This article studies the teaching practice of the elective course of "Research Methods in Clinical Thought" which covers the formation,regulation and method of clinical thought.It suggests that a course of critical thinking in clinic should be set up to cultivate students' ability of clinical thought after finding the characteristics and thinking process of students' diagnosis and treatment in clinical set.

Objective To investigate the differential expression of ST8SIA4 in the both chronic myeloid leukemia(CML) cell lines KCL22 and adriamycin resistant cell lines KCL22/ADR ,peripheral blood mononuclear cells (PBMC) of CML patients ,to clar-ify the correlation of ST8SIA4 and multidrug resistance of CML .Methods Using real-time PCR and Western blot for quantification of ST8SIA4 ,we compared the differential expression of ST8SIA4 in CML cell lines and PBMC of CML patients .The differentially expressed ST8SIA4 gene was silenced ,and the chemosensitivity to anti-tumor drugs was analyzed in vitro .Results ST8SIA4 was differentially expressed in CML cell lines and PBMC of CML patients(P< 0 .05) .The altered level of ST8SIA4 was increased drug-resistant phenotype of KCL22/ADR cells both in vitro and in vivo(P< 0 .05) .Conclusion The expression of ST8SIA4 was different in CML cell lines and PBMC of CML patients ,these characteristic alterations were associated with multidrug resistance in CML .

Objective To investigate the association between social support and family cohesion, adaptability of rural patients undergoing maintenance hemodialysis (MHD). Methods Between August 2012 and November 2012, 94 patients with incident hemodialysis from rural areas in Hebei province were consecutively recruited in the study. The social support inventory (SSI) and the Chinese version of the family adaptability and cohesion evaluation scales (FACESII-CV) were employed in the investigation 3 months after the start of hemodialysis. Pearson correlation analysis was used to estimate the relationship between social support and familiarity, adaptability in rural MHD patients. Results The score on the family cohesion the adaptability were lower than norm(all P<0.001). The social support was associated with family cohesion and adaptability. The total scores on social support, emotional support and material support were positively associated with the scores on the family cohesion and adaptability (P<0.05). Conclusions The family cohesion and adaptability in rural patients undergoing hemodialysis are both at a lower level and are closely related to emotional and material supports. The higher they get social support, the higher the levels in family cohesion and adaptability.

Objective To evaluate the effect of duration of subcutaneous injection on the extent of bruising at injection sites among patients receiving low- molecular weight heparin. Methods Randomized clinical trials and quasi-experimental within-subject design that assessed the effect of subcutaneous duration on the bruising of injection sites were selected in Cochrane library, JBI evidence-based practice medical and nursing database, PubMed biomedical information retrieval platform, Medline general medical literature retrieval database. RevMan5.3 software was used to analyze the data after quality assessment, and data extraction were made for eligible trials. Results A total of 9 trials were included. The results of Meta-analysis supported the 30 s duration injection technique on reducing the rate of bruising of injection sites than 10 s duration injection technique (odds ratio was 0.34,95%confidence interval 0.25-0.47, P<0.01).While it was failed to support the effect on reducing the bruising area 48 and 72 hours after injection (P > 0.05). Conclusions Increasing the length of low-molecular weight heparin subcutaneous injection can reduce the rate of bruising. While it could not effectively reduce the area.

Objective To investigate the ability of dental service in Yunnan province by analyzing the distribution of oral medical institutions,the distribution of oraloral medical staffs,the per capita outpatient costs,and the rate of visiting the doctor.Methods A general survey on oral medical institutions was finished by using questionnaires.Results There were 1045 dental institutions,416 of them were public dental institutions.305 were in Kunming.305 dental institutions were in Kunming,the number of dental institutions per square kilometer was 14.2,the dental manpower index wasl5,the rate of visiting the doctor was 14.19％,per capita outpatient costs were 139.9 Yuan,and the above indexes were ranked first in Kunming.Conclusions In Yunnan province,oral health resources distribution were imbalanced.Dental service ability was uneven,perfect oral disease diagnosis and treatment quality control systems needs to be established,including cultivating specialized nurses relieve the tense situation of oral health care resources,and implenting the four hand operation,so as to effectively improve the quality of medical services.

Objective To study the clinical significance for the establishment of diagnosis of small bowel obstruction by selective small bowel enterography through a nasointestinal decompression tube. Methods Tirty-five patients with small bowel obstruction, with no strangulation or other contraindications, were intubated with a 300 cm nasointestinal decompression tube till upper jejunum under X-ray monitoring. The patients firstly underwent intra-small-intestinal suction therapy. When the tube reached the diseased region, a selective small bowel enterography was performed. Under X-ray inspection, 20-100 ml of 76% meglumine diatrizoatis and 50-200 ml of air were slowly injected via the decompression tube to perform double contrast intestinal radiography. Results Intubation was successful in all the 35 patients. Mter the small intestinal decompression therapy. Obstruction was cured in 20 cases, alleviated in 15 cases, and 10 cases received operation. Small bowel enterography in this series was all of high quality, there were 6 cases in which no abnormal X-ray findings, adhesive small bowel obstruction was suggested in 15 cases, small bowel tumor was identified in 4 cases (3 metastatic tumor, 1 small bowel cancer), small bowel Crohn's disease in 3 cases, radioactive enteritis in 3 cases, enteric intussusception in 2, polyp of the small intestine in one, and carcinoma of the ascending colon in one. Conclusions The nasointestinal decompression intubation with X-ray monitoring serves a dual function for the patients with intestinal obstruction, it decompresses the small bowel and does small intestinal radiography, in this way the locale of obstruction was found and the cause of the obstruction identified.

Objective To find differential expression proteins in patients with T cell non-Hodgkin’ s lymphoma (T-NHL) by using surface-enhanced laser desorption and ionization time-of-flight mass spectrometry (SELDI-TOF-MS) technique and study their related clinical application value and prospect.Methods Serum protein of 36 T-NHL patients and 30 DLBCL patients were detected by the SELD1-TOF-MS technique and weak cation exchange (wcx-2) chip.Lactate dehydrogenase (LDH) was detected by biochemistry method.Beta2-microglobulin (β2-MG) was detected by enzyme-linked immunesorbent assay (ELISA).The significant different protein spectrometry were analyzed between DLBCL patients and T-NHL patients.The correlation analysis with protein spectrometry,disease staging,LDH and β2-MG were analyzed with Spearman.Results Nine potential candidate proteins,including the peak intensity of M/Z 1142.67,1451.43,1472.49,1512.03,3194.22,3267.41,3933.86,4593.12 and 9182.24,were identified in T-NHL patients.The 9 protein markers had no contact with disease staging of T-NHL (P ＞ 0.05).The protein markers of 4593.12 and 9182.24 were high level in T-NHL patients.LDH in these two protein markers’ positive group [(290.82±29.95) U/L,(283.94±100.94) U/L] was higher than that in negative group [(169.22±55.42) U/L,(169.50±59.25) U/L](t =-3.199,P =0.004; t =-2.378,P =0.026),and LDH was positive correlation with these two protein spectrometry (r =0.265,r =0.178,P ＜ 0.01).There was no statistically significant difference ofβ2-MG between these two protein markers’ positive group and negative group (P ＞ 0.05).The other 7 protein markers were low level in T-NHL patients,and there was no statistically significant difference of LDH and β2-MG in these 7 protein markers (P ＞ 0.05).Conclusion The protein marker of 4593.12 and 9182.24 may be the specific serological markers to identify T-NHL.The combination of these two protein markers and LDH may assess the tumor load,and provide guiding value for clinical treatment.

Around the world, the supply of health services faces challenges, especially in developing nations that suffer from inadequate infrastructure and aging equipment, frequent shortages of medicine and supplies, and low capacity and efficiency of primary health care. At present, more and more governments adopt public-private partner-ships to achieve public policy goals. Among those, Brazil, South Africa, and India have made greater achievements in changing the roles of local government, increasing the supply of primary health care and health care quality, pro-moting health care equality, meeting the needs of multi-level medical services, and promoting health capabilities by using public-private partnerships. This paper provides an overview of public-private partnership practices in the three countries, discusses their reform experiences, and concludes with implications which may be helpful for promoting and scaling up PPP in primary health care in China.

By the approach of self-assembly and electropolymerization, membrane for Bisphenol A (BPA) has been synthesized with bisphenol A as template molecule, o-aminothiophenol as functional monomer. Based on which, an electrochemical sensor was constructed and its response to BPA was evaluated by cyclic voltammetry. The peak current intensity was linear to Bisphenol A in the range of 6.0×10-7-5.5×10-5 mol/L with a detection limit of 2.0×10-7 mol/L and the RSD <5%(n=9). The response time of stable current was about 2 min. The proposed sensor exhibits good selectivity, reproducibility and stability. The AC impedance technology and chronoamperometry were employed to study the electrochemical characteristic of the membrane. The sensor was successfully applied to the determination of BPA in several samples.

Objective To evaluate the expression of vascular endothelial growth factor (VEGF)and endostatin (ES) in the serum of patients with differentiated thyroid cancer at the time of before and after operation and postoperative recurrence. Methods The serum samples were obtained from 7 patients with postoperative lung metastasis and 21 patients with local recurrence after operation.The serum samples from 30 normal subjects were obtained as control.The levels of serum VEGF and serum endostatin were analyzed by enzyme-linked immunosorbentassay (ELISA).Thelevelsofserumthyroglobulinwereanalyzedby Chemiluminescence method.Statistical analysis was performed with t-test using SPSS 13.0 software.Pearson correlation analysis was performed for the correlation between serum VEGF and serum ES and thyroglobulin.ResultsThe levels of serum VEGF and serum ES in patients with lung metastasis 3 weeks after operation were significantly lower than those before operation and at the time of recurrence [ VEGF:( 210.3 ± 30.4) ng/L vs (412.6 ±57.3) ng/L and(619.5 ± 126.4) ng/L,P ＜0.05 ;ES:(25.2 ±6.2)ng/L vs (34.3 ±7.6)ng/L and (38.6 ± 8.7) ng/L,P ＜ 0.05 ].And the levels of serum VEGF and serum ES in patients with local regional recurrence 3 weeks after operation were significantly lower than those before operation and at the time of recurrence [ VEGF:(209.3 ±36.7) ng/L vs (399.4 ±56.3) ng/L and (406.5 ±59.2) ng/L,P ＜0.05;ES:(25.7 ± 4.7 ) ng/L vs ( 35.2 ± 6.8 ) ng/L and ( 31.2 ± 7.6 ) ng/L,P ＜ 0.05 ].The expression of serum VEGF and serum ES in patients with pulmonary metastasis were significantly higher than those in patients with local regional postoperative recurrence ( P ＜ 0.05 ).There was a linear positive correlation between serum VEGF,serum ES and thyroglobulin levels in the patient with recurrent differentiated thyroid cancer( r =0.752,0.349,P ＜0.01 ).Conclusion The serum VEGF and serum ES level were significantly elevated in patients with differentiated thyroid cancer before operation and recurrence.The serum VEGF and serum ES were importantindicators to reveal the biological behaviors of differentiated thyroid cancer.