Three Modules and Three Stages proposed by guidelines on college English teaching that will be issued by the Ministry of Education gives direction for college English teaching.Through the investigation of the students' cognition and learning of English curriculum,combined with the teaching experiment,the new system of English curriculum,which reflects the characteristics of medical colleges and universities,has been preliminarily established,aiming at cultivating medical students' comprehensive English abilities in medical study and career development.Considering students' language abilities in different stages,college English curriculum can be designed in three modules,that is,English for general purpose (EGP),English for academic purpose (EAP) and intercultural communication,in three stages,that is,the basic stage,the improvement stage,and the development stage.The practice shows that the new curriculum system can promote the interaction,reform and development of teachers,teaching teams and Foreign Language Department.

Objective To evaluate the relationship between 5,10-Methylenetetrahydrofolate reductase(MTHFR) gene polymorphisms and colorectal cancer(CRC).Methods Studies were selected based on the criteria for inclusion.The Meta-analysis software,REVMAN 4.2,was applied for checking the heterogeneity across the studies and calculating the pooled OR.The results were evaluated by the analyses of publication bias and sensitivity.Results A total of 9 787 cases and 12 986 controls from 18 studies for C677T and a total of 4 422 cases and 5 819 controls from 9 studies for A1 298C were included.No heterogeneity among the studies was found.For codon 677,the frequencies of CC,CT and TT genotypes were 46.48%,43.81% and 9.71% in cases,and 45.03%,43.08% and 11.89% in controls,respectively.The pooled OR of TT vs.CT+CC was 0.80(95%CI 0.74～0.87).For codon 1 298,the frequencies of AA,AC and CC genotypes were 53.60%,39.39% and 7.01% in cases,and 53.31%,38.67% and 8.03% in controls,respectively.The pooled OR of CC vs.AC+AA was 0.84(95%CI 0.72～0.97).Conclusions MTHFR 677TT is at lower risk of developing CRC and 1 298CC genotypes might be associated with the decreased risk of developing CRC.

Objective To elucidate the relationship between Child-Pugh grading and the degree of hep- atic cirrhosis.Method Six patients each with hepatic cirrhosis in Child-Pugh grade A and B were selected.The livers were observed with gross examinations during operation,and the liver specimens were observed with gross ex- aminations and also checked with light and electron microscopies.Results With naked eyes,it was quite difficult to find differences in size,shape and between different Child-Pugh grades.With hght microscopy,hepatic fibrosis of Ⅰ-Ⅱ degrees was commomly seen in Child-Pugh grade A and necrosis of hepatic cells was slight,while fibrosis of Ⅲ-Ⅴ degrees was usually found in grade B and necrosis was severe.With electron microscopy the collagen fib- rils in Disse's spaces were white cloud-like in grade A,while they were band-like in grade B.Of swelling and de- generation of organellae of hepatic and Kupffer cells,they were worse in grade B than in grade A.Conclusion The parameters in Child-Pugh grading are not complex,but they can be used to evaluate the degree of lesions. There is a positive relationship between them.

Objective To compare the efficacy of internal fixation with non-operative treatment of traumatic flail chest combined with sternal fracture.Methods A retrospective review was made on 102 patients with traumatic flail chest combined with sternal fracture treated from January 2007 to January 2014.There were 71 patients in operation group and 31 patients in non-operation group.Operation group was allocated to pure titanium rib plating (Group Ⅰ,22 cases),porous titanium screw fixation (Group Ⅱ,20 cases),and nickel-titanium memory alloy sternal rib plating (Group Ⅲ,29 cases).Rib traction was performed in non-operation group.Clinical results and incidence of complications were compared between the two groups.Results At 24 and 72 hours,operation group was superior over non-operation group with regard to HR [(100.4 ± 9.5) times/min vs (105.2 ± 10.1) times/min,(92.1 ± 9.9) times/min vs (102.1 ± 9.2) times/min],MAP [(97.7 ± 14.5) mmHg vs (91.0 ± 13.3) mmHg,(112.5 ± 15.2) mmHg vs (93.1 ± 13.8)mmHg] and CVP [(7.8 ±3.7)cmH2O vs (9.4 ±3.8)cmH2O,(6.2 ±2.9)cmH2O vs (9.1 ±3.2) cmH2 O] (P ＜ 0.05).Duration in ICU [(5.1 ± 0.8) days vs (9.3 ± 1.1) days],ventilation time [(4.5 ±1.0)days vs (8.2 ± 1.4)days],hospitalization time [(14.6 ±3.5)days vs (23.3 ±4.4)days] and incidence of complications were significantly lower in operation group than in non-operation group (P ＜ 0.05).Two months after discharge,tidal volume (VT) [(0.52 ±0.04)L vs (0.40 ±0.03)L],inspiratory capacity (IC)[(1.99 ±0.45)L vs (1.22 ±±0.33)L],forced vital capacity (FVC) [(3.52 ±0.51)L vs (2.44 ±0.42)L],total lung capacity (TLC) [(5.41 ±0.82)L vs (3.72 ±0.56)L] and forced expiratory volume in one second (FEV1) [(2.80 ± 0.43) L vs (1.95 ± 0.50) L] showed significantly better results in operation group than in non-operation group (P ＜ 0.05).Operation time,intraoperative bleeding and daily drainage volume were (38.8 ±9.2)min,(43.5 ±7.6)ml and (10.9 ± 1.1)ml in Group Ⅱ versus (62.5 ± 10.1)min,(100.0 ± 10.5) ml and (26.8 ±3.1)ml in Group Ⅰ and (49.3 ±9.6)min,(61.4 ±8.3)min and (19.8 ±1.6)ml in Group Ⅲ (P ＜ 0.01).Conclusion For traumatic flail chest combined with sternal fracture,the internal fixation should be done as early as possible so as to reduce incidence of complications.Relatively,porous titanium screw fixation has better clinical outcome.

AIM: To develop a method for determining ginsenoside Rb_1,Rc,Rb_2 and Rd in Shenqi Granules (Radix Rhizoma Ginseng,Radix Astragali,Rhizoma Atractylodis macrocephalae,Poria,etc.) by microbore LC.METHODS: Microbore liquid chromatography was applied.Microsil C_(18) column( 150 mm×1.0 mm) was used with the mobile phase containing acetonitrile-water for gradient elution.The flow rate was 50 μL/min,and the detection wavelength was set at 220 nm.RESULTS : The relationships between the concentrations and the peak areas of these for components were all linear.The recoveries were 98.14% for ginsenoside Rb_1,98.04% for ginsenoside Rc,98.79% for ginsenoside Rb_2,and 97.97% for ginsenoside Rd respectively.The relative standard deviations (RSD) were 0.67%,0.99%,0.75%,and 1.46%,respectively.CONCLUSION: This method is simple,convenient and can be used for quality control.

Objective To evaluate the indications and clinical efficacy of the different surgical methods for lumbosacral tuberculosis.Methods 112 patients suffering from lumbosacral tuberculosis from January 1998 to October 2011 were reviewed retrospectively.Based on American Spinal Injury Association (ASIA) grading system,31 case was classified as grade C,32 as grade D and 49 as grade E.The affected locations were L5,S1 in 66 cases,L4-S1 in 32,and L5-S2in 14 cases.41 cases (posterior group) underwent posterior pedicle screw instrumentation,debridement and allograft; and 38 cases (anterior group) underwent one-stage anterolateral debridement plus allograft and internal fixation.33 (posterior-anterior group) cases experienced posterior pedicle screw instrumentation and anterior debridement and allograft.All cases underwent routine support and anti-tuberculosis treatment before and after operation.The change of erythrocyte sedimentation rate (ESR),signs of tuberculosis activity,graft fusion,neurological recovery and correction of deformity were evaluated in follow-up and compared among three groups.Results The average operating time in posterior,anterior and posterior-anterior group was (150±22) m in,(140± 18) min,(180± 1 8) min respectively.ESR and C-reactive protein (CRP) were recovered to normal 3 months post surgery.The quality of life total score of lumbosacral tuberculosis patients was very low (55.54 ± 9.23).After surgery and drug treatment,the total score and each dimension scores of the SF-36 were significantly improved.Postoperative ASIA classification and 1umbosacral angle were significantly improved.Tuberculosis recurrence occurred in three cases,fixation loosening in two cases,fixation fracture in one case,and all above cases were cured after revision surgery.The others all were cured and bone graft fusion was determined.Conclusion The quality of life of lumbosacral tuberculosis patients were impacted seriously,and which could be significantly improved with surgical intervention.According to the patient MRI,CT characteristics,surgical approach selection was based on lesion location.Effective internal fixation was based on the extent of damage in bone structure and anatomical characteristics.Following above principles,satisfactory clinical results could be achieved.

The survey aims at probing into the current development of medical instruments in hospitals and computerized quality control,upgrading the competence of hospital engineering departments and guiding the development of medical clinical engineering.Questionnaire surveys were made to the medical engineering departments of 195 hospitals above secondary hospitals in Zhejiang,totaling 1001 professionals.The results indicate significant differences among hospitals of various scales in terms of deployment of medical engineering Professionals,working conditions,and computerized applications,yet a consistency in academic title promotion and training requirements.In this consideration,it is imperative to build the team,maintain consistency in professional certification of medical engineering professionals,build a regular and systematic examination,promotion and certification system,enhance training in professional knowledge and equipment quality control,as well as promoting information and resources sharing.All these efforts are essential for better quality control and management of medical engineering departments,and promoting computerized management of medical instruments.

Objective To investigate the exercise performance in maintenance dialysis patients,and analyze its correlative factors.Methods Maintenance dialysis patients admitted in Tongji Hospital of Shanghai from December 2014 to March 2015 were enrolled,with their baseline data and biochemical measurement being collected.The anthropometric indexes including arm circumference,triceps skinfold,waist circumference and hip circumference were detected.The exercise activity was assessed by hand grip test,timed up and go test (3mTUG) and five times sit-to-stand test (FTSST).Patients were divided into fast group (3mTUG≤12 s) and slow group (3mTUG ＞ 12 s).Univariate and multivariable analyses were used to evaluate the factors influencing exercise performance in maintenance dialysis.Results There were 121 patients enrolled:62 on peritoneal dialysis and 59 on hemodialysis,76 men and 45 women.Patients' average age was (61.6± 13.0) years and median dialysis age was 31.7(12.3,69.0) months.There was no statistical difference between fast group (n=80) and slow group (n=41) in gender,dialysis method,dialysis age,body mass index (BMI),arm muscle area (AMA),waist-hip ratio (WHR),hemoglobin (Hb) and total cholesterol (TC).Patients in fast group were younger,had higher serum albumin,prealbumin,serum phosphate and iPTH,and less prevalence of diabetes than those in slow group.In exercise activity,patients in fast group had better performance in handgrip,3mTUG and FTSST (all P ＜ 0.05).Univariate analysis showed that,handgrip was correlated with sex (male),AMA,BMI,age,diabetes,serum phosphorus and TC;scores in FTSST was correlated with age,BMI,diabetes,WHR,dialysis method,dialysis age,prealbumin and serum phosphorus;scores in 3mTUG was correlated with age,diabetes,WHR,dialysis method and dialysis age,prealbumin,serum phosphorus and iPTH (all P ＜ 0.05).Multiple stepwise regression analysis showed that sex (male),age,AMA and diabetes were independently correlated with handgrip in dialysis patients (all P ＜ 0.05);age,dialysis method,BMI and diabetes were independently correlated with scores in FTSST (all P ＜ 0.05);age,dialysis method,diabetes and WHR were independently correlated with scores in 3mTUG (all P ＜ 0.05).Conclusions The exercise performances of patients on maintenance dialysis are impaired.Age and diabetes are independent factor associated with the exercise performances of patients on maintenance dialysis.AMA is independently associated with upper limb movement,and dialysis method,BMI and WHR are independent factors associated with lower limb movement in dialysis patients.

AIM:To develop a method for determining ginsenoside Rb_1,Rc,Rb_2 and Rd in Shenqi Granules(Radix Rhizoma Ginseng,Radix Astragali,Rhizoma Atractylodis macrocephalae,Poria,etc.)by microbore LC.METHODS:Microbore liquid chromatography was applied.Microsil C_ 18 column(150 mm?1.0 mm)was used with the mobile phase containing acetonitrile-water for gradient elution.The flow rate was 50 ?L/min,and the detection wavelength was set at 220 nm.RESULTS:The relationships between the concentrations and the peak areas of these for components were all linear.The recoveries were 98.14% for ginsenoside Rb_1,98.04% for ginsenoside Rc,98.79% for ginsenoside Rb_2,and 97.97% for ginsenoside Rd respectively.The relative standard deviations(RSD)were 0.67%,0.99%,0.75%,and 1.46%,respectively.CONCLUSION:This method is simple,convenient and can be used for quality control.

This paper reviewed the basic concepts of creativity and systematic perspective on creativity and systematically analyzed the connotation of creativity in doctoral candidates,thus summarizing the advantages of the development of creativity in doctoral candidates:physiological function,intellectual quality,non-intellectual quality and professional innovation that may help to unleash creativity,knowledgeable,dedicated,and innovative supervisors and a correspondingly suitable environment,which is of great importance to the researches on unleashing the creativity in doctoral candidates and creating innovative results.