Examination reform was explored in Introduction to clinical medicine, and a new evaluation system was constructed which included the combination of formative assessment and sum-mative assessment as well as content system, operation system and monitoring system. The feedback mechanism of formative assessment was put into a full use to improve the teaching effect in this new evaluation system. At the same time, the method of summative assessment was substituted from the traditional closed-book exam to literature translation and presentation carried out by groups. The com-bination of summative assessment and formative assessment could evaluate the teaching efficiency of introduction to clinical medicine more comprehensively and objectively. In addition, it played an ac-tive role in improving students' comprehensive ability and their learning enthusiasm.

Objective To study the effect of platelet-derived growth factor(PDGF)and lysosomes on lung injury in macaque with early-phase endotoxie shock.Method Eleven macaques were randomly divided into two groups,namely,control group(Co group,n=5)iand endotoxic group(En group,n=6).The macaque of the Co group injected with 1 ml/kg normal saline and the macque of the En group received a dose of 2.8 mg/kg Lipopolysaccharides(LPS)i.v.The blood gas was detected at 120 minutes after LPS challenging. Uhrastructure,cytochemistry of acid phosphatase(ACPase)detection by electronic microscopy and immunohistochemical assay of PDGF were completed in hmgs of all the macaque .Results Administration of LPS did not change the parameters of gas exchange,namely,PaO_2,PaO_2/Fi and PaCO_2.In the early phase,of endotoxic shock,ACPase activity products increased and lysosome destroyed in the alveolar cells.The pathologic changes of alveolus,such as degeneration of vessel endothelium,injury of alveolar epithelium and damage of basement membrane,and transudation of blood component were observed by electron microscopy in the En group. However,no pathological changes were found in the control group.By immunohistochemical staining,PDGF on alveolar wall in the En animals was observed,whereas no PDGF protein in the Co macaques was noticed. Conclusions Administration of LPS induced the expression of PDGF in the alveolar wall and lysosome injury in the alveolar cells,as a result of alveolar damage in early-phase endotoxin shock.In the meantime,the parameters of gas exchanges did not change.The PDGF may play an important role in the pathogenesis of lung during the early-phase of endotoxin shock.

Objective To explore the effectiveness and safety of the improved preoperative guidance on bowel preparation in elderly patients undergoing colonoscopy .Methods One hundred and twenty elderly patients undergoing colonoscopy were randomly divided into the observation group and the control group , each with 60 cases.The patients all received the non-residue diet three days before examination , liquid diet at the dinner one day before examination , fasting at the day of examination , and the sodium phosphate oral solution as the purgation medicine .The observation group received the improved preoperative guidance , and the control group received the conventional preoperative guidance .The quality of bowel preparation , the incidence rates of adverse reactions including nausea and vomiting , and the variabilities in blood pressure , heart rate and respiration were observed .Results The cases of patients who were pleased with the quality of bowel preparation were 53 cases in the observation group , and were significantly higher than 40 cases in the control group , and the difference was statistically significant (χ2 =8.0765, P <0.01 ).The incidence rates of adverse reactions including nausea and vomiting in the observation group were significantly lower than those in the control group , and the differences were statistically significant (χ2 =11.116 6, 13.330 8, 10.108 6, 7.529 4, respectively;P<0.01).No differences were found in the blood pressure , heart rate and respiration before the examination in two groups (P>0.05);The blood pressure, heart rate and respiration in the observation group were lower than those in the control group after the examination, and the difference was statistically significant (P<0.01). Conclusions The improved preoperative guidance is more effectiveness and safety in bowel preparation in elderly patients with colonoscopy , and has important clinical significance .

Objective To design a device for the patients with amyotrophic lateral sclerosis (ALS), who are disable to speak and move, to call for the nurses independently when necessary. Methods The electroencephalographic signals were collected and processed with TGAM, and the extracted attention characteristic values were transmitted to a computer with Bluetooth. The loudspeaker would call the nurses when the attention characteristic value exceeds the normal range. Results In the testing process of 20 participants in 10 tests, the success rate was 81.5%, and the average misjudged frequence was 0.2 within 20 min. Conclusion The device can be used in the nursing of the patients with ALS to meet the needs of daily nursing work.

Objective To analyze the perioperative mortality,stroke rates and late benefits of carotid artery stenting for the treatment of unilateral severe stenosis of carotid artery with contralateral obliteration in a single medical center.Methods Clinical data of 38 cases were analyzed retrospectively,including postoperative period and follow-up.Results The technical success rate was 100％ ( 38/38 )with no peri-operative 30-day mortality or ischemic stroke.The overall peri-operative complication rate was 34.2％ ( 13/38),including transient ischemic attack (TIA) in 5.3％ (2/38).The average follow-up time was ( 29 ± 13 ) months with follow-up rate of 86.8％ ( 33/38 ).The mortality was 0 and the overall complication rate was 12.1％ (4/33),including TIA in 6.1％ (2/33).No patients had recurrent stroke.Twenty-three cases underwent whole brain CT perfusion evaluation before and after the therapy.A significant improvement of the perfusion parameters was observed in the stenotic side after CAS.Conclusions CAS contralateral to an occluded carotid artery can be performed with acceptable perioperative mortality and stroke risk rates,as well as a satisfactory long-term beneficial effect in stroke prevention.

Objective To evaluate the clinical characteristics and surgical treatment of renal stenosis resulting from fibromuscular dysplasia ( FMD ). Methods 16 cases from 1998 to 2011 were reviewed,the average age was (28 ± 13 ) years old. Among them, all patients suffered refractory hypertension and only one presented renal dysfunction. Aorto-renal bypass was performed in 2 cases.Resection and reconstruction was performed in 2 cases,balloon angioplasty in 10 and stent implantation in 3.Results There was 1 death peri-operatively.13 out of 15 cases were followed-up with no death.Significant decline of blood pressure [ (134 ± 14 )/( 83 ± 8 ) mm Hg vs.( 151 ± 17 )/( 96 ± 16 ) mm H g ( P ＜ 0.01 ) ]and 100％ effective rate were observed.The creatine level were preserved after surgical treatment [ (61 ±22) μmol/L vs.(69 ± 22) μmol/L,(P ＞ 0.05 ) ] with 4 cases improved and the other 9 stable.12 patients received ultrasound surveillance with only one case of 20％ restenosis. Conclusions Renal stenosis due to FMD are most common in children and the youth with hypertension as major presentation. Balloon angioplasty is the first choice of surgical treatment with positive efficacy.

Objective To retrospectively analyze the geometrical characteristics of abdominal aortic aneurysms undergoing endovascular treatment in a single medical center.The long-term effects as well as the strategies for the prevention and treatment of complications have been reviewed.Methods From January 2003 to December 2010,clinical data and geometrical parameters of 344 cases undergoing endoluminal repair of abdominal aortic aneurysms were analyzed retrospectively.Results The diameter and length of proximal neck was (23 ± 3 )mm and ( 26 ± 12) mm respectively.The angle between the neck and the abdominal aortic aneurysm was (25 ± 28) degree.The surgical success rate was 99.7％.The average follow-up time was 32.9 months (3 -84 months) with follow-up rate 81.8％ (279/341).The mortality was 1.1％ (3/279),the re-intervention rate was 10.4％ (29/279) and the overall complication rate was 12.9％ ( 36/279),including endoleak of 5.7％ ( 16/279 ),stent-graft migration of 1.1％ ( 3/279 ),aneurysm expansion or rupture of 5.4％ ( 15/279 ),and other complications like limb occlusion.Severe infrarenal aortic neck angulation ( ＞ 60 degree) was associated with type Ⅰ endoleak ( P =0.010 ).Conclusions A careful preoperative case selection and evaluation is the key for a successful endovascular aneurysm repair.Endoleak continues to be the major long-term complication of the endoluminal grafting technique,and the major cause for re-intervention.Life-long follow-up is extremely important.

OBJECTIVETo investigate the clinical applications of portable spirometry in asthma.

METHODSTwenty patients with asthma were recruited from Peking Union Medical College Hospital. Flow-volume loop, simultaneous asthma symptoms, and mood were monitored three times a day for consecutive 14 days.

RESULTSIn patients with a normal daytime spirometry, marked decline of forced expiratory volume in one second (FEV1) and peak expiratory flow (PEF) were observed at night and/or in the early morning. A within subject correlation analysis between FEV1, PEF, and asthma symptoms showed that the correlation between symptoms and airway obstruction was found only in seven out of twenty patients (35%). Four patients (20%) reported many symptoms with nearly normal portable spirometry. Accordingly, their symptoms were not correlated with FEV1 and PEF. This group of patients was defined as over-perceivers. On the contrary, another two patients (10%) did not report any symptoms while obvious airways obstruction was recorded by a portable spirometry. These patients were defined as under-perceivers.

CONCLUSIONSDynamic monitoring of flow-volume loop with a portable spirometry is more accurate than routine lung function test in assessment of asthma severity. In addition, combined with simultaneous monitoring of symptoms, it would be of particularly helpful in identifying two specific types of asthma patients, e.g. over-perceivers and under-perceivers.

Adolescent ; Adult ; Asthma ; physiopathology ; Female ; Forced Expiratory Volume ; Humans ; Male ; Middle Aged ; Peak Expiratory Flow Rate ; Spirometry ; instrumentation ; methods

[Objective]To investigate the relationship between clopidogrel response , early neurological deterioration and CYP2C19 gene polymorphism in sICAS patients.[Methods]116 sICAS patients were divided into deterioration group and non-deterio?ration group by whether appear early nervous function deterioration. Record included the baseline data,the genotypes of CYP2C19, platelet maximum aggregation rate after 7 days of given clopidogrel,CYP2C19 genotype and clopidogrel reaction were compared be?tween two groups.[Results]The deterioration group combination with diabetes ,stroke/TIA were significantly higher than the non-de?terioration group(P<0.05);The frequency of CYP2C19*2 AA genotype and A allele were significantly higher than those in non-dete?rioration group. The frequency of GG genotype were significantly lower than non-deterioration group (27.27% vs 2.13%,50.00% vs 14.84%,27.27% vs 72.34%)(P<0.01);The poor metabolic genotype platelet maximum aggregation rate were significantly higher than that of the fast-metabolic genotype and middle metabolic genotype(P<0.01,P<0.05),Middle metabolic genotype platelet maxi?mum aggregation rate were significantly higher than fast-metabolic genotype(P<0.01);The deterioration group fast-metabolic geno?type were significantly lower than non-deterioration group ,poor metabolic genotype were significantly higher than non-deterioration group(22.73% vs 65.96%,36.36% vs 5.32%)(P<0.01);Clopidogrel resistance rate 59.09% were significantly higher non-deteriora?tion group 28.72%(P<0.05).[Conclusion]Clopidogrel response and early neurological deterioration in sICAS patients is associatedwith CYP2C19 gene polymorphism.

Objective To probe into the pre-operative design and the operative approach dealing with anastomotic vein and superior sagittal sinus in patients with large meningiomas in the sagittal sinus and falx cerebri. Methods Thirty-five patients with large meningiomas in the sagittal sinus and falx cerebri, admitted to our hospital from January 2001 to December 2010, were chosen; their clinical data were analyzed retrospectively. The resection of the tumors by microsurgery (total or subtotal resection) was performed and intraoperative effective management of the sagittal sinus and falx cerebri was done. Results Resection was performed in these 35 patients, including Simpson grade Ⅰ in 21(60.0％), grade Ⅱ in 12 (34.2％), and grade Ⅲ in 2 (5.7％). Skull defect was noted in 5 patients. Unilateral　paralysis of limbs (muscle strength grade Ⅰ-Ⅳ) in 5; paralysis of both lower extremities (muscle strength grade Ⅰ-Ⅱ) in 1; good results were achieved after 1-6 months of hyperbaric oxygen, acupuncture and physiotherapy. During the follow-up period for 6 to 24 months, the tumor recurred in 2 with Simpson Ⅲstage resection (5.7％). Conclusion Designing a detailed pre-operative design according to the MRI,MRA, DSA and CTA, application of microsurgical techniques, avoidance of damage to the cerebral cortex and veins of central suleus and protection of the sagittal sinus are important factors that increase the success rate of surgical resection, reduce complications, prevent the tumor recurrence and improve the survival outcome in patients with parasagittal meningiomas.