Clinical Clerkship is the necessary stage from theory to clinical practice,As teaching hospital of Nanjing Medical University.we explore various kinds of methods of clinical practice quality improvement by emphasizing practice training,developing multiform teaching activities,highhghting autonomic learning and strengthening intemship management.

Objective To study the effects of perinatal exposure to bisphenol A(BPA) on the expression of estrogen receptor ? and ? mRNA in the brain of F1 male offsprings. Methods Pregnant SD rats were given BPA at 2, 20, 100 mg/kg bw per day respectively from eleventh day of gestation throughout the whole lactation by gastric gavage until their pups were weaned on postnatal day 21, F1 male pups from each group were killed on postnatal day 21 respectively, the brain was removed for detecting the expression of estrogen receptor ? and ? mRNA by RT-PCR. Results BPA treatment caused a up-regulation of ER? mRNA and ER? mRNA relative expression in the brain,especially in the middle-dose and low-dose groups it was so obvious. Conclusion Perinatal exposure to BPA can cause a change of ER? mRNA and ER? mRNA expression in the brain of the male offspring,which may be a part of the mechanism of BPA induced brain development damage.

Objective To investigate the imaging findings of primary hepatic carcinoid tumor with dynamic MRI and spiral CT.Methods Eleven cases with pathologically confirmed primary hepatic carcinoid tumor were analyzed retrospectively.Four cases were examined with spiral CT,and 8 cases were examined with MRL Results Two of 11 cases had multiple tumors,presenting as two or more nodular lesions,while the remaining 9 cases had single tumor.Four cases showed well-defined low density on the plain scan of CT,with central irregular cystic areas.Lesions enhanced unevenly on arterial phase of CT,with no enhancement in the central part The edge of lesions showed delayed reduced enhancement on portal vein phase.than the arterial phase,while non-enhanced lesions in the center areas.Eight cases were detected by MRI,seven On MRI,7 of 8 lesions showed uneven low signal on T_1WI and high signal with central low intensity on T_2WI.On arterial phase of MRI,7 cases had uneven enhancement at the peripheral part and irregular non-enhanced signal in center.Lesions showed delayed mild enhancement in the peripheral parts,with a relatively smaller non-enhanced central area.One case was cystic,with high signal included in the extensive low density on T_1WI.The case appeared high signal on T_2WI and had uneven enhancement at the edge on arterial phase,low signal on delayed phase.Conclusion Primary hepatic carcinoid tumor exhibits some imaging features on plain and dynamic contrast-enhanced MRI and spiral CT,which can be the clue for the diagnosis.

Objective To evaluate the sensitivity and specificity of histopathologie analysis vs cytomegalovirus (CMV) detection for the diagnosis of CMV-infected hepatitis post liver transplantation. Methods Twenty-five biopsies with CMV infection and twenty-five without CMV infection were collected. Histopathologic observation, immunohistochemical staining and virus detection were performed on both groups to evaluate the sensitivity and specificity of these examinations for the diagnosis of CMV-infected hepatitis. Results The detection rate of microabscess, aggregation of monocyte and rnacrophage, and cytomegalic change in CMV infection group was higher than that in the group without CMV infection (P<0.05), but there was no significant difference in intranuclear inclusion and eosinophilic body between the two groups (P>0.05). The sensitivity and specificity of IHC and PCR for CMV detection were 20% and 100%, 72% and 84%, respectively. Conclosions CMV detection with PCR combined with histological observation is the most effective diagnostic scheme for CMV disease of liver.

Objective To investigate the effect of hydrogen sulfide (H2S) on brain injury and inflammatory response after cerebral ischemia/reperfusion in rats.Methods Forty-eight malc SD rats were randomly divided into four groups:sham operation group,ischemia/reperfusion (I/R) group,H2S-30 ppm group,and H2S-60 ppm group (n=12 in each group;1 ppm=1 mg/L).The middle cerebral artery occlusion method was used to induce a model of focal cerebral ischemia for 2 h and reperfusion for 24 h.After reperfusion for 24 h,the tape remove experiment was used to perform the nerve function evaluation.2,3,5-triphenyl-tetrazolium chloride staining method was used to measure the percentage of cerebral infarction volume.Enzyme-linked immunosorbent assay was used to measure the levels of interleukin (IL)-1 β and IL-6.Western blotting was used to detect the expression levels of inducible nitric oxide synthase (iNOS) and intercellular cell adhesion molecule-1 (ICAM-1),as well as the transposition activation of nuclear factor-κB (NF-κB).Results Inhalation of H2S could shorten the time required to remove the tape in a dose-dependent manner compared with the I/R group (I/R group vs.H2S 30 ppm group and H2S 60 ppm group:180 s vs.130 [113-157]s vs.110 [87-138] s;P＜ 0.05),reduced the cerebral infarct volume (48.8％ ± 9.1％ vs.23.3 ％ ± 5.1％ vs.17.3 ％ ± 3.5 ％;P ＜ 0.05),downregulated the expression levels of IL-1β (39.53± 6.02 pg/mg protein vs.30.17± 3.46 pg/mg protein vs.22.69± 6.09 pg/mg protein;P ＜0.05) and IL-6 (54.65 ± 10.68 pg/mg protein vs.37.89 ±4.54 pg/mg protein vs.27.00 ±3.08 pg/mg protein;P ＜ 0.05) in ischemic brain tissue,significantly decreased NF-κB nucleus/ cytoplasm ratio (4.40 ± 1.05 vs.3.07 ± 0.82 vs.2.30 ± 0.60;P ＜ 0.05),inhibited expressions of iNOS (4.22 ±0.67 vs.3.14 ±0.90 vs.2.08 ±0.35;P ＜0.05),and ICAM-1 (5.45 ± 1.08 vs.3.45 ±0.67 vs.2.21 ±0.39;P ＜0.05).Conclusions Inhalation of exogenous H2S can reduce cerebral infarct volume after cerebral ischemia/reperfusion in a dose-dependent manner and improve neurological function.Its mechanism may be associated with the inhibition of NF-κB activation,down-regulation of its downstream iNOS and ICAM-1 expression levels,and decrease of IL-1β and IL-6 levels.

Purpose A systematic analysis of the articles published in the Chinese Journal of Medical Imaging from year 2013 to 2015 was performed to investigate its features of acceptance and publication for future decision making.Methods The printed journal and retrieved data from the Chinese Hospital Knowledge Database was analyzed using biometrical index,including the number of the papers,subspecialties,publication types,medical imaging modalities,MeSH frequency,citation and download.Results From year 2013 to 2015,there were 770 papers published,21.4 articles per issue and 0.267 articles per page in average.The top three subspecialty were abdominal imaging,chest imaging and reviews/comments,accounting for 17.27％,9.61％,9.48％,respectively.The top three modalities were CT,ultrasound and MRI,accounting for 39.61％,38.31％,29.87％,respectively.The original research papers were 584,accounting for 75.84％.The frequent MeSH subjects were differential diagnosis,angiography,pathology,computer-assisted image processing and contrast agents.Totally,there were 2395 citations and averagely 3.11 citation for each paper.The top citation was 36.There were 71317 downloads and 92.62 for each paper in average,the top download was 499.Conclusions The publications and its density per page increased annually from 2013 to 2015.The subspecialty were fully covered,the papers focus on original researches and clinical applications.The publication theme could follow the tendency of the imaging technology and had good and steady effects in the field.

Adolescent ; Adult ; Cataract ; epidemiology ; Humans ; Middle Aged ; Occupational Exposure ; Welding ; Young Adult

Cardiovascular Diseases ; epidemiology ; etiology ; Environmental Exposure ; adverse effects ; Humans

Objective To explore the effect of postural reduction and balloon dilation on the correction of vertebral height following balloon percutaneous kyphoplasty (PKP) for osteoporotic vertebral coinpressive fracture (OVCF).Methods From June 2012 to December 2013,47 OVCF patients involving 57 fractured thoracolumbar vertebrae with intact posterior wall underwent PKP.In all patients postural reduction was performed under general anesthesia.The percentages of vertebral height loss before and after balloon dilation were compared.The curative effects were evaluated by comparing preoperative and postoperative visual analogue scale(VAS) scores and cobb angles.Results Compared with preoperation,the vertebral heights of anterior and middle columns were significantly improved after postural reduction,balloon dilation and PKP (P ＜ 0.05),but there was no significant improvement before and after balloon dilation (P ＞0.05).The postoperative average cobb angle (22.8°± 8.1°) was significantly decreased compared with the preoperative one (22.8° ± 8.1°) (P ＜ 0.05).The VAS scores at preoperation,one day postoperation and the final follow-up were respectively 8.5 ± 0.4,3.4 ± 0.2 and 3.1 ± 0.3.The postoperative ones were significantly lower than the preoperative one (F =7.518,P =0.006).Conclusions In PKP,postural reduction under general anesthesia plays an important role,but balloon dilation may exert an insignificant effect on restoration of vertebral height.

Objective The purpose of the experiment is to research the effects of different kind of anti-platelet drugs and their combinations in prevention of vascular restenosis after ballon-injury, and to evaluate the best way of clinical utility of anti-platelet drugs.Methods Fifty-six male New Zealand White Rabbits were randomly assigned to 3 groups: the control group (ML) , the model group (M) , the experimental group.The experimental group was divided to 5 subgroups, the aspirin group (A), the cilostazol group (B) , the clopidogrel group (C), the aspirin plus cilostazol group (A + B) , and the aspirin plus colopidogrel group (A + C).Femoral artery stenosis model was induced by halloon injury except the control group.The rabbits were fed different drugs 3 days before operation except the normal group and the model group.On the 14th day after operation, the rabbits were sacrificed and the iliofemoral arteries were removed and made to the pathological section.We measured the internal elastic lamina, external elastic lamiua and luminal areas measured.Then calculate the area of intima, media and the ratio of intima vs.media.Results ①There is no endothelium hyperplasia in control group.Compared with the control group, we observed endothelium hyperplasia in both model group and the experimental groups.Compared with the model group, endothelium hyperplasia in all experimental groups is in a lower degree;② Cilostazol alone works better than aspirin alone and clopidogrel alone in prevention of vascular restenosis after ballon-injury.Clopidogrel combined with aspirin and cilostazol combined with aspirin both work better than aspirin alone in prevention of vascular restenosis after ballon-injury.There is no apparent difference between the effect of clopidogrel combined with aspirin and cilostazol combined with aspirin.Conclusions ① Different anti-platelet drugs and different combinations of them can prevent the happening of vascular restenosis after ballon-injury.② Cilostazol works better than aspirin and clopidogrel in prevention the happening of vascular restenosis after ballon-injury, and combination of anti-platelet drugs which contains cilostazol works better than other way of combination of anti-platelet drugs.③ Cilostazol and combination of anti-platelet drugs which contains cilostazol is potential useful in clinical uses to prevent restenosis after PTA.