Objective To understand the effects of reform on clinical teaching taking patient's symptoms as the starting point and to investigate students' recognition degree towards this reform and their information feedback.Methods Totally 42 clinical students of the second clinical medical college (the second class) of China Three Gorges University were enrolled in the study and clinical teaching taking patient's symptoms as the starting point was conducted.Thirty-nine clinical students of the second clinical medical college (the fourth class) were enrolled as control group and traditional method was conducted.Effects of clinical teaching were evaluated by examination score and students' recognition degree towards this reform was investigated by self-made questionnaire and information feedback.Data were processed using SPSS 13.0 statistical software; t tests were used to compare students' scores of theoretical test and skill test; P ＜ 0.05 signifies that the difference is statistically significant.Results There was no statistical difference in theoretical test score between experiment group and control group (P ＞ 0.05).Skill test scores were higher in experiment group than in control group (P＜0.01).Students highly admitted this teaching mode and they thought that this mode can improve their self-study ability,clinical practice skill and clinical thinking ability without influencing their theoretical learning.Conclusions Practice of clinical teaching taking patient's symptoms as the starting point is feasible,which can increase scores of skill test significantly without influencing scores of theoretical test.

The criterion of injury severity is an important part of evaluation,which can affect the treatment for closed fracture.The reaction in soft tissue healing process contains microvascular responses and inflammation.Take soft tissue with low immunity as a incision will lead to wound dehiscence and deep infection.Therefore,realization of injury severity lays a foundation for effective treating with closed fracture.Many treatment methods,such as splint fixation,cryotherapy,compression or delayed operation,can prevent soft tissue from a second injury,and promote self-repair ability prior to operation.The newly development surgical tech-nique can improve efficacy of therapy,meantime,decrease the incidence of complications.

Objective To prove the existence of dry eye in children and to learn the clinical characteristics of them. Design Prospective observational case series. Participants 38 cases(76 eyes) of suspected children of dry eye diagnosed by adult standard and 38 normal children subjects. Methods 38 suspected child patients were studied who were diagnosed clinically with dry eye by adult standard, and were followed up 6 months. The control group consisted of 38 normal children with no significant difference in age. Dry eye examinations including Schirmer test, break-up time(BUT) and fluorescein staining were performed on these two groups. Following items were recorded in 38 suspected children of dry eye, including symptoms and causations. Main Outcome Measures Symptoms, Schirmer test, BUT and fluorescein staining. Results In the 38 suspected patients, frequent blinking was the most common symptom in 21 cases(55.26%), followed by dryness (15 cases, 39.47%), redness (14 cases, 36.84%) and photosensitivity (14 cases, 36.84%). The Schirmer test and BUT were decreased remarkably in the suspected patients compared to those of normal subjects (P=0.0000). In both groups, right eyes were correlated with left eyes in both Schirmer test and BUT. Between these two groups, Schirmer test was nol correlated with BUT. In the suspected patients, the results of BUT and fluorescein staining were improved (P

The glucose metabolism pathways including glycolysis and oxidative phosphorylation in vivo.The metabolism of tumor cells depends on glycolysis,which enhances the adaptability of tumor cells to the microenvironment and promotes the proliferation of tumor cells,which is called Warburg effect.Arsenic is one of the chemical pollutants,which is widely distributed in natural environment.International agency for research on cancer (IARC) has made it clear that arsenic and its compounds are carcinogens.However,the mechanism of carcinogenesis induced by arsenic still remains obscure.Recently,researchers have found that Warburg effect plays an important role in the process of arsenic carcinogenesis.In this paper,we have reviewed the definition and function of glycolysis,its relationship with inflammation and tumorigenesis,and the role of Warburg effect in arsenic carcinogenesis.

Objective To investigate colonization of multidrug-resistant organisms (MDROs)in neonatal intensive care unit (NICU)newborns on admission.Methods From April to November 2013,293 newborns who admitted to NICU of a hospital were screened for methicillin-resistant Staphylococcus aureus (MRSA)by nasal and throat swabs and for extended-spectrumβ-lactamases (ESBLs)bacteria and vancomycin-resistant Enterococcus (VRE)by anal swabs.Results Of 293 newborns,61 were detected MDROs (20.82%).The positive rate of MDROs screening in newborns aged <3 days(5.92%)was lower than those aged <3-6 days(37.74%)and 7-28 days (43.66%), the difference was significant (P =0.000).The major colonized MDROs were ESBLs-producing bacteria(83.60%), the major colonized site was anus(88.52%).Conclusion Neonatal anus and stool are important sources of MDROs in NICU;more attention should be paid to colonization screening for MDROs by anal swabs in newborns aged >3 days,and appropriate isolation measures should be taken for positive screening patients to prevent the transmission of MDROs.

ObjectiveTo evaluate oncoplastic techniques on breast conservative surgery.MethodsClinical data of 50 breast cancer patients who received oncoplastic breast conservative surgery from October 2009 to August 2011 were retrospectively analyzed.The indication,methods,outcome and morbility of oncoplastic surgery were assessed. ResultsAll patients had solitary tumors.Twelve patients received neoadjuvant therapy and thirty-eight received upfront surgical therapy.Different oncoplastic surgery techniques were applied based on the location of tumor.There were 20 tumors located in upper outer quadrant receiving lateral radial or horizontal excision; Four lower inner and seven lower outer tumors received V and J shape excision respectively; Three low pole and seven upper pole tumors received inverted T and batwing excision respectively; Six tumors located periareolar area and three tumors located retroareolar area were removed using round block and J shape excision.Two patients experienced postoperative hematoma and three patients had incisional dehiscence followed by secondary infection. Another developed skin ischemia and necrosis. Thirty-five patients have finished the postoperative adjuvant radiotherapy. The appearances of the breasts were satisfactory in all patients except one having deviation of nipple and two patients suffering from dimpling in incisional region.Patients gave high scores about their breast appearance.After 4- 27 months follow-up,two patients had local recurrence and received mastectomy.Other patients were free of recurrence.ConclusionsBreast oncoplastic surgery technique benefits those whose tumors located in special area of the breast resulting in a satisfactory cosmetical appearance of the breast.

Objective To investigate the significance of routine exposure of recurrent laryngeal nerve (RLN)in thyroidectomy.Methods The data of consecutive 232 patients with thyroidectomies during 2009-2010 were retrospectively reviewed.All operations,either lobectomy or total thyroidectomy were performed by the same surgeons.The RLN was identified routinely during the operation.Results Totally 280 RLNs were exposed in 181 thyroid lobectomies and 51 total thyroidectomies(98.9%).Ten patients experienced post-operative hoarseness(3.6%).Seven patients were diagnosed with paralysed vocal cord post-operatively,although the RLN were identified intact during the surgeries,and their voice became normal in 2 months.Another 3 patients'RLNs were transected injured and re-anastomosed during the same procedures and their voice became normal in 4 months.Conclusions Exposing the recurrent laryngeal nerve in the thyroidectomy is an effective way to prevent permanent injury to RLN.

In order to assess colonic motility of chronic constipation, colonic transit test was carried out in 34 patients with chronic constipation and in 20 healthy subjects. 20 radiopaque markers are ingested at 8 am before the day test, and plain abdominal films were obtained at 24 h, 48 h and 72 h. The normal value of colonic transit test was 16(80%), or more markers passed after 72 h. By means of transit time study, 34 constipated patients were classified into 2 groups: 12 normal transit patients and 22 slow transit patients. There was no difference in colonic transit time between normal transit patients and controls (P＞0.05). Patients with slow transit had more markers left in right colon, left colon and rectosigmoid colon at 48 h (P＜0.01, respectively) and 72 h (P＜0.01, respectively). According to the transit index, 22 slow transit patients were divided into 3 types: 10 cases colonic stasis, 8 cases outlet obstruction and 4 cases colorectal stasis. The study suggests that chronic constipated patients have abnormalbilities of colonic transit.

Objective To explore the effects of the therapeutic effects of interventional heated chemotherapy( IHC) for moderate and advanced huge primary hepatocellular carcinoma and compare with transcatheter arterial chemoembolization( TACE) . Methods The 68 pa-tients with moderate and advanced huge primary hepatocellular carcinoma accepted the treatment of IHC were considered as the observation group,and 32 patients managed TACE were regarded as the control group. The therapeutic effects,living quality,secondary surgery rates,The reduced level of serum AFP,survival rate,and toxic side effects of 2 groups were contrasted. Results The effective rate of observation group was obviously higher than that of control group (79. 4% vs 56. 3%,P <0. 05),and secondary surgery rates was increased(70. 6% vs 43. 8%,P<0. 01). The ratio of increased Karnofsky score was more than 20 in observation group,which was obviously higher than that of control group(35. 3% vs 12. 5%,P<0. 01). T The reduced level of serum AFP was more than 50% in observation group,which was higher than that of control group (52. 9% vs 25. 0%,P<0. 01). The survival rate of 12,18,24 months after treatment in control group was in-creased than that in control group individually (P<0. 01). Conclusion IHC is effective for huge primary hepatocellular carcinoma and in-creases the secondary surgery rates,which is one of the safe and effective methods for huge primary hepatocellular carcinoma.

0.05). Conclusion There are MA and mutation of p53 gene in T-cell lymphoma though no significant correlation between them. But, MA positive cases might experience high mutation of p53 gene in T-cell lymphoma.