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Objective To explore the effect of cisterna magna plastic repairing (posterior vertebral column resection and cerebella tonsillectomy and reconstruction of the cisterna magna by artificial dura) on cerebrospinal fluid dynamics in Chiari malformation type Ⅰ with syringomyelia and evaluate the efficacy of this surgical method.Methods Forty patients with Chiari malformation type Ⅰ with syringomyelia (CMI-SM),admitted to and diagnosed by MRIin our hospital from January 2011 to December 2013,were selected.All patients were treated with cistema magna plastic repairing.Phase-contrast MR imaging (PC-MRI) was performed,changes of cerebrospinal fluid dynamics indicators of cerebral aqueduct,pons ventral side and C3 ventral side were detected and compared and Japanese Orthopaedic Association (JOA) scale scores were evaluated 24 h before operation and 12 months after operation.Results No neurological deterioration or death was noted;JOA scores in all patients were increased from 7.89±3.52 to 12.53±4.32,with significant difference (P＜0.05);post-operated PC-MRI indicated that the cistema magna formed well,spinal subarachnoid space was clear,syringomyelia in 30 patients was significantly reduced;as compared with those before operation,the stroke volume and mean flux were significantly increased,but maximum peak velocity was significantly reduced (P＜0.05).Conclusion Cisterna magna plastic repairing can reduce syringomyelia,increase cerebrospinal fluid flow,and reduce peak flow of cerebrospinal fluid,which is an effective surgical procedure for Chiari malformation type I with syringomyelia.
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Objective To explore the improvement of teaching effects for clinical medical undergraduates by combining methods of lectures and simulations practice.Methods Totally 40 2007 grade five-year clinical medical undergraduates were randomly divided into five groups,eight undergraduates each group.During clinical practice of anesthesiology teaching in the fifth semester,mini-lecture combing theoretical lesson with simulations practice was conducted for 45 rain including preoperative preparation,spinal epidural anesthesia,general anesthesia,brachial plexus block and cervical plexus block.Results were evaluated by questionnaires.40 copies were handed out and the effective recovery rate was 100％.Results All students approved this kind of teaching activities; 97.5％ believed that it can arouse their interest in study; 95％ wrote down the lectures and operation process,all students listened carefully and operated meticulously.Conclusions Lectures combined with simulations practice promote students' operation capacity and thinking ability thus to raise the basic clinical skills of students.