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 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.

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 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.

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.

Objective To investigate the clinical characteristics of patients with polyarteritis nodosa (PAN),and to improve the understanding of the disease.Methods The data of 65 consecutive PAN patients admitted to Peking Union Medical College Hospital from October 2001 to March 2013 were analyzed.Patients were divided into two groups based on hapatitis B surface antigen (HBsAg) status.Chi-square test,Fisher exact probability,t test and Mann-Whitney test were used for statistical analysis.Results The male/female ratio of patients with PAN was 1.3/1,and the average age was (37.6±1.6) years old.Fever (in 40 cases,62％) was the most frequent manifestation.Skin was involved in 51 cases (79％),urologic involvement in 44 cases (68％),peripheral nervous system involvement in 22 cases (34％) and gastrointestinal involvement in 21 cases (32％).Forty-six (71％) patients had high-sensitivity C reactive protein (hs-CRP) elevation and 11 (17％) patients had eosinophil count elevation.The most common vascular involvements were limb arteries in 22 cases (34％),renal artery in 19 cases (29％),and gastrointestinal artery in 17 cases (26％).Patients with negative HBsAg had more frequent arthralgia or arthritis(41％ vs 9％,x2=4.00,P＜0.05),more indicators of poor prognosis (30％ vs 0,P＜0.05) and more glucocorticoid pulse therapy (30％ vs 0,P＜0.05) when compared with patients with positive HBsAg.Conclusion Clinical manifestations of PAN are complex.Young patients with fever of unknown origin,rash,weight loss,myalgias,accompanied by symptoms of multi-organ damage including urologic,peripheral nervous system,gastrointestinal involvement and negative autoantibodies should be highly suspected for the diagnosis of PAN.For the treatment of patients with positive HBsAg,special attention should be paid to maintain the delicate balance between controlling the organ damage caused by PAN and prevention of hepatitis B virus (HBV) infection reactivation.

Despite the gradual improvement in surgical treatment techniques and surgical instruments, the complications and mortality of gastric cancer patients after gastrectomy remain high because of an increased proportion of advanced age and incidence of preoperative morbidity in these patients. Therefore, reducing the peri-operative adverse outcomes in gastrectomy is highly significant. According to published literature, the risk factors of morbidity and mortality may include age, TNM stage, ASA score, POSSUM score, complication, surgeon workload, hospital operation volume, lymphadenectomy scope, combined multiple organ resection, and gastrecto-my type. This review summarizes the recent progress in the risk factors for the mortality and morbidity of gastrectomy.

OBJECTIVE: To introduce the basic functions, working conditions and requirements of bioreactot, additional, to discuss the research process of bioreactor.METHODS: PubMed database (http://www.ncbi.nlm.nih.) and CNKI database (www.cnki.nat/index.htm) were retrieved by the first author with search terms of "bioartificial liver, bioreactor, membrane material" both in English and Chinese. The time was limited between January 1994 and August 2009. Inclusion criteria: ①literatures closely linked to the article; ②papers published in more authoritative journals in recent years. ③the contents of old or duplicate documents were excluded.RESULTS: Totally 150 documents were seized by primary screen, 88 irrelative papers and 32 duplicate documents were excluded, finally, 30 literature entered further analysis. Bioartificial liver system has become an effective in vitro supportive treatment for hepatic failure patients. Bioreactor is an important ingredient of bioartificial liver, which provided a platform for the hepatocytes growth metabolism, substances exchange and immune isolation. The main cellulose semipermeable bioreactor comprises fiat membrane bioreactor and hollow fiber bioreactor, and the main types of semipermeable membranes contain mixed cellulose ester membrane, cellulose acetate membrane, cuprophan membrane, PVDF membrane, as well as poly(ethylene terephthalate) membrane.CONCLUSION: As a dynamic system, the optimal of control system in bioreactor is conductive to regulating mass transfer and establishing bionic physical or chemical gradients, which can implement the construction of hepatocyte with smallest unit. The selection of membrane is the key link in bioreactor construction of bioartificial liver system

Objective To observe changes in hippocampal network electrical activities in electroacupuncture regulation of abnormal cardiovascular activities and explore the central mechanism of the regulation. Method Experimental rats were randomized into three groups: normal urethane anesthesia without electroacupuncture (n=15), urethane enhanced deep anesthesia (n=9) and normal anesthesia plus anal canal pressurization (n=15). Femoral arterial pressure, cardiac electricity, hippocampal field potentials and cellular discharge were recorded in the three groups. The normal anesthesia group did not receive intervention measures. The other two groups received acupuncture intervention after successful induction of abnormal blood pressure. Result In rats with normal urethane anesthesia, sleep-like periodic hippocampal electrical activity occurred with periodic cardiovascular activities and theta oscillations was corresponding to increased heart rates. In rats with deep anesthesia and hypotension, theta oscillations appeared in hippocampal network with increased blood pressure and heart rates after electroacupuncture (P<0.001). Anal canal pressurization induced increases in blood pressure and heart rates and caused theta oscillations in hippocampal network. During that time, electroacupuncture could still activate theta-related cells, reduce blood pressure and decrease heart rates (P<0.001). Conclusion Theta oscillations in hippocampal network are involved in the bidirectional regulating effect of electroacupuncture on abnormal cardiovascular activities.