Clinical medicine is a practical discipline.Students combine theoretical knowledge with practical operation and develop clinical thinking at stage of clinical practice.From the perspective of education administration,a series of measures were carried out throughout the whole teaching in clinical internship in our university.Students were trained to gain the abilities of combing knowledge with practice,analyzing and solving issues individually and thinking logically and scientifically.Through years of research and practice,remarkable achievements were gained and both clinical skill and comprehensive quality of our students were greatly enhanced.

Objective To report the preliminary experiences in the treatment of old unstable thoracolumbar vertebral fractures by using anterior decompression, bone graft or titanium mesh and internal fixation with Z-plate system. Methods There were 23 cases (18 males and 5 females) with age range of 25-66 years (mean 41.7 years) as well as thoracolumbar vertebral fracture history for 1.2-28 years (mean 5.6 years). All cases complained of severe lower back pain, 17 of whom had slight neurological deficits (Frankel Grade D). Preoperative radiographic evaluation showed that all 23 cases had various degrees of kyphosis (25?-40?, averaged 34?), spinal cord compression and vertebral instability. Of 23 cases, 15 were treated with anterior decompression, full-thickness iliac crest autograft and internal fixation with Z-plate and the other 8 with titanium mesh instead of full-thickness iliac crest autograft. Results No severe complications happened during and after operation. The lower back pain and neurological deficits were improved or disappeared 2-3 months postoperatively. The average kyphotic correction degrees ranged from preoperative 34? to postoperative 12?. No patients' symptoms worsened during follow-up. In three cases with preoperative Frankel Grade D, the myodynamia recovered slightly but the Frankel Grade remained unchanged. The postoperative MRI examinations showed that vertebral canals were well decompressed. Conclusions Anterior decompression, autograft or titanium mesh and internal fixation with Z-plate are proved to be safe and effective techniques for clinical management of old thoracolumbar fractures, for they have advantages in effective decompression of neural structures, high healing rate of autograft and correction of kyphotic deformity.

Cell-Derived Microparticles ; Disease Progression ; Humans ; Leukemia ; pathology

Amoxicillin ; adverse effects ; Anti-Bacterial Agents ; adverse effects ; Child ; Humans ; Male ; Renal Insufficiency ; chemically induced

Objective To investigate the clinical features and long - term prognosis of neonatal lupus erythe-matosus(NLE)and to improve the understanding of NLE. Methods The clinical manifestations and related serologi-cal tests of NLE children diagnosed from June 2010 to January 2014 were analyzed. Regular follow - up was carried out to detect the general condition,rash,blood routine,urine routine,liver and kidney function,complement,red blood cell sedimentation rate(ESR),auto antibodies,electrocardiogram,and ultrasound cardiogram. Results Among the 11 NLE cases,there were 6 male and 5 female patients. All had lesions on skin,3 cases had hematologic changes,7 cases were had liver damage,and 4 cases had heart impairment. The antinuclear antibody and anti - sjogren sydrome A/ Ro antigen (SSA/ Ro)were positive in all the patients. The anti - sjogren sydrome B antigen was positive in 5 patients. The anti -double stands deoxyribonucleic acid antibody was positive in 4 patients. Antibody against U1 - ribonudeoprotein was positive in 3 patients,and the level of ESR was higher in 5 patients. The antinuclear antibody and anti - SSA/ Ro anti-body were positive in all mothers. Only 1 mother had no symptom before pregnancy,7 patients had SLE,3 patients had sjogren syndrome. Seven patients received protect liver enzyme treatment,3 cases of glucocorticoid therapy,and 1 case had combined intravenous treatment with gamma globulin. Among the 11 cases,10 cases were followed up for 10 months to 4 years,while 1 case died from complete bundle branch block after 5 weeks of birth. At 1 year old,10 cases of cuta-neous lupus damage had liver damage were resorted to normal,and the rheumatic autoimmune related autoantibodies of 9 cases turned to be negative,but 1 case was diagnosed as Kawasaki disease when she was 1 year old. Conclusions One of the most common clinical manifestations of NLE was damage of skin,had the liver and blood system abnormity were common but usually not serious. Heart disease especially complete atrioventricular block was less. The long - term follow - up for children with NLE is necessary,and the majority of the prognosis is good,as only a few have the possibi-lity of developing other autoimmune diseases.

Objective To evaluate the short-term results of ARCH plate in cerical expansive open-door laminoplasty(ELAP)for OPLL.Methods From June 2010 to September 2011,a total of 12 cases with OPLL underwent open-door ELAP by ARCH plate fixation and were followed up in our hospital.8 cases were males and 4 cases were female.The average age was 60.5 years.The neurological effect was evaluated by use Japanese Orthopedic Association(JOA)scoring criteria for cervical myelopathy.The ana-tomical effect was analyzed by compare roentgenogram and CT before and after surgery.Results The JOA scores were improved for 39% after the operation,while the saggital diameters of the cervical spinal canaldural after operation was enlarged for 82%(P<0.05).X-ray films and CT scan after operation that there was no occurrence of re-close of door,there was no occurrence of anchor loosing.Conclusion For OPLL,ELAP using ARCH plate fixation bring less occurrence of re-close of door,slight postoperative neck AS,and satisfactory clinical outcomes.

Objective To observe the effect of pigplacenta ins tead of Ziheche (P lacenta Hominis) for the treatment of senile dementia. Methods Seventy Kunming mice were divided into blank group, model group, pos itive control group, Zih eche low and high dosage groups, and pigplacenta low and high dosage grou ps, wi th 10 in each. The senile dementia models were established with the D-Galactose subcutaneous injection. The blank group was not administered any medicines. The model group was prescribed normal saline instead of the tested medicine; the pos itive control group was given Naofukang by gavage; the Zih eche low and high dosage groups were given 2g/kg and 4g/kg Ziheche respectivel y by gavage; while the pigplacenta low and high dosage groups were treated wi th p igplacenta 4g/kg and 8g/kg respectively by gavage. After treatment for 6 week s, the behavior experimental dark-avoiding test and step-down test were applied to test the effect of the medicines on the learning memory of mice, and acetylchol inesterase and monoamine levels in brain tissues. Results There was no s ignificant difference between the effect of pigplacenta and Ziheche in resi stin g senile dementia. In the latency of dark-avoiding test, the effect of high d osa ge of pigplacenta was significantly better than that of Ziheche (P

Objective To explore the interventional treatment method for complex and refractory lymphatic malformation in children.Methods The clinical data of 78 cases with complex and refractory lymphatic malformation during January 2013 to January 2016 in our department were retrospectively analyzed.The lesions involved the neck in 28 cases,maxillofacial regions in 19 cases,the chest and armpit in 8 cases,the limb in 7 cases,the pelvic cavity and retroperitoneal space in 6 cases,the superior mediastinum in 3 cases,the hypogloeeis in 3 cases and scrotum or perineum region in 4 cases.All the children underwent ultrasound or MRI imaging studies preoperatively.The interventional procedures included:(1) Percutaneous puncture of the LM for sclerotherapy.The lesions were punctured with 20 G needle under the guidance of DSA or ultrasound and the correct positions were confirmed with angiography.The liquid of the lesions was extracted as far as possible.The dosage of sclerosing agents was adjusted according to the size of lesion.The dose of Laurolacrogol injection was 1/10—1/5 of the amount of the liquid in the lesions and the maximum of Laurolacrogol foam was ≤8 ml(20 mg).The dose of Pingyangmycin was ≤ 8 mg.(2) The drainage catheter placement and sclerotherapy.Percutaneous catheter drainage under ultrasound guidance or by surgery was conducted.The liquid in the lesions was drained by retaining the catheter for 1-4 weeks,and sclerotherapy was applied for several sessions during this period.(3) Treatment for one time a week,2 times a session.The interval of every two sessions was 4 weeks.The sclerosing agents included:Laurolacrogol Injection or Pingyangmycin for the lesions with high tension,Laurolacrogol foam for the lesions with low tension,Pingyangmycin for the microcystic lesions.Statistical analysis was conducted using SPSS20.0 software.Results A total of 208 sessions of sclerotherapy for 78 LM patients were performed and average session was (3.0±0.8).Nine patients used Lauromacrogol foam,23 patients used Lauromacrogol Injection,39 patients used pingyangmycin,while combined treatment was conducted in 7 patients.Laurolacrogol injection was used in 20 cases,Pingyangmycin in 29 cases and combination therapy in 5 cases for the high tension lesions in the neck,maxillofacial,chest and armpit.The low tension lesions of pelvic cavity and retroperitoneal space in 6 cases and of superior mediastinum in 3 cases were placed with draining catheters,and treated with sclerotherapy with Laurolacrogol foam.Three cases with hypogloeeis LM was neonates,who were treated with Laurolacrogol injection.The lesions on the limb and scrotum or perineum region were almost microcystic,were treated with Pingyangmycin in 9 cases and with combination therapy in 2 cases.The total curative rate was 97.4％ (76/78),total effective rate was 100％ (78/78).Imaging examinations showed that the cavities were closed or only a small amount of residual sclerotic lesions were present.Clinical examinations showed that the surface masses almost disappeared.The follow up period was 6 months to 2 years.There were no serious complication and adverse reactions occurred.Conclusions Interventional treatment is a safe,effective,and minimally invasive treatment for the complex and refractory lymphatic malformation.In order to receive the best treatment effect,we should use targeted therapy for different region and type of LM.

Objective To analyse clinical features of dead children in pediatric intensive care unit(PICU) of Children's Hospital of Chongqing Medical University from 2005 to 2014.Methods Clinical data of 917 dead cases in PICU from January 2005 to December 2014 in this hospital were collected,then distribution characteristics of age,length of hospital stay,time of dead and transfer department were analysed.The death cause analysis was conducted as well.Results According to systematic classification of disease,the top 10 leading causes of death for 917 dead cases in PICU from 2005 to 2014 in this hospital were congenital deformity,infectious disease,respiratory disease,injury and poisoning,digestive system disease,tumor,symptoms,signs and abnormal clinical and laboratory findings not elsewhere classified,circulation system disease,nervous system disease,blood system disease.Compared with 2005-2014,the ratio of dead cases due to infectious diseases to the total cases was declined,while that due to non-infectious diseases was increased,there was statistically significant difference (x2 =26.29,P =0.00).Whereas,the ranks of septicopyemia and hand-foot-mouth disease in the rank order of death causes both were increased.Condusion Congenital deformity is the first cause of death in PICU of this hospital.The key to cutting children's mortality is to reduce newborn with congenital deformity.

The demand of hospital car in first-aid and patients carrying is urgent in paroxysmal epidemic,disaster and wartime.According to types and characteristics of civil-train,many methods are used to rapidly refit civil-train to hospital car,such as rapid taking down devices from civil-train,installing medical appliances and unloading the device in the civil-train and auxiliaries.Based on analysis and comparison,YZ25G hard-seat train is the best one to refit from civil-train to hospital car.