Objective To study indole alkaloids of Ervatamia hainanensis. Methods The compounds were separated and purified by column chromatography with silica gel and Sephadex LH-20. The structures were identified by IR, MS, and NMR. Results Seven alkaloids were identified as: hainanervatasine (Ⅰ), hainanervatacine (Ⅱ), vobasine (Ⅲ), coronaridine (Ⅳ), 3-hydroxyl coronaridine (Ⅴ), 3-(2-oxopropyl) coronaridine (Ⅵ), and tabernamine (Ⅶ), respectively. Conclusion Compounds Ⅰ and Ⅱ are new compounds. Compounds Ⅳ and Ⅵ are isolated from this plant for the first time.

This paper discussed the problems of clinical teaching quality for medical students against the expansion of medical students scale and the change of medical environments as well as the countermeasures of improving clinical practice quality and strengthening clinical practice skills of medical students.

From the current state of the medical environment and health issues,we dis-cuss the necessity of physician-patient communication skills and find the way to enhance the skills of interns.

With the development and the expansion of higher medical education,lack of course resource became a “bottleneck” which restricted the development of medical schools.Teaching hospitals played some roles in medical education,but there was a huge gap in teaching ability between these hospitals and the hospitals affiliated with universities.The Clinical College analyzed the current situation of teaching ability in teaching hospitals and did the preliminary research for the solutions of this situation.

With the development of computer technique, Excel office software is widely applied in the management of clinical teaching. According to the problems existing in the clinical teaching management of our college, Excel electronic software is accepted to reform the present management measures. Its designation, essential archives establishment, method, result, analysis and discussion are introduced definitely in this paper.

Objective To investigate thc cvent-based prospective memory (EBPM)and time-based prospective memory(TBPM)in the inpatients with abstinent alcohol dependence and the relationships between prospective memory and symptoms.Methods 32 male patients with alcohol dependence and 30 normal controls matched by age,education,HAMD and HAMA were assessed with a neuropsychological battery of tests including EBPM and TBPM tasks.Results A statistically significant in EBPM was observed between patients with alcohol dependence and normal controls (3.91 ± 0.69 vs.4.47 ± 0.63,t =-3.348,P ＜ 0.0 1) and the same result in TBPM (3.28 ±0.77 vs.4.20 ±0.66,t=-5.032,P＜0.01).The positively correlation was showed between the duration of abstinence and EBPM (r =0.444,P ＜ 0.05),as well as TBPM (r =O.423,P ＜ 0.05) in the patients.Conclusion The results suggest abstinent alcohol dependence patients impairs both EBPM and TBPM.PM shows correlated with duration of abstinence moderately in the patients.

Objective To investigate the therapeutic effects of early enteral nutrition by gastroscopeguided naso-jejunal feeding tube placement on the intestinal endotoxemia of patient with severe acute pancreatitis (SAP).Methods Fourty-three patients were randomized into two groups:patients receiving early enteral nutrition (EN) by gastroscope-guided naso-jejunal feeding tube placement (24 cases) and those receiving total parenteral nutrition (TPN) ( 19 cases).The serum endotoxin(ET),albumin (ALB) and amylase (AMY) levels were measured.Abdominal distension and other complications were observed in the two groups.Results The abdominal pain and distension relief time,intestinal bleeding,infectious complications of EN group were significantly improved compared with that of TPN group ( P ＜ 0.01 或 P ＜ 0.05 或 P ＜ 0.001 ).The serum ET levels of EN group was much lower ( [ 0.19 ± 0.11 ] EU/ml) than that of TPN group ( [ 0.85 ± 0.28 ] EU/ml)on day 14 post-treatment (t =10.456,P ＜ 0.001 ).The serum AMY levels were decreased significantly in two groups after treatment,and the difference between two groups was not significant (t =3.l17,t =1.889,P ＞0.05 ).The serum ALB recovery of two groups was not significantly different ( P ＞ 0.05 ).Conclusion Gastroscope-guided Naso-jejunal feeding tube placement for early enteral nutrition can protect intestinal mucosa,reduce complications,alleviate symptoms of patients with SAP,which are benefitial factors for the treatment of intestinal endotoxemia in patients with SAP.

BACKGROUND: Vascular injuries of the extremitiesy are frequently concomitant with vascular defects and are usually repaired by autologous vessel grafting. However, the source of autologous vessels is limited and the preparation of them is traumatic.OBJECTIVE: To retrospectively evaluate the extremity-preserving efficacy of vascular prosthesis grafting in repairing major vascular injuries of the extremities in 29 cases.DESIGN: A retrospective study.SETTING: Department of Orthopedics and Traumatic Surgery, Center for Battle Wound and Trauma of Chinese PLA, Research Institute of Surgery,Daping Hospital, Third Military Medical University of Chinese PLA.PARTICIPANTS: We selected 29 patients with major vascular injuries of the extremities repaired by vascular prosthesis grafting who received the treatment at the Department of Orthopedics and Traumatic Surgery of the Center for Battle Wound and Trauma of the Chinese PLA of the Research Institute of Surgery of, Daping Hospital of the Third Military Medical University of Chinese PLA between January 1989 and December 2000. There were 23 males and 6 females. Injury sites: 9 cases were at subclavian artery, 6 at axillary artery, 2 at brachial artery, 10 at femoral artery, 1 at femoral vein and 1 at popliteal artery. 11 of these 29 cases (37.9%) were complicated with shock, 8 with fractures and dislocations, 5 with peripheral nerve injuries and 3 with infections.METHODS: The vascular prosthesis was anastomosed end to end with the trimmed culprit vessels. As for the 3 cases with infective arterial injuries,the vessels were placed away from the infected region and were bridged together in a non-inf1ammatory region and then muscles or musculo-cutaneous flaps were used to cover the infected regions.The functions of the extremities of the patients were evaluated according to MAS at week 2 and 1 year after the operation.MAIN OUTCOME MEASURES: The vascular patency rate and the extremity-preserving outcomes..RESULTS: All 29 patients entered the stage of result analysis. Extremitypreserving efficacy: All the patients who underwent vascular prosthesis grafting had their extremities preserved. Only 1 patient had the late sequelae of ulcers in the foot sole due to extended extremity ischemia and nerve damage. The rate of 2-week patency rate of the grafted vessels was 100% and the 1-year rate of patency was 96.5%, as revealed by Doppler blood stream scanning. The excellent and good rate of the function of extremity was 89%.CONCLUSION: Vascular prosthesis grafting is the one of the methods for repairing the major vascular injuries so as to preserve the extremities and their functions.

OBJECTIVE: To study the relationship between fibrinogen level and pathogenesis of sudden sensorineural hearing loss(SSHI.). METHOD: Fifty patients (55 ears) with SSHL within 7 days of the onset were studied: a control group was consist of 50 normal-hearing people who were individually matched on a pairwise basis according to the same gender and age. Both the patients and the normal people were tested for the parameters of hemorheology, blood biochemistry, whole blood cell count and clotting function. RESULT: Fibrinogen level and plasma viscosity in patients with SSHL were significantly higher than that in control subjects. Prothrombin time and activated partial thromboplastic time were significantly less in the patients group than that in the control group (P < 0.05). There were statistical difference. The parameters of blood biochemistry, whole blood cell count and platelet adhesion test of two groups had no significant difference (P > 0.05). CONCLUSION Elevated plasma fibrinogen may be a major pathogenesis of SSHL. An increase in plasma fibrinogen level may lead to elevated plasma viscosity. All these may promote a prothrombin or hypercoagulable state and impair blood perfusion of cochlea.
Adolescent ; Adult ; Aged ; Case-Control Studies ; Female ; Fibrinogen ; metabolism ; Hearing Loss, Sensorineural ; blood ; etiology ; Hearing Loss, Sudden ; blood ; etiology ; Hemorheology ; Humans ; Male ; Middle Aged ; Young Adult