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.

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 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.

Objective To evaluate the clinical value of gemstone spectral imaging (GSI) in preliminary assessment of esophageal carcinoma pathology features.Methods 58 patients were analyzed which were diagnosed with histological pathology as esophageal carcinoma underwent GSI enhanced scans before surgery.The iodine concentrations (IC) in the lesions were measured on the iodine-water based material-decomposition images.The results of IC value were evaluated retrospectively with different pathological grading,locations and pathological morphology according to the final pathologic findings.Results 52 cases patients were squamous cell carcinoma and 6 patients were adenocarcinoma.The IC values were (14.75±4.24) mg/ml and (12.86±5.09) mg/ml.The IC value between the two different pathological types had not statistically difference (P =0.35).The IC of different pathological grading:Well differentiation was (20.08± 4.66)mg/ml,n =19.Medium was (14.13±3.39) mg/ml,n =25.Poor was(11.73±3.21) mg/ml,n =14.The IC values between pathological grading had significant difference(P =0.00).There were four different pathological morphology including m edullar (n =16),m ushroom type (n =21),ulcer (n =13) and narrow type (n =8).Their IC values respectively were (16.34±2.56) mg/ml,(18.70±3.03) mg/ml,(14.31±4.60) mg/ml and (11.18±2.09) mg/ml.The IC value between mushroom and narrow type had statistical difference (P =0.04).The Other types had no statistically difference (P =0.19).Conclusions The results of this study demonstrate that GSI has a certain ability of pathologic stage of esophageal cancer.The GSI has a certain clinical value in guiding treatment and judging prognosis of esophageal carcinoma.

Objective To investigate the effect of endogenous electric fields on proliferation and migration of epidermal stem cells (EpSCs) in vitro.Methods EpSCs in the first passage were cultured on simulated endogenous electric field.Galvanic stimulation set at an intensity of 0 mV/mm (Group Ⅰ),100 mV/mm (Group Ⅱ) and 200 mV/mm(Group Ⅲ) was given twice a day for 3 days with each time continuing 1 hour and resting 1 hour.Effect of bio-electric field on cell proliferation was measured by direct cell counting in fixed visual field.Repeated experiment but continued stimulation for 3 hours was performed.Live cell migration was monitored to determine the effect of bio-electric field on the process of cell migration.Results For the EpSCs cultured in endogenous bio-electric simulation platform for 24,48 and 72 hours,cell proliferation rate was the highest in Group Ⅲ [(107.4 ±21.9)％,(270.2 ± 71.4) ％,(544.0 ± 95.1) ％] (P ＜ 0.01).And higher cell proliferation was observed in Group Ⅰ [(35.1 ± 21.0) ％,(138.6 ± 31.0) ％,(323.5 ± 23.0) ％] than in Group Ⅱ [(66.9 ±24.2) ％,(192.1 ± 36.2) ％,(406.7 ± 50.7) ％] (P ＜ 0.01).After continued galvanic stimulation for 3 hours,cells in Groups Ⅱ and Ⅲ oriented towards cathode,but cells in Group Ⅰ moved randomly.In measurements of track velocity (Vt),displacement velocity (Vd) and electric field migration rate (Vx),Group Ⅲ revealed increased values[(42.5 ± 2.8),(32.3 ± 1.8),(29.7 ± 1.3) μm/h] as compared with Group Ⅰ [(36.2 ±2.2),(23.6 ±2.9),(18.2 ± 1.8) μm/h] and Group Ⅱ [(34.3 ±1.6),(23.8±l.2),(21.2±l.6)μm/h] (P＜0.01).Conclusion In vitro experiments reveal that endogenous electric fields can promote the proliferation of EpSCs and induce oriented movements towards the cathode.

Objective To observe the effect of bronchial asthma combined with allergic rhinitis by azelastine hydrochloride nasal spray.Methods Eighty-seven cases of bronchial asthma combined with allergic rhinitis patients were divided into treatment group(45 cases)and control group (42 cases) by random number table method,both groups were given the treatment of bronchial asthma according to the guidelines for regulating,treatment group on the basis was combined with azelastine hydrochloride 1 spray per side,2times per day,for 3 months.Observe two groups of asthma symptoms within 3 months control situation,the number of antibiotics and hospitalization for acute exacerbation.Results Treatment group total effective rate,asthma control test score,number of antibiotics and due to the number of exacerbations hospitalization were superior to control group [93.33％(42/45) vs.76.19％(32/42),(23.80 ± 2.15)scores vs.(22.05 ±3.16) scores,13.3％ (6/45) vs.35.7％ (15/42),11.1％ (5/45) vs.33.3％ (14/42)] (P ＜ 0.05 or ＜ 0.01).Conclusion Combined by azelastine hydrochloride nasal spray may make a good control,reduce the use of antibiotics for acute attack and times of hospitalization,worthy of clinical application.