Teaching of medical courses in English has been adopted in Chongqing University of Medical Sciences. The preliminary experiences of teaching of Neurosurgery in English are reviewed from the aspect of teaching. The issues concerning the selection and training of lecturer, teaching preparation, lecturing skills and assessments after course have been discussed in order to improve the teaching.

Objective To determine the best position of the catheter to achieve a low recurrence rate during subdural drainage for chronic subdural hematoma (CSDH). Methods A retrospective study was done on 130 cases with CSDH in regard of preoperative thickness of CSDH, preoperative midline displacement, postoperative locations (forehead, temple, cupula and occiput) of the subdural drainage catheter, postoperative width of the subdural space and the relationship of the accumulated air in ipsilateral subdural space with postoperative relapse. Results The CSDH thickness and the midline displacement on preoperative CT scan had no correlation with the postoperative recurrence rate of CSDH. Seven days after operation, the width of the subdural space over 1 cm or the accumulated air of the subdural space exceeding 20% of the the subdural space volume would result in obvious increase of recurrence rate of CSDH. The catheter locating on the frontal lobe cortex postoperatively had the lowest recurrence rate of CSDH. Conclusions Postoperative recurrence of CSDH can be reduced by placing the tip of the drainage catheter on the frontal lobe cortex to remove subdural air during or after surgery. CT scanning at postoperative day 7 is helpful for determine recurrence rate.

Studies in recent years have demonstrated that there is close relationship between estrogen and aneurysmal subarachnoid hemorrhage. Estrogen affects the occurrence and development process of intracranial aneurysm through multiple pathways, thereby reducing the incidence of aneurysm rupture. Estrogen also alleviates vasospasm after subarachnoid hemorrhage.Identifying the effects and their mechanisms of estrogen on aneurysmal subarachnoid hemorrhage may find a new drug target to prevent the occurrence of aneurysmal subarachnoid hemorrhage and the secondary injury.

Cerebral amyloid angiopathy is closely associated with intracerebral hemorrhage. In recent years, a further understanding of etiology, pathogenesis, diagnosis and treatment on cerebral amyloid angiopathy-related intracerebral hemorrhage has been achieved.

Objective To investigate the relationship between the levels of serum glial fibrillary acidic protein (GFAP) ,ubiquitin carboxy-terminal hydrolase L1 (UCH-L1) ,CT findings and outcome in patients with severe traumatic brain injury .Methods En-zyme linked immunosorbent assay (ELISA) was conducted to detect the serum level of GFAP and UCH-L1 in 62 patients with se-vere traumatic brain injury at the time of 12 h and 36 h after the trauma .CT scans of the brain were obtained within 12 h of injury . Outcome was assessed by glasgow outcome scale (GOS) at 6th month .The relationship between GFAP ,UCH-1 ,CT findings and outcome were analyzed .56 healthy persons were selected as control group .Results The concentrations of serum GFAP and UCH-L1 of patients were significantly higher than those of the control group (P< 0 .05) ;GFAP levels were higher in patients with mass lesions than in those with diffuse injury while UCH-L1 levels were higher in patients with diffuse injury (P< 0 .05) ;the levels of GFAP and UCH-L1 of patients with unfavourable outcome(GOS 1 - 3 scores) were significantly higher than those of patients with favourable outcome(GOS 4 - 5 scores) ,and the concentrations of biomarkers were significantly negatively correlated with outcome . Conclusion Serum levels of GFAP and UCH-L1 are good predictors for severity and outcome in severe traumatic brain injury (TBI) .The levels of GFAP and UCH-L1 could reflect different injury pathways which were different in patients with mass lesions and diffuse injury remarkbly .GFAP and UCH-L1 could provide better characterization of subjects for specific types of cellular dam -age than that obtained with CT alone .

Objective To investigate the expressions and correlation of monocarboxylate transporter-1 (MCT1) and CD147 in human gliomas,and analyzee the relationship between their expressions and prognosis.Methods Immunohistochemistry SP methods were applied to detect the expressions of MCT1 and CD147 in 28 cases of low grade gliomas and 32 cases high grade gliomas.Their expression level and correlation were analyzed statistically.Prospective cohorts were set to acquire follow-up data.Kaplan-Meier curve and Cox multi-factor model were used to analyze patients’ prognosis.Results Both CD147 and MCT1 had strong expressions in human gliomas.The positive expression rate of MCT1 and CD147 (93.8% and 90.6%) and the strong positive expression rate (73.3% and 72.4%) in high grade gliomas were significantly enhanced compared with that of low grade gliomas (positive expression rate:46.4% and 50%,strong positive expression rate:30.8% and 35.7%,P

Objective To explore the value of applying personalized medicine in the clinical teach-ing of glioma surgery. Methods Totally 80 7-year program undergraduates were divided into experimental class and control class randomly, with 40 cases in each group. The experimental class received personalized medical teaching through introducing idea and method of personalized medicine. The control class received conventional teaching. The effect of teaching was evaluated by questionnaire and examination. The data were analyzed through Chi-square and t-test test. Result Questionnaire survey of satisfaction showed that 37 students of experimental class (92.5%) were interested in the new course. Questionnaire survey of teaching effect showed that in experimental class 36 students (90%) felt it could increase learning interest, 37 students (92%) believed it improved glioma diagnosis and treatment, 34 students (85%) felt their medical view ex-panded, 38 students had consolidated clinical thinking, and 32 students (80%) improved negotiation with patients. All issues were significantly better than control class (P<0.05). Meanwhile, statistical difference was found in average score between experiment class and control class [(88.71 ±6.54) vs. (76.49 ±7.32)] (P=0.000). Conclusion The introduction of personalized medicine concept helps medical students to make personalized diagnosis and treatment plan for glioma patients, and is conducive to the cultivation of their clinical thinking ability and evidence based medicine concept, which is worthy of promotion.

The neurosurgery clinical practice is difficult and important for most undergraduate. The reasons come not only from the development of neurosurgical science,but from shortage of contents in basic peviod,so in clinical education the re-teaching of basic neurosurgical knowledge is important. Teachers should make full use of clinical resources to fulfill this teaching aim and the emphasis should be neuroanatomy and neurophysiology.

ObjectiveTo investigate the relationship of clinical manifestations with prognosis of patients with diffuse axonal injury (DAI) and select the indices that can accurately evaluate the prognosis so as to create a predictive model of outcome of DAI patients.MethodsClinical data of 98 DAI patients were retrospectively analyzed to identify the relationship between the indices and outcomes through Cochran-Mantel-Haenszel x2 test or Student-Newman-Keuls one way variance test via SAS 8.1.Then,the indices was analyzed through multivariant cumulative stepwise way so as to establish the Logistic regression model. Results (1)The indices including Glasgow Coma Score (GCS) on admission,combined with other type of cerebral injuries,unstable vital signs,abnormal pupil size and reactivity,decerebrate rigidity,imaging with characteristic DAI signs,paralysis of the limbs and length of coma were correlated with the outcome,while the indices including gender,age,injury mechanism,pathologic signs and decorticate rigidity were insignificantly associated with the outcome.(2) The logistic regression model showed that GCS on admission,paralysis degree of the limbs,abnormal pupil size and reactivity,and combined with cerebral injuries were the optimum predictors of outcome of the DAI patients.ConclusionsThe logistic regression model in the study is a reliable tool in predicting the prognosis of DAI patients.The patients wit higher GCS on admission may have better outcome.The patients with light degree of paralysis,normal pupil size and reaction,and combined with none cerebral injuries may have sound prognosis.

Objective To investigate the expression of C/EBP homology protein (CHOP) in peripheral brain tissue of patients with severe traumatic brain injury (TBI) and its correlation with the injury severity.Methods The study included peripheral brain tissues of 41 TBI patients (TBI group).Another 16 autopsy specimens succumbed to other diseases (except for TBI or other central nervous system diseases) were selected as controls.The control group and TBI group were subdivided into immaturity group (≤18 years),adult group (18-59 years) and elderly group (＞59 years).According to Glasgow Coma Scale (GCS) on admission,TBI group was classified as severe TBI group (GCS of 6-8) and particularly-severe TBI group (GCS of 3-5).CHOP expression in peripheral tissues after TBI was compared in between different age,gender and GCS.Nerve cell apoptosis was detected by TUNEL technique and correlation between CHOP level and apoptotic number was analyzed.Results There were no age and gender differences regarding CHOP expression in control group (P ＜ 0.05).Compared with control group,expression of CHOP presented notable up-regulation in TBI group (P ＜ 0.05).Expression of CHOP presented no gender difference in TBI group (P ＞ 0.05),but its expression was lower in the aged than in adult or immaturity (P ＜ 0.05) as well as notably higher in particularly-severe TBI group than in severe TBI group (P ＜ 0.05).Nerve cell apoptosis in TBI group was far greater in number than that in control group (P ＜0.05).A positive correlation was observed between CHOP level and apoptotic index (r =0.72,P ＜ 0.05).Conclusion Expression level of CHOP after TBI is closely related to the injury severity and nerve cell apoptosis,but the apoptosis pathway induced by CHOP may not be a major factor in secondary brain injury after TBI in the aged patients.