Objective To investigate the score changes of graduates majoring in clinical medicine after using the method of “role of identification”. Methods Sixty students who were undertaking internship in Endocrinology Department of Shanghai Traditional Chinese Medicine Hospital received three-week clinical teaching and examination. Then they got into one-week “role of identification”, and were appointed as clinical teachers to teach what they have learned during the last 3 weeks to the next batch of interns and make another examination. Scores of the two examinations were compared. Results Scores of the examination after received the method in“role of identification”improved significantly (P<0.01). Conclusion The method of“role of identification”can enhance clinical medicine graduates’ mastery of professional knowledge.

Objective To evaluate the impact of different ages, different gender, with or without exercise and different fracture sites on the nutritional status using mini nutritional assessment (MNA-SF) in hospitalized elderly fracture patients. Methods A total of 1 353 hospitalized elderly patients with fracture were included. The MNA-SF investigations were completed within 3 days after admission. The diet, body weight, physical activity, psychological trauma or stress, psychological problems, body mass index (BMI), calf circumference (CC), history of aerobic exercise and the fracture sites were recorded three days after admission. The nutritional status were evaluated including normal nutrition, risk of malnutrition and malnutritional status. The relationships of nutritional status were analyzed between different ages, different gender, with or without exercise, different fracture sites. Results There were significant differences in the incidence of normal nutrition, risk of malnutrition malnutrition and non-normal nutritional status between different ages, different gender, with or without exercise, femoral intertrochanteric fracture and upper limb fracture. There were also significant differences in the incidence of normal nutrition, risk of malnutrition and malnutrition between femoral neck fracture and upper limb fracture. Conclusion There is a higher incidence of non-normal nutritional status in patients older than 80 years, female, with no regular exercise and with femoral intertrochanteric fracture.

Acupuncture Therapy ; Aged ; Aged, 80 and over ; Bulbar Palsy, Progressive ; etiology ; therapy ; Female ; Humans ; Male ; Middle Aged ; Stroke ; complications

OBJECTIVE: To discuss the clinical characteristics of bilateral bronchial foreign body in children, increase the curative rate and reduce the complications. METHOD: The clinical data of 35 cases with bilateral bronchial foreign body in children were retrospectively analysed, including surgery, key surgery points, and postoperative combined therapy. RESULT: The foreign bodies of all cases were removed under intravenous general and tropical anesthesia without complications. CONCLUSION The bilateral bronchial foreign body is a serious case, the timely and effective treatment can lower the mortality rate and postoperative complications. The children lack of oxygen for a long time before and in operation should be give comprehensive therapy, for example: sedation and hyperbaric oxygen.
Anesthesia ; Bronchi ; pathology ; Bronchoscopy ; Child ; Foreign Bodies ; diagnosis ; surgery ; Humans ; Oxygen ; Postoperative Period ; Retrospective Studies ; Treatment Outcome

Objective To evaluate the effects of ischemic time factors on reduction of myocardial ischemia-reperfusion injury by sulfentanil postconditioning in rats .Methods Healthy adult male Sprague-Dawley rats ,weighing 230-250 g ,were heparinized and anesthetized with intraperitoneal 5% chloral hydrate 8 ml/kg .The hearts were excised and perfused in a Langendorff apparatus with K-H solution .After 30 min of stabilization ,48 isolated rat hearts were randomly assigned into 6 groups (n=8 each) using a random number table .In I/R1-3 groups ,the hearts were subjected to 30 ,45 ,and 60 min of myocardial ischemia ,respectively ,followed by 90 min of reperfusion . In SP1-3 groups , the hearts were subjected to 30 , 45 , and 60 min of myocardial ischemia , respectively ,followed by 90 min of reperfusion ,and sulfentanil 100 nmol/L was added to K-H solution at 15 min of reperfusion for postconditioning . Left ventricular end-diastolic pressure (LVEDP ) , left ventricular developed pressure (LVDP) ,+dp/dtmax ,-dp/dtmax ,HR and coronary flow (CF) were measured at the end of equilibration and 15 ,30 ,60 and 90 min of reperfusion .Creatine kinase (CK) and lactate dehydrogenase (LDH) activities in coronary effluent were measured at 5 min of reperfusion .Myocardial infarct size was determined in 5 hearts chosen randomly at 90 min of reperfusion .Results LVEDP was significantly higher ,and LVDP , ± dp/dtmax and CF were lower at each time point of reperfusion than at the end of equilibration in I/R1-3 groups ( P<0.05) .Compared with I/R1 and I/R2 groups ,LVEDP was significantly increased ,and LVDP and ± dp/dtmax were decreased at 30 ,60 and 90 min of reperfusion ,HR and CF were decreased ,and CK and LDH activities in coronary effluent and infarct size were increased at 15 and 30 min of reperfusion in group I/R3 ,and LVEDP was significantly decreased ,LVDP , ± dp/dtmax and CF were increased ,CK and LDH activities in coronary effluent and infarct size were decreased at 30 , 60 and 90 min of reperfusion in groups SP1 and SP2 ( P< 0.05 ) . Compared with group I/R3 , LVDP was significantly decreased at 30 ,60 and 90 min of reperfusion ( P<0.05) ,and no significant change was found in CK and LDH activities in coronary effluent and infarct size in group SP3 ( P>0.05 ) .Conclusion Sulfentanil postconditioning can attenuate myocardial ischemia-reperfusion injury when the rats are subjected to 30 or 45 min of ischemia ,however ,it provides no myocardial protection when the rats are subjected to 60 min of ischemia .

The treatment of triple-negative breast cancer with highly malignant tumors is limited by the formation of drug-resistant clones of cancer cells and the severe toxicity of conventional chemother- A peutic drugs to normal tissue. Recent studies have shown that in the comprehensive targeted therapy of triple-negative breast cancer not only nano-drug delivery systems, with their unique physical and chemical properties of nanomaterials, can load chemotherapeutic drugs, active gene fragments and immunopotentiator, but also attenuate the effects of chemotherapeutic drugs, inhibit gene proliferation and stimulate the immune system by means of photothermal ablation. So that cancer cells are inhibited and killed. The nano-delivery system has changed the pharmacokinetic characteristics of conventional chemotherapeutic drugs and significantly reduced adverse drug reactions. This article reviews the progress in nano-delivery systems in the comprehensive targeted therapy of triple-negative breast cancer.

BACKGROUND:Osteoporosis caused by diabetes melitus as common secondary osteoporosis has been paid more and more attention recently. Zoledronic acid serves as a novel drug for osteoporosis, and its effect on osteoblasts in vivo remains unclear. OBJECTIVE:To investigate the changes of the expression of bone morphogenetic protein 2 andNoggin in the femur of type 1 diabetes melitus rats and the effect of zoledronic acid on them. METHODS:Models of type 1 diabetes melitus were established by intraperitoneal injection of streptozotocin in 130 Wistar rats. 3 days later, rats with blood sugar > 16.7 mmol/L for three consecutive times were considered as successful models, 120 in total. These models were randomly divided into model, prevention and treatment groups. Rats in the prevention and treatment groups were intravenously administered zoledronic acid (0.1 mg/kg) on the day of modeling and 2 weeks after model establishment. An additional 40 rats were injected with citrate buffer solution as control group. RESULTS AND CONCLUSION: Compared with the control group, femur bone mineral density, serum alkaline phosphatase levels, and femur bone morphogenetic protein 2 mRNA expression levels were significantly lower in the model group (P < 0.05), butNoggin mRNA expression significantly increased (P < 0.05). Compared with the model group, bone mineral density and bone morphogenetic protein 2 mRNA expression levels were significantly higher in the prevention and treatment groups (P < 0.05), butNoggin mRNA expression significantly lower (P < 0.05), and serum alkaline phosphatase levels gradualy restored. These results indicated that the bone metabolic disturbance occurs in early stage in rats with type 1 diabetes melitus. Zoledronic acid can promote bone formation, increase bone density, and improve bone metabolism.

Objective Cardiovascular diseases comorbid with mental disturbances are described as psycho-cardiology diseases, which have been paid attention increasingly. The aim of this study is to summarize and analyze the findings about the study of psycho-cardiology over a year , and to obtain the baseline data of psycho-ca rdiology diseases in inpatients of cardiology department. Methods Subjects in this study were inpatients of cardiology department in the First Affiliated Hospital of Kunming Medical University in the past 21 months. The demographic and clinical data of the inpatients were collected. Anxiety and depression were evaluated by the Hospital Anxiety and Depression Scale. The prevalence of anxiety and depression in patients with various cardiovascular diseases were calculated respectively. To detect the potential risk factors of anxiety or depression, two logistic regression models were established. Results The prevalence of anxiety, depression, anxiety and/or depression, and anxiety comorbid with depression was 38.6%, 12.4%, 51.0%, and 7.9%,respectively. The prevalence of depression in patients with chronic heart failure was 24.6%, which was higher than the general level and that of patients with other cardiovascular diseases. The prevalence of anxiety in patients with acute myocardial infarction, arrhythmia, and hypertension ranged from 39.6% to 41.7%. The long course of diseases, multiple diseases, and the history of cardiac interventional operation were the common risk factors for anxiety and depression. Conclusion Anxiety and depression are common in patients with cardiovascular diseases. Cardiologists should take mental disturbances seriously, and pay more attention to the patients with above risk factors.

Objective To discuss the electrocardiogram(EKG)positioning method to the guiding role of determining the pipe length and the accuracy of operative localization in central venous catheterization procedure. Methods Chose 32 cases of tumor patients who had center venipunture.Use the catheter taken EKG data when cath-etering,and then given validation using postoperative chest X -ray or fluoroscopy.Judgment the sensitivity,specificity and disposable catheters success rate of the EKG positioning method.Results In the 32 cases of cancer patients, 30 patients had characteristic P waves,when the chest X -ray confirmed the superior vena cava or the junction with the right atrium,one case into the right atrium,when one case of non -P -wave in the subclavian after intravenous discounts tune into the tube after it confirmed the superior vena cava.Conclusion EKG positioning method with high accuracy in the deep venous catheter in the catheter tip positioning applications.The clinical applications are feasible.

Objective To investigate the amlodipine or hydrochlorothiazide and valsartan combination thera-py in elderly hypertensive patients with blood pressure variability ( BPV ) and nitric oxide ( NO ) , endothelin role. Methods 552 elderly patients with hypertension were divided into the observation group and control group,276 cases in each group,the observation group was given amlodipine valsartan for treatment,while the control group was received hydrochlorothiazide combined with valsartan for treatment,the two group were treated for three months,the content of BPV,NO and plasma endothelin were analyzed.Results After treatment,the 24hSBPV,day SBPV,24hDBPV,day DBPV of the observation group significantly decreased compared with pre-treatment, the difference was statistically significant(t=20.09,15.97,9.31,9.41,all P<0.05),patients in the control group only 24hSBPV and day SBPV [(9.12 ±2.57)%,(8.43 ±1.97)%]were significantly lower than before treatment(t=12.31,9.53,all P<0.05);The day SBPV,24hDBPV,day DBPV[(7.21 ±1.34)%,(12.31 ±2.54)%,(10.59 ±2.73)%]of the ob-servation group after treatment were significantly lower than those of the control group(t=10.52,12.34,8.35,all P<0.05);The NO[ (66.12 ±23.57)%,(68.29 ±21.52)%]and endothelin levels[(34.43 ±7.97)%,(34.21 ± 7.34)%]of the two groups after treatment were significantly lower than those of before treatment(tobservation grou P=31.39,11.79,tcontrol grouP=28.31,9.35,all P<0.05).Conclusion The amlodipine or valsartan hydrochlo-rothiazide used clinically can effectively control blood pressure, significantly increase NO levels, decrease plasma endothelin levels,which is worth to be used in the clinical.