With the establishment of bio-psycho-social medical model,the higher requirements are put forward for medical students′ professional qualification,which include solid theoretical foundation,superb clinical skills,profound humanistic knowledge,and noble medical ethics.It is of great significance to cultivate medical students′ professional qualification,since it can help medical students promote their competitiveness in the job market,improve the quality of medical services and build a harmonious relationship between doctors and patients.There are many approaches to train medical students′ professional qualification,including improving medical curriculum construction,deepening teaching reform of clinical practice,strengthening the integration of professional education and humanities education,conducting medical ethics education,and establishing an assessing system for medical students′ professional qualification.

Objective To explore the features of clinicopathology,gastroscopy,endoscopic ultrasonography (EUS) and immunohistochemistry of esophageal mesenchymal tumors (EMT).Methods The clinical data of 98 cases of EMT patients who underwent endoscopic biopsy,endoscopic treatment or surgery and were diagnosed according to pathological and immunohistochemistry examination were collected.The clinicopathologic characteristics,endoscopy,EUS and immunohistochemistry of these cases were retrospectively analyzed,and differentiated from other submucosal tumor.Results Among the 98 cases of EMT,there were 77 leiomyomas (LM),15 gastrointestinal stromal tumors (GIST),four lipomas,one leiomyoblastoma and one schwannoma.The age of GIST group were older than that of LM group,and most were male patients predominated in these two groups.Dysphagia was the most common symptom of EMT.Gastrointestinal bleeding was rare,which was different from other gastrointestinal mesenchymal tumors.Under endoscopy,the appearances of EMT were similar,as submucosal protuberant lesions.One esophageal GIST was extraluminal lesion.Under EUS,LM,GIST and schwannoma showed low echo images originated from the muscularis propria or muscularis mucosa.Lipomas showed high echo images originated from submucosa.Pathological examination indicated that main cell type of LM and schwannoma was spindle cell,part of GIST was epitheloid cell type.The expressions of CD117 and CD34 were high in GIST,the expressions of SMA and Desmin were high in LM.S-100 was expressed in schwannoma.Other submucosal tumors,such as esophageal cyst,esophageal tuberculosis,esophageal carcinosarcoma,and some esophageal squamous carcinoma were easily misdiagnosed as EMT.Conclusions Esophageal LM is the most common EMT,followed by GIST.EUS is helpful in EMT diagnosis,however it can not accurately distinguish GIST,LM or schwannoma.

Objective To explore the differences and similarities of clinical characteristics,pathological features, treatment and prognosis between primary gastric lymphoma(PGL)and primary intestinal lymphoma (PIL). Methods The clinical characteristics, pathological features, therapeutic results, the detection of Helicobacter pylori (Hp) and prognosis of 48 PGL cases and 15 PIL cases were retrospectively analyzed. Results There was no statistical significance in age, gender, abdominal pain, gastrointestinal bleeding, B symptoms, clinical stage, mortality between PGL and PIL groups (P>0. 05). However, there were significant differences in the pathological type, acute abdomen emergency surgery between these two groups (P<0. 05). There was 12 Hp positive cases in mucosalassociated lymphoid tissue (MALT) lymphoma of PGL group (12/19), and 5 Hp positive cases in diffuse large B-cell lymphoma (DLBCL) (5/20). There was significant difference in Hp detection rate of these two pathological types. Hp was not found in PIL group. The Cox multivariate analysis indicated that stage Ⅲ-Ⅳ was the independent adverse factors affecting PGL prognosis (P<0. 05).Conclusions Mainly histological types are DLBCL and MALT lymphoma in PGL, and DLBCL in PIL.PIL predispose to T-cell lymphoma compared with PGL. MALT lymphoma is rare in PIL group. The mainly clinical stage is Ⅲ-Ⅳ both in PGL group and PIL group. Emergency surgery is often needed in PIL because of intussusception or perforation. The prognosis of PGL is correlated with the stage and the prognosis of PIL are correlated with the stage, B symptoms and T cell phenotype.

Objective To investigate the expression of Smac/DIABLO, XIAP mRNA in acute pancreatitis (AP) and the relationship with the severity in rats.Methods Fifty-four SD rats were randomly divided into three groups:sham-operation (SO) group, acute edematous pancreatitis (AEP) group and acute necrotizing pancreatitis (ANP) group.The models of AEP and ANP were induced by retrograde injection of 1％ and 3.5％ sodium deoxycholate into the pancreaticobiliary duct respectively.The specimens of pancreatic tissue at 3 h, 6 h, 12 h were collected, pathological changes of the pancreas were observed, apeptosis in pancreas were detected by TUNEL method and the expression of Smac/DIABLO, XIAP mRNA were analyzed by real-time PCR.Results Pathological changes of the pancreas confirmed the establishment of AEP and ANP.Apeptosis indexes in SO group, AEP group and ANP group were 0.67±0.82, 6.62 ±0.78 and 4.70 ±0.82, and the differences were significant (P< 0.05).The expression of Smac/DIABLO mRNA of AEP group increased with time, while the expression of ANP group decreased with time.Compared with SO group, Smac/DIABLO mRNA expressions at 6 h in AEP and ANP group were 2.41 ± 0.92 and 1.47± 0.53, and the differences were significant (P<0.05).By contrast, the expressions of XIAP mRNA in AEP group decreased with time,while the expressions in ANP group increased with time.The expressionsof XIAP mRNA at 6 h in AEP and ANP group were 5.51 ± 1.07 and 6.99 ± 1.00, and the differences were significant (P<0.05).Conclusions In acute pancreatitis, the expression of Smac/DIABLO mRNA was consistent with the apoptosis of pancreatic acinar cells, but not consistent with the severity of pancreatitis.The expression of XIAP mRNA was consistent with the severity of pancreatitis.Smac/DIABLO, XIAP mRNA is associated with regulation of apoptosis.

OBJECTIVE:To establish a method for the simultaneous determination of(R,S)-goitrin,chlorogenic acid,luteolo-side and isochlorogenic acid A in Xiaoer ganmao granule. METHODS:HPLC was performed on the column of Hedera C18 with mo-bile phase of acetonitrile-0.1% formic acid aqueous at a flow rate of 1.0 ml/min,the detection wavelength was 254 nm,330 nm and 370 nm,column temperature was 40 ℃,and the injection volume was 5 μl,RESULTS:The linear range was 6.6-105 μg/ml for (R,S)-goitrin (r=0.999 9),9-140 μg/ml for chlorogenic acid (r=0.999 9),9-144 μg/ml for luteoloside (r=0.999 8) and 9-138 μg/ml for isochlorogenic acid A(r=0.999 6);the limits of quantitation were 330 ng,450 ng,450 ng and 450 ng,limits of detection were 66 ng,90 ng,90 ng and 90 ng,respectively;RSDs of precision,stability and reproducibility tests were lower than 3%;recoveries were 95.01%-98.77%(RSD=1.48%,n=6),95.14%-98.91%(RSD=1.52%,n=6),95.11%-97.54%(RSD=0.93%,n=6) and 95.58%-99.63%(RSD=1.73%,n=6). CONCLUSIONS:The method is simple and accurate,and suitable for the simultaneous determination of(R,S)-goitrin,chlorogenic acid,luteoloside and isochlorogenic acid A in Xiaoer ganmao granule.

Objective To investigate the regulation and the mechanism of Melatonin in calcium overload of pancreatic acinar cell in acute necrotizing pancreatitis (ANP). Methods Fifty-four Sprague-Dawley (SD) rats were equally divided into three groups:sham-operation group (SO group),ANP group (created with retrograde cholangiopancreatography injection of sodium taurocholate) and MT group (ANP model made after intra-peritoneal injection MT for 30 mins).Rats were sacrificed at 1,4 and 8hours after operation and pancreas tissues were underwent pathological examination.The free calcium concentration of pancreas tissues was determined by fluorescence minitoring method; and the expression of CaMK Ⅱ in pancreas tissues at mRNA and protein level was tested by real-time PCR and Western Blot.Results Pancreatic pathological injury in ANP groups was progressively severe as time extended,which was obviously ameliorated in MT group compared with ANP group (the t value of compared pathological score at 1,4 and 8 hour was:-7.95,-9.72 and -7.69,all P=0.00).Compared at same time point,the free Ca2+ concentration of pancreas tissues in ANP group was significantly higher than that of SO group (the t value of 1,4 and 8 hour was 13.09,18.58 and 16.56,all P=0.00).It was a little bit higher in MT group compared with that of SO group,however was significantly lower than that of ANP group (the t value of 1,4 and 8 hour was -10.03,-11.75 and -11.02,all P =0.00).Compared with SO group,the expression of CaMK Ⅱ at mRNA and protein level significantly increased in ANP group; MT significantly inhibited its expression.Conclusions The expression of CaMK Ⅱ may be inhibited by MT interfere,and then lower the calcium overload in pancreatic acinar cell,which play a role in pancreas tissue protection.

Esophageal submucosal hematoma is rarely seen in clinical practice and its clinical presentations are untypical.Gastroscopy might injure the esophageal mucosa and cause bleeding.Computed tomography had the advantages of quick examination and formation of imaging,as well as non-invasiveness,which is helpful for the diagnosis and differential diagnosis of the esophageal submucosal hematoma.The clinical data of 9 patients with esophageal submucosal hematoma who were admitted to the Yueqing People's Hospital,the First Affiliated Hospital of Wenzhou Medical University,the First Affiliated Hospital of the Zhengzhou University and the Third People's Hospital of Wenzhou from July 2005 to February 2014 were retrospectively analyzed.The features of computed tomography examination of esophageal submocosal hematoma include the range of the esophageal submucosal hematoma exceeds 2 parts of the esophagus,the rip of the esophageal mucosa begins and ends at the physiological narrowing of the esophagus,thickening of the esophageal wall,stricture of the esophagus,annular thickening and eccentric thickening of the esophageal wall,crescent,spot or gas shadows of the esophageal cavity,the density of the hematoma decreases as the time passed by.These features of computed tomography are of great importance for the diagnosis of esophageal submucosal hematoma.