To solve the problems of the clinical education for adult undergraduates,the author analyzed thoroughly the characteristics of the adult students and their learning needs.Then the author brought forward some thoughts on the reformation of clinical education for adult undergraduates: define a special goal for the medical education of adults;foster the persons qualified to teach;found the new teaching methods to make the greatest benefits of teaching and learning.

Objective To explore clinical value of the single-hale video-assisted thoracoscope surgery in lung surgery.Methods In our hospital from January 2015 to June 2015, a total of 60 patients was performed with lung partial resection line thoracoscope surgery, 28 routine puckering traditional video-assisted thoracoscope treatment, in the same period 32 underwent video-assisted thoracoscope surgery.Intraoperative blood loss, operating time, postoperative pain degree, and postoperative chest such as flow rate were compared between two groups.Results Two groups of patients had no perioperative death and severe complications.Intraoperative blood loss and operating time were no significant significance between single-and double-hole operation groups.The degree of postoperative pain score was (0.8 ± 0.5) in puckering thoracoscope group, and (1.2 ± 0.6) in traditional thoracoscope group, with significant difference (P =0.009).Conclusions Single-hole thoracoscope surgery in the treatment of lung diseases is feasible and reliable compared to traditional thoracoscope surgery, and patients can effectively reduce postoperative pain, and improve the quality of life.

To study the characteristics of eye signs in chronic hepatitis B patients with blood stasis syndrome and the association between blood stasis syndrome and eye signs.

Objective: Blue dye was one of the methods for sentinel lymph node biopsy in breast cancer, but the success rate was affected by multiple factors. This study was to determine the related factors contributing to the success of sentinel lymph node biopsy in breast cancer using blue dye method. Method:From Jan. 2007 to Aug.2008, sentinel lymph node biopsy was performed by periareolarly injecting 1% methylene blue in 141 breast cancer patients followed by axillary clearance. Pathological diagnosis was performed for all of the lymph nodes by conventional HE staining. Unconditional logistic regression was applied to make both univariate and multiva-riate analysis. Results:Sentinel lymph node was successfully detected in 126 patients. But the biopsy was failed in the 15 patients. The success rate was 89.4% and the false negative rate was 6.82%. Univariate analysis showed that success rate of biopsy was in association with patients' age, body mass index (BMI), tumor size, preoperative axillary node's status, pathological grade as well as ≥4 positive axillary lymph nodes involved. Multivariate analysis indicated that the patients'age (OR=4.587, P=0.024), BMI (OR=4.882, P=0.011) as well as 4 or more of the axillary nodes involved (OR=3.143, P=0.013) were independent predicting factors for the success of sentinel lymph node biopsy. Conclusions:Methylene blue dyeing is a reliable method for sentinel lymph node biopsy. The rate of success is associated with patients' age, BMI as well as the number of metastases in axillary lymph nodes.

Objective To evaluate contrast-enhanced endoscopic uhrasonography(CE-EUS)in the differential diagnosis of pancreatic diseases.Methods Eighteen patients with suspected pancreatic neoplasms and chronic pancreatitis,which would be finally affirmed with EUS-FNA or histophathologic examinations,as well as five normal control subjects were enrolled and underwent CE-EUS by using ultrasonic contrast agent(sonovue,Bracco Co.,Italy).Characteristics of enhancement including form,echo and enhanced blood perfusion of the target areas were investigated in normal pancreas and various diseased ones.Results By CE-EUS,five cases of normal pancreatic parenchyma were presented as punctiform or claviform enhancement pattern with homogeneous distribution(type Ⅰ-Ⅱ);while two chronic pancreatitis cases were presented as claviform or plaquelike enhancement pattern with inhomogeneous distributition(type Ⅱ-Ⅲ).In addition,thirteen pancreatic carcinomas were presented as inhomogeneous punctiform or claviform enhancement(typeⅠ-Ⅱ)partially with border enhancement and with slow enter-in and fast wash-out phase.However,three benign insulinomas were presented as holo-plaquelike enhancement(type Ⅲ),and 2 with fast enter-in and fast washout phase.Besides,different enhancement intensity was identified in different diseases.Conclusion CEEUS,from which different enhancement pattern,phase and intensity would be shown in various pancreas,is a safe and feasible imaging modality in the differential diagnosis of pancreatic diseases.

Objective To evaluate the effects of asymptomatic arteriovenous fistula closure on left ventricular morphology and function in renal transplant recipients.Methods Between March 2007 and March 2011,a total of 60 patients undergoing consecutive kidney transplantation with asymptomatic arteriovenous fistula were divided randomly into two groups: arteriovenous fistula closure group,and non-arteriovenous fistula closure group.By using echocardiography,the changes in CO,CI,EF,LVEDV and LVMI were analyzed.Results At 12th month after transplantation,the values of CO,LVEDV and LVMI were significantly lower than those before transplantation (P＜0.05).The value of CI also showed a tendency to decrease (P＞0.05),and the value of EF was increased significantly (P＜0.05).At 6th month after arteriovenous fistula closure (18 months after transplantation),the values of CO,CI,LVEDV and LVMI were significantly lower than those before arteriovenous fistula closure (12 months after transplantation) (P＜0.05),and the value of EF was increased significantly (P＜0.05),but the values of CO,CI,EF,LVEDV and LVMI remained unc(b)anged in controls (P＞0.05).At 18th month after transplantation,the values of CO (4.4 ±0.8 L/min),CI [3.0 ± 0.8 L·min-1·m-2],LVEDV (110.0 ± 17.4 ml) and LVMI (114.7 ± 42.5g/m2) in trial group were significantly lower than the values [CO: 5.1 ± 0.9 L/min,CI: 3.5 ± 1.0L·min-1·m-2,LVEDV: 121.4±19.3 mL,LVMI: 138.4±44.1 g/m2] in controls (P＜0.05),and the value of EF (75.2％ ± 7.4％ vs.70.5％ ± 8.2％) significantly higher (P＜005).Conclusion In both groups,kidney transplantation benefits significantly the regression of cardiac mass,cardiac index and left ventricular dimensions,but closure of asymptomatic AVF induces more significant regression.

Objective To evaluate the accuracy and clinical application of endoscopic ultrasound guided fine needle aspiration (EUS-FNA) in diagnosis of occupying lesions in upper digestive tract and its pe-ripheral areas. Methods The data of 64 patients who underwent EUS-FNA for occupying lesions in upper di-gestive tract, between July 2006 and December 2007, were retrospectively analyzed. Results EUS-FNA was successfully performed on 62 patients, with a success rate of 96.88%. The overall diagnostic accuracy, sensi-tivity, specificity, positive predictive value and negative predictive value of EUS-FNA for occupying lesions in upper digestive tract and its peripheral areas were 88.71%, 86.54%, 100.00%, 100.00%, and 58.82%, respectively. There was no significant difference between the foei larger and smaller than 3cm (P > 0.05), re-garding the diagnostic accuracy and average puncture numbers. Diagnostic accuracy of those with real-time cy-tolngical evaluation was significantly higher than those without (P=0.029), and the puncture numbers were less (P=0.001). Among the total 99 punctures, the positive diagnostic accuracy of those with 5ml negative pressure suction was significantly higher than those of 10 ml (P = 0.044). Conclusion EUS-FNA is a safe and applicable approach to diagnosis of occupying lesions in upper digestive tract and its peripheral areas with higher diagnostic accuracy, sensitivity, specificity and positive predictive value. Moreover, the real-time cyto-logical evaluation and adequate negative pressure might facilitate the diagnosis accuracy.

Objective To investigate the availability and strategy of breast reconstruction for patients with caesarotomy scar using pedicled TRAM flap.Methods From January 2007 to May 2011,12 cases of breast reconstruction with caesarotomy scar were carried out with pedicled TRAM flaps.All the patients that were classified as the class Ⅱ that was 0.5 or less by score were operated on by using the inverted trapezoid incision,of which the upper edge was 2 or 3 cm down to the umbilicus.Double pedicles were adopted for the patient with the longest vertical scar; single pedicle of the breast contralateral side and the muscle sheath of the breast ipsilateral side were harvested for the rest of the patients.A synthetic mesh was used for the enforcement of the muscle and sheath defect.Results No flap necrosis or abdominal complications were observed.With the follow-up from 3 months to 4 years and 4 months,the overall satisfactory rate was 100 ％.Conclusions The strict patient selection and the operating strategy are the keys to the successful breast reconstruction for patients with caesarotomy scar using pedicled TRAM flap.

ObjectiveThe purpose of this study was to observe the correlation of mTOR and VEGF gene with nephropathy indicators in diabetic rats. Methods Forty-eight male Sprague-Dawley(SD)rats were divided into diabetes mellitus group(DM=28)and control group(NDM=20). Diabetic models were produced by injection of streptozotocin. In the courses of 12,16,20 and 24 weeks,the histology scores(HS)and glomerular basement membrane(GBM)thickness were collected. The protein and mRNA expressions of the gene of mTOR,VEGF and VEGFR2 were observed by immunohistochemistry and real-time quantitative polymerase chain reaction (RT-Q-PCR)by SYBR Green. And the standardized cycle of threshold(SCt)was regarded as the indicators of the mRNA expression. Results HS and GBM thickness were significantly higher in DM rats than those in NDM rats,especially in DM rats of the courses of 20 and 24 weeks(P < 0.01). IHC scores of VEGF and VEGFR2 were higher in total DM rats and were positively correlated with each other. There were positive correlations between HS with VEGF and VEGFR2 in total DM rats(P < 0.05). SCts of VEGF and VEGFR2 were significantly higher and were positively correlated with each other in total DM rats(P < 0.01). SCt of VEGF and GBM thickness showed positive correlation in total DM rats. SCt of VEGF was highest in the course of 12w DM rats. SCt of VEGFR2 gradually decreased following by the diabetic course,and was lowest in the course of 24w. There were no significantly differences in IHC scores and SCt of mTOR between DM and NDM rats. But the IHC scores of mTOR,VEGF and VEGFR2 were positively correlated with each other and with HS in total DM rats(P < 0.05). Conclusion HS and GBM thickness were higher in diabetic rats,especially in the course of 24w,which could reflect the injury of nephropathy. The protein and mRNA of VEGF and VEGFR2 were high expressed in kidney of DM rats and increased with the increasing of diabetic course. The mRNA expression of VEGF was positively correlated with GBM thickness of in diabetic nephropathy(DN). The protein expressions of mTOR,VEGF and VEGFR2 might have synergistic effects in DN of DM rats. But the results could not exclude the influences of different courses,sample size and experimental conditions.

Objective To investigate MRI diagnosis of intracranial extra-encephalon cavernous angiomas.Methods In 9 intracranial extra-encephalon cavernous angiomas,5 masses located in the parasellar,2 masses in the lateral ventricle triangle,1 mass in the fourth ventricle and 1 mass in temporal subdural space.The MRI features of the masses were analyzed.Results 5 parasellar cavernous angiomas enclosed the ipsilateral internal carotid artery and extended the saddle.The masses showed homogeneous low intensity on T1WI,high intensity on T2WI,obvious enhancement on enhanced scan.Of 2 cavernous angiomas in the right lateral ventricle triangle, 1 mass showed homogeneous low intensity on T 1WI,high intensity on T2WI,obvious enhancement on enhanced scan;the other mass showed isointensity on T1WI,slight high intensity on T2WI,high intensity on DWI,low intensity on SWI and patchy enhancement on enhanced scan.1 cavernous angioma located in the fourth ventricular showed mixed intensity on T 1WI and T2WI,low signal rim around the mass on T2WI,inhomogeneous high intensity on DWI sequence and little enhancement on enhanced scan.1 mass located in temporal subdural space showed homogeneous low intensity on T 1WI,high intensity on T2WI,low intensity on DWI,isointensity on SWI and homogeneous obvious enhancement on enhanced scan.Conclusion The MRI findings of the intracranial extra-encephalon cavernous angiomas are characteristic.Most masses show homogeneous low intensity on T1WI,high intensity on T2WI and obvious enhancement on enhanced scan.The masses should mainly be distinguished from meningiomas.