It is necessary for the improvement of the medical education and medical system to reform the model of clinical teaching.This article analyzes some problems of today's clinical teaching and clarifies specific demands and aims of teaching,learning and managing in the process of clinical teaching.In order to improve the quality of clinical teaching,the author puts forward some conceives about constructing the "three-in-one" system including teaching,learning and managing in clinical education.

Objective To investigate the related factors of the retinal hemorrhage in high-risk infants (HRI).Methods Eight hundred and sixty HRI with histories of high-risk pregnancy and/or neonatal asphyxia after 1-5 days of birth were enrolled in this study.In 860 cases of HRI,498 infants were vaginal delivery and 362 infants were delivered through cesarean sections.Among 498 vaginal delivered infants,407infants were eutocia and 91 infants were with forceps delivery; 298 infants were born following normal labor,102 infants experienced prolonged labor,and 98 infants were urgent birth.The retinal hemorrhages were observed and conditions were graded into three degrees of Ⅰ,Ⅱ,and Ⅲ.Conditions of neonatal asphyxia were evaluated based on criteria of Apgar score.The incidence of retinal hemorrhage in the different types of deliveries and labor processes were compared,and the relationship between degree of retinal hemorrhage and grade of neonatal asphyxia were analyzed.Results In 860 cases of HRI,retinal hemorrhages were found in 202 infants (23.5％).Within these 202 infants,75 infants (37.1％) were Ⅰdegree retinal hemorrhage,75 infants (37.1％) were Ⅱ degree retinal hemorrhage,and 52 infants (25.8％)were Ⅲ degree retinal hemorrhage.In these 202 infants of retinal hemorrhage,172 infants (85.1 ％) had histories of asphyxia; 119 infants (69.2％) were graded as mild asphyxia-risk,and 53 infants (30.8％)were graded as severe asphyxia-risk.There was a statistical difference of the degree of the retinal hemorrhage between the mild and severe asphyxia-risk infants (x2 =34.61,P＜0.01).The incidence of retinal hemorrhage after vaginal delivery was higher than cesarean section delivery with significant statistical difference (x2 =30.73,P＜ 0.01).The incidence of retinal hemorrhage after forceps delivery was significantly higher than eutocia with statistical difference (x2 =62.78,P＜0.01).Both prolonged and urgent childbirth had statistically significant higher incidences of retinal hemorrhage compared to normal labor in the process of vaginal delivery (x2＝45.86,71.51; P＜0.01).Asphyxia,types of delivery,prolonged and urgent labors were risk factors of retinal hemorrhage for HRI (r=7.46,4.87,15.03,6.47;P＜ 0.01).Conclusions The incidence of retinal hemorrhage in high-risk infant was 23.5％.And,asphyxia,types of delivery,prolonged and urgent labors may play roles of risk factor in retinal hemorrhage of HRI.

AIM: To establish a RP-HPLC for determing the contents of naringin,hesperidin and baicalin in Qingfei Huatan Pill(Arisaema Cumbile,Fructus Aurantii,Pericarpium Citrireticulatae,Radix Scutellariae,etc.). METHODS: Naringin,hesperidin and baicalin were separated on a RP C_(18) column.Acetonitrile-water(20(∶)80)(adjusted to pH 2.2 with phosphoric acid) was used as the mobile phase.The detective wavelength was set at 280 nm. RESULTS: The linear ranges were in 1.24-6.2 ?g for naringin (r=(0.999 7))、1.1-5.5 ?g for hesperidin(r=(0.999 8)) and 2.32-11.6 ?g for baicalin(r=(0.999 9)).The recoveries were 99.29% with RSD of 1.78% for naringin、100.08% with RSD of 1.44% for hesperidin and 98.76% with RSD of 1.42% for baicalin respectively. CONCLUSION: The method is simple,accurate and reproducible.It may well be used for the quality control of this product.

Objective To investigate the expression of inducible nitric oxide synthase (iNOS) in human gastric carcinoma and its relationship with angiogenesis, lymph nodes metastasi s and clinical staging of gastric carcinoma. Methods The expression of iNOS in 50 patients with gastric carcinoma was studied with im munohistochemical method. Microvessel density (MVD) of human gastric carcinoma was also determined with anti-CD34 as the labelled vascular endothelial cells. Results The rate of expression of iNOS in 50 cases of gastric carcinoma was 70.0% , and MVD averaged 22.0?9.8, higher than those in the tissues around cancer (16 .2%,6.1?3.4) and normal gastric tissues (15.0%,5.5?2.6; P

Objective To investigate the influence of Batroxobin on plasma level of lysophosphatidic acid(LPA) in patients with acute cerebral infarction.Methods A total of 61 patients with acute cerebral infarction were selecued randomly to Batroxobin group ( n=31) or control group ( n=30). Aspirin and Danshen root were used in both groups as basic treatment. Batroxobin was used in Batroxobin group for one course of treatment. The plasma levels of LPA were measured before treatment and 5th, 7th, 10th, and 14th day after treatment in both acute cerebral infraction groups, and compared with health volunteers(normal group).Results The plasma levels of LPA in both Batroxobin group and control group were remarkably higher than that in normal group(all P0.05). In Batroxobin group the plasma levels of LPA were significantly lower than that in control group at 5th, 7th, 10th, 14th day after treatment(all P

Objective To study the short-term efficacy of arthroscopic debridement,lateral patellar decompression,and rehabilitation thearpy for osteoarthritis of the knee joint,and to discuss the long-term outcomes of the treatments.Methods A total of 85 cases of osteoarthritis that were diagnosed according to the clinical diagnostic criteria of ACR were enrolled in this study.The patients were randomly divided into groups A(39 cases) and B(46 cases) to underwent arthroscopic debridement and arthroscopic debridement combined with lateral patellar decompression respectivley.All the operations were performed by a same surgeon.Postoperative rehabilitation thearpies were carried out by one group of therapist.The Lysholm,HSS,and PPI scores were evaluated before the operation,as well as patellar tilt test and patellar gliding test.The examinations were repeated in 3 and 6 months respectivley after the surgery.Results In group A,the scores of Lysholm,HSS,and PPI determined at month 3 were significantly higher than those before the operation,but not changed markedly at month 6.Whereas,in group B,the scores kept being increased after the surgery.At month 3,the scores in group A were higher than those in group B,however,at month 6,the Lysholm score in group B was higher than that in group A.Conclusions Arthroscopic debridement and postoperative rehabilitation are effective for imroving the symtoms and knee function in patients with osteoarthritis and limited ROM of the patella.Combining with lateral patellar decompression,the treatments can achieve better outcomes in 6 months.

objective: To observe the variations of stress magnitude in the cervical vertebra exerted by vertical traction force from various angles and different points. Methods: The cervical vertebra model was produced by using elastic material of light (polycarbonate) and silica rubber(1:1). By calculating the arithmetical progression of interference fringe. The author judged the stress magnitude in the posterior edge of the C4-7 vertebral bodies when different kinds of pulling force acted on. Result: The interference pattern was seen clearly on the screen while the force acted on the model. When the pulling force acted on C1 or C2, the force was acting at an angle of 150the maximum of the stress presented in C4-5 and when the force acted at an angle of 25° the maximum stress presented in C5-6 and C6-7. Conclusion: The stress distributed upon the posterior edge of the vertebral joints is closely related to the points that the force aced on and the direction of the force． Appropriate points and direction of the pull should be selected according to the change of the lesion joints when manual manipulation is used for the treatment of cervical vertebral disease.

Objective To compare the effectiveness and the influence on life quality of endovenous laser obliteration with those of traditional surgical ligation in treating varicosis of lower extremity.Methods By using numerical random grouping method,40 patients with varicosis of lower extremity were divided into traditional surgical ligation group (high ligation plus stripping,traditional group,n=20) and endovenous laser obliteration group (laser group,n=20).The curative effect and complications were compared between the two groups.According to the brief health survey (SF-36) scale,the influences of the two treatments on the life quality were evaluated.Results During the follow-up period,the differences in the curative effect and complications between two groups were not significant (P＞0.05).The life quality assessed by SF-36 scores in the laser group was better than that in the traditional group,the difference between the two groups was statistically significant (P＜0.05).Conclusion For the treatment of varicosis of lower extremity,endovenous laser obliteration is safe and effective,it carries less influence on the patient's life quality when compared with traditional surgical ligation therapy.

Objective To discuss the efficacy and complications of using AngioJet rheolytic thrombectomy in treating acute lower extremity deep vein thrombosis (DVT).Methods The clinical data of 22 patients with acute lower extremity DVT,who were treated with AngioJet rheolytic thrombectomy during the period from February 2015 to August 2016,were retrospectively analyzed.The improvement of clinical symptoms and the thrombus clearance rate were calculated to evaluate the curative effect.The procedure-related complications were documented.Results The clinical symptoms were relieved immediately after operation in all 22 patients.The thigh circumference difference between the affected side and the healthy side decreased from preoperative (4.5±0.6) cm to postoperative (1.0±0.4) cm,the difference in change was statistically significant (P＜0.05).The mean used dose of urokinase was (0.18±0.03) million unit and the average duration of thrombolysis was (4.2±0.7) hours.Complete removal of DVT (＞90％) was achieved in 19 patients,most removal of DVT (50％-90％) in 2 patients,and partial removal of DVT (＜50％) in one patient.After treatment,6 patients developed transient hemoglobinuria,which was relieved after hydration with fluid infusion on the same day.No serious complications such as pulmonary embolism or hemorrhage occurred.Conclusion For the treatment of acute lower extremity DVT,AngioJet rheolytic thrombectomy is safe and effective with less complications.

Objective To observe the effect of enhanced extracorporeal counterpulsation (EECP) on intraocular pressure (IOP). Methods 25 patients were measured their IOP bilaterally with Schoitz tonometer before and after EECP. Results The IOP decreased in both left and right eyes after EECP (P<0.01). Conclusion EECP can reduce intraocular pressure.