Satisfactory communication skill is the essential requirement for medical students to become future qualified medical doctors.Clinical clerkship is the key process to absorb medical knowledge and professional skill,cultivate the ability to solve practical problems in medical practice,and develop medical students into qualified doctors by guiding them to reasonably handle physician-patient relationship,better solve medical disputes,and gradually improve their legal awareness.Therefore,medical students should strengthen to cultivate their communication ability,and set up reasonable sense of physician-patient communication.

Objective: To investigate the Ventral Pallidrm′s function of cardiovascular adjustment by observing the changes of the rats′blood pressure. Methods:Ten SD rats′blood pressure were respectively observed through a catheter in one of the common carotid arteries after unilateral Ventral Pallidum stimulation by certain concertration,certain volume glutamate solution under stereotaxic guidance. Results:Glutamate stimulation on Ventral Pallidum caused elevation of the rats′blood pressure,thechanges were significant. Conclusion:Ventral Pallidum has a role in regulating blood pressure. It belongs to behavior related pattern and sympathetic regulated.

Objective To observe the effects of marzulene(L-glutamine and sodium gualenate)on cellular immune function in patients with severe acute pancreatitis(SAP). Methods A prospective study method was conducted in which 80 patients with SAP were divided into trial group and control group(each 40 cases)according to the table of random number methods,and in the mean time 20 healthy volunteers were enrolled in the healthy control group. Both SAP groups received standard total parenteral nutrition(TPN)with same quantities of heat and nitrogen, and the trial group additionally accepted intravenous drip of marzulene 0.4 g?kg-1?d-1(once a day)for 7 days,while the control group received the same amount of normal saline intravenous drip for 7 days. One day before treatment and on the 7th day after treatment,the peripheral venous blood samples were collected. The T-lymphocyte proliferation activity was tested by methyl thiazolyl tetrazolium(MTT)assay,and the interleukin-2(IL-2)and interleukin-6(IL-6) secretion levels were detected by enzyme-linked immunosorbent assay(ELISA). Results Compared to the healthy control group,the levels of T lymphocyte proliferation activity〔absorbance(A)value〕and IL-2(ng/L)were markedly decreased and IL-6(ng/L)secretion level was obviously increased before treatment in the two SAP groups(P<0.05 or P<0.01). Compared to prior treatment,the levels of T lymphocyte proliferation activity and IL-2 were significantly increased after 7 days of treatment in the trial group(both P<0.05),and basically restored to normal levels,while in the control group they were progressively decreased(both P<0.05),the levels in trial group being significantly higher than those of the control group(T lymphocyte proliferation activity:1.08±0.27 vs. 0.43±0.25,IL-2:16.5±1.4 vs. 9.4±2.9,both P<0.05),but compared to prior treatment,the level of IL-6 was significantly decreased in the two SAP groups(both P<0.05),the level of IL-6 in control group was recovered to the level of healthy control group,and the level in trial group being significantly lower than that of the control group(18.8±4.5 vs. 22.3±3.1, P<0.05). Conclusions The patients with SAP have cellular immune dysfunction,the manifestations being the suppression of T lymphocyte proliferation and IL-2 and increase of IL-6 release. Early application of marzulene can help to improve the immune function of lymphocytes in patients with SAP.

Diabetes is a kind of metabolic disease characterized by hyperglycemia The oral hypoglycemic agents used currently are required to take every day,which brings inconvenience to patients.Omarigliptin is a small molecule DPP-4 (depeptidyl peptidase-4) inhibitor.The drug is developed by the Merck Co,mainly for the treatment of type two diabetes.The drug only need to be taken once a week,so as to improve the patient's compliance and adherence,thereby improving the therapeutic effect.This article introduces the information of omarigliptin from the aspects of synthesis,pharmacology,pharmacokinetics,and clinical research,which provides valuable information for pharmaceutical workers.

With the Meta-analysis method, the clinical efficacy of acupuncture and other regular methods for aphasia was evaluated, and the acupoints selection for aphasia was explored. The acupuncture literature of clinical randomized control trials for aphasia published in CNKI, WANFANG, VIP and CBM database was searched; the statistical analysis of clinical efficacy of acupuncture and other regular methods for aphasia was performed by using software Revman 5. 2 provided by Cochrane library. A file of Microsoft Excel was established to perform the analysis of acupoints selection based on frequency analysis method, so as to summarize the characteristics and rules. Totally 385 articles were searched, and 37 articles those met the inclusive criteria was included, involving 1,260 patients in the acupuncture group and 1 238 patients in the control group. The Meta-analysis results showed OR = 3.82, 95% Cl [3.01, 4.85]; rhombus was located on the right side and the funnel plot was nearly symmetry, indicating the treatment effect of the acupuncture group for aphasia was superior to the control group (Z = 11.04, P < 0.000 01). The frequency-analysis results showed that the frequency of acupoints from top to bottom was Lian-quan (CV 23), Tongli (HT 5), Yamen (GV 15), Jinjin (EX-HN 12), Yuye (EX-HN 13), Baihui (GV 20), Yuyan II, Yuyan I and Yuyan III. The frequency of meridians from top to bottom was the governor vessel, extra channels, conception vessel, heart meridian and large intestine meridian. It is concluded that the clinical efficacy of acupuncture combined with speech rehabilitation training and medication treatment for aphasia is superior to that of speech rehabilitation training and medication treatment alone. The clinical treatment for aphasia focuses on its local effect; the main acupoints are in the head and face, and the meridians are governor vessel, extra channels and conception vessel.
Acupuncture Therapy ; Aphasia ; therapy ; Databases, Bibliographic ; Humans ; Retrospective Studies

Objective To discuss the clinical value of CT combined electronic level guided percutaneous transthoracic needle biopsy in diagnosis of small pulmonary nodules.Methods 44 cases of lung mini-nodule underwent CT combined electronic level guided percutaneous transthoracic needle biopsy.After operation the tissue was sent for pathologic examination.The nodules were divided into two groups,including Group A (diameter 0.5-1.0 cm,N=10) and Group B (diameter 1.1-2.0 cm,N=34),according to the different sizes of diameter.The excision of postoperative pathological and diagnosis result of clinical diagnosis and treatment of more than 12 months follow up were taken as the final result.The sensitivity,specificity,veracity and complications were compared and analyzed using paired x2 test,taking P＜0.05 as significant difference.Results (1)The arrival rate of target puncture were 100 ％ in 44 cases,with the sensitivity rate of 90.9％,specificity rate of 100 ％,veracity rate of 88.6 ％,positive predictive value of 97.5 ％,and negative predictive value of 100 ％.The sensitivity,specificity and veracity of Group A were 77.8％,100％ and 70.0％ respectively.And the sensitivity,specificity and veracity of Group B were 94.1％,100％ and 94.1％ respectively.The sensitivity,veracity of Group A was higher than Group B (P＜0.05),while there was no difference in specificity.(2)Complication:the incidence rate of pneumothorax,pulmonary bleeding symptoms and hemothorax were 9.1％,11.4％,2.3％,respectively.The incidence rate of total complication was 22.7％,and all be cured after the treatment.The lesions with emphysema around is a risk factor for pneumothorax and pulmonary bleeding symptoms (x2 =11.2,10.2,P＜0.05).However,the position,size and deepness was not correlated with the complications mentioned above (P ＞0.05).Conclusion CT combined electronic level guided percutaneous transthoracic needle biopsy is a safe,effective and accurate diagnostic method for lung mini-nodule lesion.

Objective To evaluate the reliability of PainVision method for assessment of postoperative pain in patients undergoing gynaecological laparoscopy.Methods Twenty ASA physical status Ⅰ-Ⅱ patients,aged 30-45 yr,undergoing gynaecological laparoscopy under fentanyl-propofol-cisatracurium anesthesia,were studied.Pain intensity was simultaneously assessed using PainVision method and visual analog scale (VAS) at 12,24 and 48 h after surgery.PainVision was a new method for quantitative measurement of pain intensity using a painless electrical stimulation (PainVision PS-2100 device).Pain degree was calculated from two parameters,current perception threshold and pain compatible electrical current by using PainVision.The former parameter was defined by the lowest electrical current detected ; the latter parameter defined by the electrical current judged as being compatible with the intensity of ongoing pain.Results There was a significant positive correlation between pain degree calculated by PainVision method and VAS scores,and the correlation coefficient was 0.902 (P ＜ 0.01).Conclusion PainVision method can be applied for assessment of postoperative pain in patients undergoing gynaecological laparoscopy.

Objective To analyze the influence of donating kidney of marginal donors on the early prognosis of living-related kidney transplant recipients.Methods Sixty-six cases of living-re-lated kidney transplant patients between February 2004 and September 2007 were divided into the marginal donors group(28 cases)and non-marginal donors group(38 cases).Serum creatinine before and after surgery,creatinine clearance after surgery and perioperation complications were compared respectivelv between the 2 groups.Results The serum creatinine levels in the marginal donors group and non-marginal donors group were 154,131,127μmol/L and 132,117,118 ttmol/L on 7th day,1st month and 3rd month after transplantation respectively,and there were no significant differences between the 2 groups(P＞0.05).The serum creatinine level in parent-child donating kidney of the 2 groups Was 160,131,126μmol/L and 132,129,126μtmol/L on 7th day,1st month and 3rd month after transplantation respectively,and there were no significant differences too(P＞0.05).There was no difference in the rate of perioperation complications and creatinine clearance after kidney transplantation between the 2 groups.Conclusions The early prognosis of marginal donors'recipients is ideal.The marginal donors could be selected as the living-related kidney transplant donors,especially between parent and child,as long as they are evaluated according to stricter criteria.But the long-term prognosis of the recipients should be further observed.

Objectives To investigate the influence of cytomegalovirus infection after kidney transplantation on the recipients and the associated risk factors of cytomegalovirus infection .Methods Data of 892 kidney transplantation recipients from January 2000 to December 2004 in our department were analyzed retrospectively . All the recipients were divided into case group (with cytomegalovirus infection) and control group (without cytomegalovirus infection) . Log-Rank test was used to compare the 1-, 3-, 5-year survival of patients and grafts between two groups . The incidence of complications, the difference of regiment of immunosuppressant and anti-CMV drugs were compared as well . The independent risk factors of cytomegalovirus infection were assessed by Logistic regression analysis . Results One-, 3-, 5-year survival rates of patients in case group were 81 .3%, 72 .8% and 54 .8% respectively, while the patients in control group were 96 .4%,91 .4% and 79 .9% respectively, the prior was significantly lower than the latter (Log-Rank value=49 .62, P＜0 .01) . One-, 3-, 5-year survival rates of grafts in case group were 71 .0%, 66 .2% and 46 .1%, while the grafts in control group were 91 .5%, 86 .6% and 74 .5% respectively, the prior was significantly lower than the latter as well (Log-Rank value=44 .87, P＜0 .01) . The incidence of acute rejection in case group was 24 .9%, while it was 13 .9% in control group, with significant difference between two groups (x2=14 .49, P＜0 .01 ) . Logistic regression showed that acute rejection,mycophenolate mofetil dose more than 2 g, and usage of ATG/ALG or OKT3 were the independent risk factors of cytomegalovirus infection (OR=1 .464, 3 .097 and 2 .837, P＜0 .05 ) . Ganciclovir was the protective factor of cytomegalovirus infection (OR =0 .234, P ＜0 .01) . Conclusions Cytomegalovirus infection decreases the long-term survival of recipients and grafts in kidney transplantation . Acute rejection, high dose of mycophenolate mofetil, and ATG/ALG or OKT3 are the independent risk factors of cytomegalovirus infection . Prophylactic usage of ganciclovir after kidney transplantation can effectively reduce cytomegalovirus infection .

Objective To study the causes and protection of intracranial aneurysms uncompletely embolized with micro-coils. Methods 47 cases of intracranial aneurysms were treated with micro-coils to embolize the aneurysaml sac via femoral artery approach to endovascular embolization.The aneurysms were located on AcoA in 19,on MCA in 7,on PcoA in 16 and on ICA in 5,2 aneurysms were foundin each of 2 cases. Results The uncompletely occuluded in 12 of them,aneurysms were completely occluded in 35,9 aneurysms wereoccluded to 95%,2 aneurysms were occluded to 90%,1 neurysms were occluded to 80%. Conclusion The wide neck intracranialaneurysms,hugeness intracranial aneurysms and ophidian,irregular intracranial aneurysms are of high rate of uncompletely occluded.Usingbasket-technique,remodel technique,vein rebuild technique and nibble subdivision endovascular embolization can decrease the rate ofuncompletely embolize intracranial aneurysm.