Neurosurgery is a superior difficulty and high risk surgical medicine.It will take a longer period time to finish the clinical residence training in neurosurgery.Standardized residency training is an inevitable way for the transition from medical students to the neurosurgical resident doctors,the central task of?residency training is to improve the clinical skills.In recent yea rs,smartphone-based mobile learning plays an increasingly important role in medical education.As a member of National bases of standardized residency training,we have analyzed the characters of training residency,and employed the Medical related Applications (Med-Apps) as modernized teaching technology to improve the clinical skills in areas of neuroanatomy,operation,management of patient and evaluation of trainees' competency.We help training residency finish the transition from smartphone-player to smartphone-learner,with the potential to improve overall clinical skills of training residency.

Objective To study the relationship between expression of Fas ligand (FasL) in colorectal cancer tissues and apoptosis of tumor-infiltrating lymphocytes (TIL). Methods FasL protein and its mRNA were measured by immunohistochem istry and in situ hybridization in the consecutive tissue slices of 30 colorecta l cancers respectively. Immunohistochemistry and terminal deoxynucleotidyl tra nsferase mediated dUTP nick end labeling assay (TUNEL) were used to detect the cell count of TIL and the count of TIL being apoptosis in both negative and pos i tive regions of FasL in the consecutive tissue slices of cancers respectively. T UN EL method was used to detect apoptosis of tumor cells among different FasL expre ssion regions. Results ①High expression of FasL was examined in 30 cases of colo rectal cancer; there were expressions of FasL in more than 75% tissues in each slice. ②In the consecutive tissue slices, the location of expression of FasL protein corresponded with that of FasL mRNA. ③FasL expression was not eve n in the same or among different tissues. The cell count of TIL was less in FasL positive region than that in FasL negative region in the same tissue, the latt er be ing as 2.88 times as the former. ④ The cell count of TIL being apoptotic in the positive regions was as 2.13 times as that in the negative ones. ⑤ Apoptotic r ate of tumor cells was higher in FasL negative region (81.2%) than that in FasL positive region (47.4%, P

Objective To study the difference of IGF-1,Bcl-2,survivin and Ki-67 protein expression in reactive and neoplastic astrocytes and the significance of them.Methods Immunohistochemistry and tissue microarray techniques were used to determinate the expression of IGF-1,Bcl-2,survivin and Ki-67 protein in normal brain tissues, astrocytes proliferation,low-grade astrocytomas, and high-grade astrocytomas.Results The expression of IGF-1,Bcl-2,survivin and Ki-67 protein were all negative in control group.The positive expression rates of them in reactive astrocytes were 28.9%, 26.7%, 26.7% and 22.2%,respectvely; and in low-grade astrocytomas were 63.8%, 50.0%, 53.2%,70.2%; in high-grade astrocytomas were 88.9%, 79.2%, 88.1%,95.2%.IGF-1,Bcl-2,survivin and Ki-67 all had significant difference among the three experimental groups(P

Objective To investigate the role of KAI1, intergrin ?5?1 and FAK proteins in occurrence and development and invasion and metastasis of lung cancer and their value in predicting the prognosis of lung cancer by analyzing the expression levels of KAI1, intergrin ?5?1 and FAK proteins in lung cancer and the relationship between them and clinicopathological parameters.Methods Lung cancer and normal lung tissue and metastasis cancer were detected and analyzed for their KAI1, and FAK protein level using immunobiochemical method. Results The positive rate of KAI1 in normal tissue, primary cancer and metastasis cancer was respectively 100.0, 24.7 and 0.0. The positive rate of intergrin?5?1 was respectively 0.0, 49.4 and 83.3. The positive rate of FAK was respectively 10.0,48.3 and 83.3. The difference of above three marker among three groups was significant (P

Based on the particularity of the following medical disciplines, Three orientation is the higher medical personnel training mode which orients in the future development of medical students, and makes scientific allocation and combination to medicine curriculum system , personnel training system , management mode and evaluation system and so on. The clinical practice ability of medical students is the core of the professional quality training in the three orientation. In this article, the ability of professional quality, clinical practice ability and the ability to operate are clinical practice ability training goals and the training methods and evaluation system are divided into 2 stages, the fourth year and the fifth year, as well as three aspects such as professional quality ability training, clinical practice ability training and skills training.

The related curriculum knowledge system was constructed according to the orientation and goal of the three oriented medical personnel training. In order to provide important foundation for further formulating curriculum standards, revising basic requirements of curriculum, compiling relevant teaching materials and innovation of curriculum reform. This study constructs three oriented curriculum system mainly from the following six aspects: medicine and humanity, patient and doctor, innovation and practice, medical foundation and clinical application, teachers and learning promotion, quality control and teaching evaluation. The reference to teaching innovation of integrated curriculum will be provided.

Objective To study the prevalence and the related risk factors of diabetic peripheral neuropathy(DPN) after good blood glucose well controlled among in middle-aged and old-aged population with type 2 diabetes mellitus in a community of Beijing.Methods DPN was screened by Michigan neuropathy screening instrument (MNSI),and common blood biochemical parameters were tested,among over 45 years of age registered population patients with type 2 diabetes mellitus in Shuangjing community of Chaoyang District of Beijing.Results The blood glucose control rate was 90.36％ (253/280),and the prevalence of DPN was 25.36％ (71/280) with male of 24.47 ％ (23/94) and female of 25.81％ (48/186).Univariate analysis showed that both age and HbA1c in DPN group were higher than that of non-DPN group,and the differences were statistically significant(P =0.000,0.008).The level of plasma low density lipoprotein cholesterol(LDL-C) of the DPN group was lower than that of the non-DPN group,and the difference was statistically significant (P=0.017).The hypertension prevalence rate of the DPN group was 87.32％(62/71),higher than that of the nonDPN group(75.6％ (158/209)),and the difference was statistically significant (P =0.037).The multivariate logistic regression analysis showed that the estimate of parameter for age was 0.143 (P =0.0001),OR was 1.153,95％CI was from 1.029 to 1.219,for HbA1c was 0.529(P=0.03),OR was 1.698,95％CI was from 1.053 to 2.738,and for LDL-C was-O.919 (P =0.018),OR was 0.399,95％ CI was from 0.186 to 0.854.Conclusion The prevalence of DPN is still above 25％ among middle-aged and old-aged in a community,even though the well controlled rate of blood glucose control rate is above 90％.It is possible that old age and HbA1c are related to DPN,apart from blood glucose.

Objective To explore the effect of sealing tube with regular urokinase for the malfunction of central venous catheter(CVC) in patients with hemodialysis (HD).Methods This was a prospective randomized controlled study,132 HD patients with cuff CVC were studied.In the early stage,52 H D patients without 80 patients with regular catheter-locking solution of urokinase.To analyze effect of cuff CVC malfunction,blood flow(BF),dialysis adequacy,anemia and serum albumin (ALB) with regular catheter-locking solution of urokinase.The incidence of catheter malfunction was calculated based on the catheter dysfunction in the first 3 months.Clinical index was measured,recorded BF and calculated urea clearance rate (Kt/V).Results HD patients catheter-locking solution with regular urokinase could reduce the incidence of dialysis catheter malfunction ( 26.3％ vs 32.7％,x2 =32.727,P ＜0.01 ),increase the BF,Kt/V,levels of hemoglobin(HGB) and ALB(P＜0.05 or P ＜0.01).Conclusion Regular catheter-locking solution with urokinase is effective in reducing HD patients incidence of dialysis CVC malfunction,increasing patients BF,dialysis adequacy and the level of ALB,improving anemia.

Objective To observe the application of dysphagia ventilation swallowing and speaking valve inchildren with swallowing disorder after tracheostomy.Methods Four children with tracheostomy done and swallowing disorders(3 with brainstem encephalitis caused by hand,foot and mouth disease and 1 post-surgery case of cerebellar astrocytoma)were observed.Videofluoroscopic swallowing studies(VFSS)showed cricopharyngeal achalasia and silent aspiration.After VFSS assessments,ventilation swallowing and speaking valves(Passy-Muir,USA,PMVs)were applied to the 4 children.After that they received comprehensive swallowing trainings including balloon dilatation,breathing exercises,sensory stimulation and electrical stimulation.Results Four children could pronounce with PMVs immediately.After(36.50 ± 35.63)d of comprehensive intervention,all of them could live without tracheostomy tube or nasal feeding tube,their swallowing function improved obviously and could take food per os.Conclusions The application of PMVs combining with swallowing training is effective for children with swallowing disorder and dysphonia after tracheostomy.It is helpful to decrease the risk of aspiration,to open the cricopharyngeus muscle and to restore pronunciation.

Objective To investigate the modulatory effect of orexin A on glutamate receptor-mediated current in the freshly isolated pyramidal neurons from the rat prefrontal cortex (PFC). Methods Deep layer (Ⅴ-Ⅵ) prefrontal cortical pyramidal neurons from postnatal 10 to 14 day-old Wistar rats were acutely dissociated by a combination of mechanical and enzymatic method. Subsequently, the effect of orexin A on the current induced by glutamate was studied by the technique of whole cell patch clamp. Results Both orexin A and glutamate dose-dependently evoked the inward transmembrane current. The current was evoked by 1 mmol/L glutamate as a control group(100%). After treatment with 1 mmol/L orexin A for 4-10 s, 1 mmol/L glutamate induced-current was increased by (46.59?15.19)% (n=8, P