Both the lecture based learning mode and problem based learning mode have their advantages and disadvantages in imparting knowledge and cultivating students'ability.Therefore according to the characteristics of clinical education,two kinds of methods should be used together to complement each other in clinical education of surgery so that knowledge can be systematically imparted to students through lecture based learning,and the abilities such as self-study,oral expression,cooperate and innovation can be cultivated through problem based learning to improve the quality of education.

Objective To study the CT characteristics of rare renal malignant tumors.Methods 7 cases with rare renal malignant tumors confirmed by operation and pathology were reviewed and their CT manifestations were analyzed retrospectively.In clinical, all cases had abdomen pain,6 cases had macroscopic haematuria,and 1 case had asymptomatic by chance.Results Of 7 cases,3 ca-ses were sarcomatoid carcinoma,1 case was carcinosarcoma,1 case was malignant mesenchymal tumor,1 case was lymphoma,and 1 case was neuroendocrine carcinoma.The diameter was about 4.0-12.3 cm.1 case had uniform density,6 cases uneven,and the boundary was not clear.Conclusion The rare renal malignant tumors are misdiagnosed easily.Combined clinical data with imaging performance are helpful to make comprehensive analysis,and to improve accuracy rate for diagnosis,definite diagnosis still depends on pathological examination.

"3+2" educational model was performed in our clinical medical college as a reformation based on traditional "4+1" model.After 5 years teaching practice,it obtained some good results as we prospected,however,there still exists some problems.This article analyzes the problems around the aspect of the teachers,the students,the teaching administration and arrangements,and proposes the corresponded measure to improve it.

Objective To test the effect of different flexion angles of knee joint on the myoelectric activity and torque of quadriceps femoris and hamstring muscle when these muscles contracting.MethodsElectromyographic activities and isometric torque measurements were performed on 10 healthy subjects at 30°, 60° and 90° of knee joint flexion.ResultsThe results indicated that the greatest maximal voluntary isometric contracture-torque of quadriceps femoris occurred during knee extension at 60° of knee flexion ( P<0.01). However, no significant relationship of maximal voluntary isometric contracture-electromyography and maximal voluntary isometric contracture-torque of quadriceps femoris were found in 10 subjects. But when knee joint was at 90° flexion, hamstring muscle had a greatest neuro-myoelectric activity.ConclusionThe exercise of maximal voluntary isometric contraction of quadriceps femoris and hamstrings muscles at certain knee joint angle can help to maintain the stability of knee joint.

AIM: To explore the characters of fibroblast-like (F-L) cells cultured from granunocyte clony stimunating factor (G-CSF)-mobilized peripheral blood cell (PBC) harvests. METHODS: The adherent cells in the PBC harvests were cultured for 2 week in the mediums of RPMI-1640/L-DMEM/G-CSF or interleukin-3 (IL-3) plus RPMI-1640, the cultured F-L cells were analyzed by flow cytometry (FC). RESULTS: The adherent non-confluent F-L cells obtained from the four groups were similar in their phenotypes: CD33+, CD11c+, CD64+, CD14+, CD45+, HLA-DR+, CD86+, CD34-, CD38-, CD3-, CD19-, CD56-, CD29-, CD44-, CD105-. The F-L cells are similar to monocytes except CD38-and were distinct from dendritic cells (DC) or mesenchymal stem cells (MSC). CONCLUSION: The cultured F-L cells are macrophages rather than DC or MSC. G-CSF, rhIL-3 enhances their numbers.

Objective To evaluate the result of fresh autologuos pericardium for the reconstruction of new pulmonary arterial root in arterial switch operation (ASO). Methods Between January 2004 and June 2010, 63 consecutive infants with congenital heart disease were treated with ASO. A new pulmonary arterial root was reconstructed with a fresh autologuos pericardium which clipped pants-like. The followed up time was 3 months to 6 years after discharge. Patients were reexamined consecutively at 3- and 6-month; 1-, 2- and 6-year. Two-dimensional echocardiography was performed for measuring the pulmonary artery diameter. The pulmonary arterial blood speed was measured by continuous Doppler during systole. The pulmonary flow and the pulmonary artery diameter of healthy children of same age were also measure as control group. Simplified Bernoulli formula was adopted to calculate the pressure gradient through pulmonary artery anastomose for, evaluating whether it had pulmonary stenosis or not. Results Fifty seven infants were cured and discharged. Forty nine patients were finished follow up with a mean duration of( 18 ±4) months. The blood speed in the pulmonary artery anastomosis was 0.70 -2.16 m/s with a mean of (1.31 ±0.40) m/s. No pulmonary stenosis was found with the simplified Bernoulli formula. There was no significant difference regarding the pulmonary diameter and the pulmonary artery flow velocity as compared with the normal children of the same age. Conclusion The fresh autologuos pericardium is reliable for reconstruction of new pulmonary arterial root in ASO.

Inflammation plays an essential role in the pathophysiology of atherosclerosis. Our study was aimed to investigate whether salvianolate, a novel water-soluble phenolic compound of Danshen, alleviates atherosclerosis via regulating the inflammation in rats. High fat diet feeding plus vitamin D3 injection was used to induce atherosclerosis in rats. Salvianolate (60, 120 or 240 mg/kg) or placebo was given to atherosclerotic rats. The plasma lipids, interleukin 6 (IL-6) and C reactive protein (CRP) were measured by ELISA. CD4+CD25+Foxp3+ cells were determined by flow cytometry. Histological changes were examined by hematoxylin and eosin staining. The results showed that the levels of plasma IL-6 and CRP were elevated in the rats fed on high fat diet, and the histological analysis demonstrated the successful establishment of atherosclerosis models. Treatment with salvianolate alleviated the atherosclerotic process and decreased the levels of plasma IL-6 and CRP. Also the number of CD4+CD25+Foxp3+ cells was increased in salvianolate-treated rats. It was concluded that salvianolate could treat atherosclerosis via modulating the inflammation at cytokine and cell levels.

Objective To establish a stable,repeatable and long-lasting rat model of myocardial infarction,and to evaluate the feasibility of monitoring electrophysiological changes and left ventricular function after myocardial infarction by electrocardiography (ECG) and ultrasonic cardiography(UCG). Methods Wistar rats were ligated on the left anterior descending coronary artery after anaesthesia with 10% chloral hydrate and machinery assisted respiration. Then they were monitored by ECG and UCG afer 4,8 and 12 weeks,and were sacrificed and pathologically examined at 12 weeks after operation. Results The rat model of myocardial infarction was established with a survival rate of 83.3% at 72 hours after the operation and 73.3% at 12 weeks after the operation. In the myocardial infarction group,the PR,QRS,QT and QTc intervals were statistically significantly longer than that in the sham operation group. UCG showed that the left ventricular internal diameter at end-diastole (LVIDd) and the left ventricular internal diameter at end-systole (LVIDs) were statiscally significantly higher in the infarction group,and the ejection fraction (EF) and fractional shortening (FS) significantly lower than those in the sham operation group. Long-lasting pathological changes can be seen in the tissues at 12 weeks after operation. Conclusions The method used in the present study is an simple,less injurious and highly successful technique,and the changes in electrophysiology and left ventricular function can be well monitored by ECG and UCG at different times during this period.

Objective: To explore therapeutic effect of in-hospital intravenous alprostadil injection on patients with acute myocardial infarction (AMI) complicated diabetic nephropathy (DN) undergoing percutaneous coronary intervention (PCI), and evaluate their long-term prognosis.Methods: A total of 80 AMI + DN patients undergoing PCI were selected from our hospital.They were randomly divided into alprostadil group (n=40) and routine treatment group (n=40).Renal function after PCI, cardiac function during hospitalization, serum creatinine (Scr) level on 72h after PCI and incidence of major adverse cardiovascular events (MACE) within one-year follow-up were compared between two groups.Results: Compared with routine treatment group on 72h after PCI, there was significant reduction in Scr level [(126.92±35.28) μmol/L vs.(104.32±22.91) μmol/L], and significant rise in estimated glomerular filtration rate [eGFR, (55.23±31.48) ml·min-1·1.73m-2 vs.(62.14±36.23) ml·min-1·1.73m-2] in alprostadil group, P<0.05 both.Postoperative one-year follow-up indicated that there were no significant difference in incidence rate of MACE and percentage of kidney replacement therapy between two groups, P>0.05 all.Conclusion: Intravenous alprostadil injection based on routine treatment possesses significant therapeutic effect on renal function in AMI + DN patients after PCI, and it's safe

Objective To investigate the safty and feasibility of simultaneous minimally invasive technique for congenital heart disease (CHD) and pectus excavatum (PE).Methods From July 2006 to June 2011,6 children with PE associated with CHD were treated by simultaneous minimally invasive technique.They were 4 boys and 2 girls,aged from 4 years to 6 years 5 months ( average 5 years and 4 month),.The body weight were from 16 kg to 20 kg [ average ( 18.00 ± 1.79kg ].CT Hailer index were 3.9 - 5.0 ( average 4.35 ± 0.43 ).4 patients with ventricular septal defect (VSD) were treated by minimally invasive closure device,including 3 membranous VSD and 1 subaortic VSD.The defect diameter was 4 - 5 mm.2 cases with atrial septal defect (ASD) were treated using the same technique.the diameter of ASD was 12 - 16 mm.After minimally invasive heart surgery,Nuss operation was carried out in all 6 patients for their PE.Results All operations were successful and patients were extubated 5 - 11 h after operation [ mean ( 8.17 ± 2.04) h ].The pericardial mediastinal drainage was removed at 48 h postoperatively.There were no operative mortality and severe postoperative complications.1 patient had delayed wound healing and was successfully discharged.The plate was removed in 3 cases,and they all had satisfactory outcomes.Conclusion Simultaneous minimally invasive technique is a safe and effeictive mothod for treating pectus excavatum and congenital heart disease.