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Background: Dexamethasone (DEXA) is commonly used to reduce brain swelling during neurosurgical procedures. DEXA, however, has many side-effects that can increase the risks of post-operative complications. In contrast, progesterone (PRO) has fewer side-effects and has been found to be neuroprotective on traumatic brain injury (TBI). Whether PRO may be used as an alternative to DEXA during routine procedures has not been fully explored. Object: To compare the effects of DEXA and PRO on surgical brain injury (SBI). Methods: Seventy-five adult male Sprague Dawley rats were randomized into five groups: (1) SBI + drug vehicle (peanut oil, 1 ml kg � 1 ); (2) SBI + DEXA (1 mg kg � 1 ); (3) SBI + low-dose PRO (10 mg kg � 1 ); (4) SBI + high-dose PRO (20 mg kg � 1 ); and (5) sham SBI + drug vehicle. Magnetic resonance imaging study and assessments of brain water content (BWC), blood–brain barrier (BBB) permeability, cellular inflammatory responses and matrix metalloproteinase 9 (MMP-9) expression were conducted. Results: This model consistently resulted in increased BWC and BBB disruption. PRO reduced astrocyte and microglia responses and attenuated brain oedema with preservation of BBB. A significant down-regulation of MMP-9 expression occurred in the PRO 20 group. Conclusions: PRO is as effective as DEXA in reducing brain oedema and inflammation following SBI; 10 mg kg � 1 of PRO was demonstrated to be more effective in relieving acute cellular

Post-operative volume of subdural fluid is considered to correlate with recurrence in chronic subdural haematoma (CSDH). Information on the applications of computer-assisted volumetric analysis in patients with CSDHs is lacking.To investigate the relationship between haematoma recurrence and longitudinal changes in subdural fluid volume using CT volumetric analysis.Fifty-four patients harbouring 64 CSDHs were studied prospectively. The association between recurrence rate and CT findings were investigated.Eleven patients (20.4%) experienced post-operative recurrence. Higher pre-operative (over 120 ml) and/or pre-discharge subdural fluid volumes (over 22 ml) were significantly associated with recurrence; the probability of non-recurrence for values below these thresholds were 92.7% and 95.2%, respectively. CSDHs with larger pre-operative (over 15.1 mm) and/or residual (over 11.7 mm) widths also had significantly increased recurrence rates. Bilateral CSDHs were not found to be more likely to recur in this series. On receiver-operating characteristic curve, the areas under curve for the magnitude of changes in subdural fluid volume were greater than a single time-point measure of either width or volume of the subdural fluid cavity.Close imaging follow-up is important for CSDH patients for recurrence prediction. Using quantitative CT volumetric analysis, strong evidence was provided that changes in the residual fluid volume during the 'self-resolution' period can be used as significantly radiological predictors of recurrence.

Aim: Real patients are generally recruited to participate in assessment of medical students all over the world in their clinical examinations. In the past, such voluntary patients were taken for granted. However, this is no longer true nowadays. Method: A questionnaire survey was conducted on 72 patients who participated as volunteers in an undergraduate final MBBS clinical examination. Each patient underwent a total of three to four focused physical examinations, at the conclusion of which the survey was conducted. Results: The majority of the subjects had little or no previous encounters with medical students. Most volunteers reported to have participated out of a willingness to help. Only a small number did so for financial rewards or more expeditious medical treatment. Positive experiences were reported by 82% of the volunteers and over 90% said they would encourage others to participate similarly. Fatigue is a common complaint which may be due to the long duration of the examination rather than the number of physical examinations performed. Volunteers expected to be better informed about the details of the examination including the numbers of times of physical examination, and the presence of observers. Conclusion: Printed information given during recruitment, and briefing sessions conducted immediately prior to the examination are recommended to improve patients’ satisfaction

An undergraduate education in liberal arts is viewed by many, especially in North America, as a desirable preparation for medical school. In countries where such a pre-medicine curriculum is not available, an introduction of 'humanities in medicine' has recently been emphasized. Few, however, has entertained the idea that Medicine already possesses many elements of a liberal arts education. In this article, the author discussed how Medicine may be treated as a liberal arts curriculum, and how the very awareness of this possibility should be articulated and shared by both medical students and teachers. Medical education in countries without a pre-medical curriculum may be transformed from doctor-training to a new level of an explicit and complete education for the individuals.