There are two critical factors that can reflect the quality of teaching in clinical teaching of neurosurgery.The first is the effectiveness of the teachers' teaching methods,the other is the intensity of the students' learning will.With both factors adapted to each other,the teaching quality will be greatly improved.However,in neurosurgical intensive care(NIC) practices,due to the particularity of the NIC,these two factors will lead to a confliction,and result in a negative effect of clinical teaching.This article is based on practical experiences of the author in clinical teaching.In view of this contradiction,brief analysis should be made both for clinical teachers and medical students,and a corresponding solution should be proposed in order to raise the standards of clinical teaching.

OBJECTIVE:To get to know the preoperative and postoperative medication of patients with cataract.METHODS:The preoperative and postoperative medication of 564 cases with cataract extraction in our hospital from September 2004 to October 2004 was analyzed statistically.RESULTS:Antibacterial eye gutta was mainly used before cataract extraction while compound eye gutta containing antiseptic drugs and glucocorticosteroid were chiefly used after cataract operation.CONCLUSION:The preoperative and postoperative medication for patients with cataract in our hospital was reasonable.

OBJECTIVE:To provide suggestions for the improvement of eye drops specifications(EDS)so as to promote safe and effective use of eye drops.METHOD:123kinds of EDS in18categories in our hospital pharmacy were investigated and analyzed.RESULTS:Several important contents in the specifications like pharmacology and toxicology,pharmacokinetics,ad-verse reactions,contraindications,precautions,medications for pregnant and nursing women,and that for children and senile patients,drug interactions and overdose failed to fully meet the national criteria.The quality of the imported EDS was superior to that of the domestic EDS.CONCLUSIONS:The EDS were still far from being perfect and improvement of which is neces-sary so that more detailed drug information is available for physicians,pharmacists and patients,which is conducive to safe and effective use of drugs.

Objective To explore the distribution and drug resistance of extended-spectrum beta-lactamase (ESBLs)producing Klebsiella pneumoniae in elderly and young and middle-aged patients,and provide reference for rational use of antibiotics for clinicians.Methods Specimens of elderly (≥ 60 years old) and young and middle-aged (18-59 years old) patients who with various clinical infection in Shengjing Hospital of China Medical University from January 2016 to December 2016 were collected as the research object.ESBLs-producing Klebsiella pneumoniae was isolated from 125 patients (60 elderly patients and 65 young and middle-aged patients).The preliminary screening and phenotypic confirmatory test of ESBLs were carried according to the method which was recommended by American Clinical and Laboratory Standards Institute.The drug resistance of ESBLs-producing Klebsiella pneumoniae was analysed and the resuh of the two groups were compared.Results The specimens of ESBLs-producing Klebsiella pneumoniae strains of elderly patients were mainly from urine (36.67％),sputum (33.33％) and whole blood (11.67％);the specimens of young and middle-aged patients were also mainly from urine (24.62％),sputum(24.62％) and whole blood (15.38％).There was statistical significance in the distribution of ESBLs producing Klebsiella pneumoniae in the specimens secretions between the elderly patients and the young and middle-aged patients(P ＜0.05).There was no statistical significance in the distribution of ESBLs producing Klebsiella pneumoniae in the specimens of urine,sputum,whole blood,bile,pus,drain,cerebrospinal fluid,ascitic fluid and catheter between the elderly patients and the young and middle-aged patients (P ＞ 0.05).ESBLs-producing Klebsiella pneumoniae strains of elderly patients were mainly isolated from department of respiration (20.00％,12/60) and department of urinary surgery (18.33％,11/60);the ESBLs-producing Klebsiella pneumoniae strains of young and middle-aged patients were mainly isolated from department of intensive care (16.92％,11/65) and department of neurosurgery (16.92％,11/65).There was statistical significance in the distribution of ESBLs producing Klebsiella pneumoniae in the department of respiration and obstetrics and gynecology between elderly patients and young and middle-aged patients(P ＜ 0.05);there was no statistical significance in the distribution of ESBLs producing Klebsiella pneumoniae in the department of urinary surgery,general surgery,intensive care,neurosurgery,rheumatoid immunology,invasive technology,oncology,digestion,infection,kidney,orthopaedics,rehabilitation,hematology,neurology and other department between elderly patients and young and middle-aged patients(P ＞ 0.05).The drug resistance rates of ESBLs-producing Klebsiella pneumoniae to beta-lactam antibiotic in elderly and young and middle-aged patients were more than 90.00％;the drug resistance rates of ESBLs-producing Klebsiella pneumoniae to carbapenems were nearly 0.00％ in elderly and young and middle-aged patients.There was significant difference in the drug resistance rates of ESBLs-producing Klebsiella pneumoniae to ceftazidime and gentamicin between elderly patients and young and middle-aged patients(P ＜ 0.05);there was no significant difference in the drug resistance rate of ESBLs-producing Klebsiella pneumoniae to another antibiotic between elderly patients and young and middle-aged patients (P ＞ 0.05).Conclusion Both elderly and the young and middle-aged patients can be infected with ESBLs-producing Klebsiella pneumoniae.There was no significant difference in the distribution of ESBLs-producing Klebsiella pneumoniae in most clinical departments (except respiratory and obstetrics and gynecology).The most effective antimicrobial drugs at present for the treatment of ESBLs-producing Klebsiella pneumoniae was carbapenems.There is no significant difference in the drug resistance rates of ESBLs-producing Klebsiella pneumoniae to common antibiotics between elderly patients and young and middle-aged patients.Clinicians should rationally use antibiotics according to the results of susceptibility tests.

Objective To investigate the expression and clinical significance of β2 microglobin (β2-MG)protien and vascular endothelial growth factor (VEGF) protien in diffuse large B-cell lymphoma (DLBCL).Methods The expressions of VEGF protien and β2-MG protien were evaluated in 49 DLBCL patients which started the initial treatment by luminex suspension array.Results Among 49 DLBCL patients,expression of β2-MG protein was high in 37 cases and the expression of VEGF protein was high in 23 cases.The expression of VEGF protien and β2-MG protien were not related with gender,age,B symptoms,clinical stage and lactic acid (LDH).There was positive correlation between the high expression of β2-MG protien and chemotherapy (P =0.037).There was relevant trend between the higher expression of VEGF protien (P =0.067).Conclusion The expressions of VEGF protien and β2-MG protien are detected in DLBCL,both proteins may be the potencial markers of DLBCL and therapeutic targets for DLBCL.

Objective To investigate the current status of nurses'' needlestick injuries during venous blood sampling, evaluate effective prevention strategies.Methods A stratified cluster sampling method was used to investigate clinical nurses in China by questionnaire, contents of questionnaire included the general information of nurses, training and management on venous blood sampling among nursing staff, adherence to wearing gloves before blood sampling, the occurrence of needlestick injuries during the process of venous blood sampling in the past year and so on.Results A total of 2 861 questionnaires were distributed, and 2 575 valid questionnaires were recovered.93.17％ of the investigated nurses had participated in the training of venous blood sampling regularly;87.15％ received regular check of venous blood sampling;before venous blood sampling, only 72.74％ knew whether the patient had bloodborne infectious disease;only 61.01％ wore gloves during blood sampling.Incidence of needlestick injuries during venous blood sampling was 20.78％ in the past year.There was no significant differences in the incidence of needlestick injuries when using 3 different types of needles(Pearson x2=1.649, P=0.438).48.21％ of needlestick injuries occurred during disposing medical waste.Conclusion The training and management on nurses'' venous blood sampling is better in China, but incidence of needlestick injuries is still high.It is necessary to formulate safety operation regulations of venous blood sampling, standardize the operation procedures and specify the contents of training, so as to correct nurses'' unsafe behavior during venous blood sampling.

Objective To investigate blood plasma melatonin level in night-shift nurses and explore the relationship of blood plasma melatonin level with nervous system symptom (insomnia、anxiety、depression). Methods ELISA were used for detection of blood plasma melatonin level in 80 night-shift nurses of different age group. Results Blood plasma melatonin level of shift work nurses (36to40、41to45 yearold) were significant lower than the corresponding age group of the control group, the nervous system symptom of these age group night-shift nurses correlated to melatonin level of melatonin. Conclusions Blood plasma level of melatonin have a close relation to nervous system symptom(insomnia、anxietydepression).

Objective To analyze the published articles on the etiology of rheumatoid arthritis (RA) and catch the recent research hot topics.Methods Literature searching on the etiology of RA was conducted through PubMed database of US Congress Library of Medicine published in past five years.Bibliographic Item CO-Occurrence Matrix Builder (BICOMB) to bibliometric analysis and statistical product and service solutions (SPSS) 19.0 were used for cluster analysis and plotting strategic coordinate figure.Results Four research hot topics were identified by analyzing the keywords:① Therapeutic and adverse effects of antirheumatic agents;② Genetics and complications of RA;③ Immunity of autoantigens and autoantibodies in RA;④ Immune cells and microRNAs in RA.Conclusion Researches on RA etiology have developed steadily,with different current status and developing tendency,which provides reference for related studies.

Objective:To discuss the effect of Jiegeng Yuanshen Tang(JGYST)on airway tissue inflammation and mucus secretion in the mice with allergic asthma,and to clarify the related mechanism.Methods:Forty male C57BL/J mice were randomly divided into control group,JGYST group,ovalbumin(OVA)group,and OVA + JGYST group.The mice in OVA group and OVA +JGYST group were sensitized with 50 μg OVA via intraperitoneal injection twice weekly,followed by 20 μg OVA nasal drops daily for 7 d to induce asthma;the mice in OVA +JGYST group were gavaged with 200 μL JGYST 1 h before each OVA challenge,and the administration lasted for 7 d;the mice in control group were given equivalent dose of PBS via intraperitoneal injection,nasal drops,and gavage;the mice in JGYST group were given the same dose of PBS for intraperitoneal and nasal administration and gavaged with the same dose of JGYST.The pathomorphology of lung tissue of the mice in various groups was observed by HE staining and periodic acid-Schiff(PAS)staining,and the inflammation and PAS scores were calculated;flow cytometry method was used to detect the numbers of eosinophils,neutrophils,helper T lymphocyte 1(Th1)cells,helper T lymphocyte 2(Th2)cells,and dendritic cells(DCs),as well as the percentage of mature DCs and level of reactive oxygen species(ROS)in lung tissue of the mice in various groups;real-time fluorescence quantitative PCR(RT-qPCR)method was used to detect the expression levels of interleukin-4(IL-4),interleukin-10(IL-10),and tumor necrosis factor-α(TNF-α)mRNA in lung tissue of the mice in various groups.Results:The HE and PAS staining results showed that the mice in control group had intact airway and alveolar structure,without infiltration of inflammatory cells or mucus secretion;compared with control group,there was a large number of infiltrating inflammatory cells in airway tissue of the mice in OVA group,and the inflammation and PAS scores were increased(P<0.01);compared with OVA group,the infiltration of inflammatory cells in airway tissue of the mice in JGYST group and OVA + JGYST group was decreased,and the inflammation and PAS scores were significantly decreased(P<0.01).The flow cytometry results showed that compared with control group,the numbers of eosinophils,Th2 cells,and DCs in lung tissue of the mice in OVA group were increased(P<0.05 or P<0.01),and the percentage of mature DCs and level of ROS were significantly increased(P<0.01);compared with OVA group,the numbers of eosinophils,Th2 cells,and DCs in lung tissue of the mice in JGYST group and OVA + JGYST group were decreased(P<0.01),and the percentage of mature DCs and level of ROS were significantly decreased(P<0.01).The RT-qPCR results showed that compared with control group,the expression levels of IL-4,IL-10,and TNF-α mRNA in lung tissue of the mice in OVA group were increased(P<0.01);compared with OVA group,the expression levels of IL-4 and TNF-α mRNA in lung tissue of the mice in JGYST group and OVA + JGYST group were decreased(P<0.01),while the expression level of IL-10 mRNA was increased(P<0.01).Conclusion:JGYST can alleviate the airway tissue inflammation and mucus secretion in the mice with allergic asthma,and its mechanism may be related to reducing the number of Th2 cells and DCs,decreasing the ROS level and expression level of proinflammatory cytokine,and increasing the expression level of anti-inflammatory cytokine.

Objective To evaluate the role of multiple dorsal midline plication (MDMP) procedure in correction of Donnahoo type Ⅲ chordee in postpubertal patient.Methods From September 2010 to July 2013,33 postpubertal patients with Donnahoo type Ⅲ chordee (＞ 20°) were treated with MDMP procedure.The age ranged from 18 to 37 years with an average of 29 years.Primary surgery was indicated in 18 patients including type Ⅲ chordee in 11 and type Ⅲ/Ⅳ in 7,with associated hypospadias in 12.Redo surgery was warranted in 15 patients including type Ⅲ chordee in 13 and type Ⅲ/Ⅳ in 2,with associated urethral defects necessitating repair in 12.Intraoperative artificial erection was induced to confirm the degree and length of chordee.Longitudinal plication sutures,4 dots each,were applied close to the midline in a parallel fashion on each apex of curvature,to achieve satisfactory orthoplasty with 16-dot to 64-dot plication according to the chordee status,and the urethral repair indicated was achieved simultaneously.Results Satisfactory orthoplasty was achieved with 16-dot plication in 16 patients,24-dot in 10,32-dot in 6,and 64-dot in 1 patient whose penile curvature was severe and long.Followup was obtained from 35 to 69 months with an average of 46 months.Three patients lost of followup.Urethroplasty-related complications were noted in 5 patients including urethrocutaneous fistula in 2,urethral dehiscence in 1,urethral diverticulum in 1,and urethral stricture in 1.Mild cicatrical curvature (less than 15 degree) was noted in 2 patients.No postoperative priapism,erectile dysfunction,and paraesthesia was noted,nor chordee recurrence.Conclusions When applied appropriately,MDMP is an effective procedure in correction of Donnahoo type Ⅲ chordee in postpubertal patient with good and long-standing orthoplasty.