Compared with"Global Minimum Essential Requirements in Medical Education",our standardized surgery resident educating training performance is basically identical at training requirements and even more advanced in some aspects according to the situation of our country.But many"no standard"things still exist in course of practing.We have analyzed the problems of educ-tion of operation sense of them and make suggestions in the article for eduction of operation sense.

Objective To investigate metabolic characteristics and insulin resistance in newly diagnosed type 2 diabetes pa-tients with nonalcoholic fatty liver disease .Methods Two hundred patients with newly diagnosed type 2 diabetes mellitus including 140 with nonalcoholic fatty liver disease (NAFLD) (NAFLD group) and 60 without NAFLD (non-NAFLD group) were recruited. Metabolic characteristic were measured and recorded .homeostasis model assessment insulin resistance ( HOMA-IR) index and HOMA-C were used to assess insulin resistance .Results were compared between two groups .Results Compared with non-NAFLD group, body mass index (BMI), fasting blood glucose (FBG),alanine aminotransferase (ALT),gamma-glutamyl transferase (GGT), uric acid ( UA) , triglyceride ( TG) , low density lipoprotein cholesterol ( LDL-C) ,fasting insulin ( FINS) , fasting C peptide ( FCP) , gly-cated hemoglobin a1c (HbA1c), HOMA-IR, and HOMA-C were significantly higher in the NAFLD group ( P <0.05).Logistics re-gression analysis showed that BMI , TG, GGT, and UA were risk factots for NAFLD ( P <0.05, OR =1.82, 1.53, 1.37, and 1.09 ) .Conclusions Compared patients without NAFLD , newly diagnosed type 2 diabetes patients with NAFLD present more meta-bolic disturbance, and severely insulin resistance.Obesity and the increased level of postprandial UA , triglyceridemia, and GGT might increase the risk of NAFLD in the patients with newly diagnosed type 2 diabetes mellitus .

Objective To test and estim ate the forensic application of G oldeneyeTM DNA ID 25A K it. Methods The kit was validated by a series of tests for accuracy, sensitivity, consistency, peak height balance, stability, and m ixed sam ples through m easured blood sam ples and other sam ples in routine casework. Results The peak height balance of the different loci was ≥42% . The genotyping results of the positive control DNA was accurate. The com plete STR genotyping result could be obtained from 0.125 ng positive control DNA . Conclusion G oldeneyeTM DNA ID 25A K it is suitable for crim inal cases and DNA database in forensic practice.

Objective To evaluate the clinical value of cervical conization in diagnosis and management of cervical carcinoma in situ.Methods The clinic-pathological data of the 65 patients with cervical carcinoma in situ from Jan 2004 to Feb 2007 were analyzed retrospectively.Results(1)Of the 65 patients,59 cases had received the colposcopical multiple biopsies before the cervical conization and there was a correlation in pathology between cervical conization and colposcopical multiple biopsies in 46 cases(78.0%),but there was not much correspondence between cervical conization and colposcopical multiple biopsy in 13 cases(22.0%).(2)30 patients were received hysterectomy or cervical conization again.Patients with positive margins were significantiy more likely to have residual disease than those with negative margins(P

Objective To explore the clinical characteristics and management of urinary tract injuries incidental in gynecologic surgery. Methods Urinary tract injuries in gynecologic surgery during the past 10 years were reviewed retrospectively.The clinical features of initial operations including the types of disease,operative procedures and the methods of diagnosis and treatment was studied. Results 21 urological injuries were incurred during the performance of 6075 gynecologic surgical procedures,an incidence of 0.35% including of 10 ureter injuries and 11 bladder injuries with incidence of 0.16% and 0.18% respectively. The time of diagnosis from 0 to 23 days postoperatively.As for operation way,Laparoscopic surgery 10 cases(48%),radical surgery for cancer 7 cases(33%),other surgery 4 cases.injury of urinary tract was found intraoperatively in 15 patients(67%) and postoperatively in 7 patients(33%).Urinary fistulae occurred in 6 patients(29%).Urinary tract injuries were mainly diagnosed methylene blue infusion,via excretory urogram(IVP),CTU.An appropriate repair during operation,putting the doubleJ-catheter and catheterization was useful. Conclusion The rate of urinary tract injury is increased as more patients received laparoscopic surgery.Most of urinary tract injuries in gynecologic surgery had optimal results when they were diagnosed early and managed correctly.

OBJECTIVE:To improve the formula of urea cream and establish its quality control methods.METHODS:The matrix component of formula was adjusted to prepare O/W matrix.Prednisone was added into matrix to prepare urea cream;UV spectrophotometry was applied to determine the content of urea and evaluate the quality of preparation and the stability of 3 batches of samples setting for 40 days under different conditions.RESULTS:The preparation was white cream and its inspection results were in line with the standards stated in Chinese Pharmacopoeia(2005 edition).The linear range of urea was 30.5～180.2 ?g?mL-1(r=0.999 0) with an average recovery of 99.68%(RSD=0.49%).The quality of 3 batches of samples kept stable during observation.CONCLUSION:Improved formula is reasonable,simple in preparation technology and quality control.

Objectives:To observe the role of peri operational nutritional support in the old patients with gastrointestinal carcinoma. Methods: One hundred and seventeen cases of aged patients with gastrointestinal carcinoma were divided into two groups: nutritional support (NS) group and normal therapy(NT) group. The therapeutic effects of peri operational nutritional support were studied. Results: All patients survived. The rate of complication in group of NT was higher than that of NS group. The recovering time of the gut function after operation and average duration in the hospital of the NT group were longer than that in the NS group. The recovery of body weight, level of plasma albumen and nitrogen balance in NS group was faster than that of NT group. Conclusions:Peri operational nutritional support in the aged patients with gastroenterological carcinoma is of significance, improving the nutritional condition,enhancing the endurance from the surgical trauma and decreasing the rate of postoperative complication.

Objective To evaluate the pathogenesis and disease progression by detecting the expression of Serum High mobility group protein 1 (HMGB1) and TLR2 in monocytes of patients with systemic lupus erythematosus (SLE).Methods Forty patients with SLE were selected randomly,20 patients were in active disease group and others were in stable disease group.The expression of HMGB1 in the serum of these cases were detected by enzyme linked immunosorbent assay (ELISA) and TLR2 on CD14+ monocytes in the peripheral blood were detected by FCM.The correlation between these indexes and clinical,laboratory indexes about SLE were analyzed using one-way ANOVA,and Kruskal-Wallis test.Results The expression levels of HMGB-1 in serum was [(48.9±11.3) μg/L] in the active group,while that was [(14.8±1.9) μg/L] in the stable group was,and [(13.5±3.6) μg/L] in the control group.HMGB1 in the active SLE group was significantly higher (P＜0.05) when compared with that of the stable and control group.The expression of TLR2 in the peripheral blood mononuclear cells was [(96.7±1.3)％] in the active group,[(83.5±9.1)％] in the stable group,and [(83.3±9.9)％] in the control group TLR2 in the active SLE group was up-regulated when compared with the stable and control groups (P＞0.05).There were positive correlation between the serum levels of HMGB1and TLR2 in the peripheral blood mononuclear cells (r=0.551,P＜0.05).Conclusion The expression levels of HMGB-1 in serum and the expression of TLR2 in peripheral blood mononuclear cells may participate in the pathological processes of SLE.

Objective To investigate the pathogenesis and clinical features of ankylosing spondylitis (AS) concurrent with multiple myeloma (MM).Methods The clinical characteristics,pathogenesis,diagnosis and treatment of 3 cases who were diagnosed as AS concurrent with MM were analyzed and relevant literatures were reviewed.Results MM was confirmed in patients who had long-term stable AS.A wide variety of manifestations,including persistent pain in spine and thorax,pathologic fracture,anemia,kidney damage and nervous system abnormalities were frequently presented.These patients were insensitive to nonsteroidal anti-inflammatory drug treatment,and they had a unfavorable prognosis.Conclusion Patients who are diagnosed as AS concurrent with MM can present with a variety of clinical features.Manifestations which are difficult to explain clinically by AS and poor response to treatment especially when the patients have longterm stable AS are potential clues for MM.

Objective Establishing a trapezoid micro-plate method to detect ABO blood group in serum.Methods Select 32 blood samples containing A,B,O or AB types randomly.Use orthogonal design principle to select the optimum conditions of the blood plasma dilution,erythrocytes density,temperature and static time.The mix-blood samples are serially diluted.The agglutinating and nonagglutinating gray zones are also defined.Based on the optimum conditions and criterions,the reproducibility test,sensitiveness test,accuracy test,lipaemia interference test and haemolysis interference test are carried out.6 ABO subgroup(AM,AX,A2B,A3B,AXB,BM) and 5 irregular antibody(anti-M,anti-N,anti-P1,anti-Leb,anti-HI) are detected to evaluate the ability of the trapezoid micro-plate method to detect special samples.Results The trapezoid micro-plate method's repetitiveness tests coincidence is 100%.Its sensitivity is identical to the test tube method.The accuracy is 99.99%.In the 47 various kinds of lipaemia blood samples' anti-interference tests,the correct interpretation at one time is 100%.In the haemolysis interference tests,when hemoglobin content are below 20g/L,there are no obvious influences found.When sever haemolysis appears(blood plasma hemoglobin content are above 20g/L),there is no effect on the agglutination,but make a difference to the nonagglutinating.The ability to dectect 6 ABO blood subgroups and 5 irregular antibody blood samples is great.Conclusion The trapezoid micro-plate method not only has good ability to detect the ABO blood group both in the red cell typing and serum typing,but also enhances the accuracy in detecting the agglutinating blood samples and improves the exactitude of the tests.