This article described the importance of mechanism refonil in the graduate student training and presented its contents.Also,It summarized the characteristics of the reforill proposals in some universities,and analyzed the problems required to attend and solve ia the refogln.The characteristics of the proposals included to set up innovative fund by university,to perform the student awarded police of tutor leading,to establish the scientific system in recruiting students.By analyzing the problems developed during the reform four measures were lannched,which included to establish evaluating system in assessing students,to create a good relationship between students and tutors,to improve the ability and morality of tutors,and to adjust the management method of research funding.It would be possible to reach the objective of perfecting the reform proposal during the implementation of the measures.

ObjectiveTo evaluate the effects of selective cyclooxygenase-2 inhibitor nimesulide lone and combined with cisplatin on tumor growth,and Ki67 and Caspase-3 expression in lung cancer xenografts in nude mice. Methods The mice were randomly divided into 4 groups:the control group,the nimesulide group,the cisplatin group and the nimesulide combined with cisplatin group. A549 cells were injected into BALB/c nude mice subcutaneously.On the 21st day after treatment tumor tissues were collected,and the xenografts growth were observed. The expression of Ki67 and Caspase-3 were detected by immunohistochemical method.ResultsNimesulide combined with cisplatin could significantly inhibited the xenografts growth compared with nimesulide or cisplatin.The tumor inhibition rate was 44.33％ in the nimesulide group,53.61％ in the cisplatin group and 80.41％ in the nimesulide combined with cisplatin group (P ＜ 0.05).Immunohistochemical analysis showed that the expression rates of Caspase-3 was significantly increased in the nimesulide combined with cisplatin group (67.43 ± 23.57 ) ％,the cisplatin group (48.40 ± 20.37 ) ％,and the nimesulide group (38.65 ± 15.37)％,compared with the control group (27.63 ± 13.03)％ (P ＜ 0.05).The expression rate of Caspase-3 was significantly increased in the nimesulide combined with cisplatin group compared with the nimesulide group or the cisplatin group (P ＜ 0.05 ).The expression rate of Ki67 was significantly decreased in the nimesulide group combined with cisplatin group (24.34 ± 15.90)％,the cisplatin group (40.85 ± 22.47)％ and the nimesulide group (53.33 ± 19.67)％ compared with the control group ( 80.43 ± 16.88 ) ％ ( P ＜ 0.05 ).The expression of Ki67 was significantly decreased in the nimesulide combined with cisplatin group compared with the nimesulide group or the cisplatin group ( P ＜ 0.05 ).Conclusion Nimesulide can inhibit human lung cancer A549 cells xenografts in nude mice growth,Nimesulide enhanced the inhibitory effects of cisplatin.The mechanism may be related to inhibition of tumor cell Ki-67 expression,increased expression of Caspase-3,inhibition of tumor cell proliferation,and inducing tumor cell apoptosis.

Objective To investigate the relationship between neck circumference and metabolic syndrome(MS) and its components in type 2 diabetes Methods A total of 272 subjects with type 2 diabetes were recruited.According to the diagnostic criteria of MS,all subjects were divided into MS group and non-MS group.According to neck circumference tertile,all subjects were respectively divided into male and female of three groups to analyze the relationship between neck circumference and MS and its components.Male:Q1＜38.8 cm,Q2=(38.8-41.3) cm,Q3≥41.4 cm;female:Q1＜34.0 cm,Q2=34.0-36.3 cm,Q3≥36.4 cm.The optimal cut-off points of neck circumference were used to determine the MS by ROC curve.Results (1) Compared with non-MS group,subjects in MS group had significantly higher neck circumference((38.3±3.2)cm vs.(36.1±3.7) cm),waist circumference((94.1±8.4) cm vs.(82.7±10.8) cm),waist-hip ratio(0.93±0.06 vs.0.88± 0.08),body mass index ((26.2 ± 2.9) kg/m2 vs.(23.9 ± 3.5) kg/m2),fasting plasma glucose(9.0(6.7-11.5) mmol/L vs.7.7(5.9-10.2) mmol/L),systolic pressure(140(130-150) mmHg vs.130 (120-130) mmHg),diastolic pressure (80 (80-90) mmHg vs.80 (75-85) mmHg),triglycerides (1.9(1.4-2.8) mmol/L vs.1.2 (0.9-1.5) mmol/L),low-density lipoprotein cholesterol (LDL-C) ((3.3 ± 1.0)mmol/L vs.(3.0±0.9) mmol/L) and blood uric acid((322.7±90.1) mmol/L vs.(270.3±82.3) mmol/L),and the differences were significant(t or Z=-4.843,-8.622,-5.157,-5.592,-2.729,-5.723,-3.847,-6.856,-2.123,-4.545;P＜0.05).While the level of total cholesterol((2.7±2.8) mmol/L vs.(4.9±1.3)mmol/L) and high-density lipoprotein cholesterol (HDL-C) (1.0 (0.8-1.2) mmol/L vs.1.2 (1.1-1.5)mmol/L) were decreased,and the differences were significant (t or Z =-2.269,-7.068;P ＜ 0.05).(2)Compared with those with lowest tertiles(Q1 ＜38.8 cm) of neck circumference,male subjects with highest tertile (Q3≥41.4 cm) had higher level of waist circumference((97.8±8.6) cm vs.(89.9±8.5) cm),waist-hip rati (0.96±0.07 vs.0.93±0.06),body mass index((27.4±2.1) kg/m2 vs.(23.8±2.3) kg/m2),blood uric acid ((374.0±85.6) mmol/L vs.(305.8±73.6) mmol/L),and the differences were significant(P＜0.05).While age((52.1±10.7) years vs.(60.4±11.8) years) andHDL-C((1.0±0.3) mmol/Lvs.(1.2±0.5) mmol/L) were decreased,and the differences were significant (P＜0.05).Female subjects with higher tertile (Q3 ≥ 36.4 cm) had significantly higher level of waist circumference ((96.8 ± 10.1) cm vs.(79.5 ± 8.5) cm),waist-hip ratio(0.94±0.07 vs.0.86±0.06),body mass index((28.5±3.1) kg/m2 vs.(21.9±2.2) kg/m2),blood uric acid((295.2±94.3) mmol/L vs.(244.6±62.3) mmol/L),the frequency of MS(83.3％(40/48)vs.21.7％(10/46)) than with lower tertile(Q1＜34.0 cm).(3) Logistic regression analysis showed that neck circumference (β =0.187,P ＜ 0.001) was an independent risk factor of MS (y =0.187x-6.613).(4) The optimal cut-off points of neck circumference to MS were 40.1 cm (AUC =0.682,P=＞0.008) in male,and 35.3cm (AUC =0.766,P＜ 0.001) in female.Conclusion Neck circumference increases when type 2 diabetes patients with MS.Neck circumference is an independent risk factor for MS,which can be used as an indicator to evaluate MS.

OBJECTIVE To analyze the susceptible factors to offer prevention and treatment of nosocomial pulmonary fungal infection in comprehensive ICU. METHODS The clinical materials of 82 patients with pulmonary fungal nosocomial infection in our department from May 2003 to May 2008 were reviewed. RESULTS The infection rate of total 836 patients was 9.81%.Candidiasis was the most frequent type in fungal infection,59.7% of which were due to Candida.The most clinical features were a large amount of light yellow sputum after tracheotomy and intratracheal indwelling cannula.The factors related to pulmonary fungal nosocomial infection were the severity of the underlying disease,tracheal intubations,broadspectrum antibiotics abuse,long-term use of glucocorticoid,interventional treatment,etc.Fluconazole,amphotericin B and voriconazole had better clinical effects on treatment of fungal infection than other antifungal drugs. CONCLUSIONS It′s important to eliminate the susceptible factors and to provide the early diagnosis and experimental treatment.

Objective To compare the peri-operative anaesthetic management between emergent and selective operations of(off-pump) coronary artery bypass grafting(OPCAB).Methods A retrospective review was conducted on clinical data of 50 cases of OPCAB from January 2001 to December 2004 in this hospital,including 30 emergent operations(Emergent Group) and 20 elective operations(Selective Group).The preoperative assessment and preparation,hemodynamic changes,vasoactive agent usage,hemostatic functions,and postoperative outcomes were compared between the two groups.Results ①The risk assessment score was greater in the Emergent Group(18.56?5.12) than in the Selective Group(8.98?3.12)(t=-7.479,P=0.000),and the application rate of(intra-aortic) balloon pump assist device(IABP) before the operation was higher in the Emergent Group(93%) than in the Selective Group(50%)(?~2=12.354,P

Objective To summarize the clinical,radiographic and genetic features of a family with metatropic dysplasia,in order to improve the level of understanding and diagnosis of this disease.Methods The proband,a one-year old boy,was diagnosed as metatropic dysplasia.His mother was 26 years old with mildly phenotype.Their clinical features and bone X-ray findings were analyzed.The DNA samples of the proband and his parents were collected.The coding exons and flanking introns regions of transient receptor potential vanilloid 4 (TRPV4) gene were amplified by polymerase chain reaction (PCR) and analyzed by DNA automatic detector.The pathology,diagnosis,treatment and prognosis were expounded.Results The symptoms of the boy were characterized by short extremities,a short trunk with progressive kyphoscoliosis,and craniofacial abnormalities that include a prominent forehead,midface hypoplasia,and a squared-off jaw.His motor development was slightly delayed.Mental development was normal.Bone X ray of the boy showed platyspondyly and severe metaphyseal enlargement with shortening of long bones and irregularities and delayed ossification of epiphysis.The patient and his mother were heterozygous for the nucleotide substitutions c.2396 ＞ T (p.P799L) in TRPV4 gene.Conclusions The patient and his mother with metatropic dysplasia were diagnosed with TRPV4 gene analysis.The patient showed typical clinical features.His mother was mild.Metatropic dysplasia had significantly clinical heterogeneity.Gene analysis is helpful for the diagnosis.

Abstract: Objective　To explore clinical characteristics and the related factors of multidrug-resistant tuberculosis and rifampicin-resistant tuberculosis (MDR/RR-TB) patients with decreased peripheral blood CD4+T lymphocytes, providing a basis for the prevention and treatment of multidrug-resistant tuberculosis. Methods　A retrospective analysis was conducted on 311 MDR/RR-TB patients hospitalized at Chengdu Public Health Clinical Center from January 2018 to December 2020. according to whether accompanied by peripheral blood CD4+T lymphocyte reduction, patients were divided into two groups, the decreased group (n=115) with CD4+T lymphocytes count <414 cell/μL and the normal group (n=196) with CD4+T lymphocytes count ≥ 414 cell/μL. Clinic data, including demographics, types of tuberculosis, complications, clinical symptoms, chest imaging, and treatment outcomes were collected. The binary logistic regression equation was used to analyze the risk factors of MDR/RR-TB with peripheral blood CD4+T lymphocyte reduction. Results　In total, 311 cases with MDR/RR-TB were enrolled, with a male-to-female ratio of 1.68∶1. The median age [M(P25, P75)] was 32 (24, 45) years. The median CD4+T lymphocyte count was 492.0 (328.0, 661.0) cells/μL, and 115 patients had CD4+T lymphocyte counts <414 cells/μL. Compared with the normal group, the proportion of older patients, male, baseline anemia, baseline leukopenia, baseline hypoalbuminemia, combined with other chronic respiratory diseases, hematogenous disseminated pulmonary tuberculosis, tuberculous pleurisy, and tuberculous meningitis were higher (P<0.05), while the success rate of treatment was lower in the decreased group (P=0.024). Being male (OR=2.045, 95%CI : 1.147-3.648), older age (OR=1.032, 95%CI : 1.012-1.052), baseline anemia (OR=2.246, 5%CI : 1.457-3.426), and baseline leukopenia (OR=2.398, 95%CI : 1.387-4.148) were risk factors for decreased CD4+T lymphocyte count in MDR/RR-TB patients. Conclusions　MDR/RR-TB patients with decreased CD4+T lymphocytes are more likely to suffer from severe tuberculosis (hematogenic disseminated tuberculosis, tuberculous meningitis) and tuberculous pleurisy, meanwhile the success rate of treatment was lower. Male, elder age, baseline anemia, and baseline leukopenia are associated with decreased CD4+T lymphocyte count in MDR/RR-TB patients, and the immune status of these patients needs to be paid attention to in clinical work.

This paper discusses the effectiveness of tutor-postgraduate communication in terms of frequency,approach,activeness and content by analyzing the questionnaire filled by the postgraduate students who graduate in 2013 in Peking University Health Science Center.3 suggestions were put forward to enhance the efficiency and quality of tutor-postgraduate communication,including guideline from tutors,active involvement of graduates and facilitation of Scientific research management.

ObjectiveTo observe the effects of mild hypothermia on post-resuscitation myocardial dysfunction in rabbits in order to elucidate the underlying mechanism of hypothermia.Methods After setting up rabbit model of cardiopulmonary resuscitation,20 rabbits were randomly ( random number)divided into two groups,namely normothermic resuscitation group (group A,n =10 ) and post-ROSC hypothermia group ( group B,n =10).In the group A,animals wore treated with standard CPR after cardiac arrest.In post-ROSC hypothermia group,the body temperature of animals was cooled to 32 ～ 34°C after successful ROSC.The left ventricular end-diastolic pressure (LVEDP),left ventricular pressure rise and fall rates ( ± dp/dtmax,serum concentrations of heart-type fatty acid-binding protein (H-FABP) and 8-isoprostaglandin F2a (8-iso-PGF2a) and Cyclooxygenase-2 (COX-2) were observed. Results Compared with the A group,the B group had significantly better hemodynamics,and lower serum H-FABP,8-isoPGF2a and COX-2 levels in the early stage of post-resuscitation ( both P ＜ 0.05 ).ConclusionsMild hypothermia attenuated post-resuscitation myocardial dysfunction during the early period of postresuscitation.The cryoprotective effect on myooardium is likely associated with the reduction of 8-iso-PGF2a and COX-2.

Obiective To elaborate the application of PCT/CT orientation Gamma Knife in the body.Methods From May, 2007 to May, 2008, PET/CT equipment was used on 120 cases with gamma knife body positioning and image fusion, Re-sults The PET/CT scan may not have iodine in the contrast agent to enhance the effective conduct of tumor imaging and CT position provides more simple and more accurate image information to guide target(GTV) of the outline. Conclusion The PET/CT in the gamma knife treatment can improve in the positioning accuracy of GIN, and improve treatment opportunity for iodine allergy patients.