Standardized training of resident doctors has become a necessary way to train qualified doctors. In order to unify the training standards, standardize management and improve the training effect, the relevant state departments have issued a series of documents, but there are still many regulations in the process of non-standard situation. Especially in surgical inpatients of standardized training of residents, we only pay attention to the training of students' operation skills but infusion of the operation consciousness such as whether the surgery should be done, when operation should be done, what kind of surgery should be implemented as well as operative effectis insufficient. Based on the problems existing in the clinical study and work of the surgical residents in the affiliated hospital of a university, we discuss the effective strategies for the standardized training of surgical residents.

Objective To assess the diagnostic value of CT-gnided pereutaneous fine-needle aspiration biopsy (FANB) for the space-occupying lesions of the pancreas. Methods The authors retrospectively reviewed the medical records of 68 patients with pancreatic lesions who underwent CT-guided percutaneous fine-needle aspiration biopsy. The lesions were located at the pancreatic head (n = 49), body (n = 12) or tail (n = 7). The maximum diameter of the 68 lesions ranged from 2 cm to 7 cm. The lesion's diameter was < 3 cm in 10 cases and was ≥ 3 cm in 58 cases. A 20-gauge fine-needle was used to puncture and to make the aspiration in all patients. Both plain and contrast-enhanced abdominal CT scanning were performed before the biopsy procedure. The technical key points of aspiration biopsy included selection of the appropriate cross-section, the entry of the needle, and multiple insertions in fan-like fashion with fast manipulation of puncture and aspiration. All biopsy specimens were sent for pathologic evaluation. Results All the lesions were safely and successfully punctured through the anterior approach without major complications. The technical success of needle puncturing was 100%. Of 68 patients, the pathological results obtained from the biopsy included malignant tumor in 46, benign lesion in 17 and no abnormal finding in 5, of which follow-up observation found no abnormality in 2 and malignant process was eventually confirmed in remaining three. The overall accuracy, specificity and sensitivity of the biopsy were 96%, 95% and 100%, respectively. The accuracy of CT-guided biopsy for malignant and benign lesions was 94% and 100% respectively (P > 0.05). The diagnostic accuracy for lesions larger than 3.0 cm (97%) or located at the pancreatic tail (100%) was a little higher than that for lesions smaller than 3.0 cm (90%) or located at the pancreatic head (96%) or body (92%), although the difference was not statistically significant (P > 0.05). No serious complications occurred in our series. Conclusion CT-guided percutaneous fine-needle aspiration biopsy is a safe and effective technique for the diagnosis and differentiation of the space-occupying lesions of the pancreas.

Objective To investigate the diagnostic value of contrast-enhanced ultrasound (CEUS), and compare it with contrast-enhanced CT(CECT). Methods Eighty-one focal liver lesions were evaluated with CEUS and CECT, diagnostic value of two modalities were calculated, vaseularity manifestations of two modalities in arterial phase were compared. Results The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CEUS were 96.6 %, 86.9 %, 94.9 %, 90.9 %, 93. 80%, respectively, and the diagnostic value of CECT were 98.3%, 82. 6%, 93.4%, 95.0%, 93.8%, respectively. Among all the metastasis, hypervascular manifestation lesions in arterial phase of CEUS and CECT were 72% (18/25) and 32% (8/25)( P <0.05). Conclusions The diagnostic value of CEUS and CECT in focal liver lesions are comparably satisfying,and there is no significant difference between them, the combination use of two modalities would improve the diagnosis performance. CEUS can show more hypervaseular metastasis than CECT in arterial phase.

Objective To explore distribution and genetypes of plasmid-mediated quionlone resistance genes qnrA.qnrB and qnrS in Enterobacteriaceae isolates iu Renmin Hospital of Wuhan University.Methods The qnrA,qnrB and qnrS genes in Enterobaeteriaceae isolates including nonrepetitive 129 isolates of E.coli.13 isolates of E.cloacae and 37 isolates of k pneunoniae were detected by PCR.Antibiotic suseeptibility testing for 15 antibiotics were also performed by K.B in virto.MICs of ciprofloxacin were determined by agar dilution methed.Plasmid conjugatable test wag applied to examine whether qnrA,qnrB and qnrS genes were located in conjugatable plasmid.For qnr-positive strains,integrase I and SHV-1,TEM-1,CTX-M,OXA-I,OXA-Ⅱ,OXA-Ⅲ,DHA and EBC β-lactamases genes were examined.Results 25 qnr-positive isolates were detected among 179 Enterobaeteriaceae isolates,including 6 qnrA-positive isolates,9 qnrB-positive isolates and 10 qnrS-positive isolates,which were presented in 3.35%.5.02%,and 5.59%respectively.All positive isolates were susceptible to imipenem but resistance to some other drugs.2 qnrA-positive isolates and 4 qnrB-positive isolates of them were susceptible to Quinolones.The plasmid wag eonjugatable in 2 qnrA-positive isolates and 4 isolates carrrying qnrB and qnrS.23 qnrA-positive isolates harbored type 1 Integrase,but one isolate with both qnrB and qnrS did not carry Type 1 Integrage.14 isolates of them were TEM-1 producing strains.6 isolates were OXA-Ⅲ-producing strains.and 7 isolates of them were EBC-producing strains.Conciusions In HuBei province,a low prevalence of qnrA,qnrB and qnrS wag determined in Enterebacteriaceae isolates.Muhidrng-resistance was found in qnr-pesitive isolates and qnr genes were detected in quinolone susceptible strains.Extendedspectrum β-lactamages could be presented in qnr-positive isolates too.

To cultivate nursing students with international professional ability for higher vocational education is the key to promote the internationalization of Chinese nursing field. Through analyzing the de-veloping trends and problems of international nursing education in China, based on the international nurses' ability, and study from the nurses training model of Philippines, the international nursing training model was constructed. The paper discussed the selection and retention of students, emphasizing the cultivation of students' international nursing concept and professional English, focusing on the ISPN curriculum and the integration of theory and practice, encouraging the cooperation of international school and faculties sharing, adapting the students-centered teaching methods, and establishing a corresponding sound evaluation system.

Objective:To explore the pharmaceutical care on an uremia patient with pulmonary infection complicated with epilepsy to provide ideas for clinical pharmacists in the clinical practice. Methods: According diagnosis and drug treatment characteristic of Chronic renal insufficiency, clinical pharmacist supplied individual treatment regiment and treatment of complications and adverse drug reactions occurred in the course of treatment, and pharmaceutical care for the patient in the whole process. Results: Pharmaceutical care on patients with uremia complicated with pulmonary should focous on the safety and rationality of the used of antibiotics, the poten-tial interaction of drugs, the treatment of adverse drug reaction, and the education of patients. Conclusion:Clinical pharmacist should supplied conventional pharmaceutical care on patients with uremia complicated with pulmonary to improve the safety and effectiveness of drug treatment.

A novel high performance liquid chromatographic method was developed for the determination of 4-O-methylhonokiol in rabbit plasma and was applied to its pharmacokinetic investigation.Plasma samples were treated by one-fold volume of methanol and acetonitrile to remove the interference proteins.A reverse phase column of SHIMPACK VP-ODS (150 mm× 4.6 mm,5.0 μm) was used to separate 4-O-methylhonokiol in the plasma samples.The detection limit of 4-O-methylhonokiol was 0.2 μg/L and the linear range was 0.012- 1.536 mg/L.The good extraction recoveries were obtained for the spiked samples (84.7％,89.3％ and 87.7％ for low,middle and high concentrations of added standards,respectively).The relative standard deviation of intra-day and inter-day precisions was in the range from 0.6％ to 13.5％.The pharmacokinetic study of 4-O-methylhonokiol was made and the results from the plasmaconcentration curve of 4-O-methylhonokiol showed a two-apartment open model.This work developed a sensitive,stable and rapid HPLC method for the determination of 4-O-methylhonokiol and the developed method has been successfully applied to a pharmacokinetic study of 4-O-methylhonokiol.

ObjectiveTo observe the expression of nerve growth factor(NGF)and its receptors (TrkANGFRand P75NTR) in hepatocytes and to explore the biological effects of exogenous P75NTR protein on hepatocytes.MethodsL02 hepatocytes were cultured in vitro.The expression of NGF,TrkANNGFR and P75NTR in L02 cells were assessed by immunocytochemistry and fluorescent quantitation polymerase chain reaction (PCR). The effects on L02 cell proliferation by exogenous P75NTR,NGF,NGF+ P75NTR,anti-TrkANGFR and anti-P75NTR were detected by XTT assay.The effect of exogenous P75NTR on L02 cell apoptosis was measured by flow cytometry (Annexin V/PI) and the effect of exogenous P75NTR on L02 cell cycle was determined by flow cytometry (PI).ResultsL02 cell proliferation was promoted by P75NTR and in dose-dependent manner.The A value of NGF group and NGF+ P75NTR group was 0.4916±0.0565 and 0.5839 ± 0.0733,respectively,and there was statistical significance compared with control group (0.3601 ± 0.0310,P＜0.05).The A value ot anti-TrkANGFR group was 0.2689±0.0229,and there was statistical significance compared with control group (P=0.003).The A value of anti P75NTR was 0.3524 ± 0.0312,and there was no statistical significance compared with control group (P=1.000). Exogenous P75NTR had anti-apoptosis effect on L02 cells,the antiapoptosis effect was strongest when 100 ng/ml P75NTR was added and the expression quantity was 3.70 ±0.26.However there was no statistical significant compared with control group (4.10 ± 0.62,P=1.000).P75NTR affected the cell cycle S phase of L02 cells and in dose-dependent manner,which was inverted U shaped curve.The effect was strongest when the concentration was 100 ng/ml (25.60 ±0.40) and there was statistical significance compared with control group (20.10 ±1.00,P=0.000).Exogenous NGF,P75NTR and NGF + P75NTR up regulated the gene expression of NGFmRNA,TrkANGFRmRNA and P75NTR mRNA in L02 cells and there was statistical significance compared with control group (P＜0.05).There was no significant difference in the gene expression of NGFmRNA,TrkANGFFR mRNA and P75NTR mRNA between anti-TrkANGFR,anti-P75NTR groUp and control group (P＞0.05).Conclusion NGF and its receptors TrkANGFR and P75NTR were expressed in L02 cells.The appropriate dose of exogenous P75NTP protein promoted L02 cells proliferation via TrkANGFR/P75NTR heterodimer signal pathway.

Objective: To establish a method of restriction fragment length polymorphism (RFLP) to determine the origin of sika deer bones.Methods: The DNA in the bone samples was extracted after decalcification, and then amplified using polymerase chain reaction (PCR).The origin of the samples was further identified using RFLP analysis.Results: The bone samples of sika deer and red deer could be distinguished from those of pig, bovine and dog by PCR.And the samples of sika deer and red deer could be further distinguished by RFLP through the analysis of the length of restriction enzyme XbaI.Conclusion: A RFLP method is established to determine the origin of sika deer bones.

Pharmacology , pharmacokinetics , clinical study and safety of enzalutamide in the treatment of castration-resistant pros-tate cancer (CRPC) were reviewed in the paper.Enzalutamide, a pure second-generation androgen receptor antagonist , can inhibit multiple points in the androgen receptor signaling pathway , including the inhibition of androgen binding to the androgens receptor , nu-clear translocation of the androgens receptor complex and binding of the androgens receptor complex to deoxyribonucleix acid ( DNA) . The phase 3 clinical trials have revealed that enzalutamide is effective to delay the progression of metastatic CRPC , reduce the prostate-specific antigen (PSA) levels, decrease the progression time of PSA and prolong the overall survival time and the time of first skeletal -related events .Enzalutamide has become a novel treatment option for CRPC patients .Enzalutamide is well tolerated with low incidence of side effects .