Standardized training program for residents in Shanghai is one of the important measures in the health care reform.In accordance with Implementary methods of standardized training for residents in shanghai (for trial implementation),the department of stomatology in the affiliated Changzheng Hospital quickly initialized the standardized training program by defining the training objectives,establishing the training mechanisms,formulating the training contents and building the system of the assessment.Special attention was paid to improve the professional skill of the residents including ① clinical diagnostic ability; ② medical theoretical level and the medical thinking ability; ③ interpersonal communicational skill; ④ professionalism; ⑤ scientific research ability.Useful exploration was made to test the feasibility of the training program based on the practices and the effect was encouraging.

Objective To explore the relationship between music preferences and mental health in medical students and to propose countermeasures.Methods Music Preferences Questionnaire and Chinese college students mental health scale(CCSMHS) were used to test 538 randomly selected medical students and the data was analyzed by descriptive statistics,T test and variance analysis with SPSS 20.0 and the inspection level was α=0.05.Results ①Statistically significant (P＜0.05) differences were found on somatization,anxiety,depression,inferiority,paranoid,force,social withdrawal,reliance,impulse and psychotic tendencies in medical students with different preference of music style; ②Statistically significant (P＜0.05) differences were found on anxiety and inferiority in medical students with different preference of music type; ③Statistically significant (P＜0.05) differences were found on anxiety,depression,paranoid,force,social withdrawal and reliance in medical students with different participating ways of music; ④Statistically significant (P＜0.05) differences were found on somatization,anxiety,inferiority and paranoid in medical students with different attitude about participating music activities; ⑤Medical students with different preferences of music activities preferences did not have significant difference on factor of mental health(P＞0.05).Conclusion The relationship between medical students' mental health and music preferences is very close.By training and guiding music preferences of medical students in mental health education,we can improve their mental health effectively.

Objective To construct a luciferase reporter vector containing the 3′untranslated region (3′UTR) of nuclear factor I-C (nuclear factor I-C, Nfic), and apply dual luciferase reporter gene system to determine the association between microRNA-20a (miR-20a) and its potential target gene Nfic. Methods The potential complementary binding sites of miR-20a and Nfic were predicted by Targetscan. The 3′UTR of Nfic fragment amplified by PCR was cloned into luciferase reporter vector MIR- Report Luciferase. The luciferase reporters containing 3′ UTR of Nfic and miR- 20 mimics (experimental group) or NC mimics (control group) were co-transfected into 293-AD cells. Cells were collected, and then dual-luciferase reporter assay was performed to detect the luciferase activity of the two groups of cells, consequently the relationship between miR-20a and Nfic was identified. The miR-20a mimics and NC mimics were transfected into marrow stromal cell line ST2 respectively. The total cell lysates were collected, and the expression level of NFIC was detected by Western blotting assay. Results Results of double enzyme digestion and DNA sequencing showed that sequence of luciferase reporter vector was correct. miR-20a specificity bounded to Nfic 3′UTR and inhibited the luciferase activity of the reporter construct (P<0.05). Western blotting assay showed that the NFIC protein level was obviously down-regulated in ST2 cells after the transfection of miR-20a mimics compared with that of control. Conclusion The luciferase reporter vector containing the 3′UTR of Nfic is constructed successfully, which confirms that miR-20a can direct effect on Nfic3′UTR and repress its luciferase activity.

Objective To compare the clinical effect and safety of limited fluid resuscitation and aggressive/normotensive fluid resuscitation in treatment of earthquake-induced traumatic hemorrhagic shock patients so as to provide reference for clinical application.Methods A total of 62 patients with traumatic hemorrhagic shock in earthquake were employed and divided randomly into limited fluid resuscitation group(Group Ⅰ,30 patients)and aggressive/normotensive fluid resuscitation group(Group Ⅱ,32 patients).All the patients were resuscitated by using halanted solution and HAES-steril as resuscitanaid resuscitation.Then,surgical hemostasis was carried out and dynamic changes of mean blood pressure(MAP),heart rate and central venous pressure(CVP)observed.The base excess,lactic acid and creatinine were detected at four resuscitation points.Results Before full fluid resuscitation,MAP remained at 50-70 mm Hg and 70-90 mm Hg respectively in both groups.After early resuscitation.heart rate showed significant decrease,while CVP increased(P＜0.01)but still changed at normal range.Total transfusion volume in Group Ⅰ was less than that of GroupⅡ(P＜0.01).There was no statistical difference upon urine volume(P＞0.05).There was statistical difierence upon base excess value after resuscitation within group(P＜0.01)but no statistical difference between two groups(P＞0.05).After resuscitation,hetic acid level wag obviously reduced in both groups(P＜0.01),with more significant change in Group Ⅰ,with statistical difference compared with Group Ⅱ(P＜0.01).There showed a significant decrease of creatinine in both groups after resuscitation.with statistical difierence within group (P＜0.01)but without statistical difference between two groups(P＞0.05).Conclusions Compared with aggressive/normotensive fluid resuscitation,limited fluid resuscitation is a more safe and effective way for fluid resuscitation of traumatic hemorrhagic shock,for it can not only reduce transfusion volume and ameliorate hemodynamic indices,but also can increase oxygen supply,improve microcirculation and protect renal function.

Objective To establish and apply the procedure of survey on quality indicator in clinical laboratory and to analyze the status in quo of the 15 quality indicators in Zhejiang province .Methods A network platform for the survey on quality indicator in clinical laboratory was designed and developed by our center.The online questionnaires that should be reported back within one month were assigned to 473 laboratories.The developed software and SPSS 13.0 were used for statistical analysis .13 indicators expressed in rate were further evaluated with sigma scales .The 25th percentile, 50th percentile, and 75th percentile of the distribution of each quality indicator were regarded as the minimum , appropriate and optimum quality specifications, respectively.Results Totally 444 laboratories submitted the survey results.The overall sigma levels of 10/13 indicators were all >3, of which the inappropriate CV of internal quality control and unacceptable performances in EQA were still less than 3σin 15.8%and 9.2%of the laboratories.The rates of quality indicators in different scales of laboratories and diverse disciplines were significantly different .Pre-analytical TAT in routine examination for clinical chemistry and immunology was 50 min, on average.And the time for routine examination of blood , urine and stool was 30 min.Pre-analytical TAT in emergency examination for all four disciplines were all between 10 and 15 min. Intra-analytical TAT for clinical immunology was the longest , which was 154 min for routine examination and 40 min for emergency examination, respectively.The optimum quality specifications for 8 indicators were 6σ, while the minimum quality specifications were less than 1σfor 4 indicators.Conclusions According to the results of our survey, the pre-analytical quality indicator perform better than that of Intra-analytical and post-analytical phase.The laboratory should strengthen the laboratory information system technology construction to ensure the reliable data collection and long-time monitoring.

An on-line two dimensional liquid chromatographic (2D-LC) method was established by using an ultimate dual gradient liquid chromatography, three chromatographic columns and valve-switching technology to detect 2460A in trichoderma hazianum fermentation liquor. MF C8 column (10 mm×4. 6 mm, 5. 0 μm) was used as purification column and MG C18 column (20 mm×4. 6 mm, 5. 0 μm) was used as enriching column. Methanol and water were used as mobile phase with a gradient elution at a flow rate of 2. 0 mL/min. The sample was separated on the Thermo Hypersil GOLD C18 column (250 mm×4. 6 mm, 5. 0μm) maintained at 40 ℃ using methanol and water. The flow rate was 1. 0 mL/min and 1. 0 mL sample was injected into the 2D-LC system. The detection wavelength was 424 nm. The whole analytical time was less than 60 min. The standard curve was linear over the 2460A concentration range of 0. 0025-10. 0 mg/L(r=0. 9981, n=8). The limit of detection was calculated to be 1 . 2μg/L ( S/N=3 ) and the limit of quantification was calculated to be 2 . 5 μg/L ( S/N=10 ) . The average recoveries varied from 88 . 0% to 104 . 4%.

A method of on-line solid phase extraction ( SPE )-two dimensional liquid chromatography electrospary-tandem mass spectrometric method was established for the determination of Teicoplanin concentrations in human cerebrospinal fluid. Cerebrospinal fluid samples were treated by the on-line SPE treatment, and analyzed by LC-MS/MS. The chromatographic separation was performed on a Shiseido CAPCALL-PAK C18 column with gradient elution by using 25 mmol/L ammonium acetate ( pH 6. 0 )-acetonitrile as mobile phases, and the flow rate of 1 mL/min. Detection was carried out under the selected reaction monitoring ( SRM) in positive ionization mode with scopolamine hydrobromide as internal standard. Matrix-matched calibration curves with good correlation coefficients (R2=0. 9993, n=6) were obtained in the concentration range of 25-5000 μg/L. The average recoveries varied from 100. 8% to 109. 9%. The intra-and inter-day precisions were less than 6%. The method is proved to be rapid, sensitive, accurate, and suitable to determine Teicoplanin concentrations in human cerebrospinal fluid.

Objective To improve the anderstanding of clinical profile of primary plasma cell leukemia.Methods Case report and literature review.Results A rare case of nervous system relapse in primary plasma cell leukemia was reported.Six patients were identified from the literature.The type of immunoglobulin included IgG(3 patients),IgD(2 patients).Clinical manifestations of nervous system were variable.The average interval from initial diagnosis to the development of nervous system relapse was 16.5 months.Plasma cells were found in cerebrospinal fluid in 4 patients.The mean surviaval time was 6.7 months after nervous system relapse.Conlusion Nervous system relapse in primary plasma cell leukemia is rare with poor prognosis.

OBJECTIVE: To summarize the experience of improving survival rate of microsurgical free flap transfers for head and neck reconstruction. METHOD: One hundred and seventy-nine consecutive microsurgical free flap transfers performed in patients with head and neck region defects after surgical procedure due to carcinoma were reviewed. The microsurgical free flap survival rate and postoperative complication were evaluated. RESULT: The overall success rate of flap was 98.9%. The overall complication rate was 7.8%. The flap crisis rate was postoperative flap crisis incidence rate was 4.4%. The success rate of immediate surgical exploration within 6 hours successfully rescued the flap in were 6 six cases, and the other else two cases cut died flap and repaired the region defect in the head and neck with pectoralis major myocutaneous flap. CONCLUSION Key factors in improving the succeess rate are to guarantee vascular anastomosis patency, to achieve a good haemostasis, and to promptly closely observe discover blood vessel flap crisis after operation in the first 6 hours and immediate surgical exploration.
Anastomosis, Surgical ; Carcinoma ; surgery ; Female ; Free Tissue Flaps ; transplantation ; Head and Neck Neoplasms ; surgery ; Humans ; Image Processing, Computer-Assisted ; Male ; Postoperative Complications ; Survival Rate ; Thigh

OBJECTIVE:To optimize the extraction and purification technology of total flavonoids from Engelhardia roxburghi-ana,and to establish the method for the content determination of 3 kinds of effective components. METHODS:Using the extrac-tion transfer rate of astilbin as index,single factor test was used to investigate extraction solvent,extraction method,volume frac-tion of percolation solvent ethanol,percolation material-liquid ration,soaking time before percolation and percolation rate of extrac-tion technology,and volume fraction of eluant ethanol in AB-8 resin purification technology. The contents of 3 effective compo-nents as astilbin,texifolin and engelitin in total flavonoids from E. roxburghiana were determined by HPLC. RESULTS:The opti-mal extraction technology was using 70% ethanol as extraction and percolation solvent,percolation extraction,soaking for 8 h be-fore percolation,percolation material-liquid ratio of 1∶16(g/ml),percolation rate of 30 ml/(min·kg). The purification technology was diluting the solution to 0.5 g (crude drug)/ml with water,ethyl acetate extraction,dissolved extract with 50% ethanol after evaporated to dryness,AB-8 resin for sampling,eluted with 50% ethanol,concentrating and drying. In verification test,extraction transfer rate of astilbin was more than 80%(RSD=0.42%,n=3). The contents of astilbin,taxifolin and engeletin in total flavo-noids from E. roxburghiana by purified were 57.94%,3.72% and 2.83%,respectively;the contents of 3 components accounted for 64.00% of total flavonoids. CONCLUSIONS:The extraction and purification technology is stable,rational and reliable;the content determination method of 3 effective components in total flavonoids of E. roxburghiana is accurate,simple and producible.