Objective Structured Clinical Examination(OSCE)is a popular and objective clinical examination mode in recent years.Teaching Section of Internal Medicine of the First Clinical College of Harbin Medical University adopts the OSCE assessment approach in the internship phase exam of the clinical overseas students to check the study effect in internal medicine internship and objectively and scientifically evaluates their overall quality through multimedia technology,standardized patient,multi-functional simulation man and other means.

Objective To study the effect of different dialysis modalities on pruritus in elderly maintenance hemodialysis patients.Methods Totally 51 patients were randomly divided into hemoperfusion combined with hemodialysis group (HD+ HP),hemodiafiltration group (HDF) and hemodialysis group (HD).Plasma β2-microglobulin(β2-MG) and intact parathyroid hormone (iPTH) were measured by means of radio immunoassay at pre and post dialysis,4 weeks and 8 weeks after dialysis,cutaneous pruritus was scored.The remission rate of itching was calculated at 8 weeks after dialysis.The parameters were compared among different groups.Results The level of plasma β2-MG was lower in HD+HP group after dialysis than pre dialysis [(13.48±3.05)mg/L vs.(16.27±4.73) mg/L,t＝2.044,P＜0.05],at 4 weeks and 8 weeks after dialysis,its levels were decreased to (10.97±3.25)mg/L(t＝3.808,P＝0.002)and (6.47±2.35)mg/L(t＝7.650,P＝0.000),respectively.The levels of iPTH were also found decrease from(887.5 ± 242.7)ng/L to (688.3 ±223.4)ng/L(t＝3.384,P＝0.004)at 4 weeks and (467.2±102.5) ng/L(t＝6.578,P＝0.000) at 8weeks after dialysis in HD+HP group (all P＜0.01).There were differences of the levels of plasma β2-MG and iPTH at 4 weeks and 8 weeks after dialysis in HDF group (all P＜ 0.05),but no differences of the levels of plasma β2-MG and iPTH during every period were found in HD group(all P＞0.05).The scores of cutaneous pruritus were decreased from (21.17± 5.01) scores to (13.37±2.85) scores(t＝ 5.580,P＝0.000)at 4 weeks and (8.52±4.38) scores(t＝7.838,P＝0.000)at 8 weeks after dialysis in HD+ HP group,and also the scores at 4 and 8 weeks after dialysis in HDF group (all P＜0.01),but there were no significant differences of the scores during every period in HD group (all P＞0.05).The remission rate of itching was better in HD+ HP group than in HDF group [88.24％ (15/17 cases) vs.58.82％ (10/17 cases),x2＝14.44,P＝0.000],better in HDF group than in HD group 23.53％ (4/17 cases) (x2 ＝4.37,P＝0.037).Conclusions HD+HP is superior to HDF in efficiently clear β2-MG and iPTH,and relief cutaneous pruritus,but HD can poorly clear β2-MG and iPTH or relief itching.

Objective To detect the DMD gene mutation sites and the regions of breakpoints in Duchenne/Becker muscular dystrophy (DMD/BMD) patients in northern China. Methods Multiplex amplifiable probe hybridization (MLPA) was used to detect the mutation in 59 cases (51 cases with DMD and 8 with BMD) from northern China and dystrophin gene mutations in their parents. Results From northern China and dystrophin gene mutations 59 families found gene deletions in 33 cases of 59 DMD/BMD patients (55.9%), duplications in 6 cases (10. 2%) and point mutation in one case (1.7%). Intron 44 was most frequently affected (n = 13, 33.3%), followed by intron 50 (n = 11, 28.2%) and intron 45 (n=8, 20.5%). The novel mutations were identified, in two patients including two independent duplications carried by patient D1 149 and a point mutation [5208del(A)] carried by patient D1 65, which were not included in Leiden database. In addition, an exon 22 deletion was found in one patient, which was the first reported case in Chinese patients. Conclusions Deletions are mostly located in the hotspot between exon 45 and 50. Duplications mostly occurred in the 5' end of the gene. Intron 44 is the most frequently affected breakpoint in northern Chinese population.

Objective To assess the efficacy of fish oil in the treatment of IgA nephropathy using the method of Meta-analysis. Methods Randomized controlled trials of fish oil in the treatment of IgA nephropathy were searched in the database of Cochrane library,PubMed, EMBASE and CNKI. Data extracted from the literatures were analyzed with Revman software (version 5.0). Results In comparison with the controlled group, proteinuria in the fish oil group was significantly decreased [SMD=-0.27, 95%CI (-0.52 to -0.03), P=0.03], while the renal function deteriorated [SMD=0.30,95%CI(0.05 to 0.55), P=0.02]. Conclusion Fish oil can decrease the proteinuria of IgA nephropathy, but can not prevent renal function from deterioration.

Objective To explore the effect of pain management by pain resource nurse (PRN) attending pain nursing group, and to know the patient′s satisfaction. Methods Advanced practice nurse as the lead of the group. The selection of PRN members in the group was made on merit which all have definite responsibility and like pain nursing, established pain management quality control system in group and training,standardized pain management processes and the regulations, educated knowledge and skills of pain management for PRN. Results Patient satisfaction with pain management increased significantly from 82.0%(496/605) to 97.1%(572/589)(P<0.05). Moderate and serious pain rate of patients decreased significantly from 60.0%to 20.0%(P<0.01). The qualified rate of pain assessment increased from 84.9%(514/605) to 95.1%(560/589)(P<0.05). Conclusions The establishment of pain nursing group can not only improve pain management quality and patients satisfaction, but also improve of PRN′s professional behaviors and development of clinical pain nursing .

Objective To observe the clinical curative effect of modified Qiwei Baizhu Powder for mesenteric lymphadenitis in children with spleen deficiency and dampness retention. Methods A multi-center randomized and controlled trial was carried out in 150 cases of mesenteric lymphadenitis in children with spleen deficiency and dampness retention. The patients were randomized into Chinese medicine group, western medicine group and combination group, 50 cases in each group. Chinese medicine group was treated with modified Qiwei Baizhu Powder, western medicine group was treated with Cefaclor for Oral Suspension, and the combination group was treated with modified Qiwei Baizhu Powder plus Cefaclor for Oral Suspension. Before treatment and after treatment for 7 days, one month and 3 months, changes in syndrome manifestations and the size of abdominal mesenteric lymph nodes were monitored. The total effective rate and cure rate of the three groups were compared, and the safety of the regimen was also evaluated. Results (1) In Chinese medicine group, 5 patients dropped out, and a total of 45 cases completed the trial; in western medicine group, 3 patients dropped out, and a total of 47 cases completed the trial; in the combination group, 7 patients dropped out, and a total of 43 casescompleted the trial.(2) The total effective rate of Chinese medicine group and combination group after treatment for 7 days, one month and 3 months was significantly higher than that of western medicine group (P < 0.05), and the cure rate after treatment for one month and 3 months was also significantly higher than that of western medicine group (P<0.01). The differences of total effective rate and cure rate were insignificant between Chinese medicine group and combination group(P>0.05) at various time points.(3) After treatment for 7 days, one month and 3 months, the transverse and longitudinal diameters of mesenteric lymph nodes in Chinese medicine group and combination group were shorter than those of western medicine group (P < 0.05) , but the difference was insignificant between Chinese medicine group and combination group (P>0.05). (4) Except for the drop-out cases, all of the children finished the trial. During the treatment, no obvious adverse reaction was found. Conclusion Modified Qiwei Baizhu Powder exerts certain efficacy for the treatment of mesenteric lymphadenitis in children with spleen deficiency and dampness retention.

Objective To analyze the therapeutic effect and prognosis of peritoneal dialysis in patients with end-stage polycystic kidney disease.Methods A retrospective analysis was performed on patients with polycystic kidney disease who were treated with peritoneal dialysis for more than 3 months between July 2007 and September 2016 in the Second Hospital Affiliated to Soochow University.A total of 45 patients were enrolled in this study.Another 45 patients of non-diabetic nephropathy were selected as the control group matched by gender,age,and time of PD initiation.The information of the two groups such as general data,dialysis related complications,incidence of peritonitis,prognosis was recorded.Survival analysis was performed using the Kaplan-Meier method and Log-rank test.The risk factors affecting patients' survival were analyzed with Cox regression model.Results There were no significant difference in pre-dialysis age,sex ratio,blood pressure,urine volume,body weight,eGFR,biochemical data,and the proportion of hypertension and diabetes mellitus in the polycystic kidney group and control group.24 h ultra-filtration volume,4 h D/Pcr,Kt/V and Ccr between the two groups showed no significant difference (all P ＞ 0.05).The incidence of peritonitis and the time of the first peritonitis in the two groups respectively as one episode per 82.4 months vs one episode per 81.5 months,(35.8±22.8) months vs (34.5±20.9) months had no statistical difference.The ratio of hernia (6.6％ vs 2.2％),thoracic and abdominal leakage (4.4％ vs 2.2％),dialysate leakage (0 vs 0),catheter dysfunction (4.4％ vs 6.6％),exit-site infections (11.1％ vs 6.6％),tunnel infections (4.4％ vs 2.2％) and non PD related infections (11.1％ vs 13.3％) had no significant difference.The 1-year,3-year,5-year patient survival of two groups respectively were 95.2％ vs 93.3％,78.9％ vs 75.0％,67.6％ vs 64.9％ (P=0.475),and 5-year technique survival was 78.7％ vs 76.7％ (P=0.623),demonstrating no obvious difference.Cox regression analysis showed that age and serum albumin were risk factors for the survival of patients.Conclusions The effect and prognosis of peritoneal dialysis in patients with polyeystic kidney and non polyeystic kidney were similar.Peritoneal dialysis is not the contraindication of polycystic kidney.Peritoneal dialysis can be used as a routine renal replacement therapy in patients with polycystic kidney disease.

Objective To summarize our experience in the liver transplantation from the donation after cardiac death (DCD).Methods The livers from three DCD donors (2 cases of brain trauma and 1 case of cerebral hemorrhage) were harvested according to the Guidelines for Donation after Cardiac Death in China.These grafts were orthotopically transplanted into three recipients including 2 cases of decompensative hepatic cirrhosis and 1 case of primary liver cancer.The warm ischemic time ranged from 7.5 to 10 min and the cold ischemic time was 4.5,8.2 and 6.5 h respectively.Postoperative immunosuppressive regimens included prednisone,FK506 and mycophenolate mofetil (MMF).Antibiotics and anticoagulatants were used accordingly.Results All of the 3 recipients obtained normal liver function within 3 weeks since the grafts were implanted without PNF,thrombosis and rejection.No postoperative complications occurred in 3 recipients during the follow-up period of 2 to 9 months with normal liver function.Conclusion The liver transplant from DCD donor showed good results in our center.Chinese group Ⅲ of DCD donor,UW score above the middle level and the short warm ischemic time are three keys ensuring the success of the liver transplant from DCD donors.

Objective:To investigate specificity of neurovascular compression in patients with primary trigeminal neuralgia (PTN) by three-dimension reconstruction and computational fluid dynamics.Methods:Clinical characteristics and preoperative magnetic resonance imaging (MRI) data of 20 patients with both PTN and single artery compression (PTN group) and 10 patients without PTN but having neurovascular contact in MRI images (control group) in the Second Affiliated Hospital of Zhengzhou University from January 2018 to December 2019 were collected and analyzed. After three-dimension reconstruction of the MRI images, curvature of the arterial loop, angle between the plane of arterial loop and the trigeminal nerve and location of the compression were observed. Then bidirectional structure-fluid coupling based on the optimized stereolithography models of arterial loop and nerve were processed by ANSYS 19.2 software. In the location of the compression of contact, equivalent stress (ES) of arterial loop on the nerve, shearing stress (SS) of the blood flow and local deformation of the nerve were iteratively computed. All parameters were analyzed and compared between the PTN group and the control group, and the correlation analysis was proceeded between the anatomical parameters and hemodynamical parameters.Results:The curvature of arterial loop [0.21(0.12) mm -1vs 0.13(0.07) mm -1, U=34.00, P<0.05], the angle between vascular loop and nerve [69.70(30.67)° vs 43.40(37.21)°, U=38.00, P<0.05] in the PTN group were significantly greater than those in the control group, and the location of compression was significantly closer to the root of nerve in the PTN group [PTN group: (4.23±1.29) mm vs control group: (5.54±1.85) mm, t=-2.26, P<0.05]. The average SS [15 952.48(5 365.56) Pa vs 12 501.97(6 355.26) Pa, U=53.00, P<0.05], ES [24 965.65(7 693.22) Pa vs 14 992.99(9 824.08) Pa, U=32.00, P<0.05] in the PTN group were significantly greater than those in the control group. The curvature of arterial loop was positively correlated with the SS ( r=0.931, P<0.05) and ES ( r=0.962, P<0.05), and the latter two ( r=0.787, P<0.05; r=0.853, P<0.05) were positively correlated with the local neural deformation. Conclusions:In patients with PTN, offending artery compresses the root of nerve by greater arterial curvature and angle between the arterial loop and nerve. These anatomical differences will cause significantly greater SS, ES and local neural deformation.

Objective:To investigate the effect of thoracolumbar osteoporotic vertebral compression fracture (OVCF) combined with lumbar degenerative spondylolisthesis (LDS) on spinopelvic sagittal parameters in the elderly.Methods:A case-control study was conducted to analyze the clinical data of 77 patients with thoracolumbar OVCF admitted to Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine from December 2016 to December 2021. There were 16 males and 61 females with the age of 61-92 years [(73.9±8.4)years]. All patients had single-level thoracolumbar fractures (T 11-L 2). Simple thoracolumbar OVCF was found in 49 patients (OVCF group) and thoracolumbar OVCF combined with LDS in 28 (OVCF+LDS group). The pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), thoracic kyphosis (TK), thoracolumbar kyphosis (TLK), sagittal vertical axis (SVA) and Roussouly types were detected and compared between the two groups before operation. Results:There was no significant difference in PT and SVA between the two groups (all P>0.05). The PI, SS, LL, TK and TLK in OVCF+LDS group were (55.8±11.0)°, (34.1±10.9)°, (45.7±9.1)°, (35.7±6.1)° and (24.8±5.2)°, significantly larger than (47.9±8.8)°, (27.0±9.4)°, (33.1±7.9)°, (29.5±6.2)° and (18.4±5.5)° in OVCF group (all P<0.01). Roussouly types I-IV counted 22, 16, 5 and 6 patients in OVCF group, compared to 8, 5, 6 and 9 patients in OVCF+LDS group ( P<0.05). Conclusions:Elderly patients with thoracolumbar OVCF combined with LDS can significantly alter spinopelvic sagittal parameters, and LDS may aggravate the thoracolumbar kyphosis of OVCF. To avoid sagittal imbalance, surgery should be performed as soon as possible.