Clinical practice course during the physical diagnosis studying is very important for the medical undergraduate students. It’s a bridge between the medical basic knowledge and clinical work. Several aspects such as moral education,learning attitude,scientific schedule,mas-tering the basic medical knowledge and physical examination,typical case and communicating skill must be emphasized in the clinical practice course.

Objective To explore the effect of rhynchophylline and isorhynchophylline on headshakes behavior and levels of monoamine neurotransmitter in model rats with Tourette syndrome.Methods 40 Wistar rats were randomly divided into DOI-induced head-shakes rats (HSR group),haloperidol group,rhynchophylline group and isorhynchophylline group with 10 in each group.The inhibitory effects of rhynchophylline and isorhynchophylline were estimated by observing the HSR behavior.Dopamine (DA) and 5-hydroxytryptamine(5-HT) in the rat striatum were detected by the enzyme-linked immunosorbent assay (ELISA) method.The 5-HT2A receptor mRNA expression in prefrontal lobe cortex of the rats was measured by real-time PCR.Results Compared with HSR group,the head shakes of the rats in haloperidol group and isorhynchophylline group were significantly decreased(P＜0.01),and no change of head-shakes number was observed in rhynchophylline group (P＞0.05).There was no significant difference of head-shakes number between the haloperidol group and isorhynchophylline group(P＞0.05).Compared with HSR group,DA levels in the rat striatum were significantly decreased in isorhynchophylline group and haloperidol group((152.35± 5.80) μ~L vs (111.19±4.30) μg/L,(152.35±5.80) μg/L vs (126.42±3.17) μg/L,P＜0.01),while DA levels in the rat striatum in rhynchophylline group were not changed ((152.35±5.80) μg/L vs (142.71±5.51) μg/L,P＞0.05).There was no significant change of 5-HT2A receptor mRNA expression in rat prefrontal lobe cortex in every group(P＞0.05).Conclusion Isorhynchophylline may have an inhibitory effect on rats with DOI-induced HSR.Isorhynchophylline may decrease the DA levels in the rat stratum with DOI-induced HSR.Rhynchophylline has no significant inhibitory effect on head-shakes behavior and DA levels in the rat stratum with DOI-induced HSR.

Lives are maintained by enough oxygen.Blood oxygen saturation is one of the important parameters which reflects oxygen concentration in blood.The accurate monitoring of blood oxygen saturation is very important to both physiological research and medical application.At present,dual-wavelength method is widely adopted in noninvasive detection of blood oxygen saturation.Therefore,accurate recognition of peak-to-peak value of pulse waveform is a key process in monitoring blood oxygen saturation.In the paper,LMS self-adaptive arithmetic is applied to processing pulse waveform signal.The ratio of corrective detection is improved by the method.

Objective To study non-invasive measurement of reflectance oxygen saturation.Methods Diffusion theory was used to explain the action of light in tissue and deduce reflectance oxygen saturation formula.Then,Reflectance Oxygen Saturation Detection System based on MSP430 was developed and calibrated.Result The calibration result and calibration curve was ascertained and analyzed.Conclusion The formula for detection and measurement of oxygen saturation is put forward by using Reflectance Oxygen Saturation Detection System.

Objective To investigate the efficacy of autologous peripheral hematopoietic stem cell transplantation in the treatment of adult dermatomyositis. Methods A 21-year-old patient with dermatomyositis received autologous peripheral hematopoietic stem cell transplantation and was followed up for 6 years. Autologous peripheral hematopoietic stem cells were mobilized by recombinant human granulocyte colony stimulating factor (rhG-CSF) before the transplantation, and the conditioning regimens consisted of cyclophosphamide,methylprednisolone and cyclosporin. Rabbit anti-human T lymphocyte immunoglobulin began to be applied on day 3 after retransfer of stem cells. The improvement in symptoms, physical signs and biochemical indicators was observed, and hematopoietic restructuration and immunity resurrection were evaluated after the transplantation. Results After the transplantation, skin eruption greatly improved and gradually subsided. The muscle force of extremities restored from level Ⅳ before transplantation to level Ⅴ. The level of creatine kinase declined sharply after transplantation, but gradually returned to previous level. Leucocyte count began to decrease on the day of retransfer, and returned to the normal level on day 8. Immune function remained normal before and after the transplantation. Conclusion Autologous peripheral hematopoietic stem cell transplantation is an alternative treatment for severe and refractory dermatomyositis.

Objective To understand the adherence to current treatment guidelines after training in man-agement of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in emergency department (ED),and to assess the patients' prognosis. Methods Were ED doctors trained with a standard management flow-sheet for AECOPD. The treatment of 152 AECOPD patients recruited from November 1,2008 to April 30,2009 in our hospital and their prognosis were compared to those of 133 AECOPD patients who were treated between Novem-ber 1,0007 to April 30,2008. Results After training, the ED doctors' management of AECOPD is more standard. The rate of the combination of inhaled anticholinergics and short-acting β_2-agonists was increased from 12.0% (16/133) to 27.6% (42/152), the use of inhaled glucocorticosteroids was increased from 52.6% (70/133) to 88.8% (135/152), and the early use of noninvasive imermittent positive pressure ventilation(NIPPV) for the mod-erate to severe was increased from 10.5% (14/133) to 16.4% (25/152). The use of theophylline was decreased from 69.2% (92/133) to 49.3% (75/152). The in-ED mortality rate was decreased from 15.8% (21/133) to 12.5% (19/152). All the difference were significant (P< 0.05). The rate of inhaled β_2-agonists was increased from 78.2% (104/133) to 82.9% (126/152), the use of systemic glucocorticosteroids was decreased from 63.2% (84/133) to 56.6% (86/152),the use of antibiotics was increased from 88.0% (117/133) to 92.8% (141/152), and the use of invasive mechanical ventilation was increased from 14.3% (19/133) to 15.1% (23/152) ,the in-hos-pital mortality rate was decreased from 6.0% (8/133) to 5.3% (8/152), the average days in hospital was decreased from 13.3 to 12.4 days, but the difference was not significant (P > 0.05). Conclusions There are still some differences exist between guideline recommendations and actual ED management of AECOPD. After training ED doctora with a standard flow-sheet, their management of AECOPD is improved. The rate of the combination of inhaled anticholinergics and short-acting β_2-agonists, use of inhaled glucocorticosteroids, and early use of NIPPV is increased. The use of theophylline and the in-ED mortality rate is decreased.

Anal Canal ; surgery ; Child ; Child, Preschool ; Colon, Sigmoid ; surgery ; Digestive System Surgical Procedures ; methods ; Female ; Hirschsprung Disease ; surgery ; Humans ; Infant ; Laparoscopy ; Male ; Rectum ; surgery ; Treatment Outcome

Pancreatic cancer is a highly malignant tumor with a high mortality.Surgery is the only potential hope of cure for patients with pancreatic cancer.Imaging examination plays an essential role in both the early diagnosis and preoperative assessment.Accurate tumor staging has guiding significance for clinical practice.Appropriate therapeutic schedule will be selected according to the tumor staging,and then patients' prognosis can be evaluated.Recently,the TNM staging systems for pancreatic cancer have been updated by American Joint Committee on Cancer (AJCC).Major changes were made in the T and N staging.This article will review the updates of the 8th edition of AJCC cancer staging for pancreatic cancer from radiography aspect.

Background The protective effects against reperfusion injury of cardioprotective drugs have recently been evaluated and found to be inadequate. Guanxinshutong (GXST), a combination of the traditional herb and Mongolian medicine, is effective and safe in treating angina pectoris in clinical trials. We assess the cardioprotective effects of GXST against myocardial ischemia and reperfusion (MI/R) injury in rats and explore its possible mechanism. Methods Forty-five male Sprague Dawley rats were randomized into three groups: non-MI/R group (Sham, n = 15), MI/R group treated with vehicle (Control, n = 15) and MI/R group treated with GXST (Drug, n = 15). MI/R was induced by ligation of the left anterior descending coronary artery (LAD) for 30 minutes, followed by 2/24 hour reperfusion in the Control and Drug groups. In the Sham group, the LAD was exposed without occlusion. GXST powder (in the Drug group) or saline (in the Control and Sham groups) were administered via direct gastric gavage from 7 day prior to surgery. Blood samples were collected from the carotid artery (10 rats each group) after 2 hours of reperfusion, to determine the levels of tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), interleukin-6 (IL-6) and intercellular adhesion molecule-1 (ICAM-1) using enzyme-linked immunosorbent assays. The animals were then sacrificed and the hearts were harvested for histopathology and western blot analysis. Infarct size was measured in the remaining five rats in each group after 24 hours reperfusion. Results GXST significantly decreased levels of TNF-α, IL-1β, IL-6, ICAM-1, apoptosis index (AI) and infarct size. GXST also obviously inhibited nuclear factor kappa B (NF-κB) activity when compared with the Control group (all P < 0.05). Conclusions GXST is effective in protecting the myocardium against MI/R injury in rats. Its possible cardioprotective mechanism involves inhibition of the inflammatory response and apoptosis following MI/R injury.

Objective To assess the effects of Guanxinshutong capsule(GXST)on protection of left ventricular(LV)function after acute myocardial infarction(AMI)in rats.Methods Twenty-eight male Sprague Dawley rats were randomized to Model group,Drug group and Sham-operated group,with acute myocardial infarction(AMI)achieved by ligating coronary artery in Model and Drug groups.From one week before surgery to four weeks after surgery,GXST for Drug group(1.5 g/kg,2 times/day)or saline for Model and Sham-operated groups was administered via direct gastric gavage.After four weeks of treatment following surgery,measurement of LV function,pathohistological observation and analysis were performed.Results Compared with rats in the Model group,LV systolic pressure(LVSP)[(97.7 ± 9.0)mm Hg (1 mm Hg =0.133 kPa)vs(85.9 ±9.4)mm Hg],the maximum rising rate of LV pressure(+ dp/dtmax)[(4810.2 ± 595.0)mm Hg/s vs(3786.2 ± 723.0)mm Hg/s]and the maximum dropping rate of LV pressure(-dp/dtmax)[(3781.6 ±573.6)mm Hg/s vs(2774.4 ±633.5)mm Hg/s]in the Drug group were significantly increased,while LV end-diastolic pressure(LVEDP)[(10.3 ± 0.7)mm Hg vs(12.7 ±2.4)mm Hg]in the Drug group was significantly decreased(all P ＜ 0.05).Myocardial pathohistological morphology was improved in the Drug group with fibrosis alleviated[(5.13 ± 1.37)％ vs(7.27 ±1.01)％]and infarct size reduced[(20.14 ± 8.49)％ vs(31.90 ± 4.98)％].Apoptosis index(AI)was decreased[(14.05 ± 4.04)％ vs(20.87 ± 6.03)％]and vessel density was significantly increased by 1.48-fold in the Drug group(all P ＜ 0.05).Conclusions GXST is effective in protecting LV function after AMI in rats,which may be affect through increasing vessel density of infarction area,improving myocardial pathohistological morphology,alleviating fibrosis,reducing infarct size and decreasing AI.