Clinical medicine is a practical discipline.Students combine theoretical knowledge with practical operation and develop clinical thinking at stage of clinical practice.From the perspective of education administration,a series of measures were carried out throughout the whole teaching in clinical internship in our university.Students were trained to gain the abilities of combing knowledge with practice,analyzing and solving issues individually and thinking logically and scientifically.Through years of research and practice,remarkable achievements were gained and both clinical skill and comprehensive quality of our students were greatly enhanced.

Objective To investigate the value of fasting plasma glucose (FPG) in 75 g oral glucose tolerance test (OGTT) on the diagnosis of gestational diabetes mellitus (GDM).Methods Data of 6516 pregnant women who accepted prenatal cares from Beijing Obstetrics and Gynecology Hospital,Capital Medical University between Jan.2010 and Dec.2010 were collected.All patients had normal FPG at first trimester,and accepted 75 g OGTT after abnormal 50 g glucose challenge test (≥7.8 mmol/L).According to the result of OGTT,they were divided into 12 groups,and Chisquare test was used to analyze the role of FPG of OGTT in GDM diagnosis.Results According to the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria,15.0％ (980/ 6516) of this group of pregnant women was diagnosed with GDM by FPG (≥5.1 mmol/L) of OGTT in this study.Then,the rest 5536 pregnant women with normal FPG of OGTT were divided into 12 groups according to FPG level (FPG level interval 0.1 mmol/L).As FPG level rose,the incidence of GDM also rose (X2 =282.175,P =0.000).Similar results also appeared when the interval was 0.2 mmol/L and the FPG level was between 4.0 and 4.8 mmol/L (X2 =274.364,P=0.000).When FPG level was lower than 4.2 mmol/L(22.1％,1226/5536),the incidence of GDM diagnosed by OGTT was 3.6％ (44/1226).And when FPG level of OGTT was higher than 4.8 mmol/L,the incidence of GDM was 26.2％ (298/1138).Conclusions FPG screening is recommended between 24 and 28 gestational weeks before OGTT,and GDM low-risk women whose FPG ≤4.2 mmol/L do not need OGTT.

Objective To investigate the risk of heart failure to the mother and the neonate.Methods The clinical data of 30 pregnant womem with heart failure from January 1993 to December 2010 from Capital Medical University Tongren Hospital was retrospectively analyzed.Results Of the 30 patients,there were 12 affected with congenital heart disease (40％) ; 9 with rheumatic heart disease 30％,7 with heart failure in pregnancy-induced hypertension 23％.Heart failure appeared at the average of (34.20 ± 4.25) weeks in pregnancy.The average terminal time of pregnancy was (34.84 ± 2.17) weeks.The rate of early birth was 73.33％.The average birth weight was (2011 ±568) g,with 7 babies less than 2000 g.No death occurred in both new the mother and the neonate.Condusion The main causes of heart failure in pregnancy are congenital and rheumatic heart disease and pregnancy-induced hypertension.For those heart failure occurs before 30 weeks,it is the first selection that pregnancy shoud be terminated; For those occur after 30 weeks,active treatment should be performed to improve maternal heart function and promote fetal maturity.Apropriate threatment during per-cesarean section may decrease the case fatality of the mother and neonate.

AIM: To establish an HPLC-MS for determining seven bioactive components,including vanillin ferulaic acid,ligustrazine,senkyunolid I,H,and A,and ligustilide in Ligusticum chuanxiong Hort. . METHODS: The bioactive components were extracted by ultrasonic method,and then were separated by reverse HPLC,and finally were determined by the multiple reaction mode of MS. RESULTS: The detected limits of the seven bioactive components such as vanillin were 40,20,80,20,10,60 and 50 ng/mL,respectively. Their linear range were 1450,4-490,1-625,2-360,2-700,1-244 and 21-210 ?g/mL,respectively. The average contents of the above components in Ligusticum chuanxiong Hort. were 0. 12,0. 25,0. 41,0. 99,0. 30,8. 96 and 11. 25 mg/g,respectively. CONCLUSION: The proposed method has the characteristic of simplicity,rapidty and high sensitivity. It could be used in analyzing the whole components of Ligusticum chuanxiong Hort. .

Objective To evaluate CT virtual cystoscopy (CTVC) in the diagnosis of bladder tumor. Methods 22 cases of bladder cancer were examined by spiral CTVC with intravenous injection of 60% urografin or omnipaque.The images obtained were compared with that observed on coventional cystoscopy and operation. Results Based on CTVC images and transverse section images of CT,tumors were classified as 3 catogories:(1)superficial papillary tumor.(2)tubercular mass papillary tumor.(3)infiltrated tumor.Of the 22 cases examined with CTVC,18 were papillomas,11 tubercalar mass papillomas and 1 infiltrated tumor.The smallest was 3.0 mm in diameter.CTVC findings have been similar to those observed on conventional cystoscopy and operation. Conclusions CTVC,a new,noninvasive,safe and useful technique,can correctly demonstrate the details of surface of bladder tumor when the latter was greater than 3.0 mm. It could show the normal or abnormal mucosal folds and the relationship of the tumor to the ureteral orifices and the bladder neck.CTVC my be helpful in the choosing of management,in the clinical staging and diagnosis of bladder tumor.

Objective To study the effect of dexamethasone on pulmonary fibrosis model induced by bleomycin in rats and the expression of STAT1 and PDGF in lung tissue,and to discuss the possible mechanism.Methods Forty-five Wistar rats were randomly divided into three groups(15 in each group).They were dexamethasone group(DXM group),bleomycin group(BLM group) and control group(NS group):① The DEX group were intratracheally instilled with belomycin(BLM)(5mg/kg,in 1ml 0.9% NaCl solution),and then were treated with dexamethasone 3mg/kg via celiac injection daily;② BLM group were intratracheally instilled with BLM(5mg/kg),and then were treated with saline 3mg/kg via celiac injection daily;③ NS group were intratracheally instilled with saline(5mg/kg),and then were treated with saline 3mg/kg via celiac injection daily.Five rats in each group were sacrificed at 7,14,and 28 days after intratrachel instillation.Histological changes of the lungs were evaluated by HE stain.The bronchoalveolar lavage fluid(BALF) of right lung was gotten and the cells counting as well as differentiation were figured out.The expression of STAT1 and PDGF protein was assessed by immunohistochemistry.Results(1) The total number of inflammatory cells in BALF in BLM group was the highest at day 7 and diminished at day 14 and 28,which was significant different compared with that of the NS group(P

ObjectiveTo investigate the safety, efficacy and therapeutic mechanism of focused ultrasound surgery (FUS) on focal epilepsy of brain functional area in cat. MethodsThe focal epileptic models in the cats' motor cortex by penicillin were established. The different techniques were apphed in the animals epilepsy model. FUS, cortex thermocoagulation and multiple subpial transaction (MST) were compared in seizure control and functional preservation by observing behavior and electroencephalogram ( EEG), and the therapentic mechanism was compared by analysis of histopathology in the damaged cortex. ResultsIn seizure control and EEG changes, three kinds of techniques were similar without prominent difference in statistics (P ＞ 0.05). The same pathologic changes were showed in FUS group and cortex thermocoagulation group, ischemic change and coagulative necrosis of superficial layer nerval cells.The major pathologic change in MST group was an irregular crevice which was vertical with the surface of the cortex. The edema and mild gliosis were found around the crevice. ConclusionsThe focused ultrasound can effectively destroy and cut off the association of cortical horizontal fibre, meanwhile, the cortical function still to be reserved.Therefore, FUS is safe and effective as well as MST and cortex thermocoagulation on focal epilepsy in brain functional area.

Objective To investigate the effect of perfusion and preservation with intragraft dipeptidyl peptidase Ⅳ (DPP Ⅳ) catalytic inhibitor on pulmonary function after lung transplantation in rats. Methods Pure SD rats were divided into six groups. Syngeneic rats (SD to SD) served as donors and recipients. Orthotopic lung transplantation model was used. Grafts of control groups (CONI and CON2) were flushed and preserved in LPD-glucoae exposed to 18 h of cold ischemia before transplantation. Peak airway pressure (PIP), blood gas (PO2), wet/dry weight ratio (W/D), the activity of myeloperoxidase (MPO) and the content of malonyldialdehyde (MDA) of CON1 group were analyzed at first day after transplantation. In CON2 group, the 7-day survival rate post-transplantation was observed. Experimental groups were divided into four sub-groups (EXP1-EXP4), and grafts were perfused and stored for 18 h with LPD-glueose plus DPPⅣ catalytic inhibitor. The pulmonary function was detected at 1st (EXP1), 3rd (EXP2), 5th (EXP3), and 7th day (EXP4) posttransplantation, respectively. Results The rats in CON2 were died at 7th day post-transplantation,and all rats in EXP4 group survived to the 7th day post-transplantation. As compared with CON1 group, PIP, W/D, MPO activity and MDA content were reduced (P<0. 01 or 0. 05), and PO2 increased (P<0. 05) in EXP4 group. The pulmonary function of DPPⅣ catalytic inhibitor-perfused grafts from 1 to 7 days was improved and all tested parameters were close to normal at 7th day.Conclusion Perfusion and preservation with an inhibitor of CD26/DPP Ⅳ enzymatic activity obviously reduced severity of ischemia-reperfusion injury and was beneficial to the rehabilitation of grafts'pulmonary function.

Objective To explore the curative effect of triple lumen feeding tube on upper gastroin-testinal tract perforation after endoscopic operation.Methods A total of 1 12 patients with upper gastrointes-tinal perforation after endoscopic operation were involved in this prospective control test.The remission rate of abdominal pain and abdominal distension,gastric pH,lesion healing time,length of stay and the success rate of conservative treatment were compared between the control group (indwelling traditional gastric tube and intravenous use of omeprazole injection)and the experimental group (intestinal administration of PPI through triple lumen feeding tube).Results The remission rate of abdominal pain of the experimental group was 61. 3% at 6 hours,and 83. 2% at 12 h,which were significantly higher than those of the control group (P<0. 05 ).The lesion healing time(of cases where lesions were not clipped)and length of hospitalization of the experimental group were significantly shorter than those of the control group(P<0. 05 ).The gastric pH and success rate of conservative treatment of the two groups had no significant difference(P>0. 05 ).Con-clusion The curative effect of triple lumen feeding tube on upper gastrointestinal tract perforation after endo-scopic operation is ideal.

Objective To explore the reproductive outcomes of different management strategies of ectopic pregnancy .Methods A retrospective cohort study was performed for 648 consecutive patients with a diagnosis of ectopic pregnaney between June 2011 and september 2013.The follow-ups were conducted telephone interviews of pregnancy outcomes after various treatments .Results The subsequent intrauterine pregnancy rates after surgical , medical and expectant managements were 89(65.0%), 35(79.6%) and 6 (54.5%) the intrauterine pregnancy was higher for medical treatment than that for surgical treatment (P<0.05).The subsequent infertility rate after surgical , medical and expectant management were 4.5%, 36.4%, 19.0%.The subsequent infertility rate after medical treatment was lower than that for surgical and expectant managament ( P<0.05) .The re-ectopic pregnancy rates of laproscopic versus abdominal operation were [11 (11.7%), 13(30.2%)] with significant difference (P<0.05).And abdominal operation was higher than laproscopic operation .Conclusion For younger ectopic pregnancy patients , medical treatment shold be as possible as we can .If operation is necessary , laproscopic operation is preferred .