It is advocated on clinical medical education to let students contact clinical diagnosis and treatment earlier, visiting more patients and promoting the ratio of visitation and course. But as more and more students flood into university, clinical visitation has turned into a difficulty to improve students' ability. To resolve this problem, we have made some efficient practice and exploration.

Objective The objective of this study was to observed the effect of target control intravenous (TCI) anesthesia and intravenous inhalational anesthesia in the postoperative cognitive function in elderly patients with intracranial tumor at different time points.Methods Seventy patients were divided into the experimental and control groups according to the different methods of intraoperative anesthesia.The experimental group was selected to treat with propofol combined with remifentanil TCI anesthesia,and the control group was treated with intravenous anesthetics combined with inhalation isoflurance.Recovery time of respiration,time of opening eyes,extuation time,orientation recovery time,OAAS score before and after operation,and cognitive function (MMSE)were observed in two groups.Results They were no differences in the recovery time of respiration,time of opening eyes and extubation time in two groups (P ＞ 0.05).The orientation recovery time in the experimental group was 20.4 ± 5.8 min and 23.2 ± 4.3 min in the control group.They had significantly different between experimental and control groups (P ＜ 0.05).The time of extubation,leaving the operating room and after 1 h of extubation,OAAS point for the experimental group was 3.3 ± 0.5,4.2 ± 0.4,4.6 ± 0.6 min,respectively,and 2.3 ± 0.2,3.3± 0.4,3.9 ± 0.3 in the control group,respectively.They were significantly different between the experimental and control groups(P ＜ 0.05).Prior to treatment,there was no significant difference in MMSE score between the two groups(P ＞0.05).MMSE score was 25.0 ±0.4 and 27.9 ± 1.1 in the experimental group after treatment for 24 h and 48 h,respectively.MMSE score in the control group was 23.2 ±0.9 and 25.8 ± 1.3 after treatment for 24 and 48 h,respectively.There had a significant different from two groups (P ＜ 0.05).Conclusion For elderly patients with intracranial tumor surgery,TCI anesthesia with propofol and remifentanil is stable and awake,and the effect on postoperative cognitive function is relatively small.

Objective To study the role of gene Fas and FasL expression in apoptosis of plcenta with ICP. Methods TUNEL (TdT-mediated dUTP nick end labeling) and immuno-hisochemistry methods were used for 31 placental samples with ICP and 31 normal placental samples to detect apoptosis index (AI) and the expression of Fas and FasL in placental tissues. Results AI of cytotrophoblast, syncytotrophoblast, decidual cells and mediate cell(49.09?9.13,t=13.41;46.64?9.77,t=12.16;35.09?9.49,t=8.43;38.74?9.70,t=11.28) in ICP group was significantly higher than that of control group (P

OBJECTIVE: To prepare Kuijieyu enemas and establish its quality standard.METHODS: Most of traditional Chinese medicines in prescription were decocted using water and some were crushed.Then they were concentrated to prepare enemas.Pueraria lobata,Rhizoma Coptidis,Scutellaria baicalensis in Kuijieyu enemas were qualitatively identified by TLC.The content of baicalin in Kuijieyu enemas was determined by HPLC.RESULTS: The TLC spots were clear,well-separated and specific.The linear range of baicalin were 210～1 750 ?g(r=0.999 9) with an average recovery of 99.13% (RSD=1.1%,n=6).CONCLUSION: The preparation process is simple and convenient.The quality control method is simple,reliable,specific and reproducible.

Objective We aimed to investigate the role of McMaster model of family therapy in improving family function of patients with advanced hepatocellular carcinoma (HCC).Methods Patients who had advanced HCC and received transarterial embolization (TAE) or transarterial chemoembolization (TACE) from Department of Hepatobiliary Ⅰ,Eastern Hepatobiliary Surgery Hospital between October 1,2012 and June 25,2013 were randomly divided into two groups:the experimental group (51 patients) and the control group (49 patients).The control group received routine family support education.The experimental group not only executed routine family support education,but also was given McMaster model of family therapy according to evaluation results of family assessment device (FAD) on the second and third day of hospitalization.The status of family function of all patients were assessed by FAD on the fnrst day of hospitalization and fourth week after therapy.We compared the status of family function between the two groups.Results In age,gender,educational level,place of residence,occupation,family economic status,medical payment,liver or kidney function,HBV infection,cirrhosis and tumor burden,no statistical differences were found between the experimental group and the control group patients before TAE or TACE.Two groups were dysfunction in communication,roles,affective responsiveness,affective involvement,behavior control,and general function in addition to problem solving before TAE or TACE.No statistical differences were found between two groups.After the therapy,compared with the control group,those patients in the experimental group had a lower level scoring in communication,roles,affective responsiveness,affective involvement,behavior control,and general function in addition to problem solving on the fourth week after the therapy,t value was-2.544,-3.767,-3.904,-2.848,-4.950 and-4.953,the difference had statistical significance.Conclusions McMaster model of family therapy may help to improve family function of patients with advanced HCC.

Objective To observe the major adverse reaction of irinotecan in combination with fluorouracil for advanced colorectal cancer,and sum up the nursing experience of acetylcholine syndrome and acute delayed diarrhea.Methods Pathologically confirmed 45 cases of patients with advanced colorectal cancer were treated with modified FOLFIRI regimen for total of 190 cycles.Results Acetylcholine syndrome rate was 28.9%,the incidence of acute delayed diarrhea was 40.0% ,more than 3 grade diarrhea was 6.7%.Conclusion The incidence of acute delayed diarrhea in Chinese patients is lower than in caucasians,and reasonable care measures can reduce the occurrence of adverse reactions,irinotecan in combination with fluorouracil is a safe and effective regimen for Chinese patients.

Objective To investigate the imaging features of the juxta-artieular bone cyst (intraosseous ganglia). Methods The imaging findings of 54 cases histopathologically confirmed were studied retrospectively. X-ray, CT, and MRI were performed in 46 eases,30 cases, and 14 cases, respectively.Results Of the 54 cases, 27 arised from the ankle (including multiple lesions), 16 from the knee joint,7 from the hip joint, 1 from the proximate end of the humerus, ulna, trapezium bone, the first phalange in each, and 1 from the talus and the distal end of the tibia. There were 43 eases (44 lesions) in the ankle and knee joints, with 29 (65.9%) lesions located in the medial articular surface. Fifty-four eases had thinning sclerotic rim, showing a unilocular round osteolytic appearance in 44 cases and a muhiloculated-cystic appearance with septa in 10 cases. Discontinuous articular surface were seen in 15 cases, articular surface collapse in 1, gas density in 3 and fluid-fluid plane in 1. (1) On x-ray films, 46 cases (47 lesions) with well-defined sclerotic rim revealed round, arch or irregular lyric areas at the adjacent articular surface. The fissures were found at the adjacent articular surface in 6 lesions. No joint spaces were abnormal. (2)On CT,30 cases with sclerotic rim showed round in 19 lesions, arch in 3, and irregular in 8. The fissures were seen at the adjacent articular surface in 14 lesions. The density showed homogeneous in 27 lesions, and gas existed in 3. (3) Fourteen cases (15 lesions)showed hypointense to isointense signal on MR T1 Wl and hyperintense signal on T2WI. Fluid- fluid plane was found in 1 ease. The fissures were observed at the adjacent articular surface in 8 lesions. 7 cases showed swelling soft tissue. Conclusion The characteristic locations combined with the typical imaging features may suggest the diagnosis of jaxta-articular bone cyst.

Objective To evaluate the association between vitamin D deficiency and diabetic nephropathy in type 2 diabetic patients.Methods A total of 594 patients with type 2 diabetes were enrolled from the inpatients of the Nanjing Medical University Affiliated Nanjing Hospital.Fasting serum lipid profile,25-hydroxycalciferol vitamin D and urinary albumin excretion rate were investigated.The relationship between nephropathy and vitamin D deficiency (＜ 20 μg/L) or insufficiency (20-＜ 30 μg/L) was analyzed.Results Nephropathy was found in 177 subjects (29.8％) with albuminuria in 141 and proteinuria in 36 subjects.Vitamin D deficiency was found in 180 subjects and insufficiency in 157 subjects.The proportion of vitamin D deficiency was higher in the individuals with nephropathy than those without nephropathy (36.2％ vs 27.8％,P ＜0.05).The urinary albumin excretion rate was significantly higher in the patients with vitamin D deficiency than those with normal vitamin D concentration [(123.0 ± 299.2)mg/24h vs (47.6 ±97.1) mg/24h,P ＜0.01].The prevalence of nephropathy was higher in the patientswith vitamin D deficiency than those with normal vitamin D concentration (35.6％ vs 26.1％,P ＜ 0.05),while the prevalence of proteinuria was higher in patients with vitamin D deficency (12.2％ vs 3.1％,P ＜0.01).Logistic regression analysis demonstrated that vitamin D deficiency was associated with nephropathy (OR 1.57,95％ CI 1.04-2.37),even after the adjustment for age,gender,hypertension,dyslipidemia,smoking status,use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (OR 1.78,95％ CI 1.12-2.81).The Vitamin D concentration was significantly negatively correlated with urinaryalbumin excretion rate (r =-1.783,P ＜ 0.001).Conclusions Type 2 diabetic patients have a high prevalence of vitamin D deficiency.Vitamin D deficiency is independently associated with diabetic nephropathy.

Objective To evaluate the significance of color Doppler ultrasound examination of renal blood flow combined with the detection of bone morphogenetic protein-7(BMP-7)in early diagnosis of type 2 diabetic nephropathy.Methods Blood BMP-7 level was tested in 90 patients with type 2 diabetic nephropathy and 30 controls,and parameters of renal blood flow were measured by color Doppler ultrasound examination.Blood BMP-7 level as well as resistant index(RI)of segmental renal artery(SRA)and interlobar renal artery(IRA),were compared between these two groups.Results Compared with controls,blood BMP-7 level gradually decreased with the aggravation of diabetic kidney damage(P＜0.01).The peak systolic velocity(Vmax)and the end diastolic velocity(Vmin)of SRA and TRA were slowed gradually,while RI increased(P＜0.01).Blood BMP-7 level was negatively correlated with IRA's and SRA's RI of IRA and SRA(r =-0.603,P＜0.01;r =-0.652,P＜0.01).Conclusions Color Doppler ultrasound examination of renal blood flow combined with detection of BMP-7 might play an important role in early diagnosis of type 2 diabetic nephropathy.

Objective To explore the effect of general intervention in improving the psychological condition of healthy pregnant women. Methods Totally 96 pregnant women who made prenatal visits in our obstetrics and outpatient department were divided into the control and the intervention group stochasti-cally. The intervention group started from first prenatal visit. The general intervention measures included cognitive intervention, the behavioral intervention, family coping intervention and psychological intervention with self-designed relaxation exercises. While conventional prenatal visit, propaganda and nursing were im-plemented to the control group.Self-made general questionnaire and symptom checklist 90 (SCL-90)were used to survey and analyze the results. Results Post-natal depression and anxiety of the control group was obviously higher than that of the prenatal. The Post-natal obsessive-compulsive symptom, interpersonal sensitivity, depression, hostility, terror and bigotry in the intervention group were greatly alleviated. Com-pared with the control group, obsessive-compulsive symptom, interpersonal sensitivity, depression, hostility and terror of the intervention group were significantly different (P<0.05). The depression improved while the difference was not evidently differenL Conclusions Delivery had great influence on the psychological status of women,especially anxiety and depression. General intervention measures like psychological relax-ation exercises can improve the psychological condition of healthy pregnant women obviously,especially de-pression.