Questionnaire survey and semi-structured interview were done in December 2005 and April 2006 to explore the reasons why foreign and minority medical students failed in course examinations last year.It is found that many factors affect their studying such as proficiency in Chinese,original foundation,studying and living habits,familiarity to the regulations of educational affairs,time and effort spent for self-studying and the attitude in which the teachers treat them.And also the correspondent countermeasures are given according to the survey and interview.

The finite element method (FEM) is a mathematical technique using modern computer technology for stress analysis, and has been gradually used in simulating human body structures in the biomechanical field, especially more widely used in the research of thoracolumbar spine traumatology. This paper reviews the establishment of the thoracolumbar spine FEM, the verification of the FEM, and the thoracolumbar spine FEM research status in different fields, and discusses its prospects and values in forensic thoracolumbar traumatology.
Biomechanical Phenomena ; Computer Simulation ; Finite Element Analysis ; Humans ; Lumbar Vertebrae/injuries* ; Models, Theoretical ; Stress, Mechanical ; Thoracic Vertebrae/injuries* ; Traumatology

Objective To assess the clinical value of serum uric acid levels in patients with acute ST-elevation myocardial infarction(STEMI).Methods A total of 502 consecutive patients with STEMI were enrolled from January 2005 to December 2010 for retrospective study.The level of serum lipid,echocardiographic data and in-hospital major adverse cardiovascular events(MACE)in patients with hyperuricemia(n =119)were compared with those in patients without hyperuricemia(n =383).The relationship between the level of serum uric acid and the degree of diseased coronary artery was analyzed.All data were analyzed with SPSS version 17.0 software to make t test and x2 test and Pearson correlation analysis.Results Serum uric acid level was positively correlated with serum triglyceride level.Compared with non-hyperuricemia patients,hyperlipidemia was more commonly found among hyperuricemia patients (43.7％ vs.33.7％,P =0.047),and serum triglyceride level was significantly higher in hyperuricemia patients[(2.11 ± 1.24)mmol/L vs.(1.78 ± 1.38)mmol/L,P =0.014].But a significant association between serum uric acid level and one or more diseased vessels was not observed(P ≥ 0.05).Leftventricular end-diastolic diameter(LVEDd)was found to be larger in hyperuricemia patients than non-hyperuricemia patients[(53.52 ±6.19)mm vs.(52.18 ±4.89)mm,P =0.041].Higher incidence in left systolic dysfunction and diastolic dysfunction was discovered in hyperuricemia patients(36.4％ vs.15.1％,P ＜0.01; 68.2％ vs.55.8％,P =0.023).Also,hyp-eruricemia patients had more in-hospital MACE(P ＜ 0.05).Conclusions Serum uric acid level is positively correlated with serum triglyceride level,but not with the severity of coronary artery disease.Hyperuricemia patients after STEMI tended to have higher incidence in left systolic dysfunction and diastolic dysfunction,and have more in-hospital MACE.

Objective To investigate the therapeutic effect and advantage of laparoscopic appendectomy by concealed three-ports technique. Methods The clinical data of 283 patients received concealed three-ports laparoscopic appendectomy were retrospectively reviewed. Results All the patients were cured after appendectomy,including 5 patients required conversion to operation(because of adhesions around the appendix and difficult to dissect). The surgical time ranged from 25 min to 110 min and the mean time was 38 min. After 8 ～ 12h the patients could move and the average length of postoperative stay was 5d (range 4 ～ 6d). 3 cases had postoperative wound infection. None occurred complications such as postoperative bleeding, abdominal abscess, intestinal fistula, adhesion ileus and incision hernia in 6 months on average (range 1 ～ 18 months)after operation. Conclusion Laparoscopic appendectomy by concealed three-ports technique was a safe and available method and had advantages such as convenience and safety,good cosmetic results,less injury,rapid recovery,less complications,cheap and easy.

Objective To investigate the causes and managements of dys-seal syndrome (DSS) developed after esophageal stent placement. Methods From June 2001 to June 2008, esophageal stenting was performed in 98 consecutive patients with malignant esophageal obstruction. A total of 99 metallic stents were used. Of 98 patients. gastroesophageal anastomosis stricture was seen in 19, preoperative radiotherapy history in 26 and tracheoesophageal fistula in 34. Results DSS occurred in 7 patients, with an occurrence rate of 7.14% ,which was significant higher than that in patients with preoperative radiotherapy history and in patients showing marked dilated esophagus proximal to the obstructed site (X~2=0.017, 0.005, P=0.036, 0.013, respectively). After treatment, such as fasting, IPN or nasogastric feeding,only 1 case retumed to semi-liquid diet. Among the rest 6 cases of DSS, an additional stent was employed in one (but in vain), nasogastric feeding tube was used in 2, and removal of the stent under endoscopic guidance was carried out in 3. Conclusion DSS is one of the complications developed after esophageal stent placement, its prognosis is rather poor. Removal of the inserted stent may be the optimal treatment. The prevention of DSS includes proper pre-operation evaluation, selection of suitable stent, enhancement of perioperative nutritional support, etc.

Objective To evaluate the efficacy of Fluency stent-graft (Bard Corp) in transjugular intrahcpatic portosystemic shunt (TIPS).Methods The clinical data of 21 consecutive patients treated by TIPS using Fluency stent-grafts were retrospectively reviewed.All of them were recurrent variceal bleeding secondary to portal vein hypertension,1 was bleeding secondary to primary hepatic carcinoma with port vein thrombns,and 1 was Budd-Chiari syndrome.They were followed-up after (10.1 ± 4.6) months (2.0 to 24.0 months).Stent-grafts patancy,portal vein pressure and liver function were recorded and compared.Results Twenty-five stent-grafts were successfully implanted in 21 patients,23 stent grafts were 8 mm 2 were 10 mm in diameter.The covered length of the stents varied from 6 to 8 cm.The bleeding was stopped and the portal vein pressure decreased significantly from (25.4 ± 3.5) mm Hg to (15.4 ± 2.8) mm Hg (t = 12.495,P < 0.01).During the follow-up period,The patient with primary HCC and portal vein thrombosis died 4 months after the procedure. One case had a new primary HCC during the follow-up and died 24 months after the procedure.One ease with variceal bleeding secondary to portal vein hypertension died of muhisystem organ failure.One case occluded in the hepatic vein and had another stcnt graft implanation.The other 17 cases had no stenosis after 7 to 17 months follow-up.Ultrasound showed that the stents were patent 1 week before the patients died.Three cases had transient symptoms of hepatic encephalopathy and recovered after treatment.The Child scores of the 19 patients survived more than 6 months were 6.3 ±1.4 before and 6.4 ± 1.9 after the procedure without significant difference (t = 0.645,P > 0.05).Conclusion The Fluency stent-grafts could increase the patency of the TIPS,but its efficacy on the long-term effect and hepatic encephalopathy need further investigation.

Objective To figure out the effect of resveratrol (Res) in skin and lung pathology of systemic sclerosis (SSc) animal model and find a new target of anti-fibrosis therapy in SSc.Methods First, we establish ed SSc animal model by daily subcutaneous injection of bleomycin (BLM) for 4 weeks in BALB/c mice.Then we fed the mice with Res.We observed the pathological changes in skin and lung and the expression of the deacetylase SIRT1.We observed the following parametrs.The pathologicalchanges in injected skin and lung which shown by hematoxylin-eosin (HE) staining, the expression of α-smooth muscle actin (α-SMA) in injected skin and lung which measured by immunohistochemistry, the expression of SIRT1 and pro-collagen Ⅲ mRNA which assessed by Real Time polymerase chain reaction (PCR).For the homosce dasticity data.We used one-way analysis of variance (ANOVA) and LSD-t test to compare between the groups.Results Daily subcutaneous injection of BLM for 4 weeks in Balb/c mice could successfully establish a mouse model of SSc.The thickening of skin and alveolar septum, the infiltration of inflammatory cells in lung, and even fibrosis insome area of lung could be observed.The number of α-SMA positive cells and the expression of pro-collagen Ⅲ mRNA were increased (P＜0.05).Meanwhile, the expression of SIRT1 mRNA was decreased [the number of α-SMA positive cell: skin 26.4±5.9 vs 4.4±2.2, lung 14.6±4.6 vs 2.4±1.1, cells per view, P＜0.01;the expression of pro-collagen Ⅲ mRNA: 1.06±0.24 vs 0.45±0.14, relative to glyceraldehyde phosphate dehydrogenase (GAPDH), P＜0.05].Meanwhile, the expression of SIRT1 mRNA was decreased (1.01±0.51 vs 5.03±1.59, relative to GAPDH, P＜0.05).Treated with Res, the pathological changes in skin and lung were alleviated and the number of α-SMA positive cells in lung and skin was decreased [skin 26.4±5.9 vs 10.0±3.5 (high dosage group), 26.4±5.9 vs 13.4±4.4 (medium dosage group);lung 14.6±4.6 vs 8.8±3.5 (high dosage group), cells per view, P＜0.05].There was were no significant differences in the expression of SIRT1 and pro-collagen Ⅲ mRNA in lung after treated by Res.Conclusion Daily subcutaneous injection of BLM for 4 weeks could successfully establish a mouse model of SSc.Res could be a new medicine for the treatment of SSc.

Objective To evaluate the conditions and risk factors of esophageal stent dys-seal phenomenon (ESDP) .Methods Ninety-eight patients with malignant esophageal obstruction underwent metallic stent placement and 7 patients with ESDP were analyzed.The possible contributing factors,including age,gender,obstruction segment,esophagorespiratory fistula,surgical intervention,radiotherapy,the degree of upper obstruction segment expansion,stent with bellmouth,application of covered stent were investigated.All factors mentioned above were analyzed with Logistic regression analysis.Results ESDP was observed in 7 patients (7/98,7.14%) and defined as a space between the esophageal wall and the proximal part of stent without contrast agent obstruction within stent.The clinical situations of patients with ESDP included dysphagia,bucking and constantly chest pain,especially at foodintake.The results of Logistic regression analysis indicated radiotherapy (P=0.005) and the degree of upper obstruction segment expansion (P=0.017) were significantly correlated with ESDP.Conclusion ESDP is one of the complications after esophageal stent placement.It is prudent to implant esophageal stent for those patients with radiotherapy and significant upper obstruction segment expansion.

Purpose To investigate the histopathological features of cystic lung diseases ( CLD) , and to discuss the timing of clinical interventions. Methods HE and immunohistochemical staining were performed and reviewed in 125 cases of CLD. Results 125 ca-ses of CLD aged from birth to 11 years and 6 month, with an average age of 23. 0 months, median age 15 months, of which 60 cases were less than 1 year (48. 0%). 75 cases were male and 50 cases female, with male to female ratio of 1. 5 ∶ 1. Grossly, 50 cases showed single or multiple cysts with the size 0. 5 ~8. 0 cm in diameter, which did not communicate with bronchial cavity. 18 cases showed honeycomb cysts with the diameter of 0. 1~2. 0 cm. 26 cases were solid lesions without visible cysts. 21 cases were observed lung abscess with thick and rough wall and pus inside. 7 cases of emphysema showed microcysts with crepitation. 2 cases were identi-fied cystic and solid masses, with fish-fresh like cut surface. Histopathologically, 94 cases (75. 2%) were related to congenital bron-chopulmonary dysplasia in 125 cases of CLD, in which there were 59 patients (47. 2%) of congenial pulmonary airway malformation (CPAM), including 29 cases of type 1 (49. 2%), 18 cases of type 2 (30. 5%), and 12 cases of type 4 (20. 3%), there were 26 ca-ses (20. 8%) of pulmonary sequestration, including 15 cases of intralobar type (57. 7%) and 11 of extralobar cases (42. 3%), 5 ca-ses were complicated with CPAM type 2, 8 cases were bronchial cyst (6. 4%) and 1 case of enteric cyst (0. 8%). Acquired lesions were detected in 31 cases (24. 8%), including 21 cases of infected lung abscess, 1 case of fungal abscess. 7 cases of emphysema, and 3 cases of pleuralpulmonary blastoma (typeⅠ1 case and typeⅡ2 cases). Conclusion Pediatric CLD is characterized as com-plexed categories. The prognosis depends on correct pathological diagnosis, combined with imaging evaluation and appropriate timing of surgery.

Introduced in the paper is a success story of the Singapore National Eye Center (SNEC) and Singapore Eye Research Institute (SERI) in medical care,research and education.Especially noteworthy are their initiatives in talent development,research and international cooperation,which are expected to be learnt by large eye care and research institutions in China in their discipline development,translational research and interdisciplinary talents development.