Considering the modern features and requirement of our medical education, we tried some exploration and reforms of the clinical practice training on students of clinical medicine major(7-year program). By strengthening the training of clinical practice while learning subjects, we came to the conclusion that students got their study’s aim much more positively and actively in their study, and the teaching goals are more direct and the teaching effects are better.

Objective To analyze the registration and treatment outcomes of pulmonary tuberculosis (TB) between local and floating population in Panyu district in Guangzhou and provide equalization of basic public health services strategies to the prevention of TB.Methods According to the data from China Disease Prevention Information System of Panyu district, the patients between 2013 and 2015 were used for statistical analysis.The differences of treatment outcomes between local and floating TB patients were compared and analyzed by Chi-square test.Results There were 3,047 registered patients in 2013-2015 in Panyu district, the annual average TB registration rate was 68.13/100 000.1 476 of them were smear negative TB (48.44%);1421 new smear positive TB (46.64%);150 re-treated smear positive TB (4.92%).Among these patients, 2 202 cases were local pulmonary (72.27%), and 845 floating pulmonary (27.73%).There were statistical differences in the cure rate of new and re-treated patients (P<0.05).Instead, the treatment outcomes of patients with different registered residence showed no statistical difference (P>0.05).Conclusion Local and floating TB patients receive the same health service under the full process monitoring Panyu.It shows the equal basic public health services policy has come out with preliminary results.

Objective:To evaluate the clinical outcomes of patients after intensity modulated radiation therapy (IMRT) for hepatocellu-lar carcinoma (HCC) with portal vein tumor thrombosis (PVTT) or inferior vena cava tumor thrombosis (IVTT). Methods:A registry data-base of 41 patients treated with IMRT for HCC with PVTT or IVTT in Radiotherapy Center of No.3 Hospital of Beijing Chinese People Armed Police Forces between January 2013 and May 2015 were analyzed retrospectively. The biological effective dose of radiation was ranged 48-94Gy. Short-term effects and prospective efficacy were observed. Log-rank test, Cox regression were used for survival analysis and prognostic factor identification. Results: Grade 2 or higher level gastrointestinal reaction was observed in 12 patients (29.3%). Hematological toxicity was observed in 11 patients (26.8%), and radiation-induced liver disease was observed in 6 patients (14.6%). We found that 29.3%of patients achieved a complete response and 31.7%of patients achieved a partial response. The stable and progressive disease rates were 39.0%and 0.0%, respectively. Median patient survival was 11 months, and the 1-year survival rate was 34.1%. The significant independent variables associated with the overall survival included Child-Pugh grade, AFP test, and CHE lev-el. Conclusion:IMRT is a safe and effective treatment for PVTT or IVTT in patients with HCC.

To obtain and analyze the sequence of the nucleocapsid gene from bovine coronavirus, and to produce the fusion protein of the N gene in E.coli in order to use this recombinant protein for the study of bovine coronavirus. The N gene of BCV-DQ strain was amplified by RT-PCR, in which the primers were designed on the basis of N gene sequence of BCV-Mebus strain. The PCR products of 1 347 bp in length were cloned and sequenced, and then inserted into the prokaryotic vector pET30a. The recombinant plasmids were then transformed into Escherichia coli BL21 and identified by SDS-PAGE and Western blot assay. ELISA assay was optimized of N protein as the coating antigen to detect the viruses in the clinical samples. In comparison with 6 BCV strains in GenBank, the sequence identity was proved to be more than 98.3%. Result in SDS-PAGE showed that the fusion protein had a molecular weight of 60 ku, and could be specifically recognized by mouse serum against BCV. The indirect ELISA was used to test 256 serum samples collected from Heilongjiang province and 65.23% samples were positive. On testing field samples, an overall agreement of 95.31% was generated between the the neutralization test of viruses (VN) and indirect ELISA. It is apparent that the N gene was highly conservative and is expressed in E. coli in high level,also the prokaryotic expression products of this gene show a fine reactiongenicity in immune responses. It was also suggested that the N protein may be a useful antigen for sero-diagnosis and epidemiological investigation of BCV.

Aim: To develop a practical synthetic route of raltegravir, a drug for HIV treatment. Methods: Raltegravir was synthesized through an eight-step process including aminonitrile formation, protection with benzyloxy-carbonyl group, conversion of the nitrile to the amidoxime, cyclization to form hydroxypyrimidinone, N-methyla-tion, amidation with microwave-assistance, deprotection, amidation with acyl chloride. Results: The overall yield of the eight-step synthesis is about 12. 0% and the structure of the target compound was confirmed by ~1H NMR, ~(13)C NMR, LR-MS and HR-MS. Conclusion: The reported synthetic process of raltegravir highlights the advantages in terms of readily available starting materials, convenient operation and low cost.

Objective To investigate the effective ways of improving medical students' clinical competence during the process of internship. Methods Totally 398 students of clinical medicine from 2006 and 2007 grade in Soochow University were enrolled as research objects. Forty objects distribut-ed to the First Affiliated Hospital were taken as experiment group while 358 objects distributed to other hospital as control group. In experiment group, objective structured clinical examination (OSCE) was introduced during regular internship, innovation was made on test on completion of a course and autonomous learning and clinical practice was advocated and enhanced. Traditional practice and ex-amination method was used in control group. SPSS 19.0 was used to do statistical analysis on the test scores of students. Paired sample t test and independent sample t test were employed. Measurement data is expressed as x±s and P<0.05 signifies statistically significant differences. Results Clinical practice ability of students in experiment group was enhanced to various degrees after internship com-pared with that before internship. ECG interpretation, heart and lung auscultation, interrogation tech-nique, medical and surgical operation performances of students in experiment group were promoted significantly (P<0.05). Students' overall competence in the final graduation skill test was better in ex-periment group than in control group (P<0.05). Conclusions OSCE-test on completion of a course not only make intern management more effective, but also make students' aim more definite, therefore it is conducive to enhancing clinical competence.

Objective: To investigate the trends in the disease burden of leukemia in Jiangsu Province from 1990 to 2019, so as to provide insights into leukemia control in Jiangsu Province. Methods: The prevalence, incidence, death and disability adjusted life years (DALYs) of leukemia in Jiangsu Province from 1990 to 2019 were retrieved from the 2019 Global Burden of Disease Study (GBD 2019) database, and standardized by the age structure of Chinese populations in 2000. The trends in the disease burden of leukemia in Jiangsu Province from 1990 to 2019 were analyzed using average annual percent change (AAPC). Results : The average annual standardized prevalence, incidence, mortality and DALY rate of leukemia were 63.63/105, 9.76/105, 4.10/105 and 194.83/105 in Jiangsu Province from 1990 to 2019, respectively. The average annual standardized prevalence (AAPC=1.420%, t=5.644, P<0.001) and incidence (AAPC=0.806%, t=3.505, P<0.001) of leukemia appeared a tendency towards a rise, while the average annual standardized mortality (AAPC=-1.589%, t=-14.714, P<0.001) and DALY rate (AAPC=-1.849%, t=-9.046, P<0.001) of leukemia appeared a tendency towards a decline in Jiangsu Province from 1990 to 2019. Higher average annual standardized prevalence (65.27/105 vs. 62.38/105, P<0.001), incidence (10.32/105 vs. 9.29/105, P<0.001), mortality (4.69/105 vs. 3.57/105, P<0.001) and DALY rate of leukemia (216.94/105 vs. 172.80/105, P<0.001) were estimated among men than among women. The crude prevalence of leukemia peaked among patients at ages of 0 to 14 years and 60 to 74 years, and the crude incidence, DALY rate and mortality of leukemia peaked at ages of 0 to 14 years and 75 years and older. Conclusions The mortality and DALY of leukemia appeared a tendency towards a decline and the prevalence and incidence appeared a tendency towards a rise in Jiangsu Province from 1990 to 2019; however, there were high disease burdens of leukemia among men, children and the elderly.

Objective To study the reasons of natural death of Oncomelania hupensis snails by comparing the differences of the indicator days covered with water DCW in snail marshland and non?snail marshland around the build of Three Gorges Dam in Eastern Dongting Lake areas. Methods Two marshlands were selected one was a non?snail marshland Qianliang Lake and another was a snail marshland Junshan Park . The measuring points were set through the mechanical sampling. The snails and elevation of the points were surveyed and the data of the water levels from the hydrological station were collected and then DCWs were calculated. Results From 1995 to 2013 DCWs of the marshland of natural death of snails were all more than that of the snail marshland P<0.01 . In Qianliang Lake marshland the difference between DCW before natural death and DCW from natural death until the dam was not significant P=0.23 while DCWs of the two stages both were more than that after the dam P1=0.045 P2=0.002 . Before the build of the dam DCW of the Qianliang Lake marshland of natural death of snails was more than that after the build of the dam P=0.013 and there was the same situation in Junshan Park marshland P=0.005 . The relationship between snail density and DCW was not significant in Junshan Park marshland rs=0.008 P=0.914 and the reference range of DCW of all the measuring points was 76-251 days. Conclusion In the eastern Dongting Lake district the build of Three Gorges Dam and DCW may be not the direct factors affecting the natural death of snails and the latter may change the distribution of snails.

Objective To study the reasons of natural death of Oncomelania hupensis snails in marshland by comparing the differences of environmental factors between snail marshland and non-snail marshland in East Dongting Lake schistosomiasis en-demic areas. Methods Two adjoining marshlands were selected,one was a snail marshland and another was a non-snail marsh-land. The measuring points were set by grid of“20m × 20m”. The soil moisture,elevation,soil pH and temperature of the points were measured,and the snails of the points were surveyed. Results The elevation,soil pH and temperature of the snail natural death marshland were all lower than those of the snail marshland(P<0.01). The soil moisture,elevation,soil pH and temperature of different snail densities in the snail marshland were different(P<0.05). The soil moisture of the non-snail group was higher than that of other four groups(P<0.01)and the soil moisture of the group with 0-11 snails per frame was lower than that of other four groups(P<0.01). The elevation of the group with 0-11 snails per frame was lower than that of the group with 24-39 snails per frame and the group with more than 39 snails per frame(P<0.05). The soil pH of the group without snails was higher than that of other four groups(P<0.01)and the soil temperature of the group with 0-11 snails per frame was lower than that of the group with 24-39 snails per frame. The differences of soil moisture and elevation of different death snail densities were not significant, while the differences of soil pH and temperature were significant. The soil pH of the non-snail died group was higher than that of the 2-died,3-died and more than 3-died groups(P<0.05). The soil temperature of the non-snail died group was higher than that of other four groups(P<0.05). Conclusion The elevation,soil pH and soil temperature within the range of the research may be the factors affecting the snail natural death and the soil moisture,elevation,soil pH and soil temperature may be the factors affect-ing the distribution of snails.

Objective To understand the distribution of univalvia molluscs in Eastern Dongting lake area where the Oncome-lania hupensis is extinct,so as to explore the causes of extinction and to provide the evidence for formulating schistosomiasis con-trol strategy. Methods The univalvia molluscs of the Qianliang Lake district,Jianxin District and Junshan Park were investigat-ed in August of 2013. All the collected snails were classified and identified. The data were analyzed by using the method of Shapiro-Wilk normality test and non-parametric test. The ecological biodiversity differences from each district were compared by the biodi-versity indexes. Results The univalvia molluscs collected were from 6 species in 3 families in Gastropoda class,namely Oncome-lania hupensis Gredler in Pomatiopsidae family,Parafossarulus striatulus,Alocinma longicornis,Parafossarulus sinensis,Bithynia fuchsisana in Bithyniidae family,and one genus provisionally named Radix in Lymaneidae family. In Junshan Park ,a total of 4 553 snails were collected,among which 1 264 were Oncomelania snails. In Jianxin District,336 univalvia molluscs were collect-ed,and no Oncomelania snails were found. In Qianliang Lake district,there were only 7 Alocinma longicornis snails,2 Parafossa-rulus sinensis snails and 1 Parafossarulus striatulus snail collected. There were significant differences among the distributions of the samples from the three districts(χ2=166.225,P<0.01).The Simpson’s diversity indexes in Qianliang Lake area,Jianxin Dis- trict and Junshan Park were 0.402 8,0.718 6 and 0.678 8,respectively,and the Shannon-Wiener indexes of the 3 areas were 0.721 5,1.431 3 and 1.199 9,respectively. Conclusions With the extinction of Oncomelania snails,the species and quanti-ties of other snails become rare in Qianliang Lake area. Whether their causes are relevant is worth further studying.