Nowadays the antravention between clinical practice and protecting rights of patients' intimacy becomes more and more intense.Face to this stuation,the authors take a investigotion about 365 clinical interns in order to find out solutions.

The hemorrheological changes were observed in 7 cases with portal hypertension after they were operated on with distal splenocaval shunt (DSCS). Similar cases with splenecto-my served as controls. It was found that blood hyperviscosity was slightly decreased after DSCS and the deformability of erythrocytes was improved from 7 to 14 days after DSCS. But blood hyperviscosity was significantly increased in the cases after splenectomy. Blood hyperviscosity was lower in the cases with DSCS than in those with splenectomy. Blood hyperviscosity , expressed mainly by the aggregation rate and deformability of erythrocytes, platelet count, etc, is dependent on the spleen. Since the spleen is preserved in DSCS so blood hyperviscosity is slightly decreased and complications due to blood hyperviscosity may be less in number after DSCS.

The connections between the dorsal raphe nucleus and other nuclei in the CNS were studied with Nauta degeneration method and HRP retrograde transport method.After dorsal raphe nucleus had been lesioned the degenerating efferent fibers could be divided into dorsal, intermediate and ventral groups. Via the dorsal group the ascending fibers passed through the periaqueductal gray matter and terminated in the substantia grisea centralis, substantia grisea periventricularis, and substantia grisea paraventricularis of the ventricularis tertius. The intermediate group, lying in the raphe of tegmental and reticular formation, was projected to the mesencephalic reticular formation, substantia nigra bilaterally. The ventral group, passing through the area tegmentalis ventralis, medial forebrain bundle (MFB), zona inserta, was projected to the lateral hypothalamic region, thalamus and telencephalon.The descending projections mainly from the intermediate and ventral groups, could be traced in the lateral region of the periaqueductal gray. The degenerating fibers passed through the ventral aspect of tegmentum along both sides of the raphe, and finally continued to the lower brain stem, and the dorsal horn of spinal cord.In the lower brain stem, the descending degenerated fibers terminated in the nucleus raphe pontis, nucleus raphe magnus, nucleus raphe pallidus, nucleus raphe obscurus, nucleus reticularis tegmenti pontis, nucleus reticularis gigantocellulari, nucleus reticularis paramedianus, nucleus olivaris inferior accessoris medialis, and nucleus tractus spinalis nervi trigemini.After the injection of HRP into the dorsal raphe nucleus, labelled neurons were found in forebrain structures, consisting of nucleus periventricularis, nucleus anterior medialis thalami,nucleus habenularis lateralis,nucleus anterior hypothalami,nucleus dorsomedialis hypothalami, nucleus preopticus medialis, nucleus mamillaris lateralis, ventral tegmental area of Tasi, zona inserta, nucleus supraopticus, and nucleus interpeduncularis. Below the level of injection site, labeled neurons were found in substantia nigra (zona reticularis and compacta), periaqueductal gray, nucleus interpeduncularis, locus coeruleus, nucleus tegmenti dorsalis, nucleus centralis superior, nucleus raphe pontis, nucleus raphe magnus, and nucleus reticularis lateralis.

Studies of the afferent connections of the nucleus accumbens in 56 rats were carried out by retrograde transport method of horseradish peroxidase (HRP). The microinjection or microiontophoretic delivery was performed either through ipsilateral vertical or through contralateral oblique approach into the nucleus. Labelled neurons were found in nucleus caudatus and putamen, nucleus septi lateralis, nucleus amygdaloideus basalis lateralis, nucleus periventricularis thalami, nucleus paratenialis, periventricular gray hypothalami, nucleus medialis thalami, nucleus reuniens, substantia nigra and area ventralis tegmenti (Tsai) in all cases. In addition, the HRP labelled neurons were observed in the cinguIate gyrus, hippocampus, nucleus parafascicularis, nucleus anterior thalami, nucleus dorsal raphe and interpeduncular nucleus in most cases.

Objective To study the teaching effects of using case discussion-analysis method in the teaching course of Nursing Research among nursing students and then put forward suggestions for improving teaching.Methods By way of case discussion-analysis,a part of teaching contents of Nursing Research were taught to the 118 nursing students in 2003 grade.The teaching effect was evaluated by observing the design ability of scientific research,the learning interest,learning attitude,etc.Results The design ability of scientific research,recognition of Nursing Research,learning attitude and learning interest,etc of the students were significantly improved.Conclusions Case discussion-analysis method could effectively excite the interest and the potential of students and then improve the ability of discovering and solving problems.

Objective To evaluate the diagnostic value of CT myelography (CTM) in brachial plexus injury. Methods Twenty-seven patients with brachial plexus injury were examined by using cervical CTM with spiral scan and bone reconstruction algorithm. CT images were reviewed by the senior radiologists, who determined if the nerve root avulsion was presented. The criteria of diagnosing nerve root avulsion were loss of normal nerve root appearance in the Isovist filled thecal sac in consecutive CTM slices plus companion signs. The sensitivity, specificity, and accuracy of CTM in diagnosing nerve root injuries were calculated with operation findings and follow-up results as gold standard. Results Direct sign of nerve root avulsion was the loss of normal nerve root defect seen in the Isovist filled thecal sac in consecutive CTM slices. Indirect signs included: (1) Pseudomeningocele bulge: The leak of Isovist into nerve root sheath, and extended into foramina; (2) Arachnoid cyst: displacement of spinal cord; (3) Dissymmetry of subarachnoid cavity: deformity of thecal sac, partially lack of Isovist into arachnoid space; (4) Non-integrity of dural capsule wall: one side of capsule cavity was obstructed. Part of the surface of spinal cord was exposed. Brachial plexus injury could be diagnosed by direct sign with one of the indirect signs. Of the 27 patients (128 nerve roots), 91 nerve root avulsions were found on CTM, and 37 was found normal. Compared with operation findings, 84 were true positive, 7 false positive, 34 true negative, and 3 false negative. Based on these results, the sensitivity, specificity, and accuracy were 96.6%, 82.9%, and 92.2%, respectively. Conclusion CTM is accurate in detecting nerve root avulsion of brachial plexus.

AIM: To investigate the effects of oridonin on the invasion and migration of hepatocelluar carcinoma cells.METHODS: Human hepatocelluar carcinoma MHCC-97H cells were cultured and treated with 5, 10 or 20 μmol/L oridonin.The migration ability was measured by wound healing assay.The invasion ability was examined by Transwell invasion assay.The adhesion capabilities were evaluated by adhesion assay.The protein levels of LIM kinase-1 (LIMK-1), cofilin and phosphorylated cofilin (p-cofilin) were determined by Western blot.RESULTS: Oridonin inhibited the migration, invasion and adhesion abilities of MHCC-97H cells in a dose-dependent manner (P<0.05).After oridonin treatment, the expression of cofilin had no obvious change, but the protein levels of LIMK-1 and p-cofilin decreased significantly.CONCLUSION: Oridonin inhibits the invasion and migration of MHCC-97H cells.The mechanism may be related with the regulatory effect of oridonin on LIMK-1/cofilin signal transduction pathway.

Objective To investigate the value of time-intensity curve of dynamic contrast enhancement MR imaging in the discrimination of benign and malignancy in musculoskeletal tumors. Methods Ninety patients were examined with fast acquisition with muhiphase enhanced fast GRE series. The TIC of lesions were obtained using slope images in which pixel intensity reflected the slope value. The curves were classified according to their shapes as type Ⅰ , washout enhancement; type Ⅱ, plateau enhancement; type Ⅲ, gradual enhancement. Taking pathological diagnosis as gold standard, the power of the maximal enhancement slope and curve types in discriminating benign and malignant lesions was evaluated by appropriate statistic analysis. Results There were 49 malignant and 44 benign lesions. The distribution of curve types for malignant tumors was type Ⅰ 75.5% ( 37/49), type Ⅱ 24. 5% (12/49). While the numbers for benign tumors was type Ⅰ 59. 1% ( 26/44 ), type Ⅱ 15.9% ( 7/44 ) and type Ⅲ 25.0% ( 11/44 ), respectively. The patterns of curve types in malignant lesions were different from benign lesions significantly ( χ2 = 14. 008, P < 0. 01 ). The slope value in benign lesion was 6. 80 + 3. 35 and that in malignant lesion was 6. 80±2. 71. The difference was not statistically significant( t = 0. 008, P > 0. 05 ). Type Ⅰ and type Ⅱ (excluding lesions with typical benign morphology ) were suggestive of malignant tumors. Type Ⅲ was indicator of a benign lesion. The diagnostic indices for the shape of TIC criterion were: sensitivity 100%, specificity 50%, positive predictive value 78%, negative predictive value 100% and accuracy 82%, respectively. Conclusion Combined with the characteristic of morphology, the TIC improves the power of MR imaging in discriminating benign from malignant musculoskeletal tumors.

Objective To summarize twenty year experience in the surgical treatment of hilar cholangiocarcinoma(H CC) and explore the effective measuers for increase in resectional rate and reducing operative morbidity and mortality of H CC. Methods Clinicopathological data of 201 patients with H CC treated surgically in our center between 1978 and 1997 were analysed retrospectively. The resection rate, operative morbidity and mortality of the patients before and after December 1990 were compared. Results Of the 201 patients, 97 underwent resection(redical resection in 51; palliative in 46), 84 subjected to internal or external drainage and 20 only laparotomy. In 75 followed up patients, the 1,3,5 year survival rate was 95.45%, 40.91%, 13.64% in radical resection group, and 55%, 10%, 0% in palliative resection group respectively; whereas in unresectional internal and external drainage group, 1 year survival rate was 36%, noone survived for more than 3 years. All the patients with only laparotomy died within 3 months after operation. Comparation of the two stages revealed that the resection rate had been increased from 34.95% before December 1990 to 62.24% after December 1990, and the radical resection rate from 15.53% to 35.71%, meanwhile the operative morbidity and mortality decreased from 39.80% and 17.84% to 18.37% and 6.12% respectively. Conclusions Radical resection plays an important role for improving long term survival rate in patients with H CC. Appropriately perioperative care can reduce the operative morbidity and mortality.