To meet the challenge of the clinical teaching,the"Regulations on the Management of Clinical Teaching Practice in Medical Education"has been made and implemented, which establish the definitude responsibilities,rights and profit relations among doctors,students and the patients. Related organizations and persons should fully realize its normative significance,implementation obstacles and deepen the study of clinical teaching research,thus facilitating the enhancement of the teaching effect,and building a harmonious triangular relationship among the concerned parties.

Dioscin is the main raw material for the synthesis of steroid hormone drugs. Currently, the direct acid hydrolysis is the mainly industrial production method for dioscin. However, the use of strong acid can not only destroy the structure of dioscin resulting in very low yield, but also produce a large amount of waste water and residues, which seriously pollute the environment. So the clean production of dioscin is the urgent demand of water conservation and environmental protection. In the paper, the recent research pro-gresses in the clean production technology and process of dioscin were summarized, and the advantages and problems were discussed in order to provide reference for the improvement and application of the new technology and process.

DNA damage repair gene mutations are prevalent in advanced prostate cancer. Among these, mutations in homologous recombination repair genes could impair the ability of cell to restore the DNA double-strand break, which can be exploited by Poly-ADP-ribose polymerase (PARP) inhibitors through synthetic lethality and result in cell death. The phase Ⅲ study " PROfound" showed that the PAPR inhibitor Olaparib could significantly improve the survival of patients with homologous recombination repair gene mutations compared with novel hormone agents, starting the era of targeted, precise and individualized treatment based on genetic profile detection for prostate cancer treatment.

Objective To recognize the CT manifestations of benign metastasizing leiomyoma (BML).Methods Four cases of BML proved by pathology were retrospectively analysed.Among these, 2 cases were pulmonary BML,1 ease was leiomyomatosis peritonealis diseminata(LPD),and 1 case was combined with pulmonary BML and LPD.All of them were female,and had a history of hysterectomy,the average age were 45.The CT findings of them were analyzed.Results The CT of pulmonary BML in three cases showed multiple rounded,well-defined discrete nodules,0.2—2.0cm in diameter,random distribution,and no calcification in the nodules.No hilum or mediastinum lymphadenopathy,and no pleural effusion.There were no enhancement after intravenous contrast examination.The CT findings of LPD in two cases were many masses around the vena cava,abdominal aorta and/or iliac artery.The masses were 4— 5cm in diameter with smooth margin and homogeneous density.No lymph node or ascites were found.One case who got intravenous contrast enhanced CT scan showed significant enhancement of the lesions;another case who got PET CT study showed no significant tracer concentration.Conclusion When multiple metastasizing nodular lesions with sharp margin and homogeneous density were found in the lungs or abdomen,they should be considered the possibility of BML in women with hysterectomy history.

OBJECTIVETo study the effect of Modified Dachengqi Decoction (MDD) as whole course therapy on mediators of inflammation in severe acute pancreatitis (SAP) model rats, and to compare interventional advantages over intestinal mucosal barrier (IMB) of SAP rats between whole course therapy of MDD and early stage therapy of MDD.

METHODSTotally 190 SD rats were divided into five groups according to random digit table, i.e., the sham-operation group, the model group, the octreotide (OT) group, the early stage MDD treatment group, the whole course MDD treatment group, 38 in each group. SAP models were established with retrograde injection of 5% sodium taurocholate into the pancreaticobiliary duct. Three hours after modeling normal saline (NS) was administered to rats in the sham-operation group and the model group by gastrogavage, once per 12 h.1.35 µg/100 g OT was subcutaneously injected to rats in the OT group, once every 8 h. 0.4 mL/100 g MDD was administered to rats in the early stage MDD treatment group, and 6 h later changed to NS (once per 12 h).0.4 mL/100 g MDD was administered to rats in the whole course MDD treatment group, once every 12 h. The accumulative survival rate and morphological manifestations of pancreas and small intestine were observed under microscope 48 h after modeling. Pathologic scores of the pancreas and small intestine were conducted at 4, 6, 24, and 48 h after modeling. Contents of serum amylase (AMY), alanine transaminase (ALT), and TNF-α were also detected. The expression of high mobility group box protein 1 (HMGB1) in the small intestine tissue was also detected by Western blot. The positive rate of bacterial translocation in mesenteric lymph nodes (MLNs) was observed within 48 h. Correlations between serum TNF-α or HMGB1 in small intestinal tissue and pathological scores of the pancreas or the small intestine were analyzed.

RESULTSThe accumulative survival rate was 100. 0% in the sham-operation group, 79. 2% in the whole course MDD treatment group, 70. 8% in the OT group, 45. 8% in the early stage MDD treatment group, and 37.5% in the model group. At 6 h after modeling, pathological scores decreased more in the whole course MDD treatment group, the early stage MDD treatment group, the OT group than in the model group (P < 0.05). At 24 and 48 h after modeling, pathological scores of the pancreas and the small intestine decreased more in the whole course MDD treatment group and the OT group than in the early stage MDD treatment group (P <0. 05). At 6, 24, and 48 h after modeling, serum contents of AMY and ALT both decreased more in the whole course MDD treatment group, the early stage MDD treatment group, the OT group than in the model group (P < 0.05). At 48 h after modeling serum contents of AMY and ALT both decreased more in the whole course MDD treatment group and the OT group than in the early stage MDD treatment group (P < 0.05). At 6 h after modeling serum TNF-α levels decreased more in the whole course MDD treatment group, the early stage MDD treatment group, the OT group than in the model group (P < 0.05). At 6, 24, and 48 h after modeling the level of HMGB1 in the small intestinal tissue decreased more in the whole course MDD treatment group, the early stage MDD treatment group, the OT group than in the model group (P < 0.05). Of them, HMGB1 levels at 24 and 48 h were lower in the whole course MDD treatment group and the OT group than in the early stage MDD treatment group (P < 0.05). The number of MLNs bacterial translocation at 48 h after modeling was lower in the whole course MDD treatment group and the OT group than in the early stage MDD treatment group and the model group (P < 0.05). Serum TNF-α contents within 6 h were positively correlated with pathological scores of pancreas (r = 0.579, P < 0.01). ROC curve showed that serum TNF-α contents could predict the severity of SAP (ROC = 0.990, 95% Cl: 0.971 to 1.000). HMGB1 in the small intestine was positively correlated with pathological scores of the small intestine (r = 0.620, P < 0.01).

CONCLUSIONSEarly stage use of MDD could effectively reduce the release of TNF-α, while whole course use of MDD could effectively inhibit the expression of HMGB1. The latter could preferably attenuate injuries of the pancreas and the small intestine, lower MLNs bacterial translocation, and elevate the survival rate.

Animals ; Bacterial Translocation ; Drugs, Chinese Herbal ; pharmacology ; therapeutic use ; HMGB1 Protein ; Intestinal Mucosa ; drug effects ; Octreotide ; Pancreas ; Pancreatitis ; drug therapy ; Plant Extracts ; pharmacology ; therapeutic use ; Rats ; Rats, Sprague-Dawley ; Taurocholic Acid ; Tumor Necrosis Factor-alpha

This study aims to investigate the preparation process and in vitro release behavior of artesunate polylactic acid microspheres, in order to prepare an artesunate polylactic acid (PLA) administration method suitable for hepatic arterial embolization. With PLA as the material and polyvinyl alcohol (PVA) as the emulsifier, O/W emulsion/solvent evaporation method was adopted to prepare artesunate polylactic acid microspheres, and optimize the preparation process. With drug loading capacity, encapsulation efficiency and particle size as indexes, a single factor analysis was made on PLA concentration, PVA concentration, drug loading ratio and stirring velocity. Through an orthogonal experiment, the optimal processing conditions were determined as follows: PLA concentration was 9. 0% , PVA concentration was 0. 9% , drug loading ratio was 1:2 and stirring velocity was 1 000 r x min(-1). According to the verification of the optimal process, microsphere size, drug loading and entrapment rate of artesunate polylactic acid microspheres were (101.7 +/- 0.37) microm, (30.8 +/- 0.84)%, (53.6 +/- 0.62)%, respectively. The results showed that the optimal process was so reasonable and stable that it could lay foundation for further studies.
Artemisinins ; chemistry ; Calibration ; Drug Compounding ; methods ; Lactic Acid ; chemistry ; Microspheres ; Polyesters ; Polymers ; chemistry ; Polyvinyl Alcohol ; chemistry

OBJECTIVETo evaluate clinical outcomes of fixation for the treatment of radial head fracture with collapse of anterior articular surface.

METHODSFrom March 2006 to January 2013,17 patients with radial head fractures with collapse of anterior articular surface were analysed. According to the Mason classification, there were 12 cases with Mason type II fractures and 5 cases with Mason type III fractures. All the patients were treated with open reduction through posterolateral entrance of elbow joint and Herbert or titanium cannulated screw internal fixation.

RESULTSAll the patients were followed up, and the duration ranged from 6 to 18 months, with a mean of 11.3 months. According to the Broberg and Morrey score system, 2 patients got an excellent result, 12 good and 3 fair. There were no complications such as infection of elbow joint, nerve injury, non-union, traumatic osteoarthritis, heterotopic ossification and elbow instability. However, the postoperative activity range of elbow in the injuried side was less than that in the normal side.

CONCLUSIONRadial head fracture with collapse of anterior articular surface is easily misdiagnosed, and it can be treated with open reduction and internal fixation through posterolateral entrance.

Adult ; Aged ; Elbow Joint ; physiopathology ; Female ; Follow-Up Studies ; Fracture Fixation, Internal ; methods ; Humans ; Male ; Middle Aged ; Radius Fractures ; physiopathology ; surgery ; Range of Motion, Articular

Objective To investigate the treatment effection of cranial decompression under temporal muscle in very-low position with large bone flap for severe cranial trauma.Methods 53 cases of severs cranial traumatic brain herniation were derided into two groups.22 cases with unilateral dilated pupil,and 31 cases of bilateral dilated pupil,all the patients were treated with cranial decompression under temporal muscle in very low position with large bone-flap.The ICP,appearance rate of cisternal,pupil contraction rate and GCS evaluation were observed,recorded and statistiely analysised.Results According to the intraeranial pressure monitoring,the rate of 24h ICP＜20mmHg was increased significantly,and the rate of 72h ICP＞40mmHg was decreased in both groups.The occurance rate of cisternal:81.82% in unilateral dilated pupil group,and 51.61% in bilateral dilated pupil group.The recoverance rate of pupil in 24h:77.2% in unilateral dilated pupil group,and 32.26% in bilateral dilated pupil group.GCS evaluation:All of the patient's average mark of GCS after operation wag(8.02±3.03)which increased(3.92±2.21)compared with the mark of GCS before operation,which was(4.10±0.82),with a significant difference(P＜0.01).Treat outcome:well/moderate disability:64.15%,severe/long-term coma:7.55%,and death:28.30%.Conclusion Cranial decompression under temporal muscle in very-low position with large bone-flap for severe cranial trauma can enlarge the cranial capacity effectively,increase the decompression space in dorsolateral cranium,which can alleviate the intracranial pressure in axial centre of brain truak,promote the effeetion of the brain herniation restore and the recover of the brain trauma.

Objective To identify the risk factors of Burkholderia cenocepacia associated nosocomial lower respiratory tract infections (NLRTIs),and to investigate the drug resistance of Burkholderia cenocepacia strains.Methods A total of 138 patients with Burkholderia cenocepacia associated NLRTIs and 40 patients with non-Burkholderia cenocepacia associated NLRTIs were enrolled in the study.All patients were collected from the Second Affiliated Hospital of Wenzhou Medical University during January 2009 and December 2012.Clinical data and results of drug sensitivity tests were retrospectively reviewed.Chi-square test and Logistic regression analysis were performed to identify the risk factors of Burkholderia cenocepacia associated NLRTIs.Results Logistic regression analvsis showed that combination use of 2 or more antimicrobial agents,mechanical ventilation,stay in intensive care unit (ICU) for more than two weeks,use of antacid H2 antagonist and deep venous puncture were the independent risk factors of Burkholderia cenocepacia associated NLRTIs (OR =6.315,5.957,5.254,4.585 and 2.017,P ＜0.05).Burkholderia cenocepacia strains were sensitive to levofloxacin,ceftazidime and sulfamethoxazole; More than 40％ strains were resistant to cefotaxime,ceftriaxone,cefepime,aztreonam and tetracycline; And nearly 100％ strains were resistant to gentamicin,amikacin and tobramycin.Conclusion Burkholderia cenocepacia associated NLRTIs are more likely to occur in patients with combination use of 2 or more antimicrobial agents,mechanical ventilation,and those who stay in ICU for more than two weeks,or received antacid and deep venous punctures,and most Burkholderia cenocepacia strains are multiple drug resistant.

Objective To study the surgical techniques of the extended subfrontal epidual approach to resect chordoma in skull base.Methods 18 cases of chordoma in skull base treated mierosurgically were analyzed retrospectively.Results Total resection were achieved in 15 patients(83%),gross resection in 3 patients(17%).There was no complication in all cases.Conclusion The microsurgery for chordoma in skull base via the extended subfrontal epidual approach is of the benefits such as clear and wide fields of vision,and minimize brain trauma.Lumber drain placement and the skull base reconstruction could improve the rate of total tumor removal and reduce complications.