Objective To reform and assess the English curriculum for medical doctor-post-graduates based on the requirement analysis theory. Methods All of the medical doctor-postgradu-ates in grade 2012 of the Third Military Medical University were surveyed using questionnaires and face-to-face interviews on randomly chosen students,which collected information on the current Eng-lish skill levels,the requirements and the motivations of English learning,the satisfiable degree of English curriculum,and the outcomes of the curriculum reform. Statistical analysis methods were ap-plied in this study,especiallyχ22 test which was used to test the impact of current English levels on the requirements and motivations of English learning and the analysis results were applied to guide the curriculum reform and assessment. Results The questionnaires were handed out for twice,340 in total. Before and after the course setting,168 and 170 effective ones were got respectively. The first questionnaire showed the requirement of English learning wasn't influenced by the current English skill levels (P=0.329). That was to say 70.2%(118/168)of the surveyed students whether they were in level 4 or 6 all desired to improve English listening and speaking skills;and regard to English lear-ning motivations,publishing SCI papers,studying abroad,personal interest,or passing the course's exams accounted for 53.6%(90/168),24.4%(41/168),15.5%(26/168),6.5%(11/168)respec-tively,but relevant to their English levels (P=0.036). Regardless of their English levels,publishing SCI papers was the chief motivation of English learning. However,passing curriculum examinations as a motivation was more relevant to low-level students. The second survey also showed that 86.5%(147/170)students satisfied the setting of ‘listening and speaking’to ‘reading and writing’(2∶1) and 86 . 3%(145/168 )of students considered necessary to have a SCI dissertation writing course . However,once taking it,30.3%(44/145)out of the 86.3%(145/168)students expressed dissatisfac-tion to the course. In addition,about 48.8%(83/170)of students supported the tiered teaching model. Conclusions The requirement analysis technique is conducive to curriculum setting for medical doc-tor-postgraduates. However,the curriculum system needs to be optimized from the aspects of teaching methods,the tiered teaching model,and the teaching staff team. In particular,the cooperation be-tween English language teachers and medical major teachers should be strengthened in order to ap-proach an adequate and effective curriculum.

Objective To evaluate the clinical applica ti ons of endoscopic thyroid surgery by way of breast areola. Methods We retrospectively analyzed clinical data of 15 cases of endoscopic thyroid surgery through the breast areola approach form August 2002 to June 2004. Proble ms on the selection of surgical methods, indications, contraindications and the safety of the procedures were discussed. Results The operation was completed smoothly in 14 cases, with an operation time of 60~120 min (mean, 100 min), whereas a conversion to open surgery was required in 1 case because o f hemorrhage. No complications were seen. The patients were fully freed of the d isease and discharged from the hospital 7 days after the operation. One patient was diagnosed as having thyroid cancer and was cured with a total thyroidectomy. Follow-up for 3~6 months (mean, 4.5 months) in 13 cases found no recurrence. Conclusions Endoscopic thyroid surgery through breast areola appro ach is safe and applicable, with good cosmetic effects.

Objective To compare the effects of dexmedetomidine (DEX) and remifentainil (REM) combined with sevoflurane (SEV) for general anesthesia on recovery quality in patients undergoing laparoscopic cholecystectomy (LC).Methods Sixty patients (ASA grade Ⅰ-Ⅱ) who underwent LC were divided into DEX combined with SEV for general anesthesia group (DEX group) and REM combined with SEV for general anesthesia group (REM group) by table of random digit,with 30 cases each.Time of first inspiration,eye opening,extubation,orientation recovery and passage of gas by anus were recorded.Vital sign,numeric rating score (NRS),Ramsay score and untoward reaction were recorded.Degree of satisfaction of patients,post-anesthesia care unit (PACU) nurse and surgeon were evaluated.Results The time of extubation and passage of gas by anus in DEX group were significantly shorter than those in REM group [(12.0 ±3.9) min vs.(15.9 ±5.6) min,t =-3.130,P =0.003; (18.5 ±3.4) h vs.(23.6 ±5.8) h,t =-5.455,P =0.000].However,the time of eye opening and orientation recovery in DEX group were significantly longer than those in REM group [(15.5 ± 4.2) min vs.(11.7 ± 2.9) min,t =4.078,P =0.000;(19.5 ± 4.5) min vs.(14.8 ± 3.6) min,t =4.315,P =0.000].During the first 2 h after operation,Ramsay score in DEX group was significantly higher than that in REM group (P ＜ 0.05),but NRS in DEX group was significanty lower than that in REM group (P ＜ 0.05),the patients with additional analgesics was minor than REM group (2 cases vs.9 cases,P ＜ 0.05).The percentages of patients suffering shivering and postoperative nausea and vomiting in DEX group were significantly lower than those in REM group [3.3％(1/30) vs.33.3％(10/30),6.7％(2/30) vs.30.0％ (9/30),P ＜0.05].Degree of satisfaction of patients and PACU nurse in DEX group were higher than those in REM group [89.0(72.0-100.0) scores vs.80.0(70.0-95.0) scores,Z =-4.066,P =0.000; 92.0 (80.0-99.0) scores vs.90.0 (80.0-95.0) scores,Z =-2.906,P =0.004],but degree of satisfaction of surgeon in REM group was higher than that in DEX group [(91.8 ± 5.8) scores vs.(81.7 ±6.1) scores,t =-6.568,P =0.004].Conclusion Compared with REM combined with SEV for general anesthesia,DEX combined with SEV for general anesthesia has a faster recovery for respiration and passing of gas by anus,lower NRS and incidence rates of shivering,nausea and vomiting,improves the quality of recovery for patients undergoing LC.

Objective To summarize the experience in transanal local excision (LE) for rectal cancer (RC). Methods The clinical data of 28 cases of RC treated by LE from 1988 to 1998 were analyzed retrospectively. Results In this series, five-year survival rate was 83.4?6.2%, and the local recurrence rate (LRR) was 17.8%. In well-differentiated carcinoma, 4 cases were convinced as local recurrence with a LRR of 17.4%(4/23); in moderately- differentiated carcinoma, one case with a LRR of 20.0%(1/5). The LRR in T 1 and T 2 group was 15.0% (3/20) and 25.0% (2/8) respectively. LRR was 16.7% (4/24) in patients with less than 1/3 bowel wall involved, LRR was 16.7%(4/24),whereas LRR was 25.0%(1/4) in more than 1/3 bowel wall involved group. In total bowel wall resection group the LRR was 16.7%(3/18) while in partial resection group was 20.0% (2/10). In patients with tumour size larger than 4 cm LRR was 22.2% (2/9), tumour size smaller than 4 cm LRR was 15.7% (3/19). Conclusion LE for RC might only be successfully performed in selected patients (T 1～T 2, N 0M 0, well or moderately-differentiated carcinoma,low RC within 6 cm from anal edge). The indications of transanal LE must be controlled strictly. Total excision of tumor and prevention of implantation of carcinoma are the main points in the prophylaxes of recurrence. Postoperative follow-up is needed in order to find local recurrence as early as possible.

Objective To explore the reasonable construction of the bilingual teaching training mode for medical professional teachers so as to improve the effectiveness of the bilingual teacher training,promote the development of faculties and the quality of bilingual teaching in colleges and universities.Methods First,need analysis was done on 45 medical teachers who had taught medical scienc.e in English or intended to do it in Third Military Medical University and four basic modules were formed lectures in class,one on one instruction,self training,simulation teaching.Lectures in class are related to how to improve students' ability of language,make PPT and design teaching plans.One on one instruction focuses on pronunciation,lecture notes writing in English,trial teaching and teaching attitude;self training includes human-computer interaction in listening and speaking,independent preparation for lessons and video learning;simulation teaching is composed of trial lecture in class,teacher-student comments and demo lessons.Then 3 students participating the training was investigated and the analytic hierarchy process (AHP) was applied to calculate the weights of every indices.Results Primary index weights are:0.490 for one-on-one tutoring;0.240 for simulated teaching;0.180 for having English lessons;0.082 for independent learning.Weights of secondary indices are as the following.Trial teaching,the lecture notes writing in English and the training for English pronunciation and teachers' classroom language which are subordinate to the primary index of one-on-one tutoring are 0.180 0,0.150 0 and 0.096 0 respectively;teachers' comments and peer feed-back and demo class under the primary indices of simulated teaching are 0.120 0 and 0.091 0.Conclusion In order to improve the teaching ability in English,it is necessary to strengthen the one-onone tutoring for medical professional teachers,highlight English teachers' comments and peer assessment and excavate the effect of demo classes in the training program.

Objective To investigate the effect of Cordyceps sinensis on renal fibrosis and its possible mechanism.Methods Thirty Sprague-Dawley rats were randomly divided into three groups:Sham operation group (Sham,n =10),5/6 subtotal uephrectomy group (SNx,n =10),and 5/6subtotal nephrectomy treated with Cordyceps sinensis group (CS,n =10).Body weights were assessed and 24-hour urine excretion was collected before and every four weeks after surgery.Rats were sacrificed at 12 weeks after surgery.Blood samples were taken for biochemical study,and kidney tissues were used for HE and Masson stains to assess histological changes.Immunohistochemical staining was used to detect the expression of transforming growth factor β1 (TGF-β1) and its receptors of type Ⅰ (TβR Ⅰ),type Ⅱ (TβR Ⅱ).Immunofluorescence was used to detect E-cadherin and α-SMA.The relative protein level of TGF-β1,TβR Ⅰ,TβR Ⅱ,p-Smad2/3,Smad7,E-cadherin,α-SMA were examined by Western blotting.Results CS group had higher body weights and lower urinary protein,BUN and Scr level compared with SNx group.Glomerulosclerosis index and tubulointerstitial injury score were significantly reduced in CS group compared with those in SNx group (all P ＜ 0.05).The protein expressions of TGF-β1,TβR Ⅰ,TβR Ⅱ,p-Smad2/3 were decreased in CS group compared with those in SNx group (all P ＜ 0.05).CS treatment up-regulated the expression of E-cadherin,Smad7 and down-regulated the expression of α-SMA compared with that in SNx group (all P ＜ 0.05).Conclusion Cordyceps sinensis has inhibitory effect on renal fibrosis in 5/6 subtotal nephrectomy rat model,which might be related with the suppression of TGF-β 1 signal pathway.

ObjectiveTo detect the expression level of programmed cell death (PDCD) 5 and tumor necrosis factor(TNF)-α in serum and joint fluid from rheumatoid arthritis (RA) and osteoarthritis (OA)patients,and analyze the correlation between PDCD5 and TNF-α in order to study the role of PDCD5 in the pathogenesis of RA.MethodsFiftypatients(including 26 RA,24 OA) between December 2009 and August 2010 were selected to this study.ELISA was used to detect the concentration of PDCD5 and TNF-α in the serum and joint fluid.Two-independent sample t-test and Pearson's correlation analysis were used for statistics.ResultsIn both serum and joint fluid,the concentration of PDCD5 from RA patients [(37±33) vs (37±26) pg/ml ] was significantly higher than that of OA patients [ ( 13± 14) vs ( 11 ±7 ) pg/ml ] (P＜0.05).The concentration of TNF-α in the serum from RA and OA patients did not differ significantly(P=0.122),but its concentration in joint fluid of RA patients was significantly higher than that of OA patients (P=0.037).In the serum,there was significant correlation between PDCD5 and TNF-α (r=-0.55,P=0.004; r=-0.51,P=0.012)in both RA and OA patients.The correlation between PDCD5 and TNF-α in joint fluid of RA patients was statistically significant(r=-0.49,P=0.012),but no correlation could be found in joint fluid between PDCD5and TNF-α of OA patients(r=-0.353,P=0.09).ConclusionThis study suggests that PDCD5 and TNF-αare important apoptosis-regulatory factors in RA,and play important roles in the occurrence and development of RA.

Objective To screen the altered gene expression profile of hippocampus after traumatic brain injury(TBI)in rats. Methods Rats(n=3)in experimental group underwent moderate fluid-percussion(F-P)brain injury and the hippoeampus sample in the injured hemisphere was removed and conserved in liquid nitrogen three hours later.The rats(n=5)of the control group underwent the same procedure except for injury.Mfymetrix rat genome 230 2.0 array was used to detect the gene expression profile of hippocampus in two groups and find the altered gene expression profile. Results A total of 159 genes in the experimental group changed significantly(≥2 folds)compared with the control group,of which 136 genes were up-regulated and 23 genes down-regulated. Conclusions The significant gene expression changes of hippocampus,especially a large mount of up-regulated genes,are detected after moderate TBI in rats,suggesting that the secondary injury following TBI is a procedure involving multiple factors.

Objective To screen and identify the colonic adaptation-related proteins.Methods Totally 20 SD rats were equally randomized into 2 groups:ultra-short bowel group (90％ of intestine was resected) and control group (transection and then anastomosis of the intestine).After 21 days of feeding,two-dimensional electrophoresis (2-DE) was performed to separate the total protein from the colon mucous epithelial tissues.Then Image Master 2D Platinum software was use to analyze differential expressional proteins,which were further analyzed by MALDI-TOF-MS and Mascot software to identify these proteins.Results The 2-DE patterns with high resolution were obtained from the colon mucous epithelial tissues of both groups.Four differentially expressed proteins were identified by MALDI-TOF-MS:M2-PK,AGR2,proteasome activator complex subunit 1,and pancreatic triacylglycerol lipase.These proteins were involved in sugar and fat metabolism and cell proliferation.Conclusion The identified proteins may play important roles in the process of colonic adaptation through substance metabolism and by stimulating cell proliferation.

Objective To explore the potential mechanism of Fasudil hydrochloride pharmacologic postconditioning that alleviated acute myocardial ischemia/reperfusion injury (MI/RI) in rats,narrowed the scope of infacted myocardium,and inhibited cell apoptosis.Methods Ninety rats were randomly and averagely divided into 5 groups:sham group,ischemia/reperfusion (I/R) group,ischemic postconditioning (IPost) group,fasudil hydrochloride (FH) group,and FH and PI3K inhibitor (LY294002) (FH + I) group.The expressions of Rho associated coiled-coil forming protein kinase-1 (ROCK-1),Bcl-2,Bax,Caspase-3,Akt,and P-Akt in rat myocardial cells were determined.Results Compared to I/R group (ROCK1:2.94 ± 0.13),ROCK1 expression was not changed in IPost group (ROCK1:2.79 ± 0.11),FH group (ROCK1:2.83 ± 0.10),and FH + I group (ROCK1:2.85 ± 0.26).Compared to I/R group (Bcl-2:1.11 ± 0.12,P-Akt:1.09 ± 0.06,Bax:1.74 ± 0.06,and caspase-3:1.32 ± 0.12),the expressions of Bcl-2 and P-Akt in FH group (Bcl-2:1.76 ± 0.08,and P-Akt:1.73 ± 0.05) and IPost group (Bcl-2:1.74 ± 0.06,and P-Akt:1.37 ± 0.05) were all significantly higher than those in I/R group (P ＜ 0.05),while the expressions of Bax and caspase-3 in FH group (Bax:0.98 ±0.14,and caspase-3:0.97 ±0.06) and IPost group (Bax:0.97 ±0.11,and caspase-3:1.07 ±0.08) were all significantly lower than those in I/R group (P ＜0.05).Compared to FH group,the expressions of Bcl-2 and P-Akt in FH + I group (Bcl2:1.05 ±0.12,and P-Akt:1.21 ±0.06) were decreased (P ＜0.05),while the levels of Bax and caspase-3 (Bax:1.61 ±0.11,and caspase-3:1.42 ± 0.11) were increased (P ＜ 0.05).Conclusions The mechanism of FH postconditioning was associated with the inhibition of ROCK activity,and the activation of PI3K-Akt pathway.