To improve the students' study interest and train the clinical thinking ability,the problem-based learning(PBL)was applied to geriatrics of integrated medicine teaching.The results showed that the students' ability of clinical thinking significantly improved and made a positive evaluation for PBL.It means that PBL is an effective learning method of medicine teaching.

Objectives To observe the effect of flurbiprofen as preemptive analgesic and it's relative adverse reactions in pa-tients undergoing selective craniotomy .Methods Sixty patients undergoing selective craniotomy were divided into two groups randomly by age,sex,location of craniotomy:observation group (Group-flurbiprofen) and control group (Group-saline).Monitored sonoclot signal and estimate bleeding amount during the operation .Evaluated the quality of emergence after operation .Recorded the VAS pain scores 2 hours,6 hours,12 hours and 24 hours after operation ,and the occurrence of adverse reactions as nausea , vomiting and respiratory de-pression.Results The concentration of prostaglandin E2(PGE2) in the serum of the observation group was lower than that of control group( P <0.05).There were no significant differences in ACT (activated coagulation time) and CR (clot rate) of the two groups( P>0.05),but the PF (platelet function) of observation group was lower than that of control group ( P <0.05).There were no signifi-cant differences in awakening time and extubation time of the two groups ( P >0.05).The 2 hours'pain scores of the two groups was of no significant difference( P >0.05),but the pain scores of observation group were lower than that of control group in 6 hours,12 hours and 24 hours after operation( P <0.05).The occurrence of nausea , vomoting and respiratory depression had no significant differences ( P >0.05) .Conclusions Flurbiprofen as preemptive analgesic can reduce the postoperative pain in patients undergoing cranioto -my,without increasing the occurrence of nausea , vomit and respiratory depression .It can effect the platelet function ,but could not in-crease the amount of bleeding .

Biomedical Research ; Cicatrix ; pathology ; Humans

Objective To investigate the susceptibility and resistance profile of clinical isolates.Methods Clinical isolates were collected from Children's Hospital of Chongqing Medical University from January 1 to December 31,2015.Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method or automated systems.Results were analyzed according to CLSI 2015 breakpoints.Results A total of 13 109 clinical isolates were collected from January to December 2015,of which gram negative organisms and gram positive cocci accounted for 65.3 ％ (8 560/13 109) and 34.7 ％ (4 549/13 109),respectively.Methicillin resistant strains in S.aureus (MRSA) and coagulase negative Staphylococcus (MRCNS) accounted for 29.6 ％ and 67.1％,respectively.Most (93.1％) MRSA strains were still susceptible to trimethoprim-sulfamethoxazole,while 80.2 ％ of MRCNS strains were susceptible to rifampin.No staphylococcal strains were found resistant to vancomycin,teicoplanin or linezolid.The resistance rates of E.faecalis strains to most antibiotics tested (except tetracycline) were much lower than those of E.faecium.Some strains of both species were resistant to vancomycin.No E.faecalis or E.faecium strains were found resistant to vancomycin.The prevalence of ESBLs-producing strains was 55.7 ％ in E.coli and 43.5 ％ in Klebsiella (K.pneumoniae and K.oxytoca) and 11.6 ％ in Proteus mirabilis isolates.ESBLs-producing Enterobacteriaceae strains were more resistant than non-ESBLs-producing strains in terms of antibiotic resistance rates.Enterobacteriaceae strains were still highly susceptible to carbapenems.Overall,less than 16.0 ％ of these strains were resistant to carbapenems.About 10.5 ％ and 9.4 ％ of the A.baumannii strains were resistant to imipenem and meropenem,respectively.Compared to the data of year 2014,the prevalence of extensively-drug resistant P.aeruginosa and K.pneumoniae strains increased.Conclusions The antibiotic resistance of clinical bacterial isolates is growing.The emerging and increasing prevalence of multi-drug or pan-drug resistant strains poses a serious threat to clinical practice and implies the importance of strengthening infection control.

Parenteral nutrition associated cholestasis (PNAC) mainly occurs in children. Currently identified risk factors include premature infants, lack of enteral feeding, repeated infections, and toxicity or nutrient deficiency of parenteral nutrition solution. Recent studies have shown that nuclear receptor-mediated bile acid transporter may be the key site of PNAC pathogenesis, in which some cytokines play important roles. New anti-cholestatic therapy based on the regulation of expression of these molecules may prevent end-stage liver disease caused by PNAC.

Objective To discuss the pharmaceutical care protocol and methods for clinical pharmacists taking part in cancer pain management. Methods A patient developed delirium and drowsiness after using oxycodone hydrochloride prolonged-release tablet ( OXYCONTIN) and morphine hydrochloride tablet for pain titration treatment. The clinical pharmacist analyzed the reasons of delirium and drowsiness,and suggested a dose reduction of OXYCONTIN or converting OXYCONTIN to another opioid analgesic. Results The suggestion of the clinical pharmacist was partly accepted. After adjusting the treatment, the delirium and drowsiness disappeared gradually, and the pain was well controlled. Conclusion In clinical practice, especially when faced with a rare adverse drug reaction, clinical pharmacists are helpful for ensuring the safety and effectiveness in pain management, as well as improving the level of the treatment, by the implementation of individualized drug therapy.

Lymph node metastasis represents a common way of distant spread of gynecologic malignancies and an independent risk factor of poor prognosis of patients. The pelvic and paraaortic lymphadenectomy is a critical part of the surgical treatment of gynecologic cancer, which potentially improves the survival outcomes of patients through clarifying the node status to guide the subsequent management and/or removal of positive nodes to reduce the tumor burden. However, when we make a decision about lymphadenectomy, we should balance the related survival benefits and morbidities impacting the long-term quality of life. It is noteworthy that the principles of lymph node management are varied between different types and different stages of tumors characterized with different clinical features. Moreover, the sentinel lymph node biopsy, which has been emerging as a promising alternative to traditional systematic lymph node dissection, provides new options while bringing new issues. Here, based on the latest progress in relevant fields, we attempt to figure out the distinct features and unanswered questions in the management of lymph nodes of patients with cervical cancer, endometrial cancer, and ovarian cancer, which may trigger meaningful thoughts regarding related clinical decision.

Antigens, Differentiation, B-Lymphocyte ; genetics ; Carcinoma, Non-Small-Cell Lung ; drug therapy ; genetics ; metabolism ; Gene Fusion ; Gene Rearrangement ; Histocompatibility Antigens Class II ; genetics ; Humans ; Immunohistochemistry ; In Situ Hybridization, Fluorescence ; Lung Neoplasms ; drug therapy ; genetics ; metabolism ; Protein Kinase Inhibitors ; therapeutic use ; Protein-Tyrosine Kinases ; antagonists & inhibitors ; genetics ; metabolism ; Proto-Oncogene Proteins ; antagonists & inhibitors ; genetics ; metabolism ; Pyrazoles ; therapeutic use ; Pyridines ; therapeutic use ; Reverse Transcriptase Polymerase Chain Reaction ; Signal Transduction ; Sodium-Phosphate Cotransporter Proteins, Type IIb ; genetics

Acupuncture Points ; Acupuncture Therapy ; Humans ; Male ; Meige Syndrome ; therapy ; Middle Aged