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.

Blood Replenishing Angelica Decoction [Danggui Buxue Tang (DGBXT)]is a wellknown TCM prescription composed of Radix Angelicae Sinensis and Radix Astragali with the actions ofinvigorating "Qi" and enriching blood. Its action to curtail endothelial permeability induced by histaminewas studied. Endothelial cells isolated from the aorta of neonatal calf were cultured on polycarbonate mi-croporus filter membrane to develop a confluent endothelial monolayer. After purfused with either plainHank's balanced salt solution or that containing 5 g/L albumin, the monolayer was treated with 10-4 mol/L histamine for 30 min either with or without preincubation for 60 min with 10-4 g/mL of DGBXT. Fluidfiltration coefficient (Kf), filtration volume (Jv) and osmotic reflective coefficient (σ) of protein were thenmeasured. The findings showed that DGBXT could curtail the lowering of Kf and Jv and elevation of σ in-duced by histamine, indicating that DGBXT could inhibit the action of histamine on endothelial permeabili-ty, but its mechanism of action needs further study.

Objective To explore the effect of sealing tube with regular urokinase for the malfunction of central venous catheter(CVC) in patients with hemodialysis (HD).Methods This was a prospective randomized controlled study,132 HD patients with cuff CVC were studied.In the early stage,52 H D patients without 80 patients with regular catheter-locking solution of urokinase.To analyze effect of cuff CVC malfunction,blood flow(BF),dialysis adequacy,anemia and serum albumin (ALB) with regular catheter-locking solution of urokinase.The incidence of catheter malfunction was calculated based on the catheter dysfunction in the first 3 months.Clinical index was measured,recorded BF and calculated urea clearance rate (Kt/V).Results HD patients catheter-locking solution with regular urokinase could reduce the incidence of dialysis catheter malfunction ( 26.3％ vs 32.7％,x2 =32.727,P ＜0.01 ),increase the BF,Kt/V,levels of hemoglobin(HGB) and ALB(P＜0.05 or P ＜0.01).Conclusion Regular catheter-locking solution with urokinase is effective in reducing HD patients incidence of dialysis CVC malfunction,increasing patients BF,dialysis adequacy and the level of ALB,improving anemia.

Objective To explore the treatment methods of periprosthetic femur fracture after hip arthroplasty.Methods 9 patiens with periprosthetic femur fracture after hip arthroplasty were selected.According to Vancouver classification,there were 1 case in A type,5 cases in B1 type,2 cases in B2 type,1 case in C type.One case were treated by nonoperative method and the other 8 cases were treated by operative method,including 5 cases treated by memory alloy embracing fixator and internal fixation,3 cases treated by long stem prosthetic replacement and iliac bone graft.Results 8 cases were followed up for 8 to 21 months,average 14.2 months.All fractures were united well with good alignment and internal fixation failure except one prosthesis loosing was observed.Conclusion For periprosthetic femur fracture after hip arthroplasty,Vancouver classification methods include the location and stability of the fracture,prosthesis loosening,and the femur in bone mass is importance to the clinical treatment.As to A type fracture,prosthesis is stable,and the conservative treatment can be choosed.As to B1 and B2 type fracture,the aggressive surgical treatment can be choosed based on patients' general condition.If prosthesis loosening after artificial hip arthroplasty,the patients should treated with long stem prosthetic replacement.

Objective To investigate the effects of percutaneous vertebroplasty in the treatment of old symp -tomatic osteoporotic vertebral fractures in elderly .Methods 56 patients with osteoporotic vertebral fractures in elder-ly were selected and treated with percutaneous vertebroplasty .The age of the patients were from 67 to 83 years old, average of 72.5 years old.Among them,there were 15 male cases and 41 female cases.The Cobb angles,Visual Ana-logue Scale score ,and postoperative complications were measured .Results All the operations were successfully com-pleted which took the time from 30 min to 55min.2~5ml bone cement was used in the operation .Pains of 56 patients were significantly reduced or disappeared .VAS:(7.9 ±1.5) of pre-operation,VAS:(2.3 ±1.2) of post operation, Cobb angles:(25.8 ±4.9) of pre-operation,Cobb angles:(12.6 ±3.6) of post operation.The patients could move after operation with the protection of waist in 3 to 9 days.After the follow-up visit of 2 to 14 months,the pains of patients were disappear , no complications of nerves injury , pulmonary embolism and bone cement leakage of spinal canal.Conclusion It suggests that percutaneous vertebroplasty can relieve the pain and improve the life quality of the patients with old symptomatic osteoporotic vertebral fractures .It is worthy of clinical promotion .

Objective To investigate the association between carotid atherosclerosis(AS) and serum magnesium(Mg) in hemodialyzed (HD) patients.Methods Clinical index was measured,and intimamedia thickness (IMT) of extracranial common carotid artery and presence of atherosclerotic plaques were determined by high-resolution B-mode ultrasonography.The data were analyzed between plaque positive group and plaque negative group.Results The age,serum phosphate (P),total cholesterol (TCH),low density lipoprotein (LDL),serum C-reactive protein (CRP),serum albumin(Alb),and serum Mg all had significant difference between two groups(t =4.153,2.908,2.301,6.322,5.791,2.341,7.778,P ＜0.01 or P ＜ 0.05).The risk factors of HD patients with AS were serum Mg and CRP(P ＜ 0.01).Conclusions The occurrence of AS was related to low Mg and high CRP in HD patients.

Objective To investigate the effect of laparoscopic cholecystectomy (LTCBDE) in treatment of patients with secondary extrahepatic bile duct stones. Methods Eighty-seven cases of our hospital patients with secondary to extrahepatic bile duct stones were randomly divided into the laparoscopic bile duct exploration and T tube drainage surgery (LCBDE) treatment group and the laparoscopic transcystic duct exploration of common bile duct lithotomy (ltcbde) treatment group. The observation focused on the operation time, bleeding volume , postoperative transfusion , postoperative drainage time , postoperative hospitalization time , cost of hospitalization, postoperative recovery time and complications compared clinical efficacies. Results LTCBDE group of patients in operation time (2.1 ± 0.5) was longer than that of the control group (1.6 ± 0.4), (P <0.001), while the bleeding volume, postoperative fluid volume, postoperative drainage time, postoperative hospitalization time, hospitalization expenses and postoperative recovery time were (17.4 ± 5.4), (6 550.4 ± 1 076.9), (3.5. 1.6), (4.1 ± 1.7), (12 243.5 ± 2 379.6), (11.3 ± 3.5) were lower than that of the group LCBDE (22.1 ± 7.5), (8 304.2 ± 1 394.8), (32.9 ± 10.4), (6.4 ± 2.4), (14 098.1 ± 2 897.3), (16.1 ± 5.7) P, respectively (P values were defined as 0.001, 0, 0, 0.015, 0.001, 0 individually); LTCBDE group of patients with bile leakage, acute peritonitis rates were 1/46,1/46,in which those were lower than the corresponding LCBDE in 6/41, 7/41 (P values were 0.033, 0.016, separately). Conclusion According to indications, LTCBD surgery has the advantages of less injury, less cost, less complications and so on. It has important significance to improve the condition of patients with secondary extrahepatic bile duct stones.

Objective To investigate relationship of platelet (PLT) count with clinicopathological features and prognosis of patients with breast cancer,and explore the susceptibility index to evaluate prognosis of patients with breast cancer.Methods A retrospective analysis of clinical data of 498 patients with breast cancer in January 1995 to December 2005 was carried out.PLT count was tested.Those patients were divided into group A (PLT ＜ 150 × 109/L),group B[(150-250) × 109/L],and group C (PLT ＞ 250 × 109/L) according to PLT count level.The relationship of platelet count with clinicopathological features was analyzed.Kaplan-Meier and Cox proportional hazards model were used for univariate analysis and multivariate analysis of PLT impact on survival time.Results There was positively correlated between PLT count and clinicopathological features (Pearson coefficient ＞ 0,P ＜ 0.05).There was negative correlated between PLT count and survival time (Pearson coefficient =-O.583,P ＜ 0.05).The survival time of groups A,B and C were significantly different (P =0.018).Cox proportional hazards model multi-factor analysis showed that PLT count was an independent factors affecting survival time (OR =2.256,P ＜ 0.05).Conclusions Patients with breast cancer associated with increased emphasis and PLT count.PLT count had negative correlation with survival time.PLT count could be a susceptible index to predict the prognosis of patients with breast cancer.

[Objective]To evaluate the efficacy of different traditional Chinese medicine(TCM)appropriate techniques on patients with coronary heart disease and insomnia by network Meta-analysis.[Methods]A computer-based search of China National Knowledge Infrastructure(CNKI),WanFang,China Science and Technology Journal Database(VIP),China Biology Medicine disc(CBM),PubMed,CINAHL,Web of Science,Embase and the Cochrane Library was conducted to retrieve the literature on the improvement of the efficacy of TCM appropriate technology in patients with coronary heart disease and insomnia.The retrieval time limit was from the establishment date of the database to December 2023.Two researchers independently screened the literature,evaluated the quality of the literature and extracted the information.The Cochrane bias assessment tool was used to evaluate the quality of the literature,Review Manager 5.3 was used for traditional Meta-analysis,and Stata 17 software was used for network Meta-analysis.[Results]A total of 31 studies involving 2 977 patients and 14 TCM appropriate techniques were included.Network Meta-analysis showed that in terms of the total effective rate of insomnia,acupoint massage+five-tone therapy[odds ratio(OR)=7.61,95％confidence interval(CI)(2.05,28.30),P＜0.05]was superior to conventional treatment,and had the best effect compared with other TCM appropriate techniques.In terms of sleep quality score,acupoint application[mean difference(MD)=0.51,95％CI(0.04,8.23),P＜0.05]was superior to conventional treatment,and had the best effect compared with other TCM appropriate techniques.[Conclusion]Existing studies have shown that acupoint massage+five-tone therapy can effectively improve the total effective rate of insomnia.Acupoint application can effectively improve the sleep quality of patients.Medical staff can select appropriate TCM appropriate techniques according to the patient's own situation.

We strive to explore a student-centered evaluation system focused on improving students' learning efficiency and learning effect. Through classroom questioning, discussion of difficult cases, new progress report, question bank test, writing of clerkship notes, simulated inquiry between students with bedside inquiry, physical examination between students with bedside physical examination, operation training of basic clinical skills, direct observation and evaluation of clinical skills, mini-clinical exercise evaluation, graduation examination and other measures, an evaluation system for promoting learning by class evaluation, clerkship evaluation and practice evaluation has been established to cultivate the connotation construction of medical moral quality and clinical practice ability of medical students, and further promote the mastery of basic theoretical knowledge and clinical operation skills. By comparing the results of the phased examination for medical practitioners, the passing rate of 2018 is significantly higher than that of 2017, with 23.31% increased passing rate of theoretical results, and 0.79% increased passing rate of skills operation results. It can be seen that the evaluation system for promoting learning has played a guiding role in the teaching practice of clinical courses in our hospital.