Objective:To evaluate the effect of tutorial system for medical undergraduates in a non-affiliated hospital of a medical university in Jiangsu.Methods:32 senior medical undergraduates in non-affiliated hospitals were divided into two groups. The experimental group adopted tutor-guided teaching, and the control group adopted traditional teaching. Professional theoretical knowledge, clinical ability, operational ability, foreign language level, basic research ability and participation of scientific research activities of students in the two groups were evaluated. SPSS 19.0 was used for t test, chi-square test and U test. Results:The results of operational ability ( t=3.537, P=0.000), the number of papers that had been read ( t=6.961, P=0.000), quality of these ( U=68.000, P=0.017), the number of literature reviews that had been written and reading notes ( χ2=4.747, P=0.000), participation in scientific research activities ( t=6.788, P=0.009) of students in the experimental group were better and higher than those in the control group. In the same period, there was no significant difference between the two groups in the scores of theoretical exam, clinical competence and foreign language tests. Conclusion:The implementation of tutorial system for medical students in non-affiliated hospitals is an effective measure to improve the quality of training. We should make full use of the short intership, to improve the comprehensive quality of students by establishing perfect rules, regulations and teaching evaluation system, and educate students in accordance with their own ability.

Objective To investigate the impact of combined postoperative transcatheter arterial chemoembolization (TACE) with antiviral therapy in hepatitis B-related hepatocellular carcinoma (HBV-HCC) patients with high risks of recurrence.Methods Fifty-three consecutive patients who underwent curative resection of HBV-HCC between January 2014 to February 2016 were enrolled.These patients were assigned to either the adjuvant antiviral therapy combined with TACE group (n =32),the treatment group or the no adjuvant treatment group (n =21,the control group).The recurrence-free survival (RFS) and overall survival (OS) were analyzed.Results There was no significant difference between the two groups in clinical characteristics (P＞0.05).The recurrence-free survival (RFS) (mean±S.D.) was (20.1 ± 1.8) months in the treatment group and (18.7±2.4) months in the control group (P=0.752).The 1-,2-and 3-year RFS rates of the treatment group and the control group were 65.6％ vs.57.1％,31.3％ vs.28.6％ and 15.6％ vs.14.3％,respectively (P＞0.05).The overall survival (OS) (mean±S.D.) was (26.8± 1.7) months in the treatment group and (21.1±2.2) months in the control group (P=0.037).The 1-,2-and 3-year RFS rates were 65.6％ vs.57.1％,31.3％ vs.28.6％ and 15.6％ vs.14.3％ in the treatment group and the control group,respectively.The 1-,2-,and 3-year OS rates were 87.5％ vs.66.7％,59.4％ vs.38.1％ and 43.8％ vs.19.0％ in the treatment group and the control group,respectively.Conclusion Antiviral therapy in combination with TACE did not decrease the RFS rate,but it improved the OS rate in HCC patients with high risks of recurrence.

Objective To investigate the clinical application of Glissonean pedicle transection method in hepatocellular carcinoma. Methods We analyzed the clinical data of 232 cases of hepatocellular carcinoma underwent hepatic resection in our department from April 2009 to April 2013. Eighty-nine cases underwent hepatic resection by Glissonean pedicle transection method, and 143 cases underwent Pringle maneuver. Results There was no significant differences in the operation time and blood loss between the two groups (P > 0.05). However, the postoperative hospital stay time and the postoperative complications in group A were better than those in group B(P<0.05). Levels of ALT and AST in group A increased significantly slowly than those in group B. The 1, 3-year disease-free survival rates in the two groups were 87.4%, 71.1% and 85.1%, 60.0%, respectively. The 1, 3-year survival rates were 93.3%, 73.5% and 93.4%, 65.0%, respectively, with no significant differences (P>0.05). Conclusion Glissonean pedicle transection method has many advantages including effectively preventing the intraoperative bleeding, maximally reserving the remaining of liver function, decreasing the rate of tumor spread and metastasis. Meanwhile, it is a safe and effective technique for hepatectomy without dissection of the hepatic artery, portal vein and bile duct in the hepatoduodenal ligament.

Objective To investigate the interconnection of the executive control network in major depressive disorder when they recognized the sad facial stimuli,and to discuss the aberrant mechanism of emotion processing.Methods Twenty major depressive patients and 20 well-matched healthy volunteers participated in the experiment.The brain actions of all subjects were recorded by the magnetoencephalography (MEG) when they were required to distinguish the emotion face.Based on prior knowledge,the interested brain area consisted of the primary visual cortex (V1),the orbitofrontal cortex(OFC),the dorsolateral prefrontal cortex (DLPFC),the anterior cingulated cortex (ACC).Then constructing three competing models to select an optimal model by the method of dynamic causal model(DCM),finally the differences of the effective connections of the optimal model between the depressed patients and healthy controls were analyzed.Results According to the results of Bayesian model selection (BMS),model 1 had the most exceedance probability of 0.80 with the features that there were bidirectional modulatory connections between the OFC,ACC and DLPFC.Given the best model,the parameters of effective connectivity of the optimal model were extracted,and then two-sample t-test over the model 1 was adopted.The modulatory effective connectivity from the OFC to the DLPFC in both hemisphere(t=-2.73,P=0.0096;t=-3.01,P=0.0046) and the OFC to the ACC (t=-2.93,P=0.0057) in the left hemisphere were significantly reduced in MDD.Conclusion There exists abnormal function of executive control network in depressed patients,the decreased effective connections between the OFC and the DLPFC,as well as the OFC and the ACC,may have correlation with the negative

Objective To explore the differences of the global efficiency of the brain structural networks between the male paranoid schizophrenia and male healthy and its relationship with the psychotic symptoms of the schizophrenia.Methods The diffusion tensor imaging data were obtained from 27 male paranoid schizophrenia patients and 28 male healthy controls.The whole cerebral cortex was parcellated into 90 regions by the anatomical label map.Tractography was performed in the whole cerebral cortex of each subject to reconstruct white matter tracts of the brain using fiber assignment by continuous tracking(FACT) algorithm.And then the brain structural binary networks were constructed using the complex network theory.The average global efficiency of the brain network and the global efficiency of the nodes of both groups were examined by two sample t-test and its relationship with the psychotic symptoms in the male paranoid schizophrenia was explored by the correlation analysis.Results Compared with control group,the average global efficiency of the brain network of the patients decreased significantly (7.87±0.56,8.17±0.56,P=0.005),and the global efficiency of the nodes in the brain network of the patient decreased significantly in the left superior frontal gyrus (orbital part) (P=0.00025),the left superior parietal gyrus (P=0.00011),the left cuneus (P=0.00012) and the left putamen (P=0.00032),all survived FDR correction.Significant negative correlation was found between the global efficiency of the left putamen and the total scores (r=-0.43,P=0.03),the positive scores (r=-0.41,P=0.03) and the cognitive scores (r=-0.40,P=0.04) of PANSS.Conclusion The decreased global efficiency of the left frontal,parietal and occipital lobes and the subcortical structures lead to the occurrence of schizophrenia.And the reduced efficiency of the subcortical structures is associated with the positive symptoms and the abnormal cognitive function of the patients.

Objective To investigate the effective connectivity of limbic circuit in patients with major depressive disorder when they recognized dynamic positive face expressions,aiming to discuss the possible mechanism of emotion processing in depressed patients.Methods Eighteen depressive patients and eighteen well-matched healthy control volunteers participated in the experiment.All subjects were asked to recognize the emotion face during the magnetoencephalograph (MEG) scanning.The regions of interested (ROI) brain areas included the orbital frontal cortex (OFC),the anterior cingulated cortex (ACC),the amygdala (AMYG),the hippocampus and the insula.The MEG data were preprocessed by the SPM8 software and further analyzed by the Granger casual model (GCM).The non-parameter permutation was used to compare the value of effective connectivity between the healthy controls and the depressed patients.Results Compared with healthy controls,the effective connectivity from the ACC to the AMYG (P=0.0052),from the OFC to the AMYG(P=0.0046),from the Hippocampus to the ACC (P=0.0016),and from the ACC to the Hippocampus (P=0.0042)was significantly reduced in depressed patients.Conclusion The depressed patients display decreased interaction of the limbic circuit during the happy facial emotion processing,indicating that the depressed patients are unable to deal with the positive stimuli,and to certain extent,explaining the abnormal neuropathophysiological mechanism of positive stimuli in MDD.

Objective To explore the differences of the connectivity strength,the clustering coefficient and the local efficiency of the nodes in the brain structural networks in the depression and healthy subjects and then analyze the mode of the local connections of the brain regions and their local efficiency of the transmission of information and their relationship with the severity of the disease in the depression.Methods The Diffusion Tensor Imaging data were obtained from 24 depression patients and 25 healthy controls.The whole cerebral cortex was parcellated into 90 regions by the anatomical label map.Tractography was performed in the whole cerebral cortex of each subject to reconstruct white matter tracts of the brain using the fiber assignment by continuous tracking (FACT) algorithm.And then the brain structural networks were constructed using the complex network theory.The local topological properties of the brain structural networks of the depression and healthy were examined by two sample t-test.Results The local efficiency of the nodes of the networks in depression decreased significantly (the left middle frontal gyrus (orbital part):0.64±0.30,the left hippocampus:0.57±0.07,the right parahippocampal gyrus:0.50±0.15) compared with the healthy (0.88±0.10,0.64±0.06,0.66±0.13 respectively,P=0.00098,0.00039,0.00017,survived critical FDR threshold for multiple comparisons) ; and the clustering coefficient of the nodes of the networks in depression (the left middle frontal gyrus (orbital part):0.14±0.07) decreased significantly when compared with the healthy (0.22±0.06,P=0.000030,survived critical FDR threshold for multiple comparisons).Significant negative correlation was found between the local efficiency of the left middle frontal gyrus (orbital part) and the total scores of HAMD-17 in the depression (r=-0.48,P=0.02).Conclusion The degree of the localization and the local efficiency of the information transmission of the frontal lobe are decreased.The local efficiency in the information transmission in the hippocampal is also decreased.And the local efficiency of the frontal lobe is negatively related with the severity of the disease in the depression.

Objective To explore the differences of the degree and distribution of hub regions of the brain structural networks between the schizophrenia and healthy and then analysis the importance of brain regions in the information transmission in across the whole brain.Methods The diffusion tensor imaging data were obtained from 22 schizophrenia patients and 24 healthy controls.The whole cerebral cortex was parcellated into 90 regions by the anatonical label map.Tractography was performed in the whole cerebral cortex of each subject to reconstruct white matter tracts of the brain using the fiber assignment by continuous tracking (FACT) algorithm.And then the brain structural binary networks were constructed using the complex network theory.The average degree of the network and the degree of the nodes in the network between the brain structural networks of both groups were examined by two sample t-tests.Results The average degree of the brain structural network in the patient group (7.82±0.56) decreased significantly when compared with the control group (8.17 ±0.56; P=0.04).The degree of the nodes in the brain structural network of the patient group (the left hippocampus:11.41 ± 1.84; the left parahippocampal gyrus:6.41± 1.33 ; the left calcarine fissure:11.50±2.97 ; the left fusiform gyrus:8.27± 1.83) decreased significantly when compared with the control group (14.43±2.26; 8.54±2.15; 14.79±2.80; 10.25± 1.36; all P＜0.01,survived critical FDR threshold for multiple comparisons).And the distribution of the hub regions in the temporal and occipital lobes of the patient group was difference from that of the control group.Conclusion The importance of the hippocampus and the brain regions in the occipital lobe is decrease for the information transmission across the whole brain.The damage of the topological properties of these brain regions maybe related to the disorder of the transmission and integration of information in the brain of the schizophrenia.

Objective To investigate whether there is exists optimal effective connections of prefrontal-amygdala in patients with major depressive disorder when they recognize dynamic positive face expressions with the technology of magnetoencephalograph (MEG),and discuss the possible aberrant mechanism of emotion processing.Methods Twenty major depressive patients and 20 well-matched healthy volunteer controls participated in the experiment.The regions of interested brain area included the primary visual cortex (V1),the precuneus (PQ),the dorsolateral prefrontal cortex (DLPFC),the anterior cingulate cortex (ACC),the amygdala (AMYG).After constructing three putative models,dynamic causal model was used to select an optimal model,then extracted all the effective connection parameters and conducted t-test under the overall optimal model between-group comparison.Results The bayesian model selection (BMS) indicated that model with top-down modulate connections between DLPFC-ACC,DLPFC-AMYG and ACC-AMYG was the most superior model,whose exceedance probability was 0.41.In the fight hemisphere of patient group,the endogenous connectivity from AMYG to ACC significantly decreased compared to healthy controls (t=-2.21,P=0.033),while the endogenous connectivity from ACC to DLPFC was enhanced significandy (t=2.50,P=0.017),which was the same with the endogenous connectivity from AMYG to DLPFC (t=2.10,P=0.040).Conclusion The effective connections of prefrontal-amygdala in major depressive disorder are exactly impaired,which may indicate that major depressive disorder have a bias toward negative.While depressed patients don' t show abnormality in the modulate connectivity under happy stimulus.

Objective To assess the efficacy of postoperative adjuvant interferon (IFN) therapy on patients with hepatitis B virus (HBV) related hepatocellular carcinoma (HCC).Methods An electronic search for articles published from January 2000 to January 2013 was conducted to identify English language comparative studies evaluating IFN therapy on recurrence and survival after surgical treatment of HCC.Results A total of five trials consisting of 694 patients were included in the Meta-analysis.The estimated odds ratios (OR) for the 1-,2-,3-,and 5-year overall survival rates of HBV-related HCC were 3.37 (95％CI:1.18-6.27,P=0.000),2.36 (95％ CI:1.45-3.83,P=0.001),1.81 (95％ CI:1.21-2.72,P=0.004),and 1.93 (95％ CI:1.35-2.75,P=0.000),respectively.The OR for the 1-,2-,3-,and 5-year recurrence rates were 0.63 (95％ CI:0.44-0.91,P=0.014),0.84 (95％ CI:0.60-1.18,P=0.322),0.88 (95％ CI:0.63-1.22,P=0.431),and 0.78 (95％ CI:0.56-1.07,P=0.120),respectively.Conclusion This Meta-analysis shows that IFN therapy had a significant clinical effect in improving overall survival rates but not in decreasing recurrence rates of HBV infected HCC patients postoperatively.