ObjectiveTo analyze the results of implementing the tutorial system for medical interns, and to put forward some suggestions. MethodsThe medical interns and the doetors selected as tutors were asked to do questionnaires to study the tutorial system's feasibility and effectiveness. Simultaneously, we adopted the Objective Structured Clinical Examination ( OSCE ) to assess its process and resuits. Results74.3％ of the students and 75.5％ of the doctors think that they need the tutorial system,73.2％of the students think that this system can train better clinical skills,67.9％ of the doetors think that they can review the knowledge learned through teaching. Implemented after one year, students' OSCE scores are improved. ConclusionTutorial system for medical interns has achieved preliminary success, and the preparatory work and related-system building need to be further improved.

Objective To compare the results of emergency clinical training for medical students and to put forward some suggestions.Methods Toatlly 207 medical students of Grade 4 studied in the first people' s hospital of Shanghai Jiaotong university from 2009 to 2011 were divided into the traditional group (n =90 ) and the experimental group (n =117 ).The students in the experimental group participated in emergency clinical training in summer vacation while those in the traditional group did not.Questionnaires about their self-learning ability,clinical communicating ability and critical thinking ability after training the were conducted and the data were analyzed by descriptive statistical analysis.Results One hundred and five effective questionnaires were recovered from the experimental group,with the recovery rate 89.7％ and 62 effective questionnaires were recovered from the traditional group,with the recovery rate 68.9％.The scores about clinical communicating ability and critical thinking ability of the experimental group were significantly highcr than those of the traditional group [ (79.45 ± 9.354)vs.(75.87 ± 9.926),(263.38 ± 30.925 ) vs.(251.36 ± 23.679),P ＜ 0.05 ].However,there was no significant difference in scores about self-learning ability between the two groups [ ( 153.97 ± 23.725 ) vs.( 149.83 ± 13.891 ),P ＞ 0.05].Conclusion Emergency clinical training is helpful to improve medical students' clinical communicating ability and critical thinking ability.It is worth popularizing.

Theory of Shen-Xu Pang-Guang-Re (SXPGR) is an important part of the theory of zang-fu in traditional Chinese medicine (TCM). And it is the generalization for etiology and pathogenesis of Lin-Zheng (LZ). In immunology, mucosal immune system is composed of mucosal-associated lymphoid tissues and immune cells, which can resist the invasion of microorganisms. Mucosal immune plays an important role in the occurrence of urinary tract infection. This paper, which was based on SIgA and homing mechanism, was to investigate the relevance between mucosal immunity and the theory of SXPGR, in order to study the connotation of SXPGR in TCM.

Objective To evaluate the methicillin-resistant Staphylococcus aureus (MRSA) colonization in infants at neonatal intensive care unit (NICU) by active surveillance cultures (ASC) and the effects of mupirocin decolonization on MRSA infection. Methods Neonates adimitted to NICU of Ruian People's Hospital of Zhejiang Province, China between October 1, 2013 and September 30, 2014 underwent ASC within 24 hours of admission (ASC group). The samples from nasal vestibule and umbilicus were cultured for MRSA, and positive cultures were considered as MRSA colonization. These with negative cultures underwent repeated culture of MRSA by ASC at the 1st and 2nd week after NICU admission. Neonates admitted to NICU between October 1, 2014 and September 30, 2015 with MRSA colonization based on ASC were decolonized with mupirocin at both nasal vestibule and umbilicus twice daily for five consecutive days (decolonization group). Culture samples were obtained one day and one week after decolonization to repeat ASC. ASC was stopped if the subsequent culture was negative twice successively; and a second mupirocin decolonizaton was performed if the culture was positive. Chi-square test was used to compare the rates of colonization and infection between the two groups. Results (1) MRSA colonization and infection in ASC group: MRSA colonization rates within 24 hours, and in the 1st and 2nd week after NICU admission in ASC group were 2.2% (9/418), 3.7% (15/402) and 3.6% (13/361), respectively. Compared with those without MRSA colonization, neonates with MRSA colonization had a higher incidence of MRSA infection [13.5% (5/37) vs 3.7% (14/381), χ2=7.524, P=0.006]. (2) MRSA colonization and infection in decolonization group: MRSA colonization rates within 24 hours, and at the 1st and 2nd week after NICU admission in decolonization group were 2.8% (12/435), 2.9% (12/414) and 1.3% (5/373), respectively. The MRSA colonization rate at the 2nd week was significantly lower than that in ASC group (χ2=3.919, P=0.048). Twenty-nine cases had MRSA colonization, among which, 27 cases were decolonized once and two cases were decolonized twice, and all were successful. The rate of MRSA infection in decolonization group was 2.1% (9/435), which was significantly lower than in ASC group [4.5% (19/418)] (χ2=4.118, P=0.042). Conclusions Rate of MRSA colonization is high at NICU. Mupirocin can decolonize MRSA carriage and reduce MRSA infection in neonates.

Objective To investigate the effect of castration on heart function in male rabbits postinfarction congestive heart failure model. Methods 32 male 4-5 months old New Zealand rabbits were randomly assigned to ligation of first branch of left coronary artery or sham operation (sham group, n=8). 3 weeks later 20 survived MI model rabbits were randomly subjected to castration (castration group, n=10) or sham operation (MI group, n=10). Serum FT, DHEAS levels and LVEF were checked at week 0, 3 and 15. Heart diameter and left ventricular wall thickness were measured at week 15. Results The serum FT and DHEAS levels decreased significantly at week 3. In MI group and castration group serum androgen level was lower and heart weight, ventricular diameters, ventricular wall thickness corrected by body weight were higher than that in sham group at week 15. The androgen level and body weight of castration group were lower than that in MI group. But LVEF in castration group was not higher than MI group. Conclusion There was no benefit effect of castration on heart function in male rabbits postinfarction congestive heart failure model.

Objective To evaluate the clinical value of different radiotherapy protocols in the treatment of advanced cervical cancer. Methods From 1976 to 2006,763 patients with stage Ⅲ cervical cancer(722 with squamous cell carcinoma and 41 with adenocarcinoma)were treated by radiotherapy in our hospital. 113 patients were treated by two-field whole pelvic irradiation in conventional fractionation plus brachytherapy (CF group), 44 by four-field whole pelvic irradiation in accelerated hyperfractionation plus brachytherapy( AHF group), and 606 by concomitant four-field unconventional fractionation radiotherapy and brachytherapy(FRT group). Sixty-one patients were treated by radiotherapy and chemotherapy. Among 350 patients who had complete data, the short-term efficacy and toxicities were compared. Results For patients in CF,AHF and FRT groups, the 3-year overall survival rates (OS) were 65.7%, 66.8% and 44.3%, respectively (P=0.000), and the 5-year OS were 65.7 % ,66.8 % and 36.3 %, respectively (P=0.000). The 10-year OS were 43.3% and 31.9% in CF and FRT groups(P=0.200). For squamous cell carcinoma,the OS was higher of patients with chemotherapy than those without. In 350 patients who had complete data,the local control rates of CF, AHF and FRT groups were 83.0% ,93.2% and 86.1%, respectively(X2=2.70, P=0.259);AHF group had the lowest side effect rate, especially skin reaction (9.1%,X2=20.25,P=0.002) ;CF group had the lowest acute bone marrow suppression rate(X2=25.95,P=0.000);for squamous cell carcinoma, the OS was higher in patients with chemotherapy than those without;the acute bone marrow and intestinal toxicities were more in patients with chemotherapy than those without. Conclusions CF and AHF groups have similar 5-year OS of patients with advanced cervical cancer. AHF group has less toxicities, shorter treatment course and a trend of better local control. Concurrent chemoradiation could improve survival and local control of the patients with advanced squamous cell cervical cancer while increase the side effects. The individual condition should be considered to choose the treatment protocol.

Objective To explore the impact of iodine nutrition on 8-10 years old children after adjusting the iodine content in iodized salt in Hangzhou.Methods Twelve counties (areas,cities) were divided into urban,suburban and rural areas in Hangzhou.By population proportion survey (PPS),every county(area,city) was divided into east,west,south,north and middle districts; one school was selected in each district; forty children (half male and half female) aged 8-10 years old in each school were selected; family salt and urine samples of each student were collected.The levels of salt and urinary iodine were measured by picric sodium thiosulfate titrimetric (GB 13025.7-2012) and spectrophotometer method (WS/T 107-2006),respectively.Results Two thousand seven hundred and twenty-five household salt samples were collected.The median of salt iodine,the iodized salt coverage rate,the qualification rate of iodized salt and the consumption rate of qualified iodized salt were 24.00 mg/kg,4.35％(2 571/2 725),91.02％(2 340/2 571) and 85.87％(2 340/2 725),respectively.The medians of salt iodine in urban,suburb and rural areas were 24.10,22.12,24.30 mg/kg,respectively.A total of 2 664 children urine samples were collected.The median of urinary iodine (MUI) of the children was 177.24 μg/L.The MUIs in urban,suburb and rural areas were 175.00,178.55,178.00 μg/L,respectively; in male was 183.00 μg/L and female was 170.50 μg/L.When non-iodized and unqualified iodized salt were taken,the differences of urinary iodine within groups were statistically significant in urban,suburb and rural areas(x2 =18.652,14.686,all P ＜ 0.05).In rural area,the difference of urinary iodine of 8-10 years old children who ingested different types of iodized salt was statistically significant(x2 =39.07,P ＜ 0.05).Conclusion After adjusting the iodine content of salt in Hangzhou,the iodine-nutritional status of 8-10 years old students is at a appropriatelevel.

OBJECTIVE Apolyclonalantibody-basedhomogeneouschemiluminescenceimmunoas-say was developed and optimized using AlphaLISA technology for the quantitative detection of microcys-tin-LR(MC-LR)inwatersamples.METHODS Thismethodwasbasedonacompetitivemodelin which an immune complex was formed from the ingegral binding of artificial MC-LR antigen-coated lumi-nescene beads,free MC-LR standards or sa mples,antibody and biotinylated second antibody.Next sensor bead were added that approached the i mmune co mplex through biotin-streptavidin interaction. With the exciting light,the energy was passed from the sensor luminescer before a special emission light could be observed.To opti mize the reaction conditions,working dilutions of polyclonal antibody and bioti-nylated second antibody were assayed while the effect of buffer syste ms and ti me of each reaction were evaluated.RESULTS Maininfluencingfactorsoftheassaywerediscussedasworkingdilutionsofpoly-clonal antibody and biotinylated goat anti rabbit IgG,assay buffer and reacting ti me.After opti mization of reaction conditions,MC-LR AlphaLISA could be finished in 40 min,with a sensitivity of 0.006 μg·L-1 and a dynamic range of 0.006 -5 μg·L-1 .The coefficient of variation was below 10% and average recovery was 1 07.7%.Moreover,the cross reactivity rates of MC-RR and MC-RY to MC-LR were 13.2%and0.91%,respectively.CONCLUSION Thismethodishighlysensitiveandspecific,time-saving and quite suitable for high throughput determination of MC-LR water samples.

Objective In problem-based learning, students are often found difficult to con-struct medical knowledge systematically and transfer knowledge to solve new problems. In face of this challenge, this study aims to investigate the effect of visualization tool-supported online problem-based learning on medical students' clinical diagnostic expertise development. Methods A controlled study was conducted and 52 medical students were randomly assigned into experimental group (using visual-ization tool-supported online PBL environment for learning) and control group (using online PBL envi-ronment for learning without visualization tool support). Participants were asked to complete the diag-nostic analysis of three kidney problems according to the requirements of the learning environments and to provide feedback of online learning experience afterwards. Paired-sample t test and one-way analysis of vonriance were used to analyze both group's case 1 and case 3 on line learing scores. Results The results revealed that the experimental group had significant improvement in online learning performance [case 1: (1.47 ±0.54), case 3: (2.14 ±0.55), P=0.015], while the control group had no significant improvement [case 1:(1.57±0.67), case 3:(1.66±0.49), P=0.234]. Early performance of online learning and group factor had interative effects (F=7.266, P=0.013). Conclusions The findings suggest that visualization tool-supported online PBL environment can facilitate medical student clinical diagnostic expertise development effectively.

Objective To explore the impact of iodine nutrition on pregnant women after adjusting the iodine content in iodized salt in Hangzhou and provide a scientific basis for supplementation of iodine to pregnant women.Methods After adjusting the iodine content of salt from 2012 to 2014,proportional probability sampling method was used to select 300 families and 100 pregnant women from every county (area,city) of Hangzhou City,and the household salt and urine samples were collected to detect iodine.Results Totally 3 904,3 900 and 3 900 samples of household salts were collected with the medians of salt iodine concentration of 23.77,22.75 and 23.30 mg/kg of each year from 2012 to 2014,respectively.The qualified rate of iodized-salt was 95.87％ (3 550/3 703),97.04％ (3 510/3 617) and 96.53％ (3 564/3 692) and the consuming rate of qualified iodized salt was 90.92％ (3 550/3 904),90.01％ (3 510/3 900) and 91.38％ (3 564/3 900),respectively,from the year 2012 to 2014.Totally 1 300,1 217 and 1 315 urine samples of pregnant women were collected and the median of urinary iodine (MUI) of each year from 2012 to 2014 was 119.90,136.40 and 124.00 μg/L,respectively.Conclusion After adjusting the iodine content of salt in Hangzhou,the salt iodine consumption levels of pregnant women's family are stable,but the level of urinary iodine is low,which should be pay attention to.