Objective To discuss some problems about current learning objectives for the speciality of clinical medicine in China,including the concepts,the decision-making systems and value-orientation,and to provide the reference for stipulating the learning objectives in future. Methods The objectives of some Chinese medical universities were collected from their websites.Some medical educators were consulted about their feelings about these learning objectives,and also were asked to identify their own objectives. Results Medical educators failed to distinguish their own objectives,and there were four main problems in current learning objectives: generalization,similarity and lack of individuality,difficulty in guide the curricula and teaching,and setting up too high object. Conclusion The learning objectives in clinical medicine should reflect both specialty characteristic and university individuality,so they should be drawn up by teachers,students and educatirnal administrators,moreover their value orientation should be eligible standard,not excellence.

Objective To investigate the clinical teaching situation by using developmental inspection of School of Medicine,Shanghai Jiaotong University(SJTU-SM),and to put forward some suggestions. Methods By checking questionnaires and informal discussions,the relevant information was collected and analyzed by using SPSS statistics sofware. Results The clinical teaching quality of SJTU-SM was basically satisfied.The satisfaction from internship of grade 2004 was better than that of grade 2003.However,some problems in clinical teaching must be improved.Conclusion The investigation showed that the clinical teaching quality of SJTU-SM is being improving.However,in order to achieve the international accreditation standards,the quality guarantee system of clinical teaching need to be further perfected.

Direct spray mass spectrometry was used to simply and rapidly differentiate Mutong of Aristolochiaceae from other two kinds of Mutong medicinal materials (Lardizabalaceae and Ranunculacea) by analyzing the chemical profile of Mutong of Aristolochiaceae.A novel method for determination of magnoflorine content in Mutong of Aristolochiaceae was established.The results showed that Mutong of Aristolochiaceae could be identified according to the symbolic component, magnoflorine.Under positive ion mode, semi-quantitative result based on the signal strength ratio of magnoflorine and nuciferin was obtained by choosing nuciferin as an internal standard.The method showed good linear coefficient in the concentration range of 0.50-20.00 mg/L of magnoflorine.The limit of detection was 0.1 mg/L.The method was simple and fast, and could be used for direct and rapid in-situ analysis and identification of Mutong of Aristolochiaceae from other closely related Mutong herbal species without sample pre-treatment.The results were important for the quality control of Mutong herbal medicine.

Objective To observe Meissner's corpuscles in prepuces of different shapes and ages. Methods The Meissner's corpuscles were detected with immunohistochemical stain in 204 prepuce sam- ples of different shapes and ages (3-59 years),and the density of Meissner's corpuscles in every sample was obtained as well.The difference of Meissner's corpuscle densities between phimosis and redundant pre- puce,and correlation between Meissner's corpuscle densities and ages were analyzed with Chi-square test and linear regression,respectively.Results The density of Meissner's corpuscles in redundant prepuce has begun to increase since infancy and reached the peak at the age about 15 years.No significant difference in densities of Meissner's corpuscles between phimosis and redundant prepuce was observed till the age of 20 years,and then there was a trend of disappearance of Meissner's corpuscles in redundant prepuce.A signifi- cantly negative correlation between the densities of Meissner's corpuscles and ages was revealed in redundant prepuce (r=-0.236,P=0.009),whereas an insignificantly positive correlation between the densities of Meissner's corpuscles and ages was shown in phimosis (r=0.193,P=0.084).Conclusions The den- sities of Meissner's corpuscles in redundant prepuce develop synchronically with genital differentiation and accord with the status of sexual function in adult males.The persistent high level of Meissner's corpuscles in adult phimosis might be a mechanism of physiological compensation.

Objective To observe the implementation of national food safety standard for “Iodine Concentration in Edible Salt”(GB 26878-2011) and its effectiveness on iodine nutritional status of key populations. Methods Information of iodine concentration in edible iodized salt of various provinces (autonomous regions and municipalities, including Xinjiang Production and Construction Corps) was collected using Baidu Searching Engine through the establishment of key words. Sal t samples were collected in Tianjin City and Aksu Region of Xinjiang , and the salt iodine concentration in both places was 30 mg/kg. In Tianjin, Hongqiao, Tanggu and Hangu, Beichen were selected as representatives of the downtown areas, the coastal areas and the suburbs, respectively and counties of Baodi and Ji were iodine deficiency areas in history. Sampling work was carried out from August 2012 to March 2013 in Tianjin. In Aksu, Yatuoer Township and Charqi Town in Baicheng County, Aotebeixi and Aketuohai Townships in Wushen County were chosen as iodine deficiency areas, and the survey was carried out from January to September 2013 . Random urine samples of school-age children ( 8 - 10 years old ) , pregnant women and lactating women were collected; urinary iodine was measured following the Method for Determination of Iodine in Urine by As3+-Ce4+ Catalytic Spectrophotometry(WS/T 107-2006) and iodine in edible iodized salt was measured following the General Test Method in Salt Industry Determination of Iodideion ( GB/T 13025 . 7-1999 ) . Results Fourteen of the provinces(autonomous regions and municipalities, including the Corps of Xinjiang) chose 25 mg/kg as their iodine concentration in edible iodized salt and 13 provinces chose 30 mg/kg. Besides, there were another 5 provinces providing 30 mg/kg particularly for pregnant women and lactating women while 25 mg/kg for other populations. In Tianjin, the medians of iodine concentration in edible iodized salt were ranged from 24.4 - 32.1 mg/kg in retail stores and 26.4 mg/kg at households. The household coverage rate of iodized salt and the proportion of households using adequately iodized salt were 78.5%(168/214) and 62.6%(134/214), respectively. The median ranges of urinary iodine were 178.2 - 183.9 μg/L in school children, 124.3 - 130.9 μg/L in pregnant women and 72.7 - 109.5 μg/L in lactating women. In Aksu, the medians of iodine concentration in edible iodized salt were 27.1 and 26.5 mg/kg in retail stores and households, respectively. The household coverage rate of iodized salt and the proportion of households using adequately iodized salt were 100.0% (363/363) and 98.9%(359/363), respectively. The median ranges of urinary iodine were 174.8 - 293.0, 154.9 - 230.0 and 135.8 - 239.3 μg/L among school children, pregnant women and lactating women, respectively. The median of iodine concentration in a special edible iodized salt sample reached 49.1 mg/kg, and qualified rate was 0(0/11) in Aksu. Conclusions All provinces , municipalities and autonomous regions ( including the Corps of Xingjiang ) in China have adjusted the iodine content in edible iodized salt in accordance with GB 26878-2011. However, in Tianjin the household iodine concentration in edible salt is lower than the local standards; the household coverage rate of iodized salt and the proportion of households using adequately iodized salt are lower than the national standards; pregnant women and lactating women are at risk of mild iodine deficiency.

OBJECTIVETo observe the improvement in post-stroke dysphagia after treatment of nape acupuncture and rehabilitation training.

METHODSEighty patients who were in compliance with the inclusive criteria were randomized into a conventional treatment group and a nape acupuncture group, 40 cases in each one, according to the admission sequence. In the conventional treatment group, on the basis of general medication, the rehabilitation training of swallowing function was applied. In the nape acupuncture group, on the basic treatment as the conventional treatment group, nape acupuncture group was given.

RESULTSAfter treatment, the improvements in bedside water swallowing test, SSA, VFSS and pharynx transit time were all superior to those before treatment for the patients in the two groups (all P < 0.05). The improvements in bedside water swallowing test, SSA, VFSS and pharynx transit time in the nape acupuncture group were all superior to those in the conventional treatment group (all P < 0.05). The total effective rate was 85.0% (34/40) in the nape acupuncture group, which was higher than 65.0% (26/40) in the conventional treatment group, indicating the significantly statistical difference between the two groups (P < 0.05).

CONCLUSIONNape acupuncture combined with rehabilitation training significantly improves swallowing function of the patients after stroke.

Acupuncture Therapy ; Adult ; Aged ; Deglutition Disorders ; etiology ; rehabilitation ; therapy ; Female ; Humans ; Male ; Middle Aged ; Stroke ; complications

OBJECTIVETo retrospectively analyze and evaluate the results of treatment for atlantoaxial instability or dislocation employing pedicle screws of atlas and axis.

METHODSThirty-one patients (23 male and 8 female) with atlantoaxial instability or dislocation were stabilized using pedicle screws of atlas and axis between May 2005 to January 2008. The patients ranged in age from 17 to 67 years (mean 43.5 years). Patients consisted of chronic odontoid fracture in 17, Os odontoideum in 8, fresh odontoid fracture in 4, transverse ligament rupture in 1, rheumatoid arthritis in 1. Clinical features included neck pain in 31; restricted neck movement in 28, varying degrees of spastic quadriparesis in 19. All patients underwent posterior C(1) to C(2) pedicle screw fixation. Operative time, intraoperative blood loss, complications were recorded, neurological and radiographic studies were carried.

RESULTSMean follow-up time was 13 months. Operative time averaged 2.5 h. Mean intraoperative blood loss was 300 ml. A patient had postoperative wound infection and was treated conservatively with antibiotics and local wound care. A patient developed pulmonary artery embolism and got well with anticoagulation. Satisfactory stability was achieved in all cases with no vascular and C(2) neuralgia. Average JOA score in 19 cases increased at final follow-up (P < 0.01). Solid fusion was achieved in 29 cases, fusion rate was 93.6%.

CONCLUSIONSStabilization of atlantoaxial complex via pedicle screws of atlas and axis has advantages of intraoperative restoration, easier placement of screw, solid fixation. It is a safe and effective treatment modality for posterior C(1-2) fusion.

Adolescent ; Adult ; Aged ; Atlanto-Axial Joint ; Bone Screws ; Female ; Follow-Up Studies ; Humans ; Joint Dislocations ; surgery ; Joint Instability ; surgery ; Male ; Middle Aged ; Retrospective Studies ; Spinal Fusion ; methods ; Treatment Outcome ; Young Adult

OBJECTIVETo investigate the effect of tumor necrosis factor alpha (TNFalpha) on radiosensitivity of nasopharyngeal carcinoma (NPC) in relation to TNFalpha-induced cell cycle synchronization.

METHODSThe radio-resistance of a NPC cell line subclone CNE-2Z-S1 was verified by in vivo experiments and flow cytometry was performed to evaluate cell cycle synchronization in TNFalpha-treated CNE-2Z-S1 cells. The radiosensitivity of the cell synchronized CNE-2Z-S1 cells was determined by clone formation in vitro and in vivo experiment in nude mice.

RESULTSTNFalpha was capable of inducing cell cycle arrest and synchronization of CNE-2Z-S1 cells. Pretreatment with TNFalpha remarkably enhanced the radiosensitivity of CNE-2Z-S1 in vitro, and in vivo experiments with nude mice also suggested the role of TNFalpha in enhancing the radiosensitivity of NPC.

CONCLUSIONTNFalpha can enhance the radiosensitivity of NPC cells by inducing cell cycle synchronization.

Animals ; Cell Cycle ; drug effects ; radiation effects ; Cell Line, Tumor ; Humans ; Mice ; Mice, Nude ; Nasopharyngeal Neoplasms ; drug therapy ; pathology ; radiotherapy ; Radiation-Sensitizing Agents ; pharmacology ; Tumor Necrosis Factor-alpha ; pharmacology ; Xenograft Model Antitumor Assays

OBJECTIVETo study the outcome of laminoforaminotomy with posterolateral discectomy for patients with lateral disc herniation at C(7)-T(1).

METHODSFrom August 2000 to August 2008, 12 patients with lateral disc herniation at C(7)-T(1) underwent posterolateral discectomy were analyzed retrospectively. Neurologic function were evaluated with the Motor Scoring System. Preoperative motor were compared with postoperative one. The unique clinical manifestation, imageology features and intraoperative findings were analyzed.

RESULTSAll these twelve patients were lateral type. All the patients showed hand intrinsic muscles atrophy and hand weakness. Nine patients had no paraesthesia. The average follow-up period was 26 months. Postoperative scores were significantly higher than preoperative ones.

CONCLUSIONSDisc herniation at C(7)-T(1) is predominantly lateral type and present C(8) nerve motor deficit (hand intrinsic muscles atrophy and hand weakness) and only minority has paraesthesia in C(8) nerve dermatome. Posterolateral cervical discectomy technique is safe and effective for patients with lateral disc herniation at C(7)-T(1).

Adult ; Cervical Vertebrae ; Female ; Follow-Up Studies ; Humans ; Intervertebral Disc Displacement ; diagnosis ; surgery ; Male ; Middle Aged ; Retrospective Studies ; Thoracic Vertebrae ; Treatment Outcome

UNLABELLEDOBJECTIVE To compare the differences in the scores of blood stasis syndrome (BSS) in three subtypes of acute ischemic stroke (AIS) based on modified Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria, and to explore the influencing factors of BSS.

METHODSPatients with AIS were classified by modified TOAST criteria. The BSS score was determined in 418 patients of atherosclerosis thrombosis (AT), cardioembolism (CE), and small artery disease (SAD) subtypes. The BSS scores were compared in the three subtypes. Univariate analysis and multivariable Logistic analysis were carried out to analyze the influencing factors of BSS.

RESULTSAs for the BSS score, CE (120.08 +/- 14.91) > AT (79.56 +/- 11.43) > SAD (37.88 +/- 8.32), and there was statistical difference among different subtypes (P < 0.01). Univariate analysis indicated that age, heart disease, carotid stenosis, NIHSS, GCS, and multiple infarction positions had significant effects on BSS. Multiple Logistic regression analysis suggested that age (OR: 1.71, 95% CII: 1.13-2.74, P = 0.034), heart disease (OR: 2.05,95% CI: 1.52-4.15, P = 0.000), carotid stenosis (OR: 2.74, 95% CI: 1.65-4.55, P = 0.007), and multiple infarction positions (OR: 3.46, 95% CI: 2.16-6.62, P = 0.005) were independent influencing factors of BSS.

CONCLUSIONSDifferent TOAST subtypes of BSS had different BSS scores, which was helpful to indicate the reasons for BSS. Age, heart disease, carotid stenosis, and multiple infarction positions were independent influencing factors of BSS.

Adult ; Aged ; Aged, 80 and over ; Brain Ischemia ; classification ; Female ; Humans ; Logistic Models ; Male ; Medicine, Chinese Traditional ; methods ; Middle Aged ; Multivariate Analysis ; Stroke ; classification