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.

Considerable knowledge about the biology of forest tree has been gained in the recent years by the application of the new genomic technologies to study tree growth and development as well as the response of trees to biotic and abiotic stresses. Proteomics is becoming an important content in the biology of forest tree. A review is given about the progress in forest tree proteomics research in the areas of population genetics, genetic mapping, stress physiology, organs and tissues, and wood formation, etc. Furthermore, forest tree proteome database is briefly introduced. Finally, the prospect of proteomics is discussed.

Objective To provide the anatomical data for single-nostril transsphenoidal microsurgery for pituitary adenoma.Methods Microanatomic structures were observed and measured in 20 cadaveric a- dults heads.Results(1)The diaphragmal opering was 5 mm or greater broad in 90%.The mean thick- ness of the diaphragma sellae was (0.18?0.08)mm.(2) A sphenoid sinus with complete pneumatization was named as all-sellae type,its percentage in all specimens was 85%,85% sphenoid sinus had middle sep- tum of which only 18.8% located in the medial sagital section.(3)The meant thickness of the sellar floor was (0.81?0.34) mm,70% of which were not more than 1 mm.Of the sellar floors,that the shape was flatness reach 15%.(4) The relationship between ICA and sphenoid sinus had two aspects,one was to be mutually apart (55%),the other was to communicate (45%),which formers carinae on the lateral wall of the sphe- noid sinus,espeially in the superior surface of posterior part.The relationship between optic nerve and sphe- noid sinus,one was to be mutually apart (27.5%),the other was to communicate (72.5% ),which formers carinae on the lateral wall of the sphenoid sinus,especially in the superior surface of anterior part.(5) Three main types of the intercavernous sinus were the anterior intercavernous sinus,present in 80%,the inferior in- tercavenous sinus (25%),and the posterior intercavenous sinus (15%).Conclusion The knowledge of the anatomy of the sellar region and sphenoid sinus is helpful to safe operation in the single-nostril transsphe- noidal approach for pituitary,adenoma microsurgery.

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.

Animals ; Astragalus Plant ; chemistry ; Coxsackievirus Infections ; physiopathology ; Flavonoids ; pharmacology ; Mice ; Mice, Inbred BALB C ; Myocarditis ; physiopathology ; virology ; Myocytes, Cardiac ; drug effects ; virology

Objective To discuss the experience in the diagnosis, treatment, complications and follow up of carotid body tumor. Methods All the 25 cases were diagnosised by DSA and CTA. The tumor was resected under carotid adventitial plane in 18 cases, with external carotid artery resection in 4cases, and in 3 cases, internal carotid artery (ICA) and external carotid artery (ECA) were resected simultaneously in which internal carotid artery was reconstructed in two cases including using self vein bypass in one and anastomosis between ICA and ECA in the other. ICA was ligated in the third case. Results No cases died perioperatively. ALL CBTs were treated successfully. Horner syndrome and trachyphonia were relieved after operation. Postoperative trachyphonia, bucking and lingual paralysis developed in 3 cases, and in one case with vagus resection caused dyspnea tracheotomy was performed. The rate of nerves injuries was 12% but no semiplegia and aphasia occurred. Follow up period was from 4 to 90 months (average 44 ±6 months) for 21 cases. The trachyphonia and bucking were improved during follow up but the lingual paralysis persists, and tumor recurred in two cases with one dying. Conclusions CBT treatment should include active surgery, sufficient preoperative preparation and avoiding the postoperative nervous complications.

Objective To define the variables associated with preterm infants with patent ductus arteriosus (PDA) and identify the optimal timing for PDA closure clinically.Methods Three hundred and fifty-three premature babies with gestational age ＜ 32 weeks in Ba Yi Children's Hospital,Beijing Military General Hospital,from February 2011 to January 2013 were selected.Among them the PDA patients with degree of cardiovascular dysfunction using a scoring system (CVD) ≥3 scores at 48 hour life by using the cardiovascular dysfunction scoring systerm received primary drug treatment with 1-3 cycles Ibuprofen.If drug treatment failed or contraindicated,underwent surgical closure.Gestational age,body weight,presence of symptomatic hypotension,drug treatment or surgical closure were analyzed to see whether these factors were related to clinical outcomes,including hospital mortality,necrotizing enterocolitis (NEC),intraventricular hemorrhage(IVH),retinopathy(ROP) and bronchopulmonary dysplasia(BPD) at 36 weeks.Data were analyzed with Kruskal-Walls test,Wilcoxon signed rank test,Pearson x2 test,Fisher's exact test,Friedman,Halton,Logistic regression model.Results In the PDA patients with CVD≥3 scores persistently,the effectiveness of Ibuprofen was lower as time went on,PDA and BPD(OR =3.163,P =0.002),ROP(OR =2.557,P =0.007) were related markedly,and surgical treatment was possibly required.When CVD scores ≥ 3 after birth,drug treatment for one cycle was effective in 169 cases(47.8％),52 cases (14.7％) for two cycles,and 44 cases(12.5％) required surgical ligation after drug treatment failed.Such patients had younger gestational age [(29.4 ± 2.4) weeks vs (30.7 ± 1.4) weeks,P ＜ 0.000 1],and lower body weight at birth [(1 450 ± 577) g vs (1 750 ± 508) g,P =0.004).Conclusions The prolonged patency of the ductus arteriosus in preterm infants is related to an increase for IVH,BPD and ROP.Surgical ligation of PDA is a safe and effective treatment and should be done soon after two complete cycles of Ibuprofen,especially in selected patients who CVD ≥3 scores,to reduce the possibility of BPD and ROP occurence.

BACKGROUND: At present, the commercial artificial small vascular grafts (diameter < 6 mm) are still unsatisfactory, due to poor blocompatibility and low long-term patency rate. Therefore, finding a vascular substitute with normal biological function and studying construction and function of tissue-engineered blood vessel have become hot topics recently.OBJECTIVE: To construct a novel tissue-engineered blood vessel by rabbit bone marrow mesenchymal stem cells (MSCs) and vascular acellular matrix, and to investigate the biocompatibility and patency rate of tissue-engineered blood vessels.DESIGN, TIME AND SETTING: An in vitro randomized controlled study at level of cytology and histopathology was performed at the Laboratory of Affiliated Drum Tower Hospital of Nanjing University Medical School from January 2006 to June 2008.MATERIALS: The decellularized vascular acellular matrix was obtained by a detergent-enzymatic procedure. MSCs from rabbits were isolated using density gradient centrifugation method and cultured in culture flasks coated with fibronectin. Subsequently, the expanded MSCs were seeded on the decellularized scaffolds, and then co-cultured in the self-made bioreactor to construct the tissue-engineered blood vessels.METHODS: Sixty rabbits were randomly divided into three groups. A1.0-cm abdominal aorta was sheared, and a tissue-engineered blood vessel was transplanted on the abdominal aorta using 8/0 polypropylene thread. Tissue-engineered blood vessel group: Tissue-engineered blood vessel was considered as the transplanted vessel; vascular acellular matrix group:Xenoma artery treated by vascular acellular matrix was considered as the transplanted vessel; xenoma artery group: Fresh xenoma artery was considered as the transplanted vessel.MAIN OUTCOME MEASURES: Immunocytochemical staining was used to identify the cultured MSCs. After 3 months of transplantation, the grafts were retrieved for digital subtraction angiography, pathological test and scanning electron microscope examination.RESULTS: Rabbits MSCs presented a whirlpool-like appearance at 8 days after culture. The immunocytochemistry results were consistent with the phenotype of MSCs. After high proliferation, MSCs were seeded onto the vascular acellular matrix for 12 days,and seed cells attached to well in the lumen of blood vessels. Three months after implantation, the patency rate was 90% of tissue-engineered blood vessel group and 80% of vascular acellular matrix group, which was superior to xenoma artery group (25%). At three months after transplantation, HE staining and scanning electron microscope demonstrated that internal, middle,and external membrane were clearly observed in the tissue-engineered blood vessel group, and the membrane morphology was similar to normal artery. The endothelial cells were covered completely. However, the endothelial cells were not covered completely in the vascular acellular matrix group, while mural thrombosis, mild proliferation of intima, and inflammatory cell infiltration were observed. The intima was thick and necrotic in the xenoma artery group, while lumens were stenotic and accompanied with a certain degree of thrombus organization.CONCLUSION: This study provides a new strategy to develop a tissue-engineered blood vessel with excellent biocompatibility and high patency rate constructed by rabbit MSCs and vascular acellular matrix.

Objective To compare the outcome of adult-to-adult single kidney transplantation from donation after drain death and cardiac death. Methods The outcome of adult-to-adult single kidney transplantation from October 2012 to September 2015 in kidney transplantation center of Zhujiang Hospital was retrospectively analyzed. 53 recipients received donation from donors after brain death (DBD group) and 28 from cardiac death (DCD group). The deadline of follow-up is May 2016. Results During the period of observation, the mean follow-up was (17.26±10.85) months and patient's survival rate was 100%. When compared graft survival rate with the two groups, survival rate is 93.7% in DBD group and 92% in DCD group (χ2= 0.184,P = 0.668). There was no statistically significant difference (P > 0.05), the overall incidence of DGF was 28.4%. General DGF incidence is 28.4%, and DGF incidence between groups is χ2= 4.402,P = 0.036. Infection rate within 1 year is χ2= 4.507,P = 0.034, and the difference is significant (P < 0.05). There were no statistically significant difference (P > 0.05) in AR, eGFR of 1 month, proteinuria of 1 month after, transplantation and surgical complications. Conclusions Adult-to-adult single kidney transplantation from donation after cardiac death (DCD) has a higher rate of incidence of DGF, and the postoperative infection rate within 1 year. Renal transplantation from donation after cardiac death could have a good outcome.

AIM: To investigate the changes of the L-type calcium channel subunit expression and calcium currents (I_~Ca -L) in cultured rat ventricular myocytes infected by coxsackie virus B_3 (CVB_3). METHODS: Primary cultured neonatal rat ventricular myocytes were infected with CVB_3. The changes of L-type calcium channel subunits mRNA in normal and infected myocytes were measured by semi-quantitative reverse transcription-polymerase chain reaction. I_~Ca -L was recorded in two groups respectively using whole cell patch-clamp techniques. RESULTS: The expression of ?_1 and ? subunits of L-type calcium channel mRNA increased in the infected group compared with the normal one (4.00?0.07 vs 2.21?0.41, P0.05). The average current density of I_~Ca -L significantly increased by CVB_3 infection [(-8.66?0.99) pA/pF vs (-6.97?1.75) pA/pF, P