The formative assessment system has been applied to the internship education for the clinical anesthesia with the aim to improve students' initiative and to evaluate their outcomes more compre-hensively. The students' performance in the shift exchange, case discussion, raising question, solving question at the time points of after the preclinical train, one month and 3 months into the anesthesia internship, and after the completion of internship, and their capability in preoperative patient assessment, condition report, clinical practice, review writing have been evaluated to determine the educational quality and to instruct the improvement of educational approach. Assess process takes into account both the individuality and the gen-eral character of the students and feedbacks the evaluation result to improve the practice teaching The im-plementation of the evaluation can promote students' autonomous learning and comprehensively evaluate students' practice process.

BACKGROUND: Cancer stem cells have bean a hot topic in life science research. EpCAMhigh/CD44+ colorectal cancer stem cells are beneficial to observe morphological characteristics and distribution of cancer stem cells.OBJECTIVE: To investigate the quantity, location, distribution and hematoxylin-easin staining morphologic features of colorectal cancer stem cells (Co-CSCs).DESIGN, "rIME AND SETrlNG: The observational study was performed at the Department of Pathology, Lanzhou General Hospital of Lanzhou Military Area Command of Chinese PLA from March to August 2008.MATERIALS: A total of 67 colorectal cancer paraffin embedding samples were collected from 200512007 archive at the Department of Pathology, Lanzhou General Hospital of Lanzhou Military Area Command of Chinese PLA, comprising 27 males and 40 females, aged 29 90 years.METHODS: EpCAM and CD44 was used to label cancer stem cells in paraffin embedding colorectal cancer samples. The locations of EpCAM and CD44 double positive cells were detected by SP(streptavidin HRP) immunohistochemical staining and double immunohistochemical staining. The morphologic features of them were investigated on hematoxylin-easin staining at the same position.MAIN OUTCOME MEASURES: Number, location, distribution of EpCAM and CD44-posltive cells, and morphology following hematoxylin-eosin staining.RESULTS: The number of double-positive cells accounted for 0.1% to 30.0% of all tumor cells, and the cells were scattered or distributed focally along the basement of glandular-like structure. The cells with scarcely cytoplasm were cube or oval, and its nucleus was oval or high cylindrical, deep stained and homogeneous; The quantity of double-positive cells were negatively correlated with the differentiation of colorectal cancer.CONCLUSION: Cancer stem cells are the causes of tumor development, metastasis and recurrence and drug resistance. To observe the number, location, distribution and morphology of Co-CSCs and to analyze the relationship between Co-CSCs and pathological parameters will provide guidance for the diagnosis, staging, prognostic evaluation and clinical prognosis of cotorectal carcinoma.

Objective To discuss the value of digital tomosynthesis for detection of pulmonary nodules. Methods Thirty patients suspected of having pulmonary nodules underwent chest radiography, digital tomosynthesis and CT examination. Above image data were transferred to postprocessing work station and were reviewed by 2 radiologists with 3 years of chest-radiology diagnosis experience in a double-blind method. The number, location and size of nodules were recorded. Then, 2 radiologists reviewed the all images once more, and discuss in consensus. The sensitivities of chest radiography and digital tomosynthesis for detection of pulmonary nodules were respectively calculated according to the CT results. Chi-square test was used for radiography, digital tomosynthesis and CT examination. Results Of 30 patients, 21 were detected having pulmonary nodules by X-ray radiography and 9 were negative, the total number of 40 nodules was detected, while 89 nodules in 26 patients were detected by digital tomosynthesis, and only 4 patients were negative. CT demonstrated 102 nodules in 27 patients, and 3 patients were negative. Taking CT as "gold standard", the sensitivities of X-ray radiography and digital tomosynthesis were 27.4%(28/102)and 87.2%(89/102), X~2=4.35, P<0.05, respectively. Conclusion Digital tomosynthesis has a high sensitivity for detection of pulmonary nodules compared with X-ray radiography, and could be an excellent and necessary supplementary technique of X-ray radiography.

Objective To explore the more effective measures for the prevention of deep vein thrombosis (DVT ) by comparing the different efficacy between the multimodal strategy and liberal measures .Methods From July 2011 to June 2013 ,medical records of 289 patients who had accepted total knee replacement (TKR) were collected .Patients were divided into two groups according to whether exploring to the multimodal strategy or liberal measures after TKR .The multimodal strategy consisted of sequentially used perioperative intermittent pneumatic compression ,intermittent pneumatic compression ,and postoperative continues femoral nerve block analgesia .Patients in group A were treated during July 2011 to June 2012 ,and accepted liberal measures for the prevention of DVT .Patients in group B were treated after June 2012 ,and accepted multimodal strategy .The data of each group were collected for statistical analysis on the following aspects :DVT occurrence rate ,DVT distribution ,age ,gender ,body mass index ,disease ,operation duration ,volume of blood loss and transfusion during operation phase ,drainage volume after TKR .Results The DVT occurrence rate of patients in group B were significantly lower than that of patients in group A (P<0 .05) .No significant difference were foun-ded in the DVT distribution between the two groups(P>0 .05) .Conclusion The multimodal strategy consisted of sequentially used perioperative intermittent pneumatic compression ,postoperative low molecular weight heparin ,and postoperative continues femoral nerve block analgesia is more effective than liberal measures for the prevention of DVT .

Objective To study the mechanism of oxidative stress involved in the pathogenesis and relapse of acute monocytic leukemia (M5 ).Methods We detected reactive oxide species (ROS)levels,conducted plasma analysis obtained from 76 M5 patients at diagnosis and at relapse,and observed the ultrastructure of mitochondria of mononuclear cells in peripheral blood by transmission electron microscope.Results Compared with that in the control group,the average fluorescence intensity of intracellular ROS was significantly increased in M5 groups, especially in the relapse patients (P < 0.05 ).Low total antioxidative capacity (T-AOC)and antioxidant enzyme activity were characteristic of M5 at both diagnosis and relapse. However, lactate dehydrogenase (LDH ), malondialdehyde (MDA)and 8-hydroxy-2’-deoxyguanine (8-OHdG)increased significantly at both diagnosis and relapse (P < 0.05 ).Prominent ultrastructural abnormalities (mitochondrial swelling,outer membrane blebs,and aberrant cristae disorder)were present in patients with primary M5,and they were obviously abnormal in relapsing M5 patients.Conclusion Oxidative stress is the initiating factor of M5.Mitochondria are the main intracellular location for ROS generation.To maintain the dynamic balance between ROS and antioxidant defence may be the critical factor for preventing relapse.

Objective To evaluate the effect of ultrasound-guided arterial catheterization in internships of anesthesiology.Methods Sixty students were randomly divided into ultrasound-guided teaching group(n=30,3 male) and traditional teaching group (n=30,4 male).In the two groups,the ultrasound-guided arterial catheterization technology and artery catheterization technique were adopted respectively for teaching.The success rate of arterial catheterization was compared between the two groups after 2 months internships and when finishing internships of anesthesiology.The questionnaire was investigated in ultrasoundguided teaching group after finished internships of anesthesiology.Results The success rate of arterial catheterization in ultrasound-guided teaching group was extremely higher than in traditional teaching group after 2 months internships of anesthesiology (52 ± 8)％ vs.(38 ± 10)％,(x2=7.746,P=0.005).After finishing internships of anesthesiology,the success rate of arterial catheteri-zation was (67±7)％ in ultrasound-guided teaching group and (59 ± 9)％ in traditional teaching group (x2=5.531,P=0.036).And all students thought ultrasound-guided arterial catheters teaching was helpful to them and could improve their learning interest.Conclusion Ultrasound-guided arterial catheterization is beneficial to the internship teaching of undergraduate of anesthesiology,which can help them to master the arterial catheterization technique better,and improve the success rate of arterial catheterization and their learning interest.

Objective To observe the effects of Tongluo-Jiedu-Huazhuo decoction on hemorheological indexes and gastric juice components in patients with chronic atrophic gastritis.Methods According to the inclusion criteria,84 patients with chronic atrophic gastritis were randomly divided into the observation group and the control group,with 42 cases in each group.The control group received the routine clinical treatment,and the observation group was treated with Tongluo-Jiedu-Huazhuo decoction on the basis of the control group.The clinical symptoms were scored before and after treatment.The blood viscosity,plasma viscosity,hematocrit,fibrinogen and erythrocyte aggregation index were measured bY automatic hemorheology instrument,and gastric juice pH,free acid,pepsin and nitrite levels were measured by serial gastric juice detection method.The clinical efficacy was evaluted.Results The total effective rate of the observation group was 90.5％ (38/42),and the total effective rate of the control group was 76.2％ (32/42),with statistically significant difference (Z=-2.683,P＜0.05).After treatment,the scores of epigastric pain,stomach swelling,nausea and vomiting,acid reflux and dietary deficiency in the observation group were significantly lower than those in the control group (t were 4.865,4.632,4.716,4.582,4.433,respectively,all Ps＜0.05),and the whole blood viscosity,plasma viscosity,hematocrit,fibrinogen and erythrocyte aggregation index were significantly lower than those in the control group (t were 5.044,4.462,5.274,4.231 and 4.485,respectively,all Ps＜0.05).The gastric juice pH (2.28 ± 0.33 vs.2.75 ± 0.38,t=4.825),nitrite (33.27 ± 4.45 mg/L vs.38.80 ± 4.93 mg/L,t=5.136) in the observation group were significantly lower than the control group (P＜0.05).The free acid (22.13 ± 3.36 mmol/L vs.18.65 ± 2.54 mmol/L,t=5.382),pepsin (144.56 ± 15.86 U vs.137.16 ± 14.63 U,t=5.736) in the observation group were significantly higher than the control group (P＜0.05).Conclusions The application of Tongluo-Jiedu-Huazhuo decoction in patients with chronic atrophic gastritis can improve the hemorrheology index and regulate the function of gastric secretion,which is helpful to protect the gastric mucosa and relieve the clinical symptoms.

Objective To explore the effects of acupoint application combined with modified Xiaoqinglong decoction on airway remodeling and serum C-reactive protein (CRP), interleukin-8 (IL-8) and eosinophil chemotactic factor (eotaxin) levels in patients with bronchial asthma. Methods A total of 78 patients with bronchial asthma were randomly divided into two groups, 39 cases each group. The control group was treated with conventional western medicine therapy, and the study group was treated with acupoints plus Xiaoqinglong decoction on the basis of the control group.The treatment effect,adverse reaction were observed, and airway remodeling associated indicators like Transforming growth factor-β1 (TGF-β1), vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), and serum CRP, IL-8, Eotaxin levels were detected as well. Results After treatment, the clinical asthma control rate was 87.18% (34/39) in the study group and 58.97% (23/39) in the control group, and the difference was statistically significant (χ2=7.885,P<0.05).After treatment,the TGF-β1(6.74 ± 2.21 μmol/L vs.10.90 ± 2.24 μmol/L,t=8.256),VEGF(27.63 ± 5.14 ng/ml vs.35.76 ± 5.82 ng/ml,t=6.539),bFGF(7.15 ± 1.54 μmol/L vs.12.62 ± 2.23μmol/L,t=12.605)in the study group were significantly lower than those of the control group (P<0.05). After treatment, the CRP (9.16 ± 1.85 mg/L vs.16.74 ± 2.20 mg/L,t=16.468),IL-8(51.26 ± 17.25 pg/L vs.114.32 ± 20.15 pg/L,t=14.847),IL-8 (98.59 ± 34.12 pg/ml vs.159.62 ± 52.74 pg/ml,t=6.068)in the study group were significantly lower than those of the control group (P<0.05). There was no significant difference in the incidence of adverse reaction between the study group 20.5%(8/39) and the control group12.8%(5/39) during treatment (χ2=0.831, P>0.05). Conclusions The acupoint application combined with modified Xiaoqinglong decoction can significantly improve the clinical effect, inhibit airway remodeling, decrease the level of serum CRP, IL-8 and Eotaxin in patients with bronchial asthma, and its safety is high.

Objective To observe clinical effect of Huxiang-Yangwei powder combined with conventional western medicine on gastric motility and gastrointestinal hormones in patients with chronic atrophic gastritis. Methods A total of 100 patients with chronic atrophic gastritis according to the inclusion criteria were randomly divided into the observation group and the control group, with 50 cases in each group. The control group was given routine symptomatic treatment. Based on the treatment of control group, the observation group was given Huxiang-Yangwei powder therapy. After 1 month, the gastroscope score, pathological tissue score, gastric motility index (gastric motility rhythm, gastroelectric rhythm and gastric antrum motility), and the improvement of plasma gastrointestinal hormone (MTL, GAS, SS) were compared. Results The total effective rate of the observation group was 92.0% (42/50), and the total effective rate of the control group was 78.0% (39/50), with statistically significant (Z=-2.978, P=0.003). After treatment, the under gastroscope score (0.59 ± 0.06 vs. 1.23 ± 0.17, t=4.877) and the pathological organization score (0.65 ± 0.08 vs. 1.33 ± 0.19, t=5.096) of the observation group were significantly lower than those of the control group (P<0.05). After treatment, the gastric motility rhythm (76.15% ± 8.77% vs. 62.35% ± 7.31%, t=5.301), gastroelectric rhythm (81.02% ± 9.23% vs. 73.02% ± 8.43%, t=5.286), gastric antral motility (0.012 ± 0.002? vs. 0.008 ± 0.001 ?, t=4.160) of the observation group were significantly higher than those of the control group (P<0.05). After treatment, the plasma MTL (246.73 ± 31.82 pg/ml vs. 203.86 ± 27.91 pg/ml, t=5.832), GAS (49.55 ± 6.25 pg/ml vs. 35.81 ± 4.63 pg/ml, t=5.126), SS (17.35 ± 2.76 pg/ml vs. 15.01 ± 2.60 pg/ml, t=4.970) of the observation group were significantly higher than those of the control group (P<0.05). Conclusions The application of Huxiang-Yangwei powder in the treatment of chronic atrophic gastritis patients can repair gastric mucosa, regulate gastrointestinal hormone levels and increase gastric motility.

Objective To explore the long-term outcomes and complications of patients with hematological malignancies (HM) after haploidentical donor transplantation (HDT) or siblingidentical donor transplantation (SDT).Methods From June,2011 to July,2016,89 patients with HM receiving allo-HSCT were retrospectively analyzed,including 57 patients undergoing HDT and 32 cases undergoing SDT.Results The median time to achieve neutrophil engraftment was 2 days shorter after HDT than SDT,whereas that of platelet engraftment was 3 days longer after HDT than SDT.The cumulative incidence for 3 to 4 grade acute graft-versus-host disease (GVHD) was not obviously different between HDT and SDT (8.77％ versus 12.5％ respectively;x2 =0.313,P =0.576).The cumulative incidence for chronic GVHD was not significantly different between HDT and SDT (45.6％ versus 37.5％;~ =0.551,P =0.458).Cytomegalovirus (CMV) reactivity was significantly higher in patients after HDT (77.19％) than those after SDT (21.88％) (x2 =25.633,P＜0.001).The occurrence of hemorrhagic cystitis was also obviously higher in patients after HDT (26.32％)than those after SDT (3.85％) (x2 =5.340,P =0.021).The 1-,2-,and 3-year relapse-free survival rate of patients receiving HDT and SDT was 63.9％,55.4％,44.3％ and 71.2％,58.3％,51.8％,respectively (P =0.541).The 1-,2-,and 3-year overall survival rate of patients receiving HDT and SDT was 75.3％,65.3％,52.3％ and 76.9％,62.9％,62.9％,respectively (P =0.777).Conclusion Considering similar incidence of severe GVHD and long-term outcomes,haploidentical donors should be recommended as a potential alternative donor source when an identical donor is lacking for patients with HM.