The author reviewed the development of general practice education in our country,deliberated and summarized the problems about the construction of curriculum system,the ranks of teachers and practice base in general practice education in higher medicine colleges.

Objective To probe into the usage of statins in the patients with coronary artery disease in elderly patients. Methods From Jun 1,2009 to Mar 31,2009 in our hospital, 323 elderly outpatients with coronary artery disease were included in the investigation. The data were statistically analyzed. Results 62.2% of the patients used statins. The statins usage rates (44. 8% ,61.3% ,71.3% ) among three age groups(60 -69 years old,70- 79 years old, and ＞ 80 years old)were significantly different. The rates of statins usage were significantly different between male and female groups. Conclusion The usage of statins as secondary prevention of coronary artery disease varies and there is urgent need to standardize the usage of statins according to the treatment guideline.

Securin is a multifunctional protein which is encoded by PTTG gene.In the metaphase to anaphase transition during mitosis,Securin is involved in sister chromatid separation.The aberrant expression of Securin is found in many endocrine and related cancers,such as pituitary tomour,thyroid cancer,ovarian cancer,colon cancer et al.The function of Securin in cancer is related to its gene transactivation and association with other poteins like p21,p53.

OBJECTIVE To strengthen and explore the effect of target monitoring in ICU.METHODS To put out prospectively the target monitoring of the nosocomial infection in ICU from Jan 2006 to Dec 2007.RESULTS A total of 3917 patients were monitored and 217 of them suffered from infection.The day infection rate was 11.7‰,and the infection rater per thousand day were 13.4‰,10.0‰ in 2006 and 2007,respectively.The infection rate related to urinary catheter,central venous catheter and ventilator were 1.2‰,0.9‰,4.1‰,2.8‰,14.2‰,6.0‰ in the past two years,respectively.It decrease 0.3‰,1.3‰,8.2‰,respectively.Ventilator-associated infection was the main infection part of hospital infection,and the patients after liver transplantation ICU had the highest infectionrate.CONCLUSIONS Prospective target monitoring is a scientific monitoring method that plays an important role in controlling and preventing hospital-acquired infection.It deserves recommendation.

Objective To study the effects of using the dropping retention-enema in the clinical practices.Methods Divided 60 cases who need retention-enema into the experimental group and the control group,there were 30 cases in the each group.The traditional retention-enema method was used in the control group,while the dropping retention-enema method was used in the experimental group.Compared the related factors between the two groups.Results All the factors which can indicated the clinical effects in the experimental group were better than those of in the control group,P

Objective To investigate the influence of neutrophil-lymphocyte ratio (NLR) on radiosensitivity and prognosis,the relationship between NLR and clinical features,and the clinical value of NLR in patients with nasopharyngeal carcinoma (NPC).Methods 2006 to 2011 in the cancer center of Zhongshan University admitted to the newly diagnosed nasopharyngeal cancer patients in 266 cases.The association of pretreatment NLR with radiotherapy doses 20,40,and 60 Gy and therapeutic effect at 3 months after radiotherapy was analyzed,as well as the influence of NLR on overall survival (OS),local recurrence-free (LRF),and distant metastasis-free (DMF) rates.The Kaplan-Meier method was used to calculate survival rates and the log-rank test was used for survival difference analysis.Results NLR showed differences across patients with different T stages and sexes (P=0.039,0.032).The patients with NLR≤3 had significantly higher OS,LRF,and DMF rates compared with those with NLR＞ 3 (P=0.004,0.025,0.045).As NLR increased,the radiosensitivity in patients with NPC was reduced gradually,and radiosensitivity showed a significant difference between sensitive group and moderately sensitive group (P=0.043).When the radiotherapy dose was 40 Gy,the tumor regression group had a lower NLR than the residual tumor group (P=0.025).Conclusions In patients with NPC,an increased pretreatment NLR is an adverse prognostic factor,and NLR can be used as a simple and convenient method to evaluate the prognosis of patients with NPC.

Objective To investigate the effect of small interfering RNA (siRNA) mediated silencing of △Np73 on 5-FU chemotherapy sensitivity in SW620 colocancer cells and provide new treatment approach for the colon cancer.Methods siRNAs were transfected into SW620 colon cancer cells.The expression of △Np73 was observed.Cell viability of colon cancer cells were measured by MTr assay and cell apoptosis was assessed with flow cytometry after treatment of control siRNA or △Np73 siRNA or combined with 5-FU,respectively.The tumorigenesis was assessed by injecting △Np73 siRNA or control siRNA transfeeted SW620 colon cancer cells into nude mice,followed by treatment with 5-FU in the tumors.Results △Np73 siRNA was able to strongly inhibit △Np73 expression,however,it did not inhibit the growth of cells.Combination treatment with △Np73 siRNA and 5-FU produced significant higher apoptotic cell(42.9%) as compared with those with 5-FU treatment(18.9%) alone or those with △Np73 siRNA(8.8%) alone.The treatment with 5-FU in the xenngrafts derived from △Np73 siRNA transfected SW620 cells in nude mice can inhibitor tumor growth significantly (t=15.32,P<0.05).Conclusion △Np73siRNAs can specifically repress the expression of △Np73.Thus it sensitizess the cells to 5-FU chemotherapy in colon cancer.

Objective To demonstrate the imaging characteristics of pancreatic neuroendocrine neoplasm (P-NEN).Methods The CT and MRI findings of 43 cases of P-NEN confirmed by pathology were analyzed,and compared with pathological results.Results Mean size of 43 lesions in 43 P-NEN patients were (25.00± 1.82)mm.Necrosis cystic degeneration were found in 26 lesions.In CT plain scan,15 lesions were isodense,28 lesions were hypodense.All of 43 lesions were hypointensity signal on T1WI;27 lesions were hypointensity signal,16 cases were isointensity signal on T2WI.Twenty-seven lesions showed envelope;30 lesions showed clear outline.In enhancement images,24 lesions were marked enhancement since arterial phase;8 lesions showed delayed enhancement;5 lesions showed centrality enhancement;6 lesions showed wild enhancement.Conclusion P-NEN has some characteristics on CT and MRI scanning,imaging can play an important role in diagnosis for P-NEN.

Objective To assess the efficacy and safety of nalbuphine in preventing the side effect of pruritus induced by intrathecal morphine after cesarean section. Methods Sixty patients aged 18- 35 years with ASAⅠ~Ⅱand undergoing cesarean section with combined spinal-epidural anesthesia were randomly and double blindly divided into two groups. Patients in Group N (30 patients) received nalbuphine 4 mg (2 ml) by intravenous route after clamping of the umbilical cord; Patients in Group P (30 patients) received 0.9% NaCl (2 ml) by intravenous route after clamping of the umbilical cord. The protocol of postoperative analgesia was intrathecal morphine 0.2 mg. The patients were followed up for 4 h , and the vital signs were detected at the time of returning to patient s room (T0), 1 h (T1), 2 h(T2), 3 h(T3) and 4 h(T4) after operation. The VAS scores, pruritus severity scores, time of pruritus onset, Ramsay sedation scores and and other adverse effects were recorded. Results The levels of MAP, SpO2, HR in two groups at T0, T1, T2, T3, T4 had no significant differences (P>0.05). The rate of pruritus severity score 0-1 score in group N was significantly higher than that in group P (χ2=17.4, P=0.00). The VAS scores and the rate of drowsiness, nausea, vomiting, shivering and dizziness in two groups had no significant difference (P>0.05). Conclusions Nalbuphine provides a significant reduction of morphine induced pruritus for patients who received intrathecal morphine analgesia after cesarean section.

Objective:To investigate the predictive value of matrix metalloproteinase-9 (MMP-9) and neutrophil to lymphocyte ratio (NLR) in delayed perihematomal edema (dPHE) after spontaneous intracerebral hemorrhage (sICH).Methods:Patients with sICH admitted to Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School within 24 h of onset from January 2018 to June 2020 were enrolled retrospectively. Serum MMP-9 levels and peripheral blood cell counts were detected, and NLR were calculated within 24 h of onset. dPHE was defined as an increase of 3 ml in absolute edema volume at 10-21 d after onset of sICH compared with that at 5-9 d. The demographic and baseline clinical and imaging data of the dPHE group and the non-dPHE group were compared. Multivariate logistic regression analysis was used to identify the independent predictors of dPHE. The receiver operating characteristic (ROC) curve was used to evaluate the predictive values of MMP-9 and NLR for dPHE. Results:A total of 195 patients with sICH (61.88±10.60 years old) were enrolled in the study. One hundred and forty-eight patients were males (75.9%). There were 53 patients (27.2%) in the dPHE group and 142 (72.8%) in the non-dPHE group. Univariate analysis showed that age, baseline hematoma volume, baseline National Institutes of Health Stroke Scale score, fasting blood glucose, high-sensitivity C-reactive protein, MMP-9, neutrophil count, NLR and the proportion of irregular hematoma in the dPHE group were significantly higher than those in the non-dPHE group (all P<0.05). Multivariate logistic regression analysis showed that after adjusting for confounding factors, higher MMP-9 (odds ratio [ OR] 4.291, 95% confidence interval [ CI] 2.041-6.590; P=0.007) and higher NLR ( OR 2.530, 95% CI 1.157-4.022; P=0.011) were all the independent predictors of dPHE. ROC curve analysis showed that the area under the curve of MMP-9 for predicting dPHE was 0.819 (95% CI 0.756-0.884; P<0.001), the optimal cut-off value was 164.0 μg/L, and the sensitivity and specificity were 86.79% and 66.90% respectively. The area under the curve of NLR for predicting dPHE was 0.788 (95% CI 0.719-0.856; P<0.001), the optimal cut-off value was 5.683, and the corresponding sensitivity and specificity were 77.36% and 71.13% respectively. Conclusions:sICH patients with higher baseline MMP-9 and NLR are more likely to develop dPHE. Early detection of MMP-9 and NLR in peripheral blood after admission can predict dPHE.