Teaching in out-patient clinic is a new and unique teaching mode,which is characteristic of one-to-one tutoring experiences.Students are put in the key positions while mentors serve as assistants in the whole process.By means of repeated practicing,summing-ups and perceiving,students improve their ability to combine theory with practice,enhance capabilities of communication,enrich their social experience and increase their talent of independent working.Meanwhile,further trainings may endow our medical students with better abilities of summarization.Through practice,teaching clinic has been proved to be a reasonable teaching mode which deserves promotion.

Objective To investigate the effect of ramipril on urinary protein in elderly type 2 diabetic patients with nephropathy in different periods.Methods 120 type 2 diabetic patients with nephropathy (64 males, 56 females) with mean aged (68±3) years were randomized into treatment group and control group (n =60, each).According to test results of 24 h proteinuria and renal function, they were divided into 3 subgroups: the normal urine albumin (normal control) group, the early diabetic nephropathy group, and the clinical diabetic nephropathy group.The control group received conventional treatment, while the treatment group used conventional treatment combined with ramipril 2.5 mg/d.Both groups had treatment course of 3 months.The changes in 24 h urinary total protein and urinary albumin before and 1 and 3 months after treatment, and the changes in blood urea nitrogen and serum creatinine levels in patients with renal dysfunction before and 3 months after treatment were observed and compared.Results 24 h urinary total protein and urinary albumin were significantly decreased along with the extended treatment time (P＜0.05 or 0.01).The blood urea nitrogen and serum creatinine levels were significantly declined at 3 months after treatment versus pre-treatment (P＜0.05 for both).There were no significant differences in 24h urinary total protein and urinary albumin in control group before versus after treatment (P＞0.05 for both).At 1 and 3 months after treatment, there were significant differences both in the decrement of 24h urinary total protein and urinary albumin, and in the blood urea nitrogen and serum creatinine levels between the clinical diabetic nephropathy treatment group and the control group (P＜0.05 or 0.01).Conclusions Ramipril combined with conventional treatment can effectively reduce proteinuria and promote the recovery of renal function for type 2 diabetic patients with nephropathy.

Objective To investigate diagnostic value of ectopic pregnancy by transvaginal sonography (TVCDS) combining with detection of blood β-human chorionie gonadotropin(β-HCG) and progesterone(P) level. Methods 96 ectopic pregnancy patients were exahined by TVCDS,and detected β-HCG and P in the same day or next day,every two days or several days reexamination of β-HCG and P were given to the hospitalization patients. Re-suits 96 ectopic pregnancy patients including massive type 76(79.1%) ,diameter (47.6±18.4) mm;embryo sac type 20(20.9%) ,showed embryo sac structure in ectopic pregnancy area,saw pulsation in saccus vitellinus and fetus vascular color,diameter (12.86±6.85)mm. 94(97.9%) displayed Doppler signals in ectopic pregnancy area, and 89(92.7%)cases were detected low resistivity nutrient artery flow spectrum by PW, the PI average value was (0.46±0.03).96 ectopic pregnancy patients' blood β-HCG and P level were significant low(P<0.01). Conclusion TVCDS combining with detection of β-HCG and P can raise early diagnosis level of ectopie pregnancy.

As a major adhesion molecule of endothelial junction, vascular endothelial cadherin (VE-cadherin) plays a very important role for the maintenance of vascular homeostasis. It regulates infiltration of vascular endothelia on contents in plasma such as eukocytes and lipid, as well as cellular proliferation and apoptosis. It plays an important role by involving in angiogenesis in the multiple links of the process of atherosclerosis, This article reviews the recent progress in research on the effects and mechanisms of VE-cadherin in the occurrence and developmaent of atherosclerosis in recent years.

Objective To explore and analyze the clinical curative effect and prognosis of enteric -coated aspirin combined with clopidogrel in the treatment of unstable angina pectoris of coronary heart disease.Methods 84 patients with unstable coronary heart disease angina pectoris were selected in the research,and they were divided into regular treatment group and combination group,42 cases in each group.The patients in conventional treatment group were given enteric -coated aspirin therapy,and the combined treatment group were given clopidogrel on the basis of routine treatment.The myocardial enzymology indexes of 24h before and after drug treatment,electrocardio-gram (ECG)recovery,curative effect and adverse reaction were compared between the two groups.Results After treatment,the myocardial enzymology indexes of the combined treatment group (AST,CK -MB,cTnT,cTnI)had sig-nificant differences compared with the general treatment group (t =3.98,P <0.05,t =0.05,P <0.05,t =0.05,P <0.05,t =0.05,P <0.05).After treatment,the ECG total recovery rate of the combination group increased obviously compared with the conventional treatment group,the difference between the two groups was significant (χ2 =5.49, P <0.05).The total effective rate of the combined treatment group increased obviously compared with the conventional treatment group,the difference between the two groups was significant (90.5% vs 64.3%,χ2 =4.48,P <0.05).The incidence rate of adverse reactions had no obvious difference between the two groups (83.3% vs 66.7%,χ2 =2.88, P >0.05).Conclusion Drug combination therapy in the treatment of unstable type of coronary heart disease angina pectoris can synergistically improve clinical symptoms and physical fitness,improve patients'quality of life,it is safe and reliable,which is worth popularization and application widely.

Objective To investigate the protective effects of Shenfu injection on myocardium against ischemia and reperfusion injury in rats. Methods Twenty-four healthy male SD rats weighing 230-280 g were randomly divided into three groups (n = 8,each): sham-operation group(Sham), ischemia and reperfusion group (I/R), Shenfu injection group(SF) . In Sham group, the anterior descending branch of left coronary artery was exposed and a piece of silk thread was placed around the artery but untied. The ischemia and reperfusion injury models in I/R and SF groups were made by temporary ligation of the anterior descending branch of left coronary artery,ischemia lasted for 30 min and reperfusion for 60 min. In SF group, the Shenfu injection(10 ml/kg) was intraperitoneally injected 30 min before ischemia. In Sham and I/R groups, normal saline (10 ml/kg) was intraperitoneally injected. After 60 min reperfusion, the blood samples of all rats in each group were collected from the left carotid arterial catheter for determination of the concentrations of plasma TNF-?, IL-6 ( ELISA) . The myocardium samples were obtained for ultrastructure observation (Electron-microscope) .Results Compared with that in Sham group, the plasma concentrations of TNF-? and IL-6 in I/R group significantly increased( P

Objective:To explore the Wnt-β-catenin signal molecule expression level in acute kidney injury rats renal tissue. Methods:A total of 48 rats accorded to the random number table method were divided into normal control group ( Control group) ,sham operation group ( Sham group) and ischemia reperfusion group ( IRI group) ,each group with 16 rats,Control group was given normal fed,IRI group were established ischemia reperfusion injury rats model,Sham group opened dorsal skin and then wound was closed. 4 rats were sacrificed respectively at 1,3,5,7 d after surgery,the pathological changes of kidney tissue were observed in the three groups,and the serum creatinine,urea level was detected in the three groups. Wnt4,β-catenin,Lrp6 protein expression was detected in three groups of rats by Western blot,Wnt4,β-catenin,Lrp6 mRNA in renal tissues were detected by Real-time quantitative RT-PCR. Results:There was no significant difference in renal injury score and serum creatinine between Control group and Sham group (P>0. 05),IRI group kidney injury score and serum creatinine,urea first increased and then gradually decreased,which was the highest in 3 d after surgery,IRI group renal injury score and serum creatinine,urea were significantly higher than those in Control group and Sham group 1,3,5,7 d after surgery (P<0. 05). There was no significant difference in Wnt4,β-catenin,Lrp6 protein between Control group and Sham group (P>0. 05),IRI group Wnt4,β-catenin,Lrp6 protein gradually increased,which reached to peak at 5 d after surgery,and then gradually decreased,IRI group Wnt4,β-catenin,Lrp6 protein were significantly higher than those in Control group and Sham group 1,3,5,7 d after surgery(P<0. 05). There was no significant difference in Wnt4,β-catenin,Lrp6 mRNA between Control group and Sham group (P>0. 05),IRI group Wnt4,β-catenin,Lrp6 mRNA gradually increased,which reached to peak at 3 d after surgery,and then gradually decreased,IRI group Wnt4,β-catenin,Lrp6 mRNA were significantly higher than those in Control group and Sham group 1,3,5,7 d after surgery (P<0. 05). Conclusion: The expression of Wnt-β-catenin signal molecule are significantly increase in acute kidney injury,and the activation of Wnt-β-catenin signal pathway is involved in the repair process of renal tissue.

Taking 201 Hospital of PLA as an example, the paper introduces the design of interface betweenNo.1 Military Medical Projectand the New Rural Coadjutant Medical Care ( NRCMC) system from the aspects of interface system constitution and technical design, etc.The system runs smoothly since application, promotes business dealings between hospital and NRCMC center, and it is worth promotion.

Objective To investigate the effects of direct peritoneal resuscitation (DPR) with sodium pyruvate from hemorrhagic shock (HS) on intestinal injury in rats.Methods Fifty SPF male Sprague-Dawley rats,weighing 200-250 g,were used in this study.The animals were anesthetized with 1％ pentobarbital sodium 40 mg/kg,tracheostomized and mechanically ventilated.Femoral artery was cannulated for mean arterial pressure (MAP) monitoring,blood-letting,blood sampling and fluid infusion.HS was induced according to the method described by Wiggers.MAP was maintained at 35-40 mm Hg for 60 min.The animals were then randomly and equally divided into 5 groups:sham operation group (group S) ; conventional resuscitation group (group CR) ; DPR with different fluid groups (DPRt-3 groups).In group CR,at 1 h after HS,the animals were resuscitated with infusion of the blood withdrawn and normal saline (the volume was 2 times volume of blood loss).In DPR1-3 groups,conventional resuscitation was performed,at the same time,1.5 ％ glucose-based peritoneal dialysis solution containing lactate,1.5％ glucose-based peritoneal dialysis solution containing lactate (40.00 mmol/L),and 1.5％ glucosebased peritoneal dialysis solution containing high lactate (80.00 mmol/L) 20 ml were infused intraperitoneally over 30 min,respectively.MAP was recorded before blood letting,at 5,30 and 60 min of HS,and at 5,30,60,90 and 120 min after the end of resuscitation.At 120 min after the end of resuscitation,the lactate level in the arterial blood was measured.The animals were then sacrificed.Small intestinal samples were obtained for determination of malondialdehyde (MDA) content,myeloperoxidase (MPO) activity and tumor necrosis factor-α (TNF-α) expression,and for microscopic examination.The damage to the small intestinal mucosa was assessed and scored.Results Compared with MAP before blood letting,MAP during HS was significantly decreased,and no significant change in MAP was found after resuscitation in CR and DPR1-3 groups (P ＜ 0.05).The lactate level in the arterial blood,MDA content,MPO activity,TNF-α expression and intestinal mucosal damage scores were significantly higher in CR and DPR1-3 groups than in S group (P ＜ 0.05 or 0.01),while lower in DPR1-3 groups than in CR group (P ＜0.01),and in DPR2,3 groups than in DPR1 group (P ＜ 0.05 or 0.01).The lactate level in the arterial blood,MDA content and TNF-α expression were significantly lower in DPR3 group than in DPR2 group (P ＜ 0.05 or 0.01).Conclusion Direct peritoneal resuscitation with sodium pyruvate can reduce the intestinal injury induced by HS and inhibition of lipid peroxidation and inflammatory responses is involved in the mechanism in rats.