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 effect of reserpine,an efflux pumps inhibitor,on the activities of fluoroquinolones (FQNs) against Enterococci,and the distribution of efflux pump genes emeA and its correlation with the resistance of Enterococci.To elucidate the relationship between FQN resistance in Enterococci and active efflux.Methods One hundred isolates of enterococci were identified by VITEK microbe automatic system.The antibacterial agent susceptibility tests were performed by the disc diffusion method (K-B) in accordance with the CLSI standards.The minimum inhibitory concentration (MIC) of each FQN was tested by the agar dilution method,and the MIC changes were detected after adding reserpine.The distribution of emeA in 100 isolates of Enterococci was determined by PCR.Thex2 test was used to compare the differences of statistical results.Results After reserpine was used,three-FQN resistance in Enterococci was reduced.Ciprofloxacin,gatifloxacin and levofloxacin resistance was reduced from 42％ (42/100) to 28％ (28/100),from 30％ (30/100) to 17％ (17/100),and from 33％ (33/100) to 23％ (23/100),respectively.The positive rate of emeA gene in 100 strains of Enterococci was 55％ (55/100).There were 45 positive strains(72.6％) in 62 E.faecalis and 10 positive strains (26.4％) in 38 E.faecium.The positive rate of emeA gene in the resistant strains against ciprofloxacin,gatifloxacin and levofloxacin was 73.8％ (31/42),76.7％ (23/30),75.8％ (25/33),respectively,and the positive rate of emeA gene in the susceptible strains against above 3 antibacterials were 41.4％ (24/58),45.7％ (32/70),44.8％ (30/67).Efflux pump genes emeA in resistant strains is higher than the sensitive strains,with the statistically significant difference(x2 =13.02,8.13 and 8.57,P ＜ 0.005).Conclusions Reserpine could inhibit the active efflux of in FON Enterococci and reduce the MIC for drug-resistant strains in vitro.Multidrug-resistant efflux pump gene emeA was relevant to antimicrobial drug resistance in Enterococci.

Purpose To investigate the clinical and pathological features and differential diagnosis of alveolar soft part sarcoma (ASPS).Methods The clinical data were retrospectively analyzed in 21 cases of ASPS. Histopathological and immunohistochemical changes of the tumors were also observed in the paraffin-embedded tissue samples.Results In 21 cases, 11 were male and 10 females. Ages of the patients ranged from 4 to 56 years old,with mean 25.9 years old.The lesions were mainly located in the deep soft tissues of legs.Microscopically,tumor cells with granular cytoplasm arranged in alveolar or solid structures,and were separated by sinusoidal vessels. There existed crystals in the cytoplasm of tumor cells after PAS staining.Immunohistochemically,10 cases were positive for MyoD1, 4 positive for desmin,9 positive for S-100,11 positive for NSE, and 11 positive for Vim. All of ASPS were negative for AE1/AE3,CK, EMA, SMA, MSA and Syn.Conclusions ASPS is a rare malignant neoplasm in adolescents and young adults. It is prone to early hematogenous metastases and a high recurrence rate after conservative surgical excision. Therefore, the prognosis of ASPS is poor. Careful analysis of the clinicopathological features and immunohistochemisitry will be helpful to reach an accurate diagnosis.

Objective To investigate the risk factors for postoperative nausea and vomiting (PONV) in spinal anesthesia patients.Methods A total of 841 patients received spinal anesthesia were visited after operation.Data were analyzed using univariate analysis and multivariate Logistic regression to identify risk factors related to PONV.Results PONV occurred in 94 patients (11.2％,94/841).Univariate analysis showed that PONV was unrelated with gender,age,ASA classification,anesthesia mode (P ＞ 0.05),related with operation department (P =0.026),body mass index (P =0.020),education level (P =0.000),history of previous surgery anesthesia (P =0.005),history of PONV (P =0.000),history of kinesia (P =0.002),smoke (P =0.019),intraoperative using of tramadol (P =0.018).Multivariate analysis showed that operation department (OR =4.039,95％ CI 1.331-12.259,P=0.048),education level (OR =3.504,95％ CI 1486-8.260,P=0.015),history of PONV (OR =5.113,95％ CI 1.790-14.606,P =0.002),intraoperative using of tramadol (OR =5.316,95％ CI 1.091-25.908,P =0.039) were identified as independent risk factors for PONV.Conclusions The independent factors associated with PONV following spinal anesthesia include operation department,education level,history of PONV,intraoperative using of tramadol.Identifying patients who are at high risk for PONV will enable the formation of more timely management project.

Objective To identify the differentially expressed microRNAs in the early transformed cells,the late transformed cells and their parental BEP2D cells.Methods The differentially expressed microRNAs in the above cells were identified by microRNAs microarray assay.Results There were 38differentially expressed microRNAs in R15H20 cells versus BEP2D cells,with 18 upregulated and 20downregulated microRNAs.R15H20 and RHT35 cells shared 25 differentially expressed microRNAs compared with BEP2D cells,with 15 down-regulated and 10 up-regulated microRNAs.There were 87differentially expressed microRNAs in RHT35 cells versus BEP2D cells,with 47 upregulated and 40 downregulated microRNAs.There were 38 differentially expressed microRNAs in RHT35 cells versus R15H20 cells with 20 upregulated and 18 downregulated microRNAs.Conclusions microRNAs are differentially expressed in the different stages of carcinogenesis of BEP2D cells induced by α particles,which suggests that microRNAs may play an important role in α particle-induced malignant transformation of BEP2D cells.

Objective To evaluate the reliability of PainVision method for assessment of postoperative pain in patients undergoing gynaecological laparoscopy.Methods Twenty ASA physical status Ⅰ-Ⅱ patients,aged 30-45 yr,undergoing gynaecological laparoscopy under fentanyl-propofol-cisatracurium anesthesia,were studied.Pain intensity was simultaneously assessed using PainVision method and visual analog scale (VAS) at 12,24 and 48 h after surgery.PainVision was a new method for quantitative measurement of pain intensity using a painless electrical stimulation (PainVision PS-2100 device).Pain degree was calculated from two parameters,current perception threshold and pain compatible electrical current by using PainVision.The former parameter was defined by the lowest electrical current detected ; the latter parameter defined by the electrical current judged as being compatible with the intensity of ongoing pain.Results There was a significant positive correlation between pain degree calculated by PainVision method and VAS scores,and the correlation coefficient was 0.902 (P ＜ 0.01).Conclusion PainVision method can be applied for assessment of postoperative pain in patients undergoing gynaecological laparoscopy.

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.

Objective To observe the effects of passive movement on the functional outcome after occlusion of the middle artery in the brain and reperfusion, and to explore the molecular mechanisms involved. Methods Cerebral infarction models were established in rats using left middle cerebral artery occlusion ( MCAO). The survivors were randomly divided into a passive movement group and a natural recovery group. There was also a sham-operated group and a normal group. Passive movement treatment (twice a day, twenty min per time) was started at different times after reperfusion. The expression of brain-derived neurotrophic factor (BDNF) and B cell lymphoma/leukemia-2 gene (Bcl-2) were determined using real-time PCRs. Results Expression of BDNF and Bcl-2 was detected a-round the infarction area in both groups. The expression of BDNF and Bcl-2 was highest in the sub-groups where passive movement was begun 24 or 48 h after the operation. Conclusions The expression of BDNF and Bcl-2 in the brain peaks when daily, moderate intensity passive movement is administered beginning 24 to 48 h after reperfusion. Passive movement might have a protective and rehabilitative effect after cerebral infarction.