The practical teaching of clinical medicine is in progress on the last stage of the 5-year university life,so it has the feature of the employment preparation and is influenced by a lot of factors.To make the practical teaching of clinical medicine take the right turning and get a satisfactory result,we should not only lay stress on the construction of teachers'contingents,but also bring the students'initiative to play and tighten up the management.

To improve the quality education of medical students,we should attach importance to the construction of teaching staff,improve learning environment,strengthen selected course construction and arrange for students to take social practice.

OBJECTIVE:To study the pharmacokinetics and relative bioavailability of metformin hydrochloride enteric-coated tablets and validate the bioequivalence between the domestic and the imported metformin hydrochloride enteric-coated tablets.METHODS:An oral single dose(1 000 mg)of domestic or imported metformin hydrochloride enteric-coated tablets was given to 26 healthy volunteers in a randomized crossover study.The time-concentrations of metformin hydrochloride were determined by HPLC.The pharmacokinetic parameters as well as relative bioavailability of the domestic tablets were computed.RESULTS:The concentration-time curves of the two kinds of metformin hydrochloride enteric-coated tablets were in line with one-compartment model.The main pharmacokinetic parameters of the domestic vs.the imported metformin hydrochloride enteric-coated tablets were as follows:Cmax(84.9?16.4)?g?L-1 vs.(84.5?13.8)?g?L-1;tmax(0.67?0.07)h vs.(0.77?0.08)h;t1/2 Ke(1.90?0.17)h vs.(1.79?0.19)h;AUC0～t(161.9?16.8)?g?h?L-1 vs.(157.2?19.7)?g?h?L-1;AUC0～∞(179.7?18.2)?g?h?L-1 vs.(173.4?19.2)?g?h?L-1.The relative bioavailability of the domestic enteric-coated tablets was(109.0?7.2)% as against the imported enteric-coated tablets.CONCLUSION:The two kinds of tablets were bioequivalent.

To analyze the clinical characteristics of postmenopausal ovarian tumors and explore the predict indicators and treatment for ovarian benign and malignant tumors.A retrospective analysis was performed for clinical data and pathological results of 125 patients with postmenopausal ovarian tumors from January 2008 to January 2013.The symptoms of malignant patients included abdominal pain (n =30),bloating (n =11) and weight loss (n =5).It had significant difference compared with benign tumors (P ＜0.05).Ultrasound showed that there was 44 cystic and solid tumors with 22 malignancies and 57 cystic tumors with 5 malignancies.There was significant difference in morbidity of malignant ovarian tumors between them (P ＜ 0.05).The incidence of malignant tumor in 5-10 cm group was 56％.There were significant differences compared with the ＜ 5 cm group (P ＜ 0.05).The specificity of ultrasound plus a combined detection of CA125 for malignant epithelial tumor of ovary was 91％ with a sensitivity of 93％.Thirty-one cases of malignant tumor were accurately diagnosed with preoperative ultrasound.Ultrasound plus CA125 could help distinguish the characteristic of tumors.

A total of 78 pelvic abscess cases were confirmed by operation retrospectively.Group A underwent celiotomy ( n =30 ) while group B laparoscopic surgery ( n =48 ).Medical history , clinical symptoms and outcomes were analyzed.Operative durations of groups A and B were ( 90 ±21 ) and ( 70 ± 14) min, the amount of hemorrhage (70 ±24) and (46 ±24) ml and wound dehiscence rate 20% and 0 respectively.There was significant inter-group difference.And the efficacy of group B was better than that of group A.The postoperative recurrence rate was 13% and 4% and there was no significant difference.Laparoscopic surgery is suitable for treating pelvic abscess.It is mini-invasive, has a quick recovery and does not increase operative complications.

Objective:To investigate the relationship between some common risk factors of the cerebralvascular diseases and PD.Methods:Case-control study was carried out.Blood glucose,low density lipoprotein cholesterol(LDL-C)and homocysteic acid(Hcy) levels were detected by routine methods.The intima-media thickness(IMT)of carotid artery was measured by color Doppler ultrasound.The PD patients were graded by Unified Parkinson's Disease Rating Scale(UPDRS).Results:The blood glucose and Hcy in PD patients were higher than that in control group,and the LDL-C,IMT of carotid artery in PD were lower than that in control group.The Hcy was positively related to risk of PD,while IMT of carotid artery and LDL-C were negatively related to risk of PD by Spearman analysis.Conclusion:The Hcy level is a risk factor of PD.The LDL-C and IMT of carotid artery in PD patients were lower than that in control group,which suggests that the probability of PD patients who suffer from atherosclerosis is small.

Child ; Humans ; Urolithiasis ; diagnosis ; therapy

[Objective] To review the treatment of metabolic syndrome from phlegm and stasis, so as to provide effective ideas for the treatment of metabol-ic syndrome.[Method] Through searching for literatures related to Chinese medicine treatment of metabolic syndrome in the last decade, we can summarize the role of phlegm and blood stasis in the metabolic syndrome and its relationship with various components of metabolic syndrome. We can also research the application of the resolving the phlegm and removing blood stasis in the metabolic syndrome. [Results] Phlegm, blood stasis consistently run through the metabolic syndrome, and have a close relationship with each component of metabolic syndrome. The prescription of resolving the phlegm and remov-ing blood stasis can not only improve the clinical symptoms, but also can improve obesity-related indicators, reduce blood glucose, increase insulin sensitiv-ity, improve endothelial function and so on. [Conclusion] Treating metabolic syndrome from phlegm and stasis is safe and effective, which can reverse dia-betes, insulin resistance and prevent cardiovascular events through multi-channel, multi-level, multi-target. It has a broad application prospect and is worth further in-depth study.

OBJECTIVE:To explore the clinical efficacy and safety of Leukotriene receptor antagonist combined with Gluco-corticoid nasal spray(called“intranasal steroid”for short)in the treatment of different degree of adenoidal hypertrophy(AH)com-plicated with allergic rhinitis (AR). METHODS:240 AR children with AH were randomly divided into control group,intranasal steroid group and drug combination group,with 80 cases in each group. Control group was given physiological seawater,3 presses each nostrile,in the morning and evening. The intranasal steroid group received Momestasone furoate nasal spray,one press each nostrile,qd. Drug combination group was additionally given leukotriene receptor antagonist Montelukast sodium chewable tablet,4 mg for under 5 year-old and 5 mg for 5-year-old or above,qd,at bedtime. Treatment course of 3 groups lasted for 12 weeks. The change of clinical symptoms and signs(such as nasal obstruction,snore,mouth breathing,etc)and adenoid/pharyngeal ratio(A/N ratio)were compared among 3 groups after treatment as well as the occurrence of ADR. Each group was divided into two sub-groups (medium and severe) according to the severity of AH so as to evaluate therapeutic efficacy. RESULTS:21 children withdrew from the study,including 11 cases in control group,6 in intranasal steroid group and 4 in drug combination group. After treatment,clinical symptom score and A/N in subgroups of drug combination group and intranasal steroid group were all lower than those of control group,with statistical significance(P<0.05). There was no statistical significance in clinical symptom score and A/N between drug combination group and AR complicated with medium AH subgroup from intranasal steroid group(P>0.05). Clini-cal symptom score and A/N of AR complicated with severe AH subgroup from drug combination group were lower than intranasal steroid group,with statistical significance (P<0.05). No obvious ADR occurred in 3 groups. CONCLUSIONS:Intranasal steroid alone and intranasal steroid combined with leukotriene receptor antagonist can improve clinical symptom of AR patients with AH, and reduce adenoid volume. It is suggested to use intranasal steroid firstly for medium AH complicated with AR,and additionally use Leukotriene receptor antagonist for severe AH complicated with AR.

Objective To study the relationship between voice acoustic analysis(VAA) and voice handicap index (VHI) in patients with vocal cord polyps,and to investigate the characteristic of the VHI.Methods 35 subjects with normal voice and 35 patients with vocal cord polyps underwent VHI,were tested by VAA.Results The parameters such as APQ、jitter、shimmer、NHR in patients with vocal cord polys were much higher than those in the normal voice group.The average score of VHI was 43.32?4.66,while the average score of the normal voice group was 12.51?1.88.There was no correlation between VHI and VAA.Conclusion Since there is no correlation between VHI and VAA in patients with vocal cord polys.One can not speculate the VHI score by the voice acoustic analysis.