Standardized training of resident doctors is the golden stage for clinicians to establish good clinical thinking. Although respiratory disease is common, there are serious and critical diseases, which need to develop clinical thinking and improve the analytical ability. The resident physicians' instructor should help residents to establish the correct diagnostic thinking through the following means: clinical demonstration teaching show, guidance of reading the relevant literature and books, strengthening the basic skills of collecting patients' history and physical examination, and guidance of appropriate use of auxiliary examination and analysis of the results. For the treatment thinking, solid theoretical knowledge and life-long learning ideas and habits can improve the successful rate of initial treatment. Furthermore, being familiar with the efficacy evaluation system and analyzing the reasons for the success and failure of the treatment will help the residents to develop a good therapeutic thinking. The good clinical thinking established by the residents in the department of respiration will be conducive to their own follow-up specialist training and career development.

Objective To compare the discriminative ability of MRI linear measurements and volumetric measurements between patients with Alzheimer disease (AD) and control subjects, and to evaluate their clinical value. Methods The study group consisted of 32 patients with probable Alzheimer disease and 32 healthy control subjects. Linear measurements and volumetric measurements of the bilateral hippocampal formations, temporal horns of lateral ventricle, parahippocampal gyri, and entorhinal cortices were performed on the serial reconstructed MR images. Discriminant analysis was used to identify measurements independently contributing to discriminating between AD and control subjects. Results With a stepwise method, the right height of temporal horn and right thickness of entorhinal cortex of linear measurements entered the function. The specificity, sensitivity, and accuracy of this function were 96.9%, 84.4%, and 90.6%, respectively. The left entorhinal cortex and left hippocampus of volumetric measurements entered the other discriminant function. The specificity, sensitivity, and accuracy of the second function were 100.0%, 90.6%, and 95.3%, respectively. All the linear and volumetric measurements of cerebral regions were significantly different between AD group and control subjects(t= -6.80～12.53,P

Objective To observe two main subtypes of MAPK family-ERK and JNK activation in HSCs and investigate the effects of the serum of Radix Salviae Militiorrhizae treated animals on the activation of ERK and JNK in HSCs. Methods HSCs were cultured in vitro. After the model of hepatic fibrosis was replicated in SD rats, Radix Salviae Militiorrhizae decoction was given via gastrogavage to the rats of treatment groups to obtain serum containing the drug. The dose was 10 times of dose per kg per day for adults in 2 divided doses for 6 consecutive days, while the same volume of 0.9% NaCl was given to the rats of non-treatment groups. on the 7th day, the routine dose was orally given again; the blood sample was drawn from the vena cava after 2 hour; the serum was isolated and inactivated with water bath at 56℃; finally, the serum was filtered to eliminate bacteria. Just before using the serum, RPMI-1640 culture medium was added to prepare culture media of 10% drug-containing serum, which was incubated with the subcultured HSCs. The experiment was divided into the following groups: A: serum of extracted from normal rats; B: medicated serum of RSM extracted from normal rats; C: serum from CCl_4-induced liver fibrosis rats; D: medicated serum of RSM extracted from CCl_4-induced liver fibrosis rats.After 24h incubation with above every group serum which were added blindly to HSCs, P-ERK and P-JNK were detected by Western blot respectively. Results Both RSM Pharmacological serums decreased P-ERK and P-JNK in HSCs significantly compared with controls (P

Objective To evaluate the value of measurement of medial temporal structure by MR imaging volumetry in the differential diagnosis for patients with Alzheimer′s disease (AD) and subcotical ischemic vascular dementia (SIVD) Methods Thirty three probable patients of AD, 33 normal controls, and 17 patients suspected with SIVD had been scanned by MRI, and volumetric measurements of amygdala (AMY), hippocampal formations (HF), entorhinal cortices (EC), parahippocampal gyri (PHG), and temporal horn of lateral ventricle (TH) were done on a serial reconstructed MR images Results Both atrophy of HF and dilatation of TH were significant ( P

Objective To examine the distribution and antibiotic resistance proifle of the bacterial isolates from lower respiratory tract of hospitalized patients for better empirical therapy.Methods A total of 3 155 lower respiratory tract specimens were collected from Respiratory Department of the First Afifliated Hospital of Chongqing Medical University in 2013 to identify bacterial pathogens for susceptibility testing. The results were compared with the data of 2011 and 2012.Results The top three bacterial species from lower respiratory tract in the period from 2011 to 2013 wereA. baumannii,P. aeruginosa, andK. pneumoniae. The prevalence ofS. aureusincreased, while the prevalence ofS. maltophilia andS. pneumoniae was still low.A. baumannii isolates were highly resistant to antibiotics. Not more than 40% of these strains were susceptible to the antimicrobial agents except minocycline, which was active against more than 60% of the ICU and non-ICU strains. More than 70% of theP. aeruginosa strains from non-ICU were susceptible to cefepime, meropenem, imipenem, levofloxacin, and ciprofloxacin in the three years, 50%-70% of the strains from ICU were susceptible to the antimicrobial agents tested. Carbapenem-resistantA. baumannii andP. aeruginosa strains were identiifed.S. maltophilia strains were relatively susceptible to minocycline and levolfoxacin. All the S. aureus isolates were susceptible to vancomycin, linezolid, and tigecycline. The prevalence of MRSA increased year by
year. More than 80% of theK. pneumoniae andE. coli strains were susceptible to imipenem, piperacillin-tazobactam, and cefepime. ESBLs-producingK. pneumoniae was identified. More than 85% of theH. influenzae strains were susceptible to meropenem, ceftazidime, cefuroxime, ciprolfoxacin, levolfoxacin, and amoxicillin-clavulanate potassium. All theS. pneumoniae isolates were susceptible to vancomycin, and 80%-96% of these strains were susceptible to levofloxacin and penicillin.ConclusionsA. baumannii,P. aeruginosa, andK. pneumoniae are the top three bacterial species isolated from lower respiratory tract. Carbapenem-resistantA. baumannii,P. aeruginosa and ESBLs-producingK. pneumoniaeare emerging. The prevalence of MRSA is increasing year by year, which poses a challenge to antimicrobial therapy. It is urgent to contain and control the growing antibiotic resistance.

Objective:To observe the effects of mycobacterium tuberculosis components (mannose-capped lipoarabinomannan,ManLAM) on the maturation of dendritic cells and downstream immunity.Methods:The peripheral blood mononuclear cells were obtained from healthy individuals,and then were cultured in medium with GM-CSF and IL-4.Five days later the medium was changed and cytokine was added to.On the sixth day,the cells were divided into three groups.Meanwhile ManLAM and LPS were added to stimulate the DCs according to the experimental design.Seven days later,the cells were collected and the level of DC-SIGN,HLA-DR,CD86 and CD83 were detected by flow cytometry.The levels of IL-12 and IL-10 in the supernatant were measured by enzyme-linked immunosorbent assay (ELISA).Proliferative induction of DCs to CD4+T lymphocytes was measured by mixed lymphocyte reaction(MLR).The naive CD4+CD45RA+ T cells and allogeneic DCs were co-cultured for 48 hours.Subsequently,the supernatant IFN-? level in each group was measured by ELISA.Results:(1)The expression of CD86 and CD83 on DCs in ManLAM group was lower than those of the mature group (P

0.05). Conclusion Lentivirus-mediated RNAi of DC-SIGN gene suppresses the gene expression on the surface of DCs effectively,but had no effect on the maturity and functions of DCs.

We report a spectrophotometic method for the determination of cyanogen chloride (CNCl) in air pollution.Experimental parameters for the stability and absorbility of CNCl gas in the different media were studied.The experimental conditions were optimized for CNCI as follows:absorbent:1%isonicotinic acid-barbituric acid;reaction acidity:pH 5.8 in phosphate buffer at room temperature;masking agent:0.01mol/L EDTA;λmax:598nm. The apparent molar absorptivity was found to be 1.17×105L·mol-1·cm-1,the linear range was within 0～5μg of CNCl in 25 mL solution; the regression equation of the curve has given by A=-0.0040+1.935C(r=0.9999).The method has been applied to the determination of CNCl in chimney gas,workshop air and production area air of the cyanuric trichloride plant,chemical works and pharmaceutical factory air.The relative standard deviation was below 2.7%(n=4)for the cyanogen chloride amount within 13～64mg/m3,and when CNCl amounts were within 0.1～1.0mg/m3,RSD was below 6.9%(n=6).The recovery was 98.7%.

Objective To investigate the feasibility of application of anterograde tubular ileal fistula in Ⅰ stage anastomosis of colon cancer with acute obstruction. Method Eighty patients of colon cancer with acute obstruction who treated with anterograde tubular ileal fistula in Ⅰ stage anastomosis were analyzed restropectively. Result Clinical observation showed that 80 patients were cured and discharged,no one did occur anastomotic leakage, abdominal abscess,and other serious complications. Conclusion If correctly graspe the timing of operation for colon cancer with acute obstruction,irrigation methods,good perioperative management,select the anterograde tubular ileal fistula, Ⅰ stage resection and anastomosis is safe and feasible.

ObjectiveTo study the expression level of HER-2 gene in the same pathological stage gastric cancer,and discuss the feasibility of HER-2 gene being the prognostic indicator.MethodsThe expression of HER-2 in gastric cancer was detected by immunohistocehmical technique and analyzed in relation with the pathological stage and prognosis of the patients.ResultsThe total positive rate of HER-2 in gastric cancer was 33.64％ (37/110).In stage Ⅱ,the weakly and strongly positive rates of gastric cancer were 21.31％ ( 13/61 ) and 9.84％ (6/61).In stage Ⅲ,the weakly and strongly positive rates of gastric cancer were 20.41％ (10/49) and 16.33％ (8/49).In the same pathological stage,the survival rate of patients with negative HER-2 expression was higher than weakly positive ones.And the survival rate of patients with strongly positive HER-2 expression was the lowest.The difference had statistical significance (P ＜ 0.01).ConclusionThe prognosis of patients in the same stage was correlated with the expression level of HER-2,which can be used to evaluate the biological behavior and prognosis of gastric cancer.