Objective To apply a complete evaluation system for clinical teaching quality and improve the objective and method of the quality control of clinical teaching procedure. Methods Clinical teachers and staff from four clinical medical colleges(Ruijin,the Sixth,the Ninth,and Tongji) were investigated.The data of their cognition about clinical teaching,weakness in teaching procedure,situation,and quantity and quality control of clinical teaching were collected and analyzed. Results The appraisal system for clinical teaching quality was established in all four clinical medical colleges.The improvement was required in evaluation of executive supervision of the present system.The quality control about clinical ability teaching was the key point to perfect the system. Conclusion It is necessary to further discuss consummation of system,establishment of evaluation method and standard so as to perfect the evaluation system of clinical teaching.We should begin with the weakest procedure,and then improve the present condition step by step.

Objective To investigate the clinical value of proximal femoral nail antirotation ( PFNA) in treatment of intertrochanteric fractures.Methods From April 2007 to July 2009,112 patients with intertrochanteric fractures were treated by using PFNA.There were 34 males and 78 females,at mean age of 76 years.Of all,80 patients were with type 31-A2 fracture and 32 with type 31-A3 fractures according to AO classification.According to Singh index classification,there were 4 patients at grade Ⅰ,21 at grade Ⅱ,70 at grade Ⅲ and 15 at grade Ⅳ.The fracture was caused by low-energy injury in 97 patients and by high-energy injury in 15.The Salvati-Wilson score was used to evaluate the hip function postoperatively.Results Ninety patients received 12-24 months follow-up (average 18.6 months).The Salvati-Wilson score was (29.98 ± 5.18 ) points.The result was excellent in 41 patients,good in 40,fair in 6 and poor in 3,with excellenct rate of 90％.The introduction of the nail in operation was difficult in 22 patients,of which 3 patients suffered femoral cortex rupture.Displacement or separation of the fracture segments occurred in 34 patients and distal locking difficulty in nine during the screw blade tapping process.Local complications included hip pain in 21 patients,thigh pain in 4,apparent coxa vara in 2 and delayed healing in 7.There were no cutting-out or femoral shaft fractures no matter what type of Singh index was.The systemic complications included cardiovascular and cerebrovascular disease in one patient,pulmonary infection in four,deep vein embolism in one and perineum congestion or swelling in seventeen.Conclusion PFNA is effective in treating intertrochanteric fractures especially osteoporotic fractures,but delayed healing of the fractures and the mismatch between the intramedullary nail and the proximal femoral morphology remain to be addressed.

Two hundreds postmenopausal women with osteopenia, aged 45-80, were randomly divided into 4 groups, and received different drug interventions. After treatment for 12 months, the lumbar spine bone mineral density(BMD)and total hip BMD in alendronate group increased significantly(3.5% and 2.6%, both P＜0.05), the lumbar spine BMD raised 2.0% in selective estrogen receptor regulator group(P＜0.05). Bone turnover indices improved in both groups(all P＜0.05). No change in BMD or bone turnover indices was found in patients treated with active vitamin D3and calcium.

Objective To investigate the effects of physical exercises on cardiac function and plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) levels in hypertensive patients combined with diastolic cardiac dysfunction.MethodsA total of 66 essential hypertension patients who had abnormal left ventricular relaxation and normal systolic function were assigned to the intervention group ( n =33 ; doing physical exercises once a day,5 days a week) or control group (n =33 ).All the patients received standard treatment.At 6 months,body weight,blood pressure,heart rate,NT-proBNP,and echocardiography were measured.ResultsAt 6 months,body weight [ (68 ± 7 ) kg vs (72 ± 8 ) kg ],systolic blood pressure [ (135.4 ±5.1) mm Hg (1 mm Hg =0.133 kPa) vs (141.9 ±5.2) mm Hg ],diastolic blood pressure [ (81.1 ±4.0) mm Hg vs (84.7 ±4.6) mm Hg],New York Heart Association class (1.4 ±0.3 vs 1.8 ±0.4),NT-proBNP level [ (526 ± 126 ) ng/L vs (741 ± 189 ) ng/L] were significantly decreased in the intervention group when compared with the control group ( all P ＜ 0.05 ) although left ventricular ejection fraction (LVEF) (62.9 ±6.7 vs 59.0 ±5.6) and E/A ratio ( 1.1 ±0.3 vs 0.9 ±0.3) were significantly increased ( both P ＜ 0.05).ConclusionPhysical exercises could play a role in reduced blood pressure and body weight and improved cardiac function in hypertensive patients with diastolic cardiac dysfunction.

Objective To investigate the risk factors for postmenopausal osteoporosis in Shanghai.Methods Five hundred postmenopausal community-dwelling women aged 45-80 years were recruited. The case-control study was performed from June 2008 to September 2008.A total number of 250 women with postmenopausal osteoporosis identified with their bone mineral density (BMD) were selected as case group, and 250 non-osteoporosis women were selected as control group. BMD was measured by dual energy X-ray absorption (DEXA). Results Univariate logistic regression analysis showed that age, eduction level, occupation, years since menopause, BMI, use of calcium,historyofnon-violencefracture,fall,diabetesmellitus,chronicgastricdiseases, gastrointestinal resection and diarrhea were related to osteoporosis.Multiple logistic regression showed that age, years since menopause and nutritional status were the risk factors for osteoporosis. ConclusionsThe occurrence of osteoporosis is related with many factors in postmenopausal women in Shanghai, and women with early menopause, low BMI and older age should pay more attention to the prevention and treatment of osteoporosis.

Abstract: Objective　To investigate the clustered regularly interspaced short palindromic repeats (CRISPR) genotypes and regional distribution of Yersinia pestis strains in the natural plague foci of Hainan Tibetan Autonomous Prefecture of Qinghai Province (referred to as "Hainan prefecture") and provide a scientific basis for plague prevention and control in this area. Methods　A total of 36 representative Yersinia pestis strains, which were isolated from different host animals and insect vectors from 1954 to 2009 in Hainan Prefecture, were selected as experimental subjects. The DNAs were extracted using the traditional sodium dodecyl sulfate decomposition and phenol-chloroform method. Three pairs of CRISPR primers (YPa, Ypb, YPc) were used for PCR amplification, sequencing and analysis of the DNA of the tested strains, respectively, as a means to identify the CRISPR genotypes of Yersinia pestis in Hainan Prefecture. Results　A total of 17 spacers were observed among 36 strains of Yersinia pestis, including 9 of YPa, 5 of YPb and 3 of YPc. All strains were divided into 5 CRISPR gene clusters (Cb2, Cb4 ', Ca7, Ca7 ', Ca35 ') and 6 genotypes (G1, G9, G22, G22-A1 ', G26-A1 ', G26-A1 'A4 -). The G26-a1 ' was the main genotype, which was distributed in Gonghe, Guide and Xinghai County, and the G22 is the second type, which was distributed in Gonghe and Guide County. Conclusions　The genetic polymorphism of CRISPR loci of Yersinia pestis strains in Hainan was high, and the regional distribution characteristics of Yersinia pestis strains with different genotypes were significant.

Abstract: Objective To investigate the current status of streptomycin resistance of Yersinia pestis caused by point mutations of rpsL gene in Qinghai, so as to provide theoretical basis for precise clinical medication and prevention of drug resistance of human plague outbreak in South area of Qinghai Province in the future. Methods A total of 104 representative strains of Yersinia pestis collected from plague patients, vector insects and intermediate hosts in South area of Qinghai Province from 1957 to 2009 were screened, isolated and cultured by Hiss agar plates. The DNA of representative Yersinia pestis was extracted by sodium dodecyl sulfate lysis and phenol-chloroform method. The primers forward primer and reverse primer and TaqMan-MGB probes probe1 [FAM] and probe2 [VIC] were designed for the rpsL gene of streptomycin resistance gene in China. Real-time PCR with TaqMan-MGB fluorescent probe was used to detect the mutations of rpsL gene in streptomycin resistance locus of 104 strains of Yersinia pestis in South area of Qinghai Province. Results The FAM test results of 104 strains in South area of Qinghai Province were positive, corresponding to the detection of rpsL (128 : A ), RFU peak >1 000,negative <200. VIC test results of all tested strains were negative, corresponding to the detection of rpsL (128:G), RFU peak <200, positive >1 000. That is, no strains with rpsL gene mutation related to streptomycin resistance were found in the 104 strains of Yersinia pestis in Qingnan Province. Conclusion This study provides basic data on the distribution of streptomycin resistance of Yersinia pestis in South area of Qinghai Province, and lays a foundation for preventing the occurrence of drug resistance and clinical treatment of Yersinia pestis in South area of Qinghai Province.

BACKGROUNDChronic liver disease causes aberrant formation of fibrous tissue that impedes normal liver function, ultimately resulting in liver cirrhosis. Iron uptake can occur within the hepatic parenchyma or within the various nodules that form in a cirrhotic liver, termed siderotic nodules (SN). We aimed to investigate the diagnostic performance of susceptibility weighted imaging (SWI) for detection of SN in patients with liver cirrhosis, and to evaluate the potential of SN numbers for assessing the degree of hepatic iron deposition, liver function, and liver fibrosis stage.

METHODSNinety-one patients with chronic liver cirrhosis, who underwent megnetic resonance imagine (MRI) scanning in our department between November 2010 and April 2011, were included in the study. A 3.0T MRI scanner was used to acquire T1WI, T2WI, T2WI, and SWI images. The number of nodules, signal intensity ratio (SIR), and contrast noise ratio (CNR) were recorded and analyzed by chi-square and ANOVA statistical tests. Correlation analysis was performed to evaluate the correlations between the number of SN and Child-Pugh classification, ferritin and hyaluronic acid levels.

RESULTSThe sensitivity of SWI, T1WI, T2WI, and T2 WI for detecting SN was 62.5%, 12.1%, 24.2% and 41.8%, respectively. SWI detected significantly more nodules than routine T1WI, T2WI, and T2 WI procedures (P < 0.05). The SIR was the lowest in SWI (0.361 ± 0.209), as compared to T1WI (0.852 ± 0.163), T2WI (0.584 ± 0.172), and T2 WI (0.497 ± 0.196). The CNR was the highest in SWI (13.932 ± 5.637), as compared to T1WI (9.147 ± 5.785), T2WI (9.771 ± 5.490), and T2 WI (11.491 ± 4.573). The correlation coefficients of the number of SN with ferritin, Child-Pugh classification, and hyaluronic acid levels were 0.672, -0.055, and 0.163, respectively.

CONCLUSIONSThe sensitivity and contrast of SWI for detecting SN in patients with liver cirrhosis are higher than conventional MRI. The number of SN can help to assess the degree of iron deposition in patients with liver cirrhosis.

Adult ; Diffusion Magnetic Resonance Imaging ; methods ; Female ; Ferritins ; blood ; Humans ; Hyaluronic Acid ; blood ; Liver ; pathology ; Liver Cirrhosis ; blood ; pathology ; Male ; Middle Aged ; Sensitivity and Specificity

0bjective To observe effects and safety of exercise in elderly patients with diabetes mellitus in order to offer the guideline for the diabetic education about exercise.Methods We designed the five sport prescriptions about the different intensity and evaluated the effect of exercise training on plasma glucose, heart rate.blood pressure and a consumption of the difie,rent exercises.Twentv patients with diabetes mellitus in elderly individuals were evaluated before and after zero hour,4 hours,and 12 hours while exercises were over. And we followed up the effects after 12 weeks.Results The level of glucose in different sport time and in different exercise prescriptions showed significant(P<0.05).The change about the blood pressure in different sport time and in different exercise prescriptions has no statistical significance(P>0.05).After the 1 2 weeks following,the level of plasma glucose,ltbAlc,albumin in urine,triglyeeride,cholesterol,low density lipoprotein and blood pressure decreased(P<0.05).But the change about the weight and high density lipoprotein did not have statistical significance(P>0.05).Conclusions It is effecfive and safe to carry out individual exercise prescriptions among elderly patients with diabetes mellitus.

OBJECTIVETo explore the relation between serum vitamin D (25(OH)D) concentrations and liver cirrhosis.

METHODSA nested case control study was designed based on the Nutrition Intervention Trial (NIT) cohort, from which non-degraded serum samples and complete baseline and follow-up data were available for 282 individuals diagnosed with liver cirrhosis and 564 healthy controls. The serum samples were tested by enzyme-linked immunosorbent assay to detect and quantify 25(OH)D, as well as hepatitis B virus surface antigen and core antibody and hepatitis C virus antibody. The study participants were divided into four groups according to quartile range of 25(OH)D concentration and logistic regression modeling was used to evaluate the relation with liver cirrhosis risk by estimating odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTSThe liver cirrhosis group had a significantly lower concentration of 25(OH)D than the control group (median and quartile range in nmol/L, cases: 15.3 and 13.8; controls: 20.2 and 16.6; t = 5.169, P = 0.002). When the first interval was set as the reference level, the ORs(95% CIs) of the second, third, and fourth intervals were: 0.495(0.333 - 0.736), 0.452(0.303 - 0.675), and 0.349(0.231- 0.527). After adjusting the analysis for the presence of pathogenic-related confounding factors, the ORs(95% CIs) of the second, third, and fourth intervals were: 0.499(0.328 - 0.759), 0.427(0.278 - 0.654), and 0.344(0.222-0.532). The 25(OH)D level was inversely correlated with risk of liver cirrhosis (Chi2 = 25.200, P < 0.001).

CONCLUSIONRisk of liver cirrhosis increases as 25(OH)D serum concentration decreases. Vitamin D might function as a protective factor against development of cirrhosis.

Adult ; Aged ; Case-Control Studies ; Female ; Humans ; Liver Cirrhosis ; blood ; epidemiology ; Logistic Models ; Male ; Middle Aged ; Prospective Studies ; Risk Factors ; Vitamin D ; blood