The author analyzed current situtation of teachers and students during clinical practice,and proposed that we should well attach importance to the training of behaviour,including working style,basic skill,clinical thinking and research idea,to improve the quality of medical education in clinical teaching,

Objective To retrospectively review the epidemiological data from 159,242 patients hospitalized after traumatic brain injury in traffic accidents and provide epidemiological evidences for the prevention and treatmentmeasures.Methods Patient data were collected using the Chinese Trauma Database for the years 2001-2007.Epidemiological features of age,gender,time distribution,length of hospital stay,state of injury,and treatment outcome were recorded.Results Age of the patients was (33.01 ± 15.20) years and ratio of male to female patients was 2.39∶ 1.The majority were aged 21-50 years with the 31-40 age group were more vulnerable.Annual average growth of age was 3.92％.Within a year,number of the patients accounted for 54.10％ from July to December with it reached the peak in October.Mean length of stay was 20.20 days with the longest stay in the ≥90 age group and shortest stay in the ≤10 age group.Mean hospital charges was 13 689.8 yuan with the ≤10 age group occupying the least and 51-60 age group occupying the most.Overall cure rate was 66.92％ and mortality was 4.22％.Proportion of severe traumatic brain injury in traffic accidents increased and related cure rate decreased with increased age.Male patients showed higher death rate and lower cure rate compared with female patients.Conclusions Incidence of traffic accidents-related traumatic brain injury is the most in the young and middle-aged population and is prevalent in the second half year.There should be emphasis on the aged or male patients.Measures to prevent and treat the injury may produce better results when defined based upon these epidemiologic features.

Objective To investigate the clinical effect of using uninterrupted vacuum sealing drainage combined with routine debridement and pedicled periosteal flap sealing frontal sinusitis in treating frontal sinusitis after craniotomy.Methods The clinical data in 31 cases of frontal sinusitis after craniotomy in our hospital from January 2006 to December 2014 were retrospectively analyzed.Seventeen cases adopted simple debridement and drainage treatment and 14 cases were treated with continuous vacuum sealing drainage combined with routine debridement treatment.Postoperative follow up lasted over 1 year.Results In simple debridement and drainage,12 cases were cured,the other 5 cases recurred after operation,and the cure rate was 70.6 ％.But in the continuous vacuum sealing drainage combined with routine debridement treatment,14 cases were cured,no case recurred after operation,and the cure rate was 100％.Therefore,the cure rate of continuous vacuum sealing drainage treatment combined with routine debridement was higher than that of simple debridement and drainage treatment(P＜0.05).Conclusion Adopting vacuum sealing drainage combined with routine debridement and pedicled periosteal flap sealing frontal sinusitis can promote the infection focus clearance and wound healing,and increases the cure rate.

Objective To study the mechanism of glycerol in treatment of trigeminal neuralgia. Methods After chronic constriction injury was produced to the infraorbital nerve and the model of trigeminal neuralgia in rats was successfully established, the trigeminal ganglion and preganglionic rootlets were exposed through infratemporal fossa approach. In the experimental group, pure glycerol was instilled into the preganglionic rootlets, while in the control group physiologic saline instead. The electrophysiologic response and the results of the electron microscopy were observed at different time points after glycerol injection. Results The latency of sensory evoked potential in the experimental group was longer than that in control group. Under the electron microscope, demyelination and degeneration were very similar in two groups, but disruption of neuraxon was only observed in the experimental group. Neuraxon regeneration occurred 10 weeks later. Conclusion Retrogasserian glycerol rhizotomy in treatment of trigeminal neuralgia was through disruption of myelinated nerve fiber that is reversible.

Objective To investigate the relationship between hypoxia and stemness of cancer stem cells ( CSCs ) . Methods U87 cells,U251 cells and primary glioma cells were experienced hypoxia. Detected the ultrastructure of these cancer cells with transmission elec-tron microscopy;detect the cell growth with MTT assay;cell cycle and CD133 expression were detected by flow cytometry;and the cell mi-gration ablity were detected through transwell chamber assay;the colony-forming efficiency were deteced by colony-forming assay; and real-time quantitative PCR and Western blot were carried out to detect the mRNA and protein expression of markers of stem cells and their differ-entiation respectively. Results Hypoxia maintained the undifferentiated state of primary glioma cells, slowed down the growth of glioma cells which were in a relatively quiescent stage, increased the colony forming efficiency and migration of glioma cells, and increased the expression of markers of stem cells, but the expression of markers for stem cell differentiation was reduced after hypoxia treatment. Conclusion Hypoxi-a may induce the “dedifferentiation” of differentiated glioma cells which then acquire the stemness.

Objective　To investigate the mechanism affecting on permeability of vascular endothelial cell by nitric oxide (NO). Methods　Series concentration of sin-1（a donor of NO） were added to ECV 304, a cell line of human umbilical vein endothelium. Cell growth and expression of f-actin, a cytoskeleton protein were observed. Results　Cell growth was inhibited with a dose from 6.25 to 100 μmol/L and was caused to death at the concentration of 50 to 100 μmol/L by sin-1. The expression of f-actin was suppressed obviously after cultured with 100 μmol/L sin-1 for 4 hours. Conclusion　It suggests that anomaly increased NO can increase permeability of blood vessels by suppressing the expression of f-actin, inhibiting cell growth or even resulting in cell death.

Objective To explore the relationship of phosphatase and tensin homology deleted on chromosome ten ( PTEN ) expression with the positioning of AMPA recepter subunit GluR2 in hippocampal neuron after stretch injury. Methods The primary rat hippocampal neuron from neonate rats were cultured and the model of stretch injury established. Western blot and TUNEL staining were used to detect PTEN expression and the positioning of AMPA receptor subunit GluR2 in rat hippocampal neuron at different time intervals after stretch injury. Results The PTEN expression was increased obviously after stretch injury, while the expressions of AMPA receptors GluR1, GluR2 and GluR3 showed no evident differences at every time point. However, AMPA receptor subunit GluR2 located at cytomembrane was down-regulated obviously after stretch injury. Conclusion The intracellular PTEN expression and the expression of AMPA receptor subunit GluR2 located at cytomembrane are on the contrary, indicating that PTEN phosphatase may participate in the transport and reintegration process of AMPA receptor subunit GluR2 located at cytomembrane.

Objective To evaluate the effect of MRS-assisted stereotactic radiosurgery (SRS) for small recurrent high grade glioma (HGG).Methods A total of 54 patients with recurrent HGG were selected,the tumor diameter was less than 3 cm,the patients were divided into the conventional MRI group of 26 cases,and MRI+MRS group of 28 cases.The target region of the conventional MRI group was defined as the enhanced and short T1,long T2 area;MRI+MRS group was defined as the region of Cho/NAAindex (CNI) ≥1.6 in the surrounding short T1,long T2 and enhanced area.All the patients were followed up at least 12 months,analysed their therapeutic effect.Results Compared with the conventional MRI group,MRS+MRI group margin dose increased (19.46 Gy vs.13.58 Gy),the average diameter of target were smaller (2.6 cm vs.3.0 cm),progression-free survival was longer (6.8 months vs.5.6 months),the 1-year survival rate was higher (78.6％ vs.50.0％),and the occurrence rate of brain edema was lower (5 vs.17),the difference was statistically significant (P＜0.05).Conclusion MRI+-MRS assisted SRS helps to accurately identify the scope of HGG,its short term effect was superior.

Objective:To determine the difference of curative effects of gamma knife treatment and microsurgery on patients with recurrent trigeminal neuralgia (TN) after microvascular decompression (MVD).Methods:From January 2011 to December 2018, 65 patients with recurrent TN after MVD were enrolled in the study; 40 patients received gamma knife treatment and 25 patients received secondary microsurgical treatment. Barrow Neurological Institute (BNI) proposed pain grading was used to evaluate the efficacies right after treatment and 3 years after follow-up in all patients, and grading I-III was defined as pain relief.Results:Patients received gamma knife treatment had pain relief within 4-10 weeks of treatment and disappeared gradually; patients received secondary microsurgical treatment had disappeared facial pain immediately after waking up from anesthesia or completely alleviated facial pain within one week of treatment. Up to 3 years after surgery, follow-up results showed that 17 patients (68.0%) in the gamma knife treatment group had pain relief, and 16 patients (94.1%) in the microsurgical treatment group had pain relief; the difference in pain relief rate between the two groups was statistically significant ( χ2=4.100, P=0.043). Facial numbness was noted in the gamma knife treatment group, with an incidence of 24.0%; in the microsurgical treatment group, hemiplegia was noted in one patient and facial numbness was noted in the left ones, with complication rate of 29.4%; and the difference in complication rate between the two groups was not statistically significant ( χ2=0.010, P=0.921). Conclusion:For patients with recurrent TN after MVD, secondary microsurgical treatment and gamma knife treatment are safe and effective, among which secondary microsurgical treatment is more effective than gamma knife treatment.

Objective To study the factors influencing prognosis in the patients with recurrent glioblastoma muhiforme (GBM) and to investigate the effect of retreatemt.Methods The retrospective analysis method was adopted to collect the clinical and follow up data in 36 cases of recurrent GBM retreatment in the neurosurgery department of this hospital from March 2008 to March 2013.The prognosis influencing factors were analyzed.Results The univariate analysis results showed that the gender,resection degree,treatment mode and initial scheme had the influence on the progression free survival(P＜0.05).The resection degree had an impact on the overall survival(P＜0.05).The multivariate analysis results showed that KPS score,resection degree and treatment mode had effect on the progression free survival(P＜0.05).The resection degree had an influence on the overall survival (P＜0.05).Conclusion If the patients with recurrent GBM still hasthe chance of operation whole excision,the re-treatment can reach the effect for relieving the symptoms,improving the quality of life and prolonging the survival period.