Normative training of residents is a start and necessary course in entering medical practice, and is very important for medical practitioners in their career. Clinical practice is a very key period for resident doctors to obtain clinical theory, skills and experience. Hence teaching of clinical practice becomes vitally crucial. Based on years of clinical teaching experiences revealed by senior neurosurgical doctors in a large general hospital, and the characteristics of neurosurgical residents, the author suggests a classification of three-stages in normative residency training proposes and explores teaching strategies in each stage.

Surgical treatment is an important method for the treatment of inflammatory bowel disease (IBD) when it is complicated with other intestinal diseases or medical treatment fails.The appropriate timing of surgery can reduce the incidence of postoperative complications and is the key factor for the success of treatment.Excessive emphasis on medication and blindly extending the course of medication in case of invalidation will make patients lose the best opportunity of surgery.Surgeons should master different surgical techniques of acute and selective surgeries for IBD.Multi-disciplinary treatment mode is recommended.Adjustment of the preoperative medication,improvement of the nutritional status and the overall condition of the patients are necessary when surgery is unavoidable.

Inflammatory bowel disease (IBD) is a bowel disease with uncontrolled inflammation and unknown etiology.With the recent expert consensus,multidisciplinary collaborative groups focusing on IBD have been gradually built in China,and IBD is not only an internal medical disease anymore.Furthermore,the therapeutic effect of IBD has also been greatly improved,but it is still not satisfactory.Precision therapy is the future direction of treatment for IBD,meanwhile,stem cell therapy and fecal transplantation also provide the new choices for refractory IBD.

Objective To observe the expression changes of microRNA-124(miRNA-124) following traumatic brain injury (TBI) in mice and investigate the correlation of miRNA-124 with neural axon regeneration.Methods Ninety-one C57BL/6 mice were assigned into TBI group (n =63) and control group (n =28) according to the random number table.Mice in TBI group were subjected to controlled cortical impact and euthanized at 12 hours and 1,3,7,14,21,28 days postinjury for the collection of brain tissue in the trauma zone.Mice in control group underwent craniectomy only.Trauma zone observation was done using the HE staining.Expression of miRNA-124 was detected using the real-time PCR.Levels of Nrp-1,Gap-43 and Tau were detected using the Western blot and immunohistochemical staining.Results After injtury,study of mice behavior and HE staining indicated the establishment of experimental model was successful.Expression of miRNA-124 reached the peak at 3 days postinjury (3.80 ± 0.22),expression of Nrp-1 reached the peak at 7 days postinjury (2.006 ±0.179),expression of Tau reached the peak at 14 days postinjury (2.063 ±0.172),and expression of Gap-43 sustained high level since 12 hours after injury(1.355 ± 0.093) (P ＜ 0.05).Count of axon marker positive cells in TBI group was the lowest at 1 day postinjury due to the direct damage and edema,and then slowly recovered.There was no significant difference in the count of axon marker positive cells between the two groups at 14,21 and 28 days postinjury (P ＞ 0.05),but the morphology in TBI group changed obviously.Although the positive cells of axon marker decreased at 1 day postinjury,expressions of miRNA-124,Nrp-1,Tau and Gap-43 in TBI group were significantly increased compared to the detections in control group (P ＜ 0.05).Conclusion Increased expression of miRNA-124 in trauma zone may closely related to axon regeneration after TBI in mice.

ObjectiveTo study central venous oxygen saturation (ScyO2) in controlled hemorrhagic shock rabbits resuscitation process as a transfusion trigger and traditional transfusion trigger of comparison.MethodsSelection New Zealand pure line of rabbit 32 only,simple randonly divided into 4 groups,groups A and B for the observation group,groups C and D as control group,groups of eight only.A,B,C,D four groups respectively by ScvO2 ≤70％,ScvO2 ≤75％,hemoglobin (Hb)≥8g/dl,blood loss for the whole blood volume≥30％ as transfusion trigger.From right femoral artery bloodletting 10 minute inside,made the MAP to about (40 ± 5 )mmHg,and maintained the blood pressure 60 minutes,established controlled hemorrhagic shock rabbits of animal model.And then started to resuscitate,with colloid and crystalloid infusion according to the proportion 1∶2,infusion rate of about 10 ～ 15ml/( kg · h),according to the blood pressure and heart rate,and proper adjustment according to the different requirements of each group conducted a blood transfusion.Monitoring based value,shock,shock treatment 30 minutes,60 minutes,120 minutes,180 minutes all time points,and various indexes of blood loss,blood transfusions,crystalloid and colloid fluid volume and so on.ResultsIn shock treatment observation group A late blood pressure,pH,BE,HCO3-,O2ER etc compared with the other three groups had obvious statistical differences ( P ＜ 0.05 ),group B with C and D two groups at the same time points each monitoring were no significant differences ( P ＞0.05 ).The volume of transfusion group C was most,compared with the other three groups were significant difference ( P ＜ 0.05 ),group D of blood transfusions than A,B two groups (P ＜ 0.05 ),groups A and B infused colloid fluid,crystal fluid volume than groups C and D ( P ＜ 0.05 ),each group blood lossed without significant difference.ConclusionScvO2 for controlled hemorrhagic shock rabbit resuscitation monitoring can guide controlled hemorrhagic shock rabbit of blood transfusions,according to ScvO2 ≤75％ transfusion with traditional according to Hb or blood loss transfusion trigger comparison,can achieve the same resuscitation effect,and can more accurately and individualized guide transfusion,reduce unnecessary blood transfusions,save resources.

This paper designs a heart sound processing analog circuit, in which the amplification circuit, the filter circuit and the lifting of electrical level circuit are involved. It also gives a safety design problem analysis using an electret capacitor microphone to pick-up the heart sound signals. It is proved that the circuit is reliable and effective.

Objective To evaluate the effects of inhaled nitric oxide(INO) in the early period after Fontan operation. Methods Twenty children receiving INO [(10 ～ 25) × 10 -6] after fight heart bypass for congenital heart disease were evaluated. The changes of hemodynamic and respiratory parameters were observed at two different intervals. The levels of methemoglobin (MetHb)and nitrogen dioxide(NO2)were monitored. Results In INO therapy group,CVP decreased from (20.8±4.8) mm Hg to (14.3±1.8) mm Hg,TPG decreased from (16.3 ±3.0) mm Hg to (8.8±2. 1) mm Hg,PaO2/FiO2 increased from (70.3±16.9) mm Hg to (120.5 ±14.0) mm Hg,and arterial oxygen saturation increased from 0. 78 ±0. 14 to 0. 91 ±0. 09 ,blood lactic acid level decreased from (3.98 ± 0. 86) mmol/L to (1.29 ± 1.60) mmol/L. No toxic side effect was observed. Conclusion INO has no significant long-term effect on patients after Fontan operation, but it can improve respiratory function, and reduce the incidence of low cardiac output syndrome and high cava pressure caused by reactive elevation of pulmonary vascular resistance in the early postoperative period after Fontan operation.

Objective To investigate the effect of implantation of bone marrow mononuclear cells (BM-MNCs)on neovascularization and ischemic-type intrahepatic biliary lesion in rabbits.Methods The animals were divided into the sham-operation group, experimental model group and BM-MNCs implantation group with 10 rabbits in each. The animal model of ischemic-type intrahepatic biliary lesion was established by clamping the hepatic artery and common bile duct. The BM-MNCswere isolated from the tibial plateau by means of density gradient centrifugation and were implanted through the common hepatic artery. Changes of some biochemical markers such as ALT, AST, ALP,γ-GT, TBIL and DBIL etc. were detected. In 4 weeks after operation, the cholangiography, histopathological manifestation, differentiation of BM-MNCs, and microvessel density were observed.Results At each observation time, the degree of change of biochemical markers in group C was lower than that in group B. The engrafted cells could differentiate into vascular endothelial cells. The intrahepatic biliary lesion of group B was severer than that of group C but had fewer new capillary blood vessels around it. Conclusion The implantation of BM-MNCs can promote neovascularization and increase blood supply to the ischemic bile duct to diminish or prevent ischemic-type intrahepatic biliary lesion.

Objective To analyze the clinicopathological factors on the prognosis and investigate the necessity of adjuvant chemotherapy for patients with stage Ⅱ colorectal cancer.Methods The clinical data of 255 patients with stage Ⅱ colorectal cancer who were admitted to the First Affiliated Hospital of Sun Yat-Sen University from January 2000 to December 2005 were collected.The survival curve was drawn by Kaplan-Meier method,and the survival rate of the patients were analyzed by Log-rank test.Factors influencing the survival were analyzed by Cox regression model.Results All patients were followed up till April 23,2010,and the mean time of follow-up was (63 ± 22)months.The median survival time was 63 months.The 5-year and tumor-free survival rates were 85.3％ and 83.7％,respectively.The 5-year overall and tumor-free survival rates of patients without preoperative bowel obstruction or perforation were 86.9％ and 85.6％,which were sigaificantly higher than 72.7％and 68.4％ of patients with preoperative bowel obstruction or perforation(x2 =4.546,4.573,P ＜ 0.05 ).The 5-year overall and tumor-free survival rates of patients with negative resection margin were 85.5％ and 83.9％,which were significantly higher than 75.0％ and 75.0％ of patients with positive resection margin(x2 =7.020,6.009,P ＜ 0.05 ).The result of multivariate analysis revealed that preoperative bowel obstruction or perforation were the independent risk factors for patients with stage Ⅱ colorectal cancer(Wald =4.477,relative risk =2.371,95 ％ confidence interval:1.066-5.275,P ＜ 0.05 ).The 5-year overall and tumor-free survival rates were 87.3％ and 86.0％ for patients who received adjuvant chemotherapy,and were 82.2％ and 80.3％ for patients who did not receive adjuvant chemotherapy (P ＞ 0.05 ).Conclusions Preoperative bowel obstruction or perforation are independent risk factors for the survival of patients with stage Ⅱ colorectal cancer.Adjuvant chemotherapy could not improve the prognosis of patients with stage Ⅱ colorectal cancer.

Objective To explore the effect of glucocorticoid receptor(GR)expression in rat hippocampus on cognitive function after traumatic brain injury(TBI). Methods The TBI model wag established in rats.Then,immunohistochemistry and Western blot were used to detect the GR expression and evaluate its relation with cognitire dysfunction by Morris water maze. Results Expression of hippocampal GR was down-regulated 4-10 days after TBI.Morris water maze test showed significant impairment of the cognitive function in rats. Conclusion There is correlation between expression change of hippocampal GR and cognitive dysfunction.