This paper provides an insight into the "3+2" clinical teaching mode implemented from 2001,ponders on and explores related problems in the present mode and proposes the optimization strategy.

Eight-year program of clinical medicine is an important way to develop high-talented students for medical education. According to the educational characteristics of general surgery,and based on the teaching achievement both in domestic and overseas schools,this article probes into the general surgery clinical practice for the military eight-year medical students.

Objective To summarize the experience in diagnosis and treatment of primary splenic tumor. Methods The clinical data of 43 cases of primary splenic tumor patients treated in our hospital between January 1990 to January 2003 were retrospectively analyzed. Results The detectable rate of B-US was 95.3% and that of CT was 96.6%. All the 43 patients included 28 with benign tumors and 15 with malignant ones. The median follow-up period was 6.8 years(2 months-15 years). The 5-year overall survival of benign tumor was 100% and The 1-,3-and 5-year overall survival rates of malignant tumor were 80%, 53.3 % and 26.7%, respectively. Conclusion The image methods such as B-US and CT are the main diagnostic methods for primary splenic tumor. Early diagnosis, radical operation and combined therapy are important for improving the prognosis of the tumor.

Objective: To investigate the relations among the levels of TNF,TNFR and the frequency of multiple organ dysfunction syndrome(MODS),and to study the possible effect of sTNFR Fc in the treatment of MODS. Methods: Totally 48 healthy male SD rats were randomly divided into the control group, the MODS model group and the sTNFR Fc group.MODS group were established by two hit. At the early stage of resuscitation, 0.4 mg/kg of sTNFRp75 Fc was administrated via vein as the sTNFR Fc group. Levels of TNFR1 and TNFR2 expression on the cell membrane of various organs in the 3 groups were analyzed by Western blot. Results: After administration of sTNFRp75 Fc, the functions of the main organs were obviously improved. The morbidity(43.7%) of MODS and the mortality(12.5%) of animals decreased significantly in the sTNFR Fc group compared with model group(100.0% and 50.0%). The serum TNF bioactivity was significantly blocked by TNFR Fc administration. Both TNFR1 and TNFR2 expression in the control group were low while higher in the MODS model group; however, they were decreased significantly in various organs after sTNFRp75 Fc treatment.Conclusion: Our results suggest that TNF ? and TNFR play key roles in the pathogenesis of MODS and sTNFR could reverse the effects of TNF ? and decrease the morbidity of MODS and the mortality of animals in MODS model.

The studies were undertaken on the trauma model of rats,whose right hind legs were amputated,in order to investigate the change in the immune adherence function of red cells,and the effect of treatment with Traditional Chinese Medicine,consisting of a mixture of Shen-er,to decrease immune adherence function of red cells after trauma.The results indicats that after trauma (1) the activity of C3b receptor of red cells decreased;(2) the amount of immune complexes on the surface of red cells increased;(3) the activity of the enhancing factors for the immune adherence of red cells dropped;(4) the activity of the inhibitors for the immune adherence of red cells elevated;(5) there is remarkable interrelation in the changes between the activity of the C3b receptors of red cells and the activity of the inhibitors for the immune adherence of red cells;(6) the mixture of Shen-er could effectively raise the inhibited activity of the C3b receptor of red cells;(7) the mixture could also effectively regulate the activity of the inhibitors of the immune adherence of red cells.

Objective To investigate the relation of the peripheral blood C-reactive protein (CRP)and procalcitonin (PCT) and multiple organ dysfunction syndrome( MODS ) for patients with multiple trauma.Methods A total of 136 patients with multiple trauma were divided into MODS group (49 cases) and non MODS group (87 cases),and 50 healthy volunteers were chosen as control group. Peripheral blood CRP and PCT concentration were detected at different times. Results The highest concentration of peripheral blood CRP in MODS group was appeared on 48 h [(38.7 ± 2.7) mg/L], CRP concentrations in MODS group were significantly different with non MODS group and control group (P ＜0.05). The highest concentration of peripheral blood PCT in MODS group was appeared on 24 h [(20.3 ± 1.7)μ g/L], PCT concentrations in MODS group were significantly different with non MODS group and control group (P＜ 0.05). Conclusions CRP and PCT are relevant to the occurrence of MODS in trauma acute stage. The observation of peripheral blood CRP and PCT concentrations can predict the occurrence of MODS.

Objective To analyze the etiology of duodenal trauma and improve the result of its diagnosis and treatment. Methods The data of 28 cases with duodenal trauma during March 1968 to September 2007 was analyzed retrospectively. Results Twenty-two (78.6%) patients had blunt injuries. The rate of duodenal trauma and associated injuries was 21.4%(6/28)and 89.3% (25/28) respectively. The easiest injury part on the deseending part constituting was 46.4% (13/28) ,the secondary on the horizontal part constituting was 21.4% (6/28).The postoperative complication rate was 28.6% (8/28), the mortality rate was 3.6% (1/28), and the cure rate was 96.4% (27/28). Conclusions The incidence of blunt injuries is high compared with other kinds of duodenal trauma in China. It suggests that the early diagnosis, exploration proper surgical management,and intensive postoperative care are emphasized to reduce the mortality and complication rate.

Objective:To investigate the expression and correlation of cyclooxygenase-2(COX-2) and c-erbB-2 in human breast cancer.Methods: The expressions of COX-2 and c-erbB-2 in 48 breast cancer patients with breast cancer were detected with immunohistochemistry examination and was analyzed.The relationship between their expression and the clinicopathologic characters of breast cancer was also analyzed.Results: The positive rate of COX-2 was 60.4%(29/48) in these patients;the expression was higher in patients with tumor size larger than 2 cm,lymph node metastasis,and negative expression of ER or PR,but was not related with the ages,the pathologic types and the TNM stages.Expression of c-erbB-2 was identified in(39.6%)(19/48) of these patients;the expression was significantly higher in patients with lymph node metastasis or negative expression of ER and PR,but was not related with the ages,the sizes and the pathologic types.COX-2 was positive in 84.2%(16/19) of patients positive of c-erbB-2 and in 44.8%(13/29) of patients negative of c-erbB-2,with significant difference found between the 2 figures(P=0.006).Conclusion: The high expression of COX-2 in breast cancer is related to the expression of c-erbB-2,suggesting that they may regulate each other and jointly contribute to the tumorigenesis and progression of breast cancer.

Objective:To investigate the effect of continuous blood purification on the expression of cytokines in pig lungs during MODS.Methods:Twenty-five pigs were randomly divided into model group,control group and high volume hemofiltration(HVHF) group.Blood bio-chemical and organ function indexes were determined.Real-time quantitative PCR was used to determine the expression level of IL-6 mRNA and IL-8 mRNA and TNF-? mRNA. Results:After HVHF,the serum chemical and organ-function indexes were improved and the morbidity and mortality of MODS were much lower than those in model group.The expression level of IL-6 mRNA and IL-8 mRNA and TNF-? mRNA in the lung were reduced significantly compared with model group.And the expression level of cytokines associated mRNA in the lungs was interrelated with the rate of respiratory failure. Conclusion:HVHF could decrease the over-expression of cytokine mRNA in the lung after trauma when used at early period so that pulmonary function would be improved.

Objective: To investigate the changes of sTNFR in rats with MODS and its clinical implication. Methods: Rat delayed two phase models of MODS were replicated, then serum sTNFR were measured respectively pre and post MODS by ELISA method. Results: Serum sTNFRⅠ pre and post MODS was (112.15?24.95) pg/ml and (438.06? 67.06) pg/ml ( P