The clinical teaching is a key link to the cultivation of clinical ability.The quality of clinical practice will affect directly the students' medical treatment level and their comprehensive quality.Therefore,in the integrated Chinese-western surgical clinical teaching,we have adopted the standard teaching and strict management,and deepen the reform in education,thus cultivating a batch of interns with very good comprehensive quality and increasing the clinical teaching quality.

Objective To observe and compare the effect of different concentration of ropivacaine on elderly patient with bra-chial plexus block under ultrasound-guided ,to assess its effectiveness and security ,so as to determine the optimum dosage of anes-thetic for elderly patients with brachial plexus block .Methods 120 patients undergoing elective surgery of forearm or hand in this hospital from February 2013 to December 2014 were selected as the observation group in this study .These patients were randomly divided into four groups on average ,narcosis was conducted in each group with ultrasound-guided :group A with 30 mL of 0 .250%ropivacaine ,group B with 30 mL of 0 .375% ropivacaine ,group C with 30 mL of 0 .500% ropivacaine ,group D with 30 mL of 0 .750% ropivacaine .The onset time of sensory block ,motor block level ,duration of analgesia and adverse reactions were observed and recorded .Results With the increase of concentration of ropivacaine ,the onset time of narcotize became shorter(P< 0 .05) and duration of analgesia became longer(P < 0 .05) .There were no significant difference in the effects of brachial plexus block (P>0 .05) .There was no complications occurred in four groups after narcosis .Conclusion Concentration of ropivacaine more than 0 .375% can achieve perfect clinical effect on elderly patients with brachial plexus block under guidance of ultrasound .

Objective To explore the clinical value of Glucosamine hydrochloride tablets(GH)alone and combination with Xianlinggubao capsules(XLGB)for treatment patients with knee osteoarthritis(KOA).Methods 96 patients with KOA were selected,and were divided into two groups according to the random number method, 48 cases in each group.The control group was treated with GH alone,while the observation group was treated with XL-GB on the basis of the control group.US Western Ontario and McMaster University Osteoarthritis Index (WOMAC) were used to evaluate the symptoms change,including pain,stiffness,physical function scores and total scores before and after treatment.The onset time,knee function (HSS)score at 3 months and 6 months after treatment were recor-ded.CRP and ESR were measured,and the total efficacy was evaluated at the end of treatment.Results The differ-ence of WOMAC score between the two groups was not statistically significant before treatment (P >0.05 ).After treatment,pain,stiffness,physical function scores and total scores were (10.2 ±1.4)points,(3.5 ±1.6)points, (40.5 ±5.0)points and (56.4 ±6.7)points in the observation group,those were (14.8 ±2.6)points,(6.2 ±2.3)points, (52.2 ±6.8)points and (73.3 ±4.5)points in the control group,the differences were statistically significant (t =7.631,4.721,6.791,10.26,all P <0.01).The onset time,HSS score at 3 months and 6 months after treatment in the observation group were (6.0 ±2.2)d,(68.2 ±6.4)points and (84.3 ±6.2)points,while those were (9.8 ± 2.8)d,(58.5 ±3.9)points and (72.8 ±5.4)points in the control group,the differences were statistically significant (t =5.228,6.341,6.852,all P <0.01 ).The improvements of CRP level and ESR in the observation group were more pronounced than those in the control group (t =3.880,2.668,all P <0.05).After treatment,the total effective rate of the observation group was 93.8%(45 /48),while that was 77.1%(37 /48)in the control group,the difference was statistically significant (χ2 =5.352,P <0.05).Conclusion GH combines with XLGB can significantly improve symptoms in patients with KOA,with more rapid recovery of knee function,thus it is a safe and effective therapy.

Objective To estimate the efficacy of super-early minimal invasive evacuation of hematoma via keyhole for treating hypertensive basal ganglionic hemorrhage. Methods 36 patients with hypertensive basal ganglionic hemorrhage(9 cases in grade Ⅱ, 17 in grade Ⅲ and 10 in grade Ⅳ) were treated by minimal invasive evacuation of hematoma via keyhole at super-early stage, and their efficacy was statistically compared with 35 patients with hypertensive cerebral hemorrhage underwent conservative therapy or lateral ventriculopuncture. Results In the 36 patients underwent minimal invasive evacuation of hematoma via keyhole, 22 cases had a good prognosis(61.1%), 9 had a poor prognosis(25.0%), and 5 died(13.9%). Among the 35 patients underwent conservative therapy or lateral ventriculopuncture, 5 cases had a good prognosis(14.3%), 22 had a poor prognosis(62.9%), and 8 died(22.9%). There was a significant difference in good and poor prognostic rate between the two groups(P

Objective To observe the curative effect and side effect ofdifferent dosage of flurbiprofen applied in refractory renal colic cases.Methods Two hundred refractory renal cohc cases were randomly divided into group A and group B,each group was 100 cases.Group A were apphed 100 mg flurbiprofen injection,group B were applied 50 mg flurbiprofen injection.Observed the time of the colic pain reheved,the curative effect and side effect Results The total effective rate of group A and group Bwere 99%(99/100)and 91%(911100)respectively,there was significant difference between two groups(P<0.05).In the time to relieve of group A and group B were(8.3±5.7)min and(13.2±9.1)min respectively,there Was significant difference between two groups(P<0.05).Analgesia continuous time of group A and group B were(19.3 ±3.2)h and(14.5 4±5.1)h respectively,there was no significant difference between two groups(P>0.05).And side effect was no significant difference between two groups.Conclusion The curative effect of 100mg flurbiprofen injection applied to the refractory renal colic cases is very outstanding,the time to relieve is very shod but side effect dose not increase.

Objective To understand the potential internet addicts personality traits through the use of Thematic Apperception Test (TAT) and provide evidence for psychological therapy.Methods The experimental group included 34 outpatients defined as Internet Addiction Scale (IAS) ≥ 5 points,and the control group included 34 volunteers with the same age and the common cultural backgroud and defined as IAS ＜ 5 points.Results Compared with the control group,the internet addiction group had a higher desire projects including antisocial aggression (4.83±2.16),substance destroy (2.56± 1.61),intraggression (3.40±2.43) and passivity desires (2.65± 2.29) (P＜0.05).In contrast,the internet addiction group had a lower desire projects including achievements(2.31 ±2.14),domination (1.51±1.29),nurturance (2.30±2.34),succorance (1.80± 1.25) (P＜0.05,P＜0.01).Compared with the control group,the internet addiction group had a higher pressure projects include emotion (3.90±2.81),emotional language offensive attack (3.62±2.18),physical social aggression (2.73±2.23),physical antisocial aggressive (3.95± 1.88),substance destroy (3.33± 1.78),nuturanced (4.53 ± 2.57),rejected (2.18 ± 2.19),loss (4.01±2.41),physical danger pressure (2.65±2.37) and total pressure (49.49± 36.16) (P＜0.05,P＜0.01).Conclusion Internet addiction patients have potential personality with ultra-low in superego,lack in ego,possess stronger in id.Outpatient treatment with internet addicts should focus on psychotherapy,and improve interpersonal relationships.

OBJECTIVE:To discuss the countermeasure on the quality improvement of the drug clinical trials in our hospital based on the discovery of key links of the quality of clinical trials. METHODS:Quality results of 14 drug clinical trials in 10 ma-jors from the drug clinical trial institute in our hospital in 2014 were investigated. Referring to the grading and classifying methods of the inspection problems in European Medicines Agency,the key links of occurring problems were analyzed,and the effects of interventions for key links were evaluated. RESULTS:In 2014,totally 125 important and general problems were found,in which, the numbers of problems occurred in case report form filling,informed consent of subjects,enrolling and screening of subjects,in-vestigational products management accounted for 79.20%. The above 4 links were the key links affecting quality of drug clinical tri-als. According to strengthening the training about relevant knowledge of the researchers,improving system and standard operation procedures management,enhancing link quality control,introducing project clinical research coordinator,developing centralized drug management and other interventions,the total numbers of found important and general problems in 2015 and 2016 were 68 and 59,respectively. Compared with 2014,the differences were statistically significant(P<0.05). The numbers of found important problems in 2015 and 2016 were 7 and 4,respectively. Compared with 2014(4 important problems),the differences were not sta-tistically significant (P>0.05). There were no severe problems during 2014-2016. After interventions,numbers of occurring prob-lems in majors with less complex drug clinical trial had obviously declined in 2016. Compared with 2014,the differences were sta-tistically significant (P<0.05). While the major with relatively high complexity of drug clinical trial had no obvious decline in 2016. Compared with 2014,the differences were not statistically significant(P>0.05). CONCLUSIONS:Controlling the key links in drug clinical trial process can obviously reduce the occurrence of general problems while has little effect on the occurrence of im-portant problems. It is different for different majors in undertaking drug clinical trial projects,so as the links and degree of occur-ring problems. It should be distinguished in quality control checking.

Objective To discuss the clinical efficacy of compound gastritis mixture (CGM) in treating precancerous lesions of gastric carcinoma (PLGC).Methods Totally 85 PLGC patients were randomly divided into treatment group and control group. The treatment group took CGM and the control group took Vitacoenzyme tablets. One therapeutic course was three months, and the treatment lasted for two courses. The clinical symptoms, electronic gastroscopy presentation, and pathological tissues before and after treatment were observed, the clinical efficacy was evaluated.Results There was statistical significance in TCM syndrome between the two groups (P<0.05), and the effective rate in the treatment group was more obvious than that in the control group (P<0.01). The symptoms of the two groups were significantly improved (P<0.05,P<0.01), but the improvements of the main symptoms in the treatment group were superior to those in the control group (P<0.05,P<0.01). The total effective rate of electronic gastroscopy presentation was 80.0% (36/45) in the treatment group, which was better than that of the control group (P<0.05). Pathological curative effects of chronic atrophic gastritis, intestinal metaplasia, and dysplasia in the treatment group were also better than those in the control group (P<0.05).Conclusion CGM has definite clinical efficacy in treating PLGC.

Aim To investigate Jianpi Qinghua Chinese herbal compound( JQCC) on the expressions of the rel-evant proteins of TLR4 and its downstream MyD88-de-pendent pathways, and on the inflammatory factor TNF-α in the animal model of chronic atrophic gastritis ( CAG) in rats, so as to discuss the molecular mecha-nism of JQCC in the treatment of CAG. Methods 53 Wistar rats were randomly divided into the blank con-trol group(n=8) and the CAG model group(n=45), and the animal model of CAG in rats was replicated by the “ammonia + sodium deoxycholic acid + ethanol”method. After the successful modeling was confirmed, the rest of the 40 CAG rats in the CAG model group were divided into the model group, the vitacoenzyme-tablet group, the low dose of JQCC group, the medium dose of JQCC group, the high dose of JQCC group ( each group n =8 ) . The experimental animals of all the groups were given intragastric administration of medication continuously for 30 days. Then the patho-logical histological changes were observed by HE stai-ning. The protein expressions of TLR4, MyD88, NF-КB and COX-2 were tested by Western-blot assay. And the serum TNF-α level was measured by ELISA. Results The protein expressions of TLR4 , MyD88 , NF-КB and COX-2 and the serum TNF-α level in the rats in the model group were increased evidently ( P<0. 01). Compared with the model group, the gastric mucosa lesions were improved in the low dose of JQCC group, the medium dose of JQCC group, the high dose of JQCC group, together with significant decreases of the protein expressions of TLR4 , MyD88 , NF-κB and COX-2 and the serum TNF-α level ( P <0. 05 or P <0. 01 ) . Conclusion JQCC could effectively improve the pathological and histological changes in the gastric mucosa in CAG rats, and the therapeutic mechanism might be related to the expressions of the relevant pro-teins of TLR4-MyD88-dependent pathways and the ex-pressions of anti-inflammatory cytokines.

Objective To retrospectively analyze the effect of two kinds of biological agents in volume -re-duced bullae .Methods 11 patients who suffered from bullae were operated under large C-arm locating ,and infused two kinds of biological agents through micro catheter of fibreoptic bronchoscopy .All of them were randomly divided into the two groups .The biological agents in group A were fibrinogen and diluent thrombin , and that of group B was Porcine Fibrin Sealant Kit .In group A,the micro catheter with diameter of micro thread less than 1.2mm was placed in bullae through fibreoptic bronchoscope ,and then the 2mL lidocaine,5 ml fibrinogen,and double of 500u diluent thrombin were inproperorder injected through micro catheter .In group B,the Porcine Fibrin Sealant Kit was injected at the same method,and then the suspension fluid was exacted .The operation time was recorded ,and then the clinical efficacy and incidence rate of complications were compared .Results The operation time of group A was 5-15 minutes, and that of group B was 6-20 minutes.For all the patients ,4 cases were totally effective ,2 cases were significantly effective,and 2 cases were totally non-effective.The total effective rate was 81.82%(9/11).The incidence rates of common complications in group A and B were 52.38%(22/42),58.33%(14/24),respectively,the difference was not significant (χ2 =0.22,P>0.05).Moreover,there were no serious complications in all cases .Conclusion The security and effect of two kinds of biological agents might be well enough ,but in view of less cases ,they were worth to further popularized and applied in clinical practice .