The hardcore of clinical medicine program education is to insist on improving the students'practical capability.The efficient methodology is the key to it.In this paper,the authors investigate the practice of Suzhou University and try to find out the ways to assess the graduates in this program.Also,the authors point out the deficiency in the assessment and put forward mending measures in order to improve the quality of clinical medicine graduate program education.

Objective To study the expression changes of transcription factor genes and their underlying involvement in rat liver regeneration(LR) at transcription level. Methods The transcription factor genes and their function were collected by referring to the putative literatures and databases.Then,their expression in rat LR were checked by Rat Genome 230 2.0 array.LR-related genes were identified through the comparison of discrepancies in gene expression between partial hepatectomy(PH) and sham-operation(SO) groups. Results 320 genes were determined to be LR-related,which were involved in 16 biological processes,such as cellular metabolism,proliferation,differentiation,apoptosis,etc.Expression profiles of above genes were classified into 41 categories according to their functions and expression trends,implying their diversity and complexity during LR.The expression of transcription factor genes that were involved in carbohydrate biosynthesis,lipid metabolism,and inflammatory response was enhanced in the forepart(0.5-4 hours after PH) and prophase(6-12 hours after PH) of LR.Cellular proliferation,growth,differentiation and apoptosis related transcription factor genes were promoted in the metaphase(16-66 hours after PH) and anaphase(72-168 hours after PH).Conclusion Physiological and biochemical activities in LR were regulated by multiple transcription factor genes,and e2f1,fos,copeb,etc.played key roles in it.

Some specific markers are useful of separating and identifying gastric cancer stem cells.They are including gastric stem cells,general tumor stem cells and mesenchymal tissue stem cells.At present,more and more new biomarkers are discovered besides familiar CD133 and CD44.Combined detection helps to separate pure gastric cancer stem cells and promote the therapy of gastric cancer.

Objective To estimate the association of the single nucleotide polymorphism (SNP) and the serum concentration of interleukin (IL)-18 with ulcerative colitis (UC) . Methods Samples collected from 50 patients with UC and 128 healthy controls were detected for SNPs of IL-18 gene including rs187238, rs5744228, rs360718 and rs360717 using polymerase chain reaction (PCR) and direct sequencing. Meanwhile, the serum level of IL-18 was measured. ResultsSerum concentration of IL-18 was higher in patients with UC than in healthy controls [(3029.9±111.7) pg/ml vs ( 133.2±39.4) pg/ml,(P<0.01)], rs187238 C, rs360718 C and rs360717 A were significantly related to UC (X~2=9.26, P<0.01). There was significant difference in frequencies of rs187238 C, rs360718 C and rs360717 A between patients with UC and healthy controls (X~2=9.26, P<0. 01). Serum concentration of IL-18 was higher in UC patients with C allele than in healthy controls (P<0.05).Conclusions There is correlation between SNP and serum level of IL-18 , which may involve in susceptibility to UC.

Objective To discuss the diagnostic value of regular ultrasonic combined with ultrasonography micro-vessel enhanced presentation for breast malignant disease.Methods 152 patients with single breast tumour were collected,they were examined by regular ultrasonic,ultrasonography micro-vessel enhanced presentation before operation and received regular pathology after operation.The diagnostic sensitivity,specificity,negative predictor,positive predictor,accuracy,area under ROC curve,95 ％ reliable interval of regular ultrasonic,ultrasonography micro-vessel enhanced presentation and the combination for breast malignant disease were analyzed.Results Ultrasonography micro-vessel enhanced presentation is better than regular ultrasonic in the diagnostic sensitivity,specificity,negative predictor,positive predictor,accuracy (P =0.002).The combination of regular ultrasonic and ultrasonography microvessel enhanced presentation could improve the detection rate of breast malignant disease(regular ultrasonic compared with combination,P =0.002 ; ultrasonography micro-vessel enhanced presentation compared with combination,P =0.000) and increase area under ROC curve (P =0.000).Conclusion Regular ultrasonic combined with ultrasonography micro-vessel enhanced presentation has complementary advantages and can increase early detection rate for breast malignant disease.

Objective To observethe effect of continuous veno-venous hemofiltration (CVVH) on serum level of antibrain-antibody (ABAb) in patients with severe traumatic brain injury.Methods Thirtysix patients with severe traumatic brain injury were randomly divided into control group (19 patients) and CVVH group (17 patients).The control group accepted conventional treatment,the CVVH group accepted CVVH treatment additionally for 7 d.ELISA was used to measure serum level of ABAb at 1,3,5,7,14 d after treatment.The change of ABAb in serum of each group was observed.The scores of Glasgow coma scale (GCS) was assessed everyday.Results The level of ABAb in CVVH group was significantly lower than that in control group from the third day after treatment[the third day:(1.28 ± 0.25) kU/L vs.(1.33 ± 0.30) kU/L;the fifth day:(1.37 ±0.17) kU/L vs.(1.42 ±0.22) kU/L;the seventh day:(1.45 ±0.37) kU/L vs.(1.52 ± 0.35) kU/L;the fourteenth day:(1.49 ± 0.41) kU/L vs.(1.67 ± 0.39) kU/L,P ＜ 0.05 or ＜ 0.01].The scores of GCS in CVVH group was significantly higher than that in control group from the seventh day after treatment [the seventh day:(6.95 ± 1.24) scores vs.(5.74 ± 1.51) scores;the fourteenth day:(9.29 ± 1.76) scores vs.(7.22 ± 1.24) scores] (P ＜ 0.01).Conclusion CVVH can decrease the level of ABAb and improve the prognosis.

Hepatic veins as the only hepatic drainage veins are the important functional part of liver anatomy in the field of surgery.With the development of imaging technology,especially the application of three-dimensional visualization technology,it can provide precise and comprehensive information in the study of hepatic veins.And thus this paper comprehensively reviewed the recent researches on the three dimensional visualization technology for observign the hepatic veins.

The training of clinical skill is closely linked with medical personnel education.However,traditional paper-type training materials were unable to meet the training needs.As a new type of training materials,trial-and-error video-type clinical skill training materials (abbreviated as TEVT clinical skill training materials) have gradually attracted attention with its characteristics of lively and interesting,potentially informative,high acceptance among students,the advantages' of stimulating students' initiative exploration and consideration,fostering students' critical spirit and humanities.On the basis of analyzing the advantages' of TEVT training materials,we discussed the developing specialties of TEVT clinical skill training materials from four aspects as the material orientation and the application object,material sources,constructing the developing team and editing the teaching materials.Furthermore,we reflected the application prospect of TEVT clinical skill training materials in the future,in order to explore an available implementation path for the development of TEVT clinical skill training materials.

Objective To observe the change of serum anti-brain antibodies after cardiopulmonary resuscitation,and investigate the clinical significance.Methods A total of 27 cases of cardiopulmonary resuscitation after cardiac arrest patients with success and survival more than 12 weeks were divided into two groups according to Glasgow Coma Scale (GCS) score:mild and moderate group with GCS score ≥ 8 scores (12 cases) and severe group with GCS score≤7 scores (15 cases).The serum anti-brain antibody levels at 3,7 days and 2,3,4,12 weeks after recovered in the spontaneous circulation (ROSC) was compared between two groups,and compared with control group (15 cases of healthy persons).Results The serum anti-brain antibody levels at 3,7 days and 2,3,4,12 weeks after ROSC were significantly higher than those in control group [(1.34 ± 0.23),(1.30 ± 0.27) kU/L vs.(0.28 ± 0.05) kU/L,(1.38 ± 0.33),(1.44 ± 0.30) kU/L vs.(0.28 ±0.05) kU/L,(1.44 ±0.31),(1.51 ±0.33) kU/L vs.(0.28 ±0.05) kU/L,(1.53 ±0.27),(1.67 ±0.36) kU/L vs.(0.28 ±0.05) kU/L,(1.72 ±0.25),(1.93 ±0.44) kU/L vs.(0.28 ±0.05) kU/L,(1.98 ±0.45),(2.15 ±0.52) kU/L vs.(0.28 ±0.05) kU/L],and there were significant differences (P＜ 0.01).The serum anti-brain antibody levels in severe group were significantly higher than those in mild and moderate group,and there were significnat differences (P ＜ 0.05).Conclusions The serum anti-brain antibody levels after cardiopulmonary resuscitation rise significantly.Anti-brain antibody may be used as a biochemistry marker to judge degree and prognosis of brain injury with patients after cardiopulmonary resuscitation.

Objective To investigate the laboratory ifndings, clinical manifestations and treatment in hemolytic disease caused by red cell immune antibodies in neonates. Methods The laboratory and clinical data from 4 cases of hemolytic disease of neonates caused by red cell immune antibodies were retrospectively analyzed. Results IgG antibody were detected in all mothers of 4 cases during pregnancy and they were anti-E, anti-D, anti-Jkb and the autoantibody with the titer being 16, 2048, 1 and 16 respectively. The four neonates were all full-term. The jaundice appeared 6 h to 3 d after birth with varying degrees of skin stained yellow, with or without anemia. Serology and elution test found the existence of antibody same as the one on their maternal red cells and the titer was 4, 512, 0, and 2, respectively. All neonates were treated by phototherapy. Two servere cases were also treated by whole blood exchange and red blood cells transfusion. The prognosis were good in all neonates. Conclusions Prenatal immune hematological tests facilitated early detection of irregular erythrocyte antibodies and thus assessment of the risk of hemolytic dis-ease of the fetus and neonates.