Considering the fact that the critical medical education was relatively backward, and the basic medical education was out of touch with clinical practice, this study, combined with the complexity, uncertainty and comprehensiveness of critical care medicine , puts forward the concept of critical care medicine holistic medicine in clinical practice. We try a patient-oriented approach in clinical practice, focusing on the whole, focusing on the interaction relationship among patient and disease and its pathologi-cal and physiology processes, development, complication and prognosis of disease, instead of paying atten-tion only to disease or single organ itself. The purpose of patient-based learning is trying to train medical students and junior residents to form good clinical thinking ability and decision-making ability.

Objective To evaluate the efficiency and safety of domestic rapamycin-eluting stent(Firebire stent) in the treatment of coronary heart disease.Methods Coronary angiography and stenting were carried out through femoral artery approach in 331 patients with coronary heart disease.The incidences of in-hospital major adverse cardiac events were recorded all the patients were followed up for 1 year.The follow-up angiography was carried out at at 6-9 months after discharge.Results A total of 597 domestic rapamycine-eluting stents were implanted in 331 patients.One patient died of pump failure after primary PCI and another patient required emergency CABG because of coronary artery rupture.NSTEMI happened in 3 patients after PCI.The incidence of in-hospital MACE was 1.5%.Three hundred and one patients finished a mean follow-up of 12.3?3.2 months.During the follow up period,non-fatal myocardial infrarction was recorded in 1 case,recurrent angina in 16 cases and target lesion revascularization in 5 cases.The overall MACE rate was 4.3%.Follow-up angiography was completed in 110 patients and the restenosis rate was 5.5%(6/110).Conclusion Domestic rapamycin-eluting stent(Firebird stent) was safe and effective in the treatment of coronary heart disease and may provide a higher cost-effectiveness due to its relatively low price.However,its long-term effect needs more studies to verify.

Objective To investigate the signal transducer and activator of transcription 1(STAT1) and matrix metalloproteinase 3(MMP3)′s genetic expressions and their clinical significance on urothelial carcinoma after renal transplantation. Methods Fifty-one patients with urothelial carcinoma were recruited in this study. Sixteen of them who had renal transplant were in the experimental group and 35 of them without renal transplant were in the control group. All the cases had been proved postoperatively having transitional cell carcinoma by histopathological study. The human genome oligo arrays were used to analyze the gene expression spectrum of urothelial carcinoma after transplantation, aiming the STAT1 and MMP3's expression. Real time RT-PCR and immunohistochemical staining were used to compare the differences in the 2 groups. Results The experimental group showed that there were 35 genes up-regulated compared with the control group. Of them, 23had known gene function or partly known, and 12 had unknown gene function. There were 76 genes down-regulated. Of them, 46 had known gene function or partly known, and 30 had unknown gene function. After pathway analysis of the differentially expressed genes, there were 23 groups of pathways which had significant differences (P＜0.05), referring to the aspects of immunosuppressive and tumor growth. The levels of STAT1 and MMP3 expressions had significant differences between the 2groups(P＜0.05)as well. Conclusions The differential expression of urothelial tumor genes is obvious between patient who has had renal transplant and who has not. There are many aspects that are related to the tumor's growth like signaling pathways regulating proliferation, apoptosis of tumor cells, tumor angiogenesis and the tumor metastasis potential. STAT1 and MMP3 maybe become the targets of chemoprevention for post-transplantation urothelial carcinoma.

Objective To study the clinicopathologic features of post-transplant lymphoproliferative disorders (PTLD) following renal transplantation.Methods Four cases of PTLD following renal transplantation were studied and relevant literatures were reviewed.Results All the 4 cases had received 3-drug-immunosuppression after transplantation.The duration between renal transplantation and diagnosis of PTLD was 5-112 months,averagely 34 months.The patients were suffered from infective monocytic hyperplasialike PTLD,plasmacytic hyperplasialike PTLD,polymorphic PTLD and monomorphic PTLD respectively in morphology and had no specific symptoms.All the patients received therapy with dosage reduction of immunosuppressants and some received rituximab or chemotherapy.The case of monomorphic PTLD died in a short time after diagnosis.Conclusion PTLD is a lymphoproliferative disease with distinctive morphologic and clinical characteristics.The main treatments include the dosage reduction of immunosuppressive agents,biotherapy and chemotherapy.The prognosis of monomorphic PTLD is poor.

Objective To investigate the effect of cyclosporine on matrix metalloproteinase-3 (MMP-3)’ s genetic expression on bladder cancer in rats induced with BBN and its clinical significance.Methods Twenty SD rats were divide into experimental group or control group randomly.Ten samples of SD rats bladder cancer induced with BBN and cyclosporine simultaneously and 10 samples of SD rats bladder cancer induced with BBN only as control were used to observe the effect of cyclosporine on MMP-3’ s genetic expression.Real time RT-PCR and immunohistochemistry stain were used to analyze MMP-3 mRNA and protein levels of bladder cancer in rats respectively.Results The MMP-3 mRNA median expression were 7.6 (4.2-9.1) in experimental group and 4.7 (2.8-7.7) in control group.The MMP-3 protein expression were 1 case with (-),4 cases (+),5 cases (++) in experimental group and 3 cases (-),4 cases (+),3 cases (++) in control group.The differences of MMP-3 mRNA and protein levels of bladder cancer between experimental group and control group were both significant (P ＜ 0.05).Conclusion Cyclosporine may stimulate the growth and development of bladder cancer through changing expression of some genes like MMP-3,and MMP-3 maybe become one of the targets of chemoprevention for post-transplantation bladder cancer.

Objective To investigate the effect of cyclosporine on signal transducer and activator of transcription 1 (STAT1) genetic expression on bladder cancer in rats induced by BBN and its clinical significance.Methods Twenty SD rats were divide into experimental group or control group randomly.Ten samples of SD rats bladder cancer induced with BBN and cyclosporine simultaneously as experimental group,and 10 samples of SD rats bladder cancer induced with BBN only as control.Real time RT-PCR and immunohistochemistry stain were used to detect STAT1 mRNA and protein level expressions of bladder cancer in rats respectively.Results The STAT1 mRNA median expression fold was 4.5 (2.1-6.6) in experimental group and 5.6 (3.4-8.5) in control group.The STAT1 protein expression were 5 cases with (-),3 cases (+),2 cases (++) in experimental group and 0 case (-),5 cascs (+),5 cases (++) in control group.The expression of STAT1 mRNA and protein level of bladder cancer between experimental group and control group were both significant different (P ＜ 0.05).Conclusions Cyclosporine may stimulate the growth and development of bladder cancer through changing expression of some genes like STATI,and STAT1 maybe become one of the targets of chemoprevention for post-transplantation bladder cancer.

ObjectiveTo investigate DNA loads and risk factors of BK virus infection in renal transplant recipients.MethodsWe developed a real-time PCR assay to quantitate BK virus loads in 80 patients receiving renal transplantation in our center,and correlation between the BK virus load and clinical course was analyzed.BK virus loads were measured in urine and plasma. Epidemiological features and risk factors of BK virus infection were analyzed.ResultsThe positive rate of BKV viruria and viremia in 80 renal recipients was 37.5％ (30/80) and 8.75％ (7/80),respectively.BKV loads were higher in renal allograft recipients whose age was more than 50 years old.BKV loads were observed in urine and plasma (compared with group whose age was less than 50 years,P=0.017 and 0.05,respectively).BKV DNA copies were higher in group Tac than that in group CSA (P＜0.05),and the peak of BKV load in serum appeared at14th and10th month after transplantation,respectively,but the peak in urine was ahead of that in serum,appeared at 2nd and 8th month,respectively.ConclusionSerial measurement of BKV viral loads by quantitative PCR is a useful tool in monitoring the course of BK virus infection.The ages of recipients (＞50 years) and using Tac + MPA can reactivate BK virus and then result in BKVAN in renal transplant recipients. Intensive BKV monitoring is necessary for these recipients.

Hirsch index or h-index of a subject means that the subject has h published papers which are cited at least h times for each.This index is considered as both quantity and quality of the SHbiect's academic outcome.In this paper the data showed that the h-indexes of the Chinese medical SUbiects were different.The SUbiect's h-index could be used as a balance factor.which made the outcome of scientists from different SUbiects comparable.Using h-index and the other 2 indexes.Chinese medical snbiects were clustered into 4 groups,which could be used as a guideline for classified management and the evaluation of the medical subjects

Objective To explore the creation and control of measurement technique error on digital subtraction angiography (DSA). Methods The data was obtained from Advantx LCV Plus DSA system made by GE Corporation. We divided the screen into three areas, per area account for 1/3, ie, central area, middle area and outlying area. The enlargement rate or reduction rate of the target object was respectively calculated according to the different calibration, different height of the bed and different X-ray source to image distance (SID). Results The target object was enlarged gradually from the central area to the outlying area, and the lengthwise enlargement rate was more obvious than transverse. The different of target object measured by coin (diameter was 20.4 mm) with steel ball (diameter was 7.7 mm) was not significance, but the target object was underestimated significantly used the calibration by 4F catheter. When the target object was measured by the calibration in same area and same axis, the error of measurement technique was controlled rang from 1.0% to-2.5%. Conclusion This systematic investigation suggest that the screen was divided into the central area, middle area and outlying area will be beneficial to control DSA measurement error for the interventional physician. The target object was close to real size when it measured by transverse of the calibration, and the error was better controlled when the calibration was in the same area and same axis as the target object.

Objective To study the application of continuous infusion of remifentanil combined with propofol with different velocity du-ring induction of general anesthesia in elderly patients. Methods Sixty elderly patients were divided into 4 groups randomly(n=15) and given remifentanil with continuous infusion rate of 0.1,0.15,0.2 and 0.3 ?g?kg-1?min-1,respectively.After given midazolam and propofol,remifentanil infusion started with different velocity.Three minutes later,vecuronium was given and intubation performed 2 min later.After that,propofol infusion rate was adjusted according to the changes of blood pressure and kept at 4 mg?kg-1?h-1 5 min before incision.Blood pressure(BP),heart rate(HR),intubation score(following Grant's method) and all side effects and adjuvant drugs used were recorded. Results Grant scores in all patients were less than 8.Atropine and ephedrine were given more in large dose groups and with decreasing of usage of propofol.HR decreased markedly in 0.3 ?g?kg-1?min-1 group after remifentanil began(P