Aiming at present situation and difficult position of clinical medical education,and based on the demand goal of modern medicine,this paper put forward constucting the mul-ti-dimensional optimization training pattern for five-year system clinical medicine inter-disciplinary talents by renewing the education idea,adopting the curriculum reform,the quality regulation,the educational reform,the innovation of teaching methods,and the construction of community medi-cal service practice base and so on,which is of great significance to train the high quality tal-ented person with adaptability to social development.

The application of standardized patient SP is the tendency of medical education in China.The applied characteristics of using SP in diagnostics teaching were summarized in this article.We described the recruitment,training and application of SP in the teaching process of diagnostic.The great advantages of SP and its shortage were analysed,and our expectation of deepening SP was brought forward.

This study was designed to explore the mechanism of signal transduction on BBB damage in brain injury. 75 male SD rats were randomly devided into 5 groups: control, sham operation, injury only, injury with Forskolin-treatment and H7 treatment.Evans blue permeation was observed qualitatively with an epifluo resence and mesured quantitatively with a spetrophotometer.The result shcwed that Evans blue significantly permeated in injuried group,and noticeably decereased in H7 treatment group and Forskolin treatment group. It indicated that Forskolin and H7 can effectively prevent BBB opening,and suggest that Forskoling and H7 may provide new ways on BBB protection.

This study was designed to explore the mechanism of signal transduction on BBB damage in brain injury. 75 male SD rats were randomly devided into 5 groups: control, sham operation, injury only, injury with Forskolin-treatment and H7 treatment.Evans blue permeation was observed qualitatively with an epifluo resence and mesured quantitatively with a spetrophotometer.The result shcwed that Evans blue significantly permeated in injuried group,and noticeably decereased in H7 treatment group and Forskolin treatment group. It indicated that Forskolin and H7 can effectively prevent BBB opening,and suggest that Forskoling and H7 may provide new ways on BBB protection.

Objective To investigate effects of pedicle processing methods on the survival and appearance of the pedicle flaps. Methods The study involved 17 patients with soft tissue defects of extremities treated with the “exclamation mark” shaped pedicle flaps from October 2009 to January 2011.The traditional pedicled rotation flaps was designed to be a tennis racket-like shape,then the rotational pedicle was designed to small round tension reduction flap and pedicled rotation flaps,which contributed to formation of the “exclamation mark” shaped pedicle flaps.The soft tissue defects was located at the upper extremity in three patients and at lower extremity in 14,with defect areas of 4.0 cm× 7.2 cm-5.8 cm × 14.0 cm.There used two superficial radial nerve vasotrophic flaps,one ulnar artery supra-carpal cutaneous flap,eight sural neurocutaneous vasotrophic flaps and six saphenous nerve vasotrophic flaps.Results All flaps survived at Ⅰ stage except that one flap had partial distal necrosis postoperatively,which was cured after dress change.The follow-up ranged from six months to one year,which showed unobvious swelling of the survived flaps and good appearance of the rotation point of the pedicle. Conclusion The “ex(c)lamation mark” shaped pedicle flaps can reduce entrapment of the distal pedicle,promote venous drainage,improve survival and modify the appearance of the flaps.

BACKGROUND: Researches indicated that bone marrow stem cells (BMSCs) could differentiated into neural stem cells in vitro, but what was the role of neural stem cells(NSCs) in the recovery of cortical injury,whether the NSC is capable of growing and migration in injured still remained unknown.OBJECTIVE: To explore the growing state of autograft NSC derived from crab-eating macaque BMSC transplanted in brain.DESIGN: Prospective case control study based on experimental animals.SETTING: Department of neurosurgery in a hospital of a military medical university.MATERIALS: This study was carried out at Center Laboratory of Neurological Research Institute, Zhujiang Hospital affiliated to the First Military Medical University of Chinese PLA. Six healthy adult crab-eating macaques were purchased from the South China Primate Animal Center.INTERVENTIONS: BMSCs harvested from six crab-eating macaques were cultured in vitro and induced to differentiate into neural stem cells, which then labeled by bromodeoxyuridine(BrdU) and autografted into brains.MAIN OUTCOME MEASURES: Brain tissues underwent hematoxylin and eosin(HE) staining and immunohistochemical staining before observed under optical microscope.RESULTS: The results of HE staining showed that the cell number in injured brain vas obviously higher in both instant and delayed transplanting groups than sham-transplanting group; moreover cells were proved reacting to BrdU by immunohistochemical staining in cortical injuries of both groups at 1-6 months following stem cells autograft, as well as at neighboring white matters at half year later, but no BrdU positive cells could be found in traumatic controls, sham-transplanting group and normal brains.CONCLUSION: NSCs derived from in vitro cultured BMSCs were proved capable of surviving, proliferating, differentiating and migrating in cortex after autograft, so that BMSCs is considered as replacing cells or the source of NSCs; moreover autograft stem cells could survive, proliferate and migrate in old cortical traumatic focus.

Objective To assess the irregular shape of hematoma with math methods,which is one of the risk factors of hematoma enlargement.Methods We reviewed images data of patients with spontaneous intracerebral hemorrhage treated nonsurgically who underwent initial computed tomography (CT) within 6 hours and repeated CT within 48 hours of onset.The area(s),the circumference(L),the greatest diameter(A)and the transverse diameter(B)of the greatest hemorrhage CT slice was measured.The formula X=L/S waft used to calculate the value.We calculated the area(S1)and the circumference (L1) of the ellipse with A as its long diameter and B as its short diameter.The formula X1=S1/L1 was used to calculate the value. We used formula R=X/X1 to assess the irregular hematoma shape.The relationships between hematoma enlargement and R was analyzed. Results Thirty-one patients(25.8%) showed enlarged hematomas after admission.The larger the value of R,the more irregular the shape of hematoma.When R≥1.3,the shape of the hematoma was significantly irregular.36.0% patients with R≥1.3 had hematoma enlarged.compared with only 18.6% those with R<1.3(χ2=4.62,P=0.032).Conclusions The irregular shape index R Can be used to assess the shape of a hematoma. A particularly high likelihood of hematoma enlargement is observed in patients with an irregularly shape index R≥1.3.

Objective To study the initial application of 3.0T high field intensity intraoperative magnetic resonance(iMR)for cranial tumors.Methods Forty-three patients with cranial tumors including 23 glioma cases,12 pituitary tumor cases,3 brain stem cavernous hemangioma cases,2 meningioma cases,2metastatic tumor cases,1 neurilemmoma case,received operation examined with GE Signa HDX 3.0T iMR system.The operation process and influence of iMR were reviewed.Results In 43 patients,average iMR examination was 1.3(1-3)times.In 16 patients the first iMR examination revealed tumor remnants,and in 13 of them continued surgical interventions and complete resection.The rate of complete resection was increased from 63％(27/43)to 93％(40/43).No complications related to iMR occurred.Conclusion 3.0T high field intensity iMR can provide accurate positioning and real-time navigation for the surgery,increase the rate of complete resection,improve the accuracy and safety of cranial tumor resection,and decrease complications.

Objective For decreasing the infected rate,the prevention and cure methods of intracranial infections following posterior fossa craniotomy were study. Methods Twenty-eight patients with the intracranial infections following posterior fossa craniotomy were examined by lumbar puncture,and analyzed cerebrospinal fluid with routine examination and reference to the bacteriological data and drug sensitive tests. All the patients were treated with high dosage sensitive antibiotics, and draining continually the infected cerebrospinal fluid by lumbar puncture catheterization and injected small dosages of antibiotics into intraspinal for most cases. Results Twenty-eight patients had intracranial hypertension by lumbar puncture examination, outcome of cerebrospinal fluid culture indicated that 17 cases had bacteria growth and 11 cases had no bacteria. The intracranial infection was controlled effectively,and 96.4%(27 cases) were cured, 1 case dead of systemic failure. Conclusions Strict aseptic techniques,reduce operative time,decrease intracranial place of foreign matters, such as gelfoam, hemostatic gauze and artificial implants, could reduce the possibilities of intracranial infections. Appropriate antibiotics selection,lumbar puncture catheterization and intraspinal administration of antibiotics can cure intracranial infections effectively.

BACKGROUND: Since there are only cell axons of neurons in peripheral cells, the study on neural stem cells (NSCs) is almost focused on neuronal cells, for which, the study on repair of peripheral nerve may be based on some experiences in NSCs.OBJECTIVE: To observe the repair of peripheral nerve after graft of autologus bone marrow derived NSCs in the injured area. To observe whether the grafted NSCs were survived and migrated in spinal cord as differentiated neurons in the injured area of peripheral nerve or not.DESIGN: Observed controlled experiment was designed.SETTING: Institute of Neurological Medicine of Zhujiang Hospital affiliated to Southern Medical UniversityMATERIALS: Eight New Zealand big white rabbits were employed, of clean grade, mass weighted varied from 1.5 to 2.5 kg and of either sex.METHODS: The experiment was performed in Institute of Neurological Medicine of Zhujiang Hospital affiliated to Southern Medical University collected from New Zealand big white rabbits for culture and differentiation was prepared. Sciatic neural injured area of one side was randomized as graft side. Physiological saline, collagen matrix and cellular embedding solution were infused up to 0.01 mL (containing stem cells 1×1010L-1). Another side was taken as the control, in which, collagen matrix suspension 0.01 mL was infused. Peffusion and fixation were followed 3 months after graft and auto-graft was performed in the injured peripheral nerve. The materials were collected for observation from graft area, spinal cord area, injured area on the opposite side and normal neural area.MAIN OUTCOME MEASURES: Morphology of nerve fibers and neuronal cells in NSC graft area, spinal cord area and non-graft area on opposite injury side.RESULTS: The density and continuity of nerve fibers grown in graft area were higher remarkably than non-graft area on opposite side and more Schwann cells were seen under optic microscope. With amplified ×400 visual field, Ranvier's node of spinal nerve fiber was visible. In addition,mucous matrix and few fibroblasts were seen also in the space of nerve fibers. The survived neuronal cells were no visible in graft area, spinal cord area and non-graft area of sciatic injury on the opposite side.CONCLUSION: Graft of autologus bone-marrow derived neural stem cells in defect area of peripheral area benefits repair of nerve fibers. But the neural stem cells cannot survive as neurons in graft area of peripheral nerve, spinal cord area and the defect control on the opposite side.