With the technology progress of human genome sequencing and biomedical analysis and the emergence of big data analysis tools,the new concept of precision medicine has been put forward.Clinically,the application of precision medicine becomes more and more widely in personalized medicine,genetic disease analysis and disease prediction,etc,which will be the trend of disease diagnosis and treatment in the future,however,precision medicine is based on the precise detection.The requirement of the precise detection promotes the rapid development of new detection methods.Clinical laboratory is the carrier to achieve accurate detection,we need to strengthen the construction of clinical laboratory and improve the management level of the laboratory,so as to achieve accurate detection,to provide a more effective basis for the diagnosis and treatment of precision medicine.

Objective:To observe the influence of emotional stress on the temporomandibular joint(TMJ) of SD rats. Methods:Standard animal model of emotional stress was created by emotion communication emergency box technique in 30 SD rats and foot-shocked in another 30. Control rats were 30 without treatment. The microstructure and ultrastructure of the disc surface, condylar surface and external pterygoid muscle were observed 1, 3 and 5 weeks after emotional stress treatment. Results:Obviously pathological changes were observed in the experimental animals, especially at 3 weeks, involving the fissures on the disc and condylar surface, the collagen fibers were disordered. Electron microscopy observation showed that condylar collagen was exposed. The mitochondria edema and vacuolar degeneration in the external pterygoid muscle were found.At 5 weeks, the condylar cartilage started to recover. Conclusion:Long term emotional stress may lead to pathological changes of the temporomandibular system. The changes can be partly recovered after a certain time of adaption of TMJ.

OBJECTIVE To evaluate the cleaning efficacy of the automatic cleaning machine and the risk factors to ensure the effect of disinfection and sterilization. METHODS Cleaning efficacy of the automatic cleaning machines was detected by STF cleaning test card.It was put in the first cabin of every automatic cleaning machine.And it was also tested for these factors in determining cleaning qualities such as enzyme concentration,water temperature and pieces of instruments washed. RESULTS The cleaning efficacy of the automatic cleaning machines was 98.9% in the continuous two years.The qualified rate was 98.6% for surgical instruments,99.4% for all instrument in clinical sections. CONCLUSIONS The machine is suitable for the cleaning of surgical instruments.It also raises working efficiency,cutting down the cost of repairs and maintenance,reducing the chances of injury and infections in nurses who performed manual cleaning precedures.The procedures of the STF cleaning test card in detecting the cleaning efficacy is simpler,safer,and suitable for clinical applications.

ObjectiveTo analyze the internet-based cognitive behavior therapy (ICBT) intervent medical university students' social anxiety,and provide experiences and theoretical basis for future social anxiety interventions.Methods45 medical students of social anxiety were voluntarily divided into the one-to-one intervention group,one-to-five intervention group and control group.The control group did not intervene,one-to-one intervention group and one-to-five intervention group were interfered single person or team by cognitive behavioral therapy,respectively.The level and symptom of social anxiety of the 3 groups were assessed before and after the intervention by social phobia inventory(SPIN) and Social anxiety symptoms interview inventory.ResultsAfter the intervention,the scores of SPIN and the 3 subscales within it (fear,avoidance and physiological) of one-to-one ICBT group and one-to-five ICBT group were lower than those of the control group (SPIN scores:one-to-one ICBT group 15.60 ±7.87,one-to-five ICBT group 14.87 ± 8.83,control group 20.20 ± 11.46).Variance analysis showed that,in addition to physiological subscale(F =0.641,P ＞ 0.05 ),the scores of SPIN,fear and avoidance subscales had significant differences among the3 groups (F=3.764,P=0.018; F=3.606,P=0.021 ; F=5.444,P=0.005).In the analysis of participants'social anxiety symptoms,after treatment,in one-to-one ICBT group,there was 1 participant changed into subthreshold social anxiety and 1 participant into normal in the 2 threshold social anxiety participants.All the 3 subthreshold social anxiety participants changed into normal.In one-to-five ICBT group,there was 1 threshold social anxiety participant lapsed to subthreshold social anxiety,1 subthreshold social anxiety participants still remained in subthreshold social anxiety,2 symptomatic social anxiety participants changed into normal.But there were no significant changes in control group.ConclusionsAll the two methods of intervention have a certain effect.The effect of one-to-one intervention therapy is most significant.

Objective To evaluate the differences of clinical features,neuroimaging,angiography and laboratory findings between different stroke subtypes according to TOAST criteria in elderly patients.Methods 91 patients (aged ≥ 80 years) with acute ischemic stroke were retrospectively reviewed in Departement of Neurology from April 2009 to August 2010.Subtypes of ischemic stroke were analyzed according to the classification of TOAST.Risk factors,clinical manifestations,complications,prognosis,neuroimaging,cerebrovascular lesions,and laboratory findings of different TOAST subtypes were compared.Results Large-artery atherosclerosis (LAA) (34/91) was the most common cause of acute ischemic stroke in elderly patients,and most criminal lesions (25/34) located at the intracranial arteries.In the LAA group,patients with intracranial (25/34) or extracranial (12/34) occlusive diseases were more than those in other groups.Patients with cardioembolism (CE) had lower lipid levels.In the CE group,patients with poor shortterm prognosis (7/15) were more than in the LAA or small-artery occlusion (SAO) group,and patients with severe cerebral edema (4/15) were more than those in other groups.In patients of the SAO group,complications occurred infrequently (4/20),and none had poor short-term prognosis.Conclusions There were some differences among different TOAST subtypes in clinical features,neuroimaging,cerebrovascular diseases,and laboratory findings.The clinical significance of our findings needs to be explored further.

Objective To observe the clinical efficacy of duloxetine in the treatment of malignant neuropathic pain with depression.Methods 60 patients were randomly divided into two groups as study group(30 cases) and contrdl group(30 cases) and treated for 4 weeks.The patients of study group were treated with duloxetine and oxycontin,and the patients of control group were treated with oxycontin only.Numberical rating scale (NRS) on pain,criteria of pain relief and Hamilton depression scale(HAMD,17 items) score were used to assess the therapeutic effect before and after treatment.Results By the end of the fourth week of treatment,the average usage of oxycontin of the study group was significantly less than control group((45.6±8.5) mg vs (88.2±5.2)mg,P＜0.05).The effective rate of pain relief in the study group was significantly higher than that in control group (93.3％ vs 73.3％,P＜0.05).Comparing pre-treatment,the score of HAMD of the study group had a remarkable decrease ((11.45±4.56) vs (23.07±5.47),P＜0.01).In comparison to the score of control group,study group had a significant effect ((11.45±4.56) vs (18.75±4.21),P＜0.01).Conclusion Duloxetine is one of effective agents in the treatment of malignant neuropathic pain with depression,which can alleviate depression and relieve pain.Duloxetine have mild adverse effects and good tolerance.

Objective To study the safety and feasibility of tubeless percutaneous nephrostolithotomy by hemostasis gel closure of mini-percutaneous renal-channel.Methods Eighty patients after conventional percutaneous nephrostolithotomy are selected and divided into two groups according to the principle of randomization.Control group adopts conventional percutaneous nephrostolithotomy calculi lithotripsy with renal pelvis drainage tube placement whereas the experimental group adopts tubeless percutaneous nephrostolithotomy by hemostasis gel closure of mini-percutaneous renal channel.Both experimental group and control group will be scientifically and statistically analyzed via the incidence and the dose of using sedative for alleviating pain after operation,hospital stay,level of hemoglobin,and the occurrence of complications such as continuate hemorrhage,infection,urinary extravasation,etc.Results The operation of both groups are successful in phrase Ⅰ.The incidence and the dose of using sedative in control group are obviously higher than that in experimental group(45％ vs 20％).However,the incidence of postoperative complications like infection and hemorrhage and hospital stay between two groups are undifferentiated in statistics(P ＞ 0.05).Neither the experimental group nor the control group has perinephric hematoma,and seven cases of control group have urinary leakage after remove of fistula.Conclusion Tubeless percutaneous nephrostolithotomy by hemostasis gel closure of mini-percutaneous renal-channel is safe and feasible and it can reduce the incidence of postoperative pain and avoid urinary leakage.

Objective:To compare the therapeutic and adverse effects of concurrent raltitrexed plus oxaliplatin and radiotherapy with those of PF synchronous radiotherapy in the treatment of advanced esophageal cancer. Methods:A total of 84 pathologically con-firmed patients with advanced esophageal carcinoma were randomly distributed to the concurrent raltitrexed plus oxaliplatin and ra-diotherapy group (experimental group, n=40) and to the PF synchronous radiotherapy group (control group, n=44). All patients were treated with 3DCRT at a total dose of 60 Gy/30f. The chemotherapy in the experimental group consists of raltitrexed at 2.5 mg/m2, d1, plus oxaliplatin at 130 mg/m2, d2. The chemotherapy of the control group consists of DDP at 25 mg/m2, Dd1-3, plus 5-FU 500 mg/m2, d1-5. Two cycles of concurrent chemotherapy were administered during radiotherapy on d1 and d29. The comparison results were used to estimate the therapeutic and adverse effects of the two groups. Results:The rerponse rate, complete response, and one-year overall survival rate of the experimental group were higher than those of the control group [(87.50%vs. 79.54%, P=0.3293), (32.50%vs. 18.18%, P=0.13), and (82.50%vs. 79.50%, P=0.701)], but the difference was not statistically significant. The incidence rates of nau-sea and vomiting, appetite degression, leucopenia, radiation-induced esophagitis, and cardiotoxicity were significantly lower (P<0.05) in the experimental group than in the control group. Other adverse effects of the two groups were similar (P>0.05). Conclusion:Simi-lar to PF chemotherapy and radiotherapy, the concurrent raltitrexed plus oxaliplatin and radiotherapy achieved a similar short-term therapeutic effect but lower adverse effects on patients with esophageal cancer.

Objective To evaluate the factors affecting the treatment of old persons diagnosed hypertension. Method A sample of 55566 persons from the community of Yanji area of Shanghai was recruited. Results Among the 19295 persons over sixty there are 5842 patients with hypertension, the morbidity was 30.3%. Among the 36271 persons aged fifteen to fifty-nine there are 3536 patients with hypertension, the morbidity is 9.7%. The ratio of non-treatment in the old age group is 3.1% and in younger group is 8.8%. However,the compliance to the treatment was better in the younger than in old group(73.7% vs 56.2%). The age,hypertension grade and sex were all accounted for the differences in the regularity of the hypertension treatment. Conclusion Further effort on the education of non-old hypertensive patients is essential to decrease the damage from hypertension.

AIM: To investigate the effects and mechanisms of intraarticular injection of doxycycline on experimental osreoarthritis in rabbits. METHODS: An animal model of osteoarthritis in knee of rabbits was established by intraarticular injection of papain. 2 mg or 4 mg of doxycycline was injected (intraarticular) once a day in four weeks. The degeneration of articular cartilage, Mankin s marks of the cartilage tissue, the expression of MMP-13, the release of nitricoxide (NO) and the activity of total nitricoxide synthase (NOS) and inducible nitricoxide synthase (iNOS) of the joint fluid were tested subsequently . RESULTS: In the osteoarthritis model group, the Mankin s marks and the expression of MMP-13 observably increased, and spectrophotometric analysis showed the high concentration of the release of NO and high activity of NOS and iNOS in the joint fluid (P