Objective To discussion on the effectiveness of the five-phase instructional method inmedical field teaching Methods Appling the five-phase teaching methods in Social Medicine and General Family Care courses,and comparing it with traditional teaching methods.Results The five-phase teaching method is more effective than traditional teaching.Conclusion To apply the five-Phase teaching method in Public Health Education can gain better feedback from students and improve the teaching quality.

Objective:To study retention force durability of root-type attachments.Methods:Five magnetic attachments(Magfit EX-600),semi-precise stud-type attachments(Bedent) and precise stud-type attachments(Dalbo-classic) were fixed on a thermal-cycling and mechanical-loading machine respectively.The retention force of each attachment was measured at the baseline and after every 1,000 cycles of seating-removing.Results:The average retention force of magnetic attachments was(3.85?0.107) N at the baseline which attenuated for 3.38% after 10,000 cycles;The retention force of semi-precise group was(14.10?0.144) N originally and decreased 90.06% of the original force after 10,000 cycles.The primary force of the precise group was 33.14 N and was adjusted to(11.95?0.082) N as baseline attenuating for 74.56%.Conclusion: The retention force of magnetic attachments is lower than the stud attachments but is stable for 10 years.The retention force of stud-type attachments is larger at the baseline but reduced rapidly.

Objective To investigate the levels of IL-18,IL-10 and MMP-9 in coronary heart disease(CAD)patients with in-stent restenosis(ISR)after percutaneous coronary intervention (PCI)treatment,so as to discuss the influence of inflammatory fac-tors to ISR after PCI.Methods CAD patients with ISR after PCI were angiographically re-evaluated and formed the ISR group(n=68)and the non-ISR group(n=173)based on the presence or absence of ISR.109 subjects without angiographic evidence of CAD formed a reference control group(control group).The plasma IL-18,IL-10 and MMP-9 concentrations of subjects were measured. Results The concentrations of serum IL-18 and MMP-9 in ISR group and non-ISR group were significantly higher than control group,while IL-10 level was the opposite.Contrasted with non-ISR group,the concentrations of serum IL-18 and MMP-9 in ISR group were significantly higher,but IL-10 level was the opposite too.There were significantly statistical differences(P <0.05)Con-clusion There is significant correlation between ISR and serum levels of IL-18,IL-10 and MMP-9.The inflammation may have im-portant impact on the process of ISR.

Objective To explore the sensitivity of contrast-enhanced ultrasound (CEUS) and ultrasonic elastography(UE) in detecting different sizes of thyroid papillary carcinoma.Methods 64 cases of thyroid papillary carcinoma were divided into two groups according to the diameter size(group 1,≤1 cm;group 2,＞ 1 cm) and examined by the contrast-enhanced ultrasound and elastography,then the features were analyzed and the sensitivity for detecting of the two methods in different groups were compared.Results The sensitivity for detecting in CEUS was higher than in UE,which had significant difference between two methods.CEUS and UE were valuable for detecting and they had no difference in sensitivity for detecting in group 1.There was a significant difference in sensitivity for detecting between two methods in group 2.Conclusions Both CEUS and UE were valuable in diagnosis of thyroid papillary carcinoma and the sensitivity for detecting in CEUS is higher than in UE in group 2.

OBJECTIVE:To develop a headspace GC method for determination of residual organic solvents invovling methanol,alcohol,acetone,acetonitrile,dichloromethane and n-butanol in meropenem.METHODS:The residual organic solvents were separated on DB-624 capillary column using temperature programming.FID was used as detector with a temperature of 250 ℃ with nitrogen as carrier gas and water as solvent.The inlet temperature was 200 ℃.RESULTS:The linear range were 12～600 ?g?mL-1 (r=0.999 8) for methanol,20～1 000 ?g?mL-1 (r=0.999 9) for alcohol,20～1 000 ?g?mL-1 (r=0.999 9) for acetone,1.64～82 ?g?mL-1 (r=0.999 8) for acetonitrile,2.4～120 ?g?mL-1 (r=0.999 6) for dichloromethane and 20～1 000 ?g?mL-1 (r=0.999 9) for n-butanol with RSD of 1.0%,2.2%,0.9%,2.2%,1.6%,1.1%,respectively.The average recoveries were ranged from 98.8% to 99.6%.The LOD were about 0.06～0.43 ng.The residual levels of six organic solvents in 3 batches samples were all up to the standard stated in Chinese Pharmacopeia (2005 edition).CONCLUSION:The method is simple,accurate,sensitive and reproducible for determination of residual organic solvents in meropenem.

This paper firstly analyzed from three aspects:the necessity of pharmacognosy medical ethics educa-tion, and then illustrates the main content of the medicine ethics education , this paper expounds the method and form of medicine ethics education , and finally summarizes the medicine ethics education for clinical practice stage of medical students experience:the medical institutions about the medicine ethics instances of intuitive for training medical students , strengthening medical students learn the importance of pharmaceutical ethics in clinical practice stage , in order to enhance the medical students medical moral sentiment , lay the foundation for clinical drug safety work.

Objective To systematically evaluate the comprehensive effect of subglottic secretion drainage (SSD) on patients with mechanical ventilation (MV) in intensive care unit (ICU). Methods The randomized controlled clinical trials (RCTs) comparing SSD (intervention group) versus non-SSD (control group) in adult patients with MV in ICU was collected through the databases such as the PubMed database of the National Library of Medicine, CNKI, Wanfang database and the Chinese journal of science and technology database (VIP). The subjects were ICU patients with MV, and the retrieval time ranged from January 2006 to December 2016. Two reviewers independently screened the studies according to the inclusive and exclusive criteria, extracted the data, and assessed the quality. Then RevMan 5.3 software was used for Meta-analysis. Sensitivity analysis was performed using Stata 11.0 software. Funnel plot was used to analyze publication bias. Results In the 1004 documents obtained from preliminary screening, a total of 13 studies involving 2052 patients were enrolled after excluding duplicated documents and literature did not meet the inclusion criteria, with 1021 patients in intervention group, and 1031 in control group. Meta-analysis showed that compared with control group, the application of SSD in patients with MV could contribute to the reduction of the incidence of ventilator-associated pneumonia [VAP; risk ratio (RR) = 0.54, 95% confidence interval (95% CI) = 0.46-0.64, P < 0.00001], the duration of MV [mean difference (MD) = -3.29, 95%CI = -4.53 to -2.05, P < 0.00001] and length of hospital stay (MD = -4.27, 95% CI = -7.36 to -1.18, P = 0.007) were shortened, while there was no significant difference in ICU or hospital mortality rate between the intervention group and control group (RR = 0.89, 95%CI = 0.73-1.09, P = 0.25). The sensitivity analysis for studies enrolled in Meta-analysis of MV duration showed that individual research results were stable through step remove of the included literatures and combined calculation of the remaining literature value, suggesting that individual research results were stable, and would not have a significant impact on the overall results. The results of the funnel analysis showed that there was a symmetry in the inclusion studies, and no significant publication bias was found. Conclusions SSD did have effect in reducing the incidence of VAP, shortening the duration of MV and length of hospital stay, while there was no significant effect on reducing mortality rate. Effective use of SSD is an important measure to prevent VAP. It is necessary to objectively evaluate the clinical effect of SSD.

ObjectiveTo investigate the correlationship between clinical and histopathological results of adrenocortical hyperplasia,adenoma and adenocarcinoma in the adrenocortical glomerular,fascicular and reticular zones. MethodsA total number of 167 702 surgical specimens were collected by the Department of pathology at the General Hospital of Tianjin Medical University from 1993 -2008.Of these,there were 631 adrenocortical specimens.Statistic analysis was done with Run test,t or t'test and x2 test on data in the aspects of proportion rate,mean age,sex proportion and relationship between clinical and pathological results of adrenocortical diseases.ResultsThe total number of adrenal diseases and adrenocortical diseases were 910 cases (0.54％) and 631 cases (0.38％),respectively.The number of adrenocortical glomerular,fascicular,reticular diseases were 310 cases (49.13％),319 cases (50.55％) and 2 cases (0.32％),respectively.The rate of adrenal diseases and adrenocortical diseases specimens did not change during the 16 year study period.The trend in proportion of hyperplasia,adenoma,adenocarcinoma in adrenocortical glomerular,fascicular and reticular zones did not change as well.The proportion pattern showed that there were more cases of adenoma than of hyperplasia and adenocarcinoma.The functional diseases of adrenocortical glomerular,fascicular and reticular zone (90.97％,79.00％,100.00％ ) were higher than nonfunctional diseases in the corresponding zones (9.03％,21.00％,0％ ) and both were higher in female patients.The mean age of nonfunctional patients with adenoma,glomerular zone adenocarcinoma and hyperplasia,adenoma of fascicular zone was higher than that in functional diseases.Interestingly,the mean age of glomerular zone adenocarcinoma patients (62.7 yrs) was higher than that in hyperplasia patients (47.8 yrs) and in adenoma patients (44.8 yrs).The mean and male diagnostic ages of adenocarcinoma of fascicular (44.3 yrs,50.0 yra) were higher than that in adenoma (44.0 yrs,49.1 yrs) and hyperplasia (41.5 yrs,40.9 yrs) respectively.But the female mean diagnostic age of fascicular adenocarcinoma (38.7 yrs) was lower than that in adenoma (42.4 yrs) and hyperplasia (41.9 yrs) respectively and the lowest average age was for nonfunctional adenocarcinoma (34.4 yrs).The diameters of the functional and nonfunctional adenocarcinoma were large (4.3 cm and 4.0 cm in glomerular zone,7.1 cm and 8.0 cm in fascicular zone).The carcinoma cells were in serious atyrpia,haemorrhage,necrosis and capsular or vascular infiltration.The rates of functional hyperplasia,adenoma with hypertension in Conn,Cushing or adrenogenital syndrome of adrenocortical glomerular,fascicular,reticular zone were higher than that without hypertension,but their tumor diameters were similar.The diameters of functional adenoma in glomerular or fascicularer ( 1.7 cm,2.3 cm ) were lower than that of nonfunctional adenoma (2.3 cm,2.4 cm ) and the diameters of glomerular tumors were smaller than that of fascicular tumors.Nonfunctional adenoma ( 2.5 cm,2.0 cm ) of glomerular or fascicular by check up finding were bigger than that of non-endocrine adenoma ( 2.5 cm,2.3cm).There were seven cases with adrenogenital syndrome (2 male cases,5 female cases ),among these,there were 4 fascicularer adenoma cases,1 adenocarcinoma case,1 network hyperplasia case and 1 adenoma case.ConclusionsGenetic abnormality plays an important role in pathogenesis of adrenocortical disease and environment had less influence.Radiological examinations (CT and MRI) of adrenocortical diseases are the first choice and have important roles in evaluating tumor characteristics.There is close relationship between clinical manifestation and pathology.However,the exact diagnosis of definite type of disease and nature of tumor needs to be made by pathologic examination.

Objective To analysis of the efficacy and toxicity of multiple primary cancer of esophagus in three-dimensional conformal radiotherapy and concomitant chemotherapy.Methods Fifteen cases of multiple primary carcinoma of esophagus who refused the operation were collected.The Elekta linac 6 MV/10 MV X ray was used to conformal irradiation in three-four coplanar wild,2 Gy/time,1 time/day,5 times/week.The dose to the target area,CTV 40-50 Gy/4-5 weeks,GTV 60 Gy/6 weeks.TP scheme (paclitaxel+cisplatin) was used in the first day and 29th day,three-dimensional conformal radiation therapy initiated in the second day after chemotherapy.Results 1,3 year local control and overall survival were 86.7 ％ (13/15),33.4 ％ (5/15) and 73.3 ％ (11/15),26.6 ％ (4/15).Class 1-2 and class 3-4 acute radiation esophagitis and leukopenia occurred rates were 86.7 ％ (13/15),13.3 ％ (2/15) and 80 ％ (12/15),20 ％ (3/15).Conclusion Radiation therapy is the better treatment method for multiple primary carcinoma of esophagus when proximal lesions located in upper thoracic and cervical high.Toxic and side-effects can be tolerated of three dimensional conformal radiation therapy combined with chemotherapy in the treatment of multiple esophageal cancer.

Objective:To investigate the expression of inducible costimulatory ( ICOS) and inducible costimulatory ligand ( ICOSL) on peripheral blood mononuclear cells ( PBMCs ) and their clinical relationship with rheumatoid arthritis ( RA ) patients.Methods:Peripheral blood samples were collected from 85 RA patients and 50 HC in this study.Expression of ICOS and ICOSL on PBMC from the subjects were detected by flow cytometry and real-time polymerase chain reaction( RT-PCR).The alteration of ICOS and ICOSL were observed after hormone therapy in 15 patients with RA and the relationship between their expression level and patients′clinical manifestations were analysed.Results:The ICOS and ICOSL mRNA level of RA patients′PBMCs were significantly higher than that in HC.The expression level of ICOS on CD4+T cells was higher than than that in HC[(7.08±4.72)% vs (3.01+1.39)%,P<0.0001].The expression of ICOSL on monocytes[(5.77±3.45)%vs (3.64±1.43)%,P<0.05] and B cells [(5.78± 4.52)%vs (3.97±1.63)%,P<0.05] were significantly elevated in RA patients.In RA patients with active disease,however,ICOSL expression on monocytes and B cells were increased as compared with those in inactive RA patients [ ( 5.45 ±3.50 )% vs ( 4.04 ± 1.55)%,P=0.036],[(6.59 ±5.74)%vs (5.63±4.30)%,P=0.016].Furthermore,after receiving immunosuppressive therapy, the expressions of ICOS and ICOSL were notably reduced as compared with pre-therapy levels on PBMCs from patients [ ( 5.45 ±3.50)%vs (4.04±1.55)%,P=0.036],[(6.59 ±5.74)%vs (5.63±4.30)%,P=0.016].Conclusion:The high levels of ICOS and ICOSL expression were closely correlated with the degree of disease and therapeutic response,suggesting that ICOS/ICOSL pathway may play a critical role in pathogenesis of RA.