In order to do medical educational research better in our country,we analyzed the Department of Medical Education in the University of Illinois and the Center of Medical Education and Ethics in the University of Washington,and besides we suggested some advice for improving our medical educational research level.

Extremely severe pancytopenia induced by low dosage of azathioprine in systemic lupus erythematosus patients is rare. A 40-year-old Chinese female was diagnosed with systemic lupus erythematosus. She suffered worse erythema, oral ulceration, raised erythrocyte sedimentation rate and high anti-dsDNA in August 2013. Then she was initiated on oral azathioprine 50mg/d and extremely severe pancytopenia was seen in September 2013. She was recovered by a series of treatments. Regular monitoring of blood counts is highly recommended to reduce the possible serious myelosuppression induced by azathioprine.

Objective To evaluate the quality of autoantibodies detection in China. Method Standardized samples were sent to 73 laboratories that are able to detect autoantibodies. The autoantibodies detected included antinuclear antibody (ANA), anti-dsDNA antibody, anti-extractable nuclear antigen (ENA) antibody, anti-mitochondrial antibody (AMA) and anti-smooth muscle antibody (ASMA). The analysis of testing results was double-blinded. Result The consistent rates of ANA, anti-dsDNA antibody, anti-ENA antibody, anti-mitochondrial antibody and anti-smooth muscle antibody were 86.2%, 75.4%, 62.7%, 100% and 61.1% respectively. Conclusion The overall accuracy has been elevated, but still needs to be improved.

Objective To explore the effects of dignity therapy on self-esteem status and negative emotions of lung cancer patients.Methods A total of 62 lung cancer patients were recruited and divided into experimental and control groups (n =31 each).The control group received routine care while the experimental group additional individualized dignity therapy.And the state self-esteem scale,self-rating anxiety and self-rating depression were used to evaluate the intervention outcomes.Results For both groups,the self-esteem status and negative emotions of the intervention group were significantly better than that those of the control group (self-esteem:61.2 ±4.6 vs.52.6 ±4.1,anxiety:52.2 ±6.8 vs.64.6 ±9.3,depression:51.1 ±7.9 vs.66.2 ±8.7,all P ＜0.05).Conclusion Dignity therapy can improve selfesteem status,decrease the levels of anxiety and depression level and boost quality of life for lung cancer patients.

Objective To evaluate the role of contrast enhanced ultrasound in treatment of ultrasound guided high intensity fo‐cused ultrasound ablation for uterine fibroids .Methods Forty eight women with uterine fibroids were allocated into contrast en‐hanced group(25cases ,42fibroids) and non contrast enhanced group(23 cases ,35 fibroids) .The average volume of fibroids and the non perfused volume and the fractional ablation and adverse effects between the tow groups were compared .Results Non perfused volume was observed in all fibroids of the two groups after high intensity focused ultrasound ablation through sulphur hexafluoride micro bubbles .The average non perfused volume was 19 .5(18 .2)cm3 and 22 .5(14 .5)cm3 ,fractional ablation was (78 ± 18)% and (87 ± 13)% of the uterus immediately after HIFU respectively .The average non perfused volume was 18 .6(18 .2)cm3 and 19 .5 (18 .7)cm3 ,fractional ablation was (85 .7 ± 15 .2)% and (87 .6 ± 8 .0)% of the uterus two days after HIFU .There was no signifi‐cant difference was observed in average non perfused volume and the fractional ablation between the two groups(P>0 .05) .During HIFU procedure ,more patients in non contrast enhanced group complained sacral pain than those in contrast enhanced group(P<0 .05) .Conclusion Contrast enhanced ultrasound is an accurate method in assessing the treatment effect of HIFU and could be safely used during HIFU treatment for uterine fibroids ,shorten therapy time ,and decrease side reaction .

Objective To investigate the clinical effects and safety of combination of open and laparoscopic surgery in treatment of elderly patients with gallbladder stones combined with common bile duct stones. Methods 140 elderly patients with gallbladder stones combined with common bile duct stones from May 2014 to May 2015 were randomly divided into control group (65 patients) with traditional open surgery and observation group (65 pa﹣tients) with combination surgery; then compared the perioperative clinical indicators, the total removal rate of stone, the postoperative analgesic used rate and postoperative complications incidence of the two groups. Results The oper﹣ation time, intraoperative blood loss volume, the exhaust time for first time and hospital staying time of observation group was significantly better than control group (P< 0.05). There was no significant difference in the total removal rate of stone between the two groups (P> 0.05). The postoperative analgesic used rate of observation group was sig﹣nificantly lower than control group (P< 0.05). The postoperative complications incidence of observation group was significantly lower than control group (P< 0.05). Conclusion Compared with traditional open surgery, combination surgery in treatment of elderly patients with gallbladder stones combined with common bile duct stones can efficient﹣ly shorten the operation time, speed up the recovery process, reduce the degree of trauma and postoperative pain and helpful to prevent the postoperative complications.

In this study, the adsorption behavior of epirubicin hydrochloride (EPI) on carboxylated single-walled carbon nanotubes (c-SWNTs) obtained by mixture acid treatment was investigated. The results indicated that the dispersion of c-SWNTs in water was obviously improved. The absorption of EPI on c-SWNTs came to equilibrium after 240 min and could be explained by pseudo-second-order model. Moreover, there were heterogeneous distribution of active sites onto c-SWNTs surface and the Freundlich isotherm model was better fit to describe the absorption precess of EPI on c-SWNTs. The absorption capacity of EPI on c-SWNTs increased obviously with the increasing pH and decreasing temperature. Compared with multi-walled carbon nanotubes, carboxylated multi-walled carbon nanotubes, SWNTs, c-SWNTs possessed higher absorption capacity for EPI. The controlled, targeted and sustained release of EPI from c-SWNTs-EPI could be instructive for the development of nano-carrier.

Objective To investigate the relationship between anti-lymphocyte antibody (ALA) and clinical and immunological parameters in primary Sj(o)gren syndrome (pSS).The significance of ALA and lymphopenia in pSS was explored.Methods Serum samples were obtained from 143 patients with pSS.Clinical and laboratory data were collected.Sera from 45 healthy individuals were collected as the controls.Serum ALA IgG was detected by indirect immunofluorescence test (IIFT).x2 test and t test were used for statistical analysis.The reasons of lymphopenia in pSS patients were analyzed.The correlation between ALA,lymphopenia and clinical manifestations as well as laboratory parameters was analyzed.Results ① Of the 143 pSS patients,25.2％(36/143) were serological positive for ALA,which was significantly higher than the normal group (6.5％,5/77) (x2=27.496,P＜O.01).② The prevalence of leukopenia (55.6％,20/36),lymphopenia (77.8％,28/36),anti-nuclear antibody(80.5％,29/36) and C3 decrease(50.0％,18/36) was higher in pSS patients with ALA than those without (x2=8.296,25.348,3.929,3.866,P＜0.05).③ 46.2％(66/143) patients had lymphopenia.Comparing with patients with normal lymphocyte count,the incidence of ALA positive,leukopenia,PLT decrease and anti-SSB antibodies positivity was significantly higher in patients with lymphopenia (x2=27.496,51.344,5.320,8.950,7.782; P＜0.05).Conclusion The ALA is likely to be a meaningful sera marker for pSS patients with lymphopenia,and this suggests that it has an important role in the clinical progress of SS.

Objective To investigate the survival status of liver cirrhosis patients without upper gastrointestinal hemorrhage after transjugular intrahepatic portosystemic shunt (TIPS).Methods From 2004 to 2013,15 liver cirrhosis patients without upper gastrointestinal hemorrhage volunteered received TIPS treatment were followed up to find out the difficulty and the success rate of TIPS procedure,the incidence of hepatic encephalopathy,upper gastrointestinal hemorrhage and improving of hypersplenism.Results The success rate of operation was 100％.The average of operation time was 60 minutes.During follow-up,no stent angulation occurred,no gastrointestinal hemorrhage happened and no one died in all 15 patients after TIPS operation.There were four patients with hepatic encephalopathy in eight weeks after operation.The anemia of four patients improved compared with that before operation.Conclusions TIPS is a safe and effective threapy in the prevention of gastrointestinal hemorrhage in the patients with liver cirrhosis accompanied with severe gastroesophageal varices.It may become the primary prophylaxis for liver cirrhosis patients without upper gastrointestinal hemorrhage.

Objective To investigate the diagnostic value and biological features of protein induced by vitamin K absence or antagonist Ⅱ (PIVKA-Ⅱ) and alpha-fetoprotein (AFP) in hepatocellular carcinoma (HCC).Methods Serum samples of 72 patients with HCC (HCC group), 54 patients with hepatitis B cirrhosis (cirrhosis group) and 30 patients with chronic hepatitis B (CHB) without cirrhosis (CHB group) were tested with the PIVKA-Ⅱ and AFP detection kits.Diagnostic efficacies of PIVKA-Ⅱ and AFP were evaluated by receiver-operating characteristic curve (ROC).The cut-off value of PIVKA-Ⅱ for diagnose HCC was also determined.Sensitivities and specificities of PIVKA-Ⅱ and AFP were compared.Results The medians of PIVKA-Ⅱ levels in HCC group, cirrhosis group and CHB group were 14.36, 11.21, and 329.88 mAU/mL, respectively.The serum PIVKA-Ⅱ level in the HCC group was significantly higher than that in cirrhosis group (U=342.50, P<0.01).And serum PIVKA-Ⅱ level in cirrhosis group was also higher than that in CHB group (U=481.50,P>0.05).The serum PIVKA-Ⅱ levels in patients with BCLC stage A, B, C in HCC group were 22.13, 345.46, and 13 057.72 mAU/mL, respectively.After comparison of stage A and C with stage B, the differences were both statistically significant (stage A to B: U=119.0, P<0.01;stage B to C: U=158.0, P<0.01).The sensitivity and specificity of PIVKA-Ⅱ with a cut-off value of 30.01 mAU/mL by means of Youden index were 0.750 and 1.000, respectively.When combined PIVKA-Ⅱ with AFP, the sensitivity and specificity were 0.800 and 0.964, respectively.The area under the curve (AUC) was highest (AUC=0.930, 95%CI: 0.852-0.974), and significantly higher than that using PIVKA-Ⅱ alone (AUC=0.892, 95%CI: 0.834-0.950,x2=21.43,P<0.01).Conclusions The diagnostic value of serum PIVKA-Ⅱ is superior to AFP.Combined with AFP, serum PIVKA-Ⅱ can improve the detection rate of HCC, and has advantages during the development of HCC and can be used to monitor the condition of HCC patients.