To improve the clinical probation in lemology teaching,we may take the following measures:amending the teaching content,improving the teaching methods and promoting doctor-patient communications.

Objective To incubate rat neural stem cells (NSCs) with selection-specific inhibitor ( LY294002) of PI3-K, and explore the effects of PI3-K/AKT signal transduction pathway in NSCs. Methods NSCs derived from E15-16 rats were isolated and cultured. After incubation of NSCs with different concentrations of LY294002 (0 to 40 μmol/L), cell survival ( WTS-8 assay), proliferation ( BrdU immunohistochemical identification), differentiation (β Tubulin-III immunohistochemical identification) and AKP phosphorylated protein (Western blotting) were detected. Results The effects of LY294002 on the survival, proliferation and differentiation of NSCs was concentration-dependent. The survival of the NSCs decreased significantly with a higher concentrations of LY294002 (25, 30, 35, 40 μmol/L) (P < 0. 05). The numbers of BrdU positive cells with LY294002 of 30, 35 and 40 μmol/L were significantly smaller than that of the control (LY294002 0 μmol/L) (P < 0.05). The numbers of β Tubulin-III positive cells with LY294002 of 35 and 40 μmol/L were significantly smaller than that of the control (P < 0. 05). The expression of AKT was blocked by LY294002 in a concentration-dependent manner. Conclusion PI3-K/AKT signal transduction pathway plays a vital role in the survival, proliferation and differentiation of NSCs.

Obesity has rapidly become a pandemic and is associated with increased carcinogenesis, especially esophageal adeno-carcinoma (EA). Adipose tissue is considered an endocrine organ because of its capacity to secrete a variety of adipokines, such as leptin, adiponectin, and resistin. Adipokines have recently been found to be associated with different types of chronic esophageal diseas-es, including gastro-esophageal reflux diseases, Barrett esophagus, and carcinogenesis. First-hand evidence supporting the inhibitory and/or active function of adipokines has been collected on human EA. This review aims to provide important insights into the potential mechanisms of adipokines in EA progression.

Objective:To investigate the effects of Dexmedetomidine for supplemental anesthesia on perioperative hemodynamics and postoperative sedation and analgesia in elderly patients receiving radical gastric cancer surgery under general anesthesia.Methods:From January 2019 to April 2020, 63 patients admitted to our hospital for radical gastric cancer surgery were included as observation objects.They all underwent general anesthesia and were divided into the Dexmedetomidine group(odd-numbered group)and the normal saline group(even-numbered group)according to the parity of serial numbers the subjects were assigned to.Changes in perioperative hemodynamic index values and the amounts of anesthetic drugs used in the two groups were monitored and recorded, and postoperative sedation and analgesia effects were evaluated by using the Ramsay sedation scale and the visual analog scale(VAS).Results:The mean artery pressure(MAP)and heart rate(HR)were lower in the Dexmedetomidine group than in the normal saline group before anesthesia induction(T1), immediately after intubation(T3)and immediately after extubation(T5)( P<0.05). The Ramsay scores were higher and the VAS scores were lower in the Dexmedetomidine group than in the normal saline group at 1 h and 4 h after surgery( P<0.05). The doses of intraoperative propofol and remifentanil were lower in the Dexmedetomidine group than in the normal saline group[(1121.5±198.5)mg vs.(1395.6±332.7)mg, (3.1±0.9)mg vs.(5.5±1.2)mg, P<0.05]. Conclusions:The use of Dexmedetomidine for supplemental anesthesia can effectively maintain the stability of the patient's intraoperative hemodynamics and enhance the sedative and analgesic effects while reducing the amount of anesthetic drugs in patients receiving radical gastric cancer surgery under general anesthesia.

Objective To investigate the success rate of fluoroscopy-guided subclavian vein catheter implantation (SVCI) in children with hematologic diseases,to improve the visualization of the position of the catheter head,and to reduce the incidence of procedure-related complications.Methods Fluoroscopyguided SVCI was performed in 183 sick children (aged 1-16 years) with confirmed hematologic disease.The success rate of the catheter implantation,the number of needle puncturing,the operation time,the fluoroscopy time and the occurrence of procedure-related complications were recorded.Results Successful fluoroscopy-guided SVCI was accomplished in all 183 sick children,with a success rate being 100％.Successful SVCI was obtained with ＜3 times of puncturing in 151 sick children (82.5％),with 4-6 times of puncturing in 25 sick children,and with 7-10 times of puncturing in 7 sick children.The catheter tip was successfully positioned at the junction of the superior vena cava with the right atrium in all sick children.The operation time ranged from 5 min to 25 min with a mean of (10.38±4.04) min.The fluoroscopy time varied from 16 seconds to 607 seconds with a mean of (65.46±55.86) seconds.During the procedure,artery was wrongly punctured two times in two sick children.The mean follow-up time was 35 days.Cather-related infection occurred in 2 sick children.No local hematoma at puncture point,nor hemopneumothorax or catheter-related thrombosis occurred.Conclusion Fluoroscopy-guided SVCI has high technical success rate in children with hematologic diseases.For a successful procedure of SVCI,less number of needle puncturing is needed by using this technique.The satisfaction rate for the placement of catheter tip is high and the incidence of complications is low.Therefore,fluoroscopy-guided SVCI is a safe and effective method.

ObjectiveTo discuss the biomechanical properties of clavicle intramedullarynail in fixing middle fracture of clavicle and compare with the traditional plate and screw and single Kirschner wire,in order to provide scientific evidence for clinical application.MethodsFifteen adult cadaver were collected to make middle fracture of clavicle models.According to the clinical operation methods,the fracture models were divided into three groups with 5 specimens each:clavicle intramedullary nail group,plate and screwfixation group,and Kirschner wire internal fixation group.Biomechanical properties of three groups were tested and compared by experimental stress analysis method.ResultsIn the load 1000 N,the bending strength and bending stiffness of clavicle intramedullary nail group[ (57.41±4.72),( 2.28±0.17) N ] had no significant difference compared with those of plate and screw fixation group[(58.50 ±t4.14),(2.26 ±0.20) N ] (P ＞ 0.05),while had statistical significance compared with Kirschner wire internal fixation group [(51.14±4.32),(1.54±0.16) N] (P ＜ 0.05).The bending strength and bending stiffness had statistical significance between plate and screw fixation group and Kirschner wire internal fixation group (P＜ 0.05).In the torsional mechanical test,torque of clavicle intramedullary nail group had no significant difference compared with plate and screw fixation group (P ＞ 0.05 ),but had statistical significance compared with Kirschner wire internal fixation group (F =14.88,P ＜0.05).In compression test of the clavicle,the compression limit load of clavicle intramedullary nail grotup [ ( 1246±87) N ] had no statistical significance compared with plate and screw fixation group [ ( 1348±121 ) N ] ( P ＞ 0.05 ),and had significant difference compared with Kirschner wire internal fixation group [ ( 870±72 ) N ] (F =14.74,P ＜ 0.05 ).Conclusions Clavicle intramedullary nailing for treating middle fracture of clavicle can provide better biomechanical strength,stiffness and stability.Meanwhile as a minimally invasive operation,this operation method is feasible.Compared to other internal fixation methods,it has certain advantages.

Objective To investigate the efficiency and safety of laparoscopic hepatectomy (LH) and open hepatectomy (OH) in patients with hepatocellular carcinoma (HCC). Methods A total of 45 HCC cases undergoing hepatectomy from January 2008 to December 2010 in our hospital were divided into LH group ( n =21 ) and OH group ( n =24 ).Their clinical efficiency and safety were compared and analyzed. Results The amount of intraoperative blood loss and blood transfusion in LH group were significantly higher than that of OH ( respectively x2 =3.973,x2 =4.862,all P ＜ 0.05 ).LH is associated with less postoperative complications and duration of hospital stay,compared with OH ( respectively x2 =4.746,t =-2.717,all P ＜0.05).Cumulative survival rates in both groups were not statistically significant ( x2 =0.172,P ＞ 0.05 ).However tumor-free survival rate in LH was significantly higher,superior to that of OH (x2 =4.543,P ＜ 0.05). Conclusions LH and OH are all safe and effective hepatectomy for HCC.LH has the advantage of less complication and shorter hospital stay.

Objective To study the genetic regulation mechanism of colorectal LST,polypoid adenomas and clolrectal cancer by detecting the expression of p53,c-myc and Ki-67 in these three lesions.Methods The expressions of p53,c-myc,Ki-67 were determined via two-step of immunohistochemistry method in LST,polypoid adenomas,invasive colorectal cancer and their significant difference were compared.Statistical analyses were used to analyze the correlation among Ki-67 expression and p53,c-myc expression in these three group lesions.Results Immunohistochemical staining was performed in 38 LST,62polypoid adenomas and 36 colorectal cancer.For p53 and c-myc,the positive rates in LST,polypoid adenomas and colorectal cancer were significantly different from each other.For Ki-67,the positive rates in LST and polypoid adenomas were significantly lower than that in colorectal cancer,but there was no statistical significant difference between LST and polypoid adenomas.The expression of Ki-67 did not correlate with p53and c-myc both in LST and polypoid adenomas.But in colorectal cancer,the expression of Ki-67 was strongly related to p53 and c-myc.Conclusion The expressions of p53,c-myc and Ki-67 were different in LST,polypoid adenomas and colorectal cancer,indicating that their genetic regulation mechanism might be different,and the genetic avenue for LST may be different from polypoid adenomas.

Objective To explore the methods of the hemorrhage prevention and the measures of hemostasis by CT guided after renal cancer cryoablation.Methods Retrospective analysis of 8 patients of renal cell carcinoma patienthave been done,all the patients were underwent cryoablation.The basic model included 10 min frozen,3 min thawed and 1 cycle were repeated.Before the cryoprobe puncture,a CT scan was taken to observe the blood supply of the tumor and the relationship between the border of the tumor and renal cortex,renal pelvis.Besides,the path of reducing the injury of normal renal cortex and renal pelvis was chosen,and the decreased number of probes was adopted by taking conformal cryoablation to reduce the damage to the renal capsule,in theensurance of the treatment efficacy.Intraoperative CT scan was performed discontinuously,to observe the covering status of the range of ice ball on the lesion and to monitor the perirenal bleeding.Postoperative ECG and blood pressure changes was observed 24 h after operation.Besides,CT scan or blood routine examination is necessary to monitor whether active bleeding happened.Results According enhanced CT image positioning puncture path,the path of probes were selected in the shortest path between the tumor margins and the renal cortical which avoid the renal pelvis.Probes were CT-guided conformal puncture into the lesion successfully for 8 patients,according to freezing basic mode to complete cryoablation.Timely intraoperative CT scan can clearly observe that a low-density ice ball wrapped lesion completely without involving the renal pelvis and normal tissue surrounding the kidney.There was no bleeding in the procedure of cryoablation.After the probe was pulled,CT scan showed:3 of the 8 patients didn't show any sign of henorrhage,in which 1 patient had heavily bleeding,about 150 ml due to the biopsy after cryoablation.The bleeding was stopped by interventional embolization.A little hemorrhage was found in two patients,about 10 ml outside renal capsule.Medium hemorrhage took place in two patients,30 nl in one patient which underwent several cycles of thawing and 60 ml in another.The patients of mild and medium hemorrhage was treated with intravenous injection of Reptilase and strict bed rest.There was a great hemorrhage in one patient,about 200 ml.The bleeding was stopped by interventional embolization.A small and moderate bleeding,it necessary to execute intravenous infusion 2 IU reptilase and strict bed rest.There was no significant active bleeding from the CT scan after 24 h operation and no change in the blood routine examination of blood hemoglobin and red blood cell count.Conclusions Before the puncture,it is necessary to perform an enhanced CT scan to understand the position,which can determine the path of the puncture.It can reduce the damage of renal cortex,renal capsule and surrounding tissue and prevent and reduce the risk of bleeding.For larger amounts of intraoperative and postoperative bleeding subjects,the embolization should be given immediately,as for the small or moderate amount of bleeding,the conservative treatment may be given firstly.