This study is based on the requirements of the construction of applied undergraduate colleges and development of excellent doctor education training pilot project of the ministry of education. The situation of higher medical education and the requirement of health career development are analyzed. The medical talents training mode of three oriented which is taking the post competency of medical students as the frame is constructed. This paper expounds the background proposed by training mode from the internal drive, external drive and project boosting. With the national education policy as the basis, the theoretical basis of the international advanced education teaching idea, theory and standard is explained. The connotation of the training mode is revealed by the humanistic quality education, professional quality training and physical and psychological quality cultivating. The evaluation strategy of clinical medical per-sonnel training standards, index system, the implementation approach and evaluation methods which have certain feasibility and timeliness is established.

The major assessment is the key link of the applied undergraduate education quality guarantee system. According to the spirit of the Ministry of Education, The Qiqihar Medical University developed the internal major assessment study and founded 8 first grade indexes and 26 second level indexes including educational idea, teaching staff, major construction. The university also established the major evaluation system, monitor and improve the university's teaching quality. This system makes sense to the establishment and improvement of undergraduate teaching quality guarantee system and has attained great achievement in the building of teaching staff, major construction, teaching environ-ment and teaching idea. Also the school has rectified the problems, making the work more perfect and the teaching better and better.

Objective To investigate the clinical efficacy of vertebral pedicle screw fixation for lumbar fractures without nerve injury. Methods A total of 100 patients with vertebral fractures from February 2012 to December 2012 in our hospital were researched.According to the order of the patient admitted to the hospital,50 patients from February 2012 to June 2012 were divided into observation group,50 pa-tients from 2012 July to December 2012 were divided into control group.The observation group were treated with vertebral pedicle screw fixa-tion,the control group were treated with a four nail fixation.The therapy and complications between two groups were compared after treatment, and the satisfaction of two groups were investigated.Results There was no significant difference in vertebral anterior height compression rate and Cobb angle between two groups before treatment(t =0.356 9,t =0.633 6,P =0.721 9,P =0.527 8),but after a week of treatment,ver-tebral anterior height compression rate and Cobb angle in observation group was better than those of the control group,the difference was sta-tistically significant(t =2.705 7,t =2.840 2,P =0.008 0,P =0.005 5).After one-year follow-up,there was no significant difference in effi-cacy between two groups(t =0.914 7,t =0.464 6,P =0.362 6,P =0.643 2).The postoperative complication rate of observation group was 4%,compared with 16% of control group,the difference was statistically significant (χ2 =4.000 0,P =0.045 5).The satisfaction rate of patient in observation group was 96%,compared with 84%of the control group,the difference was statistically significant (u =2.477 9,P =0.013 2). The fracturesof patients in two groups after 12 months were cured,without aggravating circumstances in nerve damage .Conclusion The ver-tebral pedicle screw fixation can effectively correct angular deformity,restore vertebral body height,strengthen the stability of the spine for treatment of patients with lumbar vertebrae without nerve injury.

Objective To analyze the imaging features of Castleman disease (CD) and its correlation with histopathologic and clinical features. Methods The images of 20 patients with CD were retrospectively reviewed and compared with their clinical and pathological findings. All the patients received CT or MRI plain scan and dynamic enhanced scan. 12 patients underwent CT examination and 8 underwent MRI examination. Results Locations of the lesions were found in the neck (n=6), abdomen and pelvis (n=6), mediastinum (n=3), retroperitoneum (n=2),multiple locations (n=2) and left subclavicular region (n=1). The clinical subtypes included unicentric type (n=17) and multicentric type (n=3). Histopathologic classification was as follows: hyaline-vascular type (n=16), plasma cell type (n=3) and mixed cell type (n=1). The lesions were manifested as homogeneous masses and well-defined margins of soft-tissue attenuation on the plain scan, apart from three cases with lobular, three cases with unclear margins, five cases with multiple masses and one case with heterogeneous texture. After contrast administration, 19 cases showed marked or persistent enhancement, one showed slight enhancement; 14 showed homogeneous enhancement, six showed heterogeneous enhancement; and 17 showed enlarged blood vessels within or around the mass. Conclusion Imaging features of CD are closely correlated with its clinical and pathological subtypes. A good knowledge of imaging features can contribute to a better understanding of the lesion before operation and a suitable therapeutic regimen.

Objective To create a simple model for teaching laparoscopic partial nephrectomy(LPN) in a simulated continuous blood supply setting and to introduce the main technical points of the procedure. Methods A fresh porcine kidney was placed on an unfolded metallic box,and the renal artery was infused with red-dyed water to simulate the blood supply of the kidney. The specially designed metallic box could not only fix and position the kidney, but also store the outflow of the kidney while the artery was kept artificially infused. The trainees were required to excise about 2 cm spherical renal parenchyma tissue and to suture the pelvis and renal parenchyma. The trainees had a similar laparoscopic competency and they all completed the dry laboratory training programs. During a 20-day training period, the trainees were assessed by the time periods they needed to complete LPN. The procedure and the quality of the LPN were monitored by the training mentors. Results The mean operating time decreased from (46.1 ± 1. 64) min (range, 43-49 min) before training to (27. 9 ± 1. 79) min (range, 25-31 min) after training (P<0. 001). The operating time required for suture-repairing the pelvis and renal parenchyma began to decrease after performing the fourth procedure, with the time decreased from (30. 4 ± 1. 82) min to (19. 4 ± 1. 16) min (P<0. 001). The mean quality score increased from 2. 02 ± 0. 19 at the beginning to 4. 41 ± 0. 14 at the end of the training (P<0. 001). The increase of the quality score was faster during the first five procedures. All the trainees became confident in performing a high quality LPN after completing ten procedures. Conclusion The present model with isolated porcine kidney is simple and economic. It can offer the trainees the opportunities to learn all the skills necessary for LPN.

Objective To investigate the correlation between the quantitative results,the semi-quantitative scores from ultrasound elastography and the distribution of myofibroblasts (MFS)in breast tumor,and to analyze the value of quantitative results and the semi-quantitative score from ultrasound elastography in the diagnosis of breast tumor.Methods Thirty eight patients with breast lesions underwent ultrasound elasticity examinations,tissue dispersion quantitative analysis technique was used to assess the 11 characteristic quantities and the corresponding strain ratios in all lesions,and the score of ultrasonic elastography was evaluated.38 cases were divided into benign and malignant group according to pathological diagnosis results.The expression levels of CD34 andα-SMA protein in breast tissue were examined by immunohistochemistry.The distribution patterns of MFS in breast tumor were analyzed. The correlation between the quantitative results, the semi-quantitative scores from ultrasound elastography and the distribution of MFS in breast tumor was studied.Results The expression level of CD34 in malignant group was significantly higher than that in benign group, while the expression level of α-SMA was significantly higher than that in benign group;the differences in the expression levels of CD34 andα-SMA between benign and malignant breast tumor patients were statistically significant (P < 0.01 ).The masses observed in malignant group by elastography were shown in blue,while most of the masses in benign group were shown in green.There were statistically significant differences between two groups in elastography scores (P < 0.05 ). There was a anegative correlation between the CD34 expression in tumor tissue and the score of ultrasound elastography (r=-0.423 7,P =0.027 3).There was a negative correlation between the CD34 expression and the score of ultrasound elastography (r=-0.423 7,P =0.027 3),while the positive correlation was found between theα-SMA expression and the score of ultrasound elastography (r=0.397 0,P =0.014 2).The CD34 expression was significantly correlated with the average relative strain value,entropy,area ratio of low-strain region,kurtosis, skewness and inverse difference moment (P <0.05).Among the 11 characteristics,CD34 was positively correlated with the average relative strain value (r=0.385 6,P =0.016 8)and entropy (r=0.380 5,P =0.018 5);CD34 was negatively correlated with area ratio of low-strain region (r = - 0.351 7,P = 0.030 4),kurtosis (r =-0.427 7,P =0.007 4),skewness (r=-0.394 6,P =0.014 2),inverse difference moment (r = -0.344 3, P =0.034 3),angular second moment (r = - 0.484 9,P = 0.002 0)and strain ration (r = - 0.379 0,P =0.047 5);CD34 was not correlated with standard deviation,complexity and contrast (P > 0.05).The α-SMA espression was positively correlated with kurtosis (r = 0.356 9,P = 0.027 8),skewness (r = 0.323 0,P =0.047 9),area ratio of low-strain region (r=0.382 0,P =0.021 6)and strain ratio (r=0.403 3,P =0.012 0). Conclusion The features and its scores of ultrasound elastography are correlated with the distribution of MFS in breast tumor,suggesting that the ultrasound elastography is very informative and helpful in the diagnosis of breast tumor.

Objective To explore the mechanism of gastrointestinal dysfunction caused by chronic renal failure (CRF), and to determine whether colon is involved in the activation of oxidative stress (OS) in CRF. Methods Thirty male SD rats were randomly divided into control group (n＝10) and CRF group (n＝20). The rats in the CRF group were treated with 5/6 nephrectomy to establish CRF model, and the rats in the control group were only sutured after opening renal capsule. The rats were sacrificed at 10 weeks after model administration, and the serums and colon tissues near ileocecal valve were collected. Blood urea nitrogen (BUN) and serum creatinine (SCr) were measured to evaluate the success of the model. Malonodialdehyde (MDA), superoxide dismutase (SOD), total antioxidant capacity (TAC) and 8-hydroxy deoxyguanosine (8-OHdG) in the serum and colon tissues were detected to evaluate the level of OS. The ubiquinol cytochrome C reductase core protein(UQCRC1) was tested for the evaluation of mitochondrial function. Results Compared with the control group, the levels of BUN and SCr in serum of the rats in the CRF group were increased, suggesting that the model was successfully established. Compared with the control group, serum and colonic MDA levels were significantly increased in the CRF group (P0.05); however, there were no significant differences in 8-OHdG or anti-oxidative markers (SOD, TAC) in serum or colon tissues between the two groups (P0.05). The protein level of UQCRC1 in colon tissues was significantly reduced in the CRF group compared with the control group (P0.05). However, there was no significant difference in the mRNA level of UQCRC1 in colon tissues between the control and CRF groups (P0.05). Conclusion There is an imbalance between oxidation and antioxidation in the colonic tissues of CRF rats, which may be related to mitochondrial dysfunction.

[Abstract] Objective To investigate the pathogen distribution and drug susceptibility profile of isolates from nosocomial infections in burn patients, so as to provide the reference for clinical diagnosis and treatment. Methods A retrospective analysis was carried out for the pathogens isolated from 534 patients in Changhai Hospital of Naval Medical University (Second Military Medical University) during the period from Jan. 2015 to Dec. 2017. The bacteria were identified by VITEK 2 Compact automatic microbiological analyzer or Microflex matrix-assisted laser time-of-flight mass spectrometer. The drug sensitivity was tested by VITEK 2 Compact automatic microbiological analyzer. Results A total of 1 219 strains were isolated, including 877 strains (71.9%) of Gram-negative specimens and 342 strains (28.1%) of Gram-positive pathogens. The top four Gram-negative bacteria were Klebsiella pneumoniae (203 strains, 16.7%), Pseudomonas aeruginosa (183 strains, 15.0%), Acinetobacter baumannii (176 strains, 14.4%) and Escherichia coli (101 strains, 8.3%). The top three Gram-positive bacteria were Staphylococcus aureus (136 strains, 11.2%), Enterococcus faecium (72 strains, 5.9%) and Enterococcus faecalis (60 strains, 4.9%). The pathogens were mainly isolated from wound secretions (577 strains, 47.3%), sputum/bronchoalveolar lavage fluid (341 strains, 28.0%) and urine (147 strains, 12.1%). And 93.5% (319/341) of respiratory pathogens were Gram-negative. Two or more pathogens were isolated from 58.2% (311/534) of the patients. On the top list of Gram-negative pathogens, Klebsiella pneumoniae was observed with a tendency of multi-drug resistance and was resistant to several antibiotics. The drug resistance of Pseudomonas aeruginosa could not be ignored, with a 35.5 % resistance rate for carbapenems. The resistance rate of Acinetobacter baumannii to carbapenems could reach as high as 93.2%, with resistance rate 80.0% to most other antimicrobial drugs. The prevalence of methicillin-resistant Staphylococcus aureus in Gram-positive bacteria was 69.1% (94/136). The resistance rate of Enterococcus spp. to antibiotics was 38.9%-66.3%. No Gram-positive pathogens were observed resistant to vancomycin, tigecycline or linezolid. Conclusion The pathogenic isolates causing nosocomial infection in burn patients are multi-bacterium, Klebsiella pneumoniae shows a tendency of multidrug resistance, and Gram-positive pathogens are sensitive to vancomycin, tigecycline and linezolid.

Objective To investigate the distribution and drug susceptibility profile of pathogens causing nosocomial infection in organ transplant patients, so as to provide a basis for clinical diagnosis and treatment. Methods The clinical samples were collected from 149 organ transplant patients in Changhai Hospital of Navy Medical University (Second Military Medical University) between Jan. 2016 and Dec. 2017. The isolates were identified using VITEK 2 Compact automatic microorganism analyzer system or Microflex matrix-assisted laser desorption ionization-time of flight mass spectrometry. The susceptibility test for bacteria was carried out by VITEK 2 Compact automatic microorganism analyzer system, and the susceptibility test for fungus was carried out by ATB Fungus 3 susceptibility kit. Results Most pathogenic specimens were derived from flushing fluid samples (42.3%, 101/239). A total of 239 strains of pathogens were isolated from 149 patients, including 135 (56.5%) of Gram-negative pathogens, 77 (32.2%) of Gram-positive pathogens, and 27 (11.3%) of fungi. Klebsiella pneumoniae was the most found Gram-negative pathogens (13.8%, 33/239), and its resistance to common antibiotics, such as piperacillin, was generally high with the resistance incidence being more than 50.0% and it had a tendency of multi-drug resistance. Escherichia coli had high sensitivity to carbapenems, with incidence of drug resistance being less than 5.0%. Acinetobacter baumannii had high resistance to carbapenems, with incidence of drug resistance being 81.0%. Among Gram-positive pathogens, Enterococcus had 40.0%-77.2% resistance incidence to penicillin and ampicillin, but was sensitive to linezolid and vancomycin. The sensitivity of fungi for most antifungal agents was higher than 80.0%, especiallyfor voriconazole (96.3%). Conclusion Gram-negative pathogens are the primary pathogens causing nosocomial infection in organ transplant patients. Klebsiella pneumoniae is the main pathogen and has a tendency of multi-drug resistance. Grampositive pathogens are susceptible to linezolid and vancomycin. Fungi are susceptible to commonly used antifungal agents.

Objective To confirm whether fasudil can block C2C12 myoblasts respiration dysfunction triggered by Rho-associated coiled-coil containing protein kinase 1 (ROCK1), and whether it can block the occurrence of muscle atrophy. Methods C2C12 myoblasts were cultured in vitro, and 2% horse serum was used to induce cell differentiation and maturation. The obtained mature muscle tubule cells were divided into four groups according to the different stimuli: Ad-GFP group, only transfected GPT-adenovirus vector (Adv) in C2C12 myoblasts; Ad-ROCKl group, transfected ROCKl-Adv in C2C12 myoblasts to induce ROCK1 overexpression; Ad-GFPF group, transfected GFP-Adv and given 10 μmol/L fasudil in C2C12 myoblasts; and Ad-ROCKIF group, transfected ROCKl-Adv and given 10 μmol/L fasudil in C2C12 myoblasts. The oxygen consumption rate (OCR) and extracelluar acidification rate (ECAR) of C2C12 myoblasts under different stimulation conditions were evaluated by cell energy metabolism analyzer (Seahorse), so as to determine the effect of ROCK1 overexpression and fasudil stimulation on the respiratory function of C2C12 myoblasts. Mitochondrial fission was measured by MitoTracker® red fluorescent probes. The expressions of ROCK1, mitochondrial related protein 1 (Drpl) and phosphorylated p-Drpl, E3 ubiquitin ligase muscle RING finger-1 protein (MuRFl) and muscle atrophy F-box (MAFbx, Atrogin 1) was measured by Western blotting analysis. Results Seahorse analysis showed that the OCR, ECAR, basal respiration, maximal respiration and respiration required for coupling ATP of C2C12 myoblasts in the Ad ROCK1 group were significantly increased compared with those in the Ad-GFP group (P<0.01); Meanwhile, MitoTracker® staining showed that the mitochondrial fission was increased and the mitochondrial size frequency distribution shifted left in the Ad-ROCK1 group. After exposed to fasudil. the OCR and EACR of C2C12 myoblasts in the Ad-ROCKIF group were significantly decreased versus the Ad-ROCK1 group, and the basal respiration and maximal respiration were significantly increased (P<0.05). Western blotting analysis showed that p-Drpl/Drpl ratio, and the expressions of ROCK1, MuRFl and Atroginl in Ad-ROCKIF group were significantly reduced compared with Ad-ROCKl group (P<0.05). Conclusion Fasudil, an inhibitor of ROCK1, can block the abnormal cell respiration of C2C12 myoblasts caused by overexpressed ROCK 1 in vitro, and can reduce the activity of mitochondrial kinetic protein and the expression of muscle atrophy-related proteins.