Advanced studying doctors play important roles in the clinical services, and how to train them to improve training quality is worth investigating. We classified them into three types such as the clinical skills-improved, the special skills-trained and clinical knowledge eextensively-spread, then employed the individual teaching methods and emphasized the medical ethics during the training, which is not only beneficial to us, but also of great importance and necessity to advanced studying doctors themselves.

BACKGROUND:Many foreign studies confirm that recombinant human growth hormone (rhGH) is a safe and effective agent for treatment of idiopathic short stature (iSS), but there are no long-period and systematical researches reported in China.OBJECTIVE: To observe the promoting effect of rhGH on the growth of children with ISS.DESIGN: Case-control observation.SETTING: Department of Pediatrics, the Affiliated Hospital of Medical College of Qingdao University.PARTICIPANTS: Ninety-eight children with ISS who were treated in the Department of Pediatrics, the Affiliated Hospital of Medical College of Qingdao University during December 2004 to March 2006 were involved in this study.Informed consents were obtained from the guardians of these children with ISS. According to the etiological factors, the children were assigned into 2 groups: ISS group (n =30) and growth hormone deficiency (GHD) group (n =68).METHODS : The children in ISS group and GHD group received subcutaneous administration of home-made rhGH (Jinsai Pharmaceutical Co.,Ltd., Changchun at 0.15 IU/(kg ·d) and 0.1 IU/(kg ·d) respectively before sleeping within 6 months.The body height, body mass and bone age were measured before, 3 and 6 months after treatment. The local region of injection was observed and the growth rate was calculated. Bone age was calculated by graphic atlas method and body height was predicated by BP method.MAIN OUTCOME MEASURES: Body height, body mass, bone age and growth rate of children in two groups before, 3 and 6 months after treatment.RESULTS: All the 98 children wereinvolved in the result analysis, without deletion. ①Intragroup comparison: The body height, growth rate of children in two groups 3 and 6 months after treatment were significantly superior to those before treatment [ISS group: body height:(126.5±9.4), (129.1±8.6), (121.1 ±11.0) cm (P ＜ 0.01), growth rate: (7.3±2.9), (7.5±2.7),(3.5±2.1) cm/year (P＜ 0.01); GHD group: body height: (111.0±13.0),(114.0±13.0),(108.0±12.0) cm(P＜ 0.01),growth rate: (13.2±3.5), (13.5±3.6), (4.0±2.9) cm/year(P ＜ 0.01)]. Six months after treatment, body height was increased in 27 of 30 children in ISS groups, and in all the 68 children in GHD group. ② Intergroup comparison: The growth rate of children in GHD group was concurrently higher than that in ISS group 3 and 6 months after treatment. ③Adverse reaction and side effect: During the treatment, hypothyroidism was observed in 2 children within 1 to 3 months of treatment,but there was no influence on growth rate after oral administration of thyroxin tablets. Local red swelling of skin was observed in another patient, which stopped automatically after one week duration, but the injection continued.CONCLUSION: Home-made rhGH is a safe and effective reagent for treatment of ISS. It can obviously enhance the body height and growth rate of children. Whereas the inhomogeneity of treatment effect does exist, what's more, therapeutic effect in ISS children is inferior to that in GHD children.

BACKGROUND: The oxidation of low density lipoprotein (LDL) is a key influencing factor in the occurrence and development process of atherosclerosis. How is the merit of the method for the detection of the level of anti-serum oxidized LDL (ox-LDL) antibody on the evaluation of atherosclerotic plaque?OBJECTIVE: To study the method for the detection of serum anti-ox-LDL antibody in mice with apolipoprotein E (Apo-E) genetic defect to analyze the merits of serous level of anti-ox-LDL antibody on the evaluation of the area of atherosclerotic plaque in mice with Apo-E genetic defect.DESIGN: Single factor analysis of variance (a case-controlled study)SETTING: Laboratory of nutrition and metabolism diseases in a university.PARTICIPANTS: Mice with Apo-E genetic defect were grouped into positive group (series: C57B L/6J, n = 15), while normal mice were grouped into control group (series: C57BL/6J, n = 15).INTERVENTIONS: Mice of two groups were fed in separate cage on laminar flow shelf for free drinking and eating. The venous blood was drawn from the orbit of mice after 16 weeks for the separation of mice serum. The level of anti-ox-LDL antibody was detected by enzyme-linked immunosorbent assay (ELISA) in the separated serum from either mice with Apo-E genetic defect or normal mice. The area of atherosclerotic plaque was measured by image analysis after oil red O staining.MAIN OUTCOME MEASURES: ox-LDL level and atherosclerotic plaque area in mice with Apo-E genetic defect or normal mice.RESULTS: Anti-ox-LDL antibody level of mice with Apo-E genetic defect was[ (0. 079 ±0. 028)% ], which was significantly higher than [(0. 012± 0.001 )% ] of normal mice ( F= 10. 666, P ＜ 0.01 ). The area of atherosclerotic plaque of mice with Apo-E genetic defect was (26. 25 ± 9.20) %, which was also significantly higher than 0% of normal mice, and moreover, there was a significant correlation between these two factors ( r =0. 638, P ＜ 0.01).CONCLUSION: Serum level of anti-ox-LDL antibody in mice with Apo-E genetic defect is closely correlated with the area of atherosclerotic plaque,which is an important indicator for the generation of atherosclerosis in mice with Apo-E genetic defect.

To explore the protective effect of adenovirus mediated IGF-Ⅰgene(Ad-IGF-Ⅰ)transfer on non-obese diabetic(NOD)mice. The results showed that the incidence of diabetes and degree of insulitis were significantly reduced in mice receiving Ad-IGF- Ⅰ . Treatment with Ad-IGF- Ⅰ significantly decreased apoptosis rate,expression of Fas and caspase-3, and increased expression of Bcl-xl. This study indicates the potential of IGF- Ⅰ gene therapy in protecting NOD mice from insulitis and apoptosis.

Objective:To develop an HPLC-DAD method for the simultaneous determination of seven active constituents chloro-genic acid, 3,5-dicaffeoylquinic acid,linarin, luteolin-7-O-β-D-glucoside, apigenin-7-O-β-D-glucoside , luteolin and acacetin in the different parts of Dandrantherna morifolium( Ramat. ) Tzvel. Methods:The chromatographic separation was performed on a Diamonsil C18 column (200 mm × 4. 6 mm,5 μm) with 0. 2% phosphoric acid-acetonitrile as the mobile phase with gradient elution at the flow rate of 1 ml·min-1 . The detection wavelength was set at 348 nm,and the column temperature was maintained at 30 ℃. Results:Chlorogenic acid, 3,5-dicaffeoylquinic acid, linarin, luteolin-7-O-β-D-glucoside, apigenin-7-O-β-D-glucoside , luteolin and acacetin was linear within the range of 0.014-0.560 μg(r =0.999 5) ,0.031-1.260 μg(r =0.999 6), 0.022-0.900 μg(r =0.999 8), 0. 036-1. 440 μg(r=0. 999 6),0. 029-1. 160 μg (r=0. 999 7) , 0. 005 5-0. 220 0 μg (r=0. 999 8) and 0. 006 5-0. 260 0 μg (r=0. 999 9), respectively. The average recovery was 97. 91%, 97. 91%, 97. 55%, 96. 43%, 96. 44%, 97. 07% and 97. 48%, and RSDs was 1. 24%, 1. 29%, 1. 48%, 1. 83%, 0. 67%, 1. 88% and 1. 80%, respectively. Conclusion: The method is convenient, accurate and reproducible in the quality control of the multicomponents in different parts of Dandrantherna morifolium( Ramat. ) Tzvel.

Objective To investigate whether low-protein diet has protective effect on the progression of renal interstitial fibrosis in rats with cyclosporine A (CsA)-induced nephropathy. Methods Eighteen male Sprague-Dawley rats were randomly divided into three groups (6 rats in each group). The rats in control group (C group) received common diet; in model group (M group) low-salt diet; in intervention group (Ⅰ group) low-salt and low-protein diet. After diet adaptation period of one week, the rats in C group received subcutaneous injection of olive oil 1 mg/kg daily for 5 weeks, while M group and Ⅰ group subcutaneous injection of CsA (diluted into 25 g/L with olive oil) 1 ml/kg for 5 weeks. All the rats were sacrificed at the end of the 5th week. The food-intake and body weight were measured daily. The creatinine clearance (Ccr) was examined before rats were sacrificed. The semi-quantitative pathological analysis on kidney sections was performed. The mRNA and protein expression of transforming growth factor-β1 (TGF-βI) and type Ⅰ collagen (Col Ⅰ) in kidney tissue was determined with real time PCR and immunohistochemical staining, respectively. Results The food-intake and body weight of rats in M and I groups were significantly lower than those in C group (P<0.05). Compared with C group, the Ccr levels in M and Ⅰ groups were significantly reduced [(0.65±0.15) ml/min, (0.40+0.13) ml/min vs (1.55±0.29) ml/min, P<0.05], the relative fibrosis areas of kidney interstitium in M and I groups were significantly increased (3.60%±0.46%, 3.26%±0.75% vs 0.44%±0.24%, P<0.05), the mRNA and protein expression of TGF-β1 in M and I group was significantly up-regulated (by 2.6 and 3.1 times in mRNA and by 1.5 and 1.6 times in protein, respectively, P<0.05), and the mRNA and protein expression of Col Ⅰ in M and I groups was also significantly up-regulated (by 3.0 and 3.5 times in mRNA and by 2.3 and 2.1 times in protein, respectively, P<0.05). There were no significant differences between M and I groups in every parameters above-mentioned except the rat body weight and Ccr. Both the body weight and Ccr in Ⅰ group were significantly lower than those in M group (P<0.05). Compared with C group, the urine osmotic pressure in M group and in I group were deceased (for M group, P>0.05; for I group, P<0.05). Compared with C group, the serum cholesterol levels in M and I groups were significantly increased (P<0.05), and the serum phosphorus level in I group was significantly decreased (P<0.05). The levels of serum albumin and serum calcium of all three groups had no statistical differences (P>0.05). Conclusion Low-protein diet has no renoprutective effects on the rat model of cyclosporin A nephropathy, on the contrary, may induce body weight loss.

Objective To compare the operative cooperation of da Vinci robotic surgery and traditional laparoscopic surgery, so as to provide evidence to qualify the operative cooperation of minimally invasive operation. Methods Comparison of the operative cooperation with related experiences and literature was made between the two kinds of surgeries. Results More requirements were put forward during the da Vinci robotic surgery on nurses′ service quality and training methods, ethics & law knowledge and humanistic care, equipment installation and preparation, complicated nursing performance content, system error handling and postoperative management, etc.. Conclusions It is suggested that the operative cooperation of the precise minimally invasive operation should be improved as follows:strengthen the nurses′ special training and continuing education; establish related operation process and management standards;do patients′explanation work and surgical team cooperation.

Objective To analyze the clinical features,treatment and prognosis of children with post-stroke epilepsy.Methods Sixty-nine children with epilepsy after cerebral stroke who were admitted to Guangdong General Hospital from Jan.2009 to Mar.2013 were retrospectively reviewed,including etiology,clinical features,laboratory examinations,treatment and prognosis.Results Among 260 stroke patients,69 of them (26.5 ％) developed epilepsy,but there was no significant difference between boys and girls(x2 =0.725,P =0.394).The incidence of post-stroke epilepsy differed significantly among different types (x2 =12.000,P =0.02),highest in the children with subarachnoid hemorrhage(47.8％,11/23 cases),followed by those with cerebral hemorrhage (34.6％,27/78 cases),and lastly,those with cerebral ischemia (19.5％,31/159 cases).Among them,53 patients developed seizures in the early stage (76.8％,53/69 cases),others in the late stage(23.2％,16/69 cases),early-onset epilepsy was more common in hemorrhagic stroke and late-onset epilepsy was more common in ischemic stroke,which differed significantly(x2 ＝ 4.778,P =0.029).The electroencephalogram background generally showed slow-wave in the early-onset epilepsy.The composition of seizure types differed significantly among different types of stroke (x2 =8.461,P =0.015).Forty-five of 58 patients (77.6％) suffered from cortical lesions and 13 of 58 patients (22.4％) suffered from subcortical lesions.Those children with post-stroke epilepsy who regularly use of antiepileptic drugs were followed up for 6 months to 4 years,81.2％ (56/69 cases)of clinical seizures were controlled.Conclusions The incidence of epilepsy after stroke is higher in children than in adults,cerebral stroke seizure occurs more commonly in cases with hemorrhagic stroke,especially with subarachnoid hemorrhage.Conventional antiepileptic treatment is effective.

Objective To investigate the application of combined detection of serum calcitonin(PCT),interleukin-6 (IL-6)and C reactive protein(CRP)in early diagnosis of sepsis in intensive care unit(ICU).Methods ICU ward diagnosed 89 cases of patients with early sepsis(sepsis group),fever and did not peak use of antibiotics,send blood to blood culture and detection of PCT,IL-6,CRP level,and at the same time to select 132 cases of healthy subjects(healthy control group),blood samples were collected to detect PCT,IL-6,CRP;PCT,IL-6 for the detection of electrochemical luminescence method.The detection of CRP by immunoturbidimetric method.Results ICU patients with sepsis in PCT,IL-6,CRP detection value is significantly higher than the control group,and the difference was statistically significant(P＜0.01);combined detection sensitivity and specificity was significantly higher than that of single detection,PCT+ IL-6,PCT+ CRP,PCT+ IL-6-+-CRP sensitivity of three kinds of combined detection were 91.3 ％,90.5％ and 91.9％,the specificity was 89.5％,88.3％ and 89.4％,and accuracy were 85.5％,85.3％ and 85.6％.Conclusion Combined detection of PCT+ IL-6 + CRP or PCT+ IL-6 or PCT+CRP,is helpful to the clinical recognition of early sepsis.

The aim is to explore and build the treatment-care and four linkage combination integrated care model,so as to provide methods and ideas for the medical service practice.By exploring the mechanism and hierarchical management mode of the treatment-care and four linkage combination integrated care model,we have set up a whole process management closed loop in four combined linkage,including hospital,medical care,community and family,raised to solve the medical combination of acute medical treatment and the problems existing in the continuing care.After more than a year of preparation and practice,we have build the social service centered medical combined with four linkage information platform,and have realized the online and offline medical combination of care services in hospital,medical care,community and family.Based on Intemet technology,the building of the treatment-care and four linkage combination integrated care model is the efficient method to solve the difficulties and problems of the health care and the continuation demands among elderly under the current conditions,and the feasible way to realize theslight illness in the community,disease the hospital,care in institutions,pension in the family.