Different from the general local hospital,the affiliated hospital of medical school plays double social roles that it not only serves as a teaching hospital but also a medical uniL Every medical staff in it shoulders the responsibility of teaching,researching and medical treatmenL According to the relative independence of affiliated hospital in comprehensive university,the particularity of professional and technical post,the multiplicity of post task,as well as problems existed in the current appraisal and appointment of professional and technical posts such as lacking objectivity and maneuverability in clinical skills examination and evaluation.the paper tries to put forward a new mode of clinical skills examination and evaluation system in accordance with the characteristics of affiliated hospital.

Graves' ophthalmopathy (GO) is an autoimmune disorder representing the commonest and most important extrathyroidal manifestation of Graves' disease.GO can be a debilitating component of the disease,resulting in impaired quality of life.Although therapeutic methods appear to be widespread,the optimal treatment remains challenging.This article reviewes recent studies on therapy pattern and evidence-based medicine,to provide practical information for managing patients with GO.

Exendin-4,a peptide analogue of glucagon-like peptide-1(GLP-1),is presently in clinical trials as a therapy for type 2 diabetes mellitus.Exendin-4 selectively acts on GLP-1 receptors,which are coupled to the cAMP nucleotide second messenger pathway to enhance the survival and plasticity of neurons in the brain.Exendin-4 has potent effects on homeostasis of Ca2+,on multiple targets to block apoptotic signaling pathways,and on neuronal proliferation and differentiation.It has also been demonstrated to possess properties against oxidative stress and excitotoxicity.In this review the functions of exendin-4 on central nerve system and the potentia therapeutic effects on neurodegenerative diseases will be involved.

Objective To evaluate the efficacy and adverse events of oxcarbazepine(OXC) on the children with partial epilepsy.Met-hods Sixty-four children with partial epilepsy were divided into 2 groups.Forty-one newly diagnosed patients who had never accepted standard therapy entered monotherapy group,and 23 patients who had many anti-epileptic drug(AEDs) in turn with poor efficacy served as add-on therapy group.The initial dose was 4-8 mg/(kg?d).The dosage was increased by one time every 2 weeks,and should not exceed 10 mg/(kg?d) in each time.The maintenance dose was 28-40 mg/(kg?d).With open-label autocontrol method,the efficacy and adverse events of OXC were analyzed during the first 6 months of treatment both in 2 groups.Results The effective rates were 85.4%,69.6% and 79.7%,in monotherapy,add-on therapy and total groups.The seizure free rates were 53.7%,17.4% and 40.6%.It showed that the seizure frequencies between 2 groups at 6 months after therapy were significantly difference(P0.05).The common adverse events were dizziness,headache,fatigue and nausea.Six patients had dropped out because of rashes,however,they all recovered after drug withdrawal and nonspecific therapy.Conclusion The efficacy of OXC is sustained with good safety and tolerability profiles on the treatment of children patients with partial epilepsy.

Objective To establish a method to isolate and cultivate rat bone marrow mesenchymal stem cells (BMSCs),and explore the feasibility of labeling in vitro,and tracing in vivo,BMSCs with chloromethyl-benzamidodialkylcarbocyanine (CM-Dil). Methods BMSCs were obtained and subsequently cultured with whole bone marrow cell culture system,and the third generation of BMSCs was harvested. The positive rates of CD34,CD44 and CD29 were detected by flow cytometry. CM-Dil was used to label BMSCs in vitro and the efficiency of labeling after 24 hours and at day 21 and 30 were examined under fluorescent microscope. Moreover,the growth curves were sketched to determine the negative effects of CM-Dil on the vitality and proliferation of BMSCs cultured in vitro. Rat model of focal cerebral ischemia was reproduced,CM-Dil labeled BMSCs were implanted into corpus striatum of rats' brain with computer-guided stereotaxis thereafter. Brain tissues were obtained to prepare frozen sections at 7th,14th and 21st day post-implantation,and the survival and distribution of labeled cells were observed with fluorescent microscopy. Results The third generation passage of cultured BMSCs grew orderly,with shape of desmocytes,and homogeneous in morphology. The positive rates of CD34,CD44 and CD29 expressions in BMSCs were 1.71%,80.32% and 84.89%,respectively. Red fluorescence was observed in CM-Dil labeled BMSCs in vivo 24 hours after labeling,with a positive rate of 100%. The fluorescence intensity of passage cultured BMSCs observed on day 21 was similar to that observed at 24 hours after labeling,but diminished on day 30. The growth,proliferation and morphology of BMSCs,were not influenced by CM-Dil labeling. On day 7,14 and 21 post-implantation,BMSCs decreased in quantity,appearing in oval or irregular shapes,and most of the cells were found around the needle tract,with a tendency of diffusion to peripheral area. Conclusion High purity of BMSCs may be obtained with whole bone marrow cell culture system from bone marrow of rats. CM-Dil labeling is easy to handle and effective,with no cytotoxicity to cells. The latest labeling period of CM-Dil is 21 days in vitro,therefore it seems to be an effective method for in vivo tracing of BMSCs in brain after implantation.

Objective To find out the difference or the regularity by the comparison study on the Auto-CPAP application to treating severe OSAHS patients in daytime nap and nocturnal sleep.It also supplies an evidence for reducing the expense in treating and testing severe OSAHS patients.Methods The patients who complained of snoring or dyspnea during sleeping and excessive daytime somnolence were selected as the subjects.They were monitored by PSG or Auto-CPAP ventilator system.Meanwhile their somnolent level were estimated by Epwoth.After that the patients with more than 20 AHI were selected as the advanced subjects.They were treated respectively in daytime nap and in the nocturnal sleep.And the daytime treating time lasted more than one hour and less than two hours and thirty minutes.Monitoring items included AHI,AI,HI,the longest duration of apnea or hyponea(LAHT),the lowest SaO\-2,the highest CPAP pressure(HP),median pressure(MP),90% pressure(90%P) and 95% pressure(95%P).Results The therapeutical effect is distinguished and is the same with the severe OSAHS in both daytime nap and nocturnal sleep.And also they need the same CPAP pressure level basically.Conclusion The CPAP pressure level titrated in daytime nap treatment period can be used in the nocturnal sleep therapy for severe OSAHS patients.

BACKGROUND:The assessment for long-term efficacy of chronic ischemic disease is more important than the short-term efficacy assessment, which associates with patient’s long-term quality of life and long-term survival rate. OBJECTIVE:To observe the 5-year folow-up outcomes of autologous bone marrow stem cel transplantation for the treatment of thromboangitis obliterans. METHODS:This study enroled 43 patients of thromboangitis obliterans who underwent autologous bone marrow stem cel transplantation from August 2007 to January 2010 in the Department of Thyroid Vascular Surgery, the First Affiliated Hospital of Xinjiang Medical University. At 1, 2, 3, 4 and 5 years after transplantation, pain, cold sensation, and intermittent claudication distance were folowed up by telephone; changes in limb ulcers were observed. At 1 year after transplantation, venous oxygen partial pressure and oxygen saturation of limbs were reviewed. RESULTS AND CONCLUSION:A total of 38 thromboangitis obliterans patients with complete folow-up data were included in the final analysis. Compared to the preoperation, pain, cold sensation, and intermittent claudication significantly improved. The difference was statisticaly significant (Z values:-4.277,-5.086,-3.574, P < 0.001). Compared with 1-5 years after operation, pain and cold sensation had no statisticaly difference (P >0.05). Intermittent claudication distance had increased. Differences in terms of intermittent claudication distance was statisticaly significant (Z=43.898,P < 0.001). Significant differences in venous oxygen partial pressure and oxygen saturation were detected between preoperation and 1-year posttransplantation (tvalues: 36.790, 43.964,P values: 0.040, 0.037). Above results suggest that autologous bone marrow stem cel transplantation for thromboangitis obliterans obtained stable long-term outcomes.

BACKGROUND: Cartilage stent materials were abundant. With the development of preparation technique, structure, and surface modification technique, performance of materials were improved remarkably; thus, Integrated-repaidng defects of articular cartilage and subchondral bone required high stability of cartilage replacement materials.OBJECTIVE: To evaluate the effect of polyurethane/nano-hydroxyapatite+polyamide66 (PU/n-HA+PA66) biological composite material on repairing articular cartilage and subchondral bone.METHODS: Twenty dog models were randomly divided into 4 groups: porous PU/n-HA+PA66 implant group, compact PU/n-HA+PA66 implant group, n-HA+PA66 implant group and blank control group. The macroscopic and histological evaluations were performed at 4, 12, and 24 weeks postoperatively. The interfaces of biomaterial implants with articular cartilage were observed by scanning electron microscope.RESULTS AND CONCLUSION: After 12 and 24 weeks, bone tissue grew into lower layer materials. Porous PU was well fused with peripheral cartilage. At 24 weeks postoperatively, the porous PU was closely connected with surrounding articular cartilage than the compact PU, and the articular cartilage surrounding the compact PU degenerated obviously. PU/n-HA+PA66 had a similar structure with normal cartilage and subchondral bone and had remarkable effects on repairing defects of articular cartilage and subchondral bone.

BACKGROUND: Polyvinyl alcohol hydrogel (PVA) has been generally considered as a good substitute material of articular cartilage. Polyamide 66 (PA66) polymer has achieved an extensive application in the fields of engineering and medicine owing to its high intensity, strong tenacity and good stability. Polyurethanes exhibit good histocompatibility and blood compatibility and show distinct advantages in repairing cartilage.OBJECTIVE: To compare the outcomes of repairing articular cartilage defects in rabbit knee joints with three materials and to find the best material.METHODS: Thirty-six healthy adult New Zealand rabbits were prepared for the models of articular cartilage defects by perforating on the patellofemoral joint and randomly divided into 4 groups, with 9 animals in each group. PVA, polyurethane, and PA66 were implanted into the into articular cartilage defects in rabbits of corresponding groups. There was no treatment in the control group.The macroscopic and histological evaluations of rabbit knee joints were performed at 4, 8 and 12 weeks postoperatively. The score of histology was used to evaluate the repairs of articular cartilage defects at 12 weeks postoperatively.RESULTS AND CONCLUSION: No infection was observed in all animals with good motion of joints. At 12 weeks postoperatively, the materials got well with surrounding cartilage, which did not degenerate obviously. The defects in the control group were filled with fibrous scar-like tissues that arranged in disorder. The histological score of the in the group implanted by PVA, as well as polyurethane, was higher than that in PA66 and the control groups (P < 0.05), but the difference between the two groups had no significance (P>0.05).The porous materials PVA and polyurathane have good function for replacing articular cartilage, with good biocompatibility.

OBJECTIVE To invstigate the diagnosis role of VEMP for inferior vestibular neuritis. METHODS 18 patients with inferior vestibular neuritis were studied. Especially, the oVEMP and cVEMP were recorded in all cases. RESULTS All 18 patients with VN (vertigo symptom in 15 cases, and balance disorders in 3 cases) presented normal in PTA, caloric test and Ovemp test. By contrast, the cVEMPs was abnormal in all patients with VN, including flat/no amplitude of cVEMP in 14 cases, and lower amplitude in 4 cases. After three months, 10 patients recovered, with nomal amplitude of cVEMP in 9 cases and lower amplitude in 1 case. And after half-a-year-follow-up, 18 patients went back to normal, with lower amplitude in only 2 cases. CONCLUSION The VEMP examination is valuable in the diagnosis and prognosis of inferior vestibular neuritis.