Clinical internships play an important role in higher medical education. According to the new standards in undergraduate medical education set by the MOE and MOH,we identified 4 main problems in our internships training,including lack of awareness of career planning,interns'absence from duty,lack of hands-on opportunities,psychological problems,etc. According to these problems,we carried out a series of solutions such as strengthening intern orientation,especially in aspects of professionalism and clinical skills training,optimizing the rotation schedule and improving the evaluation methods etc. Experiential evidence and perceptions of interns and their tutors showed that these changes were effective.

Hip Joint ; Humans ; Ischium/diagnostic imaging* ; Magnetic Resonance Imaging

Objective To study the protective role of AngiotensinⅡreceptor inhibitor in ventilator-induced lung injury of rats.Method Forty healthy male SD rats were equally divided into four group (A,B,C,D group,n=10).Group A served as control group,group B had low tidal volume (V_T=10 ml/kg) with breathing rate (P)=80/min;group C had high tidal volume (V_T=40 ml/kg) group with breathing rate 80/min;group D had high tidal volume (V_T=40 ml/kg) group with breathing rate 80/min,all rats in group D were pretreated with Losartan.The duration of ventilation in 'all groups was two hours.Rats were sacrificed after experiment finished. The lung lavage liquid and lung tissue were collected and preserved with well established methods.Lung pathological change was observed by microscope;lung cell apoptosis was assessed with TUNEL;the expression of ANGⅡwas assayed with RT-PCR.The measured variables also included total protein,WBC,W/D,MPO. Results In comparison with B group,all variables in group C were significantly increased (P

Objective To evaluate the therapeutic value of endoscopic submucosal dissection(ESD) for large flat gastric lesions.Methods Large flat gastric lesions (≥2cm ) were dissected with a curved needle knife following:①injecting normal saline into the submucosa to separate the lesion from the mus- cle layer;②pre-cutting the surrounding mucosa of the lesion,and③dissecting the connective tissue of the submucosa under the lesion.Results Five flat gastric lesions ranged from 2.0 to 5.0 cm were re- moved successfully.Three located in the antrum,1 in the body and 1 in the incisure.The procedure time ranged from 80 to 120 min .Average blood loss was about 100 ml.The bleeding was controlled by elec- trocoagulation,argon plasma coagulation and clip.One patient had delayed bleeding after ESD.There was no perforation.There were clear resection margins confirmed by pathology in all 5 cases.The patients were followed up for 1-6 months .There were no recurrence with complete healing of original lesions.Conclusions ESD is a useful endoscopic method in treating large flat gastric lesion.It can com- pletely remove large lesion and provide precise pathological diagnosis.

Norovirus ; chemistry ; Receptors, Virus ; physiology ; Viral Structural Proteins ; chemistry ; immunology ; Viral Vaccines ; immunology

BACKGROUND AND OBJECTIVEDetection of label retaining cells (LRCs) has been a method to confirm existence of stem cells, and bromodeoxyuridine (BrdU) has commonly been used for labeling. In this study, to verify stem cells in nasopharyngeal carcinoma (NPC), LRCs were established and detected in NPC cell line 5-8F.

METHODSThe 5-8F cells were cultured with BrdU and inoculated subcutaneously into nude mice. By immunohistochemistry, immunocytochemistry, and immunofluorescence, BrdU was detected in 5-8F cells and xenograft tumors.

RESULTSBrdU was strongly positive in cells on the 2nd and the 7th day after being added BrdU, while negative when cells were cultured without BrdU. However, only sporadic cells were positive on the 14th day after BrdU being washed out, and these cells were thought to be LRCs. The average percentage of LRCs was (0.67 +/- 0.32)%. After being cultivated with BrdU for 48 h, 5-8F cells were inoculated into nude mice subcutaneously. After chasing 8 weeks, only sporadic LRCs were detected in xenograft tumors, with a proportion of (0.55 +/- 0.36)%, and these LRCs were located at cancer margin.

CONCLUSIONThe existence of LRCs in 5-8F cells indicates the existence of cancer stem cells in NPC.

Animals ; Bromodeoxyuridine ; metabolism ; Cell Line, Tumor ; Female ; Humans ; Mice ; Mice, Inbred BALB C ; Mice, Nude ; Nasopharyngeal Neoplasms ; metabolism ; pathology ; Neoplasm Transplantation ; Neoplastic Stem Cells ; cytology ; metabolism

OBJECTIVETo investigate the feasibility and safety of endoscopic full-thickness resection(EFTR) in the treatment of colorectal submucosal tumor(SMT).

METHODSFrom September 2009 to March 2012, 4 cases with colorectal SMT received EFTR at the Endoscopic Center in the Zhongshan Hospital of Fudan University. The operative time, complications, and follow-up data were analyzed.

RESULTSThere were 3 females and 1 male. The age ranged from 33 to 78 years. The tumor location included the upper rectum(n=2), the ascending colon(n=1), and the descending colon(n=1). The mean operative time was 48.0(24-80) min. The mean diameter was 1.45(0.8-2.0) cm. Postoperative pathological examination revealed schwannoma, pneumatosis cystoides intestinalis, endometriosis, and mild hyperplasia of smooth muscle in the muscularis mucosa. There was no bleeding or perforation intraoperatively and postoperatively. Two patients developed abdominal pain and fever, one of whom had regional peritonitis and was managed by fasting and intravenous antibiotics. No surgical intervention was required. Postoperative follow up ranged from 1 to 30 months and no residual cancer or recurrence was found.

CONCLUSIONEFTR is a safe and effective method for colorectal SMT.

Adult ; Aged ; Colorectal Neoplasms ; surgery ; Endoscopy, Gastrointestinal ; methods ; Female ; Follow-Up Studies ; Humans ; Intestinal Mucosa ; surgery ; Male ; Middle Aged ; Retrospective Studies

OBJECTIVETo compare clinical results of two methods for the treatment of femoral neck fracture, which are cannulated screw fixation combined with percutaneous autogenous bone marrow grafting, and simple cannulated screw fixation. To investigate the curative effects of cannulated screw fixation combined with percutaneous autogenous bone marrow garfting to promote fracture healing and reducing femoral neck necrosis.

METHODSThe clinical data of 60 cases, which were enrolled from December 2000 to December 2008 consecutively in our hospital, were analyzed retrospectively. Thirty patients with femoral neck fractures were treated with cannulated screw fixation and percutaneous autogenous bone marrow grafting. There were 20 males and 10 females, ranging in ages from 18 to 89 years,with an average of (52.3 +/- 0.2) years. There were 13 patients with traffic accident, 3 patients with falling injuries and 14 patients with tumble. Based on the Garden classification for femoral neck fractures, 1 patient was type I, 6 patients were type II, 12 patients were type III and 11 patients were type IV. Among 30 patients in the control group, 16 patients were male and 14 patients were female, ranging in age from 18 to 91 years, with an average of (51.9 +/- 0.1) years. Twelve patients injured with traffic accident, 1 patient with falling injuries and 17 patients with tumble. Based on the Garden classification for femoral neck fractures, 5 patients were type I, 2 patients were type II,15 patients were type III, and 8 patients were type IV. Patients in the control group were treated with cannulated screw fixation only. All the patients were followed up for 2 years after operation. The fracture healing and complications were evaluated and compared between the two groups.

RESULTSThe average healing time was (7.1 +/- 1.2) months in the observing group and (8.0 +/- 1.4) months in the control group. The healing of femoral neck fracture occurred in 29 cases in observing group while in 24 cases in the control group contrast to femoral head necrosis occurred in 1 case in the observing group while in 6 cases in the control group. According to Harris scoring system, the good and excellent rate of the two groups had statistical difference (P < 0.05).

CONCLUSIONCannulated screw fixation and percutaneous autogenous bone marrow grafting is a more efficient method for accelerating healing of femoral neck fractures and reducing femoral head necrosis.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Bone Marrow Transplantation ; Bone Screws ; Female ; Femoral Neck Fractures ; physiopathology ; surgery ; Fracture Fixation, Internal ; methods ; Humans ; Male ; Middle Aged ; Transplantation, Autologous

OBJECTIVETo evaluate the efficacy and safety of endoscopic submucosal dissection (ESD) for the removal of small gastrointestinal stromal tumor (GIST).

METHODSGIST diagnosed by endoscopic ultrasonography (EUS) was managed by ESD with the needle knife as follows:(1)Injecting normal saline into the submucosa. (2)Pre-cutting the surrounding mucosa of the lesion. (3) Dissecting the submucosal tissue to display GIST and resecting the lesion completely.

RESULTSOf 20 GISTs, 12 located in gastric fundus, and 1 in gastric antrum, 3 in gastric body and 4 in rectum. Lesion diameter ranged from 0.5 to 3.2 cm and the mean resected size was 1.6 cm. Among 20 lesions, 19 were resected with ESD completely, and 1 received additional operation because of tumor residual in the wound after ESD. The success rate of ESD was 95.0% (19/20). The mean ESD procedure time was 87.5 min (ranging from 60 to 150 min). None of the patients had delayed bleeding after ESD. Perforations occurred in 3 cases after the dissection of the GIST, which were closed with metallic endoclips without additional surgical suture. The perforation rate of ESD was 15.0% (3/20). The follow up ranged from 2 to 12 months, and no recurrence was observed by EUS except the above-mentioned case undergone additional operation.

CONCLUSIONESD is effective and safe for small GIST, which can resect the whole lesion and provide pathological information.

Adult ; Aged ; Digestive System Surgical Procedures ; methods ; Endoscopy, Gastrointestinal ; methods ; Endosonography ; Esophagoscopy ; Female ; Follow-Up Studies ; Gastric Mucosa ; surgery ; Gastrointestinal Stromal Tumors ; surgery ; Humans ; Male ; Middle Aged

Objective To evaluate the therapeutic efficacy and safety of transcatheter closure of atrial septal defect (ASD) and patent ductus arteriosus (PDA) using Amplatzer occluder. Methods Routine cardiac catheterization and angiography were performed in 50 patients (23 male, 27 female, age ranging from 3 to 64 years old), including 19 cases of ASD and 31 cases of PDA under local or general anesthesia. After balloon sizing of the ASD, the optimal Amplazter septal occluder (ASO) was transmitted into the left atrial, and the left and right disks were released in turn. The Amplatzer occluder was completely released after transthoracic echocardiography confirmed that there was no residual shunts or new onset mitral valve regurgitation. The Amplatzer duct occluder (ADO) size was selected according to the narrowest point of PDA measured by angiography, and the occluder was released after the repeated angiography showed no residual shunts. Results ① The mean diameter of the ASD measured by balloon was 13-31 (23?6) mm and the diameter of ASO was (17-40) mm. The immediate closure rate was 100%. ② Angiography confirmed that closure of the ductus using ADO was achieved in 30 patients, and closure of the large size (12 mm) was achieved in 1 case of PDA patient using ASO (17 mm). No complications were encountered. Conclusion Transcatheter closure of ASD and PDA using Amplatzer device, with the advantages of simple operation, confirmative occlusion efficacy, minimal invasiveness, wide indications, and less complications, has a bright future of clinical application.