Neurology is a professional science. The content of neurotomia, sub-speciality knowl-edge and auxiliary examination are abundant, and meanwhile it is rather difficult. Clinical graduates after graduation are malnly engaged in clinical work, clinical services, and will play a variety of roles in the course of their clinical practice so it is necessary for them to learn comprehensive knowledge. This article introduced experience of clinical postgraduates tralning of neurology, such as doctor-patient communication skills, basic theoretical study (neurology, neurotomia and sub-speciality knowledge), clinical thinking, and assistant examination, clinical research capacity during these 18month. It will provide the theoretical and practical knowledge in the future work.

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by multi-organ and multisystemic involvement and various clinical manifestations.Bone marrow mesenchymal stem cells (BM-MSCs),a kind of non-hematopoietic stem cells originating from the mesoderm,are key components of hematopoietic microenvironment.Recent studies have indicated that SLE is a disorder of stem cells.Both hematopoietic and mesenchymal stem cells (MSCs) are abnormal in SLE,which mainly manifests as changes of biological characteristics,abnormal cytoskeleton and ultrastructure,shortened telomeres,increased telomerase and SA-β-Gal acitivity,decreased differentiative ability,aberrant immunoregulatory effect,and other features of senescence.The mechanism of MSC aging may be related to up-regulated expressions of aging-related genes p53/p21cip1,p16INK4a/Rb and p27kip1/pTEN,elevated levels of reactive oxygen species (ROS),endoplasmic reticulum stress,epigenetic alterations,etc.

Objective To evaluate biological behaviors of bone marrow mesenchymal stem cells (BMSCs) from patients with systemic lupus erythematosus (SLE),to confirm that the BMSCs are aging stems cells,and to explore mechanisms underlying their aging.Methods BMSCs were isolated from bone marrow of 6 patients with SLE (patient group) and 8 healthy human controls (control group) by density-gradient centrifugation and plastic adherence,and cultured in vitro.Optical microscopy was conducted to observe morphological changes and growth of BMSCs,and growth curves were drawn.The differentiation ability of BMSCs was evaluated through culture of them with adipogenic and osteogenic induction medium.Flow cytometry was performed to identify cellular surface markers and to analyze cell cycle and apoptosis,and scratch assay to assess the migration ability of BMSCs.Immunofluorcscence assay and Western blot analysis were carried out to analyze the distribution and expression of p27kip1/PTEN in BMSCs respectively.Results Patient-derived BMSCs,which had a broad,fiat and polygonal shape,showed decreased growth rate,migration activity as well as adipogenic and osteogenic ability compared with those from the controls.There was a significant increase in the proportion of BMSCs in early stage (17.98％ ± 3.26％ vs.8.23％ ± 3.25％,t =3.91,P =0.011) as well as in middle to late stages (16.80％ ± 9.63％ vs.3.33％ ± 2.21％,t =2.99,P=0.048) of apoptosis in the patient group compared with the control group.Moreover,compared with the control group,the patient group showed a significantly higher proportion of BMSCs arrested in the G0/G1 phase (92.34％ ± 5.80％ vs.78.65％ ± 3.22％,t =3.635,P =0.015),but a lower proportion in the S phase (0.86％ ± 1.72％ vs.5.06％ ± 1.874％,t =3.084,P=0.027).The protein expressions of p27 and PTEN were significantly higher in the patient group than in the control group (p27/β-actin:t =2.784,P=0.039;PTEN/β-actin:t=4.812,P =0.041).Conclusion The BMSCs from SLE patients exhibit senescence-related features,which may be associated with elevated expression levels of p27kip1/PTEN.

The medical disputes in the primary hospitals increase year by year , and the practical experience at the grass-roots level during 1999 and 2013 showed the medical disputes had various reasons .For primary hospi-tals, the reasons included incomplete reform and management , unsuitable technical level of medical staff , inappropri-ate physician -patient communication and medical service , disunity within the hospital , lack of self -protection awareness;For patients, the reasons included the high expectations of medical service , non-compliance with medi-cal workers, poor economic conditions , week legal awareness;and some reasons from the society , media, etc.To ef-fectively alleviate the tension of physician -patient relationship and build a harmonious medical environment , the pri-mary hospitals need to strengthen the internal management , improve the comprehensive quality of medical staff , en-hance the physician -patient communication , improve self-protection awareness , and establish a good image of pri-mary hospitals.

A 11-year-old child diagnosed as chronic tonsillitis and adenoid hypertrophy underwent adeno-tonsillectomy under general anesthesia. After surgery, patient complained with abdominal discomfort, paleness and vomiting, which presented as the old black contents. Complete blood count showed: 45.2 g/L, hemoglobin of red blood cells 2.57 x 10(12)/L, An emergency gastroscopy confirmed gastric ulcer with hemorrage. Hemorrage was controlled and complete blood count results restored to normal after supportive therapy. Gastric ulcer completely recovered two weeks after discharge.
Adenoidectomy ; Child ; Humans ; Male ; Peptic Ulcer Hemorrhage ; etiology ; Postoperative Complications ; Stomach Ulcer ; etiology ; Tonsillectomy

Objective To investigate the effect of asphyxia on newborn's gastric myoelectrical activity by electrogastrography (EGG). Methods Twenty four asphyxia newborns (mild and severe type) and 15 normal newborns were enrolled. Electrogastric activity were recorded by a Portable EGG. The recording were performed 30 minutes before and after feeding respectively Results Compared with normal control,bradygastria (4 cpm) increased significantly ( P 0.01). Conclusions (1)By the help of EGG, we can get information about gastric myoelectrical activity in neonatal asphyxia.(2)Bradygastria is more prominent before feeding in mild asphyxia group; Slow wave is decreased in severe asphyxia group than that of control and mild asphyxia, but tachygastria increases significantly. This kind of abnormal electrogastric rhythm may contribute to feeding difficulty, abdominal distension and vomiting in asphyxia newborns.

Objectives To investigate the postoperative quality of life of cervical cancer patients treated by laparo-scopic surgery. Methods 27 cases of cervical cancer treated by laparoscopic surgery from May 2009 to September 2010 as observation group, 27 cases of cervical cancer treated by laparotomy treatment in the same period as control group. Observe and analyzed the clinical data, operation, postoperative recurrence and survival rates and postopera-tive FACT-G score between the two groups. Results Age, body mass index has no statistical difference between the two groups ( > 0.05), the blood loss in observation group was less than that in control group ( < 0.05), the lymph node dissection number in observation group was more than that in control group ( < 0.05), the exhaust time and hospital stay in observation group were less than that in control group ( <0.05), the 1-year, 3-year and 5-year re-currence rate and survival rate in observation group showed no significant difference compared with control group ( < 0.05). The 1-year, 3-year and 5-year FACT-G score in control group were higher than that in control group ( < 0.05). Conclusion Laparoscopic surgery for cervical cancer patients can reduce bleeding, shorten exhaust time and hospitalization time, improve postoperative FACT-G score and postoperative quality of life of cervical cancer pa-tients.

Objective To analyze the expression and clinical significance of tumor suppressor phosphatase -tension protein gene(PTEN)in differentiated thyroid carcinoma and the relationship with the V600E gene site muta-tion of murine sarcoma viral oncogene homolog B1(BRAF).Methods The expression of PTEN was assayed by im-munohistochemical staining in differentiated thyroid carcinoma and adjacent tissues.The differences were compared between clinical pathological features.The BRAF V600E gene mutation was detected by fluorescence quantitative pol-ymerase chain reaction(PCR)and to investigate the correlation between the expression of PTEN and BRAF V600E mutation.Results The negative rate of PTEN was 78.75%(63 /80)in differentiated thyroid carcinoma,13.75%(11 /80)in adjacent tissues(χ2 =27.236,P =0.000).There were significant differences in the expression of PTEN between I -II and III -IV in TNMstage,grade I and II,and lymph node metastasis(χ2 =10.395,6.948,9.263,P =0.000,0.006,0.000).The differences were not significant in the expression of PTEN between different gender,≤45 years and >45 years different pathological types and tumor diameter <2cm and ≥2cm(χ2 =1.113,0.941, 2.301,1.567,P =0.185,0.213,0.087,0.181).There was correlation between the expression of PTEN and BRAF V600E mutations(r =0.301,P =0.004).Conclusion The expression of PTEN is involved in the occurrence and development of differentiated thyroid cancer and is associated with BRAF V600E.The PTEN has the predictive value of prognosis in tumors.

Objective To understand the drug resistance situation of pathogenic bacteria clinically isolated in Dongguan Munici-pal People′s Hospital during 2013.Methods The drug sensitivity test were performed by adopting the associated reagent strip of the VITEK2-compact microbial analyzer from French bioMerieux company,including AST-GN test,AST-GP33 test,AST-GP68 test and K-B method (only for Haemophilus influenzae).The data were analyzed by the Whonet5.5 software.Results In 2013,to-tally 7 543 strains of pathogens were detected out,including 6 031 strains(79.9%)of Gram negative bacteria,1512 strains(20.1%) of Gram positive bacteria.The detection rates of ESBL in Escherichia coli and Klebsiella pneumoniae were 46.9% and 28.1%,re-spectively.The detection rates of MRSA and MRCNS in Staphylococcus were 16.8% and 77% respectively.The detection rate of multidrug resistant strains was 21.5%.The resistant rate of Escherichia coli and Klebsiella pneumoniae to ampicillin and cefazolin were greater than 60%;which of Pseudomonas aeruginosa to ampicillin,furosemide,trimethoprim-sulfamethoxazole,ceftriaxone,ce-fotetan and cefazolin was more than 80%;which of Baumanii to imipenem was still 61.2%,which to aztreonam,ceftriaxone,cefotet-an,cefazolin was more than 98%.The resistance rate of Enterococcus faecium to vancomycin was 6.2%.No vancomycin-resistant Staphylococcus aureus strain was detected out.Conclusion The detected pathogenic bacteria in 2013 were dominated by Gram-neg-ative bacilli,the multidrug resistant bacterial strains had the higher detection rate,the drug resistance of Baumanii was serious.The resistance of Enterococcus faecium to vancomycin showed the increasing trend.Monitoring the bacterial drug resistance every year and understanding the change of pathogenic drug resistance can provide the basis for the rational selection of antimicrobial drugs in clinic.

Objective To solve the limitation of the wide-bound imaging from aortic arch to the bifurcation of internal and external carotid artery by changing 3D TOF MRA scan parameters, and discuss the clinical value of this technology in carotid artery angiography. Methods 108 patients with cerebrovascular disease were performed with carotid artery 3D TOF MRA. Images were performed under MIP, MPR and VR. The images of bilateral common carotid arteries, external and internal carotid artery, and vertebral artery were evaluated interactively by two independent radiologists blinded to results. Results 864 blood vessels were observed with 3D TOF MRA, including 672 normal clearly, 17 unclear, 17 congenital variants, 73 un -smooth lesion, 63 vascular stenosis, 9 vascular occlusion, 5 not display, 4 depressed downward, 4 vascular enlargement. Totally,unclear, variation and lesion blood vessels were 192. The results in combination with original image analysis could meet the need of diagonosis. Conclusion 3D TOF MRA as a noninvasive and non contrast agent imaging method can be used to select the carotid stenosis and is quite good in the value of application.