The clinical practice is a very important link for medical students to relate theory with practice and to be trained comprehensively.Stomatology is an applied science,so clinical practice is more outstanding and important during the stomatological education.This thesis discusses how to improve stomatological students' comprehensive skill in the clinical practice.

Objective To investigate the effect of ultrasound-guided paravertebral nerve block on stress reaction in patients undergoing esophageal resection. Methods Eighty patients scheduled to do the operation of esophageal resection were randomly divided into two groups with 40 cases in each group. The patients in group A were given the general anesthesia combined with ultrasound-guided paravertebral block, and the patients in group B were given the general anesthesia only. Both of two groups received postoperative patient controlled intravenous analgesia (PCIA). The amount of propofol and remifen-tanil used were recorded. The data of blood pressure, heart rate (HR) and pulseoxygen saturation (SpO2) before anesthesia (T1), before induction (T2), after intubation (T3), in 2 h of surgery (T4), after surgery (T5), 1 h after surgery (T6), 8 h after surgery (T7), 24 h after surgery (T8), 48 h after surgery (T9)were recorded. The analgesic effect was measured by VAS scores and Ramsay sedation scores were also recorded at T6-T10. The levels of blood glucose, epinephrine (E), norcpincphrinc (NE) and dopamine (DA) were also detected at T1, T4, T5, T9. Results The amount of propofol and remifentanil used in group A were lower than those in group B: (960.0 ± 216.9) mg vs. (1 242.5 ± 200.2) mg, (1.5 ± 0.4) mg vs. (2.3 ± 0.4) mg, P<0.05. The patients in two groups successfully completed surgery, and intraoperative vital signs was stable. The quiet and active VAS scores at T6-T9 in group A were significantly lower than those in group B (P<0.05). The Ramsay sedation scores at each time point in two groups had no significant differences (P>0.05). The levels of blood glucose and NE at T9 were significantly higher than those at T1, T4 or T5 of same group, P<0.05.The level of E at T4 and T5 was significantly lower than that at T1 and T9 of same group, P<0.05. The level of DA at T9 was significantly higher than that at T1, T4 and T5 in group B (P<0.05). The levels of blood glucose, NE, E and DA at T9 in group B were significantly higher than those in group A (P<0.05). Conclusions General anesthesia combined with ultrasound-guided paravertebral nerve block could offer favorable anaesthesia effect. It could decrease stress reaction and anesthetics requirements in patients undergoing esophageal resection.

Objective To investigate the effect of CDT1 gene over-expression on the apoptosis and cell cycle distribution in liver cells with a characteristic of genomic instability induced by radiation(GIR).Methods Lentivirus particles were transferred into liver cells of GIR to up-regulate the expression of CDT1 gene.The apoptosis and the cell cycle were detected by flow cytometry (FCM).The expression changes of p53,ATM,ATR,Bcl-2,and Caspase-3 genes were analyzed by real-time fluorescence quantitative PCR.Results CDT1 gene was efficiently increased by the gene transfection(t =15.56,P ＜ 0.05).In the CDT1 over-expressed cells,while the apoptosis ratio was increased (t =4.19,P ＜ 0.05),the expressions of p53 and Bcl-2 gene were decreased (t =-4.21,-2.06,P ＜ 0.05),but the expression of ATM,ATR and Caspase-3 changed with no significant difference compared with control.Conclusions Over-expression of CDT1 could regulate genomic instability through apoptosis pathway and checkpoint independent of p53.

Objective Summarize the experiences of treating after-operation ventricular electrical storm (VES) with extra-corporeal membrane oxygenation (ECMO) .Methods Examine the clinical data of seven cases of treating after-operation VES with ECMO from January 2013 to April 2014 and analyze the basic pre-operation conditions of the patients ,diagnoses ,causes of VES ,ai-ding processes with ECMO ,and prognoses .Results Seven patients all were successfully separated from the machine after the treat -ment ,one patient infected seriously after being separated from the machine ,having multiple organ failure one week later and dis-charged voluntarily ;one patient having cerebral hemorrhage two days later after being separated from the machine and discharged voluntarily ;the remaining five patients cured and discharged with no complications .Conclusion ECMO can provide effective circu-lar support to patients suffering VES after heart operation ,maintaining coronary blood supply ,avoiding further myocardial damage , stabilizing electrolytes and the internal environment ,and gain time for restoration of heart rhythm and treatment according to the causes and triggers .

Objective To study the prevention effects of AduoLa Fuzhenglin(ADL)Oll the brain injury induced by microwave radiation in rats.Methods A total of 140 male Wismr rats were divided randomly into 5 groups,including control group,microwave exposed group,low dosage(0.75 g·kg-1·d-1)group.middle dosage(1.5 g·kg-1·d-1)group and high dosage(3 g·kg-1·d-1)group.Rats in three ADL groups were lavaged with ADL per day for 2 weeks before radiation.After administration,rats were exposed to microwave at 30 mW/cm2 for 15 min.The abilities of learning and memory were detected by Morris water maze,and the contents of amino acids neurotransmitter of hippocampus were detected by HPLC, then the histology and uhrastrncture of hippocampus were observed with light and electron microscope at 6 h,7 and 14 d after exposure.Results The abilities of learning and memory were declined(F=0.000-0.043,P<0.05)from 6 h to 7 d after exposure,and the contents of four kinds of amino acid neurotransmitter in hippocampus were decreased,of which GLU,GLY and GABA were decreased significantly(F=0.000-0.007,P<0.01)at 6h after exposure,then tissue edema,neuronal degeneration,neuron mitoehondria swelling and cavitation,endocytoplasmie rotieulum broaden,synaptic cleft blurred,and perivascular space widen were found in the hippocampus at 6 h and 7 d after exposure.The changes in low dosage group were similar to those of the radiation group.However,in middle and high dosage groups,the abilities of learning and memory were normal to some extent with the significant differences compared to the radiation group from 6 h to 7 d after exposure(F=0.015-0.028.P<0.05).The contents of four kinds of amino acid neurotransmitter were not decreased,especially GLU contents close tO normal level.There were significant differences between middle and high dosage groups and radiation group at 6 h after exposure(F=0.000-0.042,P<0.05).Moreover,no obvious injury in the hippocampus was observed in middle and high dosage groups at 6 h and 7 d after exposure.Conclusions Exposure to 30 mW/cm2 microwave radiation could decrease the abilities of learning and memory,induce amino acid neurotransmitter turbulence,and injure the histology and uhrastructure of hippocampus.ADL at the dosages of 1.5 and 3 g·kg-1·d-1 would have preventive effects on the injury induced by microwave exposure.The concentration of 1.5 g·kg-1 ·d-1 of ADL might be the effective dosage to prevent the brain damage after microwave exposure.

Objective To investigate the feasibility of combined laparoscopic resection of gallbladder and other viscera. Methods The clinical data of 69 cases of combined laparoscopic resection of gallbladder and other viscera from January 1999 to July 2004 were reviewed retrospectively. Results The laparoscopic operation was successful in 69cases,and no case was converted to laparotomy.The average operation time was(85.5?18.6)min,and the time of return of gastrointestinal function was(27.3?6.2)h. The average hospitalization time after operation was(3.9?0.8)d.There were no operative or postoperative complications , and the therapeutic results were satisfactory. Conclusions The combined laparoscopic resection of the gall bladder and other viscera is safe and feasible. It is possible to treat gallbladder diseases and associated lesions of abdominal viscera simultaneously. The lesions of several organs can be treated at one operation. This can significantly decrease patients′ pain and lower the cost of treatment, and is worthy of wide usage.

Objective To investigate the effects of intrathecal dexmedetomidine administration on the development of morphine tolerance and spinal inflammatory responses.Methods Thirty-three male SD rats weighing 180～200 g were randomly divided into 3 groups (n=11):Saline group (group NS),Morphine group (group M) and Dexmedetomidine group (group Dex).Animals of group NS were intrathecally injected with 10 tμL of saline daily for seven days;Animals in group M were intrathecally injected with 15 μg of morphine daily for seven days;Animals in group Dex were intrathecally injected with a mixture of 15μg morphine and 1.5 μg dexmedetomidine daily for seven days.At 1,3,5 and 7 day of intrathecal injection,hot water tail-flick test were used to evaluate analgesic response to thermal stimuli.After the last episode of behavioral test,Western blot analysis was applied to determine the protein levels of Iba-1 (microglial marker),IL-1β,TNF-a and phospho-p38MAPK (p-p38) in the spinal cord.In addition,microglia in the spinal cord was immuno-stained with anti-Iba-1 antibody and the densities of microglia were calculated.Results In group M and Dex,the values of maximal possible effect (MPE) in tail-flick test decreased gradually along with repeated morphine administration (P＜0.05).Compared with group NS,the values of MPE in tail-flick test at 1,3,5 and 7 day of morphine tolerance were higher in group M (P＜0.05).Compared with group M,the values of MPE in tail-flick test at 3,5 and 7 day of morphine tolerance were higher in group Dex (P＜0.05).Compared with group NS,the spinal protein levels of Iba-1,IL-1L TNF-α and p-p38 as well as the density of Iba-1 positive cells in group M were increased (P＜0.05).However,Compared with group M,the of Iba-1,IL-1β,TNF-α and p-p38 as well as the density of Iba-1 positive cells were decreased(P＜0.05).Conclusion Intrathecal dexmedetomidine administration can attenuate morphine tolerance by inhibiting microglia-mediated inflammatory responses in the spinal cord.

Objective To explore the changes of SOX9 and WT1 expressions in rat Sertoli cells irradiated by EMP ( electromagnetic pulse),S-HPM ( S-band high power microwave) and X-HPM ( Xband high power microwave).Methods Primary Sertoli cells were isolated from 3-week-old Wistar rats and its purity was immunocytochemistrically indentified with WT1.After exposure to 6 × 104 V/m EMP,100 mW/cm2 S-HPM and X-HPM for 4 min respectively,SOX9 and WT1 expressions in Sertoli cells were determined with real-time PCR and Western blot,respectively.Results SOX9 mRNA expression was decreased at 6 and 12 h post-irradiation of three different bands of electromagnetic microwave ( F =15.20and 4.84,P ＜ 0.05 ).SOX9 protein expression was also decreased at 6 and 24 h after irradiation ( F =8.46 and 7.47,P＜0.05).WT1 mRNA expression was decreased at6 and 12 h (F=13.46 and 5.08,P ＜ 0.05 ),but its protein expression was decreased only at 24 h post-irradiation ( F =10.26,P ＜ 0.05 ).Conclusions Three bands of electromagnetic radiation reduce the expressions of SOX9 and WT1 in rat Sertoli cells,which may provide molecular foundation for genital system hazards induced by microwave radiation.

Objective To investigate the role of transient receptor potential melastatin 7(TRPM7) in sevoflurane preconditioning for inhibiting hippocampal neurons apoptosis and inflammation response induced by oxygen-glucose deprivation(OGD).Methods Fifty SD rats of postnatal 1 d were selected for extracting hippocampal neurons and randomly divided into 5 groups,including the control group(C),sevoflurane preconditioning group (Sev),OGD group,Sev preconditioningt OGD group (Sev + OGD) and Sev preconditioning+ bradykinin+OGD group(combined group).After 1.5 h oxygen-glucose deprivation,reintroduction was performed,and then the normal culture was performed again for preparing the OGD model.Hippocampal neurons in the control group were normally cultured only;which in the Sev group conducted 2 ％ Sev preconditioning for 1 h;which in the OGD group only prepared the OGD model;which in the SEv+OGD conducted 2％ Sev preconditioning for 1 h,and prepared the OGD model after 24 h;which in the combined group was simultaneously added with bradykinin(final concentration 200μmol/L) in Sev preconditioning,other treatment was same to that in the Sev+OGD group.After 24 h normal culture,the mRNA and protein levels of TRPM7,apoptosis rate,survival rate,mRNA and supernatant protein levels of IL-1β and TNF-α of the hippocampal neurons were detected.Results Compared with the control group,hippocampal neurons mRNA and protein levels of TRPM7,apoptosis rate,mRNA and supernatant protein levels of IL-1β and TNF-α in the OGD group were significantly increased(P＜0.05),whereas the survival rate was significantly decreased (P ＜ 0.05).Compared with the OGD group,hippocampal neurons mRNA and protein levels of TRPM7,apoptosis rate,mRNA and supernatant protein levels of IL-1β and TNF-α in the Sev group were significantly decreased(P＜0.05),whereas the survival rate was significantly increased(P＜0.05).Compared with the Sev group,hippocampal neurons mRNA and protein levels of TRPM7,apoptosis rate,the mRNA and supernatant protein levels of IL-1β and TNF-α in the combined group were significantly increased(P＜0.05),whereas the survival rate was significantly decreased(P＜0.05).Conclusion Sev preconditioning can attenuate hippocampal neurons apoptosis and inflammatory response after OGD via alleviating the overexpression of TRPM7.