Objective To explore the effect and experience of problem-based (PBL) teaching in neurosurgical clinical training and improve the quality of the neurosurgical clinical training. Methods 600 clinical medical students of Grade 2011 in their probation in our department of neurosurgery were chosen as the subjects of study and were randomly divided into the experimental (PBL, 15 groups, 20 people/group, over 300 people) and control groups (CBL+ LBL, 15 groups, 20 people/group, over 300 people). In experimental group, PBL which is a problem-based, student-centered and teacher-directed pedagogy was adopted. In control group, CBL (case-based learning) + LBL (lecture-based learning) were adopted. After probation, two groups of students had the unified test and assessed their teaching methods by questionnaire survey and at the same time, the questionnaire survey about PBL' impact on the various aspects was done only to experimental group students. SPSS 15.0 software was used to do statistical analysis and data were processed by description analysis, t test, Mann-Whitney U test and correlation analysis. Results The scores of theoretical knowledge and general ability in PBL group [(40.57 ±3.24), (41.23 ±4.56) individually] were higher than these in control group [(37.21 ±4.05), (36.51±4.11) individually]. The differences demonstrated statistically meanings. Through the surveys, the students in experimental group showed the high satisfaction (97.0%, n=291) in PBL teaching. Most of the students considered that their abilities of team cooperation (96.7%, n=290), and self-directed learning (92.7%, n=278) were improved by PBL teaching. The students in experimental group illustrated their attitudes in satisfaction of teaching; interests of clinical training, participation of teaching and understanding of knowledge were superior to the control group. The differences demonstrated statisti-cally meanings. Conclusion PBL teaching got a good effect in neurosurgical clinical training. This method, which improved students' participation and motivation of study and contributed to the training of medical students' comprehensive abilities, is suitable for modern neurosurgical clinical training.

Objective To investigate early nasogastric nutrition on patients with acute decompensated chronic heart failure,and observe its influence on patient's disease outcome.Methods From January 2012 to December 2013,100 cases with acute decompensated chronic heart failure were used as the research subjects,were randomly divided into experimental and control groups with 50 cases each group.Patients of two groups adopt expansion of blood vessels,strong heart,diuresis,and routine anti-infection treatment;Based on this scheme,experimental group adopt early nasogastric nutrition.The cardiac function index,the change of nutritional status and clinical curative effect and the result of follow-up within 1 year after discharge of two groups were compared.Results Left ventricular end-diastolic dimension (LVEDD) and left ventricular end-systolic dimension (LVESD) in two groups after treatment were decreased,and the descender of experimental group was superior to that of the control group with statistically significant difference (P ＜ 0.05).After treatment,left ventricular ejection fractions (LVEF) of two groups were improved,and the rise of experimental group was superior to that of control group with statistically significant difference (P ＜0.05).In the two groups after treatment,the serum brain natriuretic peptide (BNP) levels were significantly decreased,and the descender of the experimental group was more than that of control group with statistically significant difference (P ＜ 0.05).After treatment,body mass index (BMI),the level of serum prealbumin (PA),transferrin (TRF),and the total number of lymphocytes of two groups were increased significantly (P ＜ 0.05);and BMI,the level of serum PA and TRF,and the total number of lymphocytes of the experimental group were significantly better than those of the control group (P ＜ 0.05).The total effective rate of the experimental group was significantly higher than that of the control group (P ＜ 0.05).The exacerbation rates,readmission and mortality rate of experimental group follow-up within 1 year after discharge were significantly lower than that of the control group (P ＜ 0.05).Conclusions The early nasogastric nutrition on the patients with acute decompensated chronic heart failure was better able to improve patients' nutrition state,more conducive to patients with cardiac function recovery,improve the clinical curative effect,and reduce the exacerbation rates,and readmission and mortality rate.

Objective To explore the factors of treatment adherence for patients with hypertension.Methods Data were collected among 520 patients with essential hypertension from 2009 to 2010.It investigated the factors of treatment adherence for patients with hypertension by self-report scales.Results Structural equation model analysis showed age,self-rated health,self-eificacy,quality of life,family function and health concept were all directly associated with treatment adherence,and these variables explained 52.0％ of the total variance.Self-efficacy and quality of life were regarded as mediators in predicting treatment adherence of hypertensive patients,other variables indirectly affected adherence behavior by two mediators.Age and self-efficacy showed a strong independent predictive role to adherence.Conclusions Healthcare providers should take effective measures to improve treatment adherence for patients with hypertension based on patients characteristic once they make reasons for adherence clear,which can enhance quality of life,control blood pressure and prevent complications.

Objective To evaluate the clinical effect of tibial plateau bone defects repair using osteotomy and bone grafting with autogenous bone gain way in total knee arthroplasty.Methods From Mar.2011 to Mar.2015,28 knees of 20 patients with bone defects in medial tibial plateau were in total knee arthroplasty,the bone defects were repaired into horizontal steps,then with autogenous bone grafting by osteotomy.Results The bone defects could be repaired effectively to support the knee joint prosthesis,all the patients were followed-up through outpatient from 1 year to 4 years with the average of 2.6 years,the HSS kness score increased from (20.9 ± 1.2) before opearation to (87.6 ± 1.6) after operation.Hss score were paired t test,there was statistically significant difference (P ＜ 0.05).The location was good and there was no bone defect image,no bone resorption and no joint dislocation under X-ray.Conclusions To repair the bone defects in total nkee arthroplasty,it can use the autogenous bone by osteotomy reasonably,achieve good repair defect site,reserve the bone mass maxium,reconstrust the balanced mechanical support of tibia.

Objective To research and prepare the individualized knee in vitro guided plate by 3D printing technique and to investigate the feasibility of its application in 8-plate epiphysiodesis.Methods Twelve children patients with knee varus or valgum in our hospital from January 2014 and November 2016,7 boys and 5 girls,average age of 8.2 years old,were performed the lower extremity continuous spiral CT scanning in the knee straight position.The Dicom format stored CT data were imported into software Mimics 15.0 for reconstructing the knee joint 3D model.The knee joint data after reconstruction were guided into software Geomagic1 1.0 with the.stl format.According to the demand that screws without perforating epiphyseal and joint surface,paralle ling to the epiphyseal and locating in the anterior-posterior median line of epiphyseal,the 8-plate placing screw navigation template was designed and printed by using the 3D printing technique;the 8-plate plate and screw internal fixation was conducted by intraoperative template location.The placed screw position was evaluated by postoperative CT.Results The imaging identification showed that 8-plate epiphysiodesis by using 3D printing individualized in vitro guided plate had accurate screw placement.The cases were followed from 6 months to 2 years,the satisfactory orthopedic effect was obtained in all cases.Conclusion Preparing the individualized knee in vitro guided plate by applying 3D printing technique in assisted 8-plate epiphysiodesis for treating child knee varus or valgum has accurate screw position and satisfactory effect.

Objective To investigate the effects of magnesium isoglycyrrhizinate on liver function of patients with gastrointestinal cancer following chemotherapy.Methods From Apr.2012 to Dec.2015,a total of 168 cases of patients with gastrointestinal cancer following chemotherapy were enrolled,and were randomly divided into observation group(84 cases) and control group(84 cases).Each of the two groups was divided into A group(42 cases) and B group(42 cases) according to the treatment methods.Patients of observation group(including observation A group and observation B group) were treated with magnesium isoglycyrrhizinate,while patients of control group(including control A group and control B group) were treated with glutathione.Patients of A group(including observation A group and control A group) were treated with FOLFOX4 regimen,while patients of B group(including observation B group and control B group) were treated with XELOX regimen.The incidence of abnormal liver function and changes of the levels of liver function of each group were analyzed and compared.Results After the appropriate treatment,the abnormal rate of liver function of observation group were significantly lower than control group(P<0.05).After treatment,levels of liver function parameters in observation group and control group were all significantly increased(P<0.05),and those in control group were higher than observation group(P<0.05).After treatment,levels of liver function parameters in observation A group and control A group were all significantly increased(P<0.05),and those in control A group were higher than observation A group(P<0.05).After treatment,levels of liver function parameters in observation B group and control B group were all significantly increased(P<0.05),and those in control B group were higher than observation B group(P<0.05).Conclusion Magnesium isoglycyrrhizinate could be with protection effects on liver function of patients with gastrointestinal cancer following chemotherapy,which might be worthy of promotion.

Objective To investigate the clinical characteristics,minimal invasive operation technique and perioperative management of lateral ventrieular tumors.Methods The clinical characteristics,image diagnosis,surgical approaches and postoperative management and surgical outcomes of 65 consecutive cases of lateral ventricular tumors were retrospectively analyzed.Results In our series,total resection was achieved in 54 cases,and subtotal resection was achieved in 11 cases.Lateral ventricular tumors were mostly found in male and in the left side.Headache caused by increased intracranial pressure was the most common clinical symptom.Ependymocytoma and astrocytic glioma are the most common pathologic diagnosis.Postoperative complications included fever (26 cases),hydrocephalus (9 cases),intraventricular hematoma (7 cases) of which 2 cases were evacuated by craniotomy,epilepsy (7 cases),wound infection (3 cases).Postoperative death was happened in 3 cases.Two of them died of respiratory failure due to postoperative epilepsy.Conclusion Early discovery of lateral ventricle tumors,meticulous operation,subtle micromanipulation and right postoperative treatment are the criticality to improve the rate of total resection of lateral ventricle tumors through microsurgical treatment and reduce postoperative complications and mortality.

BACKGROUND: Pedicle screw fixation is a common repair method for thoracolumbar fractures. Of them, pedicle screw placement into the injured vertebra is an important method. However, the long-term effects and the related biomechanical properties deserve further analysis. OBJECTIVE: To analyze the long-term effect and biomechanical characteristics of the internal fixation of thoracolumbar fractures by pedicle screw implantation. METHODS: A retrospective analysis was performed in 126 cases of thoracolumbar fractures. The patients were treated with pedicle screw implantation and the treatment was fol owed up regularly. Ten specimens of fresh calf chest and lumbar spines were obtained. Five specimens served as an experimental group to prepare models of anterior middle column fractures, and these specimens received pedicle screw fixation into the injured vertebra. The other five specimens served as the control group, and did not receive any treatment. In the two groups, along the sagittal axis, axial compression displacement, anterior flexion displacement, posterior extension displacement, torsion angle and pul -out strength were measured and recorded. RESULTS AND CONCLUSION: (1) Clinical trial results: 126 patients were fol owed up for 10-36 months. Compared with pre-treatment, compression ratio of the injured vertebra, the height of intervertebral space, vertebral slip distance, visual analogue score and Cobb angle were significantly improved at 1 month after treatment and during final fol ow-up (al P < 0.05). No significant difference in above indexed was detected between 1 month and final fol ow-up (al P > 0.05). At the end of fol ow-up, Frankel spinal cord injury grade was significantly improved (Z=-4.127, P < 0.05). After operation, three patients suffered from pulmonary infection, four patients affected urinary tract infection, and one patient experienced delayed wound healing. (2) Biomechanical results: axial compression displacement, anterior flexion displacement, posterior extension displacement, torsion angle and pul -out strength were smal er in the experimental group than in the control group (al P > 0.05). (3) Above findings showed that pedicle screw fixation into the injured vertebra for thoracolumbar fractures obtained good long-term effects, and had good biomechanical properties.

Objective To detected the levels of inflammatory markers in diabetic retinopathy (DR) patients with hyperuricemia(HUA) ,and to investigated the relationship between diabetic retinopathy and hyperurice-mia .Methods 190 DR patients were enrolled in to our study at January 2016 to June 2017 ,patients were di-vided into group of diabetic retinopathy with hyperuricemia (HUDR group) and group of diabetic retinopathy (DR group) according to level of serum UA ,and selected diabetes mellitus patient (DM group) and health per-son(HC group) as control group .Detected serum interleukin 1β(IL-1β) and tumor necrosis factor-α(TNF-α) levels of participants and statistical analysis .Results The IL-1β and TNF-α levels have significant difference between HUDR group ,DR group ,DM group and HC group ,the difference was statistically significant (P＜0 .05) ;Among them ,the levels of IL-1β 、TNF-α in HUDR group was significantly higher than that of DR group ,DM group and HC group ,and the difference was statistically significant (P＜0 .05) .The proportion of proliferative retinopathy in group HUDR was 42 .1%,was significantly higher DR group which was 27 .4%, the difference was statistically significant (P＝0 .033) .Serum UA level was positively corrected to IL-1β(r＝0 .356 ,P＝0 .000) and TNF-α(r＝0 .660 ,P＝0 .000) levels of HUDR patients .Logistic regression analysis re-veal that UA(OR :1 .857 ,95% CI :1 .123-3 .229) ,IL-1β(OR :2 .124 ,95% CI :1 .336-3 .715) and TNF-α(OR :1 .673 ,95% CI :1 .108 -2 .275) were independent risk factors of diabetic retinopathy .Conclusion There are higher levels of IL-1β and TNF-α in diabetic retinopathy patients with hyperuricemia ,hyperuricemia may pro-mote the progression of diabetic retinopathy and hyperuricemia is an independent risk factor of the disease .

Objective To investigate the rehabilitation prognoses of children with traumatic brain injury (TBI).MethodsA retrospective analysis was made in 64 children who had been admitted for rehabilitation.Their clinical information,rehabilitation protocols,recovery of consciousness and ability in the activities of daily living (ADL) were analyzed. ResultsThe children's injuries were severe-42.19％ had consciousness disorders,but 80％ of them recovered consciousness after rehabilitation.Their limb motor dysfunction was dominated by hemiplegia (51.67％).For 65.63％ of the patients rehabilitation was initiated within one month after injury.The average length of stay in rehabilitation was 33.09 ± 25.96 days.Those with consciousness disorders stayed significantly longer than those without.The main treatments were hyperbaric oxygen therapy,exercise and neurotrophic drugs (the ratios were 95.31％,89.06％ and 82.81％ respectively).After the first course of inpatient rehabilitation,the conscious ness recovery rate was 81.48％ and ADL ability improved significantly.The total effectiveness rate was 90.63％.Univariate and multivariate analyses showed that the factors most strongly correlated with effective rehabilitation were age at injury and the rehabilitation intervention time.ConclusionThe results suggest that a general hospital should focus on early (acute and subacute phase) rehabilitation.So developing the rehabilitation network system is necessary and urgent.Rehabilitative therapy is very helpful in TBI cases.Being older at the time of injury and earlier rehabilitation intervention predict better short term outcomes.It is necessary to build and improve on a more standardized and systemic rehabilitation and assessment system for pediatric TBI.