To improve the training quality of medical students,the questionnaire investigation was carried out to evaluate the effects of early clinic education course,which has provided us with the evidence to amend the teaching contents,teaching model,teaching methods.

ObjectiveTo observe the effect of multi-rehabilitation techniques on hemiplegic patients.Methods90 stroke patients with hemiplegia were randomly divided into the treatment group and control group with 45 cases in each group. Patients of the treatment group were treated with multi-rehabilitation techniques, and cases of the control group were treated only with instrument of never-muscle rehabilitation.ResultsAfter treatment, the extremity motor function and ability of daily living activities and muscle function of patients of two groups were improved significantly, but there was a significant difference between the treatment group and control group (P<0.05).ConclusionThe multi-rehabilitation techniques is more effective on stroke patients with hemiplegia.

Objective To Investigate the concentration of VILIP-1 and NR2 peptide in the serum of patients with ischemic stroke , and to explore their clinic value in early diagnostic of ischemic stroke patients.Methods The levels of VILIP-1 and NR2 peptide were examined by ELISA ( enzyme linked immunosorbent assay ,ELISA) with suspicious TIA ( defined as a neurological deficit that resolved within 24 hours) or acute ischemic stroke patients ( within 72 hours of onset of symptoms ) 340 cases,102 healthy controls,98 patients with vascular risk factors and 35 patients with hemorrhagic stroke.Among all the groups , VILIP-1 and NR2 peptide level were analyzed using the nonparametric Wilcoxon test.Diagnostic performance were analyzed among the groups with the two biomarkers independently and combinedly .Results Serum levels of VILIP-1 and NR2 peptide in patients with ischemic stroke (IS) were 9.80 (1.90-14.22) μg/L, 14.40 (5.60-27.91) μg/L respectively,which was higher than that of the healthy control group [VILIP-1:0.02 (0.01-0.09),NR2:0.33 (0.02-1.15),χ2 were 5.61 and 9.54,P<0.001],the group with vascular risk factors [VILIP-1:0.03 (0.02-0.16),NR2:0.27 (0.01-1.54),χ2 were 6.74 and 10.62,P<0.001], the group of patients non-stoke [VILIP-1:0.04 (0.03-0.19),NR2:0.53 (0.45-1.21),χ2 were 3.78 and 7.63, P <0.001 ].The levels of VILIP-1 and NR2 peptide was significantly increased in IS patients presenting within 3 h of symptom onset.When differentiating IS from patients with hemorrhagic stroke ,NR2 had a AUC of 0.934,showing a strong distinguishing effectiveness.Differentiating IS from healthy controls , patients with vascular risk factors and non-stroke patients,the AUC of combination of VILIP-1 and NR2 was 0.974,which was higher than the AUC of either VILIP-1(0.849) or NR2(0.862) alone(P <0.05). Conclusions VILIP-1 and NR2 peptide are very sensitive and specific biomarkers to the early diagnosis of IS.The combination of VILIP-1 and NR2 peptide has higher value of clinical applications than one of them independently.

Objective To investigate the effect of antimicrobial-impregnated incise drape on preventing surgical site in-fection(SSI)following neurosurgical operation.Methods Patients undergoing neurosurgical operation from January to De-cember 2012 were divided into two groups:antimicrobial-impregnated incise drape group(group A)and general incise drape group(group B).The occurrence of SSI and risk factors for SSI were analyzed.Results Percentage of drape lifting at the wound edge in group A was lower than group B(38.3%[98/256]vs 96.88% [248/256],χ2 =200.57,P <0.01).Among 512 patients,SSI rate was 3.32%(n=17),SSI rate in group A was lower than group B(1.56%[4/256]vs 5.08%[13/256],χ2 = 7.93,P <0.05 ).Multivariate analysis revealed that body mass index ≥24,perioperative hypothermia,smok-ing,perioperative length of hospital stay ≥5 days,and lack of drape use were independent risk factors for SSI following neurosurgical operation.Conclusion Whether antimicrobial-impregnated incise drape is used in neurosurgical operation is one of the independent risk factors for SSI following neurosurgical operation,it can effectively reduce the drape lifting rate and incidence of SSI,and is recommended to be used in neurosurgical operation.

BACKGROUND: Belladonna drugs have been widely used in clinic in our country to improve microcirculation, or as a herbal anesthetic drug. However,there are few reports regarding the animal experiments on belladonna alkaloid against morphine addiction further OBJECTIVE: To observe the effects of belladonna alkaloid combined with morphine on morphine(Mor)-addicted mice so as to provide an experimental basis for development of belladonna to morphine addiction.DESIGN: A completely randomized-controlled study based on the experimental animals.SETTING: Laboratory of physiology of a medical college.MATERIALS: The study was performed at the Laboratory of Physiology of Medical Department of Hebei Engineering College from June 2004 to August 2004. Fifty 2-month old male healthy Kunming mice of clean grade with a body mass of(20±2) g were obtained from Experimental Animal Centre of Hebei Medical University.METHODS: According to evaluation index of dependence in Morphine-addicted animals, we chose pain threshold and naloxone-urged jumping response as items to observe. Fifty mice were randomly divided into 5 groups with 10 mice each, which were the control group (saline), the morphine group, the scopolamine(Sco)group, the anisodamine(Ani), atropine(Atr)group. The corresponding drugs or saline was administered by intraperitoneal (I. P.) injection once a day for 7 days. The pain threshold at 1 hour after I. P. Injection of drugs was observed from day 1 to day 7 by hot-plate method. Mice were given I.p. Injection of naloxone (Nal, 5 mg/kg ) 6hours after the last injection. The jumping times within 30 minutes were observed to evaluate the ,formation of the Morphine addiction.Nal-urged mice.RESULTS: The pain threshold of the mice in Morphine group was decreased significantly, and the jumping times and jumping rate were obviously increased compared with that of the control group( P ＜ 0.05 or P ＜ 0.01).The co-administration of Sco-Mor mixtures for 7 days significantly increased the pain threshold of Mor-dependent mice( P ＜ 0.01) and markedly decreased the jumping times and the jumping rate( P ＜ 0. 05) . Atr-Mor and Ani-Mor had a weak effect on the elevation of the pain threshold of Mor-dependent mice, but had strong effects on the decrease of the jumping times and the jumping rate( P ＜ 0. 01 ).CONCLUSION: Belladonna alkaloids all could antagonize Mor-dependence in mice at different degrees, which provide an important experimental evidence to develop belladonna drugs for preventing opium addiction.

Objective To evaluate the contribution of puboprostatic ligament-sparing technique in urinary continence after radical retropubic prostatectomy (RRP). Methods A total of 74 men with clinically localized prostate cancer underwent RRP. Of whom, 50 patients were performed pubo-prostatic ligament-sparing technique(group A), while 24 patients were not(group B). Patients were evaluated by independent observer questionnaire to determine their urinary continence status. Results Mean patient age [(61.3±2.4) vs (60.8±2.1)years], serum prostate-specific antigen (PSA) values [14.3±1.2)ng/ml vs (14.7±1.3) ng/ml], operative time [(110.5±10.4)min vs (109.7±10.6) mini, estimated blood loss [(250.5±23.4) ml vs (253.4±22.3) ml], and positive surgical margin rate (6% vs 8%) were not significantly different between group A and B(P>0.05). The urinary con-tinence rate with the puboprostatic ligament-sparing technique at 1-year follow-up was significantly higher than that of the control group (P<0.05). Concision The puboprostatic ligament-sparing technique significantly enhances post-operative urinary continence after RRP.

Objective To investigate the effects of preserving continence important structures during Studer pouch surgery. Methods Radical cystectomy and Studer orthotopic neobladder surgeries were performed on 68 male patients with muscle invasive bladder cancer.The anatomic configuration of the rhabdosphincter complex,pudendal nerve supply,and musculofascial support system to the proximal urethra were carefully preserved.The neobladder functions were then evaluated. Results The pathological classification of the 68 patients was as follows:T3a N0M0 in 20 cases and T2N0M0 in 48 cases.The patients were followed up for 6 to 36mon(mean 12 mon).Complete urinary continence was achieved in 67 patients 24 hours a day and the remained one had nocturnal incontinence.Of these patients,59 patients could urinate well without residual urine and the other 9 patients had residual urine of 20 to 30 ml. Conclusions A well-performed Studer pouch should pay specific attention to the anatomic configuration of the rhabdosphincter complex,pudendal nerve supply,and musculofascial support system to the proximal urethra to achieve the goal of maximizing continence preservation.

Anesthesiology rotation is an important part in resident standardization training of surgery. However, there are many problems in the teaching process. For example, the key points of teaching is not clear, the process of teaching is not coherent, and teachers and students lack interaction. The Rotation Record is introduced in order to solve those problems. The Rotation Record effectively reflects the fundamental process and major learning point of anesthesiology department which contains three items: the usage and recording of instrument; the communication and the basic knowledge and operating skills of anesthesia. The Rotation Record can initiate learning activity, emphasize important contents, supervise and urge teaching and improve the learning effect. By introducing Rotation Record, the assessment results in the surgical residency in anesthesiology has greatly improved compared to the previous ones, and has effectively improved the teaching quality of anesthesia.

Objective To summarize the clinical features of spontaneous remission in classic fever of unknown origin (FUO). Methods Medical records of 121 patients diagnosed with FUO at admission in Peking Union Medical College Hospital between January 2018 and June 2018 were reviewed retrospectively. Patients who were discharged without etiological diagnoses were followed for 2 years. The clinical features and outcomes of these patients were summarized. Multivariate logistic regression was used to analyze related factors of spontaneous remission of FUO. Results After excluding 2 patients who lost to follow-up, the etiology of 119 FUO patients were as follows: infectious diseases in 30 (25.2％) cases, connective tissue diseases in 28 (23.5％) cases, tumor diseases in 8 (6.7％) cases, other diseases in 6 (5.0％) cases, and unknown diagnoses in 47 (39.5％) cases. Totally, 41 patients experienced spontaneous remission of fever (the median time from onset to remission was 9 weeks, ranging from 4 to 39 weeks). In patients with spontaneous remission in FUO, lymphadenopathy was less common clinical manifestation, the levels of inflammatory markers including leukocyte count, neutrophil count, neutrophil ratio, C-reactive protein, and ferritin were lower, and the proportion of CD8 positive T lymphocytes expressing CD38 was lower. Multivariate logistic regression analysis of factors with a P-value < 0.05 in univariate analysis shown that white blood cell count (OR: 0.545, 95％CI: 0.306-0.971, P = 0.039), neutrophil count (OR: 2.074, 95％CI: 1.004-4.284, P = 0.049), and proportion of neutrophils (OR: 0.928, 95％CI: 0.871-0.990, P = 0.022) were independent significant factors associated with spontaneous remission in FUO. Conclusions This study suggested that most patients discharged with undiagnosed classic FUO would remit spontaneously. Thus, for patients with stable clinical conditions, follow-up and observation could be the best choice. Patients with lower level of some inflammatory factors may have a high likelihood of spontaneous remission in classic FUO.

OBJECTIVETo study micro morphology and element-mixing distribution of different alloys welded in laser and analyze the feasibility of laser welding different alloys.

METHODSAlloys and titanium were matched into 4 groups: Au-Pt with Ni-Cr; Au-Pt with pure Ti; pure Ti with Ni-Cr; Ni-Cr with Co-Cr. They were welded in laser. Changes in metallography after hybridization of crystalline grain, ranges of heat-affected zone and pores were observed through SEM with ultra-thin windowed X-ray energy atlas. Meanwhile 10 testing points were chosen with area of 300 micro m x 900 micro m along the welding surface from the side A alloy to the side B alloy, than the element mixing distribution and tendency were analyzed with X-ray energy atlas.

RESULTS1. Hybridization of different alloys: (l) in the group of Au-Pt with Ti, there was titanium element mixing into Au-Pt tissue gradually and evenly on the Au-Pt side of the interface without clear boundary and increasing in size of crystalline grain. However, there was titanium crystalline grain increasing in size, irregular morphology and small sacks on the titanium side with clear boundary. (2) in the group of Ni-Cr with Ti, there was mixing regularly, slow transition and interlocks between crystalline grains on the Ni-Cr side of the in terface. Poor transition, clear boundary and small cracks were observed on titanium side. (3) in the group of Co-Cr with Ni-Cr, there was good transition, obscure boundary on both sides resulting from network, cylinder and branch structure growing. 2. Element-mixing distribution of different alloys. In fusion zone, the metal elements in matched groups mixed well and hybridized into new alloys except titanium blocks. The location of wave peak depended on the composition of alloys. Most of elements were from the alloy far from the fusion zone.

CONCLUSIONThe hybridization between pure titanium and any other alloys is not good The effect of laser welding different alloys is ideal except with pure titanium.