Objective To evaluate the effects of leg ischemic postconditioning on focal cerebral ischemia-reperfusion (I/R) injury in diabetic rats. Methods Forty male diabetic SD rats weighing 270-320 g were randomly assigned to one of 4 groups (n=10 each):group Ⅰcontrol (C);group Ⅱ sham operation (S);group Ⅲ fecal cerebral ischemia-repertusion (I/R) and group Ⅳ leg ischemic postconditioning (IPC). Diabetes mellitus was induced by intraperitoneal streptozotocin. Local cerebral I/R was produced by middle cerebral artery occlusion (MCAO) for 1.5 h followed by 6 h reperfusion. A nylon thread with rounded tip was inserted into internal carotid artery and threaded cranially until resistance was felt. Leg isebemia was induced by placing tourniquet on beth legs at 30 min before repeffusion. The animals underwent 3 episodes of 5 min leg ischemia at 5 min intervals. Neuro-functional deficit was assessed and recorded at the end of 6h reperfusion using neurologic deficit scores (NDS) (0=no deficit, 4=unable to crawl and semiconscious). The animals were then decapitated and their brains were removed for determination of volume of cerebral infaret (by TIC staining) and ratio' of neuronal apoptosis (by TUNEL). Results NDS and cerebral infarct volume were significantly increased at the end of 6 h reperfusion in group I/R and IPC as compared with group C and S. IPC significantly decreased cerebral infarct volume and ratio of neuronal apoptosis induced by MCAO. There was no significant difference in NDA between group I/R and IPC. Conclusion Leg iscbemic postconditioning can protect the brain against focal cerebral I/R injury in diabetic rats.

Objective To investigate effects of limbs ischemic postconditioning induced remote postconditioning (RPostC) on mitochondria structure and function after focal cerebral ischemic reperfusion(I/R) injury in diabetic rats. Methods The diabetic rats models were induced by injecting streptozotocin into abdominal cavity. I/R rats models were made by MCAO with thread. Forty male SD rats models were assigned to 4 groups: control group; sham operation group; I/R group;RPostC group ( n=10 ) . 6 h after the reperfusion, the brains were obtained for HE staining. The mitchondria were isolated and content of MDA,the activities of SOD,Na+/K+-ATPase,Ca2+-ATPase and GSH-Px were tested. Morphological changes of neuronal mitochondria were observed by electronic microscope. Results In the I/R group,the content of mitchondria MDA[(4.99?1.25) nmol/mgprot]were markedly increased (P

This article introduces how to use debate in clinical teaching and explains the organization,training,choosing the debate topics,making the rule and implementation of debate.Debate is advantageous to raise and enhance the medical students' abilities of study independent,clinical thought,consult,analysis and application literatures,oral expression,team cooperation and so on.

Objective To observe the effect of ischemic postconditioning on cerebral ischemia-reperfusion (I/R)injury in diabetic rats. Methods A rat model of diabetes was established using a single intraperitoneal injection of streptozotocin in 40 male Spragne-Dawley rats.Focal ischemia was induced by transient middle cerebral artery occlusion(MCAO)using a thread.The rats were randomly assigned to a control group,a sham-operated group,an I/R group and an Ⅰ-Post group.The animals in the I/R group were subjected to MCAO for 90 min and then reperfusion.Those in the Ⅰ-post group were subjected to MCAO and 3 cycles of transient ischemia-reperfusion(15 seconds ischemia then 15 seconds reperfusion)before persistent reperfusion.Neurological deficit scores,infarct volume,histological changes in the brain and the number of apoptotic cells were measured 6 hours later.Results There was no significant difference in neurological deficit scores between the I/R group and the Ⅰ-post group.The histological changes and apoptotic cells were significantly less in the Ⅰ-post group compared with the I/R group.Conclusion Ischemic postconditioning can inhibit cell apoptosis and reduce cerebral I/R injury after focal cerebral ischemia-reperfusion in diabetic rats.

Objective To estimate the clinical value of curing children Oblique inguinal hernia through scrotum's small professional jargon.Methods 101 children with Oblique inguinal hernia through scrotum's small incision were regaled as the observation group.They were in our hospital from March 2006 to October 2008.98 patients of children Oblique inguinal hernia through small transverse incision on the surface projection of the perficial inguinal ring were regarded as the control group.They Were in our hospital from August 2003 to February 2006.The operation time,the blood loss in operation,the postoperative serotal hematoma,the wound healing,the postoperative recidivation were analyzed and compared.Results The operation time,the wound healing and the postoperative reeidivation were not obviously different between the two groups.The blood loss in operation and the postoperative scrotal hematoma were obviously different between the two groups(P＜0.05);The later average time was shorter than that of the control group through observing the operation time in different stage of the observation group.There was no obviously incision trace in the observation group.Conclusion The method of curing children Oblique inguinal hernia through scrotum's small professional jargon was more direct and easier to operate when finding sac of hemia furthermore,neision concealment.so it has clinical value.

Objective To investigate the curative effects of the modified coloclysis method on con-stipation in gerontal patients. Methods 80 cases of gerontal patients with constipation were divided into the observation group and the control group with 40 cases in each group.The observation group was treated with modified coloclysis method and traditional coloclysis method was used in the control group. The dura-tion of liquid retention time in enteric cavity, the times of defecation after coloclysis and relapse rate of constipation were recorded and compared. Results The retention time of liquid in enteric cavity was longer, the times of defecation after coleclysis was less and relapse rate of constipation was lower in the ob-servation group than those in the control group. Conclusions The modified coloclysis method to treat gerontal constipation is better than the traditional coleclysis method.

Objective To investigate effects of ischemic postconditioning on the nitric oxide ( NO) and nitric oxide synthase ( NOS) in diabetic rat brain tissues .Methods Thirty Wistar rats were diabetic models induced by intraperitoneal injuction of stepto-zotocin (STZ), and randomly divided into three groups: Control group (normal, diabetic), cerebral ischemia group, and ischemic postconditioning ( I-POST) group.The rats of cerebral ischemia group and ischemic postconditioning group were made model of cere -bral ischemia by ligation carotid artery .Hematoxylin-eosin ( HE) was used to observe their pathological changes in control and diabetic groups.Enzyme-linked immunosorbent assay ( ELISA) method was used to detect the expression and changes of NO and NOS in the sera in each group .Western Blot method was used to investigate the expression and changes of NOS in the retinal tissues in each group .Results For I-POST group , brain tissue defects were decreased , neuronal cells were increased , serum inducible NOS ( iNOS) content was significantly lower than endothelial NOS (eNOS) and neuronal NOS (nNOS) ( P <0.05), brain tissue iNOS expression was significantly weaker than ischemia group ( P <0.05 ) and was not different from normal group ( P >0.05 ) .Conclusions Is-chemic postconditioning can protect the brain tissue of diabetic rats by inhibiting NOS activity especially iNOS .

Objective This study sought to assess the value of the diaphragmatic thickening frac-tion ( DTF) , diaphragmatic-rapid shallow breathing index ( D-RSBI) and diaphragm thickening-rapid shal-low breathing index ( DT-RSBI) in predicting the outcomes of ventilator weaning. Methods A total of 59 patients receiving mechanical ventilation with indications for ventilator withdrawal were included in this stud-y. One hour within the spontaneous breath test ( SBT) began,diaphragmatic displacement ( DD) and DTF were measured with bedside ultrasonography to instead the tidal volume ( VT) in conventional rapid shallow breathing index ( RSBT) to calculate D-RSBI and DT-RSBI. Patients were divided into success group and failure group according to the weaning results. Multivariate logistic regression analysis was used to find inde-pendent risk factors of weaning failure and receiver operating characteristic ( ROC) curve was used to evalu-ate the efficacy of predicting the outcome of weaning. Results The multivariate logistic regression analysis showed that DTF was an independent factor affecting the success or failure after the correction of other fac-tors (P<0. 05), the threshold value is 35％, area under roc curve (AUC) 0. 972. Conclusions The DTF can be effectively used to predict the result of weaning from mechanical ventilation, the value of D-RS-BI and DT-RSBI in SBT needs to be confirmed by more research.

Objective:To investigate the clinical application of Bushen-Liyan Decoction combined with low frequency pulse acupoint electrical stimulation in the treatment of swallowing dysfunction of stroke patients in convalescent stage. Methods:From January 2018 to March 2020, 108 stroke patients with swallowing dysfunction in the Shandong Provincial Third Hospital were selected. They were randomly divided into two groups with 54 in each according to the random number table method. The control group was given low frequency pulse acupoint electrical stimulation on the basis of conventional treatment, and the study group was given Bushen-Liyan Decoction combined with low frequency pulse acupoint electrical stimulation on the basis of conventional treatment. Both groups were treated for 4 weeks. The National Institutes of Health Neurological Deficit Score (NIHSS) was used to assess the degree of neurological impairment, the Wada Drinking Water Test was used to assess the degree of swallowing dysfunction, and Barthel Index was used to assess the ability of daily living. The serum levels of brain-derived neurotrophic factor (BDNF), insulin-like growth factor-1 (IGF-1), VEGF, IL-18, IL-23, SOD and MDA were detected by ELISA. The adverse reactions during the treatment were observed and the clinical efficacy was evaluated.Results:The total effective rate was 92.6% (50/54) in the study group and 72.2% (39/54) in the control group, with significant difference between the two groups( χ2=7.728, P=0.005). After treatment, NIHSS score and Wata’s drinking water test score of the study group were lower than those in the control group ( t=8.383, 9.740, P<0.001), Barthel index of the study group was significantly higher than that of the control group ( t=4.064, P<0.01). The serum BDNF [(8.42 ± 0.72) μg/L vs. (6.69 ± 0.63) μg/L, t=13.288], IGF-1[(142.20 ± 12.29) μg/L vs. (118.35 ± 10.73) μg/L, t=10.742] and VEGF[(151.29 ± 12.26) ng/L vs. (102.21 ± 9.77) ng/L, t=23.006] were significantly higher than those in control group( P<0.01); The serum levels of IL-18, IL-23 and MDA were significantly lower than those in the control group( t=7.892, 9.897, 6.206, P<0.001), and the level of SOD was significantly higher than that of the control group ( t=18.510, P<0.001). During the treatment, no serious adverse events occurred in both groups. Conclusion:Bushen-Liyan Decoction combined with low-frequency pulse acupoint electrical stimulation can reduce the clinical symptoms, inflammatory reaction and brain tissue damage of stroke patients with dysphagia, improve the swallowing function and improve the clinical efficacy.

Objective:To explore the approach of continuing education for digestive specialists through the establishment of training mode for diagnosis and treatment of early gastric cancer and the evaluation of training effect.Methods:A total of 48 participants of 3 sessions in the training course of early gastric cancer in Peking Union Medical College Hospital from September 2019 to January 2020 were enrolled in this study. Effects of six training methods were evaluated subjectively and objectively by a questionnaire survey and an on-site test.Results:After the training course of early gastric cancer, the diagnostic awareness (100.0%, 48/48), basic theoretical knowledge (97.9%, 47/48), endoscopic diagnosis ability (95.8%, 46/48) and endoscopic operation skills (87.5%, 42/48) of early gastric cancer of the trainees were significantly improved.The most effective training sessions were endoscopic images recognition, lectures of theoretical knowledge, case discussion and hands-on workshop. The results of theoretical knowledge test (79.38±8.10 VS 48.33±9.96, t=-21.176, P<0.001)and image diagnosis test (81.50±8.32 VS 49.58±13.48, t=-15.408, P<0.001) after training were significantly improved compared with those of before. Conclusion:The systematic training program of early gastric cancer that includes a variety of training methods is effective and should be widely promoted in the continuing education of digestive specialists.