It is very important to train junior doctors'clinical skills,especially surgical skills.Operation protocol presentations before each surgical procedure provide good opportunities for them to learn these skills,and at same time,this presentation ensures a better surgical outcome as well.Each presentation is prepared under the direction of a senior doctor.A protocol is composed of the patient medical history,physical examination,accessory check up reports,diagnosis and surgical procedure.It is not only a good method for the young doctors to learn but also for their teachers to teach each student individually.

Objective To establish an animal model of PCOS and to detect the DNA methylation states of LHR,INSR and AR genes. Methods 24-days-old female Sprague-Dawley (SD) rats were randomly divided into two groups. The rats in the experimental group were given subcutaneous implanting of levonorgestrel silica gel staff and injected 1.5 IU hCG twice daily for 9 days from the 4th day. The rats in the control group were injected with normal saline at the same time. Ovarian morphologic changes,sex hormone levels,fasting serum insulin and glucose were detected. The LHR,INSR and AR genes' DNA methylation patterns were checked by methylation specific PCR in modeling group and control group.Results The ovarian weight and volume in modeling group were higher than those in control group. The ovaries in modeling group showed multiple follicular cysts,and the number of theca cells and interstitial cells increased. Less developed follicles and corpus lutea were seem. The serum level of progesterone,testosterone,luteinizing hormone,fasting insulin and glucose were significantly higher in experimental group than those in control group,so as the LH/FSH ratio and HOMA index. No methylation of LHR and AR genes were found in both groups. The methylation frequency of INSR gene (76.7%) was significantly higher in modelinggroup than that in control group (P

Objective To discuss the value of MRI in the assessment of diagnosis and staging of cervical carcinoma. To compare MRI diagnosis value before surgery and pathology staging after surgery in uterine cervical carcinoma. Methods Pelvic MRI were performed in 50 patients with cervical carcinoma. The pathological type included 47 cases of squamous cell carcinoma, 2 cases of adenocarcinoma and 1 cases adeno-squamous carcinoma. The MRI scanning included axial SE T1WI, axial , sagittal and coronal FSE T2WI ,and axial , sagittal and coronal enhanced or dynamic contrast-enhanced MR. MR staging were compared with surgical pathologic staging after surgery in 38 patients. Results The accuracy of MR imaging in stage Ⅰ - ⅡA of cervical cancer were 82.35 %. These patients performed an operation of hysterectomy or subtotal hysterectomy surgery. The accuracy of MR imaging in stage ⅢA-ⅣB were 100 %. The accuracy of MRI in total stage were 84.21%. Conclusion MR imaging can show the local tumors and extension of the cervical cancer clearly on multiple planes and angles. Preoperative staging with high accuracy, MR1 is conducive to preoperative evaluation, surgical plan formulation and selection.

Objective To investigate the safety and effectiveness of digital subtraction angiography (DSA) in the surgical treatment of intracranial arteriovenous malformations (AVMs) in children.Methods Between December 2015 and February 2017,the clinical and imaging data of 9 children with AVM (2-14 years) underwent hybrid surgery at the Department of Neurosurgery,Xuanwu Hospital,Capital Medical University were analyzed retrospectively.According to the Spetzler-Martin grade,there were 2 patients with grade Ⅰ,3 with grade Ⅱ,2 with grade Ⅲ,and 2 with grade Ⅳ.All the children were treated with microsurgery,and their AVMs were removed by real-time assistance using DSA technique during the operation.The imaging cure rate of surgical treatment and the complications of intraoperative angiography of the children were analyzed.The children were followed up clinically after procedure.According to the modified Rankin scale (mRS) score,their prognoses were evaluated.Results Intraoperative angiography revealed that the AVMs in 8 of 9 children were resected completely,and 1 had a residual lesion,then it was resected completely.Immediately after the resection of the nidi,the angiography confirmed that the nidi of 9 children were resected completely.No related complications caused by intraoperative angiography were observed.Nominal aphasia occurred in 1 child after procedure,and he recovered gradually after 6 months.Pulmonary infection occurred in 2 children,and they were cured after anti-infection treatments.Postoperative follow-up mRS scores were 0-1 in 8 children,2 in 1 child,and no rebleeding was observed.Conclusions In children undergoing AVM surgery,initial observation of DSA is safe and effective.Intraoperative angiography can guide the complete resection of the lesions in real time,improve the surgical cure rate of AVMs,and improve the prognosis of children.

AIM To study the role of nitric oxide (NO) and nitric oxide synthase (NOS) inhibitors during the early stage of focal cerebral ischemic injury in rats. METHODS The rat models of middle cerebral artery occlusion were established with the intraluminal suture method. The nonselective NOS inhibitor and selective inducible NOS inhibitor were used for investigating the effects of NO and NOS changes in the focal ischemic brain tissue and their respective roles during the early stage of focal cerebral ischemic injury. RESULTS This study showed that nonselective NOS inhibitors(N G nitro L arginine) aggravated brain damage in the early stage of focal cerebral ischemia and selective iNOS inhibitors (Aminoguanidine )did not significantly improve the brain damage , but could decrease markedly the deterioration of brain damage. CONCLUSION It may be concluded that the NO from defferent cells and types of NOS play unlike roles in the early stage of focal cerebral ischemic injury.

Objective: To evaluate the hemodynamic and prognostic effects of milrinone in patients undergoing valve replacement throughout the process of operation. Methods: Twenty patients undergoing valve replacement were radomized into group A ( n =10) and group B ( n =10).Before induction of general anesthesia, milrinon was administered at a 30 ?g/kg bolus dose intravenously in 10 min, followed by a continuous infusion of 0.5 ?g/(kg?min) in group A, and the same volume of normal saline in group B. The parameters of hemodynamics were obtained at the following points: before and after loading dose of milrinone, after induction of general anesthesia, after opening the chest, after weaning of CPB, before and after shutting of the sternum. The time of ICU stay and quantity of fluid in and out were calculated. Results: (1) After loading dose of milrinon, CI, LVSWI in group A were significantly higher, while PAP, CVP, SVR and PVRI were significantly lower than the same point of group B. CI, LVSWI and SVR in two groups remained significant different at the other points. (2) Patients in group A had more colloed and norepinephrine infusion than group B. Conclusion: Administration of milrinone at loading dose can effectively increase cardiac output and left ventricular stroke work, and decrease pulmonary artery pressure, pulmonary and system vascular resistance. [

Objective To establish an animal model of PCOS and to detect the DNA methylation states of LHR, INSR and AR genes. Methods 24-days-old female Sprague-Dawley (SD) rats were randomly divided into two groups. The rats in the experimental group were given subcutaneous implanting of levonorgestrel silica gel staff and injected 1.5 IU hCG twice daily for 9 days from the 4th day. The rats in the control group were injected with normal saline at the same time. Ovarian morphologic changes, sex hormone levels, fasting serum insulin and glucose were detected. The LHR, INSR and AR genes' DNA methylation patterns were checked by methylation specific PCR in modeling group and control group. Results The ovarian weight and volume in modeling group were higher than those in control group. The ovaries in modeling group showed multiple follicular cysts, and the number of theca cells and interstitial cells increased. Less developed follicles and corpus lutea were seem. The serum level of progesterone, testosterone, luteinizing hormone, fasting insulin and glucose were significantly higher in experimental group than those in control group, so as the LH/FSH ratio and HOMA index. No methylation of LHR and AR genes were found in both groups. The methylation frequency of INSR gene (76.7%) was significantly higher in modeling group than that in control group (P<0. 001). Conclusion The depression of INSR gene's transcriptional induced by DNA methylation is important in the development of insulin resistance in PCOS.

Objective To discuss the surgical strategy of parasagittal and falcial meningiomas in the middle 1/3 cortex area and raise resective rates of tumors and surgical effects.Methods The clinical,imaging and operative data of 74 cases of parasagittal and falcial meningiomas in the middle cortex area which underwent operation were reviewed and followed up.Results Of 74 tunors,67 were resected with Simpson Ⅱ grade,7 with Simpson Ⅲ,none of them with Simpson Ⅰ.Superior sagittal sinus and the vein of central suleus and feeders of cortex were reserved well.Severe brain injury was not occurred in 66 cases with tumors debulking(Simpson Ⅱ 61 cases,Simpson Ⅲ 5 cases),the neuro-functions of patients were normal or transient slight weakness of contralateral lower extremities postoperatively.Tumors of 8 cases were "turned over" and resected by piecemeal (Simpson Ⅱ 6 cases,Simpson Ⅲ 2 cases),weakness and paralysis of contralateral lower extremities occurred in 7 cases and 1 cases respectively after surgery.Followed-up ranged from 6 months to 4 years and 2 months,4 cases were lost to follow-up.Neuro-function of all cases with weakness of contralateral lower extremities recovered after one month.Muscle strength of the cases with paralysis of contralateral extremity recovered to grade Ⅳ 6 months later,no recurrence and death.Conclusion The measures,including piecemeal tumor reseeted mierosugically,good protection of the vein of central sulcus,excellent management of superior sagittal sinus,and avoiding damage to functional cerebral cortex during operations,are best ways for raising the tumor resection rate and nearo-function reserved.

Objective To find out more optimal surgical approach for glioblastoma located in sensofimotor cortex and language area. Methods A respective review of 27 cases of glioblastomas located in sensorimotor and language area were operated, via the transsylvian-opercular approach, ineluding outcomes of microneurosurgery between January 2005 to December 2007. Results Among of 27 cases, tumors in 21 cases were covered by opereular cotex and were totally resected, tumors protruded into sylvian and wrapped around middle cerebral artery in 6 cases. 3 of them were totally removed, others were subtotally. Neurofunction of 26 cases were preserved of one were injuried. Conclusion Transsylvian-opercnlar approach for resection of glioblastomas located in subcortex of sensorimotor and language area is more optimal surgical approach, which not only ensure tumor resection with great degree, but preserve neurofunction well.

Objective To observe the effects of TLR9 on the nude mouse transplanted tumor growth of human pancreanc cancer and its drug resistance.Methods The nude mouse transplated tumor of human pancreatic cancer PANC-1 was established and randomly divided into 6 groups for conducting the experiment:sterile normal saline group,TLR9 agonist,TLR9 inhibitor group,gemcitabine group,TLR9 inhibitor plus gemcitabine Bin group,TLR9 agonist plus gemcitabine.The tumor size and growth situation were recorded by the vernier caliper.The immunohistochemical method was used to detect tumor TLR9 receptor expression.The tumor growth,metastasis and paracancerous nssue invasion situation were observed by the magnetic resonance imaging (MRI).Results The volume and growth speed of resected tumor mass in the gemcitabine group,TLR9 agonist + gemcitabine group,TLR9 inhibitor plus gemcitabine group was significantly smaller than those in other groups (P＜0.05),which in the TLR9 agonist + gemcitabine group were significantly greater than those in the TLR9 inhibitor plus gemcitabine group and gemcitabine group (P＜0.05),the difference between the TLR9 inhibitor plus gemcitabine group and gemcitabine group had statistical significance (P＜0.05),while the difference among the TLR9 agonist group,TLR9 inhibitor group and normal saline group had no stastistical significance (P＞0.05).The tumor in mice at 7 weeks after planting showed oval shape with clear boundary by MRI observation,no obvious metastais and paracancerous invasion were seen in paracancerous nssues no statistically significant,5 weeks,6 weeks after planting,seven weeks mice observed in MRI,the tumor into an,state clearly that the transfer of the surrounding tissue,no significant vascular invasion,heart,liver,kidney disease.The TLR9 expression on the surface of tumor tissue was detected and identified.Conclusion Pancreatic cancer nude mouse transplated tumor has definitely positive expression of TLR9,TLR9 activation can significantly decrease the sensitivity of pancreatic cancer to chemotherapy,increases the drug resistance of tumor,on contrary promotes the tumor growth.