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 analyze and compare the clinical characteristics and therapeutic effects on pediatric patients with immune thrombocytopenia (ITP) among infants and children more than 3 years old.Methods The data of 1 015 ITP children who were hospitalized in West China Secondary Hospital of Sichuan University between January,2005 to January,2012 were collected.All of the patients were given hormone shock treatment and/or intravenous immunoglobulin (IVIG).According to the extent of platelet count and bleeding improvement,the outcome included complete response,response and no response.The patients were divided into the infant group(≤3 year old) and the elderly group (＞3 years old) based on age,acute group(≤6 months) and chronic group(＞6 months) based on the course of disease,their clinic data were retrospectively analyzed by software SPSS 12.0.Results (1) The male/female ratio of infants group was higher than that of the elderly group,and there was significant differences (57.1％ vs 45.3％,x2 =13.927,P ＜ 0.001).(2) The median platelet count on admission in the infant group was statistically higher than that of the elderly group(9 × 109/L vs 8 × 109/L,Z =2.448,P =0.014).The course of disease in the infant group was statistically shorter than that in the elderly group(7 d vs 75 d,Z =13.317,P ＜ 0.001).(3) The increase ratio of megakrocytes in infants group was lower than that in the elderly group,but no statistical differences were found (86.4％ vs 90.4％,x2 =2.534,P =0.111).(4) There was a significant difference in terms of hospital stays between the transfused patients and untransfused patients (6.5 d vs 7.1 d,Z =4.571,P ＜ 0.001).Under the same treatment,the time for the platelets to become normal in the transfused group was statistically lower than that in the non-transfused group (72 h vs 89 h,Z =4.116,P ＜ 0.001).(5)The time needed for the platelets to become normal (≥ 100 × 109/L) in the infant group were statistically lower than that in the elderly group(72 h vs 95 h,Z =6.540,P ＜0.001).(6)The ratio of chronic patients in the infant group was statistically lower than that in the elderly group (3.2％ vs 30.1％,x2 =178.42,P ＜ 0.001).Conclusions The male infants with ITP are more than the female and the course of disease is shorter.The infants' platelet count returns to normal faster,with better treatment efficacy and lower ratio of chronic patients.The hospital stays can be shortened in the patients with ITP who were transfused with platelets,but the course of treatment with hormone can not be shortened.

ObjectiveTo investigate the relationship between the clinical practice environment and the anxiety in nursing undergraduates.MethodsOne hundred and ninety nursing undergramuates in Tianjin University of Traditional Chinese Medicine and Tianjin Medical University were investjgated by The General Information Form,STAl and Clinical Learning Environmental Scale(CLES).The results underwent analysis.ResultsThe students were scored (48.84±7.56) by the state anxiety scale.The students were scored (42.06±9.91) by the trait arlxiety scale.The students were scored (146.63±23.37) by the Clinical Learning Environmental Scale.The c linical practice envinmment of clinical practice nursing undergraduates was negatively correlated to the anxiety.ConchtsionsAnxiety existed in nursirg undergraduates during clinical practice.The anxiety of clinical practice nursing undergraduates was negstively correlated to the clinical practice environment and the evaluation of the clinical practice environment has influence on the students′ anxiety.

Objectives To report the clinical features and treatment in a case with paroxysmal diagonistic ideomotor apraxia after ischemic infarction of the corpus callosum.Methods The neuropsychological tests,brain MRI,the TCD and carotid duplex sonography were carried out in the patient who is right handed and had had presentation of paroxysmal diagonistic ideomotor apraxia for ten days.Results Neuropsychological tests confirmed the diagnosis of paroxysmal diagonistic apraxia in this patient.MRI showed ischemic infarction in the right corpus callosum.The symptomsin the patient were improved after the treatment with aspirin for three months.Conclusion The infarction of corpus callosum may induce paroxysmal diagonistic apraxia.

Background The pathogenesis mechanism of diabetic cataract has not been fully elucidated.Researches showed that multiple biological pathways participate in the pathogenesis of diabetic cataract,including oxidative stress.Astaxanthin can inhibit oxidative stress-mediated injury and lipid peroxidation.However,whether astaxanthin has the preventive effects on diabetic cataract is unclear.Objective This study was to investigate the preventive effects of astaxanthin on metabolic cataract in type 1 diabetic rats.Methods Thirty-eight 6-week-old SPF male SD rats were used in this study,and 1％ streptozocin was intraperitoneally injected to establish type 1 diabetic models in 30 rats,and 24 successful models were assigned to diabetic model group,low-dose astaxanthin group and high-dose astaxanthin group.Equal volume of normal saline solution was injected in the same way in 8 rats as the normal control group.Mixture foods containing 50 mg/(kg · day) or 100 mg/(kg · day) astaxanthin with olive oil and fodder were used continuously for 3 months in the rats of low-dose astaxanthin group and high-dose astaxanthin group,respectively,and mixture food of olive oil with fodder was used in the diabetic model group.Only fodder was used in the same way in the rats of the normal control group.The opacification of lens was examined by slit lamp section radiography system and graded on a scale of 1-5.The specimen of lens were prepared for the hematoxylin & eosin stain.The expression and lation of advanced glycosylation end products (AGEs) in the lens was examined using immunochemistry.The contents of oxidative stress-related indicators in the lens,such as AGEs,malonydialdehyde (MDA),catalase (CAT),superoxide dismutase (SOD) and mass fraction of glutathione (GSH),were assayed by ELISA.The experimental process complied with the national standard (Laboratory Animal Requirements of Environment and Housing Facilities [GB14925-2001]).Results The blood glucose levels of the rats were significantly higher in the diabetic model group,low-dose astaxanthin group and high-dose astaxanthin group than those in the normal control group at 2,4,6,8,10 and 12 weeks after modeling (all at P＜0.05),while the blood glucose levels of rats were not evidently different between low-dose astaxanthin group and high-dose astaxanthin group at various time points(all at P＞0.05).The rat lenses were transparent in the normal control group with scale of grade 1,and serious lens opacification was seen in the rats of the diabatic model group,with the scale of grade 5,while the rat lenses in the low-dose astaxanthin group and high-dose astaxanthin group were in grade 3-4.The contents of AGEs in the lenses were (7.23 ±0.50) μg/ml and (7.01 ±0.37) μg/ml,and M DA contents were (1.43 ± 0.22) mmol/L and (1.35±0.16)mmol/L in the low-dose astaxanthin group and high-dose astaxanthin group respectively,which were significantly lower than (7.61± 0.45) μg/ml and (1.62 ±0.42) mmol/L in the normal control group (all at P＜0.05).GSH contents in rat lenes were (272.70±12.53) ng/L and (283.52±16.17) ng/L,and SOD coneents were (55.45± 6.47) μmol/(min · L) and (56.73±5.12) μmol/(min · L),and CAT concents were (2.91 ±0.41) μmol/(min · L)and (3.02±0.13)μmol/ (min · L) in the low-dose astaxanthin group and high-dose astaxanthin group respectively,which were significantly higher than (241.52 ± 15.13) ng/L,(51.67 ± 5.45) μmol/(min · L) and (2.72 ± 0.27)μmol/(min · L) in the normal control group (all at P＜0.05).The GSH concent and SOD concent in rat lens were lower in the low-dose astaxanthin group than that in the high-dose astaxanthin group (both at P＜0.05).Conclusions Astaxanthin can postpone the pathogenesis and development of diabetic cataract in type 1 diabetic rats by antioxydative stress.

Objective To investigate the value of application of magnetic resonance imaging (MRI) in diagnosis and treatment of leptomeningeal metastases from malignant solid tumors.Methods A retrospective analysis was conducted depend on the radiological data of 63 patients who had been diagnosed as leptomeningcal metastasis of malignant solid tumors.Results All patients received brain MRI examination.26 patients underwent cervical or lumbar spine MRI examination.The MRI images showed nodular enhancement in the gyri and sulci,leptomeningeal linear enhancement,dura mater thickening and enhancement,ependymal enhancement,intraventricular metastasis,intraspinal metastatic nodules,communicating hydrocephalus,subdural hydroma and negative imaging.Ncuroimages of ependymal enhancenent,intraventricular metastasis and intraspinal implantation metastasis appeared in 5,7 and 9 patients with small cell carcinoma,respectively,which were higher than that of the other pathological types (P =0.002,P =0.009,P ＜ 0.000 1).Seizure occurred in 7 patients after intrathecal chemotherapy,of which 5 patients had pia mater linear enhancement.Among 33 patients treated with radiotherapy combined with intrathecal chemotherapy,3 patients had poor prognosis,of which 2 patients had negative imaging findings.The conditions of 25 patients were improved obviously after treatment,of which 21 patients showed different imaging remission in MRI re-examination.Conclusions The contrast MRI has an important assistant effect in diagnosis of leptomeningeal metastasis of malignant solid tumors.The MRI findings and clinical features are related with the pathological types.The pia mater linear enhancement indicates a high possibility of seizures after inthathecal chemotherapy,and it suggests that the preventive treatment should be given for such patients.MRI is not applicable to evaluate severity,prognosis and curative effect of the disease.

Objective Peritoneal dialysis can be done at home , however , its clinical follow-up quality is lower compared with hemodialysis due to the lack of detailed follow-up system and professional management team for post-discharge nursing care .The article aimed to explore the effect of a nurse-led integrated specialized disease management model in the follow-up of peritoneal dialysis patients . Methods Nurse-led integrated specialized disease management model was provided for 270 patients with peritoneal dialysis (PD) from January 2012 to May 2013.Self-designed questionnaire on diasease knowledge and self-care assement questionnaire were used for patients to evaluate their self-care ability and understanding of disease knowledge .Regular follow-up continued . Results The patients′understanding of disease knowledge was on the rise at 1st day before discharge, 1st month and 3rd months after discharge. After the application of nurse-led integrated specialized disease management model , the patients′regular clinical follow-up rate was in-creased from 78.3% to 88.6%.The patients′self-care ability improved gradually at 1st day before discharge , 1st month and 3rd months after discharge , which was of significant differences . Conclusion The nurse-led nurse-led integrated specialized disease management model can improve peritoneal dialysis patients′self-care ability and reduce their medical expense , which is of clinical sig-nificance .

Objective To investigate the expression and clinical significance of zinc finger protein 217 (ZNF217)in human pancreatic cancer.Methods 43 cases with pancreatic cancer undergoing surgery in the PLA 117 Hospital and People's Hospital of Ruian City from Apr .2011 to May.2014 were enrolled in the study . The pancreatic cancer and the corresponding tumor-adjacent tissues were collected .Real-time quantitative PCR (qRT-PCR)was applied to detect ZNF217 mRNA expression in pancreatic cancer (n=43)and the corresponding tumor-adjacent normal tissues.The protein expression of ZNF217 was measured by immunohistochemistry(IHC). The relationship between the expression of ZNF 217 and clinical features was analyzed by pearson chi-square test . Results The expression level of ZNF217 mRNA and protein was significantly higher in pancreatic cancer tissues than in adjacent normal tissues(P<0.05).The high expression of ZNF217 protein was positively correlated with perineural invasion, tumor size, lymphatic metastasis and advanced TNM stage (P<0.05).Conclusions The expression of ZNF217 is significantly higher in pancreatic cancer tissues than in tumor-adjacent normal tissues , and the upregulation of ZNF 217 is associated with clinicopathological features of tumor malignance .ZNF217 may become a new marker and effective therapeutic target in early diagnosis of pancreatic cancer .

Objective:The clinicopathological features, diagnosis, and prognosis of follicular thyroid carcinoma (FTC) with distant me-tastasis as the first manifestation were evaluated in this study. Methods:A total of 129 FTC cases with clinical data were retrospective-ly analyzed in the Department of Pathology, Tianjin Medical University Cancer Institute and Hospital (January 2001 to January 2016). Survival analysis and conjoint analysis on FTC with clinical data, diagnosis, and morphological characteristics with distant metastasis as the first manifestation were performed. Results:Among the 129 FTC cases, 24 cases demonstrated distant metastasis as the first mani-festation (18.6%). Bone metastasis was the most common (13.2%). The presence of mass and pain at the metastatic sites were the usu-al clinical complaints. The morphological characteristics of FTC with distant metastasis can be classified into four subtypes:microfollicu-lar (10 cases), solid (4 cases), normofollicular (9 cases), and macrofollicular (1 case). Immunostaining tests on thyroglobulin and thyroid transcription factor-1 showed positive results in FTC with metastasis. Survival analysis showed that the five-year survival rates in the 24 cases were 87.1%. The prognosis of patients with solitary metastasis was better than that of patients with multiple metastasis (P=0.022). A higher survival rate was found in the normofollicular and macrofollicular subtypes than that detected in the microfollicular and solid subtypes (P=0.012). Conclusion:FTC is susceptible to distant metastasis. Some patients with FTC demonstrated distant me-tastasis as the first manifestation, and their diagnosis can be confirmed by pathological feature analysis and immunostaining. The prog-nostic significance is possibly related to the number of lesions of FTC with distant metastasis and histopathological subtypes.

Objective To study the effect of telbivudine (TBV) on the ratio of CD4+ CD25+CD127low/-regulatory T cell (Treg) of HBeAg-positive chronic hepatitis B (CHB). Methods The ratios of Treg before and after treatment for 12, 24, 36 and 48 weeks with TBV of thirty-five patients with HBeAg-positive CHB were detected. Results Ratios of Treg were (12.55 ± 1.78)%, (10.42 ± 1.04)%, (9.55 ± 0.74)%, (8.78 ± 0.67)%, (8.74 ± 0.71)%respectively before and after treatment of 12, 24, 36 and 48 weeks and all the values were lower than its former one (P < 0.05), except the 48 weeks′. Conclusions The ratio of Treg of HBeAg (+) CHB decreases after treatment with TBV.