to pilot SBME with MU students. In July 2021, fifty students participated in a week-long SBME course led by the MU trained faculty with virtual observation and mentorship from NU faculty. MU faculty reported positive experience with the SBME training and demonstrated improvement in debriefing skills after the training. The overwhelming majority of MU students reported positive experiences with SBME and endorsed desire for earlier and additional sessions.Discussion and conclusionsThis medical education partnership, developed through virtual sessions, culminated in the implementation of an independently run simulation course by three trained MU faculty. SBME is an important educational tool and faculty in a resource constrained setting were successfully, virtually trained in its implementation and through collaborative planning, became a unique tool to address gaps for medical students.

Objective To assess the patient effective dose during SPECT/CT imaging. Methods A total of 157 patients (85 males, 72 females; mean age: (60.46±13.44) years, range: 24-88 years) who underwent SPECT/CT from April 2013 to September 2014 were retrospectively analyzed. They were divided into 3 groups: 99Tcm-MDP bone scan group (n=113), 99Tcm -MIBI parathyroid imaging group (n=23) and 99Tcm-MAA pulmonary perfusion imaging group (n=21). The injection dose (MBq) was recorded and the effective dose (mSv) was estimated according to the International Commission on Radiological Protection (ICRP) guideline. The volume-weighted computed tomography dose index (CTDIvol) and dose length product (DLP) of CT were also recorded and the effective dose (mSv) due to CT was calculated. The effective doses among different groups were statistically compared by Kruskal-Wallis rank sum test and Wilcoxon rank sum test. Results The effective dose from radiopharmaceuticals were (4.02±0.35) mSv for 99Tcm-MDP bone scan, (6.13±0.53) mSv for 99Tcm-MIBI parathyroid imaging and (1.66±0.13) mSv for 99Tcm-MAA pulmonary perfusion imaging (χ2=96.853; Z=7.533, 7.262 and 5.676; all P<0.05). The effective dose due to CT were (3.84±1.98), (1.04±0.19), (4.05±0.47) mSv respectively (χ2=41.225, P<0.05), and there were significant differences between 99Tcm-MIBI parathyroid imaging group and 99Tcm-MDP bone scan group, 99Tcm-MAA pulmonary perfusion imaging group(Z=6.046 and 5.672, both P<0.05). The total effective dose during SPECT/CT imaging were (7.86±1.98), (7.21±0.81) and (5.71±0.45) mSv (χ2=28.988, P<0.05). There were significant differences between 99Tcm-MAA pulmonary perfusion imaging group and 99Tcm-MDP bone scan group, 99Tcm-MIBI parathyroid imaging group(Z=4.967 and 4.994, both P<0.05). Conclusions The increase in effective dose due to spiral CT during SPECT/CT examination should be concerned. Appropriate utilization and optimization of SPECT/CT is needed. Key words: Radiation dosage; Tomography, emission-computed, single-photon; Tomography, X-ray, computed; MDP; MIBI; MAA

Evaluate the accuracy and completeness of Chat-GPT and Bard responses to questions derived from the ICAR:SB policy statements. Thirty-four questions were created based on ICAR:SB policy statements and input into Chat-GPT and Bard. Two rhinologists and two neurosurgeons graded the accuracy and completeness of LLM responses, using a 5-point Likert scale. The Wilcoxon rank-sum and Kruskal-Wallis tests were used for analysis. Online. None. Compare the mean accuracy and completeness scores between (1) responses generated by Chat-GPT versus Bard and (2) rhinologists versus neurosurgeons. Using the Wilcoxon rank-sum test, there were statistically significant differences in (1) accuracy ( p < 0.001) and completeness ( p < 0.001) of Chat-GPT compared with Bard; and (2) accuracy ( p < 0.001) and completeness ( p < 0.001) ratings between rhinologists and neurosurgeons. Chat-GPT responses are overall more accurate and complete compared with Bard, but both are very accurate and complete. Overall, rhinologists graded lower than neurosurgeons. Further research is needed to better understand the full potential of LLMs.

Objective: To evaluate the effect of ultraviolet A/riboflavin corneal crosslinking (CXL) on keratoconic patients with a corneal thickness less than 400 μm. Methods: In this prospective study, patients with keratoconus were divided into a thin cornea group with a corneal thickness (CT) less than 400 μm and a thick cornea group with a CT more than 400 μm. The patients in the thin and thick cornea groups were treated with a hypotonic or isotonic riboflavin solution before and during CXL. Corneal morphological parameters were evaluated before and after CXL during a 3-year follow-up. The data were analyzed with a repeated measures ANOVA, t test, Wilcoxon rank sum test or Mann-Whitney U test. Results: After surgery, the maximum keratometry (Kmax) of the thin and thick cornea groups underwent a continuous decrease (F= 24.364, P<0.001; F=10.427, P=0.001). In the thin group, the Kmax value was 60.51±6.11 diopters (D) before surgery and significantly decreased to 57.43±6.82 D, 56.13±6.85 D and 54.97±6.66 D at 1, 2 and 3 years after surgery (t=3.670, P=0.002; t=4.637, P<0.001; t=5.816, P<0.001). In the thick group, the Kmax value was 54.56±6.27 D before surgery and significantly decreased to 53.25±6.42 D, 52.32±6.47 D and 51.58±6.70 D at 1, 2 and 3 years after surgery (t=2.266, P=0.040; t=3.302, P=0.005; t=3.769, P=0.002). The Kmax value of the thin cornea group before surgery was higher than that of the thick cornea group (t=2.714, P=0.011). There were no significant differences in Kmax between the two groups at 1 year, 2 years or 3 years. In the thin group, there were significant differences between the preoperative and 3-year postoperative visual acuity (UCVA), best corrected visual acuity (BCVA) and thinnest corneal thickness (TCT) (Z=-2.716, P=0.007; Z=-3.063, P=0.002; t=4.468, P<0.001). In the thick group, there were significant differences between the preoperative and 3-year postoperative UCVA, BCVA and TCT (t=3.572, P=0.003; Z=-2.956, P=0.003; Z=-3.410, P=0.001). In the two groups, there were no significant differences between the preoperative and 3-year postoperative intraocular pressure (IOP) or endothelial cell density (ECD). There were no significant differences in pre- or postoperative UCVA, BCVA, IOP, or ECD between the two groups. There were significiant differences in pre- and postoperative TCT between the two groups (Z=-4.816, P=0.001; Z=-4.024, P<0.001). Conclusion: CXL is an effective and safe way to halt disease progression and improve visual acuity in keratoconic patients with a CT less than 400 μm. Key words: keratoconus; ultraviolet A/riboflavin corneal crosslinking; hypotonic riboflavin solution; isotonic riboflavin solution; corneal thickness

Objective To evaluate the safety, efficacy and subsequent fertility outcomes of modified tubal conservative operation in treatment of ampullary pregnancy. Methods From January 1, 2015 to June 31, 2016, a total of 70 cases of patients who were diagnosed as ampullary pregnancy in Shanghai Putuo Maternity and Infant Health Hospital were chosen as study subjects, and those 70 patients had fertility requirements to retain the fallopian tubes. According to random number table method, they were divided into study group (n=36, treated by modified tubal conservative operation) and control group (n=34, treated by laparoscopic salpingostomy). A retrospective analysis method was used to collect general clinical data of two groups, including age, gravidity, menopause days, etc., and to collect treatment status of two groups, including operation duration, intraoperative blood loss, incidence rates of persistent ectopic pregnancy (PEP) and intrauterine pregnancy at the 6th and 12th months after operation, recurrent ectopic pregnancy (REP) rate, and cure rate, etc.. The age, menopause days, preoperative blood β-human chorionic gonadotropin (hCG) levels, operation duration, and intraoperative blood loss of two groups were statistically compared by independent-samples t test. The gravidity and postoperative pain duration of two groups were statistically compared by Wilcoxon rank sum test. The incidence rates of intrauterine pregnancy, PEP, REP and cure rates of two groups were statistically compared by chi-square test. The proportions of different pain levels at the 3rd and 7th days after operation of two groups were statistically compared by Mann-Whitney U test. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Shanghai Putuo Maternity and Infant Health Hospital (Approval No. 2014-18). Informed consent was obtained from each participant. Results ① There were no significant differences between two groups in the age, gravidity, menopause days, and preoperative blood β-hCG levels (P>0.05). ② The operative duration of study group was (58.3±11.2) min, which was significantly longer than that of control group (30.1±10.7) min, and the difference was statistically significant (t=10.759, P 0.05). Follow-up results at the 12th month after operation showed that the incidence rate of intrauterine pregnancy in study group was 25.0% (9/36), which was significantly higher than that of control group 5.9% (2/34), and the difference was statistically significant (χ2=4.825, P=0.028); however, there was no significant difference between two groups in the incidence rate of REP (χ2=2.802, P=0.094). Conclusions Modified tubal conservative operation for ampullary pregnancy has the advantage of higher intrauterine pregnancy rate than that of laparoscopic salpingostomy, but it has a longer operation duration and higher intraoperative blood loss. Key words: Pregnancy, tubal; Reproduction; Salpingostomy; Hysteroscopes; Guide-wire, indwelling; Women

Objective To investigate the application value and feasibility of enhanced recovery after surgery (ERAS) in thoracoscopic and laparoscopic esophagectomy for esophageal cancer. Methods The clinical data of 304 patients with esophageal cancer who were admitted to the Affiliated Cancer Hospital of Zhengzhou University from December 2013 and July 2014 were retrospectively analyzed. All the patients underwent esophagogastric partial resection, esophagogastric cervical anastomosis and 2-field lymph node dissection under general anesthesia. The management of 195 patients guided by ERAS were allocated to the ERAS group and 109 patients receiving perioperative traditional treatments were allocated to the control group. Observing indicators included: (1) enteral and parenteral nutritional support treatments; (2) nutrient indexs: levels of serum albumin (Alb) and prealbumin; (3) the recovery of gastrointestinal function: time to anal exsufflation and defecation; (4) postoperative complications and the grading according to Clavien standard; (5) duration of postoperative hospital stay and treatment expenses; (6) risk factors affecting postoperative complications by multivariate analysis; (7) independent risk factors affecting occurrence rate of postoperative complications by univariate analysis. Measurement data with normal distribution were presented as ±s and analyzed using the t test. Non-normal distribution data were analyzed by the Wilcoxon rank sum test. Comparison of repeated data was analyzed by the repeated measures ANOVA. Categorical variables were analyzed using the chi-square test or Fisher's exact probability. The multiple linear regression analysis and Logistic regression were used to measure the multivariate analysis of continuous variables and binary variable, respectively. Results (1) During the enteral and parenteral nutritional support treatments, 11 patients with surgery-related complications in the ERAS group didn't receive oral intake at postoperative day 1, 26 proceeded the intravenous rehydration at postoperative day 4 due to calorie intake less than 80% of calorie requirement, and enteral nutritional support treatment was well-tolerated in the control group. (2) Comparison of nutrient indexs: the levels of serum Alb and prealbumin at postoperative day 1, 3 and 5 were (37.2±3.9)g/L, (39.1±3.5)g/L, (38.5±3.0)g/L and (0.20±0.06)g/L, (0.13±0.04)g/L, (0.13±0.04)g/L in the ERAS group, (37.7±2.8)g/L, (39.0±3.6)g/L, (38.4±3.8)g/L and (0.18±0.06)g/L, (0.13±0.04)g/L, (0.13±0.04)g/L in the control group, respectively, showing no significant difference in the postoperative changing trends between the 2 groups (F=0.357, 0.453, P>0.05). (3) The recovery of gastrointestinal function: time to first anal exsufflation and first defecation were (2.1±0.8)days and (3.4±1.2)days in the ERAS group, (3.2±0.9)days and (5.5±1.5)days in the control group, respectively, showing significant differences between the 2 groups (t=-10.505, -13.174, P 0.05). Eight and 10 patients in the ERAS and control groups underwent gastrointestinal decompression, 6 and 8 patients in the ERAS and control groups underwent retreatment in the intensive care unit (ICU), 3 and 2 patients in the ERAS and control groups were readmitted to the hospital at 3 weeks after discharge, with no significant difference in the above indexes (χ2=0.185, 2.892, P>0.05). (5)The duration of postoperative hospital stay and treatment expenses were (6.8±2.4)days and (25 088±10 336)yuan in the ERAS group, (11.1±3.4)days and (38 819±14 854)yuan in the control group, showing significant differences between the 2 groups (t=-12.782, -9.452, P 10%, tumor staging, tumor differentiation, neoadjuvant chemotherapy and time of food intake were risk factors affecting incidence of postoperative complication in patients with esophageal cancer by the univariate analysis (χ2=2.484, 2.333, 0.061, 8.553, 2.459, 0.163, 3.462, P 10%, tumor staging and neoadjuvant chemotherapy were independent risk factors affecting incidence of postoperative complication in patients with esophageal cancer by the multivariate analysis (OR=0.365, 10.761, 0.290, 8.140, 95% confidence interval : 0.198-0.671, 4.122-28.095, 0.130-0.645, 3.946-16.791, P 0.05). Conclusions ERAS in the esophageal minimally invasive surgery for esophageal cancer is safe and feasible, with the advantages of shorter recovery time of gastrointestinal function and duration of hospital stay, lower treatment expenses and a better application value compared with traditional treatment. Key words: Esophageal neoplasms; Thoracoscopic and laparoscopic esophagectomy; Enhanced recovery after surgery

Objective To evaluate the ultrasound biomicroscopic changes of the anterior chamber and the clinical outcome after phacoemulsiftcation and intraocular lens implantation in patients with primary angle closure glaucoma （PACG） and co-existing cataract. Methods Phacoemulsification and intraocular lens implantation were performed on 20 patients （24 eyes） with PACG and co-existing cat- aract in this retrospective study. Best-corrected visual acuity （BCVA）, intraocular pressure （IOP）, cor- neal endothelial cell density, and the number of the antiglaucomatous mediation were documented preoperatively and postoperatively respectively, as well as the main complications in the early period after surgery. UBM was performed preoperatively and 6 months after surgery, and anterior chamber distance （ACD）, angle opening distances00 （AOD500）, trabecular iris angle （TIA）, angle recess area （ARA） and trabecular ciliary processes distance （TCPD） were compared preoperatively and postoperatively respectively. Variance analysis of repeated measured data, Wilcoxon rank sum test and paired t test were used to analyze the data. Results The mean follow-up period was （7.92±4.06） months. In 24 eyes, the mean BCVA improved at lweek （0.83±0.25）, 1 month （0.85±0.19）, 3 months （0.84±0.20） and 6 months （0.81±0.21） postoperatively than preoperatively （0.42±0.21） （F =113.85, P =0.000）.The mean IOP at 1 week, 1 month, 3 months, 6 months and final follow-up postoperatively were （13.88±3.64）mmHg, （13.35±2.93：）mmHg, （13.32±3.02）mmHg, （13.61±3.61） mmHg, and （13.53±3.58）mmHg respectively, which were significant lower than preoperatively （16.03±4.27）mmHg （F =6.67, P =0.000）. The mean ACD, AOD500, TIA and ARA at 6 months postopera- tively were （3.32±0.75）mm, （0.23±0.13）mm, （24.93±11.76）0, （0.17±0.22）mm2 respectively, which were significantly different from preoperatively [（1.90±0.84）mm, （0.11±0.13）mm, （11,61±11.42）° and （0.07±0.08）mm2] （Z =-3.980, t =-3.43, t =-3.33, Z =-3：123, P =0.000, 0.003, 0.004, 0.001）, while the mean TCPD （0.79±0.15）mm had not a significant difference from pre- operatively （0.77±0.22） mm （t =-0.29, P =0.776）. The mean corneal endothelial cell at 6 months postoperatively was （2189.75±518.21） cell/mm2, which had not a significant difference from that preoperatively （2405.46±624.42）cell/mm2 （Z = 1.907, P =0.057）, the mean kinds of antiglaucomatous medication decreased from （2.21±0.61） preoperatively to （0.25±0.61） 6 months postoperatively （Z =5.790, P =0.000）. The main complications in the early period after surgery were found that 10 eyes had mild and moderate corneal edema, 1 eye exudative membrane in pupil. Conclusions Phacoemulsification and ir~traocular lens implantation combined with trabeculectomy performed on the patients with PACG and co-existing cata- ract can effectively deepen the anterior chamber, and remain the configuration of the anterior chamber angle, the drainage of the aqueous humor reopen, as well, the IOP is well controlled postoperatively. Key words: Ultrasound biomicroscopy; Phacoemulsification; Glaucoma; Cataract

Objective To investigate the value of 18F-FDG SUVmax in gastric cancer diagnosis with coincidence imaging.Methods The coincidence imaging was performed in 92 patients with gastric diseases (60 males,32 females,age 65 (32-85) years; 78 malignant cases,14 benign cases).The malignant cases included 3 remnant gastric cancers and 75 primary gastric cancers (staging: 4 of Tis,13 of T1,9 of T2,33 of T3,11 of T4 and 5 without surgery).The well-,moderately-and poorly-differentiated adenocarcinomas were 22,15 and 28,respectively.Images were analyzed retrospectively with visual method and 18F-FDG SUVmax,and the diagnostic results were compared with the histopathological findings.The ROC curve was used to analyze the SUVmax.The Pearson's correlation analysis was performed to evaluate the relationship between SUVmax and tumor size.The Wilcoxon rank sum test was applied to determine the difference of SUVmax between early and advanced gastric cancers.The Kruskal-Wallis test was used to analyze the difference of SUVmax in various types of differentiated adenocarcinoma.Results No matter visual method or SUVmax was used,the sensitivity,specificity and accuracy of coincidence imaging in diagnosis of gastric cancer were 64.1％(50/78),64.3％(9/14) and 64.1％(59/92),respectively.The AUC of SUVmax was 0.695 and the cut-off value was 0.700.SUVmax Was positively correlated with tumor size significantly(r=0.489,P＜0.001).There was statistically significant difference between SUVmax of Tis-1 and that of T2-4(0.676± 1.288 vs 3.851 ±3.764;Z=-3.754,P＜0.001).However,there was no statistically significant difference among SUVmax of various grades of differentiated adenocarcinoma(2.805±4.008,3.447±2.365,3.413± 3.737 ; x2 =2.459,P＞ 0.05).Conclusions SUVmax provides more information than visual method in assessing gastric cancer with 18F-FDG coincidence imaging.Appropriate cut-off value of SUV is necessary for improvement of the diagnostic efficiency.Relationships between SUV and pathological T stage,histopathological types and differentiation degree need further investigation. Key words: Stomach neoplasms; Tomography, emission-computed, single-photon; Deoxyglucose

Objective To analyze the difference of clinical manifestations and serum levels of biomarkers between chronic obstructive pulmonary disease (COPD) patients and rheumatoid arthritis (RA) patients combined with COPD, and to reveal the cumulative effect and molecular mechanism of RA on the natural course of COPD. Methods In the study, a total of 41 patients with COPD and 43 RA patients with COPD were collected.The clinical indexes and laboratory indexes were recorded carefully in the enrolled patients.Furthermore, two-sample t-test, Wilcoxon rank sum test and Pearson correlation analysis were used for statistical analysis. Results There was no significant difference of lung function indexes [inspiratory capacity (IC), forced expiratory volume in one second (FEV1), forced vital capacity (FVC), FEV1/FVC, FEV1% pred, residual volume (RV)%pred, total lung capacity (TLC)%pred, RV/TLC%, vital capacity%pred and carbon monoxide diffusing capacity%pred] between the two groups (P>0.05). The levels of anti-cyclic citrullinated peptide and rheumatoid factor in RA patients combined with COPD were significantly higher than those in COPD group, and the difference was statistically significant (t=16.259, 23.598, both P 0.05). Compared with COPD patients, the serum levels of interleukin-17 (IL-17), erythrocyte sedimentation rate, C-reactive protein (CRP) and IL-6 were significantly increased in rheumatoid arthritis patients combined with COPD, indicating statistical difference (P 0.05). IL-17 was negatively correlated with 6MWD (r=-0.535, P<0.01). IL-6 was negatively correlated with 6MWD(r=-0.516, P<0.01). CRP was negatively correlated with 6MWD (r=-0.233, P<0.05). Conclusions RA promotes the natural progression of COPD and has a cumulative effect on the pathogenesis of COPD. Key words: Chronic obstructive pulmonary disease; Rheumatoid arthritis; Interleukin-17

Objective To evaluate the value of phase analysis of gated myocardial perfusion imaging (GMPI) in predicting major adverse cardiac events (MACE) in patients with coronary atherosclerotic heart disease. Methods Patients who underwent two-day rest-stress GMPI in the Department of Nuclear Medicine of Beijing Hospital from September 2012 to January 2014 were selected as observed subjects and analyzed retrospectively. The general clinical information, GMPI images and related parameters including phase standard deviation (PSD), phase histogram bandwidth (PBW), entropy, left ventricular ejection fraction (LVEF), summed stress score (SSS), peak ejection rate (PER), peak filling rate (PFR) were noted. Patients were followed up until the onset of MACE (cardiac death, nonfatal myocardial infarction, and late revascularization within 60 d after GMPI). χ2 test, independent-sample t test or Wilcoxon rank sum test were used to compare data between different groups. The independent risk factors of MACE were obtained by Cox proportional risk regression model. Kaplan-Meier survival curve analysis was used to analyze the cumulative survival rate without MACE. Results A total of 505 patients (235 males, 270 females, median age: 73 years) were followed up successfully, with a median follow-up period of 55.6(52.0, 60.5) months. There were 54 cases (10.7%) with MACE: 6 patients with cardiac death, 27 patients with non-fatal myocardial infarction, and 21 patients with late revascularization. The incidence of hypertension and hyperlipidemia in patients with MACE was significantly higher than that in patients without MACE (χ2 values: 4.126, 6.021, both P 80°), abnormal entropy(>58 J·mol-1·K-1) and SSS≥12 were independent risk factors for MACE (odds ratio(OR) values: 2.795(95% CI: 1.259-6.201), 3.213(95% CI: 1.468-7.029), 3.640 (95% CI: 1.999-6.628), all P 26.7°), abnormal PBW group and abnormal entropy group were 51.2%, 63.2% and 46.7%, which were significantly lower than those of normal PSD group (92.3%; χ2=77.768, P<0.05), normal PBW group (94.2%; χ2=77.741, P<0.05) and normal entropy group (92.8%; χ2=117.437, P<0.05). The 5-year cumulative MACE-free survival rate (31.7%) of patients with abnormal PBW and SSS≥12 was significantly lower than that of patients with normal PBW or patients with abnormal PBW and SSS<12 (80.1%-94.4%; χ2=185.4, P<0.01). The combination analysis of entropy and SSS showed similar results. Conclusions PBW and entropy obtained by GMPI phase analysis are independent risk factors for predicting MACE in coronary artery disease. GMPI phase analysis is useful for coronary artery disease risk stratification. Key words: Coronary artery disease; Prognosis; Myocardial perfusion imaging; Tomography, emission-computed, single-photon; Tomography, X-ray computed; Technetium Tc 99m sestamibi

Objective To investigate the application value of early-stage enteral nutritional support in patients with hepatocellular carcinoma (HCC) after hemihepatectomy. Methods Sixty-seven HCC patients who underwent hemihepatectomy from October 2010 to December 2012 in Department of Hepatopancreatobiliary Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University were enrolled in this prospective study. The patients were randomly divided into two groups using random digit table: the early enteral nutrition (EEN) group [n=32, 17 males, 15 females, mean age of (48±13) years old] and the parenteral nutrition (PN) group [n=35, 22 males, 13 females, mean age of (51±10) years old]. The informed consents of all patients were obtained and the ethical committee approval was received. Patients in both groups received standard anatomical hemihepatectomy and gastric tubes were withdrawn 24 h after operation. Routine treatments such as liver protection drugs, human albumin and so on were given to the patients according to the specific condition. Patients in EEN group were given Ensure nutrient solution orally from 24 h till 7 d after operation. Patients in PN group were given intravenous nutrition from 24 h till 7 d after operation. The changes of perioperative levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST) and albumin (ALB) of patients in two groups were observed. The application of human albumin, the length of gastrointestinal function recovery and adverse reactions of gastrointestine after operation were observed and the length of hospital stay and hospitalization cost were calculated. The measurement data between two groups was compared using t test or Wilcoxon rank sum test. Results In EEN group, the preoperative level of ALT was (33±17)U/L, AST was (35±19)U/L, ALB was (36±1)g/L. In PN group, the preoperative level of ALT was (34±14)U/L, AST was (32±18)U/L, ALB was (37±2)g/L. There was no significant difference between two groups (t=0.264, 0.664, 1.618; P>0.05). In EEN group, the levels of ALT, AST, ALB on the 3rd day after operation were (153±57)U/L, (108±46)U/L, (32±4)g/L respectively. In PN group, the levels of ALT, AST, ALB on the 3rd day after operation were (149±62)U/L, (104±45)U/L, (31±5)g/L respectively. In EEN group, the levels of ALT, AST, ALB on the 7th day after operation were (63±38)U/L, (65±44)U/L, (37±3)g/L respectively. In PN group, the levels of ALT, AST, ALB on the 7th day after operation were (68±32)U/L, (61±39)U/L, (35±5)g/L respectively. There was no significant difference in the levels of ALT, AST, ALB on the 3rd day and the 7th day after operation between two groups (t=0.274, 0.360, 0.898 and-0.584, 0.394, 2.004; P>0.05). The total volume of intravenous human albumin given to the patients after operation in EEN group was significantly less than that in PN group [(70±25)g vs. (90±35)g; t=-2.708, P 0.05). The median of total hospitalization cost in EEN group was significantly less than that in PN group [53(45-72) thousand yuan vs. 59(51-79) thousand yuan; Z=-2.34, P<0.05]. Conclusions Early-stage enteral nutritional support is useful for the recovery of gastrointestinal function of HCC patients after hemihepatectomy and it can also reduce the hospitalization cost. Key words: Carcinoma, hepatocellular; Hepatectomy; Enteral nutrition; Parenteral nutrition, to-tal; Gastrointestinal motility; Fees, medical

Objective To assess the efficacy and safety of dl-3-n-butylphthalide injection in acute ischemic stroke patients. Methods A randomized, double-blind, double-dummy trial enrolled 552 patients in China, if they were within 48 hours of onset of ischemic stroke, and had a score from 6 to 25 on the National Institutes of Health Stroke Scale (NIHSS). Three hundred and seventy patients were randomly assigned to receive infusion of dl-3-n-butylphthalide and 182 patients received infusion of ozagrel. Results In dl-3-n-butylphthalide group, NIHSS score at baseline, on the 8th and 15th days were 8.64±3.03,6.45±3.88 and 4.71±3.90 respectively, whereas Barthel index score were 45.42±20.82,55.60±25.64 and 65.39±26.85 respectively. The difference of NIHSS score between the 15th day and baseline was significantly higher in dl-3-n-butylphthalide group as compared with ozagrel group (Wilcoxon rank sum test, z=2.21, P=0.027). Similar result was found when Barthel index was evaluated（z=2.50，P=0.012）, suggesting a favorable outcome of dl-3-n-butylphthalide treatment. Among the 515 subjects included in the efficacy analysis, 14 days of treatment with dl-3-n-butylphthalide was significantly associated with a favorable outcome than that in 14-day treatment with ozagrel as measured by NIHSS（z=2.21, P=0.027）and Barthel index (z=2.50, P=0.012). The effective rate on the 15th day was significantly higher in dl-3-n-butylphthalide group as compared with that in ozagrel group. The rate of adverse events was similar between two groups (2.74% vs 4.44%，P=0.34). Elevated alanine aminotransferase was the most common adverse event. Conclusion This trial suggested that the 14-day treatment with dl-3-n-butylphthalide could improve outcomes on the 15th day after stroke, and intravenous administration of dl-3-n-butylphthalide was safety. (Trial registration:Chinese Clinical Trial Registry (ChiCTR-TRC-09000483)). Key words: Brain infarction; Benzofurans; Randomized controlled trial