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.

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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.

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.

The spike (S) and nucleocapsid (N) proteins, which are responsible for viral binding to cell surface receptors and the formation of ribonucleoprotein complexes during virion assembling, are major structure proteins of severe acute respiratory syndrome coronavirus (SARS-CoV). The expression of recombinant protein may give more accurate result for detecting SARS-CoV infection. A novel fusion protein,comprising of two fragments of N and S proteins from SARS-CoV, was prepared. Our computer-assisted analysis suggested that the immunodominant domains were located in the amino acid residues 1-227 of N protein and 450-650 of S protein, further the fusion of the two fragments did not change the immunochemical characteristics. The complementary DNA(cDNA) encoding N1-227 fused with S450-650 was obtained by sequence overlapping extension (SOE), and named NLS. It was cloned into pET-28a ( + ), an expression vector for His-tag fusion protein. This new constructed fusion protein was prokaryotic expressed in E. coli,and purified by metal chelate affinity chromatography with the purity over 95 %. The purified fusion protein was identified by anti-His monoclonal antibody and convalescence SARS patients serum. The NLS protein based ELISA showed that NLS maintained appropriate antigenicity and specificity to react with the sera of convalescent SARS patients. The functional NLS protein were successfully expressed and purified. And the fusion protein based ELISA can be used for detection of antibodies (Abs) against the S and N proteins of SARS-CoV. It may provided a novel diagnostic tool and have the potential application in developing of anti-SARS vaccine.

Objective To observe the influence of using alpha-adrenergic receptor blocker and catheterization time on the success rate of a trial without catheter (TWOC) in patients with acute urinary retention (AUR) caused by benign prostatic hyperplasia (BPH).Methods The 124patients from January 2007 to December 2009,aged 62-90 years (mean age 71.3 years),diagnosed as AUR caused by BPH in emergency room,were enrolled in this study.They were randomized to two groups:(1) Medication group:60 cases,who were given alpha-adrenergic receptor blocker 4 mg daily for 2-3 days before TWOC.Among them,there were 30 cases with catheterization for 3 days,and the rest 30 cases for 7 days;(2)Control group:64 cases,who were without alpha-adrenergic receptor blocker.Among them,there were 30 cases with catheterization for 3 days,and the rest 34 cases for 7days.The urine culture was made when the catheter was drawn out.Results (1)The success rate of TWOC was higher in medication group than in control group (71.7% vs.53.1%,x2 =4.523,P=0.033).Both in medication group and control group,the success rate was higher in patients with catheterization for7 days than for 3 days (83.3% vs.60.0%,x2=4.022,P=0.045;67.7% vs.36.7%,P=0.013).(2)After follow-up for 6 months,the patients with catheterization for 7 days had lower incidence rate of second AUR and selective operation (x2 =4.538 and 4.709,P=0.033 and 0.030).(3)There was no significant difference in rate of urinary infection between the patients with catheterization for 7 days and for 3 days (20.3% vs.16.7%,P = 0.603).Conclusions Alpha-adrenergic receptor blocker could increase the success rate of TWOC,and the success rate of TWOC is much higher in patients with catheterization for 7 days than for 3 days,while the urinary infection rate is not significantly increased.

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.