Neurology is a professional science. The content of neurotomia, sub-speciality knowl-edge and auxiliary examination are abundant, and meanwhile it is rather difficult. Clinical graduates after graduation are malnly engaged in clinical work, clinical services, and will play a variety of roles in the course of their clinical practice so it is necessary for them to learn comprehensive knowledge. This article introduced experience of clinical postgraduates tralning of neurology, such as doctor-patient communication skills, basic theoretical study (neurology, neurotomia and sub-speciality knowledge), clinical thinking, and assistant examination, clinical research capacity during these 18month. It will provide the theoretical and practical knowledge in the future work.

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by multi-organ and multisystemic involvement and various clinical manifestations.Bone marrow mesenchymal stem cells (BM-MSCs),a kind of non-hematopoietic stem cells originating from the mesoderm,are key components of hematopoietic microenvironment.Recent studies have indicated that SLE is a disorder of stem cells.Both hematopoietic and mesenchymal stem cells (MSCs) are abnormal in SLE,which mainly manifests as changes of biological characteristics,abnormal cytoskeleton and ultrastructure,shortened telomeres,increased telomerase and SA-β-Gal acitivity,decreased differentiative ability,aberrant immunoregulatory effect,and other features of senescence.The mechanism of MSC aging may be related to up-regulated expressions of aging-related genes p53/p21cip1,p16INK4a/Rb and p27kip1/pTEN,elevated levels of reactive oxygen species (ROS),endoplasmic reticulum stress,epigenetic alterations,etc.

Objective To evaluate biological behaviors of bone marrow mesenchymal stem cells (BMSCs) from patients with systemic lupus erythematosus (SLE),to confirm that the BMSCs are aging stems cells,and to explore mechanisms underlying their aging.Methods BMSCs were isolated from bone marrow of 6 patients with SLE (patient group) and 8 healthy human controls (control group) by density-gradient centrifugation and plastic adherence,and cultured in vitro.Optical microscopy was conducted to observe morphological changes and growth of BMSCs,and growth curves were drawn.The differentiation ability of BMSCs was evaluated through culture of them with adipogenic and osteogenic induction medium.Flow cytometry was performed to identify cellular surface markers and to analyze cell cycle and apoptosis,and scratch assay to assess the migration ability of BMSCs.Immunofluorcscence assay and Western blot analysis were carried out to analyze the distribution and expression of p27kip1/PTEN in BMSCs respectively.Results Patient-derived BMSCs,which had a broad,fiat and polygonal shape,showed decreased growth rate,migration activity as well as adipogenic and osteogenic ability compared with those from the controls.There was a significant increase in the proportion of BMSCs in early stage (17.98％ ± 3.26％ vs.8.23％ ± 3.25％,t =3.91,P =0.011) as well as in middle to late stages (16.80％ ± 9.63％ vs.3.33％ ± 2.21％,t =2.99,P=0.048) of apoptosis in the patient group compared with the control group.Moreover,compared with the control group,the patient group showed a significantly higher proportion of BMSCs arrested in the G0/G1 phase (92.34％ ± 5.80％ vs.78.65％ ± 3.22％,t =3.635,P =0.015),but a lower proportion in the S phase (0.86％ ± 1.72％ vs.5.06％ ± 1.874％,t =3.084,P=0.027).The protein expressions of p27 and PTEN were significantly higher in the patient group than in the control group (p27/β-actin:t =2.784,P=0.039;PTEN/β-actin:t=4.812,P =0.041).Conclusion The BMSCs from SLE patients exhibit senescence-related features,which may be associated with elevated expression levels of p27kip1/PTEN.

The medical disputes in the primary hospitals increase year by year , and the practical experience at the grass-roots level during 1999 and 2013 showed the medical disputes had various reasons .For primary hospi-tals, the reasons included incomplete reform and management , unsuitable technical level of medical staff , inappropri-ate physician -patient communication and medical service , disunity within the hospital , lack of self -protection awareness;For patients, the reasons included the high expectations of medical service , non-compliance with medi-cal workers, poor economic conditions , week legal awareness;and some reasons from the society , media, etc.To ef-fectively alleviate the tension of physician -patient relationship and build a harmonious medical environment , the pri-mary hospitals need to strengthen the internal management , improve the comprehensive quality of medical staff , en-hance the physician -patient communication , improve self-protection awareness , and establish a good image of pri-mary hospitals.

A 11-year-old child diagnosed as chronic tonsillitis and adenoid hypertrophy underwent adeno-tonsillectomy under general anesthesia. After surgery, patient complained with abdominal discomfort, paleness and vomiting, which presented as the old black contents. Complete blood count showed: 45.2 g/L, hemoglobin of red blood cells 2.57 x 10(12)/L, An emergency gastroscopy confirmed gastric ulcer with hemorrage. Hemorrage was controlled and complete blood count results restored to normal after supportive therapy. Gastric ulcer completely recovered two weeks after discharge.
Adenoidectomy ; Child ; Humans ; Male ; Peptic Ulcer Hemorrhage ; etiology ; Postoperative Complications ; Stomach Ulcer ; etiology ; Tonsillectomy

Objective To investigate the effect of asphyxia on newborn's gastric myoelectrical activity by electrogastrography (EGG). Methods Twenty four asphyxia newborns (mild and severe type) and 15 normal newborns were enrolled. Electrogastric activity were recorded by a Portable EGG. The recording were performed 30 minutes before and after feeding respectively Results Compared with normal control,bradygastria (4 cpm) increased significantly ( P 0.01). Conclusions (1)By the help of EGG, we can get information about gastric myoelectrical activity in neonatal asphyxia.(2)Bradygastria is more prominent before feeding in mild asphyxia group; Slow wave is decreased in severe asphyxia group than that of control and mild asphyxia, but tachygastria increases significantly. This kind of abnormal electrogastric rhythm may contribute to feeding difficulty, abdominal distension and vomiting in asphyxia newborns.

Objectives To investigate the postoperative quality of life of cervical cancer patients treated by laparo-scopic surgery. Methods 27 cases of cervical cancer treated by laparoscopic surgery from May 2009 to September 2010 as observation group, 27 cases of cervical cancer treated by laparotomy treatment in the same period as control group. Observe and analyzed the clinical data, operation, postoperative recurrence and survival rates and postopera-tive FACT-G score between the two groups. Results Age, body mass index has no statistical difference between the two groups ( > 0.05), the blood loss in observation group was less than that in control group ( < 0.05), the lymph node dissection number in observation group was more than that in control group ( < 0.05), the exhaust time and hospital stay in observation group were less than that in control group ( <0.05), the 1-year, 3-year and 5-year re-currence rate and survival rate in observation group showed no significant difference compared with control group ( < 0.05). The 1-year, 3-year and 5-year FACT-G score in control group were higher than that in control group ( < 0.05). Conclusion Laparoscopic surgery for cervical cancer patients can reduce bleeding, shorten exhaust time and hospitalization time, improve postoperative FACT-G score and postoperative quality of life of cervical cancer pa-tients.

Objective To analyze the expression and clinical significance of tumor suppressor phosphatase -tension protein gene(PTEN)in differentiated thyroid carcinoma and the relationship with the V600E gene site muta-tion of murine sarcoma viral oncogene homolog B1(BRAF).Methods The expression of PTEN was assayed by im-munohistochemical staining in differentiated thyroid carcinoma and adjacent tissues.The differences were compared between clinical pathological features.The BRAF V600E gene mutation was detected by fluorescence quantitative pol-ymerase chain reaction(PCR)and to investigate the correlation between the expression of PTEN and BRAF V600E mutation.Results The negative rate of PTEN was 78.75%(63 /80)in differentiated thyroid carcinoma,13.75%(11 /80)in adjacent tissues(χ2 =27.236,P =0.000).There were significant differences in the expression of PTEN between I -II and III -IV in TNMstage,grade I and II,and lymph node metastasis(χ2 =10.395,6.948,9.263,P =0.000,0.006,0.000).The differences were not significant in the expression of PTEN between different gender,≤45 years and >45 years different pathological types and tumor diameter <2cm and ≥2cm(χ2 =1.113,0.941, 2.301,1.567,P =0.185,0.213,0.087,0.181).There was correlation between the expression of PTEN and BRAF V600E mutations(r =0.301,P =0.004).Conclusion The expression of PTEN is involved in the occurrence and development of differentiated thyroid cancer and is associated with BRAF V600E.The PTEN has the predictive value of prognosis in tumors.

Objective To understand the serotype distribution ,prevalence and antimicrobial susceptibility of Salmonella strains isolatd from diarrhea patients in Dongguan ,Guangdong Province .These data may be useful for disease control and prevention and clinical treatment .Methods From April to December in 2013 ,we collected 1 150 stool specimens from diarrhea patients . Salmonella strains were cultured by using Salmonella selenite brilliant green sulfa enrichment broth and selective chromogenic plates .Antimicrobial susceptibility was tested by ATB microbial identification and drug susceptibility system .Results A total of 72 strains of Salmonella were identified including 21 serotypes .The detection rate was 6 .3% (72/1 150) .Most of the strains were Salmonellatyphimurium (22/72 ,30 .5% )and Salmonellaenteritis (16/72 ,22 .2% ).Forty‐two (58 .3% )of the strains were isolated from the patients under one year of age ,12 (16 .7% ) strains from the patients of 3‐10 years of age ,and 18 (25 .0% ) strains from the patients of at least 20 years old .The results of antimicrobial susceptibility testing showed that 50 .0% of the strains were resistant to piperacillin and 48 .6% resistant to ticarcillin .Conclusions The prevalence of Salmonella typhimurium is the highest in local Salmonella‐associated diarrhea patients ,followed by Salmonella enteritis .Most of the Salmonella diarrhea occurred in the patients under one year of age .Clinicians should strengthen the monitoring of Salmonella in patients with diarrhea , especially in infants and young children , for early detection and treatment so as to reduce complications .

Objective To investigate association between postural changes of blood pressure and carotid atherosclerosis in the elderly.Methods Standardized questionnaires,physical examination and biochemical blood tests were performed to acquire clinical characteristics of the participants.Presences of carotid plaques were identified by carotid ultrasound examination.Orthostatic hypotension (OH) and orthostatic hypertension (OHT) were defined according to the international consensus.Multivariable logistic regression analysis was performed to analyze the associations of carotid plaques with OH and OHT.Results 377 old people were finally included,of which 101 had OH and 33 had OHT.After full adjustment for possible confounders,old people with carotid plaques had significantly increased risk for OH as compared with those without carotid plaques (OR=2.27,95％ CI:1.32-3.90,P=0.003).Participants with bilateral carotid plaques were associated with significantly increased risk for OH (OR=3.45,95％CI:1.74 6.84,P=0.001),while the association between unilateral carotid plaques and OH was not significant (OR=1.71,95％ CI:0.88-3.32,P=0.112).No significant association was identified between carotid plaques (bilateral or unilateral) and OHT.Conclusions Presence of carotid plaques,particularly bilateral plaques,may be an independent risk factor for OH.