Objective To evaluate the assessment index system of internal medicine, and to analyze the factors of practical effects on internal medicine. Methods The assessment index system of clinical skills was developed by expert group based on the clinical syllabus and objectives. Internal medicine index system was divided into four items such as history-taking, physical examination, hos-pital records and case questions. 49 five-year clinical interns who took internal medicine exams were researched. Reliability, validity, discrimination, difficulty were used to analyze the quality of assess-ment index system. Gender, teaching hospital and the preparation of postgraduate examination were used to explore the influencing factors of practical effects with independent t-test and Wilcoxon signed rank tests. Results The reliability, discrimination, difficulty of the assessment index system were 0.50, 0.15 and 0.85, respectively. The removing item coefficient of history collection, physical ex-amination, hospital records, case questions were 0.38, 0.26, 0.47 and 0.53, separately, and the discrimination were 0.18, 0.17,0.27 and 0.37, separately, and the difficulty were 0.87, 0.89, 0.79, and 0.78, respectively. The scores of assessment index system of girls were higher than those of the boys(P<0.05). Moreover, the girls scored higher in history collection and physical examination, compared with the boys(P<0.05). The discrepancy scores were not statistically significant among teaching hospitals (P>0.05). The students who prepared the postgraduate examination scored lower than the others(P<0.05). Conclusions The assessment index system of internal medicine is reason-able and reliable, but the assessment of case questions still needs to be standardized. Teaching hospi-tals have little effect on internship while gender and the preparation for postgraduate examination influence practice effects in internal medicine.

Objective To evaluate clinical value of double contrast-enhanced ultrasonography(DCUS)in diagnosing gastric stromal tumors(GST). Methods The medical records of 26 patients with a histological diagnosis of GST were retrospectively reviewed. The correlation between DCUS features and pathological findings of the lesions was compared. Results Total 26 cases of GST were divided into low risk group( 16 cases) and high risk group (10 cases). The size,contour,liquefactive necrosis and enhancement distribution of lesions were markedly correlated with the pathobiologic behaviour of the tumor ( P ＜0.05). There was no significant difference in border and metastasis of lesions between two groups( P ＞0.05). It was shown that DCUS supplied statistically significant improvement in the localization diagnosis and detection of liquefactive necrosis versus oral contrast-enhanced ultrasonography ( P ＜ 0.05 ). Conclusions DCUS is considered as a valuable tool in diagnosing location as well as pathobiological behaviour of GST. It can provide the guidance and reference comments for treatment algorithms.

Aim To investigate the protective effects of chrysophanol( Chry) on immune function of lead poi-soning mice. Methods The lead poisoning model was established by peritoneally injecting mice with 7 mg · kg-1 lead acetate every day for 8 days. After Chry was ip injected for 14 days,spleen and thymus index, the white blood cell count, T, B lymphocyte proliferation, phagocytic function of macrophages, natural killer cell ( NK cell) activity were detected. The concentrations of IFN-γ,IL-2,IL-4,IL-10 in the lead poisoning mice ser-um were determined by enzyme-linked immunosorbent assay ( ELISA) . Results Intraperitoneal injection of 7 mg · kg-1 lead acetate for 8 consecutive days could cause an immunity decline in lead poisoning mice, Chry could significantly improve the immunity of lead poisoning mice. Compared with model group, Chry sig-nificantly improved growth rate, viscera index and white blood cell count of lead poisoning mice at differ-ent extent ( P<0 . 05 or P<0. 01 ) . Chry ( 1 . 0 ,10 . 0 mg·kg-1 ) significantly increased the B,T lymphocyte proliferation ( P<0 . 01 ) and the phagocytosis of macro-phage and NK cell activity ( P <0 . 01 ) . Compared with the control group, the concentrations of IFN-γ, IL-2 , IL-4 , IL-10 of lead poisoning mice serum were significantly reduced ( P <0 . 01 ) . Compared with the model group, Chry (1. 0、10. 0 mg·kg-1 ) significant-ly increased the concentrations of IFN-γ, IL-2 , IL-4 , IL-10 ( P <0. 01 ) , while there were no significant changes in (0. 1 mg·kg-1 ) concentrations of IFN-γ, IL-2 , IL-4 in Chry ( 0 . 1 mg · kg-1 ) treatment group ( P>0. 05 ) , only IL-10 was significantly increased in Chry ( 0 . 1 mg · kg-1 ) treatment group ( P<0 . 05 ) . Conclusion Chry can significantly improve the im-mune function of lead poisoning mice.

Twenty-three patients with pain from osteoporotic vertebral fractures,aged 65-90 yr,weighing 51-78 kg,received an image intensifier-assisted nerve-root block with a 6-8 ml mixture of 0.5 ％ lidocaine,mecobalamine 0.5 mg and betamethasone sodium phosphate injection 5.26 mg in a prone or lateral position.The VAS scores before operation,at 0,1 week,1 and 3 months after operation were 8.6 ± 0.9,1.5 ± 0.7,2.8 ± 0.9,1.6 ± 0.5 and 2.5 ± 0.7,respectively.VAS scores were significantly lower at each time pint after operation than before operation (P ＜ 0.05).According to modified MacNab standard,the effectiveness of treatment was rated as excellent/good in 87％ of the patients.No complication such as bleeding,hematoma,infection,pneumothorax,hemopneumothorax,headache was found during or after operation.Selective nerve-root block is effective in the treatment of pain resulting from osteoporotic vertebral fractures in patients.

Objective To determine the frequency of T helper type 22 (Th22) cells and expression level of interleukin-22 (IL-22) in peripheral blood of patients with psoriasis vulgaris,and to investigate their relationship with disease severity and clinical course.Methods Peripheral blood samples were obtained from 40 patients with psoriasis vulgaris and 30 healthy human controls.Five-color flow cytometry was performed to determine the percentage of Th22 cells in peripheral blood,and enzyme-linked immunosorbent assay (ELISA) to measure the expression of serum IL-22.Statistical analysis was carried out by t test and Pearson correlation analysis.Results Both the percentage of Th22 cells and serum level of IL-22 in peripheral blood were significantly higher in patients with psoriasis vulgaris than in healthy human controls (Th22 cells:0.65％ ± 0.48％ vs.0.33％ ± 0.15％,t =3.89,P ＜ 0.01; IL-22:(67.96 ± 14.32) vs.(40.59 ± 9.91) ng/L,t =9.45,P ＜ 0.01).Further more,Th22 cell percentage and IL-22 serum level in peripheral blood were both positively correlated with psoriasis area and severity index (PASI) in these patients (r =0.38,0.94,P ＜ 0.05 and 0.01,respectively),but neither of them correlated with clinical course of psoriasis vulgaris (r =0.20,0.10,respectively,both P ＞ 0.05).Conclusions The percentage of Th22 cells and level of IL-22 are increased in peripheral blood of patients with psoriasis vulgaris,and both of them are correlated with disease severity.

Objective:To study the biomechanical basis of swan like memory compressive connector (SMC) for treating fractures and nonunions, and the facilitating effects of dynamic memorial stress of SMC for bone healing. Methods:By computer emulation and three dimensional (3D) finite element analysis, the biomechanical behavior of humeral type connector for fixing humerus was emulated and analyzed. The finite element model of humeral type connector was divided into 3 487 units. The number of nodes was 5 397. The element was a unit with 20 nodes, 4 faces. The finite element model of humerus was divided into 5 783 units, the number of nodes was 9 863. And the finite element was a 3D unit with 10 nodes, 4 faces.Results:When the connector fixated humerus, it came in for tension stress in its inner surface, and compressing stress in its outer surface. The maximum first structural major stress of metamorphosed compressive part was 224.5 MPa and -34 MPa, far less than its utmost stress and fatigue limit. The initiative memorial bone holding force for maintaining axial stability was 125.05 N, and the longitudinal initiative memorial compression force was 196 N. The stress distribution in fixed humerus was even, the stress in most nodes was positive stress. Conclusion:The SMC has good anti fatigue and reuse characters. The dynamic memorial compressive stress field is good for the stability of fixation and enhancement of bone healing.

AIM:To study the effects of adiponectin on H 2 O2-induced cell injury and tau hyperphosphorylation in human neuroblastoma SH-SY5Y cells.METHODS:Cell viability was determined by MTT assay .H2 O2-induced cell in-jury and morphological changes in the SH-SY5Y cells with or without adiponectin treatment were observed .The level of tau phosphorylation as well as the activities of protein phosphatase 2A (PP2A) and of glycogen synthase kinase-3β(GSK-3β) were examined by Western blotting . RESULTS: Adiponectin significantly attenuated H 2 O2-induced cell injury (P<0.01).Adiponectin upregulated the activity of PP2A and decreased phosphorylation levels of tau under the stimula-tion with H2O2(P<0.01).Okadaic acid, a specific inhibitor of PP2A, blocked the protective effects of adiponectin (P<0.01).Adiponectin increased the phosphorylation level of GSK-3βat Ser9 site under H2O2stimulation (P<0.01).CON-CLUSION:Adiponectin protects SH-SY5Y cells against H2O2-induced cell injury and decreases tau hyperphosphorylation by activating PP2A and inactivating GSK-3β.

Objective To explore the influence factors of poor myocardial perfusion in patients with ST-segment elevation myocardial infarction( STEMI) after primary percutaneous coronary intervention(PCI). Methods One hundred and forty-three patients with first STEMI who were on admission from April 2010 to May 2014 and underwent primary PCI within 12 hours were enrolled as our subjects. According to the sum-ST-segment resolution(sumSTR)and TIMI myocardial perfusion grade(TMP)after primary PCI,all patients were divided into well myocardial perfusion group( sumSTR ≥ 50% or TMP 2 - 3 grade)and poor myocardial perfusion group(sumSTR < 50% and TMP 0 - 1 grade). The influence factors between two groups were collected and analyzed,including sex,age,pain to balloon time,blood pressure on admission,left ventricular ejection fraction,leucocyte count,neutrophil ratio(NR),high-sensitivity C-reactive protein(hs-CRP),blood lipid,and the history of hypertension,diabetes mellitus. Results The leucocytes count,NR,hs-CRP in patients of poor myocardial perfusion group were(11. 60 ± 3. 57)× 109 / L,0. 84 ± 0. 06 and 9. 80 ± 11. 37 mg/ L,higher than those in well myocardial perfusion group((9. 51 ± 2. 59)× 109 / L,0. 77 ± 0. 11 and(3. 83 ± 5. 58)mg/ L),and the differences were significant(t = 3. 497,P = 0. 001;t = 3. 390,P = 0. 001;t = 3. 973,P < 0. 001). Multiple linear regression analysis showed that neutrophil ratio was independent risk factor of sumSTR in STEMI patient after primary PCI(P = 0. 000). Conclusion The increase of leucocyte count,NR and hs-CRP are related to the poor myocardial perfusion after primary PCI. The increase of neutrophil ratio is an independent risk factor of poor myocardial perfusion.

Objective To explore TCM syndrome and treatment regular for AIDS dementia complex (ADC). Methods Through literature retrieval, the review of medical records and clinical investigation, expert questionnaires survey was carried out. Results The recovery rate of complete questionnaires in the 1st survey was 88.89%. The agreement rate, the arithmetical mean, the weight coefficient, the mean level and the rank sum of the concept, clinical features, diagnostic criteria, syndrome differentiation and treatment of insufficiency of kidney essence, nursing, period of treatment and curative effect standard were more than others, CV<0.076. The agreement rate, the arithmetical mean, the weight coefficient, the mean level and the rank sum of the etiology and pathogenesis, syndrome differentiation and treatment of deficiency of heart and liver yin were smaller, and CV was within 0.168–0.234. The recovery rate of complete questionnaires in the 2nd survey was 96.00%. The agreement rate, the arithmetical mean, the weight coefficient, the mean level and the rank sum of the etiology and pathogenesis, syndrome differentiation and treatment of deficiency of kidney and liver were more than the 1st survey, and CV was within 0.065–0.106, which was smaller than the 1st survey. The agreement rate, the arithmetical mean, the weight coefficient, the mean level and the rank sum of syndrome differentiation and treatment of deficiency of kidney and liver were smaller, and CV was 0.156. The weight coefficient of the 1st and 2nd survey were within 0.072–0.087, 0.071–0.089. The questionnaire reliability of the 1st and 2nd survey were 0.916 and 0.886 respectively. The half reliability of the 1st and 2nd survey were 0.81 and 0.79 respectively. Conclusion TCM syndrome and treatment regular for ADC is preliminarily formed.

Objective To observe the effect of core stability training on motor function, balance and activities for children with cerebral palsy. Methods 100 children with cerebral palsy were divided into control group (n=50) and treatment group (n=50). The control group accepted routine physical therapy, occupational therapy, acupuncture, sensory integration training and conductive education; while the treatment group accepted core stability training in addition, 3 hours a day for 12 weeks. They were assessed with Gross Motor Function Measure (GMFM-88), Berg Balance Scale (BBS) and Comprehensive Functional Assessment for Disabled Children (CFA-DC) before and after treatment. Results The scores of GMFM-88, BBS and CFA-DC improved more in the treatment group than in the control group (P<0.05). Conclusion Core stability training can further promote the recovery of motor, balance and activities in children with cerebral palsy.