The development of society raises demands for high-level talents,which requires high level post graduate education.The model of post graduate education is changing from research centered to professional skill centered.The research centered program has a long history and has gained consensus,while the professional skill program is still new.To address the social and economic needs,we explored the professional skill centered post graduate program and report our experience here.

Objective:To explore the evaluation value of abnormal muscle response (AMR) monitoring in efficacy of microvascular decompression in primary hemifacial spasm.Methods:A retrospective study was performed. Sixty-four patients with primary hemifacial spasm, admitted to our hospital from April 2019 to December 2020, were chosen. All patients underwent intraoperative AMR monitoring and were divided into AMR complete-disappeared group, AMR significant-changed group and AMR not significant-changed group according to the monitoring results. The relief of spasticity symptoms among the three groups was observed one week and one year after surgery. The specificity and sensitivity of AMR monitoring in evaluating the efficacy, the relations between intraoperative AMR changes and postoperative efficacy after microvascular decompression were analyzed.Results:The specificity and sensitivity of AMR monitoring in predicting spasmodic relief after microvascular decompression were 89.7% and 66.7%, respectively, at one week, and 86.7% and 50.0%, respectively, at one year. There were statistical differences in clinical remission rate one week after microvascular decompression among AMR complete-disappeared group ( n=46), AMR significant-changed group ( n=8) and AMR not significant-changed group ( n=10, P<0.05); there were no significant differences in clinical remission rate one year after microvascular decompression among the three groups ( P>0.05). There was no significant difference in clinical remission rate one week and one year after microvascular decompression between patients having AMR complete disappearance before Teflon and patients having AMR complete disappearance after Teflon ( P>0.05). Conclusion:AMR monitoring has high specificity but modest sensitivity in predicting spasmodic relief after microvascular decompression; intraoperative AMR disappearance is associated with short-term efficacy, but it is not a reliable indicator for long-term efficacy; the time of disappearance of intraoperative AMR has no guiding significance in judging the efficacy of patients with primary hemifacial spasm.

Objective To investigate the factors affecting the prognosis of posterior communicating artery aneurysm (PCoA) to provide theoretical foundation for treatment of PCoA.Methods The clinical data of 308 patients with PCoA,admitted to our hospital from January 1997 to June 2013,were studied retrospectively.With the therapeutic effect as the dependent variable,Logistic regression analysis was performed to examine 13 factors those potentially affected the outcomes of the patients.Results The patient's gender,side and size of PCoA,position and pointing of PCoA,timing of surgery and rupture or not during operation did not affect the outcomes of the patients (patient's age,gender,times of subarachnoid hemorrhage (SAH),Hunt-Hess grade,preoperative condition of consciousness,side and size of PCoA,position and pointing of PCoA,timing of surgery,rupture or not during operation,degrees of SAH and postoperative complications).But univariate analysis showed that the patient's age (P=0.003),times of SAH (P=0.005),Hunt-Hess grade (P=0.000),preoperative consciousness situation (P=0.003),degree of SAH (P=0.001) and postoperative complications (P=0.000) were the independent risk factors affecting the postoperative outcomes; whereas the Hunt-Hess grade and postoperative complications are fundamental risk factors that affected the postoperative effects (OR=14.330,P=0.000,95％CI:2.005-102.396; OR=19.445,P=0.004,95％CI:2.513-150.442).Conclusion Preoperative Hunt-Hess grade and postoperative complications are independent risk factors affecting the prognosis of patients; through analysis of these factors,the prognosis of patients can be broadly determined,thus the treatment of PCoA can be further guided and level of clinical treatment can be improved.

Objective:To investigate the preoperative endocrinological characteristics of pituitary apoplexy of infarcted type.Methods:Twenty-six patients with pituitary apoplexy of infarcted type, confirmed by pathological pathology in our hospital from January 2010 to October 2019, were chosen. All patients were performed pituitary adenoma stroke scale before surgery, and endocrine examinations were performed on three pituitary target gland axes, namely the pituitary-thyroid axis, pituitary-gonadal axis and pituitary-adrenal axis, to evaluate the pituitary function and functions of three target gland axes.Results:Preoperative pituitary adenoma stroke scale scores were (1.92±1.78), ranged from 2 to 8. Twenty-five patients (96%) were with impaired pituitary function, including 13 patients (50%) with panhypopituitarism and 12 patients (46%) with partial hypopituitarism; in these 12 patients with partial hypopituitarism, 9 patients were noted to be involved two target gland axes, and 3 patients were noted to be involved one target gland axis. There were 22 patients (85%) with hypophysia-gonadal axis hypopituitarism, 14 (54%) with hypophysia-thyroid axis hypopituitarism, and 13 (50%) with hypophysia-adrenal axis hypopituitarism. Preoperative levels of prolactin in 26 patients (100%), testosterone in 26 patients (100%), luteinizing hormone in 18 patients (75%), progestational hormone in 18 patients (75%), thyroid stimulating hormone in 18 patients (69%), free triiodothyronine in 17 patients (65%), free thyroxine in 14 patients (54%), estradiol in 13 patients (54%), cortisol in 13 patients (52%), follicle stimulating hormone in 9 patients (38%), adrenocorticotrophic hormone in 9 patients (35%), growth hormone in 3 patients (15%) were lower as compared with baseline levels.Conclusion:Hypophysia-gonadal axis hypopituitarism is most common in pituitary apoplexy of infarcted type, and the endocrinological features are the sharp decrease of prolactin and testosterone levels.

Objective:To explore the predictive values of preoperative CT and MRI features in intraoperative liquefaction degrees of hematoma in patients with chronic subdural hematoma (CSDH).Methods:Sixty-nine patients (83 sides) with CSDH, admitted to Department of Neurosurgery, Affiliated Hospital of Qingdao University were chosen; preoperative CT and/or MRI were performed in all patients. According to hematoma density in CT images, hematoma was divided into high-density, medium density and low-density hematoma; according to the proportion of hematoma part enjoying uniform signal in MRI images, hematoma was divided into heterogeneous signal hematoma and homogenized signal hematoma. The liquefaction degrees of hematoma in patients with different densities of hematoma, and heterogeneous signal hematoma and homogenized signal hematoma were compared, and the liquefaction degrees of hematoma in patients with special-shaped hematoma were summarized.Results:A total of 58 patients (69 sides) with CSDH completed preoperative CT examination; the intraoperative liquefaction degrees of hematoma in patients with different hematoma densities in CT images were significantly different ( P<0.05); the liquefaction degree of hematoma in patients with medium density hematoma was better than that of high-density hematoma and low-density hematoma (average rank: 40.71, 34.67 and 25.27). A total of 50 patients (63 sides) with CSDH completed preoperative MRI examination; the intraoperative liquefaction degrees of hematoma in patients with homogenized signal hematoma was better than that of heterogeneous signal hematoma, with significant difference (average rank: 46.53 and 17.00, P<0.05). The hematoma with soapy signs on preoperative CT or MRI images had blood clots mainly. Hematoma with fluid-fluid levels and fluid gradual changes had good liquefaction. Conclusion:Preoperative CT and(or) MRI images can effectively help to predict the intraoperative liquefaction degrees of hematoma in CSDH patients.

Objective: To explore the value and disadvantage of micro-mirror in the intracranial aneurysm surgery. Methods: Micro-mirror was used to assist microsurgical clipping to 36 intracranial aneurysms in 31 cases, of which 3 were carotid-ophthalmic artery aneurysms, 3 anterior choroidal artery aneurysm, 11 were posterior communicating artery aneurysms, 7 were middle cerebral artery aneurysms, 10 anterior communicating artery or anterior cerebral artery aneurysms, and the others were a posterior cerebral artery aneurysm and a posterior inferior cerebellar artery aneurysm. The micro-mirror was used before and after clipping to observe the anatomic features of necks hidden behind and medial to aneurysms, to visualize surrounding neurovascular structures, and to verify the optimal clipping position. Intraoperative indocyanine green fluorescein angiography confirmed the success of sufficient clipping. Results: All aneurysms were clipped successfully. The parent arteries were occluded temporarily in 26 cases, and 9 aneurysms ruptured during the operation. Postoperative follow-up lasted from 2 weeks to 1 year. After operations digital subtraction angiography (DSA) were repeated in 10 cases, computed tomography angiography(CTA) in 21 cases, and no insufficient clipping or occlusion of parent arteries were revealed. Conclusions Micro-mirror assisting microsurgical clipping to the intracranial aneurysm is conducive to accurate clipping, and is a convenient and practical operation.