Teaching of clinical practice is the most important part of education of Tradi-tional Chinese Medicine(TCM).We plan to make clinical rotation internships,standardize the whole process of internships,standardized management of clinical teaching,in order to achieve our objectives of TCM Clinical teaching.We hope to guide the medical students to link theory with clinical practice during clinical rotation internships,set up clinical thinking of intern,and practice the basic skills and operating specifications of intern.

Objective To investigate the molecular mechanism of resistance to carbapenems in Pseudomonas aeruginasa from 5 teaching hospitals in Beijing. Methods A total of 213 non-duplicate imipenem-resistant Pseudomonas aernginosa (IRPA) isolates were collected from 5 hospitals in Beijing from June 2004 to December 2005. The minimal inhibitory concentrations (MICs) of meropenem, imipenem and others antibiotics were determined by agar dilution method. Disk diffusion test was used for screening metalloenzymes. The bla IMP,bla VIM and OprD2 genes were amplified by PCR and only sequenced. Results Out of 213 isolates, OprD2 loss was detected in 84 isolates and IMP-1 enzyme was detected in 6 isolates simultaneously. Thirteen IRPAs only produced IMP-1 and 2 isolates only produced VIM-2. Conclusion OprD2 loss and metallo-β-lactamuse production are the parts of the mechanisms of resistance to carbapenems in Pseudomonas aeruginosa in Beijing.

Objective To survey the prevalence of Hyperuricemia (HUA) in elder population of Changchun city,and to detect the correlation between cardiovascular risk factors and the HUA.Methods 900 residents older than 55 years were selected randomly for this questionnaire survey.Physical and laboratory examinations were performed.Results The HUA prevalence rate elder people in Xixin District of Changchun was 16.0％(144/900),while the rates were 13.7％(50/365),15.2％(47/309) and 20.8％(47/226) (P＜0.05) in the elder group (55-65 years),the aged group (66-75 years),and the advanced aged group (older than 76 years) respectively;there was no statistical significant difference in the prevalences between male and female (x2=0.023 5,P＞0.05).The HUA prevalence rate was significantly different between people who had different level of blood pressure,cholesterol,hypersensitive C-reactive protein (hs-CRP),body mass index (BMI),waisthip ratio (WHR).The level of uric acid (UA),total cholesterol (TC) and hs-CRP was significantly different in people with high uric acid when compared with those of normal patients (P＜0.05).There was positive correlation between UA level and TC,triglyceride (TG) level (r=0.364,P＜0.05;r=0.479,P＜0.05).Conclusion The HUA prevalence rate increases significantly as people getting older.There is positive correlation between the increase of uric acid level and the major cardiovascular risk factor.People with hypertension,hyperlipidemia,overweight and obese have high risk for HUA,so change life style and dietary habits may prevent or reduce the occurrence of HUA.

Objective To study the effects on electroporation of Qingfengteng cataplasma transdermal absorption and describe the characteristics of animal pharmacokinetics of it.Methods Two-chamber diffusion cell was used and the plasma drug concentration was determined by HPLC.The application of AIC theory to analysis of the compartmentally based model of sinomenine transdermal delivery by electroporation.Results The Cmax,Ka,and AUC0→∞ of electroporation was larger than those of passive diffusion;t1/2(Ka)and tmax of electroporation were reduced compared with passive diffusion.The drug concentration-curve equation were C=2.884?(e-0.056 t-e-0.232 t)and C=2.512?(e-0.058 t-e-0.149 t)for electroporation and passive diffusion,respectively.Conclusion The change of in vivo drug concentration of Qingfengteng calaplasma transdermal absorption by electroporation could be analized in accordance with mammillary one-compartment open model.The etrectroporation technology could sharply enhance the bioavalibility compared with the passive diffusion.

Objective To evaluate preoperative multislice CT angiography (MSCTA) in guidance for laparoscopic right colon cancer the complete mesocolon resection (CME).Methods From September 2014 to May 2016 data of 24 patients undergoing laparoscopic CME right colon cancer surgery,were reviewed for the guidance of MSCTA over operative surgery.Results Preoperative MSCTA clearly showed superior mesenteric vascular anatomical variation and its branch,which was in closely consistent with that seen during the operation.The superior mesenteric arteries and veins (SMA/SMV) and the ileum colon arteries and veins (ICA/ICV) were seen in all the 24 cases.There are four main types anatomic variation of gastrocolic trunk (Henle trunk),of which most often consisting of three branchs (type B),accounting for about 46％.The time of completely dissecting anatomical Henle trunk was significantly longer than that for the ileum colon vessels and the middle vessels dissection (P ＜ 0.05).Conclusion Preoperative MSCTA can clearly present anatomic variation of SMV/SMA and its branch,precisely navigate the laparoscopic right colon cancer CME surgery,reducing the incidence of intraoperative vascular complications and improving the quality of surgery.

Objective To compare effectiveness and short-term outcomes between robotic-assisted and laparoscopic surgery for radical resection of rectal cancer.Methods A total of 410 patients diagnosed with rectal cancer,undergoing robotic-assisted surgery (RAS) for rectal cancer (215 cases) and conventional laparoscopic surgery(CLS) for rectal cancer (195) from Jan 2016 to Dec 2018 were included into the present study.Operative characteristics,postoperative complications and pathologic parameters were evaluated between RAS and CLS group.Results The RAS group had less intraoperative blood loss[(107 ± 46) ml vs.(147 ±35)ml,t =3.695,P＜0.05],longer operation time[(209 ±55)min vs.(195 ± 55)min,t=2.508,P＜0.05],earlier first flatus[(3.4 ± 1.4)d vs.(5.3 ± 1.6)d,t =-14.952,P＜ 0.05],and first liquid diet time [(4.3 ± 1.5) d vs.(6.2 ± 2.6) d,t =-9.109,P ＜ 0.05],more number of dissected lymph nodes[(12.6 ± 4.3) vs.(10.6 ± 4.5),t =4.468,P ＜ 0.05] compared with those in the CLS group.But more expensive total hospitalization costs[(71 775 ±45 089) yuan vs.(66 789 ± 16 721) yuan,t =4.224,P ＜ 0.05].Conclusion Compared with laparoscopic surgery,robotic-assisted surgery has less blood loss,shorter time of first flatus,more lymph nodes yield.

Objective: To understand school physician in primary and secondary schools in Yichang City, Hubei Province from 2019 to 2020, and to provide a reference for strengthening the school physician team in primary and secondary schools. Methods: 149 and 102 primary and secondary schools from 6 municipal districts in Yichang City, Hubei Province, were randomly selected in November 2019 and November 2020, respectively, and were administered by questionnaire survey. Results: The proportion of school physicians increased from 39.6% in 2019 to 65.7% in 2020. In the past two years, the equipment rate of school physician in both central and fringe urban areas increased, especially the fringe urban areas, number of school physician increased from 38 to 96. A total of 93 and 141 school physicians were selected to pariticipate in questionaire survey in 2019 and 2020 respectively. The survey showed that more than 90% of school physicians in primary and secondary schools in Yichang received training, and 74.5% had college education level. However, most of them lack professional qualification and medical background. Conclusion School physician of primary and secondary of Yichang is well development over the past two years, and the proportion substantially increased. However, there is still room for improvement in the quantity and quality of school physicians, and professional qualification needs to be improved. More attention should be paid to the marginal urban areas to achieve a balance between quantity and quality.

Objective:To investigate the safety and mid-term efficacy of robotic versus laparoscopic total mesorectal excision surgery in rectal cancer.Methods:A total of 240 patients were diagnosed with rectal cancer at the Anorectal Department of Gansu Provincial Hospital from Aug 2015 to Mar 2021, 112 patients underwent laparoscopic total mesorectal excision (L-TME group) and 128 patients did robotic-assisted total mesorectal excision (R-TME group).Results:Compared to the R-TME group, the L-TME group had higher conversion rate (5.4% vs. 0.8%, χ2=4.417, P=0.036), higher incidence of complications (32.1% vs. 17.2%, χ2=7.290, P=0.007), higher circumferential resection margin involvement (7.1% vs. 1.6%, χ2=4.658, P=0.031), lower 3-year DFS and OS(74.1% vs. 85.2%, χ2=4.962, P=0.026) and (81.3% vs. 91.4%, χ2=5.494, P=0.019), lower 3-year DFS and OS in AJCC stage Ⅲ(52.5% vs. 76.1%, χ2=5.799, P=0.016) and (65.0% vs. 84.8%, χ2=4.787, P=0.029). Conclusion:R-TME can achieve better oncological outcomes and is more beneficial for RC patients compared with L-TME, especially for those with stage Ⅲ rectal cancers.

Objective To investigate the change of antimicrobial resistance among gram-positive cocci from 1999 to 2006 in Beijing Chaoyang Hospital. Methods Antimicrobial susceptibility test was car-ried out by MIC method, data were analyzed by WHONET 5.3 software. Results A total of 6192 clinical isolates were collected. The top four pathogens were Staphylococcus coagulase-negative, Staphylococcus au-reus, Enterococcus faecalis and Enterococcus faecium. The prevalence of methicillin-resistant S. aureas and coagulase-negative were identified in 88.4% and 86.9%, respectively. The resistance rates of S. aureus to penicillin G and ampicillin were more than 90.0% during 1999-2006. Neither strains of S. aureus nor strains of coagulase-negative Staphylococcus were found resistant to vancomycin. Vancomyein-resistant Enterococci (VRE) strains were firstly isolated in 2003, thirteen vancomycin-resistant E.faecalis isolates were identified as VanB genotype by PCR and sequencing. The VanA gene was confirmed by PCR and sequencing in seven-teen vancomycin-resistant E.faecium, vancomycin-resistance E.faecium rate increased sharply. The most ac-tive antibiotics against E. faecalis were vancomycin, ampicillin, penicillin with the susceptible rates of 98.7%, 95.7% and 85.6%, however, the susceptibility rate of E. faecalis to penicillin decreased from 94.3%-84.6%. The resistance rates of E.faecalis to clindamycin was 99.0%. The resistance rates of E. faecium to erythromycin and clindamycin were more than 95.0%. The resistance rates of E.faecium to ampi-cillin, penicillin, ciprofloxacin were more than 90.0%. The most active antibiotics against E. faecium was vancomycin. The susceptibility rate of E.faecium to tetracycline increased from 27.8% to 82.6%. Conclu-sion Vancomycin remains highly active against gram-positive cocci. A total of 30 Enterococci isolates were found resistant to vancomycin.

Objective To investigate the value of platelet-to-lymphocyte ratio (PLR) and cell proliferation antigen Ki-67 in judging the chemotherapy efficacy and prognosis of patients with advanced non-small cell lung cancer (NSCLC). Methods The clinical data of 132 patients with advanced NSCLC diagnosed by pathology and immunohistochemistry from January 2015 to January 2016 in Shanxi Provincial Cancer Hospital were retrospectively analyzed. Peripheral venous blood cells were collected before chemotherapy, the platelet and lymphocyte counts were detected by using blood cell analyzer to calculate PLR. Immunohistochemical SP method was used to detect the expression of Ki-67 in tissue sections. The platinum-containing dual-drug regimen was used in the first-line chemotherapy for at least 4 cycles. The χ2 test was used to compare the count data, and the logistic regression model was used to analyze the factors affecting the effective rate. The Kaplan-Meier method and log-rank test were used for survival analysis, and the Cox proportional hazards regression model was used for multivariate analysis of prognosis. Results The total effective rate of the first-line chemotherapy was 41.7％ (55/132). The 1-year and 2-year overall survival (OS) rates were 26.1％ and10.4％, respectively. and the mean progression-free survival (PFS) time was 5.7 months (95％ CI 3.2-10.9 months) and the median OS time was 14.05 months (95％ CI 6.8-18.4 months). The median PLR was 172.0. The effective rate in PLR < 172.0 group was higher than that in PLR≥172.0 group [60.6％ (40/66) vs. 22.7％(15/66), χ 2 = 19.481, P < 0.05], and the median OS time in PLR < 172.0 group was longer than that in PLR≥172.0 group (17.6 months vs. 15.0 months, χ 2 = 4.976, P < 0.05), and there was no significant difference in the median PFS time between the two groups (8.6 months vs. 6.5 months, χ 2 = 0.078, P > 0.05). There was no significant difference in the effective rate between Ki-67 negative group and positive group [40.0％ (28/70) vs. 43.5％ (27/62), χ 2 = 0.170, P > 0.05]. The median PFS time and OS time in Ki-67 negative group were longer than those in positive group (7.6 months vs. 6.5 months, χ 2 = 7.170, P < 0.05; 18.3 months vs. 14.5 months,χ 2 = 15.870, P < 0.05). According to the results of multivariate analysis, PLR was an effective independent factor for effective rate (P < 0.05), Ki-67 was an independent influencing factor for PFS (P < 0.05), and PLR and Ki-67 were independent influencing factors for OS (P < 0.05). Conclusion PLR and Ki-67 can be used as meaningful indicators for predicting the chemotherapy efficacy and prognosis of advanced NSCLC.