To explore the application of Problem-Based Learning( PBL) method in the clinical teaching of dermatology,we discuss the specificity in teaching and problems in application of dermatology and venereology from the relations between dermatology and venereology and other subjects,between summary and each chapters,and the relationships between each diseases.

Objective To review the features of diagnosis and treatment of craniocerebral firearm wounds in peacetime. Methods A total of 86 cases with various kinds of firearm wounds were retrospectively analyzed for discussing the characteristics of diagnoses and treatment of firearm wounds so as to provide the best treatment methods for firearm wounds of the brain. Results Of all, 80 cases (93%) won full recovery and four (5%) partial recovery but two (2%) were died of massive vascular damage and severe cerebral injuries within 24 hours after operation. Conclusions Craniocerebral firearm wounds are among the most devastating causes for morbidity and mortality in the civilian population. It is important to remove all foreign bodies, especially broken bones and necrotic tissues, and turn the open injury to the close injury. Stereotactic technique, localization of foreign bodies, culture of foreign body bacteria, drug allergy test and correct use of antibiotic and antiepileptic drugs are also critical for eliminating mortality and complications of craniocerebral firearm wounds.

Objective To study the relationship between MRI and histopathological findings of cerebral schistosomiasis,and the value of MRI on this disease. Methods 18 patients with cerebral schistosomiasis proved by pathological examination and laboratory test were enrolled in the study. Plain and Gd DTPA enhanced MRI were performed in all patients with GE 1.5 T MRI scanner. Results The lesions were located in infratentorial region in 7 cases and in supratentorial region in 11. There were three types of pathological pattern in the disease including focal encephalitis and meningiomas (5), granuloma (12), and encephalatrophy (1). Most of the lesions were iso or hypointensity on T 1WI, hyperintensity on T 2WI, with nodules, spot or ring like enhancement, and periphery edema. Conclusion MRI manifestations of cerebral schistosomiasis have specific features,which is a very important tool in early diagnosis and follows up for this disease.

Objective To investigate the changes of IL-8 in peripheral blood of patients with pustular psoriasis after acitretin treatment.Methods Dual antibody sandwich enzyme-linked immunosorbent assay (ELISA)was performed to measure the IL-8 levels in the peripheral blood of 30 patients with pustular psoriasis and 30 patients with psoriasis vulgaris before and after treatment,and in 30 normal human controls.The relationship between the IL-8 level and disease severity was assessed for patients with pustular psoriasis.Results After acitretin treatment,the condition was improved greatly in patients with pustular psoriasis,together with a significant decrease in the level of IL-8 in the peripheral blood(57.07 ± 12.02 pg/ml vs.96.84 ± 14.68 pg/ml,P ＜ 0.05).Conclusion IL-8 may be involved in the therapeutic mechanism of acitretin in pustular psoriasis.

Objective To investigate the expression of granulocyte macrophage-colony stimulating factor(GM-CSF)in skin lesions and sera of patients with pustular psoriasis and psoriasis vulgaris.Methods Tissue specimens were obtained from the lesions of 15 patients with pustular psoriasis,15 patients with psoriasis vulgaris and 15 normal human controls.Immunohistochemistry and dual antibody sandwich enzyme-linked immunosorbent assay(ELISA)were carried out to detect the levels of GM-CSF in the tissue and serum specimens from the patients and normal human controls,respectively.Results Significantly higher levels of GM-CSF were observed in the tissue and serum specimens from patients with pustular psoriasis and psoriasis vulgaris compared with the normal controls(all P ＜ 0.01),as well as in those from the patients with pustular psoriasis compared with the patients with psoriasis vulgaris(both P ＜ 0.01).Conclusion GM-CSF may be involved in the pathogenesis of psoriasis.

Somatosensory evoked potential(SEP) monitoring was performed intraoperatively in 28 patients with extramedullary or intramedullary tumors.Dissection of intramedullary tumor usually leads to decrease of amplitude and increase of latency in SEP. SEP reappeared at the end of operation in 2 cases of Frankel A grade extramedullary tumors whose SEP disappeared during operation with functional recovering to some degree. In 2 cases of Frankel B and C grade intramedullary tumors, the amplitude of SEP decreased by more than 40% and the latent period in SEP increased by more than 5% during operation,and the surgical procedure was paused for a while.There was slight reversible injury of nerve post operatively. In 8 of 12 cases of Frankel D and E grade intramedullary tumors, the amplitude of SEP descended nearly by 50% and elongation of latency in SEP was about 7% during surgery. SEP was reduced lightly in other 4 cases and all achieved good recovery. Intraoperative monitoring of spinal SEP and cortex SEP can reflect the change of spinal function, reduce post operative complication, and predict prognosis.

Objective To discuss CT examination in the diagnosis of gastrointestinal perforation (GP). Methods All CT data of 13 adult patients with GP were reviewed retrospectively. Results In all 13 cases,gastric perforation occurred in 5 cases,duodenal perforation in 7,and traumatic duodenal avulsion in 1.CT findings of GP included gas accumulation under the recess of xiphoid,gas accumulation in the area of lesser omentum,gas accumulation under the recess of peritoneal cavity,and seroperitoneum. Conclusion As a non-invasive examination means for abdomen,CT examination can discover whether there is dissociative gas or not and estimate the amount of gas in abdomen more rapidly and exactly.CT can also estimate the position of perforation elementarily.The recess under xiphoid is the first place where the dissociative gas assembles after gastrointestinal perforation.

To investigate the value of the guidance of three dimensional (3-D) reconstruction of multi-slice spiral CT (MSCT) for the placement of pedicle screws, the 3-D anatomical data of the thoracic pedicles were measured by MSCT in two embalmed human cadaveric thoracic pedicles spines (T1-T10) to guide the insertion of pedicle screws. After pulling the screws out, the pathways were filled with contrast media. The PW, PH, TSA and SSA of developed pathways were measured on the CT images and they were also measured on the real objects by caliper and goniometer. Analysis of variance demonstrated that the difference between the CT scans and real objects had no statistical significance (P > 0.05). Moreover, the difference between pedicle axis and developed pathway also had no statistical significance (P > 0.05). The data obtained from 3-D reconstruction of MSCT demonstrated that individualized standards, are not only accurate but also helpful for the successful placement of pedicle screws.

BACKGROUND: The attack of temporal epilepsy is associated with the loss and death of hippocampal neurons, in which the specific pattern and mechanism of the loss of hippocampal neurons are still unclear, and it is hard to make sure the inevitable association of the epileptic discharge with activation of cysteine-containing ASPartate-specific protease (caspase 3)and neuronal apoptosis, of hippocampal neurons.OBJECTIVE: To observe the neuronal apoptosis and caspase 3 gene expression of in vitro cultured rat hippocampal neurons of epilepsy models.DESIGN: An open experiment.SETTINGS: Department of Neurosurgery, Changhai Hospital, the Second Military Medical University of Chinese PLA; Department of Neurosurgery,Changzheng Hospital, the University.MATERIALS: The experiments were carried out in the Neurosurgery Laboratory of the Second Military Medical University of Chinese PLA from June 2002 to June 2003. Ten male or female SD rats with 24 hours after birth were used. The Caspase 3 flow detection kit was purchased from American BD Company, and polymerase chain reaction (PCR) primers were synthetized by Shanghai Haojia Company.METHODS: ① The SD rats within 24 hours after birth were killed by cutting down the head to remove the brain, then bilateral hippocampi were taken out, and hippocanpal neuron models of epileptic discharge were established. The discharge of the models was recorded with whole cell patch clamp technique. The neurons cultured for 8 days and treated with Mg-free medium were taken as epileptic discharge model group, and those cultured for 8 days but not treated with Mg-free medium were taken as the blank control group, and the changes of potentials were recorded. ② The fulllength cDNA of caspase 3 was cloned with reverse transcription-polymerase chain reaction (RT-PCR), and then it was labeled. The expression of caspase 3 gene and neuronal apoptosis were detected with in situ hybridization and flow cytometry.MAIN OUTCOME MEASURES: ① Results of cDNA cloning of caspase 3; ② Results of Caspase 3 in situ hybridization; ③ Results of apoptosis.RESULTS: ① The products amplified by RT-PCR showed DNA segment lanes of about 800 bp after treated with 12 g/L agarose gel electrophoresis (Figure 1), which was concordant with the predicted value. The detection of DNA sequence showed that the length of the obtained cloning open-reading frame was 843 bp. ② The hybridization showed that in the blank control group, the positively stained hippocampal neurons were less than 10%, the neurites were well-stacked, and formed extensive synaptic association; In the epileptic discharge model group, the positively stained neurons were obviously increased at 3 hours after the Mg-free treatment, and there were many strongly and positively stained neurons at 12 hours, all these neurons kept the neurites, which became little. ③ The flow cytometry showed that at 6 hours after the Mg-free treatment, the apoptotic cells began to increase obviously, the numbers of apoptotic cells in certain times were not the same.CONCLUSION: Epileptic discharge can trigger the caspase 3 gene expression, by which neuronal apoptosis is induced.

In order to explore the MRI volume of the amygdala and hippocampus in patients with major depression, quantitative MRI of the amygdala and hippocampus were studied in 22 patients with major depression and compared with 13 age-matched controls. The results showed that both groups exhibited similar significant hippocampal asymmetry (left smaller than right). The volume of the bilateral hippocampus was significantly smaller in the major depression group than that in control group. The patients had significant asymmetry of the amygdalar volumes (right smaller than left). No correlation was found between hippocampal volume abnormalities and ill duration. It was concluded that the hippocampus and amygdala within limbic-cortical networks may play a crucial role in the pathogenesis of major depression.
Amygdala/*pathology ; Anthropometry ; Depressive Disorder, Major/*pathology ; Hippocampus/*pathology ; Magnetic Resonance Imaging