Clinical teaching and studying is suffering increasing hardship.This article analysises the present condition of clinical education problems and causes,and researches whether patients are obliged to coorperate clinical teaching and studying when they protect their rights.It also researches how to practice clinical teaching and studying in educational hospital and looks for effective pathway to go out of the clinical education problem.

Objective To explore predictive value of baseline red cell distribution width (RDW) determined in a routine blood count for severity of chronic heart failure (CHF) and mortality during hospitalization.Methods The study group comprised 135 patients hospitalized in the our hospital with CHF in the Ⅱ ～ Ⅳ class according to New York Heart Association (NYHA).The control group included 44 patients in class Ⅰ.Hematological and biochemical parameters were obtained and compared among groups.Receiver operator characteristic (ROC) curves were used for assessing predictive values.Results RDW increased significantly in class Ⅲ and Ⅳ compared to class Ⅰ [(14.3 ±2.3)％ and (14.3 ± 1.7)％ vs (12.9 ±0.8)％,P ＜0.01].Areas under ROCs (AUCs) of RDW,N-terminal prohormone brain natriuretic peptide (NT-proBNP) for class Ⅳ HF was 0.817 and 0.840,respectively.RDW was significantly elevated in mortality group compared to survival group [(15.8 ± 1.8)％ vs (13.7 ± 1.7) ％,P ＜ 0.01],predictive value of RDW was lower than that of NT-proBNP but was comparable to white blood cell (WBC),neutrophil (NEU),lymphocyte (L),and neutrophil/lymphocyte ratio (N/L) for mortality during hospitalization with AUCs (0.837,0.939,0.858,0.891,0.885,and 0.885,respectively).RDW and NT-proBNP showed low predictive values for repeated admission (≥3).RDW was an independent risk factor for mortality (OR =2.531,95％ CI:1.371 ～4.671).Conclusions RDW increased significantly in class Ⅲ and Ⅳ patients and death group.The predictive value of RDW is comparable to NT-proBNP for class Ⅳ and lower than that of NT-proBNP for mortality.Elevated RDW is an independent risk factor for mortality.

Objective To discuss and to compare the curative effects of interventional embolization with different embolic agents in treating giant hepatic cavernous hemangiomas. Methods From 2008 to 2010, a total of 30 cases with clinically proved hepatic cavernous hemangioma were treated with interventional embolization. According to the embolic agents used , the patients were divided into pingyangmycin-lipiodol emulsion mixed with sodium alginate microspheres group(PLE+KMG, group A, n=15) and pingyangmycin-lipiodol emulsion group (PLE, group B, n=15). CT scanning was performed one, 3, 6, 12 months after the treatment to evaluate the curative effect. Results The technical success rate was 100%in both groups. The mean PLE dose used in group A and B was (10.9 ± 5.2) ml and (11.4 ± 4.9) ml respectively, the difference between the two groups was not significant (P > 0.05). CT reexamination performed one, 3, 6 months after the treatment showed that a reduction in tumor volume over 50%in group A was seen in 9, 11 and 14 cases respectively, while in group B it was 0, 3 and 5 cases respectively (P <0.05). One week after the procedure, the degree of pain in patients of group A was more severe than that in patients of group B, the difference between the two groups was statistically significant (P < 0.05). Slight abnormal hepatic function was seen in some patients of both groups, which presented mainly as an elevation of aminotransferase, which returned to normal after symptomatic medication. Follow-up with questionnaire indicted that patients of group A were more satisfied with the treatment than the patients of group B. Conclusion Transhepatic infusion of pingyangmycin-lipiodol emulsion is a safe and effective treatment for giant cavernous hemangioma of the liver. Combination use of pingyangmycin-lipiodol emulsion and sodium alginate microspheres can obviously reduce the tumor size mainly in the first and the third month after the treatment, besides it produces instant clinical effect although the pain is more severe than in patients treated with pure pingyangmycin-lipiodol emulsion.

Objective To assess the effect of recombinant human leukemia inhibitory factor (rhLIF) on mouse embryo development in vitro Methods Mice were randomly divided to three groups, one in vivo control (group Ⅰ) and two in vitro (group Ⅱ and Ⅲ) Mice were sacrificed at 116 120 hours (group Ⅰ) and 44-48 hours (group Ⅱ and Ⅲ) subsequent human chorionic gonadotropin (hCG) injection Two cell embryos (group Ⅱ and Ⅲ) and blastocysts (group Ⅰ) were obtained Embryos in group Ⅱwere cocultured with human tubal fluid (HTF) + 10% human serum and in group Ⅲ with HTF + 10% human serum+rhLIF (1 000 U/ml) The number of embryo in different stage was recorded and compared Results Embryo in four, eight cell and morula was noted in group Ⅱ and Ⅲ, 87 7% versus 91 2% and 75 0% versus 85 4% respectively There was no significant difference. However, further embryo development to the blastocyst, expanded blastocyst, and hatching blastocyst in group Ⅱ (48 1%, 32 1% and 18 4%) was lower than that in group Ⅲ (82 3%, 59 7% and 36 3%) There was no difference between blastocyst in group Ⅰ and group Ⅲ (86 0% vs 82 3%). Conclusion RhLIF does not provide obvious stimulation in early mouse embryo, however, rhLIF can promote the growth, differentiation, and hatching of preimplantion blastocyst

Background and purpose:Cancer-related pain is one of the most important symptoms of patients with advanced cancer. Chemotherapy sometimes induces peripheral neuropathy and pain. These symptoms seriously affect patients’ quality of life. Cancer pain assessment is now achieved by the subjective scales of patients, but lacking objective measurement. In this study, we used the neurotic electrophysiological method by way of PainVision system (PV system) to evaluate cancer pain quantitatively to detect and analyze degree of chemotherapy-induced neuropathy. Methods:We obtained numerical rating scale (NRS) scores from patients receiving analgesics and calculated the PainRatio from PV system at the same time. Then we analyzed the relationship between NRS and PainRatio scores. We detected current perception threshold (CPT) levels of patients receiving chemotherapy to ifnd the correlation between chemotherapy and CPT level, and attempt to evaluate chemotherapy-induced neuropathy.Results:PainRatio scores were linearly associated with NRS scores (Pearson correlation coeffcient=0.849,P<0.001). Patients with neuropathy symptoms got higher CPTs. However, no statistically signiifcant difference was observed between patients treated with oxaliplatin, paclitaxel and other agents.Conclusion:PainVision system can be used in cancer pain assessment quan-titatively, and be helpful in cancer pain assessment objectively. Patients with deifned neuropathy showed higher CPTs, indicating the potential clinical value of PV system in detecting and evaluating chemotherapy-induced neuropathy.

Objective:To investigate the defect types and reconstruction methods of maxillary defects. Methods:The database of 1 107 cases with maxillary defects in Peking University School and Hospital of Stomatology from January 1985 to December 2010 was established. There construction methods were re-viewed. The defect types were classified according to Brown classification system. Results: In the 1 107 cases, 1 104 cases could be classified according to Brown classification system. The most common type was 2a with 559 cases (50. 6%). Among all the 1 107 cases, 349 cases were reconstructed with auto-transplantation, 443 cases with prosthesis, 107 cases untreated, and 208 patients lost to the follow-up. There was a significant growing trend over time for the application of free flaps and a downward trend of prosthesis. The most popular free flaps were fibular flap (88 cases) and radial forearm flap (75 cases) . Rectus abdominis flap and anterolatreal thigh flap were fit for extensive maxillary defects. Conclusion:The most common defect type is 2a. Free flap has become the dominant option for maxillary reconstruc-tion. Free flaps could be selected according to the maxillary defect types.

OBJECTIVETo investigate the clinical outcomes of the posterior C1,2 screw-rod combined with C2 unilateral translaminar screw and contralateral pedicle screw fixation and autogenous bicortical iliac crest graft fusion in treating upper cervical instability with vertebral artery variations.

METHODSFrom June 2008 to December 2012, the clinical data of 12 patients with upper cervical instability underwent C1 lateral mass screws-C2 unilateral laminar and contralateral pedicle screws fixation combined with autogenous bicortical iliac crest graft fusion were analyzed retrospectively. There were 8 males and 4 females with a mean age of 47.5 years (ranged, 16 to 77 years). Patients suffered from occipitocervical activity limitation of motion with pain or not, VAS was 0-7 points with an average of (3.50 +/- 2.71) points. Unilateral vertebral artery hypoplasia was demonstrated by vertebral arteriography (VAG) or CTA in all patients. Cervical X-ray and CT scans were done within 7 days after surgery in order to confirm internal fixation position. Internal fixation loosening and breakage, reduction losing, bone fusion ratio were observed during follow-up.

RESULTSNo nerves and vertebral artery injuries occurred during operation. Cervical pain obviously decreased and VAS was (0.92 +/- 0.90) points. Cervical alignment of 12 patients had well-recovered by X-ray while Atlantoaxial ventral lamina cortex of 1 case was encroached by CT scan without neurological symptom. All patients were followed up for 6 months to 3 years, no internal fixation loosening and breakage, reduction losing were found. All patients obtained bone fusion in 6-12 months after operation.

CONCLUSIONPosterior C1 lateral mass screws-C2 unilateral laminar and contralateral pedicle screws fixation combined with autogenous bicortical iliac crest graft fusion can achieve biomechanical stability and raise the successful rate of bone fusion, while avoiding the risk of vertebral artery injury and overcoming the insufficient of bone fusion during bilateral laminar screws placement as well. Posterior C1 lateral mass screws fixation is a safe and effective additional method in treating upper cervical instability with vertebral artery variations.

Adolescent ; Adult ; Aged ; Bone Screws ; Cervical Vertebrae ; surgery ; Female ; Humans ; Internal Fixators ; Joint Instability ; surgery ; Male ; Middle Aged ; Tomography, X-Ray Computed ; Vertebral Artery ; pathology

Objective To compare the complications of temporary ileostomy and temporary colostomy for colorectal anastomoses,then to evaluate which one is superior to another.Methods Studies and relevant literatures comparing temporary ileostomy with temporary colostomy for defunctioning colorectal anastomoses were searched though PubMed,Embase and the Cochrane Library.The rates of complications were pooled and compared using a meta-analysis.The risk ratios were calculated with 95％ confidence intervals to evaluate the safety and efficacy of each technique.Results Five randomized controlled trials and seven non-randomized studies were included,with 1687 patients in total.The meta-analysis of the RCTs demonstrated a lower risk of stoma prolapse ( Risk ratio 0.15) in the temporary ileostomy group.Meta-analysis of the non-randomized studies showed a lower risk of stoma prolapse ( Risk ratio 0.26) and wound infection after stoma closure ( Risk ratio 0.28 ) in the temporary ileostomy group.No other statistically significant difference was observed for complications.Conclusions Each type of defunctioning stoma has its advantages and disadvantages.The authors endorse temporary ileostomy over temporary colostomy.However,there is not a strong evidence for the superiority of one temporary stoma over another for colorectal anastomoses.Large scale RCTs and high quality studies are needed.

Objective:To explore the risk factors of spontaneous rupture of hepatocellular carcinoma (HCC), and to analyze the prognosis of transcatheter arterial embolization (TAE) in the treatment of spontaneous rupture of HCC.Methods:From January 2008 to December 2018, at Tianjin Third Central Hospital, 126 patients diagnosed with spontaneous rupture of HCC (spontaneous rupture group) and in the same period 252 patients diagnosed as HCC without rupture (non-spontaneous rupture group) were retrospectively selected. Independent sample t test, Mann-Whitney U test and chi-square test were used to compare the general data, laboratory test results and imaging results between spontaneous rupture group and non-spontaneous rupture group. Multivariate logistic regression was used to analyze the independent risk factors of spontaneous rupture of HCC. Kaplan-Meier method and log-rank test were used for survival analysis of 92 patients treated with TAE and 31 patients treated with conservative treatment in patients with spontaneous rupture of HCC, and multivariate Cox proportional hazard regression was used to analyze the independent prognostic factors of patients treated with TAE. Results:The proportions of tumor maximum diameter ≥5 cm, tumors mainly located in segment Ⅱ, Ⅲ, Ⅳ and Ⅵ of the liver, tumors protruding height from the surface of liver ≥1 cm, liver cirrhosis and portal vein thrombosis (PVT) in spontaneous rupture group were all higher than those in non-spontaneous rupture group (46.8%, 59/126 vs. 35.7%, 90/252; 61.1%, 77/126 vs. 46.0%, 116/252; 73.0%, 92/126 vs. 18.7%, 47/252; 81.7%, 103/126 vs. 69.0%, 174/252; 20.6%, 26/126 vs. 11.5%, 29/252), and the level of fibrinogen is lower than that in non-spontaneous rupture group ((3.07 ±1.38) g/L vs. (3.92±1.13) g/L), and the differences were statistically significant ( χ2=4.343, 7.644, 106.780, 6.918 and 5.628, t=-3.276, all P<0.05). The results of multivariate logistic regression analysis showed that the location of tumors in segment Ⅱ, Ⅲ, Ⅳ, Ⅵ of the liver, the height of tumors protruding from the surface of liver ≥1 cm, liver cirrhosis and the fibrinogen was lower than the lower limit of the reference value were independent risk factors of spontaneous rupture of HCC (odds ratio ( OR)=1.354, 5.726, 1.152, 1.892; 95% confidence interval ( CI) 1.062 to 2.008, 1.049 to 19.575, 1.016 to 1.895, 1.267 to 3.346; all P<0.05). Among 92 patients with spontaneous rupture of HCC treated with TAE, the TAE technical success rate and clinical success rate were 100.0% (92/92) and 93.5% (86/92), respectively. Thirty-one patients received conservative treatment. The median survival time of the patients treated with TAE was 243 d (38 d, 377 d), which was about 10 times that of the patients who accepted conservative treatment (23 d (9 d, 51 d)). The 1-month, 3-month, 6-month, 1-year and 3-year survival rates of the patients treated with TAE were 72.8%, 50.8%, 46.0%, 31.1% and 13.6%, respectively, and those of patients who accepted conservative treatment were 25.8%, 17.2%, 11.5%, 5.7% and 0, respectively; and the differences in survival rates between the two groups were statistically significant ( χ2=34.606, P<0.01). Log-rank test analysis showed that initial hemoglobin <60 g/L, C grade of liver function, total bilirubin (TBil)≥50 μmol/L, complicated with portal vein tumor thrombus, hepatic lobe embolism during TAE, and tumor maximum diameter ≥10 cm were all correlated with poor survival rates of patients with spontaneous rupture of HCC after TAE ( χ2=3.752, 4.146, 22.318, 4.087, 5.685 and 7.893, all P<0.05). The results of multivariate Cox proportional hazard regression analysis showed that TBil ≥ 50 μmol/L, hepatic lobe embolism during TAE, and tumor maximum diameter ≥10 cm were independent factors of poor prognosis of spontaneous rupture of HCC treated with TAE ( OR=25.873, 8.415, 18.620; 95% CI 4.916 to 126.005, 1.136 to 27.319, 2.754 to 84.368; all P<0.05). Conclusions:In HCC patients with tumors located in segments Ⅱ, Ⅲ, Ⅳ and Ⅵ of the liver, the height of tumors protruding from the surface of liver ≥1 cm, liver cirrhosis or the fibrinogen is lower than the lower limit of the reference value, close attention should be paid to the risk of spontaneous tumor rupture. TAE is an effective treatment for acute spontaneous rupture of HCC, and the prognosis of patients treated with TAE is better than that of patients receiving conservative treatment. However, patients with TBil ≥50 μmol/L, hepatic lobe embolism during TAE and tumor maximum diameter ≥10 cm have a poor prognosis after TAE treatment.