In order to accelerate the pace of teaching reform,our school explores the tutorial system of undergraduate course this year,this article emphasize the necessity and beneficial effects of this system in clinical practice.

This paper introduces interns shoule know the importance of interpersonal relationship in clinic practice thoroughly and good interpersonal relationship requires the teacher and medical students to make efforts together.

With the development of Chinese education system, academic students in medical university can not meet the demand of current social development. The combination of teaching and research ideas should run through the whole teaching process, which is an important approach to bring up innovative talents. This article focuses on teaching process of rehabilitation medicine, and how to run research ideas through each sections of rehabilitation medicine. Research ideas begins with teaching, shaped in clinical practice, and being applied for clinical work. That is just the right thinking for cultivating outstanding medical specialists in the 21st century.

Objective To provide useful information for the diagnosis and differentiation through exploring the tumor with polyserositis as the initial symptom.Methods There was a case present with fever,poor spirit,abdominal distention and edema in Children's Hospital of Hebei Province.The characteristics and results of physical examination were summarized and discussed according to the condition evolution phases.The possible etiological factors were analyzed.The treatment was adjusted.Further physical examination was improved.The final diagnosis was tracked.Results After getting admitted to hospital,the patient received CT scan and ultrasound examination for many times.The results suggested the pericardial effusion,pleural effusion,peritoneal effusion and cardiac insufficiency.The child had made a slight improvement through treatment.However,he had hemiparesis.Cerebral infarction was demonstrated through magnetic resonance imaging(MRI),magnetic resonance angiography (MRA),magnetic resonance venography (MRV).Ultrasound showed that there was more pericardial effusion,aortic root solid low echo mass,pulmonary arterial wall stiffness,left and right pulmonary artery blood flow speed increased.Neck and chest enhanced CT showed mediastinal lesions.Pathology examination results suggested myeloid sarcoma after referral to superior hospital.Conclusions When children had an unexplained polyserositis,more comprehensive analysis were needed.The illness condition should be explained with Monism as far as possible.Repeated inspections would be necessary when the pathogenesis was not clear.Careful watch for the tumor should be kept.

Objective To analyze the antimicrobial resistance profile and homology of the Acinetobacter baumannii strains isolated from Rushan People's Hospital in a three-year period for better control of hospital infections.Methods A.baumannii strains were isolated from clinical specimens during the period from 2013 to 2015.Homology analysis were conducted by pulsed field gel electrophoresis (PFGE) for 60 randomly selected isolates.Results A total of 567 A.baumannii isolates were isolated,85 isolates in 2013,156 in 2014,and 326 in 2015.These isolates were mainly from Department of Respiratory Diseases (47.4％) and ICU (23.8 ％).Overall,62.1％ of the isolates were from sputum specimens followed by secretions (15.2％).All isolates were sensitive to polymyxin B,but all resistant to sulfamethoxazole and ampicillin.The A.baumannii isolates showed increasing resistance rate to imipenem,meropenem,ceftriaxone,and trimethoprim-sulfamethoxazole over the 3-year period,but decreasing resistance rate to gentamicin.The 60 selected isolates were grouped into 4 types by PFGE.A-type was the main pattern.Conclusions A.baumannii strains were mainly isolated from inpatients with respiratory tract infections.The A.baumannii strains showed serious antimicrobial resistance associated with possible clonal spread in this hospital.

AIM: To establish a method of analysing chemical components of the essential oil in Mulberry Leaves in Xinjiang. METHODS: The essential oil of Mulberry Leaves was extracted by ultrasound-steam distillation method.components were measured by GC-MS.About 80 peaks were separated totally.55 components of which were identified.The amount of the components from the essential oil was determined by normalization method.(RESULTS:) There were alkane(C_(10)～C_(40)),alkene,alcohols,unsaturated aldehydes,unsaturated ketones,carboxylic acid,ester,heterocyclic compound and aromatic hydrocarbon in essential oil in Mulberry Leaves.The main components were octadecane(9.11%),1,2-benzenedicarboxylic acid-bis(2-methyl)propyl ester(8.92%),3,7,11,15-tetramethyl-2-hexadecen-1-o1(7.19%).there was a small amount of terpene in essential oil in Mulberry Leaves. CONCLUSION: The method is reliable,stable and has a good repeatability.This method can be applied to the analysis of the essential oil components extracted from Chinese traditional medicine.

OBJECTIVE: To investigate the effects of the combination of alpha-keto acid and low-protein diet on the levels of serum cytokines in patients performing continuous ambulatory peritoneal dialysis (CAPD) and to explore the relationship between inflammation and malnutrition in CAPD patients. METHODS: Eighty-nine CAPD patients were randomized into three groups, and 78 cases completed a one-year follow-up and with complete data. There were 31 cases in low-protein diet plus alpha-keto acid group, 26 cases in low-protein diet group and 21 cases in routine-protein diet group. The levels of serum albumin (Alb), prealbumin (PA), retinol-binding protein (RBP), transferrin (TRF), cholesterol (TC), triglycerides (TG), leptin, and triceps skinfold thickness (TSF), mid-arm muscle circumference (MAMC), body mass index (BMI) were measured. The changes of serum interleukin-1alpha (IL-1alpha), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha) and C-reactive protein (CRP) were also detected. RESULTS: Compared with low-protein diet group, serum levels of PA, RBP and TRF were significantly increased both in low-protein diet plus alpha-keto acid and routine-protein diet groups ( P<0.01), however, there was no significant difference in the levels of PA, RBP and TRF between low-protein diet plus alpha-keto acid group and routine-protein diet group. There was an increased tendency in the content of Alb, TC, TG, BMI, TSF and MAMC, but there were no significant differences. The plasma levels of IL-1alpha, IL-6 and TNF-alpha in low-protein diet plus alpha-keto acid group were decreased as compared with the routine-protein diet group, but there were no significant differences. The plasma level of CRP in low-protein diet plus alpha-keto acid group was lower than that in the routine-protein diet group ( P<0.01). CONCLUSION: The combination of alpha-keto acid and low-protein diet can ameliorate malnutrition and micro-inflammation in CAPD patients.

Objective To evaluate the effect of sevoflurane on the expression of aquaporin 8 (AQP8) in the intestinal mucosa in a pig model of hemorrhagic shock.Methods Twenty-four Bama miniature pigs of both sexes, weighing 22-25 kg, were randomly divided into 3 equal groups using a random number table: sham operation group (group S), hemorrhagic shock group (group HS) and sevoflurane group (group PS).The femoral artery and jugular vein were cannulated for blood pressure monitoring, blood-letting, and blood sampling in anesthetized pigs.Hemorrhagic shock was induced by withdrawing blood from the right femoral artery.Hemorrhagic shock was induced after cannulation in group HS.In group PS, 2％ sevoflurane was inhaled for 30 min after the model of hemorrhagic shock was successfully established.Before anesthesia, and at 0.5, 1, 1.5, 2, 3 and 4 h after hemorrhagic shock, blood samples were collected from the jugular vein for determination of serum D-lactic acid and intestinal fatty acid-binding protein (I-FABP) concentrations.The animals were sacrificed at 4 h after hemorrhagic shock, and the intestinal specimens were obtained for microscopic examination and for determination of AQP8 expression in the intestinal mucosa (by enzyme-linked immunosorbent assay).The intestinal water content was calculated.Results Compared with group S, the serum D-lactic acid and I-FABP concentrations, AQP8 expression, and intestinal water content were significantly increased in HS and PS groups (P＜0.05).Compared with group HS, the serum D-lactic acid and I-FABP concentrations, AQP8 expression, and intestinal water content were significantly decreased in group PS (P＜0.05).The pathological changes of intestinal tissues were significantly reduced in group PS as compared with group HS.Conclusion Sevoflurane can decrease the intestinal mucosal edema through inhibiting AQP8 expression, thus reducing hemorrhagic shockinduced damage to the intestinal mucosa in pigs.

Objective To investigate the risk factors for death within 30 days of stroke associated pneumonia(SAP) in elderly patients of the intensive care unit (ICU).Methods Clinical data of 116 patients with SAP who were admitted to ICU were reviewed.The predicting factors of death within 30 days were analyzed through variable analysis method.Results The hospitalization periods of the SAP group and control group were (27±8) d and (12±5) d,the difference was statistically significant(t =1 1.30,P =0.002).The most common pathogenic bacteria in SAP were Klebsiella pneumoniae,Bauman Acinetobacter,Escherichia coli,and gram negative bacteria.There was significant difference between the two groups in term of mortality rate(37.9％(44/ 116) of SAP group,22.0％ (22/100) of control group,x2 =6.423,P =0.011).Logistic regression analysis showed that basic diseases(OR =2.778,95％ CI:1.205-6.401),high CRUB-65 score (OR =1.978,95％ CI:0.871-11.098),lower Glasgow coma score(GCS) (OR=3.601,95％CI:0.244-9.477),bucking(OR=3.020,95％CI:1.305-10.603),mechanical ventilation(OR=2.654,95％CI:1.176-5.990),shock(OR=2.636,95％ CI:1.164-5.969) and high plasma CRP level(OR=2.333,95％CI:1.046-5.206) were risk factors for SAP (all P＜0.05).In Cox regression analysis,a GCS score of ＜ 9 was an independent risk factor for 30 d mortality of patientswithSAP(HR=7.23,95％Cl:2.24-20.11,P=0.001).Conclusion SAP is one of the serious complications of the elderly hospitalized for the acute stroke in the ICU,which may affect the prognosis of the patients.

Objective To investigate the expression and the clinical significance of meningioma-association protein（MAC30）mRNA and protein in colorectal carcinomas.Methods MAC30 was immunohistochemically examined in 130 primary tumours,73 distant normal mucosa specimens and 34 lymph node metastases from rectal cancer patients＇paraffin embedded blocks.MAC30 mRNA expression was detected by RT-PCR in primary tumors,adjacent and distal normal mucosa of 50 rectal cancer patients underwent colectomy.Results MAC30 cytoplasmic expression level in colorectal primary tumors and lymph node metastases was significantly higher than that in distant normal mucosa.MAC30 mRNA expression was upregulated in primary tumor,and the expression level was related to the histologic type of the tumor.Three-year survival rate of the colorectal carcinomas patients with strong expression of MAC30 was significantly lower than that of the patients with weak MAC30 expression（P 0.05）.Conclusion MAC30 overexpression might be involved in the development of colorectal carcinomas and seemed to be a prognostic factor.