Based on the principle of training students for rural areas and serving for grass roots,Mudanjiang medical college cultivates talents mainly from countryside and rural areas,thus it is of great importance to build up decent and accurate values for those will-be doctors who heal the wounded and prevent and cure diseases.As well as enhancing their professional qualifications,medical college teachers should also cultivate students' world view,philosophy,values,responsibility,occupational ethics,and a scientific development outlook.

Objective To conduct a scoping review to systematically review the literature reporting enteral feeding protocol in critical ill children. And extract elements of enteral feeding protocol. Methods The database of BIOSIS Previews, PubMed, MEDLINE, EMbase, China Biology Medicine Disc, China National Knowledge Infrastructure and Wan Fang data were searched. Data were extracted on the information of article, elements of enteral feeding, evaluation of feeding etc. Results Three historical controlled studies, three case-control studies, two cohort studies, one narrative review and one qualitative study were included. Totally 16 elements were got, such as nutrition evaluation, estimated energy requirement, contraindication, feeding intolerance etc. And all protocols defined advancement and feeding intolerance. Conclusions Enteral feeding protocol has been used in most PICUs to optimize nutrition. But we observed variability in the composition of protocols and lack of evidence-based recommendations in few elements.

BACKGROUND: Repetitive brief and non-lethal cerebral ischemia can produce cumulative neuronal damage and vascular dementia; however, precisely injured patterns and mechanisms are still unclear. Thalamus is an important structure of learning and memory; meanwhile, it is also one of the selectively vulnerable regions of cerebral ischemia.However, there are a few reports about neuronal damage induced by repetitive cerebral ischemia.OBJECTIVE: To investigate the pathological damage and mechanism of neurons induced by repetitive cerebral ischemia in thalamus.DESIGN: Randomized controlled experimental study.SETTING: Department of Neurology, General Hospital of Chengdu Military Area Command of Chinese PLA.MATERIALS: The experiment was carried out at the Animal Central Laboratory of the Third Military Medical University of Chinese PLA from March to December 1999. A total of 72 healthy male Wistar rats were randomly divided into sham operation group, single cerebral ischemic group,repetitive cerebral ischemic group, MK-801 treatment group and saline group.METHODS: Transient global cerebral ischemia models of rats were established with modified Pulsinelli-4 vessel occluing method for single 15-minute ischemia and repetitive three 5-minute ischemia at hourly intervals,followed by 5 hours, 2 days and 4 days of survival. Rats in sham operation group were not treated with burning vertebral artery and clipping common carotid artery. 45Ca autoradiography and light microscopy were used to determine the calcium accumulation and neuronal pathological changes of thalamus following repetitive cerebral ischemia as compared with single cerebral ischemia. The effects of MK-801, a N-methyl-D-aspartate (NMDA)receptor antagonist, were also examined.MAIN OUTCOME MEASURES: Distribution and degree of calcium accumulation and neuronal damage in the thalamus of rats in each group.RESULTS: Sham-operated rats revealed no abnormal calcium accumulation and neuronal damage in the thalamus. At 5 hours following ischemia,slightly abnormal calcium accumulation was found in the partial thalamus of the repeated ischemic group, and the neuronal damage was also relatively severer than that in the single ischemic group (0.98±0.19, 0.60±0.14, P＞ 0.05). At 2 days after ischemia, obviously abnormal calcium accumula tion and neuronal damage were shown in thalamus, and the degree of calcium accumulation and score of neuronal damage in repeated ischemic group were significantly severer than that in single ischemic group (1.62±0.31, 0.88±0.21, P ＜ 0.01). At 4 days, the thalamus calcium accumulation and neuronal damage were further increased, and also that in repeated ischemic group was significantly severer than that in single ischemic group (1.80±0.21, 1.02±0.23, P ＜ 0.01), especially marked calcium accumulation and cumulative damage were shown in the ventral thalamus. MK-801 significantly relieved the abnormal calcium accumulation and neuronal damage in the thalamus in repeated ischemic group, showing significant protection of thalamus neurons as compared with that in saline-treated group (0.20±0.12, 1.80±0.15, P ＜ 0.01).CONCLUSION: Repetitive non-lethal cerebral ischemia results in an intense cumulative damage in the ventral thalamus, and the excitatory amino acid and Ca2+ may play a major role in it.

Objective To investigate the therapeutic effect of extracorporeal shock wave therapy on Osgood-Schlatter disease. Methods Sixty Osgood-Schlatter disease patients were evenly randomly divided into therapeutic group 30 cases and control group 30 cases. The therapeutic group was treated with extracorporeal shock wave therapy. The control group was treated with high frequency electro therapy and rest on knee joint Results The clinical symptom and pain with visual analogous score the tibial tubercle of therapeutic group and control group were obviously decreased after treatment compared with before treatment (P< 0.05), they were (2.2 ± 1.3) scores vs (7.9 ± 2.4) scores, (4.8 ± 2.6) scores vs (8.2 ± 2.5) scores,the therapeutic group in pain resume significantly better than the control group (P<0.05 ). The cured rate of the therapeutic group was 83.33% (25/30), the control group was 63.33% (19/30), there was significant difference between the two groups (P <0.05). Conclusion The rehabilitation therapeutic effect of extracorporeal shock wave therapy on the Osgood-Schlatter disease is remarkable.

Objective To investigate the rehabilitation therapeutic effect of Super-Lizer on the early chronicity strain carpal tunnel syndrome by lassitude. Methods Ninety-eight carpal tunnel syndrome patients were randomly divided into therapeutic group (53 cases) and control group (45 cases). The control group was treated with brake and rest on wrist joint. The therapeutic group was treated with Super-Lizer plus wrist brace in neutral position brake and rest in run-up position on wrist joint. The changes of clinical symptom,feeling,muscle power and electromyography in the hands after 2 weeks were detected.Then the results were analyzed. Results The clinical symptom,feeling,muscle power and electromyography in the hands of two groups were obviously improved after treatment, the therapeutic group significantly better than the control group in motor nerve conduction resume(P ＜ 0.05 ). The cure and efficiency rate of the therapeutic group was 81.13%(43/53),the cure and efficiency rate of the control group was 57.78%(26/45),there was significantly better between two groups (P ＜ 0.05). Conclusion The rehabilitation therapeutic effect of Super-Lizer on the early chronicity strain carpal tunnel syndrome is remarkable,worthy of clinical application.

Objective To investigate the expression of PHF8(PHD-finger protein 8) in human hepatocellular carcinoma (HCC) and its clinicopathologic significance.Methods The expression of PHF8 in 60 hepatocellular carcinoma samples as well as their natched paraneoplastic tissues,and 15 normal liver tissues were evaluated by immunohistochemistry.Statistical methods were used to analyse the relationship between the expression of PHF8 and the clinicopathological features of these patients.Results The PHF8-positive expression rate in the HCC samples was 55.0％ and it was significantly higher than that in the paraneoplastic tissues and the normal liver tissucs (16.7％,6.7％,respectively,P＜0.05).The expression of PHF8 was closely related to tumor size,tumor nodular numbers,pathological differentiation and TNM-staging (P＜0.05 for all).The 5-year disease-free survival and overall survival in the PHF8-positive group was significantly lower than that in the negative group (P＜0.05).Conclusions PHF8 was overexpressed in HCC samples,and its expression was closely associated with HCC clinicopathological features and prognosis of the patients.

Objective To evaluate the resistance of multidrug-resistant Mycobacterium tuberculosis ( M. tb) strains to bedaquiline ( BDQ) and to analyze the relationships between their genotypes and BDQ-re-sistant phenotypes in order to provide a scientific basis for rational use of BDQ for the treatment of multidrug-resistant tuberculosis ( MDR-TB) in clinical practice. Methods A total of 387 clinical M. tb strains, inclu-ding 100 pan-susceptible strains and 287 strains isolated from patients with MDR ( MDR-TB strains) , were enrolled in this study. Of the 287 MDR-TB strains, 77 strains were collected in Chongqing in 2015 and the other strains were collected in a national drug-resistant tuberculosis survey conducted in China during 2007 to 2008. Minimum inhibitory concentrations (MIC) of BDQ against those strains were detected. Genotypes of those strains were analyzed by Spoligotyping. Differences in the resistant rates against BDQ between Beijing genotype and non-Beijng genotype MDR-TB strains were comparatively analyzed. Results MIC50 and MIC90 of BDQ against the 287 MDR-TB strains were 0. 03 μg/ml and 0. 25 μg/ml, respectively. Nineteen out of the 287 MDR-TB strains (6. 6%) were resistant to BDQ. Based on the Spoligotyping, 195 strains were clas-sified into Beijing genotype, and the other 92 strains belonged to non-Beijing genotype. Statistical analysis revealed that the BDQ-resistant rate in Being genotype strains (4. 6%, 9/195) was lower than that in non-Beijing genotype strains (10. 9%, 10/92, χ2=3. 955, P=0. 047). In addition, the MIC50 and MIC90 of BDQ against pan-susceptible strains were 0. 03 μg/ml and 0. 12 μg/ml, respectively. Sixty-three pan-sus-ceptible strains belonged to Beijing genotype and the other 37 strains belonged to non-Beijing genotype. None of the pan-susceptible strains was resistant to BDQ. Conclusion This study indicates that BDQ showed stronger in vitro antibacterial activity against the MDR-TB strains isolated in China. A correlation between non-Beijing genotype and BDQ resistance is observed in those MDR strains. MDR strains of Beijing genotype are more susceptible to BDQ than those of non-Beijing genotype.

Objective To determine whether regulatory T cells(Tr)are increased in patients with tuberculosis and whether they are associated with its immunopathology.Meantime,to investigate the possibility of tuberculosis(TB)as a model for studying Tr functions.Methods The lymphocyte subsets were isolated from peripheral blood mononuclear cells by sorting with flow cytometry.Total cellular RNA was extracted and RT-PCR was performed to detect the Foxp3 mRNA in purified CD3+CIM+T cells,CD3+CD8+T cells and non-CD3+CD4+CD8+T cells.Using FACS analysis.we further investigated the distribution of Foxp3+ population in CD4+ CD25+T cells.Finally,we compared the percentage of CD4+CD25highFoxp3+T cells present in 51 active patients with tuberculosis and 40 uninfected healthy control subjects by FACS.The detection of Tr infiltration of Foxp3+ cells were performed with immunohistochemistry(IHC)method on tuberculosis pathological sections.Results Foxp3 was specific expressed in CD3+CD4+T cells,either in tuberculosis patients or healthy control subjects.Foxp3+ T cells took about 85%fraction of CD4+ CD25highpopulation.We used CD4+CD25high Foxp3+as a detective markers for Tr in the FACS analysis.The results showed that patients with active TB had a 4.4 fold higher percentage within the CD4+T cells in peripheral blood compared to healthy control group(modian,1.01%vs 0.23%,P<0.01).Much higher frequency of Tr were found along with T cells infiltration at the tuberculosis pathological tissues.A few individuals that we can followed indicated the expanded Tr was declined after curative treatment with operation.Conclusion Tr cells are increased in tuberculosis patients and closely correlate with its immunopathology.Tuberculosis should be a valuable model for Tr functional study.

Objective To investigate the characteristics of VP1 gene hypervariable region in hu-man enterovirus type 68(HEV68)strains isolated in China. Methods Nucleotide sequences of the VP1 gene in the Chinese strains and strains isolated in other countries were aligned by using Clustal W in the MEGA6 program. The phylogenetic trees were constructed by using Neighbor-Joining(NJ)method in the MEGA6 program. Sequence of the amino acids encoded by that region was analyzed by compared with that of the standard strain Fermon. Results A total of 80 strains of EV68 had been isolated in China by the end of 2015. Most of the mutations occurred in BC and DE loops. The mutation sites lied in the VP1 gene of Chi-nese isolates were at 83,89,91,94,96,97,98,102,109,139,141,142,143,144 and 147. Glycine was missing from most of the amino acid sequences encoded by the VP1 gene of Chinese strains. The phylo-genetic analysis indicated that 53 and 21 EV68 strains isolated in China belonged to B and C clades,respec-tively. Conclusion Compared with the standard strain Fermon,the Chinese strains changed a lot in BC-loop and DE-loop,which were associated with the antigenicity and virulence of EV68. The EV68 strains iso-lated in China belonged to B and C clades.

Objective To investigate the prefrontal lobe function in patients with bipolar disorder with impulsive aggressive behavior using magnetic resonance spectroscopy (MRS),so as to explore the possible relationship between impulsive aggressive behavior and prefrontal brain function in patients with bipolar disorder from the perspective in brain function.Methods A total of 24 patients with bipolar disorder (10 cases with impulsive aggressive behavior,and 14 with non-impulsive aggressive behavior) were enrolled in the study.The modified overt aggression behavior scale (MOAS) and the Barratt Impulsiveness Scale 11 (BIS-11) were used to evaluate the included subjects.Magnetic resonance spectroscopy (MRI) scans were performed on the subjects using 3.0T magnetic resonance imaging equipment to analyze quantitatively N-Acetyl-L-aspartic acid/Cr (NAA/Cr),choline/Cr (Cho/Cr),and glutamine and/or glutamic acid/Cr (Glx/ Cr) ratios.Results The left prefrontal NAA/Cr value in patients with bipolar disorder was significantly lower in impulsive aggressive behavior group than that in non-impulsive aggressive behavior group,and the difference was statistically significant (P ＜ 0.05);however,there was no obvious statistical difference in the comparison of the right prefrontal NAA/Cr value,as well as left and right prefrontal values of Cho/Cr and GlX/Cr between impulsive aggressive behavior group and non-impulsive aggressive behavior group.Conclusions The NAA/Cr value is significantly abnormal in the left prefrontal cortex of bipolar disorder patients with impulsive aggressive behavior (P ＜ 0.05),suggesting that there may exist decreased density of neurons in the left side of prefrontal lobe or dysfunction of neurons in bipolar disorder patients with impulsive aggressive behavior.