The doctor-patient relationship is always the focus in the society. The relationship seems more complex and sensitive in the pediatric surgical ward because its patients are kids. However, the pediatric surgical residents' ability of doctor-patient communication is lack of systemic and norma-tive training, which is not good for the mutual understanding between doctors and patients. This study explores how to enhance the residents' doctor-patient communication skills from the perspective of awareness, professional knowledge and some specific skills. In the meantime, it discusses the need to train the teachers and set up a regular examination-assessment system.

Objective To explore the effects of estrogen on the cognitive function,the expression of Bcl-2 and Bax proteins and the neuroal apoptosis in hippocampus in rats with vascular dementia(VD).Methods 60 male Wistar rats were randomly divided into sham-operated group,VD group and estrogen group,20 rats in each group.VD models were made with permanent bilateral common carotid arteries occlusion.The 17-?estrogen (200 ?g/kg,dissolution in peanut oil ) was intraperitoneal injected in estrogen group,once in other day,for 30 times.While,same-dose peanut oil was intraperitoneal injected in the sham-operated group and VD group once in other day,total 30 times.After 60 d the capability of learning and memory were observed by Y-maze test.Neuroal morphology and the expression of Bcl-2 and Bax proteins in hippocampal CA1 subregion were detected by HE and immunohistochemistry stain respectively;neuroal apoptosis was measured by dUTP nick-end labeling(TUNEL).Results Comparing to sham-operated group,cognitive ability in the VD group and estrogen group were significently decreased;both the expressions of Bcl-2 and Bax proteins were increased in hippocampal CA1 subregion;the number of TUNEL positive cells was obviously increased (allP

AIM:To find an efficient and simple surgical procedure of the external dacryocystorhinostomy ( EXT- DCR) in the treatment of chronic dacryocystitis.
METHODS:A total of 270 cases were performed in this retrospective study. A comparison of clinical effects and hemorrhage complications between the experimental group, in which 189 eyes of 167 patients that underwent traditional EXT-DCR without packing, and the control group, in which 121 eyes of 103 patients that underwent traditional EXT-DCR with Vaseline gauze were performed. The postoperative follow-up ranged from 6 to 36mo ( the mean follow-up was 15±3. 6mo).
RESULTS: There were no significant differences in the curative rates between the two groups (97. 9% vs 97. 5%, P>0. 05). But the incidence rate of moderate or severe postoperative nasal bleeding was lower in the experimental group (15. 9%, 30 eyes) than the control group (31. 4%, 38 eyes) and P<0. 01.
CONLUSION: The traditional EXT - DCR without packingis an effective procedure and is more effective in reducing moderate or severe postoperative bleeding when the intraoperative anastomose and the postoperative drainage are well done and the intraoperative bleeding is well controlled.

A few of patients with lumbar disk herniation having a separation of clinical symptoms and signs and imaging features, can be found in clinic, but the traditional theory of direct mechanical compression of nerve roots by herniated nucleus pulposus can't be used to explain this abnormal protrusion of lumbar intervertebral disc. The clinical symptoms and signs of the atypical lumbar disk herniation are affected by multiple factors. The indirect mechanical compression and distraction effect of spinal nerve roots may play an important role in the occurrence of the separation, and the appearance of abnormal clinical symptoms and signs is closely related to the migration of herniated nucleus pulposus tissue, transmission of injury information in the nervous system, and the complex interactions among the nucleus pulposus, dural sac and nerve roots. Moreover,the changes of microcirculation and inflammation secondary to the herniated nucleus pulposus tissue, the hyperosteogeny in the corresponding segment of the lumbar vertebrae and the posture changes all results in a diversity of symptoms and signs in patients with lumbar intervertebral disc herniation. Besides, there exist congenital variation of lumbosacral nerve roots and vertebral bodies in some patients, and the misdiagnosis or missed diagnosis of imaging finding may occur in some cases. However, the appearance of a separation of clinical symptoms and signs and imaging examination in patients may be caused by a variety of reasons in clinic. The exact mechanism involved in the interaction among nucleus pulposus tissue, dural sac and nerve root, secondary changes of pathophysiology and biomechanics around the nucleus pulposus, the determination of lesioned responsible segments, and how to overcome the limitations of imaging all need the further researches.
Humans ; Intervertebral Disc Displacement ; complications ; diagnosis ; Lumbar Vertebrae ; Nerve Compression Syndromes ; etiology

Objective To observe the influence of the insulation blanket applied in general anesthesia on the incidence of postoperative delirium.Methods 60 patients with elective laparoscopic cholecystectomy under generalanesthesia with ASA of grade Ⅰ-Ⅱ were selected.According to the random number table,the patients were divided into group A(without insulation blanket)and group B (with insulation blanket),each group in 30cases.The dosage and drug batch number of anesthetic drugs were same.Evaluated each patient using the confusion assessment method-chinese revised (CAM-CR).Recorded the number of cases of delirium for each group when 24 hours,48 hours, 72 hours after operation.Results The incidence of postoperative delirium in group A was 6.7%,which in group B was 0.0%.The incidence of postoperative delirium of group B was lower than group A (P <0.05 ).Conclusion Using insulation blanket to protect body temperature in perioperative operation can reduce the incidence of postopera-tive delirium in perioperative operation.

Objective To explore the value of contrast-enhanced FLAIR imaging in diagnosis of leptomeningeal metastasis.Methods 23 cases of leptomeningeal metastasis with definite primitive-tumour were collected.All the cases were confirmed by clinic and laborotary examination.Of the 23 cases,7 cases underwent contrast-enhanced T1WI only,16 case underwent contrast-enhanced T1WI and FLAIR.Two groups were analyzed comparatively in diagnostic accuracy and displaying lesions between images of two sequence.Results(1)2 cases were missed,and 1 case was unsure diagnosed in T1WI contrast group;16 cases were all diagnosed accurately in both T1WI and FLAIR contrast-enhanced group.(2)11 cases with fine linear enhancement and 7 cases with small nodular enhancement were more obviously on contrast-enhanced FLAIR than that on contrast T1WI,but the thick linear enhancement were equal on two sequence.4 cases with more lesions were displayed on contrast-enhanced FLAIR images.The signal intensity on contrast FLAIR images were higher than that on contrast T1WI images at the same lesions.Conclusion Contrast-enhanced FLAIR has important value in diagnosing leptomeningeal metastasis.

Objective To investigate the characteristics and analyze the differences of choroidal neovascularization (CNV) image between exudative age-related macular degeneration (AMD) and central exudative chorioretinopathy (CEC) using optical coherence tomography (OCT). Methods Twenty-three eyes of 22 patients with exudative AMD and 20 eyes of 19 patients with CEC, which were diagnosed as CNV using fundus fluorescein angiograph (FFA) or indocyanine green angiograph (ICGA), were exami- ned by OCT. The size of CNV and the thickness of retinal neurosensory layer in foveola were measured by OCT software. Results On OCT image, CNV had three main types of morphological features including simple CNV, CNV with serous retinal neurosensory layer detachment and CNV with choroidoretinal exudation. Exudative AMD mainly showed CNV with choroidoretinal exudation (56.52%) and CEC showed simple CNV (90 0%). The thickness of retinal neurosensory layer in foveola of patients with exudative AMD was thicker than that of patients with CEC and the size of CNV of patients with exudative AMD was larger than that of patients with CEC. Negative correlation was found between retinal neurosensory layer thickness in foveola and vision in both groups (?=-0.521, P =0.001). Conclusions There were certain discrepancy in morphology and area involved of CNV between exudative AMD and CEC on OCT images.

Medical electronics has become an elective or the compulsory course in medical colleges,but the teaching condition has restricted the quality of teaching,so the educational reform is imperative.This article analyzed the medical electronics teaching actuality,and then according to their own teaching reform practice,put forward the future direction of the teaching reform on medical electronics —— strengthening teachers training and improving teaching condition.

Objective To investigate the effect of exogenous atrial natriuretic peptide on airway inflammation in allergic asthma mice model and its mechanism.Methods A total of 48 SPF 48 BALBc mice were selected and randomly divided into the normal group (equal quantity normal saline intervention),model group (equal quantity normal saline intervention),experimental group A (exogenous atrial natriuretic peptide 0.5 μg/g) and experimental group B(exogenous atrial natriuretic peptide 0.5 μg/g-+-A71915).The model group,experimental group A and B were given the corresponding treatment measures after successfully constructing the model,at 24 after the last provocation test,serum and bronchoalveolar lavage fluid in each group were collected for detecting inflammation factors.The HE staining was used to observe the pathological changes of lung tissue,the expression level of GATA3 protein in lung tissue was detected by Western blot technology.Results The blood EOS,lymphocyte and neutrophil ratio in the model group were higher than those in the normal group (P＜0.05),which in the experimental group A were higher than those in the model group and experimental group B (P＜0.05);bronchoalveolar lavage fluid EOS,lymphocytes,neutrophil ratio,IL-6,TNF-α levels in the model group were higher than those in the normal group (P＜0.05),alveolar lavage fluid EOS,lymphocyte,neutrophil count,IL-6 and TNF-α levels in the experimental group A were higher than those in the model group and experimental group B (P＜0.05);the expression level of GATA3 protein in lung tissue of the model group was higher than that in the normal group(P＜0.05),the expression level of lung tissue GATA3 protein in the experimental group A was higher than that in the model group and experimental group B (P＜0.05).Conclusion Exogenous atrial natriuretic peptide can further aggravate airway inflammation reaction in allergic asthma mice model,which is related to the activation of inflammatory cells,the release of inflammatory cytokines and the increase of GATA3 protein expression in lung tissue.