Satisfactory communication skill is the essential requirement for medical students to become future qualified medical doctors.Clinical clerkship is the key process to absorb medical knowledge and professional skill,cultivate the ability to solve practical problems in medical practice,and develop medical students into qualified doctors by guiding them to reasonably handle physician-patient relationship,better solve medical disputes,and gradually improve their legal awareness.Therefore,medical students should strengthen to cultivate their communication ability,and set up reasonable sense of physician-patient communication.

Objective To explore the effects of examination scores of surgical experiment on introducing simulated vessel(ISV).Method 200 students of clinical medicine were randomly taken out and divided into two groups,namely the experimental group and routine group(n=100),who were respectively tested by the surgical experiment operating and theory after were trained by the ISV and routine surgical experimentation to compare the variability of their scores.Results The scores of the surgical experiment operating and theory of the experimental group were significantly higher than the routine group(P0.05),middle score groups were higher than the routine groups(P

Objective To investigate the significance of procalcitonin(PCT),C-reactive protein(CRP),white blood cell(WBC) and other inflammatory markers in the diagnosis of pediatric patients with HFMD.Methods 138 cases of pediatric patients with foot and mouth disease(study group)and 50 cases of healthy children(control group)were recruited in the study.Procalcitonin (PCT),white blood cell(WBC),neutrophil count(NC),lymphocyte count(Ly),immunoglobulins,C-reactive protein and other indi-cators were determined and compared.Results PCT,CRP,WBC,NC,Ly% and IgM levels were higher in study group than those in control group,the differences were all statistically significant(P <0.05 );IgG,IgA levels in control group were lower than that in control group,the differences were statistically significant(P <0.05).Conclusion PCT,WBC,NC,Ly,CRP and IgA,IgG,IgM can provide experimental evidence for diagnosis of children with hand foot and mouth disease.

Objective To study the clinical diagnosis value and CT features of gastric fundus and cardiac part lesions.Methods The CT findings and examining method of gastric fundus and cardiac part lesions were analyzed and summarized in 64 cases.Results (1)Use water as oral contrast can show the gastric mucosa clearly,it was a simple,effective way.(2)CT had important significance for stages and infiltration of cardiac cancer.(3)Varix of gastric fundus had three types:pseudotumor,tuber and thinking-wall.(4)The CT characteristic features of leiomyoma were the continuous linear enhancement in mucosa.Conclusion CT is method for gastrointestinal examining,it has special value to the gastric fundus and cardiac part lesions.

Objective:To investigate the anti-myeloma cells specific immune activity induced by myeloma protein-pusled dendritic cells(DCs).Methods: DCs were obtained from peripheral blood(PB) of multiple myeloma(MM) patients after co-culture with GM-CSF,IL-4 and TNF-?.The phenotype of DCs was examined by flow cytometry.Host lymphocytes were stimulated with DCs pulsed with myeloma protein acquired from serum of MM patients on DEAE-celluose;lymphocytes treated with unpulsed-DC served as control.[~(3)H]-thymidine incorporation and 4 h ~(51)Cr-release assay were used to detect the proliferation and cytotoxicity against different targets(auto-myeloma cells,U266 cells) by T lymphocytes.Results: In vitro proliferation and cytotoxicity of T lymphocytes activated by myeloma protein pulsed-DCs were greater than those of T lymphocytes in the control group(P

Objective To explore the mechanism of HMGB1 and TLR4 in pancreatic tissue of rats with severe acute pancreatitis and the intervention effect of Ulinastatin .Methods The 54 SD rats were completely random divided into control group ,SAP group and Ulinastatin treatment group ,and each group was divided into three groups :6 ,12 h and 24 h groups (each group n=6) .In con‐trol group ,we turned the pancreatic tissue ,in SAP group ,the SAP model was made with 5% taurocholic acid ;and in the treatment group ,and intravenous injection of ulinastatin was conducted after the SAP model was successfully made .Then we observed the pancreatic tissue pathology in the three groups .The amylase in serum was detected by EPS‐G7 assay ,the HMGB1 in serum and pancreatic tissue was detected by ELISA assay ,the expression levels of HMGB1 and TLR4 in pancreatic tissue were detected by Envision two‐step immunoassay .Results Compared with control group ,the amylase of each time point in SAP group and treatment group were significantly higher ,and the pathology changed obviously (P<0 .05) ,and the SAP model was successfully made .The HMGB1 expression in pancreatic tissue and serum started increase at 6 h ,increased quickly at 12 h and maintained the increasing trend to 24 h in SAP group and it was significantly higher at the same time point compared with that of control group (P<0 .05);at the same time point ,the HMGB1 in treatment group was significantly lower than that of SAP group (P<0 .05);in SAP group , the expression of TLR4 in pancreatic tissue started increasing at 6 h ,reached its peak at 12 h and started decreasing at 24 h ,it was significantly higher than the control group at the same time point (P<0 .05) .At the same time point ,the TLR4 was significantly lower in the treatment group than SAP group (P<0 .05) .Conclusion The proinflammatory effect of HMGB1 in SAP rats pancre‐atic could be partly combine its receptor TLR4 and MyD88‐dependent pathway through implementation ,and the protecting mecha‐nism of Ulinastatin could be interrupt the HMGB1 and TLR4 signaling pathway in SAP rats pancreatic tissue .

Objective To investigate the clinical effects of mucosolvan on the respiratory tract in elderly patients with long-time tracheal intubation for upper abdominal operation.Methods A total of 88 elderly patients to receive upper abdominal surgery were randomly divided into 2 groups:the treatment group (n=41,treated with antibiotics and mucosolvan 90 mg,iv,bid,for 7 consecutive days) and the control group (n=39,with the same antibiotics but without mucosolvan).Patients indwelling endotracheal tube≤3 hours were excluded.Lung function [forced vital capacity (FVC),forced expiratory volume in 1 second (FEV1),FEV1/FVC ratios (FEV1％)],blood gas analysis (pH,PaCO2,PaO2) and lung condition changes were compared between the two groups before and after surgery.Results There was a significant difference in blood gas analysis between the two groups 3 days after surgery (P＜0.05).There were differences in FEV1 and FEV1％ between the two groups 5 days after surgery (P＜0.05),but no differences were found in FVC in the two groups before versus after surgery.There were significant differences in the incidences of pulmonary infection and atelectasis between the treatment group and the control group [4.9 ％ vs.23.1％ (2 cases vs.9 cases),0％ vs.10.3％ (0 cases vs.4 cases),respectively,both P＜0.05].Conclusions Mucosolvan has a better protective effect on the respiratory tract in elderly patients undergoing upper abdominal surgery and the synergies can be achieved in combination with antibiotics.

BACKGROUND:Long course of treatment and complications limit the extensive application of distraction osteogenesis, which cannot meet the clinical requirements. OBJECTIVE:To investigate the effect of general administration of eucommia alcohol extract on new bone regeneration based on the rabbit model of mandibular distraction osteogenesis. METHODS:Twenty-four New Zealand white rabbits were randomly divided into experimental group and control group. Unilateral mandibular distraction osteogenesis model was established by 1 mm/12 h distraction protocol. During the distraction period, the rabbits in the experimental group were intragastricaly administered with eucommia alcohol extract and the control animals received the same amount of physiological saline, respectively. Six weeks later, the animals were sacrificed for osteogenic testing. RESULTS AND CONCLUSION: New bone formation was observed in the distracted gap in both groups. However, the amount, mineralization and biomechanical strength of new regenerated bone in the experimental group were obviously greater than those in the control group by histological observation, dual energy X-ray absorptiometry, micro-CT and biomechanical test. General administration of eucommia alcohol extract can markedly promote distraction osteogensis in rabbit mandibular osteodistraction.

Objective To compare the blood high mobility group box-1 (HMGB-l) versus N-terminal prohormone of brain natriuretic peptide (NT-proBNP) for assessment of cardiac dysfunction in the patients with severe sepsis.Methods Ninety-eight patients of both sexes,aged 18-75 yr,were divided into 3 groups according to left ventricular ejection fraction (LVEF):non-cardiac dysfunction group (LVEF ≥ 50 ％,n =43),mild cardiac dysfunction group (30％ ≤ LVEF ＜ 50％,n =41),and severe cardiac dysfunction group (LVEF ＜ 30％,n =14).Acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score was performed.Venous blood samples were obtained for determination of the concentrations of HMGB-1 and NT-proBNP.Days of hospitalization and the survival rates within 28 days after admission to hospital were recorded.Pearson correlation between blood HMGB-l,NT-proBNP concentrations and LVEF was analyzed.Results Compared with non-cardiac dysfunction group,LVEF was significantly decreased,APACHE Ⅱ score and blood HMGB-1 and NT-proBNP concentrations were increased,days of hospitalization were prolonged,and the survival rates were decreased in mild and severe cardiac dysfunction groups,and the changes in the parameters mentioned above were more obvious in severe cardiac dysfunction group.The correlation coefficient between blood HMGB-1 concentration and LVEF was -0.639 and between blood NT-proBNP concentration and LVEF was-0.521,showing significant difference.Conclusion Blood HMGB-1 concentration provides higher reliability than blood NT-proBNP concentration in assessing the degree of cardiac dysfunction in the patients with severe sepsis.