Surgical base teaching is an important part of medical education.It is the important tache whether the medicos can become excellent doctors.The thesis analyses the young surgeon's problems in their working abilities in hospital,and discusses the strategies of how to improve the quality of surgical teaching,aiming to establish a solid foundation for the cultivation of the medicos.

Diffuse sclerosing variant papillary thyroid carcinoma,one of the variants of papillary thyroid carcinoma,nearly account for 0.7％ to 6.6％ of papillary thyroid carcinoma.It is an aggressive tumor that shows higher rates of recurrence,metastasis and persistent disease compares to classic papillary thyroid carcinoma,thus diffuse sclerosing variant papillary thyroid carcinoma needs stricter and more exhaustive operation.Since the incidence of diffuse sclerosing variant papillary thyroid carcinoma is low,many physicians lack of understanding of the disease,it's often missed diagnosis or misdiagnosed.Consequently.In order to let physicians understand more about diffuse sclerosing variant papillary thyroid carcinoma,this paper will elaborate the epidemiology,clinic and pathology features of it.

This paper reports the sensitizing effect of Hematoporphyrin Derivative (HPD) to Radiotherapy (RT) and long survival rates of 28 patients were treated by HPD 5mg/kg iv+D T31Gy/10f/12d+Surgery with squamous cell carcinoma in head and neck. The result was compared with 33 patients who received routine preoperative radiotherapy D T40Gy/20f/26d without HPD.The total HPD group were 44.4%(13/28) of this patients failed to evidence of living tumour cell within surgical specimens. 59.09%(13/22) of patients with the tumour diameter of 4cm in HPD group. The control group was 9.1% only (P

0.05). Conclusion The changes of serum protein electrophoresis results in the parturient women were mainly presented with the decreased in albumin and ? globin levels, increased percent of ? 1,? 2 and ? globins, increased percent of ? 2 and ? globins markedly related with increased ? and ? lipoprotein. Agarose gel electrophoresis as a screening method for component of serum proteins is valuable.

OBJECTIVE To investigate the prevailing strains of pathogens of hospital acquired infections in ICU and their drug-resistances in order to provide treatment basis for critical and severe patients in fighting against infection.METHODS A retrospective investigation analysis was made for all the isolated bacteria as well as their drug-resistance in our hospital from Jan 2000 to Dec 2005.RESULTS Totally 869 bacterial strains were isolated which included 666 strains of G-bacteria(74.3%),and 230 strains of G+bacteria(25.7%).The G-bacteria included Pseudomonas aeruginosa,Klebsiella pneumoniase,Escherichia coli,Acinetobacter baumannii,etc,which were isolated mainly from respiratory tract.The G+ bacteria consisted of Staphylococcus and Enterococcus.Staphylococcus were mainly isolated from respiratory tract and Enterococcus from urinary tract.Bacteria were highly resistant to commonly used antimicrobials and demonstrated multi-drug resistance.The isolated rate of G+bacteria and drug resistance of G-bacteria to the commonly used antibiotics was increasing yearly.CONCLUSIONS The pathogens are mainly isolated from respiratory tract and the most are G-strains and multi-drug-resistant.The selection and use of antibiotics should be based on the results of drug-sensitivity tests.

Objective To investigate the correlation between plasma pentraxin 3 (PTX3)and cardiovascular disease(CVD) in maintenance hemodialysis(MHD) patients.Methods Plasma was obtained from 98 MHD patients before and after a session of HD and 50 age-matched healthy subjects.Plasma PTX3 was measured by enzyme-linked immunosorbant assay (ELISA).Spearman correlation and linear regression were used to examine the correlation between plasma PTX3 level and other laboratory parameters.Binary Logistic regression was used to assess the correlation between plasma PTX3 level and CVD.Receiver operator characteristic (ROC) curve was used to analyze the correlation among PTX3, high sensitive C-reactive protein(hsCRP) and CVD.Results Plasma PTX3 level was significantly higher in MHD patients compared to healthy controls [1.87 (1.34-2.50) μg/L vs 1.11(0.86-1.51) μg/L, P＜0.01], and increased after a single HD session[post-HD 2.18(1.80-3.14) μg/L vs pre-HD 1.87(1.34-2.50) μg/L, P＜0.01].Patients with CVD had higher concentrations of PTX3 than those without CVD[2.18 (1.48-2.74) μg/L vs 1.76 (1.25-2.26) μg/L, P＜0.05].High plasma PTX3 (＞1.87 μg/L) was positively and independently associated with CVD[OR=3.15, 95％CI(1.17-8.50), P＜0.05].ROC curve analysis showed the PTX3 was more closely correlated to CVD than hsCRP in MHD patients with hsCRP ＞3 mg/L, and the area under the curve of PTX3 and hsCRP was 0.655 ±0.083(P＜0.05) and 0.562±0.083(P＞0.05) respectively.Plasma PTX3 level was negatively correlated with body mass index (ρ=-0.248,P＜0.05), pre-albumin(ρ=-0.218, P＜0.05), total cholesterol(ρ=-0.265, P＜0.01), triglyceride (ρ=-0.246, P＜0.05), LDL-cholesterol (ρ=-0.254, P＜0.05), hemoglobin (ρ=-0.212, P＜0.05), and positively with erythropoietin dose per week(ρ=0.184, P＜0.01), cardiac troponin T (ρ=0.287,P＜0.01), carotid artery intima-media thickness (ρ=0.294, P＜0.05).Conclusions PTX3 level ismarkedly elevated in HD patients.HD procedure induces PTX3 elevation.Plasma PTX3 could be auseful marker of CVD risk factors in MHD patients.

Objective To investigate protective effects of schisandra lignans on doxorubicin-induced liver injury in rats. Methods SD rats were randomly divided into six groups: normal control, model control, vitamin C and schisandra lignans at small, middle, and high doses. The liver injury model was established by intraperitoneal injection of doxorubicin. Normal controls were intragastrically administrated with 0. 9%sodium chloride solution,while other groups were administrated with different medications,respectively. Interleukin-10 (IL-10) in serum,nitric oxide (NO) and aspartate aminotransferase (AST) in liver tissue homogenate were measured. Histopathological changes in hepatic tissues were also observed. Results Serum IL-10 and tissue NO were obviously lower in the model control group than those in other groups,while those in all schisandra lignans treated groups were significantly improved (P<0. 05, P<0. 01). The AST level in schisandra lignans middle- and high dose groups was (372. 58±105. 80) and (327. 92±42. 80) U·g-1 ,respectively,significantly lower than (565. 07±22. 13) U·g-1 in the model control group (P<0. 05,P<0. 01). Histopathological analysis showed that degeneration and necrosis of hepatocytes were remarkably alleviated in all schisandra lignans treated groups. Conclusion Schisandra lignans protect rats against doxorubicin-induced liver injury.

Objective To clarify the effectiveness of QS Nd ∶ YAG laser on melasma in Chinese patients.Methods A group (n=45) of patients previously diagnosed as facial melasma were treated with QS Nd ∶ YAG laser at approximately 1 week intervals.Eleven to twenty treatments were per formed for each patient.The treatment efficacy of QS Nd ∶ YAG laser was evaluated by patients and doctors,respectively,at various time point such as before treatment,5 weeks and 10 weeks after treatment and end of the treatment.The skin melanin index and the transepidermal water loss were e valuated by the skin multifunction tester at different time point,respectively.Results Compared with untreated,the melanin index of melasma areas decreased significantly after the laser treatment for 5 weeks,10 weeks and the end of treatment.But there was no significant difference in the melanin index of normal skin areas with or without laser treatment.Compared with untreated,the transpidermal water loss of melasma areas increased significantly after the laser treatment for 5 weeks,10 weeks and end of treatment.The patients' skin became smooth,delicate,pores shrink and more flexible.In 45 melasma patients treated by QS Nd ∶ YAG laser,8 cases basically cured (17.78 ％),25 cases were markedly effective (55.56 ％),12 cases improved (24.44 ％) and only 1 case was uneffective (2.22 ％).Theoverall effective rate was 73.33 ％.Conclnsions QSNd∶ YAG laser is a useful treatment modality for Chinese women who have melasma with precise efficacy,less side effects and high safety.

Objective To assess the risk factors of intradialytic-hypotension (IDH) among maintaining hemodialysis (MHD) patients and to explore the relation between NT-proBNP and IDH,thus to provide clinical evidence for the prevention and treatment of IDH.Methods A total of 202 MHD patients during March 2009 to May 2009 in our dialysis center were enrolled in the study.Intradialytic blood pressure (BP) was measured during a 3-month period.IDH was defined as an event characterized by a sudden drop in systolic BP more than 20 mm Hg or in mean artery pressure (MAP) more than l0 mm Hg.Logistic regression analysis was used to assess the risk factors of IDH.ROC curve was used to evaluate the diagnostic efficacy of serum NT-proBNP.Results The incidence of IDH was 42.1％.One hundred and seventeen patients with no-IDH (＜1/10 hypotensive events per 3 months) were served as controls.Fifty-five patients with o-IDH (≥ 1/ 10 but ≤1/3 hypotensive events per 3 months) and 30 patients with f-IDH (＞1/3 hypotensive events per 3 months) were identified among 202 patients.Multivariate regression analysis showed that age,gender,ultrafiltration rate,serum NT-proBNP,serum albumin,aortic root dimension (AoRD) were associated with IDH among MHD patients.Serum NT-proBNP was positively correlated with IDH.The area under the ROC curve (AUC) of NT-proBNP was 0.76 (95％ CI 0.69 to 0.83,P＜0.01).The cut-off value of serum NT-proBNP for IDH was 1746.5 ng/L,with a sensitivity of 88.61％ and a specificity of 51.10％.Furthermore,the AUC of NT-proBNP for f-IDH was 0.65 (95％ CI 0.53 to 0.763,P＜0.01).The cut-off value of serum NT-proBNP for f-IDH was 8208.0 ng/L,with a sensitivity of 33.33％ and a specificity of 91.30％.Conclusions Elderly,female,high ultrafiltration rate,high level of serum NT-proBNP,hypoalbuminemia,shorter AoRD are independent risk factors of IDH among MHD patients.Serum NT-proBNP can be used as a predictor of IDH.

Objective To study the urea rebound after hemodialysis in maintenance hemodialysis (MHD) patients and its impact factors. Methods From 124 stable MHD patients, blood samples were collected at the beginning, immediate post-hemodialysis, 15 minutes and 30 minutes after hemodialysis. The urea rebound was quantified, and its effect on URR and spKt/V was investigated. The impact factors on urea rebound were analyzed. Results In this group of patients, average post-hemodialytic urea rebound was 13.6%, leading to over-estimation of URR and spKt/V of 0.04 and 0.14, respectively. Hemodialysis efficiency expressed as K/V determined urea rebound most significantly. Other impact factors included higher hemoglobin, higher relative ultrafiltration, arteriovenous access, and male patients. Conclusions Urea rebound is common after the hemodialysis. For specific patients and hemodialysis sessions, ignoring it would result in significant over-estimation of delivered hemodialysis dose.