Reform was made on traditional education mode based on the criterion of undergraduate medical education at home and aboard.The reform includes the changes in teaching content,teaching methods and assessment methods in an aim to establish independent learning mode,cultivate students' self-study ability,initiative spirit and innovation ability.

AIM: To establish identification and determination methods for aristolochic acids. METHODS: The extracts of the sample were developed on silica gel G F254 plate, using supernatant layer of the mixture of toluene-ethyl acetate-water-formic acid (20 ∶10 ∶1 ∶1) as the mobile phase. Chromatogram system:gradient elution with mobile phase consisting of (A) 1% acetic acid in water and (B) methanol was used. The initial condition was at 40% of B and gradient up to 100% B in 15 minutes before returning to the initial conditions. Detection was at 310 nm. The column temperature was set at 40℃ and flow-rate was set at 1.0 mL/min. RESULTS: TLC:the Rf value of aristolochic acid Ⅰ was 0.50 and aristolochic acid Ⅱ was 0.53. The results of assay were shown as follow: The average recovery of aristolochic acid Ⅰ was 103.3% (RSD=0.98%). The average recovery of aristolochic acid Ⅱ was 95.97% (RSD=1.2%). CONCLUSION: It reveals that the methods we described are accurate, rapid and reproducible.

Objective To study the effects of Interferon(IFN)in chronic hepatitis B patients genotype B and C.Methods 20 cases were genotype B ,23 cases were genotype C,all the patients were treated with 5 million units of IFN-a-lb,im,qod,for 12 months,viral markers,liver function and adverse drug reactions were observed.Results There was no statistically significant difference between B,C genotype in the negative conversion rate of HBV-DNA (60.0% ,39.1%),the negative conversion rate of HBeAg(42.9% ,30.8%),anti-HBe seroconversion rate(35.7% ,23.1 %)and the rate ALT normalization(85.0% ,73.9%)(t = 1.86,0.69,0.68 ,0.79,P ＞ 0.05).Conclusion The results suggested that therapeutic efficacy of IFN-α-lb was not significantly different between B,C genotypes.

Aim To investigate the effect of astragalo-side IV ( ASIV) on myocardial energy metabolism and mitochondrial biosynthesis in myocardial cells of dia-betic rats induced by streptozotocin ( STZ ) . Methods
50 SD rats at 6 weeks of age were assigned to 5 groups,10 for each group:control group, model group, ASIV 10 mg·kg-1 ·d-1 group, ASIV 20 mg·kg-1 ·d-1 group, ASIV 40 mg·kg-1 ·d-1 group. Except the control group,the remaining 40 were used to estab-lish type 1 diabetes model by the tail vein injection of STZ (35 mg·kg-1 ) . At the end of 16 weeks of treat-ment, left ventricular systolic pressure ( LVSP ) , left ventricular diastolic final pressure ( LVEDP ) and left ventricular maximum rising/falling rate ( ± dp/dtmax ) were tested. Pathological section was observed by HE staining. ATP, ADP, AMP levels were detected by ELISA. The expressions of PGC-1α and NRF-1 protein were assessed by Western blot. The expressions of PGC-1α and NRF-1 mRNA were determined by RT-PCR. Results Compared with control group, model group markedly elevated LVEDP and decreased LVSP, ± dp/dtmax , ATP/AMP and ATP/ADP ratio. Com-pared with model group, low-dose ASIV group did not change significantly,middle-dose ASIV group and high-dose ASIV group obviously decreased LVEDP, and im-proved LVSP, ± dp/dtmax , ATP/ADP and ATP/AMP ratio. Meanwhile, the expressions of PGC-1α and NRF-1 protein and mRNA were increased in a dose-de-pendent manner. Conclusion ASIV could promote mitochondrial biosynthesis, improve energy metabolism in myocardial cells of type 1 diabetic rats by PGC-1αand NRF-1 .

Objective To evaluate the surgical techniques and clinical applications of single-port transumlilical laparoscopic dismembered pyeloplasty for the treatment of ureteropelvic junction obstruction (UPJO). Methods From August 2009 to March 2010, 15 patients were treated with single-port transumbilical laparoscopic dismembered pyeloplasty. There were 12 males and 3 females,aged 12 to 55 years with an average age of 20 years, who were diagnosed by diuretic renography,IVU, and MRU et al. A single umbilical incision of 3. 5cm was made for single-port trocar and a flexible-tip 0°digital video-laparoscope was used in all cases. The procedures were performed according to the methods used in classical laparoscopic dismembered pyeloplasty with general instruments. ResultsAll operations were performed successfully without conversion to open surgery. The mean operative time was 90 (75-145) min, and the mean hospital stay length was 6 days. No organs injury occurred during operation, and no urine leakage was found afer operation. The symptoms of low back pain disappeared and hydronephrosis reduced apparently or dispeared without any anastomotic stenosis after follow-up of 4-6 months. Conclusions Single-port transumbilical laparoscopic dismembered pyeloplasty is feasible, effective and safe for the treatment of UPJO.

Objective To explore the relationship between pulmonary arterial hypertension (PAH)associat-ed with chronic obstructive pulmonary disease (COPD) and inflammatory reaction(inflammatory cell, bs CRP, IL-8 and TNF-α). Methods According to echocardiography results, the patients (systolic pulmonary artery pressure, SPAP>30 mm Hg) were divided into PAH group(n=36), single COPD group(n=32). All of the patients and 30 healthy subjects (control group) were recruited into the study. Lung function, arterial blood gases, cell differentials in induced sputum, and the levels of serum high sensitivity CRP(hs-CRP), IL-8, TNF-α were determined. Results The incidence of PAH associated with COPD were 53% (36/68),including 27% (3/11) of mild PAH,38% (5/13) of moderate PAH and 64% (28/44) of severe PAH and there were significantly differences in the severity of the spirometric abnormality (χ26.020, P<0.05). The mean PASP and right ventricle wall thickness (RVWT) in PAH group were significantly greater in the patients compared to single COPD[PASP: (52±15)mmHg in PAH group and (23±12) mm Hg in single COPD group, t=3.32,P<0.01 ; PVWT: (5.03±1.04 )mm in PAH group and (3.78±0.57)nun in single COPD group, t=2.36, P<0.05]. The levels of total cell count and neutrophils in induced sputum,hs-CRP,IL-8 and TNF-α in PAH group were higher than those in single COPD group and healthy subjects[toal cell count: (2.84±0.56)×109/L in PAH group and (1.73±0.42)×109/L in single COPD group and (0.68±0.21)×109/L in control group; neutrophils: (2.78±0.52)×109/L in PAH group and (2.57± 0.26)×109/L in single COPD group and (0.63±0.21 )×109/L in control group; hs CRP: (32±12) mg/L in PAH group and (23±11)mg/L in single COPD group and (11±4)mg/L in control group; IL-8: (113±34) ng/L in PAH group and (69±24) ng/L in single COPD group and (38±11) ng/L in control group; TNF-α: (206±63)ng/L in PAH group and (153±54)ng/L in single COPD group and (75±26)ng/L in control group (P<0.05)]. PASP in PAH group was negatively correlated with FEV<,1>% (r=-0.48,P<0.01) and was positively correlated with the levels of serium IL-8 and TNF-α, neutrophils in induced sputum respectively(r=0.43,0.56,0. 47,P<0.01). Conclusion Inflammation reaction is responsible for PAH associated with COPD.

Objective To explore the characteristics of cognitive impairment and its influence factors in first-epi?sode depression patients with sleep disorder. Methods Three hundred and eighteen patients with first-episode depres?sion and two hundreds and forty-three healthy controls were recruited. The patients were divided into two group accord?ing to the sleeping situation: 202 patients with sleep disorder and 116 patients without. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) was used to evaluated the cognitive function of all subjects, including immediate memory, visual span, speech function, attention and delayed memory. The 17 item Hamilton Depression Scale (HAMD-17) was used to evaluate patients’symptoms. Results The scores of immediate memory, visual span, speech function, delayed memory and the whole scale in the depression patients with sleep disorder were significantly lower than the patients without sleep disorder and the controls (P<0.05). Compared with the controls, the patients without sleep disor?der had lower scores of immediate memory, language function, delayed memory and the whole scale (P<0.05). Multiple linear regression showed that in the depression patients with sleep disorder, the RBANS score was related with the cogni?tive factors in HAMD (β=6.29, P=0.04);immediate memory was related with age (β=-0.24, P=0.04);visual span was re?lated with sleeping factor in HAMD (β=2.33, P=0.01);speech function was related with marriage (β=-5.74, P=0.01) and sleeping factor in HAMD (β=-1.20, P=0.03). In the depression patients with sleep disorder, speech function of RBANS was related with age (β=-0.32, P=0.04);attention was related with retardation factor in HAMD (β=2.52, P=0.01). Con?clusion The first-episode depression patients with sleep disorders have cognitive function damage in many aspects. The depressive symptoms (sleep changes, cognitive disorders, retardation and so on), age and marital status may be the influ?encing factors on cognitive impairment in first-episode depression patients with sleep disorder.

Objective:To understand the management status of breast cancer-related lymphedema, and to provide a basis for the formulation of prevention and treatment plans for breast cancer-related lymphedema.Methods:Using accidental sampling, a questionnaire designed by the research team was used to survey nurses in 58 hospitals in Jiangsu Province.Results:This study surveyed a total of 58 hospitals, of which 53 were general hospitals and 5 specialized hospitals. Only 11 hospitals (18.97%) had treatment rooms dedicated to conservative treatment of lymphedema, 9 hospitals (15.52%) had opened lymphedema clinics, and 15 hospitals (25.86%) had professional international lymphedema therapists. All the 58 hospitals had different degrees of prevention and management of breast cancer-related lymphedema.Conclusions:The comprehensive management of lymphedema has not yet been achieved, and the management standards of lymphedema also need to be further improved. It is important to establish a unified and standardized management plan and practice standards.

Objective To establish a rabbit model of radiation-induced skeletal muscle injury in order to study the ultrastructural pathological changes and underlying mechanism.Methods 28 New Zealand rabbits were randomly divided into 2 groups with 16 rabbits in experimental group and 12 rabbits in control group.The experimental rabbits were irradiated on hip with a single dose of 80 Gy of 9 MeV electrons from a linear accelerator.1 month and 6 months after irradiation the pathological changes were respectively observed under light microscope and electron microscope.Results One month after irradiation,the morphologic changes including degeneration,necrosis of muscle cells,and hemorrhage between the muscle cells were observed under light microscope and the swelling of myofibrillae,blurring of light and shade band,vacuolar degeneration of mitochondria and amorphous areas of necrosis were observed under electron microscope.Six months after irradiation,the morphologic changes of nucleolus chips,fibrous connective tissue,thickening of vascular wall and vascular congestion between the muscle cells and the amorphous areas of necrosis in the experimental group were much more serious than those of 1 month after irradiation.In addition,the myofilaments were lost in degeneration areas and the sarcomere became shorten.Observation with electron microscope showed that the mitochondrial size and its morphological changes were varied and the amounts of collagen between myofibrillaes were increased 6 months after irradiation.Conclusions A rabbit model of high-dose irradiated skeleton muscle injury was successfully established with a single dose of 80 Gy of 9 MeV electrons from a linear accelerator.The degeneration and necrosis of muscle cells may be promoted by mitochondrial and vascular injury,degeneration of vessel and nerve fiber.

Objective To explore the influence of dexmedetomidine combined with sufentanil on postoperative analgesia effect and immune function for patients undergoing lower limb fracture surgery. Methods One hundred cases patients of lower limb fracture undergoing open reduction and internal fixation of elective surgery in our hospital from January 2016 to November 2016 were selected ( ASAⅠ-Ⅱgrade, male 51 cases and female 49 cases, 30-65 years old, 50-75 kg). All cases were randomly divided into sufentanil group (Group S) and dexmedetomidine combined with sufentanil group (Group DS) according to the random number table, who used patient-controlled intravenous analgesia (PCIA). The PCIA drug formulations of two groups were as followings: sufentanil group (Group S) used 3 μg/h sufentanil+ondansetron 16 mg, dissolved in 0.9%sodium chloride injection 100 ml;dexmedetomidine combined with sufentanil group (Group DS) used dexmedetomidine 0.1μg/(kg · h)+sufentanil 2μg/h+ondansetron 16 mg, dissolved in 0.9%sodium chloride injection 100 ml;background infusion rate was 2 ml/h, and loading dose was 2 ml. Dose for patient-controlled analgesia (PCA) was 0.5 ml, and locking time was 15 min. The changes of pain, MAP, HR , sedation scores were recorded at 4 h (T1), 8 h (T2), 24 h (T3) and 48 h (T4) after operation; nausea and vomiting, hypotension, bradycardia, respiratory depression and other adverse reactions were aslo recorded at the same time. At 10 min before induction of anesthesia (T0) and T1-T4 after operation, the CD3+, CD4+, CD8+and NK cell activity of peripheral blood T lymphocyte subsets were determined using flow cytometry, and CD4 +/CD8 + ratio was calculated. Results The levels of MAP and HR in DS group at each time point after operation were lower than those in group S (P<0.05), the level of visual analogue score (VAS) in DS group at different time points were significantly lower than those of s group: (1.8 ± 0.3) scores vs. (2.5 ± 0.5) scores, (1.1 ± 0.5) scores vs. (1.9 ± 0.3) scores, (1.0 ± 0.5) scores vs. (1.8 ± 0.5) scores, (0.8 ± 0.3) scores vs. (1.5 ± 0.6) scores (P < 0.05), Ramsay Sedation score was significantly higher than that of s group: (3.5 ± 0.3) scores vs. (2.4 ± 0.6) scores, (3.3 ± 0.5) scores vs. (2.5 ± 0.3) scores, (3.5 ± 0.6) scores vs. (2.3 ± 0.5) scores, (3.2 ± 0.4) scores vs. (2.2 ± 0.5)scores (P<0.05);nausea and vomiting occurred in two patients after the operation of group DS , which was significantly lower than that of S group (P<0.05);compared with those at T0, CD3+, CD4+, CD4+/CD8+and NK cells in the two groups of patients decreased significantly at the time of T1-T4 (P<0.05);The levels of CD3+, CD4+, CD4+/CD8+and NK cells were significantly higher in group DS at T1- T4 than those in group S(P < 0.05). Conclusions Dexmedetomidine combined with sufentanil for analgesia in patients with lower limb fracture surgery has better effect. It decreases the incidence of nausea and vomiting, and improves the cellular immune function of patients.