Objective To study the brain functional activation under speech stimulation in presbycusis pa‐tients using blood oxygenation level dependent functional magnetic resonance imaging (BOLD - fMRI) .Methods Eighteen normal hearing young volunteers ,10 normal hearing elderly people and 10 presbycusis patients received fM ‐RI under auditory task .Experimental tasks included monosyllabic verbal stimulating at tone of 1 kHz and sound in‐tensity to 90 dB ± 3 dB(after ambient noise detector Smart Sensor AR844 measurement and calibration) randomly transmitted to left and right ear .Following block design ,each stimulus was repeated twice .The lateralization of brain activation analysis observed changes in hemispheric dominance cases (or ear advantage change) .We observed brain activation analysis and changes of hemispheric lateralization advantage (or ear advantages) .SPM5 software was used to deal with the original pictures in the off - line work station to get fictional maps ,volume and intensity of the acti‐vated brain regions of interest ,and calculate the laterality index (LI) .Results To young people ,regardless of left or right ear stimulation ,the contralateral (region of intrest ,ROI) activation volume and intensity significantly increased compared to ipsilateral ,appearing contralateral hemispheric dominance ,and laterality index were - 0 .58 (left ear stimulation) and 0 .37 (right ear stimulation) .Compared to young people ,elderly people with normal hearing and presbycusis contralateral hemisphere conduction advantage was significantly reduced under monaural stimulation ,and the laterality indexes were - 0 .24 ,0 .28 (the aged group) ,- 0 .18 ,0 .25 (presbycusis group) .Young people received the left and the right ear auditory task respectively ,and the ratio of the total volume of bilateral ROI activation was 1 :2 .06 ,appearing to the right ear advantage (left brain dominance) .While the aged and presbycusis group manifes‐ted as right ear advantage decreased (left ear advantage enhanced) ,whose the total volume ratio was 1 :1 .51 for the old normal subjects and 1 :1 .61 for the hearing impaired seniors .Conclusion Auditory verbal tasks activated brain regions in the superior temporal gyrus and middle temporal gyrus were most obvious .Aging may cause these brain regions to be activated weaker ,appearing to the trend of contralateral hemisphere .The aging and deafness lead to the cortical reorganization .This may be one of the reasons for the declined speech recognition .

There are problems in traditional medical education in China. It is important to cultivate medical talents who are adaptable to social changes and medical advancement. However, the scientific quality and innovative medical students have long been neglected. This paper discussed the essence of scientific quality and innovative talents, and introduced the experience of the program of "long term clinical medicine education" at Peking University Health Science Center. We here delineateded the key points of the scientific quality and innovation education that may provide new ideas for the training of the medical talents.

Objective To investigate the effect of acupoint massage combined with foot bathing in hot water on sleep quality of patients after gynecological operation. Methods Ninety-nine gynecological patients were divided into the control group (n=49) and the observation group (n = 50) after gynecological operation according to time of admission. The control group received the routine nursing and the observation group was treated with acupoint massage and foot bathing in hot water besides routine nursing. Pittsburgh sleep quality index was used to investigate the sleep quality at the day before operation 1 and 8 days after operation. Result The sleep quality of postoperative patients in the observation group was significantly better than that of the control group (P < 0.05). Conclusions The acupoint massage with hot bathing in hot water can improve the quality of sleep of the patients after gynecological operations. For its convenience in manipulation, it is popular among patients and their families.

Objective To examine the correlation of imbalance of urinary exosome Th1/Th2 with diabetic nephropathy (DN).Methods A total of 120 patients with type 2 diabetes mellitus (DM) and 30 healthy volunteers as control were enrolled in the study.According to urinary albumin/creatinine ratio (UACR),type 2 diabetes mellitus patients were divided into 3 groups:diabetes mellitus without nepbropathy group (DM,n=40,UACR＜30 mg/gCr),microalbuminuria group (DN 1,n=50,UACR-30～300 mg/gCr) and clinicoalbuminuria group (DN 2,n=30,UACR＞300 mg/gCr).Urine exosome-interferon-gamma (IFN-γ) and exosome-interleukin 4 (IL-4) levels were determined by enzyme-linked immunosorbent assay (ELISA).Multiple stepwise linear regression was used to analyze the correlation of exosome-IFN-γ/IL-4 with glycated hemoglobin (HbA1c),cholesterol (CH),UACR,Scr and BUN.Results Th1/Th2 ratio in DM,DN1,DN2 groups was significantly higher than that in healthy group (0.8089±0.2458,0.8993 ±0.3515,0.8571±0.2470 vs 0.6198±0.1769,all P＜0.01).Correlation analysis showed that urinary exosomeIFN-γ/IL-4 ratio was positively correlated with UACR (r=0.213,P=0.015) and BUN (r=0.292,P=0.001).Multiple stepwise linear regression analysis showed that BUN was independent determinants for exosome-IFN-γ/IL-4 (β=0.246,P=0.006).Conclusion The imbalance of urinary exosomeTh1/Th2 is correlated with DN,which may play an important role in the pathogenesis of DN.