Based on the shortcomings of graduate education in clinical medicine of our country and the characteristics of this specialty, the author point out that the cultivation of graduates in otolaryngology, head and neck surgery should be focused on the training of humanities, professional knowledge and skills. And they also make some suggestions and discussion about the reform of graduate education mode.

1he increased peripheral benzodiazepine receptors are more significant than normal ones after cerebral ischemia. Its main reactions are the multiple pathological changes,including microglial activation, participating in neuroinflammation response, and regulation of mitochondrial function. Using radionuclide-laheled specific ligands of the peripheral benzodiaz-epine receptor (such as PK11195) for in vivo imaging contribute to the location and quantitative detection for brain injury and the study of the pathophysiological changes after cerebral ischemi-a. In addition, this receptor is promising to become a new target of neuroprotective treatment.This article reviews the recent progress in research on peripheral benzodiazepine receptors and cerebral ischemia.

Objective To investigate the changes of peripheral benzodiazepine receptors (PBRs)in rat spinal cord synaptosomes during ageing and to explore the correlation between PBRs in spinal cord synaptosomes and PBRs on platelet membranes.Methods A total of 24 Sprague-Dawley rats were divided into 3-month group and 24-month group (n=6 males and 6 females for each).All animals were sacrificed by decapitation and the spinal cords were immediately removed.Synaptosomal fractions from spinal cords were isolated by gradient centrifugation.The platelet membranes were prepared from venous blood by the method of hypotonic haemolysis.The specific binding of the radioactive PBRs antagonist [3H]PK11195 to membranes was determined.Results No significant differences in [3H] PK11195 binding activity in spinal cords and platelet membranes were observed between male and female rats in the same group (all P＞0.05).[3H] PK11195 binding activity in spinal cords and platelet membranes were higher in 3-month group than in 24 month group [(213.94±10.65) fmol/mg pro.vs.(50.65± 2.74) fmol/mg pro.,(104.97± 2.24) fmol/mg pro.vs.(56.20±5.36) fmol/mg pro.,respectively,t=51.418,29.041,both P＜ 0.001].There was a positive correlation between [3H]PK11195 binding activity in platelet membranes and in spinal cord synaptosomes (r=0.985,P＜0.001).Conclusions The level of PBRs is gradually decreased in rat spinal cord synaptosomes with ageing.[3H] PK11195 binding activity of platelet membranes can reflect the changes of PBRs in spinal cords.

Klebsiella Pneumoniae is a opportunity infection and nosocomial infection bacteria in Enterobacteriaceae,which can lead to serious infection or death.Klebsiella Pneumoniae leads to increased infections proportion in recent years,which resisits to many common antibiotics.Clinical drug resistant strains include Carbapenem-resistant Klebsiella Pneumoniae,Multidrug-resistant Klebsiella Pneumoniae,Extensively drug resistant bacteria and Pandrug-resistant Klebsiella Pneumoniae.Researches beared out that the risk factors of acquiring nosocomial infection of Klebsiella Pneumoniae are state of an illness,time of hospitalization,mechanical ventilation,the kind and number of antibiotics.

OBJECTIVE To explore the expression and its significance of focal adhesion kinase(FAK)and matrix metalloproteinase 9(MMP-9)in the pituitary adenomas. METHODS The expressions of FAK and MMP-9 were determined by immunohistochemical technique in 50 pituitary adenoma tissues samples obtained during operation, including 27 invasive pituitary adenomas and 23 non-invasive pituitary adenomas. The relationship of FAK and MMP-9 expression with tumor invasiveness were analyzed. RESULTS The expression of FAK and MMP-9 in the invasive pituitary adenomas were significantly higher than those in the non-invasive pituitary adenomas(P

Objective To compare the influence between target controlled infusion propofol vein anesthesia and midazolam vein anesthesia toward serum amylase and triglyceride in children with cleft lip and palate.To make a definitude that the feasibility of target controlled infusion propofol used in children′s anesthesia.Methods Sixty children with cleft lip and palate aged from 4 months to 3 years,weighting 6.5-15.9 kg,American Society of Anesthesiologists(ASA)Ⅰ-Ⅱ,were randomly allocated to group P and group M(n=30,each).Group P received target controlled infusion propofol.Anesthesia was induced with target controlled infusion propofol at the target effect-site concentration 3.0 mg/L,remifentanyl 2.0 ?g/kg and vecuronium 0.1 mg/kg.Anesthesia was maintained with a continuous remifentanyl infusion at 0.2 ?g/(kg?min) and vecuronium 0.01 mg/(kg?min) and target controlled infusion propofol at the effect-site concentration 3.0 mg/L.Group M received intermittent boluses of midazolam 0.1 mg/kg.Anesthesia was induced with midazolam 0.2 mg/kg,remifentanyl 2.0 ?g/kg and vecuronium 0.1 mg/kg.Anesthesia was maintained with a continuous remifentanyl infusion at 0.2 ?g/(kg?min) and vecuronium 0.01 mg/(kg?min) and intermittent boluses of midazolam 0.1 mg/kg every hour.The venous blood samples were taken before anesthesia induction(T1),4 hours(T2) and 24 hours(T3) after surgery to measure the serum concentration of serum amylase and triglycride.Results The duration of anesthesia induction,extubation and emergence were shorter in group P compared with group M(Pa0.05).Conclusions The serum concentration of triglyceride may increase because of the stress of anesthasion and operation,and can be higher during target controlled infusion propofol,but does not exceed the normal value.The serum amylase concentration does not increase during target controlled infusion propofol in children.

Plasma aldosterene/renin ratio (ARR) is a sensitive screening test and parameter for primary aldosteronism(PA).The use of ARR leads to a marked increase in the detection rate of PA in the hypertensive population.However,ARR remains a nonstandardized test,and the cutoff value of ARR used in the different studies is varied.Further and systematical studies are needed to improve the accuracy of the test.

OBJECTIVE: To investigate the effect of LARS artificial ligament on reconstruction of anterior and posterior cruciate ligament of keen joint.METHODS: Articles addressing reconstruction of anterior and posterior cruciate ligament by LARS artificial ligament were retrieved from VIP database (http://www.cqvip.com/) with the key words of "LARS artificial ligament, cruciate ligament,reconstruction" in Chinese between January 2000 and February 2010.Inclusion criteria: advantages and disadvantages of reconstructing anterior and posterior cruciate ligament by LARS artificial ligament; clinical application of reconstructing anterior and posterior cruciate ligament by LARS artificial ligament.Exclusion criteria: Duplicated studies or old references were excluded.A total of 31 articles were included in the final analysis.RESULTS: Reconstruction of anterior and posterior cruciate ligament by LARS artificial ligament characterized by convenient operation, short operative time, mild trauma, engaging in movement early, great strength, simple implantation, and reliable fixation; however, most patients were not able to bear the high medical cost, thus clinical application was limited.Scholars thought that LARS artificial ligament had great effects on reconstruction of anterior and posterior cruciate ligament.CONCLUSION: Patients who had multi-ligament injury, overhauling of ligament, and early movement were treated with LARS artificial ligament.

Objective To explore the change of serum procalcitonin (PCT)in infectious diseases and the relationship between PCT and the severity of illness in children.Methods This was a single-center prospective study of serum procalcitonin concentration in children with infectious diseases.Ninty-five children with infectious diseases (mycoplasma infection 30 cases,viral infection 30 cases,bacterial infection 35 cases),hospitalized in PICU of Shengjing Hospital from April 2011 to April 2013,were divided into three groups:non-serious group(64 cases),serious group(20 cases)and very serious group(11 cases)according to pediatric critical illness score(PCIS).Bacterial infectious patients were divided into two groups:gram positive bacterial group(20cases),gram negative bacterial group(15 cases).Twenty children of non-infectious diseases during the same period were selected as the control group.Serum PCT levels were detected by using VIDAS BRAHMS PCT detection system(rapid semi-quantitative PCT test).Laboratory detection was conducted in Department of Laboratory Medicine,Shengjing Hospital of China Medical University.Results The serum PCT levels of the control,the bacterial infection,virus infection,and mycoplasma infection group were (0.41 ± 0.34) μg/L,(2.56 ± 0.38)μg/L,(0.52 ±0.44) μg/L and(0.21 ±0.10) μg/L.The serun PCT levels higher than or equal to 0.5 μg/L were defirned as positive.There was significant difference in PCT positive rate between bacterial infection group and the control grouP(x2 =28.05,P ＜0.05).The serum PCT levels of children with infectious diseases were higher than those of non-infection group,mycoplasma infection group and virus infection group(P ＜ 0.05).Besides,the PCT value of gram negative bacillus infection group was also obvious higher than gram positive infection group.There was no significant difference among the non-infection group,mycoplasma infection group and virus infection group(P ＞ 0.05).There was significant negative correlation between the serum PCT concentration and the PCIS score in children with infectious diseases (r =-0.579 ～-0.793,P ＜ 0.05).The higher concentration of PCT in children with the infectious diseases indicated higher severity illness scores,more complications,and longer length of hospital stay.Conclusions PCT may provide an informative and sensitive molecular marker for pathogen identification (bacterial infection,pneumonia mycoplasma infection or viral infection).In the early diagnosis of infectious disease,PCT assay can help predict the severity of the disease.

Objective To reduce the incidence rate of sepsis caused by multidrug-resistant acinetobacter baumanni and provide the basis for clinical antibiotics use.Methods It is one retrospective case-controled study.Thirty-six patients with multidrug-resistant acinetobacter baumanni infection(case group) and 42 patients with non-multidrug-resistant acinetobacter baumanni infection(control group) admitted in PICU during 2009 to 2013 were enrolled in the study.Seven high risk factors including the irrational antibiotics use,the length of hospital stay,tracheal intubation,the length of mechanical ventilation,the basic diseases (hematologic malignancies,congenital heart disease,inherited metabolic diseases),use of central venous catheters and the length of using central venous catheters were analyzed.The drug sensitivity of multidrug resistant acinetobacter baumanni was detected.Results There were significantly differences in 7 high risk factors between case group and control group,including irrational antibiotics using (29 cases vs.18 cases),the length of hospital stay ＞7 d(35 cases vs.12 cases),tracheal intubation(22 cases vs.8 cases),mechanical ventilation ＞ 7 d (19 cases vs.2 cases),basic diseases (9 cases vs.3 cases),using of central venous catheters (18 cases vs.2 cases) and central venous catheters using ＞ 7 d(9 cases vs.1 cases) ;multidrug resistant acinetobacter baumanni had high resistance against penicillins,cephalosporins,aminoglycesides,quinolones,sulfonamides (94.87％,74.36％,76.92％,65.38％ and 56.41％),but had high sensitivity to carbapenems and tetracyclines (55.56％ and 77.78 ％).Sixteen cases infected with pandrug resistant acinetobacter baumanni infection (44.44％),4 cases infected with whole drugresistant acinetobacter baumanni (11.11％).Conclusion The irrational antibiotics use,the length of hospital stay,tracheal intubation,the length of mechanical ventilation,the basic diseases,central venous catheters and the length of using central venous catheters are the high risk factors of spesis caused by multidrug resistant acinetobacter baumanni; only carbapenems and tetracyclines can keep high sensitivity rate to multidrug resistant acinetobacter baumanni among clinical antibiotics.