Objective]Help students to construct the system of TCM clinical thinking and to cultivate the ability of differential diagnosis and prescription. [Methods]In the late clinical teaching, make junior doctor with a high grade of students, graduate students, or some clinical experience as a research object, designing as a medical record has gradually evolved into a number of different medical records dynamic group, let students practice the tentacles medical records. [Results]Gradually,students learned to distinguish the different parties in the different clinical symptoms, and enhance the understanding of drugs and prescriptions. [Conclusion] The tentacles medical records practicing can cultivate the students' ability of dialectical thinking integration.

Background Optic neuritis is one of the common clinical neuro-ophthalmic diseases.Spectraldomain OCT (SD-OCT) is a valuable tool in assessing the thickness changes of retina,while enhanced depth imaging (EDI) OCT can further quantitatively and morphologically evaluate the changes of retina and choroid.The pathological mechanism of optic neuritis is unclear now.Objective This study was to quantitatively measure the retinal and choroidal thickness in early optic neuritis eyes by SD-OCT and EDI OCT.Methods A prospective cohort study was carried out in Tianjin Eye Hospital from July 2015 to May 2016.Twenty eyes of 20 patients with acute optic neuritis were enrolled as optic neuritis group and 22 eyes of 20 healthy subjects with matched age and gender were included in the normal control group.The mean thickness of retinal nerve fiber layer (RNFL) and choriod in superior,inferior,nasal and temporal quadrants at 3.4 mm around optic disc was measured,and the mean thickness of RNFL,ganglion cell layer (GCL),inner plexiform layer (IPL),inner nuclear layer (INL),outer plexiform layer (OPL),outer nuclear layer (ONL) and photoreceptor layer also was measured by EDI OCT.Pattern visual evoked potential (P-VEP) and visual field were examined in all the individuals,the correlations of mean defect (MD) with the thickness of RNFL,choroid and the thickness of RNFL,GCL,IPL,INL,OPL,ONL,photoreceptor layer at macular area were evaluated.Results The RNFL thickness values were (424.00±160.30),(428.40±169.83) and (108.15 ±50.66) μm in superior,inferior,nasal quadrants at 3.4 mm arear around optic disc in the optic neuritis group,which were significantly higher than (265.68±26.25),(283.27±52.81) and (72.68± 12.01) μm in the normal control group (t=4.571,3.814,3.190,all at P＜0.01),and there was no significant difference between the two groups (t =0.849,P =0.401),and no significant differences were found in choroidal thickness of 4 quadrants between the two groups (all at P＞0.05).The thickness of RNFL,GCL and IPL at 1 mm area around macula and the thickness of GCL,IPL,INL at 3 mm area around macula were evidently thining in the optic neuritis group compared with the normal control group (all at P＜0.05).The latency of P100 wave was (133.15±11.11) seconds in the optic neuritis group and that in the control group was (94.59 ±4.38) seconds,showing a significnat difference between them (t =15.058,P＜0.05).Positive correlations were found between MD and the RNFL thickess in superior,inferior,nasal quadrants at 3.4 mm arear around optic disc (r =0.649,0.649,0.635,all at P＜0.05),however,no evidentlylinear correlations were found between MD and choroidal thickness in 4 quadrands (r =-0.120,-0.102,-0.415,0.120,all at P＞0.05),and the thickness of RNFL,GCL,IPL,INL,OPL,ONL,photoreceptor layer at macular area was significantly linear correlated with MD.Conclusions EDI OCT can reflect the RNFL edema around optic disc and thining of various layers of retina at macular area in acuter optic neuritis eyes,however,the choroidal thickess is unchanged.EDI OCT is a useful tool in quantitative evaluation of retinal and choroidal thickness of early optic neuritis.

Objective To compare the consistency and difference of optical coherence tomography angiography (OCTA) and traditional multimodal fundus imaging in the diagnosis and activity evaluation of choroidal neovascularization (CNV) in exudative age-related macular degeneration (AMD). Methods A total of 112 exudative AMD patients (130 eyes) were included in this retrospective study, 62 were men (71 eyes) and 50 were women (59 eyes). The mean age was (68.250±9.789) years (range 50–91 years). All patients were underwent traditional multimodal fundus imaging including fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA) and spectral domain optical coherence tomography (OCT);OCTA was performed at the same time. The CNV type was divided into active and non-active according to the results of traditional multimodal fundus imaging. The vascular pattern was divided into active and non-active according to the results of OCTA. Using traditional multimodal fundus imaging as the standard, the sensitivity and specialty of OCTA was evaluated. Results In 130 eyes, CNV was visualized on traditional multimodal fundus imaging in 109 eyes (83.8%);CNV was visualized on OCTA in 103 eyes (79.2%), which including 7 eyes of false negative and 1 eye of false positive. The sensitivity of OCTA for CNV diagnosis was 93.6%, with specificity of 95.2%. The CNV detection rate between two methods had no significant difference (Youden index=0.89, Kappa value=0.796, P=0.07). In 109 eyes diagnosed with CNV by traditional multimodal fundus imaging, 73 eyes (67.0%) were active CNV and 36 eyes (33.0%) were non-active CNV;the vascular pattern was active in 60 eyes (55.0%) and non-active in 49 eyes (45.0%). The sensitivity of OCTA for the detection of active CNV was 82.2%, with specificity of 100.0%. The active CNV detection rate between two methods had no significant difference (Youden index=0.82, Kappa value=0.753, P=0.00). Conclusion In the diagnosis and activity evaluation of CNV in exudative AMD, there is remarkable consistency between OCTA and traditional multimodal fundus imaging.

Objective To investigate the risk factors of cognitive impairment in post-intensive care syndrome patient (PICS-CI).Methods A retrospective study was conducted. The patient who transferred from post-intensive care unit (ICU) to the general ward for more than 7 days, and with the age ≥ 18 years old in the First Affiliated Hospital of Jinzhou Medical University from October 2015 to November 2016 were enrolled. The gender, age, marital status, education, occupation, salary, economic income, smoking, alcohol drinking, previous of history, mechanical ventilation, the length of ICU stay, sedative and delirium, and initial diagnosis were recorded. According to mini-mental state examination (MMSE), the patients were divided into cognitive impairment (CI) group and non-CI group. Univariate analysis was performed to identify the risk factors of PICS-CI, and variables with statistical difference were selected to do multivariate binary logistic regression analysis for the confirmable independence risk factors.Results 104 of the 290 patients developed CI, and the incidence was 35.86%. Univariate analysis showed that the gender, age, education, financial situation, smoking, alcohol drinking, previous of history, mechanical ventilation, the length of ICU stay, sedative and delirium, and initial diagnosis were recorded of ICU were main predictors of PICS-CI patients. It was shown by multivariate binary logistic regression analysis that the age > 60 years old [odds ratio (OR) = 7.523, 95% confidence interval (95%CI) = 2.572-37.851,P = 0.001], mechanical ventilation (OR = 8.773, 95%CI = 2.588-36.344,P < 0.001), sedation (OR = 9.376, 95%CI = 2.661-42.011,P = 0.002), and delirium (OR = 13.201, 95%CI = 2.502-41.433, P < 0.001) were PICS-CI independence risk factors.Conclusions Nurse staffs should strength care and attention on ICU transferred out patients. In order to minimize PICS impairment, special precaution should be implemented according to different aspects.

To establish a multi-pretreatment method for the determination of aflatoxin B1, B2, G1, G2 in Chinese patent medicines, aflatoxins were analyzed by high performance liquid chromatography-fluorescence detector with post-column derivatization, after the multi-pretreatment of samples. The results showed that after the samples extracted with MeOH-H2O, dehydrated by anhydrous magnesium sulphate and sodium chloride, and finally purified by neutral alumina, the impurity interference of different sources in Chinese patent medicines matrix can be effectively removed, and the main peak can be nicely separated from the impurity peak. The detection limits were 0.25, 0.25, 0.50, 0.25 μg x L(-1) for AFB1, AFB2, AFG1, AFG2, respectively. The quantification limits were 1.00, 0.50, 1.00, 0.50 μg x L(-1), respectively. Aflatoxin B1, G1 showed a good linear relationship at a range of 1.0-50 μg x L(-1), aflatoxin B2, G2 at a range of 0.5-12.5 μg x L(-1) (R2 > 0.99). The average recovery was 80.40% - 108.6%. The present method is simple, reproducible with the reasonable recoveries and can be applied for the determination of aflatoxins in Chinese patent medicines.
Aflatoxins ; analysis ; Chromatography, High Pressure Liquid ; methods ; Dosage Forms ; Drug Contamination ; Drugs, Chinese Herbal ; analysis

A plasmids of continuous expressing shRNAs targeting the NDV NA-1 Phosphoprotein (P) gene was designed.Virus titration,Real Time RT-PCR,CPE indicated that P-specific siRNA could inhibit virus replication at 36 h post-virus infection.In future studies,a combination of siRNAs targeting the NP and L gene may be used as a tool to study NDV replication and antiviral therapy.

Forensic toxicology is a specialized subject which forensic medical appraisers and students must learn and master. As a new teaching mode,problem based learning method is attrcting a lot of attention. Applying "case" based PBL teaching method is an important method to train innovative and high technical ability forensic talents.

Objective To evaluate the predictive value of ABCD2 scoring system in cerebral infarction and death events in the medium-term after transient ischemic attack (TIA) of Chinese population. Methods One hundred and seventy-nine patients with TIA having complete clinical data,admitted to our hospital from January 2008, were chosen in our perspective study. The ABCD2 scale was applied to all the patients and used to observe the 18-month cerebral infarction risk events; according to these data, patients after TIA were divided into cerebral infarction group and non-cerebral infarction group; To the end of 18 months, according to the death event, the patients were divided into survival group and death group. The age, level of blood pressure, clinical features, duration of symptoms and history of diabetes were collected and compared between each 2 groups; the cutofflevel of ABCI2 scale for anticipating cerebral infarction risk and mortality was evaluated according to receiver operating characteristic (ROC) curve. Results Among the studied 179 patients, 52 patients appeared cerebral infarctions within 18 months of TIA; patients in the cerebral infarction group had significantly higher percentage of patients with blood pressure ≥ 140/90 mm Hg (86.5％), unilateral weakness (42.3％),duration of symptoms ≥60 minutes (55.8％), or duration of symptoms 10 to 59 minutes (40.4％), and diabetes (80.8％) as compared with patients in the non-cerebral infarction group (P＜0.05). According to the ROC curve, area under curve was 0.874 of ABCD2 scale for anticipating cerebral infarction risk, 95％confidence interval (CI) was 0.817-0.931 and the cutoff level of ABCD2 scale for anticipating medium-term cerebral infarction risk was 4.5. Among the studied 179 patients, 35 patients died within 18months of TIA; no significant difference in the scores of ABCD2 scale was noted between survival group and death group (P＞0.05); according to ROC curve, area under curve was 0.492 of ABCD2 scale for anticipating mortality, and 95％ CI was 0.389-0.596. Conclusion ABCD2 scale has predictive value in cerebral infarction event, while not in death event in the medium-term of TIA.

Objective To investigate the role of HBO on the change of levels of ACA and thrombomodulin among parents with ischemic encephalopathy. Methods Patients were divided into three groups: group A (patients with atherosclerosis and thrombosis),group B (patients with cardiogenic embolism) and group C (patients with small artery lesion). All patients were treated with HBO and regular drugs. And then sss scores were recorded and levels of ACA-IgG and thrombomodulin were detected by ELISA before and after therapy of HBO. Results The index of ACA-IgG and lelvel of TM in A,B and C group were higher than those in control group,there are differences among them(P＜0.05),and the level of them were higher in B group than in A and C group.There were significant differences in SSS score for brain function using different therapies in A、B and C group (P＜0.05), but there are no differences among them(P＞0.05).There were differences in the index of ACA-IgG and thrombomodulin using different therapies in A,B and C group(P＜0.05),however,there were no differences among them (P＞0.05). Conclusion HBO can alleviate clinical symptoms and improve recovery of neuron by decreasing the level of ACA-IgG and thrombomodulin in blood,but the effect is not significantly different for ischemic encephalopathy caused by different factors.

This study aims to investigate the serotype distribution of non-polio enterovirus (NPEV) isolated from patients with acute flaccid paralysis (AFP) during 2011-2012 in Hebei Province, China and to analyze the relationship between these viruses and AFP. NPEV strains were isolated from the stool specimens from AFP cases in Hebei using human rhabdomyosarcoma cells (RD) and the mouse cell line expressing the gene for the human cellular receptor for poliovirus (L20B) according to the WHO requirements. The nucleotide sequence of VP1 region was determined, and the serotypes of NPEV were identified by molecular typing. The results showed that among the 82 strains of NPEV isolated from the AFP cases during 2011-2012, 42 isolates (55.3%) were identified as human enterovirus A (HEV-A), which were classified into 4 serotypes, 34 (44.7%) as human enterovirus B (HEV-B), which were classified into 13 serotypes, 2 as adenovirus, and 4 were untyped; human enteroviruses C and D were not found in these cases. Enterovirus A71 (EV-A71) was the main type of HEV-A, accounting for 85.7% of all HEV-A strains. HEV-A, especially EV-A71, was predominant among the NPEV strains isolated from AFP patients during 2011-2012 in Hebei Province.
Acute Disease ; China ; epidemiology ; Enterovirus ; classification ; physiology ; Humans ; Paralysis ; epidemiology ; virology ; Seasons ; Serotyping