This paper analyzed the problems that currently exist in clinical practice and put forward the countermeasures to improve the quality of clinical practice,such as enhancing ideological and political education of practice students,mending check-up system in clinical practice,and so on.

Objective To study the relationship between endocervical mycoplasma infection and the spontaneous abortion due to the early embryonic death and the drug sensitivity to mycoplasma. Methods Endocervical swabs were taken from fifty normal pregnant women (normal group) and fifty-eight women with spontaneous abortion due to embryonic death.The swabs were used for ureaplasma urealyticum (UU) and mycoplasma hominis (MH) Cultivation respectively. The isolation rates of the two groups were comparedf.Results (1)In the embryonic death group, the positive rates of UU, MH and UU mixed with MH were 74.1%(43/58) , 27.6% (16/58) and 20.7%(12/58)separately.In the normal female group, however, the positive rates correspondingly were the UU 48.0% (24/50), the MH 10.0% (5/50) and the UU mixed with MH 4.0% (2/50).There had significant differences of the positive rates between the two groups( P

Objective:To clarify the relationship between epidermal growth factor receptor (EGFR) mutations and the clinicopathologic features of primary lung adenocarcinomas in Xinjiang.Methods:The mutations of EGFR gene at exons 18 -21 in 59 cases (including 15 cases of Uighur and 44 cases of Han) of lung adenocarcinoma tissues,which were obtained from surgical resection,were detected by amplifica-tion refractory mutation system (ARMS)method.And the relationships among mutations,race and clini-copathologic features were analyzed.Results:The frequencies of EGFR mutations in lung adenocarcinoma were 20% for Uighur,which was lower than that in Han (54.5%),P <0.05.The deletion mutations at exon 19 were seen in 2 of 15 Uighur cases and 9 of 44 Han cases.EGFR mutations were present,inclu-ding exon 21 L858R in one Uighur case and 12 Han cases,exon 18 G719X in two of 44 cases of Han, exon 21 L861Q in one of them.On histological type,the frequencies of EGFR mutation in alveolar pre-dominant adenocarcinoma was 71% (22 /31),which was higher than both that in solid predominant and mucinous carcinoma (6.7%,20% respectively).According to statistic analysis,EGFR mutations were without correlation with the patient’s gender,age,location,gross type,smoking status and lymph node metastasis(P >0.05).EGFR mutation was more frequent in well-differentiated cancer,mainly in acinar carcinoma,while poorly differentiated adenocarcinoma and mucous adenocarcinoma were lower.Conclu-sion:There was a difference of EGFR mutation in primary lung adenocarcinoma between Uighur and Han in Xinjiang,perhaps reflecting ethnic genetic variation,which is worth further analyzing.EGFR mutation was commonly detected in well or middle differentiated adenocarcinoma,mainly in acinar carcinoma.

Objective To evaluate the accuracy of air column width difference (ACWD) between inflation and deflation of the cuff of the endotracheal tube (ETT) in predicting post-extubation stridor (PES).Methods A total of 102 intubated patients of both sexes and all ages,who were mechanically ventilated for ≥24 h in the intensive care unit,of American Society of Anesthesiologists physical status Ⅲ or Ⅳ,were enrolled in the study.After the patients were in a stable condition and recovered consciousness and myodynamia,they were weaned from the ventilator,and ultrasound examination of the larynx was performed to determine ACWD between ETT cuff inflation and deflation.PES was assessed using blinding nethod after extubation,and the patients were divided into 2 groups depending on whether or not the patients developed PES:PES group (group P) and non-PES group (group N).Results There were 94 patients in group N and 8 patients in group P.Compared with group N,ACWD was significantly decreased in group P (P＜ 0.05).The cut-off value of ACWD determined by the receiver operating characteristic curve was 1.65 mm,the sensitivity and specificity of ACWD were 0.830 and 0.750,respectively,and the area under the receiver operating characteristic curve was 0.801.Conclusion For the intubated patients who are mechanically ventilated for ≥24 h in an intensive care unit,ACWD between ETT cuff inflation and deflation＜ 1.65 mm can effectively predict PES.

Objective To research the expression,methylated regulation and clinical significances of miR-34b in chidren with acute leukemia(AL).Methods The methylation status of miR-34b promoter CpG islands were detected with methylation-specific polymerase chain reaction (MSP) in patients with AL.Then the expression of miR-34b was compared,which was detected by Taqman real-time fluorescence quantitative polymerase chain reaction (qRT-PCR),between the AL patients and normal group,in order to analyze their relationship with the clinical indicators.Resuits In 8 leukemia cell lines (U937,HL-60,MV4-11,M2R,K562,Raji,CCRF,DAMI) showed methylation,the positive rate of the methyl was 100％.Thirty-one acute lymphocytic leukemia(ALL) pediatric patients were newly diagnosed,and 24 cases showed methylation,the methylation positive rate 77.42％ (24/31).Nineteen acute myeloid leukemia(AML) patients were newly diagnosed,and 8 cases showed methylation,the methylation positive rate was 42.11％ (8/19 cases).There was no methylation in the 23 cases of normal children.The relative expression levels of miR-34b in the normal group,the group of leukemia cell lines,the group of ALL pediatric patients with newly diagnosed,the AML group and the group with mixed lineage leukemia gene rearrangement MLL+ were 5.22 ± 1.15,0.03 ± 0.03,1.65 ± 0.69,0.18 ± 0.06,0.64 ± 0.34,respectively.The findings indicated that there were significant differences in the relative expression levels of miR-34b between the normal group and the group of leukemia cell lines,the ALL group,the AML group,and the MLL+ group.The relative expression and methylated level of miR-34b had no statistically difference in gender,age at diagnosis,WBC count,chromosome,fusion gene,MLL gene rearrangement,and the minimal residual disease(LDH) levels in newly diagnosed AML patients(all P ＞ 0.05).And the relative expression and methylated level of miR-34b had no statistically difference in gender,age at diagnosis,WBC count,immunophenotype,chromosome,fusion gene,MLL gene rearrangement,TEL/AML1 gene,risk stratification,the minimal residual disease (MRD) in thirty-three days and the LDH levels in newly diagnosed ALL patients(all P ＞ 0.05).But as for the response to prednisone experiment,there was a significant difference between the sensitive group and the non sensitive group(P ＜ 0.05).Conclusions The expression level of miR-34b in AL was significantly lower and it was regulated by methylation mechanism,which implies that miR-34b may play a role of a tumor suppressor gene in the pathogenesis of leukemia.MiR-34b may affect the early treatment response of ALL patients,and it may be an indicator of risk stratification and poor prognosis in pediatric ALL.

Objective To use metabonomics method to study the change of the basic materials of month rhythm of wei qi deficiency syndrome; To find the potential markers so as to provides a new way for the essence of the wei qi deficiency syndrome research.Methods Based on the autumnal equinox in lunar calendar month, the beginning of a month (the first day of lunar August), the middle of a month (the 15th day of lunar August), and the end of a month (the 30th day of lunar August) were set as the three days to draw experimental materials. Two weeks before drawing materials, 20 rats were randomly divided into control group and model group, 10 rats in each group. The model rats were modeled by the stimulus of fatigue combined with coldness and hotness. Control group rats received conventional breeding. The rats in the both groups during the three experiments received decollation and the blood was taken at the 12 o’clock at noon. HPLC-MS was used to detect plasma metabolites, and partial least squares were used to make statistical analysis on the data for comparing plasma metabonomics original data of control group and model group. Possible metabolic markers of wei qi deficiency syndrome were explored, and the potential makers of month rhythm change of wei qi deficiency syndrome were deduced.Results Oleamide, phosphatidyl glycerol, cortisol, proline, dimethyl fumarate, and eicosapentaenoic acid may be potential markers of wei qi deficiency syndrome in the beginning of a month. Sphingosine-1-phosphate, malic acid, cortisol, oleamide, carnitine, eicosapentaenoic acid and dimethyl fumarate may be potential markers of wei qi deficiency syndrome in the middle of a month. Cholesteryl acetate, threonine, cortisol, dimethyl fumarate, oleamide, eicosapentaenoic acid and pyroglutamate may be potential markers of wei qi deficiency syndrome in the end of a month.Conclusion Month rhythm change of wei qi deficiency syndrome may be influenced by oleamide, cortisol, eicosapentaenoic acid, dimethyl fumarate, and aconitic acid, and may be closely related to energy metabolism, meanwhile accompanied by regulation of cell, hormone and nerves.

Objective To study the plasma metabolomics features of SD rats with wei-qi deficiency respectively in spring, summer, autumn and winter; To seek the potential markers related to wei-qi deficiency; To discuss the essence of wei-qi deficiency.MethodsTwenty male SD rats were adaptively fed 7 days before Chinese Vernal Equinox Day, Summer Solstice, Autumn Equinox and Winter Solstice, synchronous controled with temporal condition. The rats were randomly divided into experimental and control groups according to random number method. Rats in the experimental groupwere made into wei-qi deficiency models through fatigue stimulation alternately with cold and heat stimulation. Blood was collected at 12:00 each solar term. High performance liquid chromatography- mass spectrometry instrument was used to detect plasma metabolites. Partial least squates-discriminant analysis was used to process statistical analysis of the data to compared the original data of plasma metabolomics between the two groups of each season, and explore the difference metabolic markers between each two groups, then speculate the potential biomakers of wei-qi differency.ResultsWith the changes of spring, summer, autumn and winter, significant differences were showed in metabolic profile between the experimental and control groups. Homocysteine showed a significant difference in spring, summer and autumn; Ceramide showed a significant difference in summer and winter; Testosterone showed a significant difference in spring and summer; Cyclic guanosine monophosphate showed a significant difference in autumn and winter; Sarcosine showed a significant difference in spring, summer and winter. The physiological functions of these substances related to lipid metabolism, amino acid metabolism, neurotransmitter and hormone regulation.ConclusionPotential biomakers of wei-qi deficiency changed along with the seasonal variation, which mainly reflected in lipid metabolism, amino acid metabolism, neurotransmitter and hormone regulation.

OBJECTIVE To study the phenotypic existence,genetic type and gene transfer of extended spectrum beta-lactamases(ESBLs) and AmpC beta-lactamase from Klebsiella pneumoniae and K.oxytoca. METHODS Disk confirmation test and 3-aminophenylboronic acid(APB) disk potentiation test were used to detect ESBLs and AmpC beta-lactamase.The genetic types of these two kinds of beta-lactamases were examined by gene chip technology and sequence analysis.The transfer of resistance genes was conducted by conjugation. RESULTS From 72 strains of K.pneumoniae and 20 strains of K.oxytoca which were not susceptible to cefoxitin,coexistence of AmpC(beta-lactamase) with ESBLs together was very common,accounted for 54.2% and 75.0%,single ESBLs accounted for 22.2% and 25.0%,respectively.There were 12.5% single AmpC in(K.pneumoniae).DHA type ampC gene and SHV type ESBLs gene were the main molecular types.These genes could be transferred from clinical isolates to recipient E.coli J53. CONCLUSIONS ESBLs as well as AmpC(beta-lactamase) are the most important resistance mechanism in K.pneumoniae and K.oxytoca.The resistance could be transferred through the bacterial conjugation.

A descriptive study to investigate the situation of cross-cultural adaptation and health status among medical international students was carried out using cluster sampling method and self-designed questionnaire in Dalian Medical University.148 international students come from 24 countries.There are 5 religions belief among these students.Islam,Catholic,Hindu,Buddhism and Sikhism.The main obstacles of cross-cultural adaptation are language,accommodation and diet.Economic status and stress of interpersonal relationship are also the main causes affecting the physical and mental health of medical international students.

Objective:To identify the risk factors for early acute lung injury (ALI) after living-related liver transplantation in pediatric patients and evaluate the value of the risk factors in prediction of ALI.Methods:Perioperative data of patients were obtained through the electronic medical records system. Patients were divided into non-ALI group and ALI group according to whether ALI occurred within the first week after surgery. The risk factors of which P values were less than 0.05 would enter the multiple logistic regression analysis to stratify ALI-related risk factors. Area under the ROC curve was used to analyze the value of the risk factors in prediction of postoperative ALI. Results:A total of 67 patients were enrolled, including 45 cases in non-ALI group and 22 cases in ALI group. Increased intraoperative blood transfusion volume and up-regulated expression of miR-122 and miR-21 were independent risk factors for the occurrence of postoperative ALI ( P<0.05), and the area under the ROC curve (95% confidence interval) of serum miR-122 and miR-21 expression was 0.946 (0.875 to 1.00), with sensitivity and specificity of 95% and 90%, respectively. Conclusions:Increased intraoperative blood transfusion volume and up-regulated expression of serum miR-122 and miR-21 are independent risk factors for early postoperative ALI, and serum miR-122 and miR-21 levels have a high value in prediction of the development of postoperative ALI in pediatric patients undergoing living-related liver transplantation.