This paper analyzed the system,methods,content,scope and standards of last two competition in order to further improve the clinical skills competition for national medical students in China.According to the characteristics of medical education,the paper proposed several opinions and suggestions as follows:repechage should be cancelled in competition system and objective structured clinical examination should be used in competition; the content,scope and criteria of the competition should take the actual ability of the medical students at graduation into consideration.

OBJECTIVE:To analysis the characteristics and regularity of the adverse drug reaction(ADR)occurred in our hospital. METHODS:307 ADR cases collected from 2004 to 2008 in our hospital were analyzed statistically in respect of patient’s age and sex,route of administration,categories of drugs,organs and systems involved in ADR and clinical manifestations,etc. RESULTS:Of total 307 ADR cases,more cases were woman;45.93% of cases were aged ≤18 a and 60 a. 80.13% of ADR cases were induced via intravenous administration. The incidence of ADR cases were mainly induced by antiinfective drugs,accounted for 48.53%. The most common manifestation of the ADR was lesion of skin and its appendants(27.97%),followed by injury of digestive system(16.10%). CONCLUSION:Great importance should be attached to rational use of anti-infective drugs and its management to reduce or avoid the occurrence of ADR and improve the quality of ADR reports.

OBJECTIVE To evaluate the clinical efficacy of cefoperazone/sulbactam(Sulperazon) for acute exacerbation of chronic obstructive pulmonary disease(AECOPD).METHODS A total of 136 cases of AECOPD were randomized into cefoperazone/sulbactam group and ceftazidime group,and sputum culture of each case was underwent before and after treatment.RESULTS The total efficacy rates and bacterial clearance rates in cefoperazone/sulbactam group and ceftazidime group were 91.18%,96.67% and 70.59%,75.86%,respectively,and the differences between the two groups were statistically significant.CONCLUSIONS It suggested that cefoperazone/sulbactam be a more effective drug for AECOPD.

Objective To observe the effects of hydrogen sulfide on hepatic and renal injury induced by thioacetamide (TAA).Methods Twenty-four male SD rats were equally and randomly divided into TAA induced model group ,control group,TAA +sodium hydrogen sulfide group , and TAA +propargylglycine group .TAA was given by intraperitoneal injection to the model group , sodium hydrogen sulfide and propargylglycine groups at the dose of 600 mg/kg on the first day, and at the dose of 300 mg/kg 24 hours later.Hydrogen sulfide sodium at the dose of 0.15 mmol/kg and propargylg-lycine at the dose of 30 mg/kg were injected abdominally 1 h before TAA injection.The dose of these two agents was halved in the next 24 h.All the rats were sacrificed and specimens were collected to test hydrogen sulfide , and hepatic and renal function.Urine after the first 24 hours was collected after the administration of TAA .Results The structure of the liver in TAA group was disordered , especially in sodium hydrogen sulfide group .Liver function of TAA group was severely damaged (ALT:980.0 ±32.0 vs 38.3 ±10.6 U/L),and deteriorated with the application of sodium hydrogen sulfide (ALT:1095.6 ± 684.2 U/L), but recovered (ALT:66.3 ±8.32 U/L) with propargylglycine application.Compared with the normal group, the renal function in TAA group was significantly injured ,but the urea nitrogen and creatinine in sodium hydrosulfide group were reduced more remarkably than in TAA group (BUN:8.4 ±1.9 vs 11.62 ±6.0 mmol/L,Cr:32.6 ±8.2 vs 42.8 ±4.4 μmol/L, P<0.05).Nevertheless, creatinine was increased in propargylglycine group ( Cr 56.7 ±14.9 vs 30.8 ±4.4μmol/L, P<0.05).The urine content within 24 hours was more significantly decreased in TAA group than in the normal group (9.2 ±2.5 vs 20.5 ±6.7 ml, P<0.01), which was mildly recovered in sodium hydrogen sulfide group (11.7 ± 1.5 vs 9.2 ±2.5 , P<0.05) but further decreased (4.2 ±1.3 vs 9.2 ±2.5, P<0.01) in the propargylglycine group . Conclusion Hydrogen sulfide can alleviates renal injury while aggravating liver injury induced by thioacetamide .

[ABSTRACT]AIM:Toestablishatransgenicheterozygousmousemodelofprecancerouslesionsofcolorectal cancer with p110δmutation in the C57BL/6J background for serving the studies on colorectal cancer research mediated by p110δ.METHODS:The transgenic heterozygous mice were generated by crossing in p110δD910A/D910A mouse and ApcMin/+mouse, and the genotype was detected by PCR .Compared with ApcMin/+mice, transgenic heterozygous mice ( ApcMin/+;p110δD910A/D910A)were counted, and the number and size of intestine polyps were analyzed after methylene blue staining . The intestinal tissue structure was assessed by HE staining .RESULTS:The transgenic heterozygous mouse model of pre-cancerous lesions of colorectal cancer with p 110δmutation was established .The number and size of polyps in the transgenic heterozygous mice were declined .CONCLUSION: A transgenic heterozygous mouse model of precancerous lesions of colorectal cancer with p 110δmutation was successfully established .The initial phenotype of intestinal tumors in transgenic mice was observed .This model will greatly contribute to the related research of colorectal cancer in mice .

Objective To analyze the quality of life and its influence factors in patients with peptic ulcer.Methods The SF-36 was used to survery 120 patients with peptic ulcer.The QOL scores at different levels of some factors including gender,age,na-tionality,occupation,marriage,medical forms,economic,cultural level,treatment method and clinical type were compared by meth-ods of two sample t-test and analysis of variance.Results Peptic ulcer patients′scores in the domain of RE,PF,RP,BP,GH,VT, SF,RE,PCS and MCS are lower than that of the normal,exception of the domain of MH(P <0.05).The differences were statisti-cally significant.Six factors can be influenced some domain or total score of the scale(P <0.05)and the differences were statistical-ly significant.Conclusion Find out the influencing factors on peptic ulcer patients′quality of life can be provided the basis for clini-cal treatments.

Objective To establish a stable and reliable model of brain death in swine, and to provide a more stable model for investigating pathomorphology in brain tissue and for studying transplantation immunology during brain death. Methods Base on the classic methodology of increasing epidural intracranial pressure, Codman intracranial pressure moni-toring probes were implanted in landrace pigs invasively. According to the relationship between ICP and MAP, brain death models were established by increasing intracranial pressure slowly and intermittently, with real-time monitoring of the intra-cranial pressure. Results Among twelve experimental landrace pigs, one died from anesthetic accident, while the rest elev-en were successfully established as brain death models. With effective respiratory and circulatory support, those brain death models can be maintained for (31.3 ± 4.7) h. Brain death model establishement is a stable and reliable process demonstrated by transcranial Doppler, EEG, ECG, mean arterial blood pressure and other monitoring methods. After brain death is con-firmed, animal models can be maintained for a long time. Conclusion Our methodology of inducing brain death model un-der ICP monitoring is stable and easy to be standardized. It can also provide a more stable model for studying brain tissue pathomorphology and transplantation immunology.

Objective:To understand the provision of preventive medicine curriculum system in the training programs of clinical medicine in the era of Healthy China.Methods:A total of 36 training programs of clinical medicine were selected from different areas of China for a statistical analysis on their basic information, involvement of concept of preventive medicine in program objectives, and provision of preventive medicine curriculum system.Results:Of all the 36 training programs of clinical medicine, 22(61%) have no mentions of prevention medicine in their program objectives; only one university’s training program states preventive medicine together with basic medicine and clinical medicine as one of the three main disciplines. The total class hours for the core courses of preventive medicine (hygiene, medical statistics, epidemiology, evidence-based medicine, and social medicine) range from 80 to 252, with an average of (156.7±43.2) hours. The average percentage of class hours for preventive medicine courses among the total class hours is 4.3%±1.1% (range: 2.5%-7.5%), and obvious differences exist among universities.Conclusions:In current training programs of clinical medicine, the proportion of prevention medicine curriculum is insufficient, the percentage of hours for preventive medicine course is very low, and the differences among various universities are obvious. It is urgently needed to strengthen preventive medicine curriculum in training programs for clinical medical students in new era. It is suggested to further promote the concept of putting prevention first, improve the curriculum system of clinical medicine, intensify the integrated development preventive medicine and clinical medicine and pay attention to clinical research ability enhancement for the further improvement of training program of clinical medicine.

Clinical and imaging data of 11 patients with dysembryoplastic neuroepithelial tumors (DNET) and 15 patients with low-grade glioma (LGG) admitted in Northern Jiangsu People's Hospital were analyzed retrospectively.Routine MRI scan,diffusion weighted imaging (DWI) and enhanced scan were performed.The workstation automatically generated apparent diffusion coefficient (ADC) maps and then to obtain ADC values of the tumor parenchymal area and the contralateral normal reference area.Relative tumor/reference ADC values (rADC) were also calculated.The ADC values of parenchymal regions of tumor and contralateral normal reference areas and the rADC between DNET and LGG were compared.There was significant difference in age distribution between the two groups [(16.6± 13.1) vs.(43.0± 19.2) years,t=3.938,P＜0.01].Six out of 11 DNET cases and none of 15 LGG cases were cuneiform or fan-shaped (P＜0.01);5/11 DNET and 0/15 LGG showed circular high signal in fluid attenuated inversion recovery-T2 weighted imaging (T2FLAIR) sequence (P＜0.01),while there no significant differences in intracapsular segmentation,peritumor edema and mass effect,enhancement,and skull compression between two groups (all P＞0.05).The ADC values of tumor parenchymal regions in both groups were significantly higher than those in contralateral reference regions (both P＜0.01),the rADC of DNET was significantly higher than that of LGG (P＜0.01).It is difficult to identify DNET and LGG by conventional image morphology,however the rADC value of DNET in DWI is significantly higher than that of LGG,and can provide important reference for differential diagnosis between them.

OBJECTIVE:To observe therapeutic efficacy and safety of budesonide and formoterol in the treatment of acute exacerbation of mild to moderate asthma.METHODS:A total of 89 patients with acute exacerbation of mild to moderate asthma were randomized divded into study group (45 cases) and control group (44 cases).Study group was given Budesonide and formoterol dry powder inhalation,one inhalation,q6 h,gargling 5 times after inhalation,6 inhalation per day at most+Montelukast tablet 10 mg orally,once a day.Control group received Prednisone tablet 25 mg orally after breakfast,once a day,d1-5+Theophylline sustained-release capsule 0.2 g,twice a day+Montelukast tablet 10 mg,once a day in the evening.Both groups were treated for 5 d.Acute AQLQ score,FEV1,PEF％pred and SpO2 were observed in 2 groups before and after treatment,and the occurrence of ADR was recorded.RESULTS:Before treatment,there was no statistical significance in acute AQLQ score,FEV1,PEF％pred or SpO2 between 2 groups(P＞0.05).After treatment,acute AQLQ score,FEV1,PEF％pred and SpO2 of 2 groups were significantly higher than before treatment,with statistical significance (P＜0.05),but there was no statistical significance between 2 groups (P＞ 0.05).There was statistical significance in the incidence of ADR between 2 group(P＜0.05).CONCLUSIONS:Budesonide and formoterol can improve pulmonary ventilation function and prognosis in patients with acute exacerbation of mild to moderate asthma with good safety.