The enrollment of foreign medical students has expanded year after year.The education of foreign students becomes an important part of college education.In order to explore an effective method of medical education,the difference between Chinese students and foreign ones has been analyzed and the experience has been concluded according to the practice in teaching clinical diagnostics in recent years.

Objective To investigate the diagnostic value of gluocose-6-phosphate isomerase (G6PI) detected by an enzy-me linked immunosorbent assay (ELISA) in patients with rheumatoid arthritis (RA). Methods The G6PI was detected by ELISA in serum samples from 106 patients with RA, 53 non-RA controls with various rheumatic diseases, and healthy individuals. The level of rheumatoid factor (RF), anti-CCP antibodies and AKA were also assessed in RA patients. The correlation analysis beween G6PI and anti-CCP, IgM-RF. G6PI, anti-CCP, IgM-RF and AKA were carried out between patients with erosion and with non-erosion diseases . Results ① G6PI serum level of patients with RA was (1.61 ±1.20) μg/ml, and was (0.11 ±0.17) in patients with other rheumatic diseases, and (0.06±0.07) μg/ml in healthy individuals. There was statistical significant difference between RA patients and patients with other rheumatic diseases (P<0.05). Receiver operator curve analysis (ROC) showed an opitium cut off level for C6PI at 0.225 μl/ml. The sensitivity of G6PI was 0.868, the specificity was 0.853 in RA. C6PI was associated with RF, but was not associated with anti -CCP. C6PI ws not associated with disease activity index by Spearman' s correlation analysis. The association between above parameters with bone erosion was not detected, however. Conclusion C6PI is abnormally increased in some RA so it may be a new diagnostic marker for RA. G6PI has a reasonable sensitivity (86.8%) and with high specificity(85.3%) to RA and it is valuable for RA diagnosis. C6PI is associated with RF, but not completely overlaps. C6PI is not associated with diseases activity. No association is found between G6PI and bone erosions.

ConclusionBushen-Yitalpowder adjuvant to progesterone therapy can improve the clinical outcome in patients with early threatened abortion.

Objective To compare the curative effects between recombinant human brain natriuretic peptide (rhBNP) and sodium nitroprusside in treatment of the acute attack of elderly patients with chronic heart failure (CHF), and probe the impacts of rhBNP on the heart function,serum B-type natriuretic peptide (BNP), norepinephrine (NE), endothelin 1 (ET-1) and antidiuretic hormone (ADH) levels. Methods The 89 patients aged 65-85 years at acute attack stage of CHF were randomized into two therapy groups: rhBNP group (n= 47) and sodium nitroprusside group (n=42). The clinical effects, heart function, serum BNP, NE, ET-1 and ADH changes were observed before and after the treatment. Results After 24 hours of treatment, the efficacy rate and total effective rate were higher in rhBNP group than in sodium nitroprusside group (51.1% vs. 26.2 %,95.7% vs. 66. 7%, respectively, P＜0. 05 and P＜0. 01), and non-efficacy rate in rhBNP group was lower (4.3% vs. 33. 3%, P＜0. 01). There was one death case in rhBNP group and three in sodium nitroprusside group. In rhBNP group, left ventricular ejection fraction values increased after 2 weeks of treatment [(46.2± 9.5)% vs. (38.1 ±6.0)%], P＜0.05. Serum BNP level significantly decreased in rhlBNP group than in sodium nitroprusside group after 2 weeks of treatment (P＜0.05).In rhBNP group, serum BNP and NE levels decreased 24 hours and 2 weeks after treatment (P＜0. 01) and the levels furtherly reduced after 2 weeks (P＜0.01). Serum ET-1 level decreased in rhBNP group than in sodium nitroprusside group 2 weeks after treatment (P＜0.05). In rhBNP group, there was no significant difference in serum ET-1 level between baseline and 24 hours after treatment (P＞ 0. 05), but the ET-1 level decreased 2 weeks after treatment as compared with 24 hours after treatment (P＜0.01). There were no significant differences between the two groups before and after treatment (P＞0.05). Incidences of headache and hypotension were lower in rhBNP group than in sodium nitroprusside group (4.3% vs. 19.0%, 14.9% vs. 23.8%, both P＜0.05),Conclusions RhBNP can be safely and effectively used for acute attack of CHF.

Adult ; Female ; Granulomatosis with Polyangiitis ; pathology ; Humans ; Pituitary Diseases ; pathology

Objective: To investigate the determinants affecting the heart rate deceleration capacity (DC) in patients with dilated cardiomyopathy (DCM). Methods: One hundred patients with DCM (DCM group) and 202 healthy subjects (control group) were respectively enrolled. Echocardiography and 24 hours electrocardiogram were performed in all subjects. DC value was compared between the two groups. Multiple regression analysis was made to evaluate the related determinants of DC ((age, sex, echocardiographic parameters including the left atrial diameter (LAD) and left ventricular ejection fraction (LVEF)). Results: (1) DC value was significantly lower in DCM group than in control group( (4.40±2.03) ms vs. (7.30±1.81) ms, P<0.01), prevalence of DC value≤4.5 ms was significantly higher in DCM group than in control group (62% vs. 6%, P<0.01). (2) DC value in the DCM group decreased in proportion to increasing LAD dimension, DC value was (5.60±2.04) ms, (4.50±2.07) ms and (3.60±1.62) ms (P<0.05) in DCM patients with LAD≤40 mm, 40 mm50 mm, respectively. (3) DC value in the DCM group was negatively related to the LAD (r=-0.366, P<0.01), positively related to the LVEF (r= 0.241, P<0.01), but not related with age and sex. Multiple factors regression analysis showed that increased LAD was related to the reduced DC values independtly. Conclusion DC value of the patients in the DCM group is decreased, which indicate the decrease of the vagus nerve tension, and increased LAD is related to the reduced DC value independtly in DCM patients.

Objective To explore the changes of related angles of knee joint in adults in recent 30 years according to the angle value of knee joint compiled by Qi Zhongzheng in 1984,to provide the basis for clinical individualized diagnosis and treatment.Methods 102 healthy volunteers underwent digital X-ray photography of lower limbs.The femoral angle,tibial angle and femoral tibial angle of bilateral knee joints were measured and compared with historical reference value.The correlation between height,weight,BMI and each angle was evaluated.The differences between different sides and different genders were also analyzed.Results There were statistical differences between the mean value and historical mean value of femoral angle,tibial angle and femoral tibial angle (P＜0.001).In female volunteers,the height was weakly correlated with tibial angle and femoral tibial angle (P＜0.05),the weight was weakly correlated with femoral angle (P＜0.01),and the weight was moderately correlated with femoral tibial angle (P＜0.0 1).BMI was weakly correlated with femoral angle or femoral tibial angle (P＜0.05).There were significant differences in femoral angle (right),tibial angle and femoral tibial angle between different genders (P＜ 0.05).Conclusion In the last 30 years,there is a statistical difference between the angle value of the knee joint and the historical reference value.There is also a statistical difference in knee joint angle value between both genders.And in female volunteers,height,weight and BMI show some correlations with the knee joint angle value.However,the cross-sectional survey data of multicenter,large sample size and the whole population are still necessarily needed for further study.

At present, some "5+3" integration students have different levels of understanding and application problems in various stages, such as role transformation, professional knowledge and technology, communication ability and humanistic care ability, clinical thinking and evidence-based medicine concepts, clinical research thinking, learning and work attitude. This research will permeate and run through the training of "5+3" integrated students' diagnostic and therapeutic operation ability through the training of modern clinical thinking oriented by post competency, and integrate humanistic care, evidence-based medicine, learning attitude, working attitude, and attitude towards patients in the whole process to gradually complete the comprehensive training goal of clinical thinking oriented by post competency + diagnostic and therapeutic operation ability.

In designated hospitals for critical patients with COVID-19 in Wuhan, time-efficient pharmaceutical emergency protection system was of great significance for epidemic prevention. Described in the paper are measures taken by the pharmaceutical department of the hospital as follows. These measures include launching an emergency response mechanism, formulating a catalogue of COVID-19 key therapeutic drugs, urgently purchasing therapeutic drugs, transforming the processes of emergency pharmacy, establishing a drug donation management system, building a COVID-19 pharmaceutical care team, and setting up a " cloud pharmacy" to meet the drug needs of patients with non-COVID-19 chronic diseases, in addition to strengthening personnel protection of pharmacists. During such an epidemic, the pharmacy administration works in a professional, comprehensive, complex and systematic emergency program, which guaranteed the safety of drug supply, medication and enabled the treatment to be carried out in an orderly manner.

After the outbreak of COVID-19, due to environmental pollution in the isolated ward and operational constraints caused by protective clothing and other factors, intravenous drugs in the designated hospitals should be centralized. Combined with the existing process mode, the process of pharmacy intravenous admixture services was optimized, the operation mode of the operation platform was adjusted, the scheduling mechanism was optimized, and the node control process of " first verify and five checks" was explored and developed, so as to meet the 24 h needs of COVID-19 patients. According to the characteristics of COVID-19 drug treatment, the focus of prescription review was adjusted to ensure the drug safety of patients. Other measures included implementing paperless prescription to reduce unnecessary media; implementing segmented infusion distribution management to ensure no cross infection; hierarchical control and configuration environment, strengthening the protection and management of pharmacists, to avoid the risk of personnel infection; optimizing human resource allocation and improving work efficiency. This process reengineering and optimization established the emergency management mode of centralized intravenous drug deployment under the background of COVID-19, which ensured the intravenous drug demand and safety of COVID-19 patients. The treatment work was carried out orderly, and could provide reference for the pharmaceutical department in medical institutions to deal with major public health emergencies in the future.