Neurology is an important clinical course. Because of old teaching contents,laggard teaching mode and single teaching goal,the students can not apply after learning neurology course. The curriculum reform of neurology should be carried out under the teaching thoughts of ‘student-centered and competency-based’,to make creation and development in teaching content,teaching style and teaching mode and so on,so as to complete teaching mission better.

Objective To compare the BIS values in patients under anesthesia with minimum alveolar concentration (MAC) of sevoflurane and median effective concentration (EC50) of propofol at loss of consciousness.Methods Sixty ASA Ⅰ or Ⅱ patients,aged 18-60 yr,undergoing elective surgery under general anesthesia,were equally and randomly divided into 2 groups:inhalational anesthesia with sevoflurane group (group Sev) and intravenous anesthesia with propofol ( group Pro).The end-tidal concentration of sevoflurane was monitored using Aestiva anesthesia machine (Datex Ohmeda) in group Sev.Anesthesia was induced with intravenous injection of etomidate 0.3 mg/kg,rocuronium 1 mg/kg,and remifentanil 0.2 μg/kg.The patients were mechanically ventilated after tracheal intubafion.Sevoflurane inhalation was started 12.5 min after intubation in group Sev.Propofol was given by target-controlled infusion with the target plasma concentration set at 3.8 μg/ml 12.5 min after intubation in group Pro.When the effect-site concentrations of propofol reached EC50 of propofol at loss of consciousness (2.2 μg/ml),1.3 EC50(2.86 μg/ml) and 1.5 EC50 (3.3μg/ml) and when the end-tidal concentrations of sevoflurane reached 1.0,1.3 and 1.5 MAC,BIS value,MAP and HR were recorded.Results HR was significantly higher at 1.3 MAC or 1.3 EC50,and at 1.5 MAC or 1.5 EC50 in group Pro than in group Sev ( P ＜0.05).BIS value was significantly decreased at 1.3 MAC or 1.3 EC50,and at 1.5 MAC or 1.5 EC50 compared with that at 1.0 MAC or EC50(P ＜0.05).There was no significant difference in MAP and BIS value at each time point between the two groups ( P ＞ 0.05).Conclusion No significant change in BIS values is found in patients under anesthesia with 1.0,1.3 and 1.5 MAC of sevoflurane and with 1.0,1.3 and 1.5 EC50 of propofol.

Purpose To investigate clinicopathologic fea-tures of sacral cellular schwanoma and the difference from sacral conventional schwanoma.Methods Eight cases of sacral cellular schwanoma were collected.Microscopic examination and immunohistochemistry were performed for studying the clinical feature,radiologic appearance,pathologic characteristic,immunophenotyping,differential diagnosis and postoperative prognosis.Results There were 5 females and 3 males,whose mean age was 46.4 years.The majority of patients complained of pain in sacrococcygeal region.Radiographically,there was an endosacral or endosacral and presacal mass.Histologically,cellular schwannoma was composed of spindle cells,arranged in interlacing fascicles without nuclear palisading and Verocay bodies.Antoni A and Antoni B were not seen overtly.The destruction of bone was found.Immunohistochemically,tumor cells were diffusely and strongly positive for S-100 protein and vimentin.The mean of Ki-67 index was 6％.Tumor recurrence of 4 cases occurred several years after initial surgical resection.The mean interval to recurrence was 6.5 years.Conclusion Sacral cellular schwanoma is a rare tumor.Compared with sacral conventional schwanoma,it shows different growth pattern and pathologic features.So pathological diagnosis of the tumor should be noted for clinical follow-up and treatment.

Purpose　The aim is to establish fermentation process of new type recombinant human necrosis factor (nrhTNF)α.Methods　The optimized host cell,culture medium and induction time were deternined according to the growth and expression specificity of nrhTNF on test tube and flask shaker. Then fed-batch culture was carried out on 5 L automatic fermentor.Results　The expression of nrhTNF in fermentor could keep in a higher level of about 50% of total bacterial proteins when fermented to around A600nm 30，with a fermentation time of 12 h to 13 h.Conclusion　A short cycle,high expression and stabilized fermentation process was established.

Objective To investigate the surgical indication,approach,resection methods and complications of total sacrectomy via posterior approach for primary malignant sacral tumors involving high level (S1,S2).Methods 5 cases of primary malignant sacral tumors treated by total sacrectomy via posterior approach and iliolumbar reconstruction from March 2010 to March 2011 were analyzed retrospectively.There were 3 males and 2 females.The mean age was 41,ranging from 32 to 55.The imageology examination showed osteolytic destruction,among which there were 4 cases of obvious soft tissue mass,1 case of obvious sacral foramina expansion with bone damage.MRI showed 1 case of the tumors in S1-S5,1 case of the tumors in S1 、S2,1 case of the tumors in S1-S3.The smallest tumor was 9.2 cm×7.6 cm×4.1 cm,while the largest was 22.0 cm× 19.0 cm× 16.0 cm.Preoperative TTNB were done on the 5 patients.Pathological diagnosis:2 cases of chordoma,1 case of malignant neurilemmoma,1 case of chondrosarcoma and 1 case of malignant hemangioendothelioma.5 patients had sacrococcygeal pain or lumbocrural pain before the surgery.Visual analogue scale (VAS):2 cases of 2,2 cases of 6 and 1 case of 8.Ilium stability reconstructions were all performed on 5 patients with spine pedicle screw-rod system.Results The mean operation time was 6.5 hours (range,4.5-11 hours),with the mean intraoperative blood loss of 3 700 ml (range,2 000-7 200 ml).There was no perioperative death.The mean follow-up time was 17 months (range,9-23 months).There were 2 cases of wound complications 2 weeks after surgery and healed by second intention with washing and drainage after debridement.There was no deep infection.1 case of rectal injury,which was performed with colostomy during the operation,and stoma returned 12 weeks after surgery.4 cases of sciatic nerve symptom of lower limbs and plantar flexion dyskinesia after bilateral S1 nerve roots resection.The patients walked with ankle brace fixed after the surgery.There was 1 case of implant breakage and no obvious spine down.5 patients had functional disability in sphincter after surgery.1 case of hemangioendothelioma recurred locally 9 months later.Local radiotherapy was performed since there was no reoperation indication.The patient is currently on the 13th month follow-up and survives with tumors.Compared with combined approach,the selection of posterior approach alone has relatively strict surgery indications.Conclusion Total sacrectomy via posterior approach is an effective way to treat the primary high-level malignant sacral tumors.The good surgical resection boundary is important to achieve the good oncology prognosis.The occurrence rate of postoperative complication is high,which has great influence on patients' postoperative neurological function.

Objective To evaluate the role of histone deacetylase in the spinal cord in the maintenance of neuropathic pain (NP) in rats.Methods Twenty-seven male Sprague-Dawley rats,weighing 230-270 g,were randomly divided into 3 groups (n =9 each) using a random number table:sham operation group (group S),group NP,and NP + intrathecal Trichostatin A (TSA) group (group T).NP was induced by chronic constrictive injury.At 7 days after operation,5％ DMSO,5％DMSO and TSA 10 μg (10 μl) were injected intrathecally once a day for 3 consecutive days in S,NP and T groups,respectively.Mechanical paw withdrawal threshold (MWT) and thermal paw withdrawal latency (TWL) were measured at 1 day before operation and 3,7,10,14 and 21 days after operation (T0-5).Results Compared with group S,MWT was significantly decreased and TWL was shortened at T2-5 in NP and T groups.Compared with group NP,MWT was significantly increased and TWL was prolonged at T3,4 in group T.Conclusion Histone deacetylase in the spinal cord is involved in the maintenance of neuropathic pain in rats.

Objective To evaluate the effect of intrathecal ropivacaine on spinal histone deacetylase 1 (HDAC1) and HDAC2 expression in the rats with neuropathic pain (NP).Methods Thirty adult male Sprague-Dawley rats, weighing 220-250 g, in which intrathecal catheters were successfully placed, were randomly divided into 3 groups (n=10 each) using a random number table: sham operation group (group S), group NP, and NP + ropivacaine group (group R).NP was induced by chronic constriction injury (CCI) in anesthetized rats.Sciatic nerve was exposed and 4 loose ligatures were placed on the left sciatic nerve at 1 mm intervals with 4-0 chromic catgut.Starting from 7th day after CCI, 0.25％ ropivacaine 20 μl was injected intrathecally in group R, while the equal volume of normal saline was given instead of ropivacaine in S and CCI groups once a day for 7 consecutive days.At 1 day before CCI (T0) ,and 3, 7, 10, 14, 17 and 21 days after CCI (T1-6) , the mechanical paw withdrawal threshold (MWT) and thermal paw withdrawal latency (TWL) were measured.After the pain threshold was measured at T4,3 rats from each group were sacrificed, and their lumbar enlargements were harvested for determination of the expression of HDAC1 and HDAC2 by Western blot.Results Compared with group S, the MWT was significantly decreased, and the TWL was shortened at T2-6, and the expression of HDAC 1 and HDAC2 was up-regulated at T4 in NP and R groups (P＜0.05).Compared with group NP, the MWT was significantly increased at T4, and the TWL was prolonged at T3.4, and the expression of HDAC1 and HDAC2 was downregulated at T4 in group R (P＜0.05).Conclusion The mechanism by which intrathecal ropivacaine alleviates NP may be related to inhibited up-regulation of spinal HDACI and HDAC2 expression in rats.

Objective To investigate the expression and distribution of aquaporin 3 (AQP3) in mouse early embryos at different stages.Methods Controlled ovarian hyperstimulation model of Kunming mouse was used to collect four-cell embryos,eight-cell embryos,morula stage,and early blastocysts.Immunofluorescence microscopy and laser confocal microscopy were used to detect expression and distribution of AQP3 channels in these stages.Results Fluorescence signal of AQP3 was found in four embryonic stages of mice.Distribution within embryo was different at different embryonic stages.AQP3 was mainly expressed on the karyotheca of blastomeres at four-cell and eight-cell stage.In morula stage,AQP3 was mainly expressed on cell membrane of each blastomere.In early blastocysts,AQP3 was predominantly expressed on the cell membrane and cytoplasm of trophoblastic cell.Conclusions AQP3 trans-membrane channel might have potential regulation function on mouse embryonic development.

There are eight forms of vitamin E in human blood, including α-, β-, γ-, δ-tocopherols and α-, β-, γ-, δ-tocotrienols. As the most abundant and active form of vitamin E, α-tocopherol is widely accepted as a reliable indicator for nutritional assessment of body vitamin E status across the world. Considering that different vitamin E forms have diverse biological activities, separation and detection of different vitamin E forms in human blood facilitates the understanding of the association between vitamin E and diseases. In this review, the advances in sample-pretreatment techniques and detection techniques for vitamin E in human blood were presented. Currently, the sample-pretreatment techniques include solid-phase extraction, liquid-liquid extraction, dispersive liquid-phase microextraction, supported liquid extraction and direct protein precipitation; the detection techniques include automatic biochemical analysis, enzyme-linked immunosorbent assay, gas chromatography, liquid chromatography and ultra-high performance supercritical fluid chromatography mass spectrometry. This review summarizes the characteristics and scope of above-mentioned techniques used for detection of vitamin E in human blood, so as to provide insights into the selection of an appropriate method for inspection technicians.

Objective:To develop a quality assessment scale of ICU transitional care based on patient-reported outcomes and test its performance.Methods:According to the guidelines of patient-reported outcomes development process, the item pool was established combining with analysis of relevant literatures and patients′ experience and needs in ICU transitional period based on the grounded theory about ICU transitional care. Cognitive test of patients and Delphi expert correspondence were utilized to amend the initial scale before pretest. One hundred and seventy-seven patients who had been transferred from ICU to general ward from March to August 2019 in Tianjin Third Central Hospital were recruited by convenience sampling method for project analysis.Results:The active coefficient and authority degree of expert were above 0.90 and 0.785 respectively for the two rounds of expert enquiry. The final scale consisted of 28 items, from which 4 principal factors, which were preparation for self-care, communication and coordination, psychological support and health belief, respectively, were extracted by exploratory factor analysis, explaining 78.307% of total variance. The content validity index of each item was 0.769-1.000, and the scale-level content validity was 0.896. The Cronbach α coefficients of the 4 factors and the scale were 0.844, 0.793, 0.897, 0.681 and 0.807, respectively.Conclusions:The patient-reported outcomes scale measuring ICU transitional care quality has good reliability and validity and can be used as an auxiliary tool measuring ICU transitional care quality in clinic.