Objective To explore the application of mini-clinical evaluation exercise (Mini-CEX) in training the diagnostic thinking ability for clinical interns.Methods 83 interns who came to the First People's Hospital of Lianyungang for clinical practice in June 2015 were divided into the experimental group (45 interns) and the control group (38 interns) according to their schools.The two groups received the same clinical teaching according to internship program of five-year clinical medicine,while the experimental group had to take a weekly Mini-CEX training in chnical sections.The diagnostic thinking ability of the two groups was measured by the Diagnostic Thinking Inventory in Chinese version at the beginning and the end of the internship respectively.SPSS 21.0 was applied to processing the data.Measurement data were expressed as mean plus or minus standard deviation,and t test was used in the comparison between groups.Results At the end of the internship,the total score of diagnostic thinking,the score of knowledge structure in memory and the score of flexibility in thinking of the experimental group were higher than scores at the beginning statistically,and the experimental group had a statistically higher score than the control groups in knowledge structure in memory [(69.36 ± 4.28) vs.(66.95 ± 4.78),P=0.018].Conclusion Mini-CEX training can enhance the clinical diagnostic thinking ability of interns by improving their knowledge structure in memory.

Objective To evaluate clinical effect and safety of direct hemoperfusion with neutral resin (NS-DHP) on patients with septic shock caused by Gram-negative bacteria infection.Methods A total of 42 patients were enrolled in the study and randomly ( random number) divided into two groups.Patients of control group ( n =24) received sepsis bundle therapy,and patients of group D ( n =18 ) were treated with NS-DHP in addition to sepsis bundle therapy.HA330 hemoperfusion device were used in each patient of group D.The procedure of hemoparfusion lasted 2.5 hours and carried out trice a 24 hours.Clinical data including APCHE Ⅱ score,PO2/FiO2 (OI),mean arterial pressure (MAP),dopamine usage (DA),plasma level of endotoxin (ET),C-reactive protein (CRP),TNF-α,IL-6 and IL-10 were recorded during the treatment.Results Patients well tolerated NS-DHP without any complication in group D.All patients in both two groups did not receive long-term renal replacement therapy.At 24 h,48 h and 72 h after the initiation of treatment,APACHE Ⅱ score,O1,MAP,DA,ET,CRP,TNF-α and IL-6 improved obviously both groups (P ＜0.05),but there was no significant ditterence in serum levels of IL-10 in both groups.In the group D,APCHE Ⅱ score,OI,MAP,DA,CRP,TNF-α and IL-6 were improved more obviously than those in the group C (P ＜0.05) ).There was no significant difference in plasma levels of ET in both groups during the treatment.Conclusions NS-DHP can improve APACHE Ⅱ score,PO2/FiO2 and MAP in patients with septic shock caused by gram-negative bacteria infection and reduce the levels of CRP,TNF-α and IL-6,but has no effect on the levels of ET and IL-10 as well as on 28-day mortality and ICU stay.

AIM To study the chemical constituents from Schisandra chinensis (Turcz.) Baill..METHODS The ethyl acetate fraction of 95％ ethanol extract of S.chinensis was isolated and purified by silica column and recrystallization,then the structures of obtained compounds were identified by physicochemical properties and spectral data.RESULTS Ten compounds were isolated and identified as dodecane (1),palmitic acid (2),arachidic acid (3),β-sitosterol (4),betulinic acid (5),deoxyschisandrin (6),γ-schizandrin (7),schizandrin C (8),gomisin B (9),schisantherin A (10).CONCLUSION Compounds 1 and 5 are isolated from this plant for the first time.

OBJECTIVE: To study the pharmacokinetics of infusion Etimicin in the patients with respiratory tract infec- tions. METHODS: Ten patients were infused with 200mg Etimicin and the concentrations of drug in the plasma, urine and sputurn were determined by microbiological method. RESULTS & CONCLUSlON: The peak concentration of plasma was 17.74?g/ml. The concentration of 0.29?g/ml maintained 12h after administration. Pharmacokinetics parameters conformed to two - compartment model. The pharmacokinetics parameters were, T1/2?= 0. 257h, T1/2? = 2. 22h, Vc = 34. 32L, K2l = 2.14h~(-1), K12 = 0. 48h~(-1), K10 = 0.39h~(-1). The cumulative percentage of renal excretion was 21.37% within 12h, Ke =0. 027h~(-1), K = 0. 431h~(-1). The drug concentration in sputum reached the peak of 2.09?g/ml 2h after infusion.

Objective To evaluate the effect of Astragalus injection on serum SOD and MDA in patients during supratentorial tumor resection. Methods Twenty-four patients with ASAⅠorⅡ degree, aged 20~55 years old, undergoing supratentorial tumor resection were randomized into the control group (group C) and the Astragalus group (group R), with 12 cases in each group. Patients in group R received 250 mL 0.9% sodium chloride in addition with 20 mL Astragalus injection. Patients in group C received the same amount of 0.9%sodium chloride. Blood samples were taken from jugular venous bulb before induction of anesthesia (T1), intubation (T2), open dura instantly (T3), 1 h after the dura opened (T4), 24 h after the dura opened (T5), and 48 h after the dura opened (T6). The levels of serum SOD and MDA were determined. Results The serum SOD in both group R and group C was lower at T3~6 than that at T1 , but the serum SOD in group R reduced significantly compared with group C (P < 0.05); The serum MDA in both group R and group C at T4~6 was higher than that at T1, but the serum MDA in group R increased significantly compared with group C (P <0.05). Conclusion Astragalus injection can enhance the serum SOD activity and reduce MDA output in patients during supratentorial tumor resection.

Objective To determine the risk factors for post-operative delirium(POD)and post-operative cognitive dysfunction(POCD)in patients undergoing spine surgery.Methods One hundred and twenty ASA Ⅰ-Ⅲ of both sexes aged 50-76 yr undergoing elective spine surgery under general anesthesia were studied.POD was assessed by Delirium Rating Scale revised 98 at 2 days after operation and the patients were assigned into POD and nonPOD group.Cognitive function was assessed by Mini-Mental State Examination(MMSE)at 1 day before and 3 days after operation.The patients were diagnosed as having POCD if MMSEpre-MMSEpost ≥ 3.The palients were assigned into POCD and nonPOCD group.Executive function and depression were assessed by stroop interference test and Beck Depression Inventory(BDI)at 1 day before operation.Age,sex,education,alcohol consumption per week,a history of psychiatric disease,ASA physical status,Charlson comorbidity score,type of anesthesia,anticholinergic drug administration and VAS score at 1 day after operation were recorded.If there was signifirant difference between the 2 groups,the factor was analyzed using multi-factor logistic regression to select risk factor for incidence of POD and POC).Results Eleven patients developed POD(9.2％)and 30 patients developed POCD(25.0％).Logistic regression model showed that lower Stroop-CW,higher BDI score,higher Charlson comorbidity score and a history of psychiatric disease were risk factors for POD,while lower Stroop-CW,higher BDI score,higher Charlson comorbidity score and higher alcohol consumption per week were risk factors for POCD.Conclusion Preoperative executive dysfunction,depression and greater preoperative comorbidity are risk factors for both POD and POCD.A history of psychiatric disease is a risk factor for POD and higher alcohol consumption is a risk factor for POCD in patients undergoing spine surgery.

Objective To study the effects of the inhibition of nuclear factor kappa-B ( NF-κB) , on the hepatic heat shock protein 70 (HSP70) expression as well as on the changes of hepatic function and ultrastructure in a rodent model of hemonhageic shock. Method Hemorrhagic shock was produced by inducing bilateral femoral fractures in male Wistar rats. Intraperitoneal injection of pyrrolidine dithiocarbamate(PDTC)was used to inhibit NF-κB activation 1 hour before induction of shock. A total of 66 adult male Wistar rats were randomly divided into 3 groups: control group (Control, n = 6), trauma shock (TS, n = 30), and NF-κB inhibition followed by trauma shock (NF-κB inhibition, n =30). Measurements of hepatic NF-KB and HSP70, hepatic function bio-markers, TNF-α and IL-6 were obtained 0.5, 2, 4, 6, 8 hours after trauma. Histopathological changes in liver tissues were also noted. Hepatic expression of NF-κB was determined by using electrophoretic mobility shift assay, while HSP70 was assayed by western blot and analyzed with computer imaging. Results In rats with trauma shock, both hepatic NF-κB activity and HSP70 expression increased significantly compared to the control group, reaching peaks at 6 hour post injury. Serum alanine transferase (ALT) and total bilirubin (TB) also rose significantly,reaching peaks at 8 hours post trauma. Light microscopy revealed hepatic congestion with infiltration of inflammatory cells into hepatic sinusoid in the TS group at 8 hours. Inhibiting the activity of NF-κB one hour before trauma significantly decreased expression of HSP70 at 6 hours post trauma [16.9±4.4 (NF-κB inhibition) vs. 23.0±1.7 (TS), P ＜ 0.05]. In addition,levels TNF-α and IL-6 in the liver tissue also decreased, and hepatic congestion as well as hepatic cell degeneration were ameliorated, showing minimal inflammatory infiltrates in the hepatic sinusoids. NF-κB inhibition also significantly lowered the levels of ALT and TB at 4 hours post trauma [ALT, 540.8 ±66.2 nmol/L (NF-KB inhibition) vs. 640.6±80.2 nmol/L (TS), P ＜ 0.05; TB,2.3±0.3 mol/L (NF-κB inhibition) vs. 4.7 ±1.1 mol/L (TS), P ＜ 0.05]. Conclusions NF-κB and HSP70 are involved in the pathogenesis of hepatic injury during hemorrhagic shock, and the degree of NF-κB activity and HSP70 expression may be consistent with the extent of hepatocellular damage. Inhibition of NF-κB helps ameliorate liver injury due to trauma shock.

Objective To summarise the imaging features of rare mastitis and explore the diagnostic value of ultrasound, mammography and MRI for rare mastitis. Methods The record of 24 patients diagnosed as rare mastitis in our hospital from Jan. 2000 to Jun. 2009 was reviewed, including clinical manifestations, pathological results, imaging diagnosis and diagnostic accurate rate. Results Of the 24 patients, 14 patients were ductal ectasia with chronic mastitis, 3 granulomatous mastitis, 6 chronic abscess and 1 mammary tuberculosis. 13 patients underwent ultrasonic scan, 12 patients underwent mammography and 3 patients underwent MRI, with the diagnostic accurate rate 77%, 25% and 100% respectively. Conclusions There are no special imaging manifestations for most rare mastitis, however, some differential characteristics still exist. MRI has a higher accuracy compared to ultrasound and mammography. The combination of multiple imaging methods can improve diagnostic accuracy.

Objective To establish a monitoring database of historical Oncomelania hupensis environments at grass?root lev?el for schistosomiasis prevention based on Google Earth(GE),so as to improve the management efficiency of historical O. hu?pensis environments. Methods GE was labeled with the information about the historical O. hupensis environments through add?ing landmark,path and polygon. Meanwhile,POCO web album was used to storage the practice situation pictures of the environ?ments,which could be imported into GE so that the environments could be monitored dynamically. Results There were 553 historical O. hupensis snail environments in Yangjian Town,Xishan District,Wuxi City and the accumulative area was 506 000 m2. Among these environments,224(40.5%)were Class IV environments,accounting for 40.5%of accumulative area. Conclu?sions The monitoring database of historical O. hupensis environments based on GE at country level is established successfully and it can be used to manage the historical snail environments visually and monitor the changes dynamically.

Aim To study the protective effects of limb remote ischemic postconditioning ( LRIP ) on is-chemic stroke rats under hyperglycemia and explore the mechanisms. Methods Rats were given 50% glucose (6 mL·kg-1 ) by intraperitoneal injection to get acute hyperglycemia model. Then middle cerebral artery oc-clusion ( MCAO) models were created. After blocking middle artery for 1. 5 h and reperfusion for 2 h, behav-ioral testing, infarct size of brain, NO concentration and SOD activity in the serum of those rats were detec- ted. Results LRIP could improve behavioral score, decrease the area of cerebral infarction, increase the concentration of NO and the SOD activity in serum of MCAO rats. Conclusion LRIP can relieve cerebral ischemia-reperfusion injury of MCAO rats under acute hyperglycemia.