In the paper, the authors not only analyzed and compared the international medical educational system, but also reviewed the medical educational system flux in China. The authors put forward several advices for perfect medical educational system according to international trend.

Animals ; Calcitonin Gene-Related Peptide ; blood ; Cerebral Infarction ; blood ; Endothelins ; blood ; Humans ; Nitric Oxide ; blood ; Plasminogen Inactivators ; blood ; Thromboxane B2 ; blood

Objective To explore the learning curve of transbronchial needle aspiration by evaluating the procedure time and the positive rate for respiratory physicians who have already mastered the bronchoscopy. Methods Clinical data of 60 patients who received TBNA procedure from May 2013 to August 2014 were retrospectively analyzed. The patients were divided into four groups (A, B, C, D) according to the time sequence of receiving the TBNA procedure, 15 patients in each group were set as a learning stage. The patients were received TBNA by the same doctor. The average time in each stage of puncture, positive rate, and puncture complications were compared among each groups. Results There did not show any significant differences in gender, age, etc. (P > 0.05) among the four groups. Puncture time in group A (15.2 ± 2.0) min and in group B (14.7 ± 2.2) min were significantly longer than that in group C (8.3 ± 1.6) min and in group D (7.6 ± 1.3) min (P < 0.05). In terms of the positive rate after the puncture, group A (26.7%) and group B (33.3%) were significantly lower than group C (80.0%) and group D (80.0%) (P < 0.05). There were no significantly different between group A and group B, and group C and group D in terms of puncture time and positive rate. Complications in each group was similar to intravascular puncture, after-puncture bleeding, pneumothorax, mediastinal hematoma, mediastinal bleeding and mediastinal infection did not show significant differences. Conclusion The learning curve of transbronchial needle aspiration for respiratory physicians who havemastered the bronchoscopy is around 30 cases.

Objective To investigate the expressions of miR-16,miR-106b,miR-449a,miR-34a and let-7g in peripheral blood plasma of the residents surrounding hot springs with radon in Hebei province.Methods A total of 41 randomly selected residents surrounding hot springs with radon were considered as the radon group,and 46 residents with same living habit but without contact with hot springs were considered as control.The miRNAs in the peripheral blood plasma of these two groups were detected with qRT-PCR.Results The levels of miR-16,miR-106b,miR-449a and let-7g in the radon group were significantly higher than those in control group (Z=-2.278,-3.835,-2.719,-2.721,P＜0.05).Alterations of these miRNAs were associated with radon exposure (t =2.154,3.711,2.319,2.015,P ＜ 0.05) but had no relationship with age,sex,smoking and drinking factors.No significant difference was observed in the plasma levels of miR-34a between the two groups.Conclusions miR-16,miR-106b,miR-449a and let-7g could be applied as potential biomarkers for radon exposure.

Objective To investigate the value of Cytochrome P450 (CYP3A5) * 3 gene polymorphism in providing individualized administration for the use of tacrolimus (Tac) in renal transplantation recipients.Method Pyrophosphate sequencing method was used to determine the CYP3A5 * 3 genotype of renal transplant patients in the first day after surgery.Sixty recipients were divided into experiment group and control group.Both groups of patients were routinely given the initial dose of Tac-4.0 mg/day in the first day after surgery.The experiment group of patients were given different doses of Tac based on the different CYP3A5 * 3 genotypes at the third day after surgery [for AA:0.12 mg/(kg· day),and for GG:0.06 mg/(kg· day)],and the control group of patients were given different dosages of Tac according to drug concentration.Different parameters were compared between two groups of patients:percentage of patients reaching the target concentration (3-8 μg/L) at the fifth day after surgery,days required to reach the target concentration level,times needed to adjust the dosage of Tac within two weeks.Result The percentage of patients reaching the target concentration in experiment group and control group was 90％ and 46.67％,respectively (P＜ 0.05).Days required to reach the target concentration were (3.67 ± 1.32) and (7.57 ± 3.42) on average,respectively (P ＜ 0.05).Times of adjusting the Tac dose in experiment group was significantly less than those in the control group (P＜0.05).In the experiment group,the target concentration was obtained even without dosage adjustment (70％).Conclusion Individualized adjustment of Tac doses for patients according to recipients' different CYP3A5 * 3 genotypes is beneficial for reaching target concentration as soon as possible,which is superior to traditional dosage regimen.

Objective To observe the effect of exhaustive exercise on the function of the kidney in rats and explore the mechanism. Methods Fourteen male Sprague-Dawley rats were divided into sedentary control group (group C) and exhaustive exercise group (group E). They were measured the urine protein, uric acid, glucose, and blood urea nitrogen after exercise. The reactive oxygen species, inducible ni-tric oxide synthase, nitro tyrosine in kidney, and nephrin protein in the kidney were detected with fluorescent probe and Western blotting, re-spectively, and observed under Harris staining. Results There were significant differences between groups C and E in urine protein, uric ac-id, glucose, blood urea nitrogen, reactive oxygen species, inducible nitric oxide synthase, nitrotyrosine and nephrin protein (P<0.05). The glomerular morphology and the deformation of capillary basement membrane were found under the fluorescence microscope in group E. Conclusion Exhaustive exercise may damage the structure of kidney in rats, which may associate with oxidative stress.

Objective To investigate the differences in dosimetry between conformal radiotherapy (CRT),field-in-field intensity-modulated radiotherapy (FIF-IMRT),and intensity-modulated radiotherapy (IMRT) after breast-conserving surgery for left-sided breast cancer.Methods A total of 31 patients who underwent breast-conserving surgery for left-sided breast cancer were randomly selected,and the plans for CRT,FIF-IMRT,and IMRT were developed.The dose-volume histogram (DVH) was used for self-control study,and the non-parametric test was used to compare the differences in target volume and doses to organs at risk (OARs).Results All the three methods met the requirements of the prescribed doses.The CRT group had a higher V105 of the target volume and higher heart V30 and Dmax (P=0.000,0.000,0.000).The IMRT group had higher V5 and Dmean (P=0.000,0.000),as well as a higher lung V5 and a lower lung V40 (P=0.000,0.000).The FIF-IMRT group had the lowest Dmean (P=0.000),and the IMRT group had significantly higher Dmean and Dmax of the right lung and the spinal cord than the other two groups (P=0.000,0.000,0.000,0.000).The FIF-IMRT group had a significantly lower single hop count than the other two groups (P=0.000).Conclusions CRT has a good dose distribution in the target volume,but greatly injures the surrounding tissues.FIF-IMRT can well protect OARs and cause less damage to the device.

Objective To describe epidemiological characteristics of scalp psoriasis in China,and to determine its influencing factors through a hospital-based,multicenter and large-scale survey.Methods An epidemiological survey was conducted on patients with scalp psoriasis in 42 hospitals in 11 provinces and 4 municipalities.A questionnaire was designed to collect general and clinical information of patients,including clinical type,lesion distribution,psoriasis scalp severity index (PSSI),aggravating factors,influence on quality of life,treatment course,degree of satisfaction with treatment,etc.Participants were asked to fill out the questionnaire with the help of well-trained dermatologists.Data were processed with the EpiData software.The WPS system and Epi Info 5.0 statistics software were used for descriptive analysis of the data.Results Totally,3 901 patients participated this study,and 3 586 valid questionaires were obtained.The mean age at onset of scalp lesions was (27.40 ± 13.34) years,and the male to female ratio was 1.6∶1 with a mean PSSI score of 13.61 ± 12.31.The hairline of the forehead was the most frequently affected area with the constituent ratio of forehead psoriasis being 74.3％ (2 663/3 586).The duration of scalp psoriasis reached 3 to 6 months every year in 1 136 (31.7％) patients,and the area affected by scalp psoriasis was less than 25％ of the total surface area of the scalp in 1 649 (46％) patients.The most frequent clinical presentation was scaling (92.1％),followed by erythema (80.6％),itching(76.7％),bunchy hairs (39.9％) and hair loss(18.0％).Disease aggravation was most frequently associated with seasons (76.7％),emotions (47.4％),stress (47.1％) and fatigue (46.6％).The quality of life (especially social,outdoor and entertainment activities) was reported to be negatively influenced by this entity to different degrees in 2 529 (70.5％) patients.Of these patients,583 (17.8％) received combination therapy (topical and systemic),with glucocorticoid ointment (27.5％),calcipotriol scalp solution (22.7％) and glucocorticoid-containing solution (11.9％) being the most commonly used topical drugs; only 38.6％ complied with medication requirements and doctors' advice for 3 to 5 weeks,and 35.2％ believed that the primary reason for poor compliance was unsatisfactory response to drugs.It was considered that an ideal drug for the treatment of scalp psoriasis should be highly effective (50.3％),safe (17.8％) and easy to apply (11％) with a rapid onset of action(11.9％).Conclusions Scalp psoriasis has a predilection for the hairline of the forehead with scaling as the main clinical presentation.Winter and spring seasons appear to be the most common aggravating factor of scalp psoriasis.The quality of life is negatively influenced to different degrees in many patients with scalp psoriasis.Topical corticosteroids plus non-hormonal drugs should be the first choice for the treatment of scalp psoriasis.Patients consider that the ideal drugs for the treatment of scalp psoriasis should be effective,safe,and easy to apply.

Objective To investigate the relationship between in vivo anti-tumor efficacy of Shenqi injection and its effect on immunologic function in H22 tumor-bearing model mice,and explore the cellular immunologic mechanism of Shenqi injection in inhibiting tumor growth.Methods Three different doses of Shenqi injection were given to H22 tumor-bearing model mice in treatment groups.The tumor growth inhibitory rate(IR) and the index of phagocytosis of peritoneal macrophage were calculated.MTT assay was used to observe the effect of Shenqi injection on spleen lymphocytes stimulated by ConA in vitro separated from H22 tumor-bearing mice.Murine serum IL-2 and IFN-? were detected by means of ELISA assay.Results IR was significantly reduced in two treatment groups compared with that of the model mice(60.72%,48.65%,P

Objective To investigate the expressions of lung cancer related genes and miRNA in peripheral blood of the residents surrounding the extremely high radon hot springs in Ruoergai County,Sichuan Province. Methods Peripheral blood samples were collected from the local residents.Expressions of lung cancer related genes (p53,k-ras) and miRNA (let-7a,miR-34a/b) were detected by real-time PCR and the protein expressions of p53 and k-ras were detected by Western blot.Results The expressions of p53 and k-ras mRNA of the residents in high radon area were 0.97 and 1.33 times of the control respectively (t =0.13,-1.12,P ＞0.05),and the p53 and k-ras protein levels were 0.70 and 1.23 times of the control respectively (t =0.72,0.46,P ＞ 0.05).The let-7a of the residents in high radon area was lower (t =1.63,P ＞ 0.05 ) while the miR-34a and miR-34b were significantly higher than those of the controls (t =- 3.20,- 3.32,P ＜ 0.05).Conclusions Based on the expressions of p53 and k-ras gene and miRNA,it can be concluded that the residents surrounding the high radon hot springs received radiation damage.