Clinical thoughts based on symptoms, physical signs and examine outcomes is a process of analysis, judgement and conclusion of disease diagnosis. To cultivate an exact thinking model can avoid taking a part for the whole or a miss in disease analysis, so to cultivate clinical thoughts in clinical practice can elevate medical students'clinical skills.

OBJECTIVE:To establish an optimal method for microbial limit test for ciclopirox olamine vaginal suppository.METHODS:The microbial limit test for antibacterial agents was validated by plating method and membrane filtration method,and the optimal method for the test of bacteria and mold were confirmed based on the recovery rate of artificially sprayed bacteria.RESULTS:By plating method,the recovery rate of artificially sprayed E.coli was more than 70%,whereas that of mould was 0%;however,by membrane filtration method,the recovery rates of bacterial and mould were all higher than 70% when flushing doses of bacteria,mold,and control bacteria were 200 mL,300 mL,and 200 mL,respectively.CONCLUSIONS:The membrane filtration method could be used for the microbial limit test of the preparation the drug quality can be kept under effective control,and the established method is accurate and reliable.

Applying the principle of Evidence-Based Medicine to the clinical teaching,we have made the students raise the cognition level on the diagnose of diseases and treating policy and trained their clinical logic thinking ability.

OBJECTIVE: Comparison of operation of epitympanic/antrum cholesteatoma excised by endoscopy and microscope. METHOD: Eleven patients with epitympanic/antrum cholesteatoma were analysed, 5 cases were excised by endoscopy and 6 cases were excised under microscope. RESULT: No complication occurred after operation and all patients got dried ear. There were no difference in hearing recovery and closure of perforation of tympanic membrane between two group. The operation time, injury degree, length of stay in hospital and hospitalization expense with endoscopy was superior to that of microscope. CONCLUSION Considering financial constraints of patients, resection of epitympanic/antrum cholesteatoma cholesteatoma can be adopted by endoscopy.
Adolescent ; Adult ; Cholesteatoma, Middle Ear ; surgery ; Endoscopy ; Female ; Humans ; Male ; Microscopy ; Middle Aged ; Treatment Outcome ; Young Adult

Objective] To observe the clinical efficacy and 5-HT of Shugan Jianpi Tiaoshen acupuncture treatment for senile patients with constipation type of irritable bowel syndrome(IBS-C). [Method] A total of 68 patients with IBS-C were allocated into control group and acupuncture group from June 2015 to June 2014. 34 patients in the control group, who accepted Lactulose oral solution and Citrate Mosapride Citrate, of in 15 males and 19 females, the mean age was 66.8, the average duration of disease was 15.6 months;34 patients in acupuncture group, who accepted acupuncture treatment based on control group, in 17 males and 17 females, the mean age was 65.9, the average duration of disease was 17.1 months. Acupoint selection:Tianshu, Zusanli, Taichong, Xingjian, Qimen, Baihui, Neiguan. Observe constipation symptoms, depressive symptoms, and quality of life and serum 5-HT levels before and after treatment. [Result] The pre-treatment constipation symptoms and depressive symptom scores in two groups were decreased than post-treatment( P<0.05), which showed two methods can improve constipation and depressive symptoms of IBS-C patients. After treatment, constipation symptoms and depressive symptoms score in acupuncture group were lower than that in control group(P<0.05), which showed the effect of acupuncture was better. The eight dimensions of SF-36 were higher than those before treatment in total patients(P<0.05), which showed two methods can improve quality of life of patients; differences of physiological function, physiological function between acupuncture group and control group had no statistical significance( P>0.05), but body pain, vitality, emotional function, mental health, social function, and general health values were higher than that of the control group( P<0.05), which showed acupuncture treatment can reduce physical discomfort and improve the quality of life of patients. After treatment,serum 5-HT in control group was 33.8 pg/ml, in acupuncture group was 27.6 pg/m, which were lower than pre-treatment. 5-HT in acupuncture group was lower than control group( P<0.05), which showed the effect of acupuncture on regulation of 5-HT was more significant. [Conclusion]Shugan Jianpi Tiaoshen acupuncture can modulate 5-HT level of elderly patients with IBS-C, and play its role in modulating gastrointestinal function, improving constipation symptoms, depressive symptoms and quality of life.It is an effective method for the treatment of elderly patients with IBS-C.

Objective:To reflect the training of basic-level medical stuff by investigating the doctor-patient cognition status of patients in a county-level hospital.Methods:The questionnaire of 180 patients collected from a county hospital in Shaanxi province was analyzed by Rank sum test and Descriptive analysis with SPSS17.0.ReSults:There were no statistically significant differences in the evaluation of current doctor-patient relationship from patients of different ages,occupations and degrees of education (P ＞ 0.05).82.2％ of the patients believed that the doctor-patient relationship is harmonious or somewhat harmonious.Moreover although the patient's trust in doctors is not high,there is a certain sense of recognition;and they put forward some expectation and requirements on doctor's professional skills,communication skills and professionalism.Conclusion:Considering the patients' feedback,local medical colleges and universities should reflect medical education ideas,play an active synergy model in the training of students' professional skills.In the meantime,they should strengthen the medical internship management,while paying equal attention to enhance students' responsibility and professionalism to serve the grassroots.

Objective To isolate water-soluble neutral polysaccharides(NTPS) and acidic polysaccharides(ATPS) from tea,investigate their hypoglycemic effects,and elucidate the relationship between structure and activity.Methods Weak base macroporous anion-exchange resin D315 was used to isolate two kinds of tea polysaccharides NTPS and ATPS based on electric charge of tea polysaccharides.Their monosaccharide compositions were analyzed by gas chromatography and ion chromatography.NTPS and ATPS were further isolated by DEAESepharose FF.Molecular weights of the main fractions were analyzed by HPGPC.The model of diabetic mellitus was established by ip alloxan in mice.The blood samples were collected with tail vein puncture to determine blood glucose.The hypoglycemic activity between neutral and acidic polysaccharides was compared after ig tea polysaccharides for 12 d successively.Results Both NTPS and ATPS were(heteropolysaccharides.) NTPS was mainly composed of neutral polysaccharide and its main monopolysaccharide was D-galactose.NTPS contained 6.82% galacturonic acid.Whereas,ATPS was mainly composed of acidic polysaccharide and contained 33.02% D-galactose,whose neutral polysaccharide was mostly(L-)rhamnose,D-arabinose and D-galactose. The molecular weights of both two kinds of tea polysaccharides were less than 3?10~4.Continuous ig administration of NTPS and ATPS [200 and 400 mg/(kg?d)] for 12 d was found to depress glucose increases in alloxan-dependent diabetic model mice.Conclusion Two different structures of tea polysaccharides NTPS and ATPS are isolated by anion-exchange resin D315 firstly.Both tea polysaccharides show good hypoglycemic effect.

Objective To establish a recombinant retroviral vector containing insulin-like growth factor-1(IGF-1) gene and to provide the basis for the application of IGF-1 in treating nervous system diseases such as stroke.Methods The plasmid pcDNA3.1-IGF-1 was cut by EcoR I/Xho I,and subcloned to retroviral vector pLXSN,resulting in the recombinant plasmid(pLXSN-IGF-1.)The recombinant IGF-1 expression vector was evaluated by using enzyme cutting and sequencing.By the Lipofectamine 2000,pLXSN-IGF-1 was transferred to packaging cell line-pA317.Culture supernatant of these cells was detected for titration of the recombinant virus.Results The two fragments from recombined IGF-1 eukaryotic expression vector by EcoR I and Xho I represented 400?bp and 6.0?kb by agarose electrophoresis,and PCR showed positive fragment which was about 400?bp long,and sequence analysis showed the same sequence as expected.The cell line pA317-IGF-1 was established,and average virus titer of the recombinant virus in the culture supernatant was about 6.5?10~5 CFU/ml.Conclusion A recombinant retroviral containing IGF-1 gene was successfully constructed.

Objective To investigate the difference of Brn-4 mRNA expression between the fimbria/fornix-transected rats and normal ones. Methods Forty-two SD rats were randomly divided into 7 groups,6 rats in each group.One group served as normal control and the others served as fimbria/fornix transected 1st,3rd,7th,14th,21st and 28th day group,respectively.Then hippocampi were isolated and total RNA was extracted.Semi-quantitative reverse transcriptase-polymerase chain reaction(RT-PCR) method was used in detection of the expression change of Brn-4 mRNA in hippocampus after fimbria/fornix transection.Results The expression level of Brn-4 mRNA started to increase on the 3 days after fimbria/fornix transection.The peak appeared on the 14 days,then decreased slowly to pre-transection level on the 28 days.Conclusion The process that the expression of Brn-4 mRNA increases significantly after fimbria/fornix transection,perhaps,might be related to the transplanted neural stem cells(NSCs) differentiating into neurons and AChE positive neurons in hippocampus.

Objective To observe and explore the value of combined detection of serum BNP and TnI in patients with acute heart failure(AHF). Methods 60 AHF patients from February 2015 to April 2016 were selected as observation group, and divided into Level III group(n=32) and Level IV group(n=28) according to NYHA classification;60 healthy patients at the same period were selected as control group.BNP and TnI levels were detected by chemiluminescence in each group, and were compared.Results BNP and TnI of observation group were(2624.4 ±378.6) ng/mL and(0.87 ± 0.22) ng/mL, while in control group were(72.4 ±20.2) ng/mL and(0.13 ±0.02) ng/mL, the differences were significant(P<0.05);BNP and TnI in level III group before treatment were significantly lower than grade IV group(P<0.05), after treatment, the level of BNP and III in group IV and group TnI were significantly lower(P<0.05), and the levels of BNP and TnI were significantly lower than those in III group after treatment(P<0.05). Conclusion BNP combine with TnI levels monitoring play an important role in AHF diagnosis and prognosis evaluation, can help to guide the treatment of AHF.