Medical clinical practice plays an important role in medical education, which influences the quality of medical peoples. In clinical practice teaching of respiratory medicine, many factors have a major impact on the quality of training. This article focuses on chnical practice teaching in influence factors and puts forward some countermeasures.

Objective To research the occurrence of liver cirrhosis and portal hypertension splenectomy treatment,and analyze the risk factors for postoperative complications.Methods Retrospectivly analyzed the clinical data of 390 liver cirrhosis cases from March 2009 to May 2013 who were admitted to department of digestion and vascular surgery,First Affiliated Hospital of Xinjiang Medical University,for splenic resection.Child classification,diabetes,amount of fluid drainage,drainage time,blood loss,emergency surgery,combined with other surgery were alalysised by Logistic regression.Results Among three hundred and ninty cases of splenectomy patients,liver cirrhosis complications occurred in 53 cases (53/390,13.58％).In these 53 cases,45 cases combined diabetes,Child grade A 12 cases,B 22 cases,C 19 cases,and theirs 24 hours drainage volume was (422.45 ±297.09) mL,drainage time was (4.96 ± 1.48) d,blood loss was (874.72 ± 106.19) mL,K value was 0.10 ±0.06,R15 value was 0.27 ±0.016,albumin concentration was (30.09 ±6.87) g/L,Among the rest 337 cases,228 cases were combined diabetes,Child grade A 134 cases,B 129 cases,C 74 cases,and theirs 24 hours drainage volume was (234.06 ± 171.15) mL,drainage time was (3.18± 1.72) d,blood loss was (261.90±98.27) mL,K value was 0.14 ± 0.09,R15 value was 0.19 ± 0.015,albumin concentration was (32.51 ±5.58) g/L.Multivariate regression analysis had indicated that Child grade,drainage volume of 24 hours,drainagetime,and K value were independent factors affecting the occurrence of complications.Conclusion The major risk factors of incidence happen on postoperative complications in cirrhosis and portal hypertension splenectomy are high Chill grading,draining a long time,and 24 hours blood loss,and k value.

Radical resection is still the only possible cure for gallbladder cancer nowadays. Rational procedures vary according to different TNM stages, locations and biological behavior of tumor. Diagnostic laparoscopic exploration offers the opportunity to identify peritoneal metastasis which may be negative on preoperative radiological findings. Besides, this can also minimize trauma to abdomen. Therefore, laparoscopic exploration is suggested in cases highly suspected of peritoneal metastasis. For incidental gallbladder cancer, radical surgery should be performed because of positive margin of cystic duct, inadequate trocar management or advanced tumor stages. Timing for reoperation is still controversial. Most scholars recommended that it should be proceed within two months after the first surgery.

Objective: To observe the therapeutic effect of treating senile intervertebral disc Herniation with acupuncture, tuina and traction and with physiotherapy and traction. Methods: Altogether 150 cases above 65 years old were randomly allocated into treatment group and control group, each containing 75 cases. Traction, acupuncture and tuina therapy were adopted in the treatment group, while traction and physiotherapy were adopted in the control group. Results: After one-month treatment, the recovery rate of the treatment group were 70.7%, which was significantly better than 53.3% of the control group (P＜ 0.05). Conclusion:Combination of acupuncture, tuina and traction has very good efficacy in treating senile intervertebral disc Herniation.

OBJECTIVETo investigate the clinical efficacy of Ginkgo biloba injection combined with traditional therapy in the treatment of explosive deafness.

METHODSFifty-six (98 ears) participants who were all coal miners were selected. These patients were diagnosed with explosive deafness. and admitted to the otolaryngology department of our hospital from May 2010 to October 2013. They were.equally divided into control group and treatment group according to the therapeutic method. The patients in the control group only received traditional therapy, such as hyperbaric oxygen, while the patients in the treatment group were given Ginkgo biloba injection in addition to the therapy for the control group. The improvement in hearing was recorded and compared between the two groups.

RESULTSThe rate of improvement in tinnitus symptom in the treatment group was 78.0% (32/41), significantly higher than that in the control group (55.6%, 25/45) (χ2=4.857, P<0.05); compared with the treatment group (93.5%, 43/46), the control group had a significant lower overall response rate at 76.9% (40/52) (χ2=5.160, P<0.05).

CONCLUSIONCompared with traditional therapy alone, combined ginkgo biloba extract injection and traditional therapy can significantly improve tinnitus symptom and overall response rate in the treatment of explosive deafness in coal miners, which suggests that the combination therapy is worthy of clinical application.

Coal Mining ; Combined Modality Therapy ; Deafness ; drug therapy ; Explosions ; Ginkgo biloba ; chemistry ; Hearing Tests ; Humans ; Injections ; Noise, Occupational ; adverse effects ; Oxygen ; therapeutic use ; Phytotherapy ; Plant Extracts ; therapeutic use ; Tinnitus ; drug therapy

Multiple myeloma (MM) is a malignant hematologic disorder.The early diagnosis,accurate staging and timely therapeutic evaluation have great impact on the treatment planning,disease monitoring and prognosis.Although X-ray examination is the standard staging modality for MM,18F-FDG PET/CT has been proved additionally valuable for diagnosis,outcome prediction of MM.This article is to update the clinical role of 18F-FDG PET in the evaluation of MM.The application of other PET radiopharmaceuticals including 11 C-MET,11 C-acetate,11 C-choline and 18 F-FLT are also reviewed.

Objective To observe the mechanism of the change in runx3 in gastric carcinoma its difference and with p53 mutation.Methods A total of 30 cases of gastric carcinoma were taken from clinical operation.PCR-SSCP method was used to detect mutations in exons 2,3,4 of runx3 gene in the gastric carcinoma.The methylation status of runx3 gene was examined by methylation-specific polymerase chain reaction(MS-PCR),PCR-SSCP method was used to detect mutations in exons 5,6,7,8 of p53 gene in the gastric carcinoma.Results Two cases with mutation were found,methylation of runx3 promoter region was confirmed in 87%(26/30) specimens of gastric carcinoma,53.3%(16/30)cases were confirmed with mutation in the p53 gene.The rate of methylation of runx3 was higher than the rate of mutation of p53(P

Bronchogenic cysts( BC) is a congenital malformation of the lung which is common in chil-dren and adolescents. Because the disease is rare and not characteristic in symptom,sign and imaging,it can be easily misdiagnosed. It is still difficult to improve the rate of correct and early diagnosis. This article reviewes the research progress of the occurrence,symptom and management of BC.

Background Descemet stripping automated endothelial keratoplasty (DSAEK) is the main treatment for corneal endothelial dysfunction.But the visual outcome after operation varies depending on the difference of corneal diseases.Objective This study was to evaluate and compare the visual outcomes following DSAEK in different keratopathy.Methods The clinical data of 72 eyes of 67 patients with endothelial dysfunction underwent DSAEK from December 2007 to December 2009 at Peking University Third Hospital were retrospectively analyzed.The patients were divided into Fuchs endothelial dystrophy (FED) group (22 eyes of 19 cases),cataract surgeryinduced bullous keratopathy group (37 eyes of 36 eases) and other endothelial keratopathy group (12 eyes of 12 cases).The distribution of visual acuity and LogMAR acuities were compared and evaluation among the 3 groups before operation and 1 day,3,7,30,90 and 180 days after operation.Results Preoperatively,the vision was lower than 0.1 in 71.83％ patients,and all the patients had the visual acuity less than 0.3.No significant difference was found in the preoperative acuity among the FED group,cataract surgery-induced bullous keratopathy group and other endothelial keratopathy group(x2 =3.427,P＞0.05).The visual acuity was ≥ 0.4 in 40 eyes (56.34％) and ≥ 0.1 in 65 eyes (91.55％),and the percentage of vision ≥0.8 was 22.73％ in the FED group,10.81％ in the cataract surgery-induced bullous keratopathy group and 8.33％ in the other endothelial keratopathy group,and no significant difference was found in the percentage of eyes in different visual acuities 180 days after operation (x2 =0.330,P＞ 0.05).In the 3 groups,LogMAR values were gradually decreased with the lapse of the time,showing a significant difference (Ftime =88.000,P ＜ 0.01).In the seventh day after operation,LogMAR value was 1.29 ± 0.57 in the cataract surgery-induced bullous keratopathy group,which was significantly higher than that of the FED group (0.82± 0.43) or other endothelial keratopathy group (0.91 ±0.39) (both at P＜0.05).Ninety days after operation,LogMAR value was 0.40 ±0.28 in the FED group and was significantly declined in comparison with the cataract surgeryinduced bullous keratopathy group (0.64±0.44) and other endothelial keratopathy group (0.73±0.54) (both at P＜0.05).However,no significant differences was seen in the LogMAR values among the three groups 180 days after operation (all at P＞0.05).The vision was stable 3 months after operation in the FED group,however,the vision was still changed over 3 months in the cataract surgery-induced bullous keratopathy group and other endothelial keratopathy group.Conclusions DSAEK is available for corneal endothelial diseases.Visual acuity improves more rapid in FED patients than other keratopathies.

Angiography, Digital Subtraction ; Embolization, Therapeutic ; Humans ; Retroperitoneal Neoplasms ; diagnosis ; surgery ; therapy ; Stents ; Vascular Surgical Procedures ; methods