Based on the concept of three-orientation medical personnel training, this article fo-cuses on practice ability oriented professional quality training, and has constructed the integrated experi-mental teaching course system based on medicine. The curriculum system not only builds the experimental teaching platform ofhigh quality resource, but also constructs the experimental teaching mode which is based on a large and diverse method to promote students'!autonomous learning. The article also discusses the reform of basic experiment course system based on the practice ability from the concept of experimental curriculum system reform, the goal of the training of the experimental course system, the implementation of the program and the evaluation system.

Objective To investigate the patients with postoperative skin damage around the stoma after Miles operation,take measures according to the influencing factors,and explore an effective way to reduce the incidence of skin damage around the stoma patients.Methods There were 62 cases of skin damage around the stoma in 110 cases of patients with permanent colostomy in out-patient follow-up.Each patient with skin damage occurring around the stoma were retrospectively analyzed the reasons,and the related factors that might affect Miles postoperative stoma skin damage were analyzed.Results The incidence rate of Miles postoperative skin damage around the stoma was 56.36％,through the multi-factor Logistic regression analysis,there were six related factors with the Miles postoperative skin damage around the stoma,patients' excrement stimulation,ostomy bag allergies,improper operation of the replacement of the ostomy bag,the potential skin disease,excessive scrub / rub the skin,unfamiliar with ostomy care knowledge were the influencing factors of patients with skin damage around the stoma.Conclusions Appropriate stoma care products and paste methods,detailed guiding of patients and their families about ostomy care knowledge and skills can significantly reduce the incidence rate of Miles postoperative skin damage around the stoma.

【Objective】To investigate the relationship between the expression of lymphocyte function-associated antigen-1 (LFA-1) on peripheral lymphocytes and acute rejection after orthotopic liver transplantation (OLTx) in rat.【Methods】Adult male rats were divided into 2 groups.In the non-rejection group,40 SD rats were used as both donors and recipients.In the rejection group,20 Wistar rats were used as donors and 20 SD rats as recipients.Blood samples were collected through the tail vein 1 day before transplantation and on days 1、3、5、7 after OLTx.The expression of LFA-1 (CD11a) on peripheral lymphocytes was analyzed by using indirect immunofluorescent marker-flow cytometry.【Results】The expression level of LFA-1 on peripheral lymphocytes in recipient rats after orthotopic liver transplantation was markedly lower than that before operation (P<0.01);The expression level of LFA-1 on peripheral lymphocytes in rats with acute liver rejection was significantly higher than that in the non-rejection group (P<0.01).【Conclusion】Monitoring the expression level of LFA-1 on peripheral lymphocytes may be helpful to the diagnosis of acute graft rejection.

Objective To investigate the relationship between the intercellular adhesion molecule-1(ICAM-1) and lymphocyte function associated with antigen-1( LFA-1) and acute rejection of liver transplantation in rats. Methods SD rats and Wistar rats were randomly divided into normal control group, isograft group, and allograft group. Liver biopsies from the recipients were obtained on the day 2,4, and 7 postoperatively to examine the expression level of ICAM-1 and LFA-1 in liver grafts. Samples were firstly stained with specific monoclonal antibodies using immunohistochemistry stain and then applied to image semiquantitive analysis. Results The expression levels of ICAM-1 and LFA-1 in allograft group were obviously higher than those in both isograft group and normal group. Moreover, the expression levels of ICAM-1 and LFA-1 were correlated positively with the degree of acute liver rejection. Conclusions Detecting the expressions of ICAM-1 and LFA-1 in liver graft tissue may be helpful to the diagnosis of acute rejection after liver transplantation.

[Objective] Based on the resting state functional magnetic resonance imaging to investigate the abnormal features of the functional connectivity of resting brain neural network in the patients with primary insomnia,by using voxel-wise whole-brain finctional networks analysis of degree centrality (DC) for imaging evidence of neural mechanisms underlying primary insomnia.[Methods] The resting state fMRI were performed in 59 PI patients and 47 age,education,and sex-matched normal healthy subjects.Analysis of DC map changes between the two patient groups and the control group were performed by two sample t test.(threshold at P ＜ 0.05).[Results] Compared with the control group,the patients with PI showed significantly reduced DC value in bilateral medial frontal gyrus (MFG),bilateral anterior cingulate gyrus (ACG),and right insula;and increased DC value in right middle temporal gyrus (MTG),and left cuneus,(CUN),P ＜ 0.05.[Conclusion]Changes of DC value occurred in some region of brain in the P[patient groups when compared with the control group.It was indicated that DC,as a novel resting-state fMRI parameter in the voxel-wise whole-brain functional networks,might be an appealing alternative approach for further study on pathologic and neuropsychological states of PI.

Objective To investigate the efficacy of liver transplantation for the treatment of polycystic liver disease.Methods The clinical data of 8 patients with polycystic liver disease who received liver transplantation at the Third Affiliated Hospital from September 2003 to July 2009 were retrospectively analyzed.All patients underwent modified piggyback liver transplantation with vena cava plasty,and 1 of the patients received simultaneons liver-kidney transplantation.Data including acute rejections,complications,graft functions and survival time of patients were recorded.Results Operation was successfully performed on all patients.The mean operation time,anhepatic phase and operative blood loss were (7.5 +2.8)hours (range,4-11 hours),(42 + 14)minutes (range,25-70 minutes) and (2250 ± 1850)ml (range,2000-6500 ml),respectively.One patient received liver retransplantation at 45 days after primary liver transplantation because of hepatic artery stenosis.Two patients died during perioperative period.One patient died of pulmonary infection and multiple organ disfunction syndrome (MODS) at 39 days after operation,and the other one died of MODS at 59 days after operation.The median follow-up time was 60 months (range,37-93 months).Six patients survived for more than 3 years,4 patients survived for more than 5 years and 2 patients survived for more than 7 years.No acute rejection of gratis was observed at the end of the follow up.Conclusion Liver transplantation is safe and effective for the treatment of polycystic liver disease.

ObjectiveTo investigate the choice of graft,and transfusion and immunosuppressant regimen of a RhD negative recipient in liver transplantation.MethodsOne RhD negative patient with hepatocellular carcinoma who received a liver graft from a RhD positive donor was retrospectively studied,and related references were reviewed.During the operation,the patient received five units of RhD negative/O RBC,3000 ml positive/O plasma and 30 units cryoprecipitate.Tacrolimus and prednisone were used to prevent rejection,and prednisone was withdrawn 30d post transplant.Results The patient's liver function recovered smoothly,without any acute rejection or hemolytic reaction.Anti-D antibody was not detected.The patient suffered from cancer recurrence 9 months and died of brain metastasis 13 months after transplantation.ConclusionsA RhD negative recipient can receive a graft from a RhD positive donor in liver transplantation.The selection of RBC and platelet from RhD negative or positive donors should be based on the result of anti-D antibody test.Plasma and cryoprecipitate can be transfused regardless of Rh type.Enhanced immunosuppressant regimen was unnecessary for these patients.

Objective To evaluate the efficacy and indications of salvage liver transplantation for patients with recurrent hepatecellular carcinoma(HCC)after liver resection.MethodsThe clinical data of 35 HCC patients who received salvage liver transplantation after liver resection at the Third Affiliated Hospital of Sun Yatsen University from October 2003 to March 2006 were retrospectively analyzed.All patients were divided into the salvage liver transplantation(SLT)group(n = 19)and extended SLT group(n = 16).Perioperative condition,postoperative complications and prognosis of the 2 groups were compared.The survival rate was analyzed and compared by the Kaplan-Meier method and Log-rank test,respectively.Results The anhepatic phase,ischaemic time,operation time,intraoperative blood loss,packed red blood cell transfusion,fresh frozen plasms transfusion,mobidity and retransplantation rate were(32 ± 9)minutes,(8.0 ± 2.1)hours,(7.6 ± 1.5)hours,2300 ml,8 U,23 U,6/19 and 2/19 in the SLT group,and(34 ± 7)minutes,(7.4 ± 2.3)hours,(7.4 ± 2.0)hours,2750 ml,12 U,20 U,4/16,1/16 in the extended SLT group,respectively,with no significant difference between the 2 groups(t=0.726,-0.804,-0.366,Z=-0.348,-0.549,-0.149,x2 =0.184,0.203,P＞0.05).The perioperative mortality,tumor recurrence rate were 0 and 2/19 in the SLT group,and 4/16 and 9/16 in the extended SLT group,with significant differences between the 2 groups(x2 = 5.363,8.426,P ＜ 0.05).The 1-,3-,5-year cumulative survival rates were 100%,84% and 84% in the SLT group,and 75%,33% and 33% in the extended SLT group.The 1-,3-,5-year tumor-free survival rates were 100%,89% and 89% in the SLT group,and 48%,29% and 19% in the extended SLT group.There were significant differences in the cumulative and tumor-free survival rates between the2 groups(x2 =11.58,19.31,P＜0.05).Conclusions The efficacy of SLT is satisfactory in the treatment of recurrent HCC.The optimal indication for SLT is Milan criteria.

ObjectiveTo study the role of micafungin in the treatment of invasive fungal infection after liver transplantation.MethodsWe retrospectively studied the clinical data of 32 patients who developed invasive fungal infection after liver transplantation treated in our center between December 2008 and June 2010.The therapeutic effect,adverse effect,and the blood concentration/dose ratio of tacrolimus (tacrolimus concentration per dose.kg-1) before and after micafungin treatment were analysed.ResultsThe curative rate was 93.7％.There were no obvious toxicity and sideeffect.The blood concentration/dose ratio in the triazoles treatment group [(1031± 634.2) ng·ml-1/mg · kg-1] was markably higher than the micafungin treatment group [(172.6±39.45) ng·ml-1/mg · kg-1] and the control group (ceasing antifungal agents) [(183.8±47.08) ng· ml-1/mg · kg-1] (P＜0.05).However,there was no significant difference in the blood concentration/dose ratio between the micafungin treatment group and the control group (P＞0.05).ConclusionsMicafungin did not significantly affect the blood concentration/dose ratio of tacrolimus,and effectively treated invasive fungal infection in patients after liver transplantation.

Objective To investigate the value of posterior short segment peg-stick system plus pediele screw fixation in treatment of thoracolumbar fractures. Methods There were 38 patients invol-ving fractures at Tn in three patients, at T_(12) in 11, at L_1 in 15 and at L_2 in nine. There were three pa-tients with simple fractures of vertebral compression, 35 with burst fractures, 33 with thoracolumbar frac-tures combined with paraplegia. The patients with simple fracture of vertebral compression were treated by posterior short-segment peg-stick system plus pedicle screw fixation. While the patients with paraplegia and intraspinal occupancy were treated by posterior decompression, vertebral enlargement and bone graft-ing (between zygopophysis and transverse process) after fixation. Results All patients received a fol-low-up for average 14.5 months, which showed accurate position of pedicle screw and fine contour of the injured vertebra after reduction, with no loosening or breakage of fixators, chronic lumbar pain or loss of the height of fractured vertebra. Of all, 33 patients were accompanied by paresis. There was one patient at Grade A, six at Grade B, 16 at Grade C and nine at Grade D before operation. But there was one pa-tient at Grade A, one at Grade B, five at Grade C, 10 at Grade D and 16 at Grade E. Conclusions For thoracolumbar fractures especially vertebral burst fractures, posterior short segment speg-stick system plus pedicle screw fixation is an ideal treatment method, for it has the following advantages: no obvious loss of the height of the vertebra after operation, protection of the intact intervertebral disc under the in-jured vertebra and minor effect on range of motion of the lumbar vertebrae.