In order to further promote teaching effect of clinical practice in higher medical college & university,we should focus on the following main points:renovating teaching ideal and educational thought;reinforcing the cultivation of diagnosis and treatment technique and diagnosis thoughts;reforming teaching method and strategy;strengthening the teaching management;combining scientific research with training practice;infiltrating humanities-social sciences thoughts.

Objective To investigate the application value of transcystic choledochoscopy combined with holmium laser for common bile duct stones . Methods Clinical data of 16 patients with common bile duct stones who underwent transcystic choledochoscopy and holmium laser cholelithotripsy between March 2012 and December 2013 in this hospital were retrospectively analyzed.During holmium laser cholelithotripsy (1.0 J/10 Hz, 400 μm fiber), the stones were fragmented under direct vision of choledochoscopy and were extracted by using water flushing or a stone basket . Results The stones were successfully removed in 15 patients, including 6 cases of laparoscopic operation and 9 cases of open operation .The operation time was (132 ±27) min for open surgery and (156 ±33) min for laparoscopic surgery .The stone fragment and removal time was (30.2 ±8.5) min for open surgery and (45.6 ±10.4) min for laparoscopic surgery .The hospital stay was (9.7 ±1.4) d.There was 1 case of failed cholelithotripsy due to obstructed water flow and blurry vision .Follow-up examinations in 14 cases for 2-24 months found no recurrence of stones or biliary strictures. Conclusion Transcystic choledochoscopy and holmium laser cholelithotripsy is intuitive , accurate, and effective, being a safe and reliable alternative for choledocholithiasis .

Objective To explore an effective prevention and management of nonunion and malunion due to insidious infection after fracture internal fixation. Methods From January 2001 to January 2006,we treated 26 patients with nonunion and malunion due to insidious infection after fracture internal fixation.They were 15 cases of femoral fractures, 2 cases of ulna fractures, 3 cases of radial fracturos, 3 cases of humerus fractures, and 3 cases of tibial fractures. The patients were treated with irrigation after debridement.In 23 fractures, the internal fixation was dislodged and changed into external fixation. In the 3 cases whose internal fixation remained, instillation and drainage were conducted after debridement. Bone grafting was performed for 20 cases after replacement of internal fixation, and for 3 cases after removal of external fixation.Three patients received no bone graft. Results The preoperative X-ray findings confirmed the diagnosis of insidious infection in 21 cases, while the other 5 cases were diagnosed by bacterial culture or pathological examination of the pus and inflammatory granulation tissue found during surgery. The bacterial culture was positive in 17 cases, including 6 cases of Staphylococcus epidermidis, 8 cases of Staphylococcus aureus, and 3 cases of Escherichia coli. All the patients were followed up for 8 to 48 months, with an average of 23.5 months. Of the 26 cases, 22 obtained bony union, 2 partial union and 2 nonunion. Complications included fistula in 2 patients and infection relapse in 3 patients. Conclusions Insidious infection may be related to the bacterial toxicity, anatomical sites and surgical methods. X-ray changes may help the diagnosis of insidious infection. Surgery is necessary for management of nonunion and malunion due to insidious infection after fracture internal fixation.

Objective To observe the morphological damages of hyperbilirubinemia on rat central nervous system, and evaluate the therapeutic effects of different routes of basic fibroblast growth factor (bFGF) administration. Methods Totally 90 Wistar rats were inflicted to hyperbilirubinemia models and then divided randomly into 3 groups:untreated group (BG),treated-1 group (T_ 1 G), treated-2 group (T_ 2 G), and another 30 rats served as control group (CG). bFGF injection were given at 30 min, 1, 3, 5 and 7 d by abdominal cavity (T_ 1 G,) and cranial cavity (T_ 2 G). GAP-43 expression levels and the micro-morphological features were observed with immunohistochemical assay and transmission electron microscopy respectively at 2 nd, 8 st, 28 st and 60 st day. Results ①Hyperbilirubinemia rat model was verified by gross and microscopic observation, bilirubin concentrations in the plasma and brain.②Compared to CG, the expression level of GAP-43 was significantly up-regulated in BG, T_ 1 G and T_ 2 G, especially in the later 2 groups (P

Objective To study the effects of suicide gene system mediated by adenovirus containing the CD-TK fusion gene controlled by human vascular endothelial growth factor(VEGF)promoter on apoptosis of human hepatocellular carcinoma cells HepG2 in vitro.Methods The VEGF-expressing HepG2 cells were infected by adenovirus vector containing CD-TK fusion gene controlled by the VEGF promoter(Ad-VEGFP-CDglyTK).The infection efficiencies in HepG2 cells were observed under a fluorescence microscope.The toxic effect of 5-fluorocytosine(5-FC)and ganciclovic(GCV)on infected cells was determined by light microscopy,electron-microscopy and flow cytometry(FCM).Results The transfection efficiency in HepG2 cells increased with the increasing adenoviral titer.The pro-drug(5-FC and GCV)could induce apoptosis of HepG2 cells in certain range of dosage(the doses of GCV+5-FC:1mg/L + 20mg/L,10mg/L + 40mg/L,100mg/L + 60mg/L)at the multiplicity of infection(MOI)of 100.The effect showed a time-dependent manner.HepG2 cells showed typical morphologic changes of apoptosis after administration of the pro-drug(GCV:10mg/L,5-FC:40mg/L)for 72 hours:chromatin condensation and disposition along nuclear membrane.Karyopyknosis and karyoklasis were seen under electron microscopy(?10 000).Apoptotic peak was also shown in HepG2 cells treated with the pro-drug(5-FC and GCV)by flow cytometry.The cell apoptosis rate was increased accordingly as the concentration of pro-drug(5-FC and GCV)increased.The apoptosis was increased obviously in comparison with the negative control group(P

To study effects of 9 cis retinoic acid (9 cisRA) on biological characteristics of lung squamous cancer cells, cell growth, cell differentiation and apoptotic indexes were observed in 9 cisRA treated L 78 and A 2 lung squamous cancer cells with flow cytometry. The results showed that 9 cisRA exerted marked inhibitory effect on the growth of two lung squamous cancer cell lines, 9 cisRA also had significant inducing effect on the differentiation of L 78 and A 2 cell lines, whereas the percentages of apoptosis of two cell lines in the treatment group were significantly higher than the control group. We conclude that 9 cisRA could inhibit growth inhibition, induce cell differentiation and apoptosis of L 78 and A 2 lung squamous cancer cells

AlM: To compare the effects of external approach microsurgery and conventional external approach surgery for retinal detachment ( RD) .METHODS: From January 2010 to January 2013, 60 patients (60 eyes) in our hospital were randomly divided into experimental group (29 cases, 29 eyes) and control group ( 31 cases, 31 eyes ) , the external approach microsurgery and conventional external approach surgery were performed respectively ( by the same skilled doctor ) . Retinal reattachment rate, visual acuity improvement rate and operative time were compared between two groups.RESULTS:lt cost shorter time for the external approach microsurgery than that of conventional external approach surgery ( P = 0. 0087 ). The once successful retinal reattachment rate in experimental group was 93% ( 27 cases ) , which was higher than that in control group (90%, 28 cases), there was no statistical difference. The vision improvement rate in control group was 86% ( 25 cases ) , compare to 90% ( 28 cases ) in experimental group, there was no statistical differences. CONCLUSlON: No statistical differences showed in visual acuity improvement and the once retinal reattachment rate between the two groups for rhegmatogenous retinal detachment. However, it is believed that external approach microsurgery could be faster, easier to learn with satisfactory effect.

Objective To explore the clinical value of 13C-methacetin breath test for the assessment of liver disorder and to analyze its predictive value to the severity of liver function injury in children.Methods Eighteen healthy children served as healthy control group,and 40 patients with different etiology and severity served as experimental group,and then the latter were divided into 2 subgroups,28 patients in Child-Pugh classification A,and 12 cases in below B(11 cases in B and 1 case in C).An oral dose of 2 mg/kg tracer 13C-methacetin was administered to each subject for the 13 C-methacetin breath test.At the same time,serum liver function markers including serum transaminase,bilirubin,albumin and prothrombin time were measured.The acquired data were analyzed by SPSS 17.0 software.Results (1) Metabolisation velocity (MV) max30 and cumulated dose (CUM) 120 in experimental group (46.64 ± 27.93,59.29 ± 30.73) were much lower than those of the healthy control group(73.56 ± 26.03,102.97 ± 41.80) (t =2.450,3.165,all P ＜0.05);(2) MVmax30 and CUM120 were closely correlated with the liver function markers of albumin,total bilirubin,direct bilirubin,prothrombin time (P ＜ 0.05);(3) MVmax30 and CUM120 could predict liver diseases in children,especially the CUM120.With CUM120 =85.80 as a cut-off value to predict liver diseases,the Youden index was 0.578 at its maximum,and the sensitivity and specificity were 77.8％ and 80.0％;(4) Compared with the Child-Pugh classification A,the CUM120 in Child-Pugh classification B and lower B was significantly lower(P ＜ 0.001);(5) CUM120 could predict the severity of liver diseases.With CUM120 =56.15 as a cut off value to predict the severity of liver diseases,the Youden index was 0.857 at its maximum,and the sensitivity and specificity were 85.7％ and 100.0％.Conclusion 13C-methacetin breath test index of CUM120 could predict liver diseases in children and the severity of liver function.

Objective To study the diagnosis and surgical outcomes of renal cell carcinoma with inferior vena cava tumor thrombus.Methods The clinical data from 31 cases of renal cell carcinoma with inferior vena cava tumor thrombus were retrospectively reviewed from January 2000 to December 2014.Among them,21 cases were male and 10 cases were female.The mean age ranged from 38 to 79 years,mean 57 years.The location of tumor included right renal in 29 cases and left renal in 2 cases.The distribution of the tumor thrombus was recorded as follow:level Ⅰ in 20 cases,level Ⅱ in 8 cases and level Ⅲ in 3 cases.All patients received radical nephrectomy and tumor thrombectomy.Ipsilateral subcostal oblique incision was chosen in 20 cases.Transrectus incision was chosen in 10 cases.And abdominal transperitoneal L shaped incision was chosen in 1 case.Three patients were given neoadjuvant molecular targeted therapies before operation.Results All patients accepted the operation successfully.There was no death during perioperative period.The pathological diagnosis showed clear cell carcinoma in 30 cases and chromophobe cell tumor in 1 case.The Fuhrman grading showed that 17 cases were grade Ⅱ,8 cases were grade Ⅲ and 5 cases were grade Ⅳ.Among them,the lymphatic metastasis in the renal hilum was found in 5 cases.After operation,16 patients received molecular targeted therapies,including sorafenib in 10 cases and sunitinib in 6 cases.Six patients were given autologous tumor lysate-pulsed dendritic cells co-cultured with cytokine induced killer cells treatment.The median overall survival was 44 months (range 4-60 months).The 1-,3-,and 5-year overall survival rates for all patients were 100％,52％,and 39％,respectively.There were significant differences of the overall survival rates between level Ⅰ / Ⅱ and level Ⅲ tumor thrombi(81.5％ vs 0) (P =0.012).Similar difference was noticed between Fuhrman grade Ⅱ and grade Ⅲ/Ⅳ (94.1％ vs 46.2％)(P =0.003).There was also significant difference between those with or without lymph node metastases (40.0％ vs 80.8 ％) (P =0.0 1 6).Conclusions Radical nephrectomy and tumor thrombectomy could improve the survival of patients of renal cell carcinoma with inferior vena cava tumor thrombus.The overall survival rate might be related to the tumor thrombus level,tumor grade,and local lymph node metastasis.

Objective To investigate the influnce factors of new diagnosed abnormal glucose metabolism in patients with acute cerebral ischemic stroke .Methods One hundres and twenty stroke patients without history of diabetes were divide into large artery atherosclerotic stroke (LAA), small arterial occlusive stroke(SAO), cardiac embolic stroke(CES), undeterminined etiology stroke (UND) subgroups according to the Trial of ORG 10172 in Acute Stroke Treatment(TOAST) classfication.The patients were tested oral glucose tolerance test (OGTT) one week later after stroke. The impaired glucose regulation ( IGR ) and diabetes patients called the abnormal glucose metabolism group ,compare related indicators and make multivariate Logistic regression analysis .Results There were 68 patients(56.7%) with normal metabolism, 52 patients (43.3%) with abnormal glucose metabolism.Among them, 38 cases were IGR (31.7%), 14 cases were diabetes (11.7%).The rate of abnormality of impaired glucose metabolism in LAA subgroup(63.8%) was significantly higher than the other subgroups (27.3%-31.4%)(all P<0.05).There was no statistically significant difference between the other subgroups .Compared with normal glucose metabolism group, age, the rate of hyperlipidemian and family history of diabetes were significant higher in abnormal glucose metabolism group (P<0.05 -0.01).Multivariate logistic regression analysis showed that hyperlipidemia ( OR=1.671,95%CI:1.208 -2.311,P=0.012), family history of diabetes (OR =1.421,95%CI:1.114 -1.813,P=0.042) and LAA(OR=2.825,95%CI:1.706-4.674,P=0.023) were independent risk factors of new diagnosed abnormal glucose metabolism in ischemic stroke .Conclusion There is a high prevalence of new diagnosed abnormal glucose metabolism in ischemic stroke .Hyperlipidemia , family history of diabetes and LAA are independent risk factors of it .