In recent years, the medical graduates who take part in postgraduate examination have been increasing each year. The preparation for postgraduate examination affects the clinical practice, but not yet has a quantitative report. This article studied the students in general surgery, which were divided into postgraduate examination group and clinical practice group. By comparing the theoretical knowledge results and the clinical practice skills between the two groups we found that there was no difference between the two groups in the theoretical and operating skill when they were just in the department, and the operating results in the clinical practice group were better than the postgraduate examination group when they were out of the department.

Objective To improve clinicians'understanding of nephrotic syndrome and myasthenia gravis as adverse events of penicillamine(D-PA).Methods Two patients were reported to develope adverse reaction after taking D-PA.The related literature were reviewed.Result The first case was a systemic sclero- sis(SSc)patient treated with D-PA who developed nephrotic syndrome and blepharoptosis.The second case was a rheumatoid arthritis patient treated with D-PA who developed dysphagia and drinking bucking.The clinical symptoms were improved after disconting D-PA.Their conditions were stable up to now.Conclusion D-PA is used widely for various of autoimmune diseases.Clinicians should pay attention to these special and rare adverse effects.

As the active ingredient of traditional Chinese medicine Scutellaria baicalensis Georgi, baicalin has a variety of pharma-cological effects. In recent years, baicalin has made significant achievement in the prevention and treatment of central nervous system diseases, such as ischemic brain injury, hemorrhagic brain injury, Parkinson' s disease and spinal cord injury. Numerous studies showed that baicalin could prevent oxygen free radical injury, inhibit nerve cell apoptosis, inhibit inflammation factor expression, pro-tect the mitochondrial energy metabolism, inhibit thrombin receptor and adjust the balance of excitatory amino acid and inhibitory amino acid. Based on the neuroprotective effect of baicalin, it may be a potential medicine for the treatment of central nervous system disea-ses.

AIM: To study the effect of breviscapine on the oxidative stress in the liver and kidney in diabetic rats. METHODS: Diabetes was induced by injection of streptozotocin (ST Z). Rats were randomly divided into three groups: control group, model group, mo del group treated with breviscapine. 8 weeks after STZ injection, liver lesion w as evaluated using HE, oil red O staining and kideny lesion using PAS staining. Malondiadehyde (MDA) levels and antioxidant activities in liver and kidney tissu e were determined by spectrophotometric method. RESULTS: Light microscopy in HE staining showed that liver fatty score was significantly lower in the breviscapine group compared with model ani mals (0.55?0.43 vs 1.54?0.65, P

Objective:To determine the diagnostic value of multislice CT urography (MSCTU) in patients with transitional cell carcinoma ( TCG) of upper urinary tract by comparing other imageology methods used. Methods: Two hundred and thirty four cases of transitional cell carcinoma of upper urinary tract, in which 82 cases were diagnosed pathologically with pelvic carcinoma and 152 cases with ureteral carcinoma, between June 2004 and September 2006 in our institute were enrolled in a retrospective study. Most of them underwent urological ultrasound, intravenous urogram (IVU) , retrograde pyelography and MSCTU. We compared the positive rate (PR) and diagnostic rate (DR) of these methods used by chi-square test. Results: Among the 234 cases, 215 patients underwent urologic ultrasound, in which 152 cases were detected to be abnormal, with the PR of 70.1% ;Meanwhile, 58 cased were diagnosed by this examination, with the DR of 27. 0%. IVU was performed in 193 patients and 132 cases were found to be abnormal, and the PR was 68. 4% , 65 cases were diagnosed by IVU and the DR was 33.7%. And 132 patients underwent retrograde pyelography, by which 115 cases of lesion were detected, with the PR of 87. 1% ; In the meantime, 93 cases were diagnosed, with the DR of 70. 5%.MSCTU was performed in 226 cases and 220 cases were found to be abnormal, and the PR was 97.3% ;214 cases were diagnosed by MSCTU, with the DR of 94. 7%. The DR of detecting TCC of retrograde pyelography had statistically significant difference with that of ultrasound and IVU(P＜0.001). As compared with retrograde pyelography, MSCTU had statistically significant superiority (P＜0.001). Conclusion: To shorten the diagnosis time and mitigate the sufferings, patients with hematuria supposed to be TCC of upper urinary tract should be recommended to undergo MSCTU first.

Objective To compare the effects and significance of laparoscopic and open D2 gastrectomy on the expression of interleukin (IL)-6 and IL-10.Methods The clinical data of 146 patients with gastric cancer who were admitted to the Southwest Hospital from November 2010 to October 2011 were prospectively analyzed.All the patients were randomly divided into the laparoscopic group (75 patients) and open group (71 patients)according to the sealed envelope method.Laparoscopic or open D2 gastrectomy were performed according to the 14th edition of gastric cancer treatment guidelines of Japan Gastric Cancer Association.Peritoneal lavage fluid was collected at the beginning and the end of operation,and the concentrations of IL-6 and IL-10 in the peritoneal lavage fluid were detected by enzyme linked immunosorbent assay.The measurement data were analyzed using the t test,and the count data were analyzed using the chi-square test.Results The preoperative concentrations of IL-6 in the laparoscopic group and the open group were (34 ± 13)μg/L and (35 ± 12)μg/L,respectively,with no significant difference between the 2 groups (t =-5.110,P ＞ 0.05).The postoperative concentrations of IL-6 in the laparoscopic group and the open group were (4015 ± 1592)μg/L and (6724 ± 2112)μg/L,respectively.The postoperative concentration of IL-6 in the laparoscopic group was significantly lower than that of the open group (t =-8.367,P ＜ 0.05),and the postoperative concentrations of IL-6 were significantly higher than those before operation in the laparoscopic group and open group (t =-59.065,-87.123,P ＜0.05).The preoperative concentrations of IL-10 in the laparoscopic group and the open group were (43 ±9) μg/L and (42 ± 10) μL,respectively,with no significant difference between the 2 groups (t =1.190,P ＞0.05).The postoperative concentrations of IL-10 in the laparoscopic group and the open group were (92 ± 32)μg/L and (62 ± 23)μg/L,respectively.The postoperative concentration of IL-10 was significantly higher than that of the open group (t =6.408,P ＜ 0.05),and the postoperative concentrations of IL-10 were significantly higher than those before operation in the laparoscopic group and the open group (t =-12.680,-6.802,P ＜ 0.05).Conclusion Peritoneal inflammatory reaction is relatively lighter after laparoscopic D2 gastrectomy when compared with open D2 gastrectomy,which might prevent the peritoneal metastasis of gastric cancer mediated by IL-6.

Advanced gastric cancer is usually dealt with D2 radical dissection. There are different opinions as to whether it is necessary to perform D3 radical lymphadenectomy.Some scholars thought that properly enlarged radical dissection can improve long-term outcomes for the treatment of advanced gastric cancer.In recent years,laparoscopic D1 and D2 radical dissection of gastric cancer could be carried out in many hospitals.However,the technique and related skills for performing D3 radical lymphadeneetomy through laparoscope remains to be explored.Based on our previous experiences,D3 radical lymphadeneetomy using artery suspension method and medial-to-lateral approach for advanced gastric cancer is proved to be safe and feasihle.

ObjectiveTo evaluate the feasibility, safety and the long-termoutcomes of laparoscopy-assisted distal gastrectomy (LADG) for advanced gastric cancer (AGC).MethodsWe retrospectively analyzed the clinical and follow-up data of 346 cases after LADG from January 2004 to June 2009, compared with 313 cases after conventional open distal gastrectomy (ODG) for advanced gastric cancer at the same period at our hospital. The surgical safety, postoperative complications, survival rate, and the recurrence and metastasis of cancer were compared.ResultsThere was no significant difference at the average time of LADG and ODG procedures (211 ± 56) min vs.(204 ±41 ) min, but blood loss during operation and length of incision in LADG group were significantly less than in the ODG group. The proximal and distal length were, respectively, (6. 3 ± 2. 0) cm and (5. 7 ± 1.7 ) cm in LADG group and (6. 3 ±2. 1 ) cm and (5.6 ± 1.6) cm in ODG group, the difference was not significant. The number of lymph node dissections was also similar: (33 ± 13) in LADG group and (33 ± 16) in ODG group. The incidence of postoperative complications in LADG group was significantly lower than that in ODG group ( 6. 7％ vs.13. 1％, P ＜ 0. 05). During the follow-up period of 6-72 months (average 37 months), the 1-, 3-and 5-year survival rates were, respectively, 87. 2％, 57. 2％ and 50. 3％ in LADG group and 87. 1％, 54. 1％and 49. 2％ in ODG group, the difference was not significant. The differences in recurrence and metastasis between the two groups were not statistically significant.ConclsionLaparoscopy-assisted gastrectomy for advanced gastric cancer is not significantly different with open surgery in postoperative survival rate or recurrence. It is less traumatic and of fewer complications.

Objective To investigate the clinical value of a new anvil inserting method for esophagogastrostomy or esophagojejunostomy during laparoscopic radical proximal gastrectomy or radical total gastrectomy for gastric cancer.Methods The clinical data of 21 patients with gastric cancer who received laparoscopic radical proximal gastrectomy or radical total gastrectomy at the Southwest Hospital from March 2010 to February 2011 were retrospectively analyzed.Five trocars were inserted through the abdominal wall of the patients.After perigastric lymphadenectomy and mobilization of esophagus,an incision was made on the esophagus above the tumor,and then the anvil with drawn wire attached was inserted into the esophagus.An endo-cutter was applied to cut the esophagus adjacent to the incision left the drawn wire untouched,and then the stem of the anvil was pulled out by the drawn wire for laparoscopic anastomosis. Results The operations were successfully accomplished under the laparoscope with no conversion to open surgery.Fifteen patients received laparoscopic radical total gastrectomy and 6 received laparoscopic radical proximal gastrectomy. The mean operation time,volume of blood loss,time to off-bed activity,passage of flatus and postoperative duration of hospital stay were (257 ± 38) minutes,( 119 ± 32) ml,(2.5 ± 0.5 ) days,( 3.7 ± 0.8 ) days and (7.5 ± 2.6) days,respectively.No perioperative mortality,anastomotic bleeding or anastomotic fistula was detected.One patient was complicated with pulmonary infection + pleural effusion and was cured by conservative treatment; 1 was complicated with anastomotic stenosis which was alleviated by gastroscopic balloon dilation; 1 was complicated by incisional infection and was cured by medical treatment after drainage.No cancer cells were detected at the anastomotic ring or resection margin of the specimen.There were 4 patients with well-differentiated adenoma,8 with moderate-differentiated adenoma and 9 with poor-differentiated mucinous adenoma.There were 5 patients in stage Ⅰ,10 in stage Ⅱ and 6 in stage Ⅲ (UICC staging).Twenty-one patients were followed up for a mean period of (11 ±4) months (range,6-17 months ),no tumor recurrence or metastasis was detected. Conclusions The new technique for anvil insertion is safe,effective and easy for manipulation and learn.It offers a new approach for laparoscopic digestive tract reconstruction.

Objective To investigate the predictive factors of progressive motor deficits (PMD) after isolated pontine infarction. Methods Consecutive patients with isolated pontine infarction admitted to hospital within 48 hours after onset were enroled. They were divided into either a PMD group (increase ≥1 within 7 days) or a non-PMD group according to the clinical course and the changes of motor scores of the National Institutes of Health Stroke Scale (NIHSS). The pontine infarction patterns were classified as basal surface infarction and deep infarction, the sides were divided into left and right, the infarct levels were divided into upper, middle, and lower according to diffusion-weighted imaging. The demographics, baseline clinical data, and imaging features were compared between the two groups. Multivariable logistic regression models were used to analyze the predictive factors of PMD after isolated pontine infarction. Results A total of 101 patients with isolated pontine infarction admitted to hospital within 48 h of onset were enroled, including 16 in the PMD group and 85 in the non-PMD group. The proportions of pontine infarction involving the basal surface (87. 5% vs. 47. 1% , χ2 = 8. 851, P = 0. 003), the infarcts on the middle levels (56. 2% vs. 24. 7% , χ2 = 4. 851, P = 0. 028), and basilar artery stenosis or occlusion (62. 5% vs. 27. 1% ,χ2 = 7. 689, P = 0. 006) of the PMD group were significantly higher than those of the non-PMD group, while the proportions of the infarcts on the left sides (18. 8% vs. 56. 5% , χ2 = 7. 664, P = 0. 006) and the infarcts on the upper levels (37. 5% vs. 72. 9% , χ2 = 7. 689, P = 0. 006) of the PMD group was significantly lower than those of the non-PMD group. Multivariate logistic regression analysis identified that pontine infarction involving the basal surface (odds ratio 5. 650, 95% confidence interval 1. 011 - 31. 580, P = 0. 049) and basilar artery stenosis or occlusion (odds ratio 4. 075, 95% confidence interval 1. 127 - 14. 741, P = 0. 032) were the independent risk factors for PMD after isolated pontine infarction. Conclusions Infarction involving the basal surface and basilar artery stenosis or occlusion may be the predictors for PMD after isolated pontine infarction.