0.05). The level of serum IL-8 and expression of TNF ? in the colonic mucosa decreased at the 7th day ( P

Based on the particularity of the following medical disciplines, Three orientation is the higher medical personnel training mode which orients in the future development of medical students, and makes scientific allocation and combination to medicine curriculum system , personnel training system , management mode and evaluation system and so on. The clinical practice ability of medical students is the core of the professional quality training in the three orientation. In this article, the ability of professional quality, clinical practice ability and the ability to operate are clinical practice ability training goals and the training methods and evaluation system are divided into 2 stages, the fourth year and the fifth year, as well as three aspects such as professional quality ability training, clinical practice ability training and skills training.

Objective:To study the expression of P selectin in the colonic mucosa and on surfaces of platelets in circulation, and determine its association with IL 8 and TNF ? in trinitrobenzene sulphonic acid (TNBS) induced colitis in rat, in order to investigate the effects of P selectin on inflammation and thrombosis in inflammatory bowel disease Methods:TNBS was instilled into the colon of the rats to induce colitis Animals were sacrificed at the 24th hour, the 1st and the 2nd week after production Blood and colonic tissues were obtained P selectin on the platelets were detected by radioimmunoassay IL 8 in serum was detected by ELISA method Expression of P selectin and TNF ? in colonic mucosa were assessed with immunohistochemistry Results:P selectin in mucosa was increased in different time points compared with control group The positive expression was above 50% P selectin on the platelets wasn't increased at the 24th hour, but increased at the 1st and 2nd week (P

0.05).Conclusion:MBL B allele is not a risk component in the developing process of SLE Chinese patients.

Objective To analyze the changes in peripheral blood monocyte subpopulations in patients with primary, secondary and latent syphilis. Methods Flow cytometry was used to detect CD14highCD16- and CD14+CD16+ monocyte subpopulations in peripheral blood from 58 patients with untreated syphilis, including 36 cases of latent syphilis,8 cases of primary syphilis and 14 cases of secondary syphilis, as well as from 65 normal human controls. Restflts Compared with the normal controls, the proportion of CD14+CD16+ monocytes among total monocytes was significantly elevated (12.0% ± 5.0% vs 6.0% ± 3.3%, t = 7.25, P < 0.01), while that of CD14highCD16- monocytes was down-regulated (88.0% ± 5.1% vs 94.0% ± 3.5%, t = -7.20, P < 0.01). No statistical difference was observed in the proportion of CD14+CD16+ or CD14hhighCD16- monocytes among the patients with primary syphilis, secondary syphilis and those with latent syphilis (all P > 0.05). Conclusions The changes in peripheral blood monocyte subpopulation in patients with untreated syphilis may be associated with the permanent infection of Treponema pallidum, but have no obvious correlation with clinical stage of syphilis.

Objective To explore the CT and MRI manifestations and diagnosis of elastofibroma dorsi(EFD).Methods CT or MRI findings of 20 cases (36 lesions)of EFD confirmed by surgical pathology were analyzed retrospectively.12 patients underwent plain chest CT,4 patients plain chest MRI,4 patients plain unilateral shoulder MRI.Results ① All of cases were located in the infrascapular region,between the thorax wall and serratus anterior,mainly shaped flat mound-like or semi-circular.CT densities and MRI signal intensities of the masses were similar to those of muscle with some interlaced fat-like areas within the lesions.The masses had irregular edges, with no clear boundary between the thorax wall and serratus anterior,with disappeared fat gaps.② Statistical difference were found in patients’incidence between men and women,incidence between unilateral and bilateral and lesion volume between the left and right (P <0.05),and the incidence in female was significantly higher than that in male,the incidence in bilateral was significantly higher than that in unilateral,the lesion volume in the right was bigger than that in the left.Conclusion ① EFD has its characteristic location and imaging findings,so a definite diagnosis can be made with CT and MRI.② The mechanical friction between the scapula and chest wall may be related to tumor growth.

Objective To investigate the clinical features of neonatal invasive fungal infection(IFI) so as to guide diagnosis,prevention and treatment of IFI.Methods Seventy-six neonates with IFI admitted to the Neonatal Intensive Care Unit (NICU) at Children's Hospital of Fudan University from 2004 to 2014 were included in the study.Pathogens,clinical manifestation,risk factor exposure,laboratory findings,complications,and clinical outcome of neonatal IFI were analyzed.Results Seventy-six cases were diagnosed as IFI between 2004 and 2014,with an yearly increasing trend.Sixty-eight patients were premature infants (89.5％).Of the 76 cases,except one with unknown birth weight,11(14.7％),34(45.3％),20(26.7％)and 10 (13.3％) cases had birth weight ＜ 1 000 g,(≥ 1 000-＜1 500) g,(≥ 1 500-＜2 500) g and ≥ 2 500 g,respectively.The pathogens were mainly Candida (74/76,97.4％),including 26 cases of Candida albicans (34.2％).However,the incidence of non-Candida albicans infection was increasing.Candida guilliermondii was the most common in nonCandida albicans,accounting for 29.2％ (14/48).All Candida albicans were sensitive to fluconazole.One strain of Candida glabrata was resistant to fluconazole.The most common risk factors included use of broad-spectrum antibiotics(93.3％,56/60),parenteral nutrition(70.0％,42/60),central vein catheterization(53.3％,32/60),invasive ventilation(40.0％,24/60) and history of abdominal surgery(21.7％,13/60).Clinical manifestations of IFI included temperature instability,frequent apnea,increased requirement of respiratory support and feeding intolerance.Among all cases,six were diagnosed as central nervous system infection.Of the patients who received cranial MRI,46.8％(22/47) showed multiple abnormal signals in cerebral parenchyma.Fiftytwo patients were cured and seven patients died before discharge,including one death due to fungal infection.Conclusions There is an increasing trend of IFI cases in NICU,especially in premature infants.Non-Candida albicans has become the main pathogenic fungus.There are no specific clinical manifestations in neonatal IFI.Use of broad-spectrum antibiotics,parenteral nutrition and central venous catheterization are common risk factors,and preventive measures should be taken in high-risk infants.In addition,IFI in neonates may affect important organs such as central nervous system,thus early treatment is necessary in suspected patients.

Objective To understand the current situation of medical waste management in primary medical insti-tutions in China.Methods The management of medical waste in 95 primary medical institutions in 5 provinces of China in 2016 were investigated.Results Of 95 primary medical institutions,90(94.74%)dispose medical waste by centralized processing,92(96.84%)separately collect medical waste,89(93.68%)have specific locations for temporary waste storage and handover registration,46(48.42%)have wastewater treatment facilities,and are re-sponsible by full-time or part-time personnel.Before 2000,only 4 (4.21%)primary medical institutions carried out medical waste classification management and centralized disposal,which increased to 92(96.84%)and 90(94.74%) respectively in 2014;before 2000,only 5(5.26%)primary medical institutions conducted temporarily medical waste storage and treatment,which increased to 89(93.68%)in 2014.Conclusion Medical waste management in primary medical institutions has been improved significantly,but there still remain some problems,training relevant to waste management knowledge needs to be strengthened among health care workers,medical waste management procedures should be standardized,sound medical waste management and supervision system should be improved.

Objective To study the immunologic mechanism of electroacupuncture at Sanyin points on chronic abacterial prostatitis rats. Methods Forty-eight male rats were divided randomly into normal group, model group, drug group and electroacupuncture group, 12 rats in each group. The animal model was made by SC purified prostate protein twice with immunologic adjuvant, and the rats in electroacupuncture group and drug group were treated by electroacupuncture at Sanyin points and feeding Cernilton for 15 days. The changes of prostate weight, index, pathology and contents of IgG, expressions of IL-2 and IL-8 in prostate homogenate were observed. Results Compared with normal group, the prostate weight and index were significantly increased in model group (P<0.05), the content of IgG was significantly increased (P<0.05), cytokine IL-2 and IL-8 were highly expressed (P<0.05, P<0.01), prostate tissue’s morphology and structure were significantly impaired in model group. Compared with model group, the prostate weight and index were significantly decreased in electroacupuncture group after treatment (P<0.05 or P<0.01), pathological changes reduced significantly, the content of IgG decreased significantly (P<0.05), the expressions of cytokine IL-2 and IL-8 were significantly decreased (P<0.05, P<0.01), and the pathological manifestation of chronic inflammation was significantly improved. Conclusion Electroacupuncture at Sanyin points can reduce the secretion of local prostate antibody IgG, regulate the expression of cytokine IL-2 and IL-8, protect the morphology and structure of prostate tissue from damage. Electroacupuncture at Sanyin points can adjust local immunologic function and promote the recovery of prostate.

Objective To investigate the changes in neutrophil immunophenotypes in neonates with late-onset sepsis and their clinical significance.Methods A total of 42 neonates with late-onset sepsis were enrolled prospectively as sepsis group from Children's Hospital of Fudan University from January 2015 to October 2016,which included 26 preterm infants and 16 term infants.Another 33 neonates without infectious diseases consisting of 20 preterm infants and 13 term infants were selected as control group.According to the severity of sepsis,neonates in the sepsis group were further divided into severe (n=11)and mild sepsis (n=31) subgroups.Expression of CD16 and CD62L on neutrophils was measured by flow cytometry to determine the distribution of neutrophil subsets in neonatal peripheral blood.Differences in the distribution of neutrophil subsets between the two groups and two subgroups were compared using Wilcoxon rank-sum test.Multivariate logistic regression analysis was used to investigate the relationship between neutrophil subsets and the severity of neonatal sepsis.Receiver operating characteristic (ROC) curves were used to assess the diagnostic value of neutrophil subsets for the severity of sepsis.Results Four neutrophil subsets were identified in neonatal peripheral blood,including early-stage neutrophils (CD16-/CD62L-),immature neutrophils (CD16-/CD62L+),mature neutrophils (CD16+/CD62L+) and activated neutrophils (CD16+/CD62L-).Activated [preterm:61.1％ (20.2％-79.4％),term:47.6％ (15.2％-70.1％)] and mature neutrophils [preterm:35.7％ (19.9％-75.8％),term:52.0％ (25.6％-82.8％)] were the dominant subsets in the control group.In preterm infants,the proportion of early-stage [3.5％ (1.7％-9.4％) vs 1.9％ (0.6％-4.0％),Z=-2.501,P=0.012] and immature neutrophils [6.3％ (0.7％-45.5％) vs 0.4％ (0.3％-0.7％),Z=-3.878,P＜0.001] were higher,but that of activated neutrophils [8.3％ (2.3％-49.2％) vs 61.1％ (20.2％-79.4％),Z=2.991,P=0.002] were lower in the sepsis group than those in the control group;same differences were found in the absolute counts of each neutrophil subsets.Among term infants,more immature neutrophils were found in the sepsis group than those in the control group [49 (18-200) vs 13 (5-36)/μl,Z=-2.193,P=0.028].The proportion and the absolute counts of early-stage and immature neutrophils in the severe sepsis subgroup were all higher than those in the mild cases [early-stage neutrophils:5.8％ (3.4％-17.8％) vs 3.0％ (1.4％-7.3％),304 (137-1478) vs 158 (53-321)/μl;immature neutrophils:23.0％ (6.3％-47.0％) vs 0.9％ (0.5％-6.8％),1003 (487-2818) vs 85 (18-275)/μl;all P＜0.05].Multivariate logistic regression analysis showed that the proportion of early-stage neutrophils was associated with the severity of sepsis (OR=1.2,95％CI:1.0-1.4,P=0.012).In addition,the diagnostic value of the proportion of early-stage neutrophils for severe sepsis was the highest when the cut-off value was 3.3％,with the area under the ROC curve was 0.7 (95％CI:0.6-0.9),sensitivity of 81.8％ (95％CI:48.2％-97.7％) and specificity of 62.3％ (95％CI:42.2％-78.2％).Conclusions There are four neutrophil subsets in the peripheral blood of neonates and autoactivation of neutrophils may exist.With the onset of sepsis,neutrophil subsets react differently between preterm and term infants.The proportion of early-stage neutrophils may be correlated with the severity of neonatal sepsis,which may have a predictive value for severe sepsis.