While the development of simulation-based medical education in China is facing such opportunities as increasing demand, information technology and internet development, there are also dilemmas that a systematic training system has not yet been formed, the professionalism of the faculty needs to be strengthened, clinical practice cannot be fully simulated, the relevant policies and systems are not perfect, and there is a gap between the construction of the center and developed countries. It is necessary to grasp the opportunity, improve the development level, adapt to social needs, strengthen teacher training, improve the rules and regulations, develop training standards, enrich simulation cases, etc., and further promote the connotative development of simulation-based medical education.

OBJECTIVE:To investigate the application of clindamycin phosphate for inpatients in a third grade class A hospital, and provide reference for the specication of its application. METHODS:Retrospective investigation was adopted to randomly obtain the medical information of inpatients who used Clindamycin phosphate for injection in a third grade class A hospital in May 2014, and its rationality was evaluated and analyzed by referred the instructions,relevant provisions and principles. RESULTS:Totally 205 patients used Clindamycin phosphate for injection,among which 174 were for the purpose of prevention medicine,31 cases for treatment purposes. There were reasonable use of 130 cases(63.4%);unreasonable prophylaxis of 71 cases(34.6%),unreason-able treatment of 4 cases(2.0%),it was mainly no indication of medicine,usage and dosage,treatment course and use of antibac-terial drugs. CONCLUSIONS:There still remains unreasonable phenomenon in the clinical application of the Clindamycin phos-phate for injection,the safe and effective clinical application can only be ensured if the drug regulatory system is improved and anti-bacterial drugs in clinical medicine guidelines is strictly enforced.

Objective To observe the clinical efficacy of cytokine-induced killer cells (CIK) combined with three dimensional conformal radiotherapy synchronization XELOX regimen in the treatment of local recurrence of rectal neoplasms.Methods A total of 81 patients with local recurrence of rectal neoplasms were divided into treatment group (41 patients) and control group (40 patients) by random digits table method.In treatment group,41 patients received simultaneous three dimensional conformal radiotherapy combined with XELOX chemotherapy,then received CIK treatment.In control group,40 patients received concurrent chemoradiotherapy.The immune function,quality of life (QOL) scores,recent efficacy,survival rate and adverse reactions were analyzed.Results In treatment group,the level of CD3+,CD4+,CD4+/CD8+ and CD16+ CD56+ increased and the level of CD8+ decreased significantly after treatment than those before treatment (0.671 ± 0.012 vs.0.625 ± 0.022,0.378 ± 0.043 vs.0.315 ± 0.035,1.59 ± 1.41 vs.1.02 ± 1.14,0.184 ±0.008 vs.0.121 +0.023,0.237 ±0.030 vs.0.308 ±0.031,P ＜0.05).Compared with those in control group after treatment,the level of CD3+,CD4+,CD4+/CD8+ and CD16+ CD56+ in treatment group increased and the level of CD8+ decreased significantly (P ＜ 0.05).QOL scores of 70.7％ (29/41) patients in treatment group was improved,significantly higher than the 32.5％ (13/40) in conctol group (P =0.001).The response rate(RR) in treatment group was 92.7％(38/41),significantly higher than that in control group [75.0％ (30/40)] (P =0.030).The 1-year survival rate in treatment group and control group were 90.2％(37/41) and 85.0％(34/40),there was no significant difference (P =0.473).The side effect in treatment group and control group showed no significant difference (P＞0.05).Conclusion CIK combined with concurrent chemoradiotherapy in the treatment of local recurrence of rectal neoplasms can improve patients 'immune function,QOL and recent efficacy.

Objective To investigate the effects ofdocosahexenoic acid (DHA) on large conductance Ca2+-activated K+ (BK) channels in normal retinal artery smooth muscle cells (RASMCs).Methods Cultured human RASMCs (6 th-8 th generations) were used to patch clamp experiment.The open probabihties (NP0) in BK channels with different concentrations (0.0,1.0,3.0,5.0,7.5,10.0 μmol/L) of DHA were recorded by patch clamp technique in single channel configuration.RASMCs were intervened by different concentrations (0.0,1.0,5.0 μmol/L) of DHA as control group,low and high doses of DHA groups,respectively.The protein expressions of β subunit of BK channels in RASMCs from three groups were measured by Western blot.Results The NP0 of BK channels were 0.044 4±0.001 2,0.081 2±0.004 2,0.209 0±0.006 1,0.310 5±0.005 3,0.465 0±0.007 8 and 0.497 7±0.014 5 with perfusate of 0.0,1.0,3.0,5.0,7.5,10.0 μtmol/L DHA.DHA activated BK channels in a dose-dependent manner (F=2.621,P＜0.05).There was no significant difference in the protein expression of control group,low and high doses of DHA groups (F=1 1.657,P＞0.05).Conclusion DHA can directly activate BK channels,no increasing in subunit expression of BK channels.

Objective: To investigate the stability of icariin, 2,3,5,4'-tetrahydroxy-stilbene-2-O-β-D-glucoside and hyperoside in Huangmai mixture.Methods: TLC was used to identify astrogaloside IV and Morindae officinalis Radix, and HPLC was used to determine the contents of icariin, 2,3,5,4'-retrahydroxy-stilbene-2-O-β-D-glucoside and hyperoside.The stability of Huangmai mixture under the conditions of accelerated testing and long-term testing was assessed.Results: Astrogaloside IV, Morindae officinalis Radix and icariin showed good stability during the accelerated testing and long-term testing.The contents of 2,3,5,4'-tetrahydroxy-stilbene-2-O-β-D-glucoside and hyperoside declined quickly during the stability testing.Conclusion: Hyperoside and 2,3,5,4'-retrahydroxy-stilbene-2-O-β-D-glucoside are unstable in Huangmai mixture.A novel solid dosage form of Huangmai should be developed to obtain better stability.

This paper presented the conventional methods for signal detection of adverse drug reactions (ADRs) and their applications, the research progress in ADRs signal mining based on healthcare big data, and briefed the methods and uses of ADRs prediction using machine learning technology in the era of healthcare big data.The conclusion was that deep learning, as a fast growing tool in machine learning, will become hotspot of research, expected to help with ADRs signal mining and rational clinical drug use.

Objective To investigate the analgesic effect of oxysophoridine(OSR)and the influence of verapamil(Ver)on the antinociception of OSR when two drugs were co-administrated in mice.Methods The number of writhing within 15 min after ip different doses of OSR was observed in painful mouse mo- dels caused by acetic acid.The hot plate method was used to assess nociceptive sensitivity of CaCl_2 and Ver before ip OSR.Nitric oxide(NO)in serum was measured by spectrophotometry.Results The number of writhing was decreased and the latency of licking the hind paws was prolonged in a dose-dependent manner after ip OSR.The antinociception of OSR could be antagonized by CaCl_2 and enhanced by Ver.No inter- ference was detected in serum volume of NO.Conclusion These results suggest that OSR can antagonize the acute pain caused by acetic acid and hot plate in a dose-dependent manner in mice.Calcium channel blocker could enhance the effect of OSR.

Objective To analyze the characteristics of iatrogenic urerteral injury and summarize the experiences in prevention,diagnosis and treatment of iatrogenic urerteral injury. MethodsA review was made on the injurycauses,the injury locations,the treatment time,the methods of surgical procedures and the results of treatment in 17 patients with iatrogenic ureteral injury treated surgically from 1997 to 2003. Results Of 17 cases of iatrogenic ureteral injuries,gynecological,general surgical and urological procedures resulted in ureteral injuries in 12 cases (71%),four (24%) and one (6%),respectively. Of all the injuries,65% (11/17) appeared in the lower part of the ureter,18% (3/17) in the middle part of the ureter and 18% (3/17) in the upper part of the ureter. The main injury causes were ligation,partial ligation,complete transection and perforation,accounting for 29% (5/17),41% (7/17),24% (4/17) and 6% (1/17),respectively. Four cases were found during operation,nine at days 2-11 after operation and four were treated 3-6 months after injury. Treatment methods included end-to-end ureteral anastomosis in seven cases,ureteroneocystostomy in three,ureteral lithotomy in one,pure ureteral lysis in three and post-lysis double-J tube insertion in three. All patients were cured. The follow-up ranging from six months to three years showed no patients suffering from urinary tract infection,hydronephrosis or atrophy. Conclusions The location and type of injury determine the type of surgical repair. A thorough knowledge of pelvic anatomy and mastering the basic steps of diagnosis and treatment are critical for prevention and management of the iatrogenic urerteral injury.

Encephalomyocarditis virus (EMCV) ,named JZ1202 ,was isolated from domesticated boar in Henan ,China . We performed the full-length genome sequencing and molecular characteristic analysis of the isolated strain .Results showed that the full-genome sequence of EMCV JZ1202 generated a sequence of 7 735 bp in length ,and had 81 .2%-99 .9% nucleotide identity with other reference strains from different animals ,but 99 .4% with Chinese reference from pig .The phylogenetic tree was constructed based on the full-length genome;ORF and VP1 gene sequences identified EMCV was divided into G1 ,G2 and G3 groups ;the strain JZ1202 belongs to G1 with other Chinese reference strains .Results identified that the EMCV infection could cause severe clinical symptoms in domesticated boar .Big regional differences exist in EMCV and the transmission is limit-ed in a range of area .However ,cross infection and prevalence of EMCV disease between domesticated boar and mice might ex-ist .Mutation of some amino acid may occurred in EMCV infected domesticated boar .

Objective To investigate the effects of intrathecal morphine remote preconditioning (MRPC) on protein-serine-threonine kinases-endothelial nitric oxide synthase (Akt/eNOS) signaling pathways and cardiac myocyte apoptosis in rats.Methods Male SD rats weighing 280-320 g were used in this study.A needle was inserted through a surgically created hole into the sub-dural space of spinal cord.Thirty-six rats in which intrathecal needle was successfully placed without complication were randomly divided into 3 groups (n =12 in each).In group Ⅰ sham operation was performed (Sham).In group Ⅱ myocardial I/R was produced (I/R).In group Ⅲ morphine was given intrathecally in 3 repeated doses of 1 μg/kg at 5 min intervals before ischemia (MRPC).Myocardial I/R was produced by occlusion of left anterior descending branch (LAD) of coronary artery for 30 min followed by 120 min reperfusion.The animals were then sacrificed and hearts removed for measurement of area at risk (AAR) and infarct size area (IS).IS/AAR ratio was calculated.Myocardial apoptosis was detected by TUNEL and apoptotic index (the number of apoptotic myocardial cells/the total number of myocardial cells) was calculated.The levels of Akt,phosphorylated Akt (p-Akt) and eNOS was determined by Western blot.Results The infarct size,myocardial cell apoptotic index and pAkt level were higher and eNOS level was significantly lower in I/R group than those in group Sham (P ＜ 0.01).MRPC significantly reduced the infarct size and myocardial cell apoptotic index,and pAkt and eNOS level up-regulated in group RMPC compared with group I/R (P ＜ 0.01).Conclusions Akt/eNOS signaling pathways probably participate in the protective effects of intrathecal morphine remote preconditioning against myocardial I/R injury and myocardial cell apoptosis in rats.