Senior medical personnel is brought up by senior medical education.In medical education clinical practicing is the important part and it impacts heavily the quality of training students.In this thesis,practice condition about students in Grade 2002 is investigated by researching and studying,problems discovered are analyzed and countermeasures are made.

Objective To investigate lipid profile in different stage of pregnant women and provide reference data for health care and complications during pregnancy .Methods A total of 1 200 healthy pregnant women were selected into pregnant womem ,and detected the blood lipid levels in different stage of pregnant ,and other 400 healthy women without pregnant were selected into the control group .Lipid profile was compared between the women in the control group and different stage of pregnant women in differ-ent stage of pregnancy .Results Compared with healthy controls ,triacylglycerol(TG) was increased significantly in early pregnancy (P<0 .05) ,the levels of TG ,total cholesterol(TC) ,low density lipoprotein cholesterin(LDL-C) ,high density lipoprotein cholester-ol(HDL-C) ,apoprotein a(Apo-A1) and apolipoprotein B100(Apo-B100) were increased significantly in middle and late pregnancy (P<0 .05) ,but no difference was detected in lipoprotein a(Lpa) level(P>0 .05) .Conclusion Compared with healthy controls , pregnant women has high lipid levels ,which gradually increased with gestational weeks .

Objective To investigate the effects of low dose testosterone on heart function,and ventricular remodeling in male rats with postinfarction congestive heart failure(CHF).Methods Sixty SD rats were undergone surgery,of which,45 rats were performed coronary artery ligation and other 15 were sham group (PS group).Six weeks later,left ventricular function of survived rats was examined by echocardiography,and LVEF≤45％ was defined as the standard of successful CHF model.All survived model rats were randomly divided into 2 groups:TU group(n =16) treated with TU 5 mg/kg per 2 weeks intramuscular injection;placebo (PL) group (n =16) treated with PL.Mter treatment for 12 weeks,left ventricular ejection fraction(LVEF) was assessed by echocardiography again.Serum testosterone level was determined by radioimmunoassay.The expression of tumor necrosis factor-or (TNF-α) mRNA and matrix metalloproteinase (MMP)-9mRNA in myocardial tissue was measured by RT-PCR.Results In male post-myocardial infarction rats,serum testosterone level and LVEF were decreased significantly than PS group(P ＜ 0.05),and the expression of TNF-α mRNA and MMP-9 mRNA in myocardial tissue was increased significantly than PS group (P ＜ 0.05).Mter low dose TU therapy,LVEF of rats in TU group improved significantly(P ＜0.05),and the expression of TNF-α mRNA and MMP-9 mRNA in myocardial tissue was reduced significantly (P ＜ 0.05).Meanwhile,the mortality was decreased (P ＜ 0.05).Conclusion Low dose testosterone therapy can restore the inflammatory imbalance and suppress the ventricular remodeling in male post-myocardial infarction rats and improve left ventricular function,as well as reduce mortality.

To compare the activity of RGD-TRAIL in different expression systems, RGD-TRAIL in both Escherichia coli (E.coli) and Pichia pastoris was constructed and expressed. In vitro activity of RGD-TRAIL from Pichia pastoris expression system was also analyzed. Genetic engineering techniques were used to construct recombinant plasmid pET30-rgd-trail and pHBM-rgd-trail. The recombinant protein RGD-TRAIL was purified with Ni ion affinity chromatography after induction. MTT assay, ELISA, scratch wound healing, transwell migration assay and Hoechst 33342 staining were performed to detect the effects of RGD-TRAIL on proliferation, binding activity, migration and apoptosis. The expression of apoptosis-associated proteins was detected by Western blotting. Recombinant protein RGD-TRAIL was successfully expressed in a form of inclusion body in E.coli, while expressed secretorily in Pichia pastoris. It possessed more potent cytotoxicity than RGD-TRAIL in E.coli by MTT assay. The RGD-TRAIL expressed by Pichia pastoris showed powerful binding affinity with cancer cells expressing α(v), DR4, DR5 and highly potent cytotoxicity through inducing apoptosis of cancer cells. Nuclear fragmentation was examined by Hoechst 33342 staining. Cleaved PARP and caspase-3 were also detected after incubation with RGD-TRAIL. Additionally, RGD-TRAIL inhibited migration significantly in A549 and HT1080 cells. The results demonstrate that Pichia pastoris expression system is more suitable for the recombinant protein RGD-TRAIL. Its binding affinity and antitumor activity might make RGD-TRAIL a promising candidate for cancer therapy.

Objective:To observe the influence of smoking in the levels of blood lipids and disease activity in the male patients with rheumatoid arthritis(RA), and to provide economical and effective intervention for the RA patients. Methods:A total of 112 male patients with RA were selected.The fasting blood samples from the ulnar vein of all patients were obtained in the morning. The level of C-reaction protein (CRP), erythrocyte sedimentation rate (ESR), total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C) and other indicators were measured. The smoking status (including years of smoking, number of cigarettes smoked per day), tender joint count (TJC), swollen joint count (SJC) and other clinical data were collected and 28-joint disease activity score (DAS28) was calculated.The patients were divided into smoking group (87 cases) and non-smoking group (25 cases).According to the smoking index (SI)(years of smoking multiplied by number of cigarettes smoked per day), the patients were divided into group A (less than 400) (34 cases), group B (between 400 to 800) (37 cases) and group C (more than 800) (16 cases).Results:The levels of TC and TG of the patients in smoking group were significantly higher than those in non-smoking group(P<0.01), the HDL-C level was lower(P<0.01), and there was no significant difference in the LDL-C level between two groups(P>0.05).W ith the increase of SI, the levels of TC and TG were increased(P<0.05), and the HDL-C levels were decreased(P<0.05);the LDL-C levels were increased, but there was no significant difference between various groups(P>0.05).The levels of CRP and ESR in smoking group were higher than those in non-smoking group (P<0.05).The TJC, SJC, and DAS28 of the patients in smoking group were significantly higher than those in non-smoking group(P<0.01).With the increase of SI, the TJC, SJC, and DAS28 were increased(P<0.05), and the CRP and ESR levels showed an increasing trend.Conclusion:Smoking may cause the abnormal blood lipid levels in the patients with RA and the increased disease activity.To quit or reduce smoking may improve blood lipid metabolism in the patients with RA and has a positive effect on reducing the risk of RA.

Objective To study biological significance of CD44v6 and p63 protein expression in buccal squamous cell carcinomas (BSCC). Methods Immunohistochemical method was used to examine the expression of CD44v6 and p63 protein in 52 cases of BSCC,10 cases of atypical hyperplasia and 10 cases of normal buccal mucosa,which were analyzed based on clinic and pathology characteristics.Results In normal tissue,atypical hyperplastic tissue of buccal mucosa and BSCC tissue,the expression of CD44v6 decreased gradually 90.0 ％ (9/10),80.0 ％ (8/10) and 55.8 ％ (29/52),respectively,and the layers of positive expression was decreased,and the expression of p63 increased gradually,30.0 ％ (3/10),40.0 ％ (4/10) and 90.4 ％(47/52),respectively.The differences of their expression rates were significant (P ＜0.05).The expression of CD44v6 and p63 had no relationship with gender,age,tumor classification,pathological differentiation (P ＞0.05).CD44v6 was relevant with invasion style and lymphatic node metastasis of BSCC (P ＜ 0.05),while p63 has no relevance with lymphatic node metastasis of BSCC (P ＞0.05).Conclusion CD44v6 and p63 participate in the regulation of generation and deve-lopment process of BSCC.CD44v6 can be utilized as a useful marker of BSCC for detection and prediction of prognosis.p63 play a role as oncogene,which can be a useful marker for BSCC detection.CD44v6 and p63 have independent function in generation,development,metastasis and aversion of BSCC.

Objective:To investigate levels of serum IL-34 in SLE patients,and correlation between concentrations of serum IL-34 and other established serum markers and disease activity indexes.Methods: In all,78 SLE patients and 53 healthy controls were enrolled in the research.Enzyme-linked immunosorbent assay(ELISA) was employed to measuring the concentrations of serological IL-34.Then,serum IL-34 levels between SLE group and healthy controls were analyzed by Mann-Whitney U test.Meanwhile,the correlation between the serum IL-34 levels and disease activity indexes and other established serum markers were assessed.Serum IL-34 levels were significantly higher in SLE patients compared to healthy controls[(Median,128.9 pg/ml) vs (Median,52.4 pg/ml),P<0.001].Results: Their levels were remarkably associated with accumulation of the clinical features of SLE.Additionally,IL-34 titers were positively correlated with the SLE disease activity indexes,anti-double stranded DNA antibody(anti-dsDNA)titers and C-reactive protein(CRP)levels,but inversely with C3 levels.Conclusion: Serum IL-34 could be a candidate biomarker for SLE as the elevated serum levels in treatment-naive SLE patients and its association with SLE disease activity.

ObjectiveTo investigate clinical effect of eradication of helicobacter pylori in patients with idiopathic thrombocytopenic purpura(ITP). Methods145 cases with HP-positive ITP paitients were divided into two groups( platelet counts results ＜ 50 × 109/L and platelet counts results ＞ 50 × 109/L). 95 cases with platelet counts ＜50 × 109/L were divided into two groups and treated with prednisone and Hp eradication(48 cases) or with prednisone without Hp eradication(47 cases). 95 cases with platelet counts ＞ 50 × 109/L were divided into two groups and treated with Hp eradication 25 cases)or follow-up without any treatment(25 cases). ResultsThe total effective rate in group treated with prednisone and Hp eradication was significantly higher than that in group with prednisone without Hp eradication( 92％ vd 75％, x2 ＝ 5.01 ,P ＜ 0.05 ). The recurrence rate in two year in group treated with prednisone and Hp eradication was significantly lower than that in group with prednisone without Hp eradication( 19％ vs 49％,x2 ＝ 9. 69, P ＜ 0. 01 ). HP eradicatiaon single can improve platelet counts in HP-positive ITP paitients.ConclusionThe detection and eradication of H pylori infection should be considered in patients with ITP. H. pylori eradication could be used for initial treatment in HP-positive ITP paitients.

Objective To evaluate the clinical efficacy of transcatheter hepatic arterial thermo-chemotherapy and thermo-lipiodol embolization in the treatment of hepatic metastases from colorectal carcinoma.Methods Sixty-eight cases with hepatic metastases from colorectal carcinoma were equally and randomly divided into two groups.The patients in study group were treated with transcatheter hepatic arterial thermo-chemotherapy and thermo-lipiodol embolization,while the patients in control group were treated with conventional(normal temperature) transcatheter hepatic arterial chemotherapy lipiodol embolization.Results The effective rate of study group and control group was 65%(22 / 34) and 32%(11 / 34) respectively,the difference between two groups was statistically significant(P

Objective To investigate the expression levels of serum CCL17 in patients with rheumatoid arthritis(RA),so as to explore its clinical sig?nificance. Methods The expression of serum CCL17 was measured by ELISA in 40 RA patients and 20 normal individuals. The correlation of se?rum levels of CCL17 with clinical active index was analyzed. Results The serum level of CCL17 in RA patients was significantly higher than those in normal controls(P<0.05). Serum CCL17 level in patient with advanced disease(DAS28≥5.1)was higher than those in medium disease activity group(3.2≤DAS28<5.1)(P<0.05). The serum level of CCL17 in RA was obviously correlated with CRP,anti?CCP,the count of PLT(P<0.05). Conclusion High level of CCL17 expression was found in serum of RA patients. Our results also proved that serum level of CCL17 has certain cor?relation with disease activity index in RA patients,which indicates CCL17 may be involved in the process of the pathogenesis and progression of RA.