For a long time, limited by the factors such as laparoscopic technology, and limited medical resources , the residents accepting standardized training are lack of mastery of the technology . Meanwhile, it is the key to the training of personnel training and reserve in the field for residents to contact the laparoscope as soon as possible and carry out scientific and effective training. Therefore, based on the traditional method, we have developed a new type of laparoscopic teaching system for the standardized training residents and increased and integrated the LAP GAME R operations training system and the real-time multimedia teaching platform. The preliminary practice effect is good.

Objective To explore preliminarily the role of the E2 subunit of pymvate dehydrogenase (PDC-E2) modified by xenobiotics (e.g.2-octynic acid,2-OA) in the pathogenesis of primary biliary cirrhosis (PBC).Methods Patients of PBC (102 cases),primary sclerosing cholangitis (PSC,34 cases) and healthy controls (HC,50 cases) were selected.The anti-PDC-E2,anti-2-OA and anti-lipoic acid (LA) antibody in the peripheral blood of the 3 groups were tested by enzyme linked immunosorbent assay (ELISA).By inhibitive ELISA (iELISA),30 of the 102 PBC patients with anti-PDC-E2 antibody but without anti-2-OA antibody were selected to detect whether there was any new epitope on the PEC-E2 conjugated with 2-OA.The chi-square test and Fisher exact test were taken to analyze the enumeration data.The two-tailed unpaired t test with Welch's correction was used to compare the measurement data.Spearman rank correlation analysis was also employed for proper test.Results The positive rate of anti-PDC-E2,anti-LA and anti-2-OA antibody in PBC patients was 94.1％(96/102),73.5％(73/102) and 53.9％(55/102) respectively,all of which were statistically significantly higher than those in healthy controls group but were of no significant difference between PSC and healthy controls group.There was no significant relevance between the levels of Anti-LA and anti-2-OA antibody in the PBC group (r=-0.065,P=0.520).The iELISA results showed that the antibody,which only identified the epitopes on 2-OA-PDC-E2 induced by the 2-OA conjugation with PDC-E2,existed in 40％(12/30) of the PBC patients,and more interestingly,this antibody was predominantly appeared in PBC patients at their early clinical stage.Conclusion There are anti-LA antibody and anti-2-OA antibody in PBC patients,which have shown no significant association with each other.It is very likely that new antigenic conformational epitopes on PDC-E2 modified by 2-OA would emerge,which might led to the immune response in the individuals who are susceptible to PBC,and thus contribute for the breaking of PDC-E2 immune tolerance,and PBC occurrence finally.

OBJECTIVE To assess the ultrasonographic features and clinical significance of the complications of the thyroglossal cysts. METHODS We retrospectively reviewed the ultrasonographic findings in 41 cases with complications of the thyroglossal cyst, which was confirmed surgically and pathologically. 43 cases with simple thyroglossal cyst consisted of the control group. The location, size, internal echo, internal septa, wall thickness, posterior acoustic feature, boundary, vascularity, and fistulas of the lesion were analyzed and compared with the control group. RESULTS Most of the inflammatory thyroglossal cyst showed thickening walls, indistinct boundaries, posterior echo enhancement, and peripheral vascularity on ultrasound images. There were significant differences of the thickness of the cyst wall, indistinct boundary, and peripheral vascularity between the two groups. CONCLUSION The characteristic findings of thyroglossal cyst with inflammation are thickened wall, indistinct boundary, and peripheral vascularities. Ultrasonography can be useful tool in determination of the appropriate time of the operation to reduce the recurrence rate.

Objective To investigate the changes in cortical excitability and inhibitory circuits of patients with Alzheimer's disease (AD) or behavioral variant frontotemporal dementia (bvFTD) using transcranial magnetic stimulation (TMS).Methods Forty-four patients with AD,30 patients with bvFTD and 44 healthy controls were enrolled in the study.The epidemiological data of all subjects were collected.Each participant received a neurological evaluation and neuropsychologic tests which included Mini-Mental State Examination (MMSE),Activities of Daily Living (ADL) and Hamilton Rating Scale for Depression (HAMD).Neurophysiological evaluations including resting motor threshold (rMT),active motor threshold (aMT) and cortical silent period (CSP) were conducted by means of TMS.Neurophysiological parameters were compared among groups.Results There were significant differences in MMSE,ADL and HAMD assessments among 3 groups,but no significant differences between AD and bvFTD groups.There were significant changes in left rMT(46.52％ ± 8.77％,52.00％ ± 7.30％ and 52.14％ ± 8.27％,F =6.295,P=0.003),left aMT(29.68％ ±7.01％,35.13％ ±8.46％ and 35.39％ ±7.24％,F=7.735,P=0.001) and right rMT(47.82％ ±7.94％,52.07％ ±8.77％ and 53.12％ ±8.61％,F=4.772,P=0.010) among 3 groups.AD patients showed significantly reduced left rMT and aMT comparing to bvFTD patients (P =0.017 and 0.008 respectively) and controls (P =0.005 and 0.002 respectively).In addition,AD patients had a significant decrease in right rMT comparing to controls (P =0.011).There were no statistically significant differences in TMS parameters between bvFTD patients and controls.Conclusions AD is associated with hyperexcitability of the motor cortex,whereas the lack of changes in motor cortical excitability is found in bvFTD.TMS technique may be helpful in differential diagnosis between AD and bvFTD.

OBJECTIVE:To establish a method for the content determination of eudesmin in Zanthoxylum simulans. METH-ODS:HPLC was performed on the column of Kromasil C18 with mobile phase of acetonitrile-water(56:44,V/V)at flow rate of 1.0 ml/L,detection wavelength was 221 nm,column temperature was 25 ℃. RESULTS:The linear of eudesmin was 0.208-2.08 μg (r=0.999 8);RSDs of precision,reproducibility and stability tests were lower than 2.0%;recovery was 96.18%-103.04%(RSD=2.58,n=6). CONCLUSIONS:The method is simple and good reproducibility,and can be used for the content determination of eu-desmin in Z. simulans.

OBJECTIVE:To explore the clinical efficacy and safety of nalmefene combined with monosialotetrahexosylganglio-side sodium in the treatment of patients in brain tumor operation. METHODS:64 patients in brain tumor operation were randomly divided into observation group and control group,32 cases in each group. Control group received brain cell protection,reducing in-tracranial pressure,anti-infective,vasodilator and other conventional treatment;observation group additionally received 0.7μg/(kg· h) nalmefene combined with 100 mg/d monosialotetrahexosylganglioside sodium from the first day of operation,for continuous 7 d. The plasma cortisol,adrenocorticotropic hormone (ACTH) before and 3,7 d after treatment,changes of serum IL-6,TNF-αand Barthel index (BI) in 2 groups were observed,improvement of neurological function and ADR were observed;Karnofsky (KPS)score was determined after 90 d follow-up used to assess the patient’s ability to take care of themselves. RESULTS:After treatment,plasma cortisol and ACTH content,serum TNF-αand IL-6 levels in 2 groups significantly decreased than before,the dif-ference was statistically significant(P<0.05);cortisol,ACTH and TNF-α levels 3,7 d after treatment,IL-6 level 7 d after treat-ment in observation group decreased more significantly than control group,the differences were statistically significant(P<0.05). After treatment,BI score in 2 groups significantly increased,and observation group increased more significantly than control group,the differences were statistically significant (P<0.05). 7 d after treatment,improvement rate of neurological function was 50.00%,which was significantly higher than that of the control group(18.75%),the difference was statistically significant(P<0.05). There was no significant ADR occurred of 2 groups in the study. Following-up for 90 d,the KPS score in observation group with not less than 70 points accounted for 71.88%,which was significantly higher than the control group(46.87%),the difference was statistically significant (P<0.05). CONCLUSIONS:Nalmefene combined with monosialotetrahexosylganglioside sodium can promote the recovery of patients in brain tumor operation,reduce cortisol,ACTH,IL-6 and TNF-α levels and improve prognosis of patients.

Objective To conduct the amplification,cloning,bioinformatics analysis,prokaryotic expression and purification of enterovirus 71 VP1 gene segment and to initially confirm the biological activity of the recombinant expression product.Methods A pair of specific primers was designed according to GenBank EV71 sequence,viral RNA as a template was extracted from the throat swab specimens in the EV71 patients.EV71 VP1 gene was amplified by RT-PCR.After enzyme digestion,the expression vector pET28a was inserted.The prokaryotic expression vector of pET28a-EV71 VP1 was constructed.Then the E.coli DH5a transforma-tion was performed.IPTG was adopted for induction expression.The expression results were analyzed by using SDS-PAGE and Western blot.The bioinformatics analysis of the sequenced results was performed by the software.Expressed protein was purified and the plates were coated,ELISA was used to test the VP1 specific IgG antibody in serum samples of EV71 positive and COX A16-positive patients.Results The BLAST alignment showed that the homology of the objective gene EV71 VP1 was 99% com-pared with other strains(JQ766207.1)in GenBank.EV71 VP1 protein was about 32×103 ,which mainly existed in the form of in-clusion body.The bioinformatics analysis showed that EV71 VP1 protein was a hydrophilic protein,without transmembrane region and N-terminal signal peptide sequence,the tertiary structure existed.The ELISA results showed that the specific IgG OD value in EV71-positive patients was(2.425±0.521),OD value in COX A16 positive patients was(1.205 ±0.314),the normal control OD value was(0.353±0.128).The sensitivity and specificity of EV71 VP1 protein detection were 84% and 88% respectively.Conclu-sion The pET28a-EV71 VP1 expression vector is successfully constructed;the preliminary analysis on the serum of the infected patients by ELISA shows that the obtained objective protein has higher sensitivity and specificity,which is initially confirmed to have biological activity and can be further used for the related study on EV71 diagnosis and vaccine.

Objective To study the prevalence of food intolerance and to explore its related factors among adult health check-up receivers.Methods A total of 863 adults who took physical examinations in our hospital from April to October 2011 were enrolled in this investigation.Height,body weight and blood pressure were measured,and serum IgG level was measured by enzyme-linked immunosorbent assay (ELISA).Results The total positive rate of food intolerance was 73％,and the leading intolerance items were crab (40.1％ ),egg (29.8％ ),cod fish ( 21.6％ ),milk ( 20.0％ ) and soybean ( 14.4％ ).Females showed significantly higher prevalence of food intolerance than males.Various positive rate of milk or soybean intolerance was found in different age groups.No correlations of serum specific IgG with body mass index and systolic or diastolic blood pressure were observed.In logistic regression analysis,the odds ratio of food intolerance of women was 1.67 ( 95 ％ confidence interval 1.190 to 2.607 ).ConclusionsThe prevalence rate of food intolerance was high.The risk for food intolerance was significantly increased in women.Specific IgG antibody detection may help to early prevent and diagnose food intolerance-related diseases.

Objective To investigate and discuss the limb salvage strategies of malignant bone tumors in region S2 of shoulder girdle.Methods The data of 17 patients(13 males and 4 females)were retrospectivelv analyzed.All of them had malignant scapular tumor at least in region S2,and underwent limb salvage between January 2005 and January 2009.They aged from 14 to 55 years old(mean,32.6 years).The histologic types of them were chondrosarcoma in 6 patients,osteosarcoma in 4,fibrosareoma in 1,myeloma in 1,Ewing's sarcoma in 1,rhabdomyosarcoma in 1,non-Hodgkin lymphoma in 1,malignant giant cell tumor of bone in 1 and recurrent chondrosarcoma in 1.The tumors were staged according to Enneking surgical staging system:IB in 4 and IIB in 13.According to the MSTS classification system,the region S2 and lateral 1/3 of region S1 were effected in 11 cases,the region S2 and large part of region S1 were effected in 6 cases.The rotator cuff was involved to some extent in all patients,and the articular capsule were involved in 8 cases.Neo-adjuvant chemotherapy was given to 14 patients.The surgical strategies were depended on the range of tumor and preservation of articular capsule.The scapular prosthetic replacement was done in 8 cases with a relatively large range of tumor or resection of articular capsule,otherwise the scapular allograft replacement was done.Among the 11 cases with region S2 and lateral 1/3 of region S1 effected,the scapular allograft replacement was done in 9 cases with articular capsule preserved and the prosthetic replacement was done in 2 cases with articular capsule resected.And the prosthetic replacement was done in the other 6 cases.The articular capsule and partial rotator cuff were preserved and reconstructed preferentially.Results All patients were followed up 16-62 months (mean,35.1 months).Postoperative complications were noted in 9 patients, including mild allograft rejection and mild allograft resorption in 1 patient,allograft rejection in 1,prosthetic acromion exposure in 3,allograft resorption in 4.Local recurrence were noted in 1 patients.Three patients were dead because of extensive metastasis.The average function scores were 74.1%(range,53.3%-93.3%).Conclusion During the limb salvage surgery.it's very important to guarantee the en bloc resection of the tumor.In the meanwhile,the en bloc resection and functional reconstruction should be well balanced.

Objective To evaluate the urodynamic and functional characteristics of 26 patients who had underwent orthotopic contient globular ileal neobladder. Methods The clinical date of 26patients who underwent radical cystectomy were reviewed. The neobladder pressure, capacity, urethral pressure and urinary flow rate were collected at 3-12 months after operation. Results The neobladders average pressure was less than 15 cm H2O when the volume was 400 ml. The pressure was 22.4 cm H2O at 100% capacity. The mean pressure of contractions was less than 40 cm H2O. The mean filling pressure after operation was relative stable while the difference between 3 months and 6 months was statistically significant. The difference between 6 and 9 and 12 month showed no statistical significance. The mean post-void residual was 42 ml. A mean voiding flow rate of 19. 6 ml/s could be obtained by Valsalva. Conclusion The neobladder not only could offer adequate capacity at low pressures but also could give a satisfied continent.