Objective To explore the effects of using standardized patients(SP)to clinical practicing teaching in traumato-osteology. Methods The records of theory exam, case aggregate analysis ability and clinical technical skills of the SP teaching group (SP group) and traditional teaching group(T group) were compared. Results The records of theory exam of the two groups had no significant difference (86.5 ±9.5 VS 82.3 ± 11.7,P>0.05). However, the case aggregate analysis ability of SP group (78.3 ±9.7) was obviously higher than that in control group (65.3 ±7.7), and the records of clinical technical skills of SP group were not significantly higher than control group (85.6 ±9.4 VS72.4 ± 11.6,P>0.05) . More of the students were generally satisfied with SP teaching model. Conclusion The using of SP acted by teachers is helpful to enhancing the clinical skills and thinking and maybe a considerable assisting teaching method in traumato-osteology.

Objective:To observe the repairment effects of vascular pediceled nervous tissue on adult rat＇s spinal cord injury. Method:A 5mm cord defect of the left lateral column was made at Ti-3 vertebral level,and then the defect was grafted randomly using vascdarized peripheral nerve (Group VPN),embryonic day 14 fetal spinal cord(Group FSC) or vascular pediceled peripheral nerve and fetal spinal cord(Group V + F).8 weeks after surgery, the survival,differentiation of the grafts, and the ability of repaired host spinal cord were assessed. Result: In VPN-FSC co-graft group, peripheral nerve segment was extensively vascularized and well innervated,plenty of Schwann cells survived and proliferated. In this group, anti-NF, S-100 positives fibers were significantly greater than group VPN (P＜0.01). The fetal implant was intimately fused with the host CNS parenchyma, the volume, nerve fibers and neurons density of the fetal implant were significantly higher than Group FSC(P＜0.01). The majority of neurons in this group were well differentiated, well-developed and synapses were scattered throughout the neuropil. SEP assessments showed that the latgncy of P1 ,N1 wave was significantly decreased in this group (P＜0.01).Conclusion:The vascular pediceled peripheral nerve could prompt the development of fetal implant and support the regeneration of central injured axons to certain degrees.

Objective To compare the survival of Schwann cells and the effects of induce axon regeneration after peripheral nerve grafted into spinal cord Methods A total of 30 adult,female Wistar rats were used in this study,and a 5 mm cord defect of the left lateral column was made at T 1 3 vertebral level The defect was grafted randomly using vascularized (group VN) or free peripheral nerve (group PN) respectively 8 weeks after surgery,the survival and proliferation of Schwann cells were assessed by histological,histomorphometric analysis Results In group VN,peripheral nerve segment was well innervated,plenty of Schwann cells were survived and proliferated In this group,anti NF,S 100 positives fibers were significantly greater than group PN Conclusion The vascularized peripheral nerve could prompt the survival and proliferation of Schwann cells and support the regeneration of central injured axons to certain degrees

Evidence-based medicine(EBM)advocates finding problems in clinical practice,searching for the best evidence,appraising and analyzing comprehensively the acquired evidence,and then applying the evidence to direct the diagnosis,therapy and prognosis of diseases.Our experiences showed that the application of EBM in clinical teaching could help the students improve their clinical intellection,clinical skills and innovation ability.

Objective To comparethe effects of four different emergency fixation methods for the open tibiofibular fractures on the treatment and prognosis of the multiple trauma patients. Methods A comparative study was carried out on the effect offour different early fixation methods on the fracture and the multiple trauma in aspects of the short-term indicators including mortality rate,acute respiratory distress syndrome(ARDS),fat embolism syndrome(FES),multiple organ dysfunction syndrome (MODS),ICU stay and the long-term indicators including wound healing time,fracture healing time,rate of joint function recovery and fracture complications in 43 multiple trauma patients. Results The locked intramedullary nail wag better than the other fLxation methods including the calcaneal traction,the gypsum external fixation and the internal fixation with steel plate and extemal fixation support in most indexes(P<0.05,0.01). Conclusion The locked intramedullary nail can significantly decrease the incidence rate of complications and obtain sound fracture healing for the patients with multiple trauma combined with open tibiofibular fractures(types Gnstilo Ⅰ,Ⅱ and Ⅲa).

Objective To evaluate the influence of preoperative MRI on tumor-positive rate of resection margins in breast cancer patients eligible for breast-conserving surgery.Methods Study group consisted of 64 consecutive patients with breast cancer eligible for breast-conserving surgery,while 73 cases as history control group.For the two groups,a first plan for breast-conserving surgery was made on the basis of conventional imaging and clinical evaluation.Study group underwent preoperative breast MRI and re-evalu-ated before final surgical plan was made.Rates of tumor-positive resection margins were compared between the 2 groups.Surgical plan alteration was recorded in the study group.Results Study group had lower rate of tumor-positive resection margin compared with control group (9.6% vs 24.7%,P =0.04).Furthermore,18.8% of study group altered the finial surgical plan to mastectomy after breast MRI.Conclusion Preoperative breast MRI can more acurately evaluate the extent of breast cancer,therefore decrease rate of tumor-positive resection margin in breast cancer patients eligible for breast-conserving surgery.

Objective To repair the injured spinal cord in adult rats using tissue-engineered neural complex constructed in vitro by tissue engineering techniques and discuss the treatment effect.Methods Neural stem cells (NSCs) from rats were cultured separately and modified collagen scaffold was also prepared to construct complex of NSCs /modified collagen scaffold in vitro.Embryo spine cord extract was administered to induce differentiation of NSCs,the structure of which was revealed by histochemical technique and scanning electron microscope.The rat models of hemisected spinal cord injury were built and grafted with tissue-engineered neural complex.Functional recovery of the models was evaluated every two weeks postoperatively.Effect in repair of spinal cord injury was assessed by histological method at postoperative three and eight weeks.Results After tissue-engineered neural complex planted in the modified collagen scaffold was grafted into the injured spinal cord in adult rats,the seed cells survived and further differentiated into functionally active neurons.The differentiated glia cells presented quite regular reticular structure.Motor function below the level of the injured spinal cord in adult rats obtained obvious recovery.Conclusion Tissue-engineered neural complex seeded in the modified collagen scaffold takes effect in structural reconstruction and functional recovery of the injured spinal cord in adult rats.

Objective To explore the risk factors of lower limb deep vein thrombosis (DVT) in patients with traumatic fractures so as to provide references for prevention of DVT. Methods A total of 1 068 patients with traumatic fractures were involved in the study to analyze the incidence of DVT under 43 risk factors including general state, injury type, fracture condition and operation and screen significant factors for multiple factor analysis. Results The total incidence rate of DVT in 1 068 patients was 12.0%. The univariate analysis showed that male patients at age ＞60 years, with BMI≥25 kg/m2, history of smoking, lack of exercises, history of diabetes, hypertension, coronary artery disease and cerebrovascular disease had higher incidence rate of DVT. In different injury types, the fall injury caused the highest incidence rate of DVT (45.6%). There were different DVT rates for different fracture position,with the highest incidence rate of DVT for femur shaft fracture (20.5%). The incidence rate of DVT was 51.7% for fractures of more than three parts, 14.2% for fractures of two parts and only 3.7% for sole part. The incidence rate of DVT for comminuted fractures was higher than the overall rate. The operation duration, massive transfusion during operation and epidural anesthesia were related with the increase of incidence of DVT. Multivariate analysis found nine independent risk factors and showed that the more risk factors were, the higher incidence of DVT was. Conclusions The risk factors of DVT for traumatic fractures include age ＞60 years, BMI≥25 kg/m2, history of smoking, fall injury, more than three parts of fractures, comminuted fractures, operation duration ＞ 2 hours, massive transfusion during operation and epidural anesthesia.

Objective To investigate the application of multi-sliced CT on breast cancer and early lymph node metastasis (LNM). Methods 30 cases with infiltrative ductal carcinoma (IDC)confirmed by pathology were collected and set as Study Group,30 fibro-mas as Control Group.128-slice CT plain and 2 phrase enhance scan was undergone.Image signs of mass of two groups were com-pared.Image signs of early lymph node metastasis were analyzed.Results In MSCT images,IDC masses had irregular shape,burr rim.2-phrase MSCI demonstrated obvious enhancement in artery phrase,persistence enhancement in vein phrase and ring shape en-hancement.There were significant different between 2 groups in mass shape,rim and enhancement mode(P<0.05).MSCT demon-strated 22 LNM,but 6 of them had no swelling but obvious enhancement.Conclusion 2-phrase MSCT plays an important role in as-sessing breast cancer and early lymph node metastasis.

Objective To study the relationship between asthma and mRNA expression of β_2AR and IL-12 gene;to determine the expression level of β_2AR, IL-12 related to CysLT_1-receptor;to analyze the correlation between the severity of asthma and the level of the genes expression. Methods White blood cells was drawn from peripheral blood mononuelear cells of asthmatic children. DNA was taken and related genes were analyzed for half quantitative analysis by D-congeal glue analyzer software. Results The level of IL-12. β_2AR mRNA expression in the asthma group is obviously lower than healthy controls (P < 0.01) ;when asthma attacks, the expression of IL-12 is positively correlated to that of β_2AR (r = 0.34, P = 0.001) and negatively correlated to that of CysLT_1-receptor (r = -0.92, P = 0.001), the expression of β_2AR is negatively correlated to the expression of CysLT_1-receptor (r = -0.85, P = 0.003). The express of IL-12 is not related to the severity of asthma (P = 0.16), while there was a negative correlation between the expression of β_2AR and the severity of asthma (P = 0.003). Conclusions The expression level of IL-12, β_22AR in the asthmatic children is obviously lower than normal;The expression level of IL-12 is positively correlated to β_2AR in PBMC of asthmatic children;The expression level of CysLT_1-receptor is negatively correlated to IL-12 and β_2AR in the PBMC of asthmatic children;The expression of β_2AR is negatively correlated to the severity of asthma.