Based on the questionnaires completed by 985 medical students,this article finds out that female students value more on the factors of health care and development when choosing a job,while male students are more confident in selecting goals and making career plans.Students from different family backgrounds have great difference when facing the elements such as reputation,social status and selfevaluation.Students from different majors take quite different opinions to health care,self evaluation,career information and career planning.There is little difference among different grades of medical students.Vocational values correlate positively with career decision-making self-efficacy.

Objective To explore the transport capacity of glucose membrane with blood cells in type 2 diabetes .Methods The anticoagulated blood of T2DM (40 cases) ,Pre‐diabetes(34 cases) ,control group(40 cases) were added to the same volume of saline and ATP ,37 ℃ 3 h .The changes of glucose was observed ,he level and Rate of glucose decreased were calculated .Results The drop‐out value in the groups of ATP was higher than which of salt water(P<0 .05) .In salt groups ,the drop ratio in the T2DM , Pre‐diabetes ,control groups were increaseed in turn .the value of glucose in T2DM was lower than which in control group and in Pre‐diabetes(P<0 .05) .In the ATP groups ,the drop‐out value in T2DM was lower than which in control group(P< 0 .05) .To T2DM patients ,the drop‐out value was (2 .81 ± 0 .52)mmol/L in salt grops ,which was (4 .73 ± 0 .69)mmol/L ,respectively .Conclu‐sion The glucose membrane transporters for T2DM were obstacles ,the obstacles associated with progression of T2DM ,ATP can improve membrane transporter of glucose .

Biomedical Research ; education ; Career Choice ; Clinical Medicine ; education ; Humans ; Physician's Role ; Physicians ; psychology ; standards ; Professional Competence ; Research Personnel ; psychology ; standards ; Teaching ; Translational Medical Research

Objective To study the clinical characteristics and treatment of adult patients with tsutsugamushi disease in Nantong area,and to reduce the misdiagnosis and missed diagnosis.Methods Clinical data of 24 adult patients with tsutsugamushi disease who were admitted between 2010 and 2012 at Department of Emergency Medicine in Affiliated Hospital of Nantong University were reviewed retrospectively.The patients were 13 males and 11 females who were aged from 25 to 70 years old.Minocycline capsule was orally administrated as the mainstay of the therapy.Results All of the 24 cases of tsutsugamushi disease were presented with fever,predominantly with high fever.The body temperature of higher than 39 ℃ was recorded in 23 cases,and temperature of 38.0 ℃ to 38.9 ℃ was recorded in one case.Three cases complained with sore throat and cough,and 1 case with palpitation and chest distress.One eschar or ulcer was seen in 21 cases,2 eschars or ulcers only in 1 case.Twenty-one cases were presented with lymphadenopathy,11 cases with rash,3 cases with enlargement of the liver,and 4 cases with splenomegaly.The distribution of eschar or ulcer included inaxillary fossa,groin,external genitalia and crissum,waist,popliteal fossa,the lower edge of the female breast and skin folds of chest wall,the inside of the wrist,ankle,neck,retroauricular region,chest-back and the buttocks.The white blood cell count of (2.5-3.9) × 109/L in blood routine test was seen in 4 cases,(10.1-18.6) × 109/L in 3 cases.The blood platelet count was decreased in 1 case.Urinary protein was positive in 4 cases by urine routine examination.Blood biochemical examination revealed that elevated serum alanine aminotransferase was seen in 2 cases,elevated serum creatinine was in 1 case,mildly elevated cardiac troporin I was in 1 case,increased C-reactive protein was found in 19 cases.On Weil-Felix test,17 cases showed OXk titers of 1∶160-1∶320.Four cases showed an increase in overall lung markings,localized pulmonary infiltration shadow and even small pleural effusion on chest radiography.Electrocardiogram showed premature ventricular beats and slight ST segment changes in 2 patients.Oral minocycline showed obvious effect.Conclusions The clinical manifestations of tsutsugamushi disease can be variable.Multi organ dysfunction could be presented besides fever.The skin eschar and ulcer are the most pathognomonic for this disease and thus should be thoroughly examined for its presence to avoid misdiagnosis.

Objective To explore the relationship between syndrome differentiation of diabetic retinopathy (DR) and pattern of visual evoked potential (P-VEP).Methods One hundred and eighty-six eyes from 104 cases of DR were allocated to three groups according to TCM syndrome:qi-yin deficiency (Group A),qi stagnation and blood stasis (Group B) and yin-yang deficiency (Group C).P-VEP induced by various space frequency (0.388?Hz,1.55?Hz) and pictures of various colors (black/white,red/magenta,blue/green) was observed in the three groups and compared with that in the normal control group (Group D).Results One hundred and three eyes in Group A mainly manifested as simple DR,47 eyes in Group B and 36 eyes in Group C mainly manifested as proliferative DR.The latency of P 100 was prolonged and the amplitude was decreassed in all groups of DR,but the latency of P 100 was much prolonged in Group B,the amplitude was much decreased in Group C and the changes were less in Group A.Conclusion P-VEP varies in different TCM syndrome types of DR,and determination of P-VEP under various stimulating conditions may serve as an index of syndrome differentiation of DR.

Objective To investigate the relationship between expression of nuclear factor kappa B p65 ( NF-κB p65) and hippocampal neuronal apoptosis in acute necrotizing pancreatitis (ANP) rats with brain injury. Methods Sixty-four SD rats were randomized into normal saline group (NS) and ANP group. The ANP rat model was induced by retrograde injection of 4% sodium taurocholate into the pancreaticobiliary duct of SD rats. Nissle stain was used to detect the brain injury. Neuronal apoptosis was determined by TUNEL.NF-κB p65 expression was detected by immunohistochemistry and RT-PCR. Results Hippocampal neuron was absent, karyopyknosis, unclear nucleolus and decreased Nissl bodies were found, the injuries was aggravated with time. The apoptosis index at the 3, 6 and 12 h in ANP group was 10.63 ±0.24, 21.02±0.25, 17.12±0.36, respectively, while they were 0.33±0.19,0.71±0.67, 0.45 ± 0. 33 in NS group, and the difference was statistically significant ( P ＜ 0. 01 ). The expressions of NF-κB p65 mRNA were 0. 63 ± 0.05,1.05 ±0.06,0.92 ±0.05, which were significantly higher than those in the NS group (0.11 ±0.01,0.12±0.01,0.08±0.01,P＜0.05).The chatge of expression of NF±κB p65 protein was consistent with that of NF-κB p65 mRNA. Conclusions The brain injury of ANP rats was highly correlated with neuronal apoptosis at the early and middle phase of ANP, and its mechanism may be related with NF-κB p65 activation.

Objective To study the effects of biofeedback combined with the fixed functional appliance in the modification of mandible in patients with Angle Class Ⅱ malocclusion and retruded mandible.Methods A Iotal of 30 orthodontic patients were divided into two groups,all patients with retruded mandible and normal maxilla,ANB>6°,aged from 9 years and three months to 14 years and 11 months.All patients were treated with Forsus fixed functional appliance combined with MBT straight-wire appliance.Muscular activity of the superficial masseter muscle before,during,and after treatment.was evaluated by assessing the average integrated eleetromyogram (EMG) .The biofeedback was performed during functional treatment in the study group,the muscular activity of the superficial masseter muscle was turned into the signal which can be read and seen by patients,and the patient can control the muscular activity of the superficial masseter muscle in a certain extent under the help of instrument.After 6 weeks fixed functional appliance treatment,the biofeedback treatment was performed in the study group with the help of instrument and trained for 10 times,and the patients could trained by themselves for 20 minutes everyday.Results The biofeedback treatment was able to regulate the muscular activity of the masseter muscle and prevent the return of muscle function and the tendency to seat the condyle back toward the fossa,maintain the treatment effect;after biofeedback treatment the decreased postural EMG activity in the masseter muscle was steady,but without statistical significance (P>0.05).Conclusion The biofeedback treatment can maintain the muscular activity of the masseter muscle effectively,enhance the effect of functional treatment and keep the stability of the mandibular position.

OBJECTIVE:To systematically review the efficacy and safety of gemcitabine combined with docetaxel in the treat-ment of non-small cell lung cancer(NSCLC),and provide evidence-based reference for clinical treatment. METHODS:Retrieved from PubMed,Cochrane Library,Elsevier,CJFD,Wangfang Database and VIP,randomized controlled trials(RCT)about the ef-ficacy and safety of gemcitabine combined with docetaxel(test group)versus the 3rd generation chemotherapeutic agents combined with cisplatin(control group)in the treatment of NSCLC were collected. Meta-analysis was performed by using Rev Man 5.3 soft-ware after quality evaluation by modified Jadad scale. RESULTS:Totally 9 RCTs were included,involving 1 986 patients. Results of Meta-analysis showed,there were no significant differences in the total effective rate [RR=0.93,95%CI(0.83,1.05),P=0.27], 1-year survival rate [RR=0.97,95%CI(0.87,1.09),P=0.64],the incidences of liver dysfunction [RR=0.35,95%CI(0.06,2.18), P=0.26] and leukopenia [RR=0.80,95%CI(0.57,1.10),P=0.17] and decreased rate of hemoglobin [RR=0.65,95%CI(0.25, 1.69),P=0.38] in 2 groups;the incidences of liver dysfunction [RR=0.09,95%CI(0.02,0.38),P=0.001] and neurotoxicity in test group were significantly lower than control group,while the incidence of lung injury [RR=8.71,95%CI(2.04,37.12),P=0.003] was significantly higher than control group,the differences were statistically significant. CONCLUSIONS:Gemcitabine com-bined with docetaxel shows similar efficacy to the 3rd generation chemotherapeutic agents combined with cisplatin in the treatment of NSCLC,less effect on renal function and nerve while high on pulmonary toxicity.

Objective To evaluate the effect of enteral nutrition by a polymeric formula in patients with severe acute pancreatitis (SAP).Methods Fifty-eight patients with SAP were randomly divided into polymeric group (29 cases) and semi-elemental group (29 cases),and the two groups of patients were treated in accordance with the conventional SAP management protocol,nasojejunal tube was endoscopically inserted for enteral nutrition.The polymeric group received enteral nutritional suspension (TPF),and the semi-elemental group received the same quantity of VIVONEX TEN.The gastrointestinal tolerance (VAS score),incidence of diarrhea,infection,28-day mortality rate,and length of hospital stay was evaluated.Nutritional parameters were evaluated by pre-albumin,albumin,alanine aminotransferase,C reactive protein at the time of admission and one week later.Results The two groups of patients were comparable in terms of VAS score,incidence of diarrhea,infection,28-day mortality rate,and length of hospital stay (P ＞0.05).And the levels of prealbumin,albumin,alanine aminotransferase,C reactive protein after admission were not statistically significant (P ＞ 0.05).Conclusions Compared with the semi-dement formula,the price of polymeric formula is cheap,configuration is convenint,enteral nutrition is well tolerated,and it is suitable for early enteral nutrition in SAP.

Objective To investigate the possible mechanism of Nrf2 in sepsis development and its effect in the septic acute liver injury ,and derive the effect of curcumin on Nrf2 expression ,which provide theoretical basis for clinical prevention and treatment of sepsis .Methods Divided putting 72 male Sprague-Dawley rats into 3 groups:control group ,experimental group and intervention group .After operation ,3 groups were further divided into subgroups 6 hours later ,12 hours later ,24 hours later and 48 hours later respectively .The septic rats model with acute liver injury was reproduced by method of cecal ligation and puncture (CLP) .The ex-perimental group and the intervention group took CLP .The rats in the intervention group were rejected with curcumin in the abdo-men at a dosage of 100 mg/kg an hour after operation .Detected the expression of Nrf2 in the livers of each group used Western blot and measure alanine aminotransferase(ALT ) in serum by drawing the rats′heart blood ;observed the pathological changes in the liver with HE coloration .Results ALT :the values of ALT in the experimental group was significantly increased compared with the control group(P<0 .05);while in the intervention group ,it was markedly improved compared with the experimental group (P<0 . 05) .The expression of Nrf2 :Nrf2 exists in control group rat′s hepatic tissue .In the experimental group ,it was progressively in-creased since the 6 h time point and decreased after the 12 h time point which shown significant decreased compared with the control group(P<0 .05) .In the intervention group ,it was gradually increased since the 6 h time point and decreased after the 24 h time point which was obviously higher than the experimental group(P<0 .05) .Pathological changes :There was no obvious abnormalities in the control group rats′liver structure ,while a lot of inflammatory cells gather and liver cells swell in the experimental group .It was obvious improved after curcumin intervention .Conclusion As Nrf2 is generally lower in the experimental group than in the comparative group ,it shows that Nrf2 directly participates in the occurrence and development of sepsis ,while severe infection blow damages the endogenou s protection system .Decreased activity of Nrf2 causes ignificantly inhibition of anti-oxidative stress and nat-ural immune response ,which may exacerbate acute liver injury by oxidative stress in sepsis .In case of sepsis ,curcumin may increase the level of Nrf2 and the antioxidant enzyme′s activity in the hepatic tissues ,enhancing the general antioxidant ability and alleviating the oxidative stress which points out that curcumin prevents the septic acute liver injury .