The training of residents constitutes the primary work of Graduate Medical Education.Reviewing the historical development of the training of residents,we find that it has experienced four stages and trended to establish the medical specialist training system.

The quality of doctoral degree conferring depends on the quality of doctoral dissertation.Based on the quality evaluation of doctoral dissertation in medical School of Shanghai Jiaotong University in 2005,the author points out the problems existing in doctoral dissertation nowadays and makes some explorations on how to improve the quality of doctoral degree conferring.

This study was set up to observe the changes in stress and immune functions in upper abdominal surgery after general anesthesia.In thirty elective upper abdominal operation patients,general anesthesia was induced with propofol,fentanyl,scoline and maintained with isoflane and atrumium. Catecholamines(CA),cortisol,interleukin-2(IL-2) and soluble interleukin-2 receptor(sIL-2R) were measured before anesthesia,after induction of anesthesia,at the end of operation,and on the first and third postoperative days.The results showed that epinephrine(E),norepinephrine(NE) concentration increased at the end of operation and on the first postoperative day(P<0.01)，Cortisol concentration decreased after anesthesia induction(P<0.05)，IL-2 concentration decreased at the end of operation(P<0.05)，and sIL-2R lever did not change.The investigation suggested that general anesthesia with propofol,fentanyl and isoflane can suppress CA and cortisol increase resulting from induction of anesthesia. There was no change in IL-2 level.However it can not suppress the increase of stress hormones and decrease of IL-2 due to operation.The stress response correlate with immune functions.

This study was set up to observe the changes in stress and immune functions in upper abdominal surgery after general anesthesia.In thirty elective upper abdominal operation patients,general anesthesia was induced with propofol,fentanyl,scoline and maintained with isoflane and atrumium. Catecholamines(CA),cortisol,interleukin-2(IL-2) and soluble interleukin-2 receptor(sIL-2R) were measured before anesthesia,after induction of anesthesia,at the end of operation,and on the first and third postoperative days.The results showed that epinephrine(E),norepinephrine(NE) concentration increased at the end of operation and on the first postoperative day(P

Objective To observe the clinical contraeeption effects of GyneFix IN IUD,MCu IUD and TCu220C IUD.Methods From January 2005 to December 2006,comparative study was carried out by randomly applying 3 different types of IUDs(GyneFix IN,MCu and TCu220C IUD) for 300 healthy women.Follow-up survey was taken after 1,3,6,and 12 months.Results The pregnancy rates with IUD among 3 types of IUDs showed no significant difference(P>0.05).The expulsion rates of GyneFix IN IUD and MCu IUD were lower than that of TCu220C IUD(P<0.01).The removal rate of GyneFix IN IUD and MCu IUD were lower than that of TCu220C IUD(P<0.05).The 12 months cumulative continuation rates of GyneFix IN IUD and MCu IUD were higher than that of TCu220C IUD(P<0.01).Conclusions GyneFix IN IUD and MCu IUD can be recommended for clinical use based upon the advantages of lower pregnancy rate,lower removsl rate because of side-effect and higher cumulative continuation rate.Proper IUD should be selected depending on individuals,in order to increase the contraception effects and decrease the side-effects.

Objective To evaluate the performance of the target controlled infusion(TCI) system with midazolam during combined spinal and epidural anesthesia. Methods Twenty female patients scheduled for selective lower abdominal or pelvic surgery under combined spinal and epidural anesthesia were enrolled in this study. They use combined spinal and epidural anesthesia with target controlled infusion of midazolam sedation. Midazolam plasma concentration was set at 100ng/ml. Blood pressure,heart rate, pulse oxygen saturation were monitored during anesthesia and operation. We use BIS as a pharmacodynamic value of midazolam sedation. Blood samples were taken from radial arterial for analysis of plasma midazolam concentration during infusion. Midazolam plasma concentration were tested by high performance liquid chromatography. Results MDPE of target controlled infusion with midazolam with Burher parameters was 38.7%, MDAPE was 38.7%,and wobble is 24.9% in Chinese female patients. Conclusions Burher parameters of midazolam target controlled infusion system should be correct, then can be used for our country female patients conscious sedation accurately.

Objective To study the difference of Han male children and adolescent bone age of wrist-hand in Beijing and Guangzhou.Methods Bone age (BA) of left hand-wrist was assessed using X-ray by two radiologists based on CHN atlas method in 993 healthy children and adolescents (age range:1.0-19.0 years).The radiologists were blinded to the chronological age (CA) of those children.The interobserver variations were analyzed for evaluating the reliability of CHN Atlas method.The difference between CA and BA were separately assessed,and were analyzed by t test.Results Close correlation was found between BA and CA (r =0.969,0.957,P ＜ 0.01) in both two regions.The bone age was advanced at 1.0-3.9,and 7.0-15.9 years in Beijing boys,and at 1.0-2.9,6.0-7.9 years in Guangzhou bpys.There was significant difference at 1.0-1.9,9.0-14.9 years between Beijing and Guangzhou.Conclusions The bone age of Han male children adolescent in Beijing and Guangzhou area has the characteristic of acceleration.There is significance difference at some years between Beijing and Guangzhou,and the results can provide potential value for the further study of BA and clinical medicine.

OBJECTIVETo observe the effects between acupuncture combined with rehabilitation and simple rehabilitation for shoulder pain after stroke, and to select the best plan of acupuncture manipulations at different stages by orthogonal design.

METHODSNinety patients were treated with comprehensive rehabilitation, and nine cases without acupuncture were arranged into a control group. Eighty-one patients of orthogonal design were applied by acupuncture with the same acupoints and course. The VAS score and its weighted value were regarded as the observation indices,and the effects between the acupuncture group and the control group were compared. The optimal plans of acupuncture manipulations of the early stage and the later stage were chosen after the first course treatment and the third course treatment separately. The acupuncture depth (factor A:A: shallow depth less than 25 mm, A(II): modest depth 25-40 mm, A(III): deep depth 40-50 mm), the acupuncture angle (factor B:B(I): perpendicular insertion, B(II): horizontal insertion, B(III): oblique insertion), needle manipulated frequency (factor C: C(I): zero time, C(II): one time, C(III): three times) and needle retained time(factor D:D(I):20 min, D(II): 30 min, D(III): 60 min) were studied. The differences among all factors and the diversity among major factors at different stages were analyzed.

RESULTS(1) Acupuncture combined with rehabilitation at the early and the later stage acquired better improvement than simple rehabilitation (all P < 0.01). (2) The optimal acupuncture manipulation plan at the early stage was A(III) B(III) C(I) D(I), which was deep acupuncture and oblique insertion for 20 min with zero-time manipulation; the optimal acupuncture manipulation plan at the later stage was A(III) B(III) C(III) D(I), which was deep acupuncture and oblique insertion for 20 min with three-time manipulation. (3) There was significance for acupuncture depth and angle at the early stage (both P < 0.01) and there was significance for insertion depth, acupuncture angle and manipulating frequency at the later stage (all P < 0.05). (4) At the early stage, the insertion depth was statistically significant between A(I) and A(II), A(I) and A(III), A(II) and A(III) (P < 0.05, P < 0.01), and the statistical significance was existed between B(I) and B(III) (P < 0.01). At the later stage, the insertion depth was statistically significant between A(I) and A(III), A(III) and A(II), A(I) and A(II) (P < 0.05, P < 0.01), and the statistical significance was existed between C(I) and C(III), C(II) and C(III) (P < 0.05).

CONCLUSIONAcupuncture combined with rehabilitation acquire apparent effect for shoulder pain after stroke. At the early stage,the optimal plan is deep and oblique insertion for 20 min with zero-time manipulation. At the later stage, the best plan is deep and oblique insertion for 20 min with 3-time manipulation.

Acupuncture Therapy ; Aged ; Aged, 80 and over ; Combined Modality Therapy ; Female ; Humans ; Male ; Middle Aged ; Shoulder Pain ; etiology ; rehabilitation ; therapy ; Stroke ; complications ; Treatment Outcome

Objective To assess the efficacy of combination therapy with all-trans-retinoic acid (ATRA ) and arsenic trioxide (ATO) in treating patients with acute promyelocytic leukemia (APL) .Methods A retrospective study was conducted to evaluate the efficacy of combining ATO with ATRA based induction therapy ,followed by 3 courses of consolidation chemotherapy and 2-year sequential ATO/ATRA maintenance therapy in newly diagnosed APL ,and the efficacy between high risk group and low/inter-mediate risk group ,also between different PML-RARa isoform sub-group were compared .Results In high risk group and low/in-termediate risk group ,the complete remission(CR)rates were 70 .0% and 96 .9% (P=0 .04) ,respectively ;the 3 years overall sur-vival rates(OS) and disease free survival rates (DFS) were(70 .0 ± 14 .5)% ,(96 .9 ± 3 .1)% ,P= 0 .01 and(66 .7% ± 19 .2)% , (93 .8 ± 6 .1)% ,P=0 .08 ,respectively .In BCR1 group and BCR3 group ,the CR were 78 .6% and 95 .6% (P=0 .14) ,respectively ;the rates of 3 years OS and DFS were(95 .7 ± 4 .3)% ,(78 .6 ± 11 .0)% ,P=0 .18 ,and(92 .9 ± 6 .9)% ,(87 .5 ± 11 .7)% ,P=0 .24 , respectively .Conclusion The results indicate that ATO based first-line protocol is highly effective for treatment of newly diagnosed APL ,especially for the PML-RARa BCR3 isoform APL .

Objective To analyze the imaging features of hepatocellular carcinoma(HCC)with bile duct tumor thrombi.Methods Thirteen patients with bile duct tumor thrombi proved pathologically underwent imaging examination.MR and CT were performed in 3 cases,and 2 cases had CT only and 8 cases had MRI only.Uhrasonography(US)was performed in all 13 patients.The accuracy of bile duct tumor thrombi detection was compared between US.CT and MRI with Fisher tost.Results Liver tumors and bile duet tumor thrombi were demonstrated in all patients on CT or MRL Presence of intraluminal soft tissue mass was found in four of five cases on CT.and mild enhancement of the intraluminal mass in the arterial phase was noted.dilated bile duct distal to tumor thrombi was detected in all five patients.Eleven Tumor thrombi showed slight low signal intensity on T1 WI,slight high signal intensity on T2 WI,and mild to moderate contrast enhancement on the contrast-enhanced MR images.The MRCP findings of tumor thrombi were as follows:interruption,stricture of the bile ducts or irregular filling defect in the bile ducts with dilated intrahepatic ducts.bile duct was abruptly interrupted or showed a"rat-tail"stricture(n=5);the common bile duct was filled with tumor thrombi.intrahepatic bile duct dilatation and missing common bile duct was noted on MRCP(n=2).Bile duct tumor thrombi were toltecfly diagnosed in 7 cases on US,and 12 cases on CT or MRI.Six cases were misdiagnosed or miss-diagnosed on US,and 4 cases were misdiagnosed on CT or MRI.There was no significant difference between US and CT/MRI in diagnosis of bile duct tumor thrombi(P=0.270).Conclusion CT or MR imaging is useful for the diagnosis of HCC with biliary tumor thrombi and for evaluating the extension of thrombi.