It showed that the distribution of examination score was Gaussian distribution,the average score was 74.4,the paper reliability was 0.81,the difficult coefficient was 0.74 by analyzing and evaluating the quality of the examination paper of pharmacology from 2002 seven-year medical students in Central South University.Some objective questions are too difficult,while some subjective questions are too easy.According to the results of analysis,we think it better to culture the student's multi-ability in analyzing and solving questions by increasing the proportion of subjective question with some difficult coefficient and improving the teaching methods in future teaching.

The article introduces characteristics of problem-based learning teaching method and traditionary medical teaching method,analyzes the current status and practical importance of pharmacology teaching with PBL,and suggests promoting the development of the teaching of pharmacology with PBL by reforming teaching approach and altering teaching thought.

Objective To build diagnostic model of stroke with qi deficiency and blood stasis.Methods Get the disease information by epidemiological investigation. All patients were recurited into training samples and testing samples by random. Diagnostic model was built by statistical method, and tested by training samples and testing samples. Results Three diagnostic models were built. The best model with discriminant function of qi deficiency and blood stasis has been proven to be the Bayes model. Conclusion The diagnostic model built by epidemiological investigation has the advantage of good accuracy. It will improve the accuracy of clinical syndrome differentiation.

Objective To observe the curative effect of open reduction and internal fixation for capitellum and trochlea fractures.Methods A retrospective case series study was performed on 14 patients with capitellum and trochlea fractures without involving lateral and lateral column treated by open reduction and internal fixation from April 2008 to August 2016.There were four males and 10 females, aged from 24 to 62 years (mean, 41.4 years).Dubberley classification was type ⅠA in four patients, type ⅠB in three, type ⅡA in two, type ⅡB in one, type ⅢA in two, type ⅢB in two.Three patients were combined with ipsilateral capitulum radius fractures, and one patient with ipsilateral ulna olecranon fracture.Visual analogue scale (VAS) for elbow pain, elbow activity and Mayo elbow performance score (MEPS) were evaluated.Postoperative complications were also observed.Results All patients were followed up for 24-55 months (mean, 27.2 months).Fracture healed after (21.3±2.1)weeks.VAS was (2.1±1.9) points at 24 months postoperatively, with painless in three patients, mild pain in seven and moderate pain in four.Elbow flexion and extension angle was (93.4±15.2)°, elbow flexion angle was (114.3±11.1)°, elbow extension angle was (33.6±20.7)°, forearm front rotation angle was (75.2±12.5)°, and forearm back rotation angle was (83.2±8.2)°.No patients had elbow instability, ischemic necrosis or internal fixation loosening.MEPS was (74.2±17.8)points, including excellent results in 3 cases, good in 8, fair in 2 and poor in 1.One case of Dubberley type ⅢA developed mild ulnar nerve symptom and alleviated after 3 months.Five cases (two type ⅢA, one type ⅢB, one type ⅡA, one type ⅡB) had a small amount of heterotopic ossification 6 month after operation, but elbow flexion and extension activity was good.One case of Dubberley type ⅢB combined with fracture of the olecranon process had elbow heterotopic ossification 1 month after operation, further developed large displaced ossification around the elbow 6 months after operation, and showed elbow flexion and extension of 30° 2 years after operation that was significantly limited compared to the contralateral side.Conclusion Open reduction and internal fixation of capitellum and trochlea fractures can improve elbow activity and reduce incidence of postoperative complication.

Objective To probe into possibilities and sensitivity of CCD video camera system in the assessment of balance function.Methods The system is composed of a CCD video camera,a video image capture board and analysis software.Three indexes:Trunks,ayAngle (TSS Trunk Sway Speed(TSS) and fall index (FI).the normal group:FI≥I; mild group:0.7≤FI＜I; moderate group:0.4≤FI＜0.7; severe group:FI ＜0.4.Disorder of balance function group:42 patients with cerebrovascular accident,mean age of (67.4±8.0) years.Control group:42 healthy subjects,mean age of (65.3±6.5) years.All cases were measured by Berg balance scale and determinated three times by CCD video camera system with eye opening (eo) and eye closing(ec),and averaged.Results There were very significant differences in TSAeo,TSAec,TSSeo,TSSec,FIeo,FIec between disorder of balance function group and control group (P＜0.01).as well as Berg balance scale (P＜0.05).In disorder of balance function group,the differences among three groups were significant in TSAeo,TSAec,TSSeo,TSSec (P＜0.05).There were significant differences in TSAeo,TSAec,TSSeo,TSSec between severe group and mild group (P＜0.01) as well as in Berg balance scale (P＜0.05).Conclusions CCD video camera system has a higher sensitivity in assessment of body,balance than Berg balance sca land great value in clinical application.

Objective To investigate the relationship between fetuin A and left ventricular function and their influences on residual renal function(RRF) in peritoneal dialysis patients.Method Eighty patients recently initiating peritoneal dialysis were enrolled into this study and were divided into high fetuin A group and low fetuin A group accordin to the value of serum fetuin A concentration.Hemoglobin,high sensitive C reactive protein(hsCRP),calcium,phosphorus,albumin,lipoproteins and left ventricular myocardial performance index(LV-MPI) were examined.All these patients were followed up for 12 months,to discover the parameters' differences between two groups and to investigate the association between fetuin A and left ventricular function and RRF.Results At the beginning of the study,there was no difference of hsCRP,calcium,phosphorus,albumin,lipoproteins and LV-MPI,estimated glomerular filtration rate (eGFR) between two groups;After 12 months follow-up,MPI was obviously shorter (P ＜ 0.05) and RRF was obviously higher (P ＜ 0.05) in high fetuin A group than thosein low fetuin A group.Compared with the beginning of the study,LV-MPI was significantly increased and eGFR was significantly decreased after 12 months follow-up (both P ＜ 0.05) in low fetuin A group,but no obviously change of LV-MPI or eGFR was found in high fetuin A group after followup.Pearson correlation analysis discovered an obvious negative correlation between fetuin A and MPI (r=-0.680,P ＜ 0.01).Multiple regression analysis indicated that eGFR had positive correlation with fetuin A (B=0.058,t=3.679,P＜ 0.01) and negative correlations with MPI (B=-0.511,t=-2.903,P=0.007),age(B=-0.144,t=-4.013,P＜0.01).Diabetes was risk factor to loss of RRF (B=-2.031,t=-2.759,P ＜ 0.05).Conclusion Fetuin A has very close relationship with left ventricular function.Decreased serum fetuin A level and decreased left ventricular function are risk factors to the loss of the RRF in ERSD patients.

Objective To investigate the association of vascular calcification,fetuin A and Creaction protein (CRP),and explore the influence on cardiovascular events.Methods Sixty peritoneal dialysis (PD) patients were enrolled in this study.Carotid intima-media thickness (cIMT),fetuin A and CRP,along with the other serum related parameters were detected to find out their influence on vascular calcification in PD patients.The relationship between cIMT,fetuin A,CPR and cardiovascular events was analyzed in PD patients with 18 months followed-up.Results Of the 60 PD patients,carotid intima-media thickness (cIMT) was increased in 38 patients(63.3％).Compared with the non-increased cIMT patients,serum fetuin A concentration was significantly decreased(P ＜ 0.05),CRP(P＜0.01) and calcium × phosphate products(P＜0.05) were significantly increased in the highincreased cIMT group.Compared with the low-increased cIMT patients,fetuin A concentration was obviously lower(P ＜ 0.05) and calcium×phosphate products were obviously higher(P ＜ 0.05) in the highincreased cIMT group.Linear regression analysis discovered an obvious negative correlation between CRP and fetuin A(R2 =0.629,F=47.522,P ＜ 0.01),as well as fetuin A and calcium×phosphate products (R2=0.299,F=11.948,P=0.002).Multiple regression analysis indicated that fetuin A was independently negatively correlated with cIMT(B=-0.019,t =-6.042,P ＜ 0.01).At 18 months,there were 36 newly-happened cardiovascular events and among which 6 cases died.Logistic regression analysis found that increased cIMT was risk factor to cardiovascular events in PD patients(OR=3.691,95％CI 1.467-9.258,P=0.006).Conclusion Decreased fetuin A and increased calcium×phosphate products deteriorate carotid calcification in PD patients.Micro-inflammation of PD patients represented by high CRP levels may increase calcium×phosphate products by depressing the fetuin A level,and in the end will stimulate carotid calcification.Increased cIMT is a risk factor for cardiovascular events.

Objective To study the effect of tanshinone ⅡA on the expression of P-selectin and ICAM-1 after cerebral ischemia reperfusion (I/R)injury in rats. Methods Rats were randomly divided into 4 groups: Sham operated group, I/R group, low dose Tan ⅡA treated group and high dose Tan ⅡA treated group. The focal middle cerebral artery occlusion (MCAO) model was made by suture-occluded method. Rats were pretreated with Tan ⅡA, ig for 3d,respectively before MCAO. After 90min MCAO following 24 hours of reperfusion, the expression of P-selectin and ICAM-1 was detected with using immunohistochemistry method. Result Compared with sham operated group, the expression of P-selectin and ICAM-1 increased after reperfusion for 24 hours in the ischemic territory(all P＜0.01).Compared with I/R group, the expression of P-selectin and ICAM-1 decreased in a dose dependent manner in low and high dose Tan ⅡA treated group(P＜0.01).Compared with that of I/R group, cerebral infarction volume was decreased in a dose dependent manner in low dose Tan ⅡA treated group and high dose Tan ⅡA treated group(all P＜0.01).The change of ischemic impairment in low or high dose Tan ⅡA treated group was less than that in IR group, and the change of ischemic impairment in high dose Tan ⅡA treated group was less than that in low dose Tan ⅡA treated group. Conclusion Tan ⅡA may reduce cerebral ischemia-reperfusion inflammation injure by decreasing the expression of p-selectin and ICAM-1.Tan ⅡA plays protective effect on cerebral ischemia injury, especially when high dose of Tan ⅡA(30mg/kg)was used.

Developing countries are facing a big challenge of how to promote sexual and reproductive healthe Poverty erasion.reproductive health service promotion,schools and communities intervention,discussion between children and their parents encouragment are helpful to solve the sexual and reproductive problems with the adolescents

OBJECTIVE:To evaluate the effects of PDCA cycle management on perioperative prophylactic application of antibiotics in typeⅠincision surgery of orthopedics department. METHODS:In retrospective analysis,512 discharge medical records, 861 ones and 1 070 ones were selected from our hospital before PDCA cycle management(Jan.-Dec. 2013,before intervention group), after first cycle of PDCA cycle management (Jan.-Dec. 2014,first intervention group) and after second cycle of PDCA cycle management(Jan.-Dec. 2015,second intervention group),respectively. The perioperative prophylactic application of antibiotics was analyzed comparatively before and after continuous intervention. RESULTS:After 2 cycles of PDCA cycle management intervention, the constituent ratio of internal fixation in orthopedics department increased significantly;utilization ratio of antibiotics,the rate of rational type,medication ratio 0.5-1 h before surgery,the rate of rational treatment course,the proportion of antibiotics use in accordance with indications increased from 50.20%,98.08%,93.77%,6.61%,82.10% to 58.41%,100%,99.04%,52.00%, 99.04%,respectively. The number of antibiotics type decreased from 4 to 2;the proportion of cephazolin increased significantly while that of clindamycin decreased significantly compared to before intervention. Postoperative prophylactic medication course decreased from(4.63 ± 2.42)d to(1.61 ± 0.75)d;the proportion of patients with medication course <24 h or ranged 24-48 h increased significantly, while those with medication course>72 h decreased significantly, with statistical significance (P<0.05). CONCLUSIONS:PDCA cycle management improves the rational rate of perioperative prophylactic application of antibiotics in typeⅠincision surgery of orthopedics department in our hospital. The prophylactic medication course of our hospital is not yet fully controlled within 24 h so it should be further intervened.