40 weeks old SHR did not differ from that in slices of age matched WKY. B max was increased in the same brain region of SHR when compared to WKY. That rats of 4 5 weeks were in prehypertensive stage;rats of 10 12 weeks and above were at the stage of establishing hypertensive stage. Conclusion: The difference between SHR and normotensive rats in 5 HT 1A receptor binding in various brain regions may be related to the development of hypertension. When blood pressure changes,binding capacity of 5 HT 1A receptor in CNS changes accordingly.

Based on the particularity of the following medical disciplines, Three orientation is the higher medical personnel training mode which orients in the future development of medical students, and makes scientific allocation and combination to medicine curriculum system , personnel training system , management mode and evaluation system and so on. The clinical practice ability of medical students is the core of the professional quality training in the three orientation. In this article, the ability of professional quality, clinical practice ability and the ability to operate are clinical practice ability training goals and the training methods and evaluation system are divided into 2 stages, the fourth year and the fifth year, as well as three aspects such as professional quality ability training, clinical practice ability training and skills training.

Objective:To evaluate the predictive value of neutrophil-to-lymphocyte ratio (NLR) for adult severe tetanus by comparing the NLR in patients with severe and mild tetanus.Methods:A total of 65 adult tetanus patients from the Linyi Central Hospital from January 2009 to December 2020 were enrolled. The patients were divided into two groups including mild group and severe group according to the Ablett classification. The general conditions, laboratory data, and NLR of patients in two group were retrospectively compared using independent samples t test. Multivariate logistic regression analysis was used for the analysis of risk factors for severe tetanus. Spearman correlation method was used for the analysis of the correlation between risk factors and Ablett grades. Receiver operator characteristic (ROC) curve was used for the evaluation of the predictive value. Results:Among the 65 tetanus cases, 34 was in mild group and 31 in severe group. The latency period of patients in severe group was (7.00±3.19) d, which was shorter than that in mild group ((9.18±2.59) d), and the difference was statistically significant ( t=3.03, P=0.004). The NLR of patients in severe group was 4.251±1.936, which was higher than that of mild group (2.533±1.026) , and the difference was statistically significant ( t=4.41, P<0.001). Multivariate logistic regression analysis showed that NLR and latency period were independent risk factors for tetanus severity (odds ratio ( OR)=2.359, 95% confidence interval ( CI) 1.415 to 3.934, P=0.001 and OR=0.748, 95% CI 0.599 to 0.936, P=0.011, respectively). In tetanus patients, the NLR level was positively correlated with Ablett grade ( r=0.644, P<0.001). The ROC curve showed that NLR had good predictive value for adult severe tetanus at a cut-off value of 2.471 (area under the curve (AUC)=0.787), with the sensitivity and specificity of 87.1% and 61.8%, respectively. When combining NLR with latency period (cut-off value of 7.5 d), predictive efficiency was further improved (AUC=0.832) with the sensitivity of 87.1% and specificity of 67.6%( Z=3.43, P<0.001). Conclusions:NLR has a good predictive value for adult severe tetanus, and the predictive efficiency is further improved when combined with latency period.

Objective To investigate the training process of clinical practice ability in medical undergraduates in the context of tutorial system,as well as new clinical training models and evaluation methods.Methods A total of 40 medical undergraduates who entered the stage of clinical practice were randomly divided into tutorial group and control group,with 20 undergraduates in each group.A diversified evaluation system was used to perform a comprehensive evaluation of clinical practice ability of medical undergraduates at different stages,with a combination of professional theory examination,Mini-Clinical Evaluation Exercise,Direct Observation of Procedural Skills,and clinical case report.All the data were analyzed by SPSS 23.0,t test was used for statistical analysis.Results Compared with the control group after the internship ended,the tutorial group had significantly higher scores of clinical professional theory (86.24 ± 2.93),clinical practice ability (7.53 ± 0.48),clinical operation skills (4.35 ± 0.47),and clinical thinking ability (6.31 ± 0.52) (all P＜0.05).Conclusion The application of the tutorial training mode during the internship of medical undergraduates can improve their comprehensive qualities such as professional quality,medical theory,and practical skills.The diversified evaluation system can evaluate the teaching effect and reflect the cultivation of comprehensive quality among students.

【Objective】 To investigate the differences in human epidermal factor receptor 2 (HER-2) expression between urothelial bladder carcinoma (UBC) and upper tract urothelial carcinoma (UTUC) and the relationship between HER-2 expression and disease recurrence and progression. 【Methods】 Clinical data of 184 patients with urothelial carcinoma admitted in our hospital during Nov.2015 and Jun.2022 were retrospectively analyzed.The patients were divided into UBC group and UTUC group.The positive expression rate of HER-2, recurrence-free survival (RFS) and progression-free survival (PFS) of the two groups were compared, and the survival curve was drawn.The effects of HER-2 expression on the recurrence and progression of disease were analyzed with Cox proportional hazards model. 【Results】 The positive expression of HER-2 was significantly higher in UBC patients than in UTUC patients (49.6% vs.32.2%, P=0.027).Among UTUC patients, there was no statistically significant difference in the positive expression of HER-2 in those with renal pelvis cancer and ureteral cancer (30.6% vs.34.8%, P>0.05).Cox analysis showed that HER-2 positive expression affected UBC recurrence (P<0.001), but had no effects on the recurrence and progression of UTUC; HER-2 positive expression (P<0.001), tumor diameter ≥3 cm (P<0.001), stage ≥T2 (P=0.003) and multiple tumor foci (P=0.033) affected the progression of UBC. 【Conclusion】 The positive expression of HER-2 is significantly higher in UBC than in UTUC, which can increase the risk of recurrence and progression of UBC, but has no significant effects on the recurrence and progression of UTUC.HER-2 expression is not recommended to independently predict the risk of recurrence and progression of UTUC.

Radical nephroureterectomy with bladder cuff resection is the gold standard for the treatment of high-grade upper tract urothelial carcinoma. Due to the multicenter characteristics of urothelial carcinoma, 22% to 47% of patients still have bladder tumor recurrence after operation. A series of randomized controlled trials have shown that postoperative intravesical chemotherapy can effectively reduce the intravesical recurrence rate after operation. At present, postoperative intravesical instillation treatment and drugs still refer to bladder urothelial carcinoma, and the standard treatment has not been established yet. This article reviews the relevant literature in recent years, and systematically discusses the research development of postoperative intravesical chemotherapy in terms of the choice of chemotherapy protocol and drugs.