After-department examination palys an important role in clinical teaching.The level of clinical teaching is one of the most important markers to evaluate the whole quality of the hospital.To improve the ability of teaching and teaching concept,we summarized the problem of after-department examination and put forward a series of reformation methods.

Objective To explore the clinical characteristics of poststroke epilepsy and to discuss the association with the type of stroke,the location of focus.Methods Clinical information of 64 patients with poststroke epilepsy taken from 932 patients with stroke were analyzed retrospectively.Results In the patients with first stroke,the incidence of poststroke epilepsy was 6.9％.Among them,47 cases belong to early seizure (73.4％) and 17 cases belong to late seizure (26.6％).The incidence of poststroke epilepsy was difference between ischemic stroke and hemorrhagic stroke.There were more cases of stroke in cortical focus than subcortial one.Onset seizures type was more cases of partal seizure than generalized tonic-seizure (GTS).The treatment on early seizure could be short-range treatment and the treatment on late seizure should be long-term standardized treatment and regular.Conclusions Occurrence of poststroke epilepsy were involved in the type of stroke,the location of focus (cortex / subcortex).It is helpful for guiding the clinical therapy of patients with stroke and improving the quality of their life to analyse the clinical characteristics of poststroke epilepsy.

Objective To examine the efficacy and adverse reactions of bortezomib-based chemotherapy in treatment of multiple myeloma (MM).Methods Twenty-eight patients with multiple myeloma received a joint chemotherapy containing bortezomib.The efficacy was determined according to EBMT criteria.Results 28 patients received the chemotherapy,20 patients were newly diagnosed and 8 patients were relapsed or refractory.25 patients can be evaluateed efficacy.The total response rate was 100 ％ (25/25),consisting of 5 patients with complete response (CR),10 patients with almost complete remission (nCR),10 patients with partial remission (PR).The main side effects include peripheral neuropathy,thrombocytopenia,gastrointestinal disorders and viral infections.These side effects were improved by symptomatic treatment and generally did not affect the treatment.Conclusion For the newly diagnosed and relapsed or refractory multiple myeloma cases,bortezomib-based chemotherapy is a safe and effective therapeutic drug with rapid onset,high treatment response rate,and adverse reaction can be tolerated.

Health is one of the essential ties between China and Africa. As the Chinese economy is experien-cing rapid development and the strategic transformation, the China-Africa cooperation is entering the era of communi-tas in all directions and the health-related aids and exchanges between China and Africa are experiencing new oppor-tunities and challenges. Previously, the China-Africa health cooperation has experienced three transitional stages from the assistance, collaboration and communitas. During the current global fight against Ebola outbreak period, while the world feared and wondered the Ebola in the beginning, China’s fast action on the fight had showed that not only the relationship between China and Africa is seen from the previous health aid legacy to Africa, but also is coming to the economic development communitas stage. Moreover, there are two essential government and non-government col-laboration established between China and Africa. So, when we analyze the fast action of China towards Ebola out-break, it is clearly shown that the China’s response is based in the perspective of humanitarian, super state accounta-ble responsibilities, and also focused on health system resilience in the epidemic countries. China and Africa are stepping into the economic development communitas stage. Therefore, this change of cooperation reflects the change of China’s position in the global health governance.

Objective To evaluate the clinical efficacy of percutaneous transhepatic biliary drainage (PTBD) and pcrcutaneous transhcpatic insertion of biliary stent (PTIBS) for malignant biliary obstruction.Methods PTBD or PTIBS were performed in 56 patients with malignant biliary obstruction, which were aused by hepatic carcinoma (n = 14), biliary duct carcinoma (n = 11), gallbladder carcinoma (n = 5),stomach carcinoma accompanied with metastasis of lymph node (n = 14), carcinoma of ampulla (n = 1 ) or carcinoma of pancreatic head (n = 11 ). The diagnosis was confirmed by ultrasonography, CT or MRI in all patients. The obstructed site was well identified, including high obstruction in 19 patients and lower obstruction in 37 patients. Based on the imaging findings, suitable interventional procedure was employed.Results PTBD or PTIBS were performed successfully in all 56 patients, of them PTBD was adopted in 11,PTIBS in 40 and both PTBD and PTIBS in 5. The serum total bilirubin decreased from (295.65±152.86)μmol/L before the procedure to (151.05 ± 107.36) μmol/L after the procedure, (P < 0.01 ). Postoperative infection could affect the fading of jaundice (P < 0.01 ), but the location of the obstruction carried no relationship with the fading of jaundice (P = 0.063). Conclusion Both PTBD and PTIBS are safe and effective palliative therapies for malignant biliary obstruction, which can markedly relieve patient of jaundice,improve the quality of life and elongate the survival period.

Objective To develop a TaqMan MGB probe-based,sensitive and specific real-time fluorescence quantitative PCR assay for rapid detection of Helicobacter hepaticus.Methods Primers and probes specific toflaB gene of Helicobacter hepaticus were designed.A TaqMan MGB probe-based,real-time fluorescence quantitative PCR was established.The specificity,sensitivity and stability of the assay were assassed.Then,the established TaqMan MGB probe real-time fluorescence quantitative PCR assay was applied to detect Helicobacter hepaticus in 1081 clinical specimens during 2008-2011,compared with bacterial isolation and culture method and conventional PCR assay.Results The specificity of this established TaqMan MGB probe-based real-time fluorescence quantitative PCR was high and there were no cross-reactivity with Helicobacter pylori,Campylobacter jejuni,Clostridium piliforme,Pasteurella pneumotropica,Escherichia coli,Pseudomonas aeruginosa.The detection limits was 8.3 copies.The correlation coefficient and slope value of standard curve were 0.999 and -3.227,respectively and the efficiency of TaqMan MGB-based probe realtime fluorescence quantitative PCR assay was 100％.The TaqMan MGB-based probe real-time fluorescence quantitative PCR and conventional PCR were preformed to detect Helicobacter hepaticus in 1081 clinical specimens,a total of 86 specimens were positive for Helicobacter hepaticus.However,there was only 4 specimens were positive by bacteria isolation and culture method.The results showed that TaqMan MGB -based probe real-time fluorescence quantitative PCR for Helicobacter hepaticas was more sensitive than bacteria isolation and culture method,and it could detect Helicobacter hepaticus DNA from clinical specimens directly,and detection time is only 2 hours.Conclusion The TaqMan MGB-based probe real-time fluorescence quantitative PCR assay was a reliable,specific,sensitive and useful tool for rapid detection of Helicobacter hepaticus.

AlM: To evaluate the application of phacoemulsification of different nucleus density using ozil and traditional mode.METHODS: A total of 89 eyes (72 patients ) ( visual acuity was of 0. 6 and above after 1mo follow - up) of different nucleus density level (LOCS Ⅱ criteria grade Ⅲ 46 eyes, grade Ⅳ and more 43 eyes ) were randomly assigned into 2 groups: ozil group (group A), grade Ⅲ 22 eyes (torsional energy 80% lP on);grade Ⅳ and more 17 eyes (torsional energy 100% lP on); Traditional mode group(group B), grade Ⅲ 24 eyes (energy 50% ), grade Ⅳ and more 26 eyes (energy 60% ~ 70% ) . All surgeries were performed by the same experienced surgeon,who use the chop to split the nucleus in the application of phacoemulsification. lntraoperative parameters were total equivalent pawer ( TEP ), cumulative dissipated energy ( CDE ) and effective phaco time ( EPT ) and surgical complications. The effectiveness of the two modes in dealing with hard - core cataract phacoemulsification were compared.RESULTS: GradeⅢ nucleus dealing: TEP of ozil group was significantly higher than that of the traditional mode group [(24.58±7.78)% vs (13.84±1.97) %]and EPT of ozil group was significantly lower than that of the traditional mode group (50. 59±14. 73 s vs 60. 19±9. 04 s, P<0. 05). CDE showed no difference between two groups [(13.12±6.03)% vs (13.38±2.85)]. Grade Ⅳ and more nucleus dealing: CDE [( 34. 10 ± 13. 48 )%] and EPT (104. 64±32. 4s) of the ozil group was higher than CDE [(30. 31 ± 13. 48)%] and EPT (93. 01 ± 41. 01s) of the traditional mode group, but there were no difference between two groups. Obstacles in the needle of phacoemulsification surgery: ozil group 4/17, traditional mode group 2/26 (χ2=2. 16, P=0. 14).CONCLUSlON: Bothozil and traditional mode can deal with all kinds of nucleus effectively and safely. Ozil mode is more efficacy and quick deal in gradeⅢnucleus. With the increase of nucleus hardness, the traditional mode still have the advantage of high efficiency and no obstacle to dealing patients with grade Ⅳ and more nucleus. Choose according to different nuclear hardness ultrasonic model can improve the operation efficiency and security.

BACKGROUND:Airway epithelial regeneration can effectively inhibit submucosal hyperblastosis and the occurrence of obliteration. Studies demonstrated that ventilation could accelerate the regeneration of airway epithelium. OBJECTIVE:To establish and improve an orthotopic tracheal transplantation model and to further observe the effects of ventilation on trachea in alogeneic mice. METHODS:C57BL/6 mouse's tracheal served as donor, and BALB/c mouse's tracheal as recipient. This experiment contained two groups. In the experimental group, the membranous part of trachea was longitudinaly dissected in two donors and sutured into an enlarged trachea, which was implanted in the recipient. In the control group, donor's trachea was implanted into the recipient in situ. Samples were obtained and detected at 28 days after surgery. RESULTS AND CONCLUSION: Hematoxylin-eosin staining results demonstrated that compared with the control group, wel-differentiated ciliated epithelium was visible in the epithelial lamina of tracheal lumen, accompanying a few non-ciliated single or stratified squamous epithelium, mild submucosal fibrosis and inflammatory cel infiltration. Morphological analysis revealed that ciliated epithelial proportion in the experimental group was higher than in the control group (P < 0.05). The ratio of lamina propria to the tracheal cartilage, submucous fibrous tissuearea and the degree of lymphocyte infiltration were lower in the experimental group than in the control group (P < 0.05). Immunohistochemical staining demonstrated that the transplanted tracheal epithelium in both groups was recipient epithelial phenotype. Results verified that a modified orthotopic tracheal transplantation model was successfuly established. The increased ventilation of the tracheal alografts can accelerate the differentiation of tracheal epithelium. The wel-differentiated airway epithelium inhibited the proliferation of fibroblast.

Objective The purpose of this study was to discuss the therapies for hemorrage caused by the fissuration of pancreatojejunal stoma and pancreatic leakage after pancreatoduodenectomy.Methods After three cases of pancreatoduodenectomy,the disruptions of pancreatojejunal stoma resulted in serious pancreatic leakage and the hemorrage in abdominal cavity.During all the second operations,the drainage-tube insertions into the main pancreatic ducts were used to lead the pancreatic juice into the neighboring loop of jejunum.Results Afer the operations,the supportive treatment,continuous irrigation of peritoneal cavity and pancreatic enzyme inhabition were given to the patients of these cases and all of the patients were successfully cured.Conclusions The bridge-crossing internal drainage which inserts drainage-tube into the main pancreatic duct was a convenient and effective therapy and method to rescue the hemorrage caused by the fissuration of pancreatojejunal stoma and pancreatic leakage after pancreatoduodenectomy.While the patients' lives were saved,their functions of pancreas were preserved and the qualities of life were improved after the operations.

Objective To investigate the clinical characteristics of hospital infection and the pathogen type,distribution and drug resistance,in the intensive care unit of our hospital,to direct proper antibiotics use and supply the scientific basis for hospital infection control. Methods The clinical data of 392 inpatients in our intensive care unit from April 2008 to March 2010 were monitored prospectively and analyzed retrospectively. Results Of the 392 impatients,78 cases had hospital infection (19.89% 78/392),112 time-case infection (28.57% 112/392). The most common infection was the main respiratory tract infections accounted for 54.46% (61/112) ,followed by urinary tract infections accounted for 15. 19% ( 17/112 ), blood infection accounted for 11.61% (13/112). 152strains pathogens were identified in the study,in which G- bacilli accounted for 69.7%, G+ bacteria accounted for 17. 8% and fungi accounted for 12.5%. Main pathogens such as acinetobacter baumannii ,pseudomonas aeruginosa,klebsiella pneumoniae, staphylococcus aureus showed multiple drug resistance in different degrees. Conclusions Intensive care unit has a high nosocomial infection rate,lower respiratory tract infection is the most frequent type and the main pathogens have different degrees of multi-drug resistance. Standardized, rational use of antibiotics,prevention of the multi-drug resistant bacteria spread may help to reduce the occurrence of hospital infection in intensive care unit.