Objective To evaluate the teaching effects of applying clinical pathway in clinical practice teaching of neurology. Methods The undergraduate interns majoring in clinical medicine were randomly divided into clinical pathway teaching method group (n=34) and traditional teaching method group (n=34). Both groups were taught by senior physicians with the same teaching content and teaching material. A control study between the two groups in theoretical knowledge, operational skills and satisfaction degrees of teaching was carried out. Results The results of clinical pathway teaching method group in theoretical knowledge[(55.2±3.70) vs. (51.8±4.6)] and operational skills [(36.3±3.2) vs. (31.3±2.19)] were both sig-nificantly better than those of traditional teaching method group (P<0.05). The satisfaction degree of teach-ing of clinical pathway teaching method group is relatively higher . Conclusions The clinical pathway teaching method enhances the scientific property and systematic property of teaching contents, obtaining a favorable teaching effect.

ObjectiveTo evaluate the changes of portal vein pressure by (PVP) radionuclide imaging in cirrhotic patients undergoing portacaval shunt or esophageal transection-splenectomy.MethodThe radionuclide imaging was used to calculate portal pressure perioperatively in 15 shunt and 20 esophageal transection-splenectomy patients of portal hypertension.Results were compared with direct portal vein manometry.ResultPVP by manometry in portal hypertension patients 〔(37?4)?cm?H 2O〕 was very close to that calculated by preoperative imaging 〔(36?4)?cm?H 2O〕r=0.81,P

Objective To investigate the clinical efficacy of liver transplantation for liver cirrhosis and portal hypertension.Methods The clinical data of 181 patients with liver cirrhosis and portal hypertension who were admitted to the People's Hospital of Peking University from January 2000 to January 2012 were retrospectively analyzed.The efficacy of liver transplantation for liver cirrhosis and portal hypertension was investigated.The indications of liver transplantation included repeated upper gastrointestinal hemorrhage,failure of medication,surgical treatment and interventional therapy,and portal hypertension combined with hepatic functional decompensation.Orthotropic liver transplantation or piggyback liver transplantation was selected according to the condition of the patients.The pressures of the portal vein were detected before and after the transplantation of the liver graft by the manometer tube.The incidence of postoperative complications was detected.Patients were followed up regularly till December 2012.The varices and rebleeding of the esophageal veins and the survival of the patients were monitored.The survival rates was calculated using the Kaplan-Meier method,and the measurement data were analyzed using the t test.Results Of the 181 patients,65 received orthotropic liver transplantation,and 116 received piggyback liver transplantation.The operation time,volume of blood loss and anhepatic phase were (485 ± 97) minutes,(4 380 ± 1 993) mL and (56 ± 24) minutes,respectively.T tube was placed in 157 patients.The portal vein pressure was detected in 102 patients.The portal vein pressures before and after liver transplantation were (32 ± 11) cmH2O (1 cmH2O =0.098 kPa) and (21 ± 6) cmH2O,respectively.There was significant difference in the portal vein pressure before and after liver transplantation (t =2.412,P ＜ 0.05).Severe infection was detected in 23 patients,acute renal failure in 20 patients,severe abdominal bleeding in 6 patients,vascular complications in 5 patients and primary graft non-function in 2 patients after liver transplantation.A total of 181 patients were followed up for 6-131 months.One hundred and thirty-eight patients received endoscopy or upper gastrointestinal imaging at 1 year after liver transplantation.The varices were disappeared in 112 patients and alleviated in 26 patients,with the overall alleviation rate of 85.71％ (138/161).Four patients were complicated with upper gastrointestinal rebleeding within 1 year after liver transplantation,and the rebleeding rate was 3.70％ (4/108).The condition of 3 patients was alleviated by haemostatics and endoscopic treatment,and 1 patient died of liver failure caused by rebleeding.The 1-month,1-,5-year survival rates were 86.8％,84.9％ and 77.4％,respectively.Twenty-three patients died.Fifteen patients died of multi-organ dysfunction syndrome,5 died of vascular complications (2 died of hepatic artery thrombosis,2 died of portal vein thrombosis and 1 died of anastomotic stricture of vena cava),2 died of primary graft non-function,and 1 died of respiratory complications.Conclusion Liver transplantation is an efficient method for the treatment of liver cirrhosis and portal hypertension with the advantages of low rebleeding rate and ideal efficacy of reducing portal vein pressure.

OBJECTIVE To investigate the feasibility of determining the maximum comfortabl level by using the acoustically evoked stapedius reflex threshold via cochlear implant. METHODS Eleve cases of Nucleus C124 cochlear implant recipients operated in our hospital were selected(8-39 years old, who can decide TIC value by themselves with the postoperative time ranging from device initiation to 1 year after operation),of those four cases were diagnosed as bilateral large vestibular aqueduct syndrome,1 case as common cavity dysplasia,.neural response telemetry of these five patients with inner ear dysplasia were very high or barely measurable.Real-MCL level and acoustically evoked stapedius reflex threshold under activated condition were measured respectively. The stimulating sound was 110dB of white noise.RESULTS The two group values of ASRT and real-MCL were found to be consistant .There is no significant difference statistically (P＞0.05). The thresholds of ASR increase with the increasing of real-MCL at the beginning of device initiation. CONCLUSION The acoustically evoked stapedius reflex threshold may reflect (ASRT) the maximum comfortable stimulation level under activated conditions in patients with cochlear implants.it is simple, reliable and may be used to determine the MCL of child cochlear implanted patients.

Objective To investigate the characteristics of spontaneous discharges of hippocampal pyramidal cells (PC) in rats in age and memory groups with the help of nonlinear theory. Methods Rats were randomly divided into age group and memory group. Age group included aged group (16-19 months) and young group (3-4 months) whereas memory group included good memory and poor memory groups in adult. Extracellular single cell recording was performed in vivo . Results No characteristics of the rhythm of spontaneous discharges of hippocampal pyramidal cells in distribution figure of interspike interval(ISI) were found, but the loss of complexity(C) and low percentage of favored patterns(PF) were found in age and poor memory groups. Conclusion The ISI complexity and the PF of the hippocampal pyramidal cells are correlated to age and memory, suggesting that the analysis of the complexity and favored patterns may be helpful for the discovery of the characteristics of the information coding in spontaneous discharges of hippocampal pyramidal cells.

The National Excellent Course of Gynecology of Chinese Medicine is a main clinical subject of TCM,which puts emphasis on clinical application.The non-medical doctoral students are lack of the knowledge of traditional Chinese medicine and clinical experience,and the existing classroom teaching has the problem of the basic theory of traditional Chinese medicine being out of line with the clinical application,which has become the hindering factors of TCM gynecology teaching.By designing and perfecting the process of preparation before class-classroom teaching-discussion teaching-clinical probation-after class feedback,the related teaching teachers better improve the non medical doctoral students' ability to put the traditional Chinese medicine gynecology basic knowledge into clinical practice,which is well received by the students.

CM gynecology is one of the main courses of traditional Chinese medicine. The cultivation of the doctor-patient communication skills is a very important among the eduction of graduate students. The paper was encouraged to summarize the condition and problems of doctor-patient communication, in order to standardize CM gynecology training and improve the quality of teaching practice.

Objective · To obtain the latest data on phospholipid composition of human milk in Shanghai and compare the differences in phospholipid composition at different lactation stages. Methods · Healthy postpartum women who delivered full-term infants in the Obstetrical Department of Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine between April and July, 2016 were enrolled. The colostrum, transitional milk, and mature milk were collected at Day 3, 10, and 45 after delivering babies, respectively. Human milk fat was extracted with Folch's method and phospholipids were separated with solid phase extraction (SPE). The phosphatidylethanolamine, phosphatidylcholine, and sphingomyelin were quantitatively analyzed with HPLC/VWD. The differences in phospholipid composition at different lactation stages were compared with univariate analysis of variance and Games-Homell test. Results · One hundred women who provided at least one breast milk sample were enrolled. A total of 70 colostrum samples, 96 transitional milk samples, and 82 mature milk samples were collected. The total phospholipid content of mature milk [(281.93±118.54) μg/g] was significantly lower than that of colostrum [(381.99±205.90) μg/g]. At all lactation stages, the relative content of phosphatidylcholine was the highest (53.74%-59.36%), followed by sphingomyelin (28.12%-32.74%). The relative content of phosphatidylethanolamine was constant (P=0.617), the relative content of phosphatidylcholine gradually decreased (P=0.000), and that of sphingomyelin gradually increased (P=0.000) during the lactation. Conclusion · Sphingomyelin and phosphatidylcholine are major components of human milk phospholipids. The amount of phospholipids varies during the lactation. The total amount of phospholipids is lower in mature milk than in colostrum and transitional milk. The relative content of phosphatidylethanolamine is consistent at all lactation stages, the relative content of phosphatidylcholine gradually decreases, and that of sphingomyelin gradually increases.

Objective To preliminarily study the effect of high concentration prolactin (PRL) on the immune system in schizo-phrenic patients by analyzing the changes of lymphocyte subsets and immunoglobulins (IgG ,IgM ,IgA) levels .Methods The flow cytometry was used to detect the T lymphocytes CD3+ ,CD4+ and CD8+ subsets ,NK cell percentages and CD4+ /CD8+ ratio re-spectively .The three humoral immune indicators(IgG ,IgM ,IgA) in peripheral blood were detected by using the immunoturbidimet-ric turbidimetric method .The data were analyzed by adopting the analysis of variance .Results Compared with the healthy control group and schizophrenia normal PRL group ,T lymphocytes CD4+ subsets percentages and CD4+ /CD8+ ratio as well as IgG were increased in the schizophrenia PRL increase group(P<0 .05) ,while the percentage of NK cells was decreased(P<0 .05) .Conclu-sion High concentration PRL may have a certain effect on the immune system by influencing the balance among lymphocyte sub-sets and the production of immunoglobulins .

Objective To evaluate the application of helix hydro-jet in laparoscopic hepatectomy (LH).Methods Clinical data of 18 patients who underwent laparoscopic hepatectomy by helix hydro-jet were analyzed retrospectively.Results There were 18 cases including 9 cases of hepatic cavernous hemangioma,5 cases of primary hepatocellular carcinoma,2 cases of hepatic focal nodular hyperplasia,1 case of hepatic metastasis from colon carcinoma and 1 case of biliary cystadenoma in left liver.In 17 out of 18 patients laparoscopic hepatectomy was successfully completed by using helix hydro-jet.Only 1 patient was converted to open hepatectomy during operation due to uncontrollable hemorrhage from the branch of left hepatic vein.Partial hepatectomy was performed in 14 cases and hepatic left lateral hepatectomy was performed in 3 cases.Average intraoperative blood loss was 230 ml and average operation time was 170 minutes.No postoperative hemorrhage and hepatic function failure was observed.Postoperative bile leakage was observed in 1 patient,which was cured by drainage.Asymptomatic pleural effusions was found in 2 patients,necessitating no special intervention.The average hospital stay after the surgery was 5.6 days.5 patients with hepatocellular carcinoma were followed up for an average of 17 months and the patient converted to open hepatectomy suffered from tumor recurrence 13 month postoperatively.No implantation metastasis was observed on the trocar sites.Conclusions Laparoscopic hepatectomy by helix hydro-jet device can provide excellent visualization of vessels and bile ducts,which can assure the safe margin of hepatic neoplasm.No severe complications were observed.Laparoscopic hepatectomy by helix hydro-jet is a safe and feasible technique.