The author proposed student-centered learning system in otolaryngology-head and neck surgery for undergraduate clinical training after exploration and intentions.Four mutual impacted frames were built including integration of teaching philosophy,visualization of training methods,diversification of educational targets and interaction of training courses.Endoscopic navigated learning and multimedia aided training were applied,respective teaching purposes were set and various clinical training courses were introduced to students in their learning of otolaryngology,which were believed to help develop more medical talents with higher comprehensive qualities and better clinical skills.

BACKGROUND:The position of median and radial nerves corresponding to elbow is usual y estimated by macroscopical measurements, but there are big data errors when the elbow is bent. OBJECTIVE:To measure and analyze the impacts of elbows in different positions on median and radial nerves under X-ray. METHODS:Ten fresh frozen upper limb specimens were selected. The distance of median and radial nerves to the osseous marks inside the elbow was measured when the elbow was in extension, extension-half pronation, bent at flexion 90 degrees and bent at 90 degrees with the injection of normal saline into the joint capsule, respectively. RESULTS AND CONCLUSION:The positions of median and radial nerves were not influenced when the elbow was in extension or in extension-half pronation (P>0.05). The distance of median and radial nerves to the osseous mark of the elbow was significantly lengthened when the elbow was moved from from extension to was bent at 90 degrees (P<0.05). The intra-articular injection of normal saline when the elbow flexion 90 degrees significantly elongated the distance of median and radial nerves to the osseous mark of elbow (P<0.05). These results suggest that the elbow in different positions can induce the displacement of median and radial nerves. In addition, the distance between median, radial nerves and the osseous marks of the elbow is obviously lengthened when the elbow is in flexion with intra-articular injection of normal saline.

Objective To explore the effect of osthole on mast cells and expression of STAT5 gene and protein in them. Methods Passive cutaneous anaphylaxis was made in mice to copy eczema model, then the allergic mast cells were separated, and the ovalbumin was used to induce allergy of mast cells. Different concentrations of osthole were used to intervene the sensitized mast cells.Then the sensitized mast cells were divided into blank control group, osthole high-dose group and low-dose group.At the end of the experiment, morphology of the mast cells was detected by immunofluorescence technology.MTT assay was used to detect the influence of drugs on mast cells proliferation. RT-PCR and Western blotting were used to detect the expression of STAT5 gene and protein. Results As compared with blank control group, the number of mast cells in the osthole groups was significantly reduced, cells and nuclei obviously shrank, even apoptosis of some cells could be observed; the inhibition rate of mast cells in osthole groups was significantly increased in concentration-dependent manner ( P<0. 01 ) . As compared with blank control group (2.16±0.57), gene expression of STAT5 was significantly decreased in osthole high-dose group (0.59±0.12) and low-dose group (0.82±0.13) (P<0.01).The protein expression of STAT5 was also significantly decreased in osthole high-dose group and low-dose group as compared with blank control group (P<0.01). Conclusion Osthole can inhibit the proliferation of sensitized mast cells, and reduce the expression of STAT5 gene and protein.

Objective To investigate the anti- inflammatory and analgesic a ctions of Huangqi Guizhi Wuwu Decoction (HGWD) and its compositions and to study its rule of compatibility.Methods Analgesic action of HGWD and its compositio ns were observed by hot- plate method and acetic- acid- induced body twist me thod. Anti- inflammatory action of HGWD and its compositions were observed on t he models of xylene- induced auricular swelling in mice, celiac capillary perme ability in mice, cotton- induced granuloma in rats, albumem- induced arthritis and adjuvant arthritis in rats.Results HGWD and its drug pairs could inhibit the acute inflammation induced by albumen and xylene and rat adjuvant arthriti, decrease the celiac capillary permeability, inhibit the proliferation of granu loma, increase the pain threshold in mice and reduce the frequencies of body tw ist induced by acetic acid.Conclusion HGWD has significant anti- inflammatory and analgesic actions, so does single drug; Radix Astragali alone, but when Ra dix Astragali is used with the other drugs in HGWD, its effect can be enhanced.

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Objective To investigate the relationship between alcohol and smoking and the development of pancreatic calcification in chronic pancreatitis (CP) in China. Methods The patients were divided into two groups according to the presence of pancreatic calcification at admission and the data were analyzed; furthermore, the discharged patients without pancreatic calcification were divided into two groups as newly diagnosed pancreatic calcification group and persistent non-pancreatic calcification group. Logistic regression and Cox proportional-hazards model was used for multivariate analysis of the risk factors for pancreatic calcification. Results From January1997 to July 2007, 449 patients with CP were enrolled and followed up successfully. 248 patients presented with pancreatic calcification at admission; among the 201 patients presented without pancreatic calcification, 13 patients developed pancreatic calcification after discharge. Patients with pancreatic calcification had a young age at onset, long CP history, higher incidence of diabetes mellitus and diarrhea. Age at onset ≤ 40, alcohol intake over 20 g/day, and diabetes mellitus and diarrhea were risk factors for pancreatic calcification. The only risk factor of development of pancreatic calcification after discharge was excessive alcohol intake (OR: 3.2). Conclusions Alcohol intake increased the risk of pancreatic calcifications, suggesting the patients abstain from alcohol intake. Further studies are necessary to clarify the role of smoking.

Objective To investigate the incidence of diabetes mellitus and risk factors for the disease in chronic pancreatitis (CP) patients.Methods A historical cohort study on subjects with painful CP who were admitted to hospital from Jan.1997 to July 2007 were conducted.A life-table method was used to estimate the cumulative probability of the development of diabetes mellitus once clinical onset of abdominal pain.Cox proportional-hazards model was used for multivariate analysis of the variables including age,sex,drinking and smoking habits,etiological factor,presence of pancreatic masses,pancreatic calcifications,measure of intervention,diarrhea,weight loss and degree of pain.Results Data were obtained from 354 patients (239 males,mean age at onset of pain (38.1±17.6) years;alcoholic origin 18.1%) with painful CP.The mean follow-up period was (45.2±32.9)months.The rate of diabetes mellitus in CP patients was 16.1%.There was a high incidence (29.8%)of diabetes mellitus 1 year before the episodes of abdominal pain.The cumulative risk of diabetes mellitus in subjects 5 and 10 years after the episodes of pain was 9.3% and 20.7%,respectively.Cox proportional-hazards model selected smoking (＞10 pack years) (hazard rate (HR)= 3.3),mild abdominal pain (HR=5.2),weight loss (HR = 2.6) and pancreatic calcifications (HR = 2.2) as variables identifying subjects with diabetes mellitus in patients with painful CP before they were performed therapeutic endoscopy or surgical intervention.Smoking (＞10 pack years) (HR = 3.0),weight loss (HR= 2.8) and distal pancreatectomy (HR =7.3) were identified with an increased risk of diabetes mellitus in these cases after they received therapeutic endoscopy or surgical intervention.Conclusion The risk factors of diabetes mellitus for CP appears to be independent of smoking (＞10 pack years),mild abdominal pain,weight loss,pancreatic calcifications and distal pancreatectomy.

Objective To investigate the incidence and risk factors of pancreatic cancer in patients with painful chronic pancreatitis (CP). Methods Three hundred and ninty-seven patients with painful CP were recruited between Jan. 1997 to July 2007. A life-table method was used to estimate the cumulative probability of the incidence of pancreatic cancer. Cox proportional-hazards model was used for multivariate analysis of the variables including age, sex, drinking and smoking habits, etiological factor, presence of pancreatic masses, pancreatic calcifications, measure of intervention, diabetes mellitus, diarrhea, weight loss and degree of pain. Results Of 397 patients,346 (87.2%) were follow-up for (34.3±27.1)months with 244 males and 102 females(2.4 :1). The mean age of the patients were (47.7 ±13. 7) years and alcoholic origin accounted for 22. 2%. The incidence of the pancreatic cancer was 8.1 % (28/346). There was a high incidence of cancers during the 4 years after the episodes of abdominal pain. The cumulative risks of pancreatic cancer 1, 5 and 10 years after the episodes of pain were 5 %, 5.6% and 11.6% respectively. Cox proportional-hazards model selected age at onset (≥51 years) [hazard rate(HR) = 3. 1], pancreatic calcifications ( HR = 4.1) ,pancreatic masses ( HR = 7. 1 )], no improvement of abdominal pain ( HR = 3. 8), increased frequency of pain (HR= 6.8), no diarrhea (HR= 15.3) as variables identified with pancreatic cancer in painful CP patients. Conclusions Pancreatic cancer should be suspected in patients with CP. The risk factors of pancreatic cancer are age at onset (≥ 51 years), pancreatic calcifications, pancreatic masses, no improvement of abdominal pain, increased frequency of pain and no diarrhea.

Objective To evaluate the risk factors of failure in pain resolution in chronic pancreatitis(CP)after endoscopic treatment.Methods We undertook a retrospective cohoa study of subjects with pain caused by CP,who underwent endoscopic treatment from January 1997 to December 2006.Cox proportional-hazards model was used for multivariate analysis of the variables that were possibly related to failure of treatment.Results Follow-up data were obtained from 172 patients(114 males and 58 females,mean age 39.4 yr.Pain resolution after endoscopic treatment was achieved in 148(86.0%).Cox proportional-hazards model showed risk factors of failure in pain resolution after endoscopic treatment were onset age(＞36 years,hazard rate(HR)=3.5),mild and moderate abdominal pain before endoscopy(HR=2.4),no decrease in amount alcohol consume(＜50%,HR=1.9)and inappropriate diet(HR=2.8).Conclusion Patients with CP should abstain from alcohol and have low-fat diet,especially for those with pain onset at older ages (＞36 years)and with mild and moderate abdominal pain before endoscopic treatment.

objective To investigate the rate and risk factors of early complications after endoscopic pancreatic sphincterotomy.Methods Data of patients,who underwent endoscopic pancreatic sphincterotomy from May 2006 to April 2007,were recorded before and during the procedure and prospectively studied.The Datients were followed up until discharge.Results A total of 165 patients underwent endoscopic pancreatic sphincterotomy,of which 25(15.2%)developed complications,including acute pancreatitis in 22(13.3%)(15 mild,6 moderate and 1 severe),hemorrhage in 1(0.6%),and acute cholangitis in 2(1.2%).There was no perforation or procedure-related mortality.Multivariate analysis indicated that risk factors of acute pancreatitis were female(OR:3.8,95%CI:1.4-10.8),recurrent pancreatitis(OR:3.1,95%CI:1.0-9.9),and parapapilla sphincterotomy(OR:5.9,95%CI:1.2-28.8).Conclusion Compared with routine ERCP,endoscopic pancreatic sphincterotomy may be associated with higher risk of acute pancreatitis,especiallv in women.patients with recurrent pancreatitis and those undergoing parapapilla sphincterotomy.