The hardcore of clinical medicine program education is to insist on improving the students'practical capability.The efficient methodology is the key to it.In this paper,the authors investigate the practice of Suzhou University and try to find out the ways to assess the graduates in this program.Also,the authors point out the deficiency in the assessment and put forward mending measures in order to improve the quality of clinical medicine graduate program education.

The syndrome of inappropriate antidiuretic hormone secretion ( SIADH ),characterized with dilutional hyponatremia,is the most frequent pathophysiology of euvolemic hyponatremia in hospital inpatients.Conventional therapies for SIADH include fluid resriction,saline infusion,and some pharmacologic adjustments of fluid balance.For various reasons,conventional therapies show poor efficiency.Vasopressin receptor antagonist,a new class of pharmacologic agent,can directly block vasopressin-mediated receptor activation and target underlying pathophysiology of SIADH.

A reninoma is a renal juxtaglomerular cell apparatus tumor that produces excessive amounts of renin,resulting in secondary hyperaldosteronism,and associated hypertension and hypokalemia.It is a rare form of secondary hypertension and occurs mainly in young adult females.Common symptoms include headache,nocturia,polyuria,polydipsia,and fatigue.Imaging examination and selective renal vein sampling has been the traditional method of localizing the tumour.The diagnosis should be considered in all patients with hypertension and hypokalemia and no evidence of primary hyperaldosteronism and renal artery stenosis.Reninoma represents a surgically correctable cause of hypertension.

Objective To clarify insulin resistances and pancreatic ?-cell hypofunctions in cases with different glucose tolerance. Methods 5523 Chinese underwent OGTT and were classified into normal glucose tolerance (NGT), isolated impaired fasting glucose (IFG), isolated impaired glucose tolerance (IGT), IFG with IGT (IFG+IGT) and type 2 diabetes mellitus (T2DM) groups based on OGTT results. HOMA-IR, HOMA-?△I30/△G30and AUCI of different groups were statistically analyzed by SPSS12.0. Results Compared to NGT group, HOMA-IR was increased by 41%, 19%, 47% and 69% respectively in IFG, IGT, IFG+IGT and T2DM groups (all P

Objective To investigate the TNF-? expression in hepatic tissue of Otsuka Long-Evans Tokushima Fatty(OLETF) rats(an insulin resistance model) with abnormalities of glucose-lipid metabolism and effect of metformin on TNF-? expression.Methods OLETF rats were randomly assigned to two groups(OLETF and OLETF/M).The OLETF/M group was treated with metformin [100 mg/(kg?d)],the OLETF group and age-matched LETO(nondiabetic Long-Evans Tokushima Otsuka rats) group were fed with placebo.Twenty-two weeks after treatment,we analyzed hepatic triglyceride level and measured expression of TNF-? by western-blot(protein) and quantitative RT-PCR(mRNA).Results Twenty-two weeks after treatment,the level of fasting glucose,insulin,triglyceride,free fatty acids(FFA) and hepatic triglyceride increased significantly in OLETF group as compared with LETO group.Western-blot method showed upregulated expression of TNF-? protein in OLETF group(1.57-fold vs LETO group,P

This study was concerned about comparing the degree and process of cardiopulmonary effect of propofol and midazolam. Forty-five adult patients,ASA grade Ⅱ, scheduled for elective operation, were randomly allocated to intravenously receiving midazolam 0.28mg?kg~(-1)(group Ⅰ,n=16), 0.40mg?kg~(-1) (group Ⅱ,n=16) ,or propofol 2.5mg?kg~(-1) (group Ⅲ,n=13) ,respectively. MAP ,HR, SpO_2 ,TV ,MV ,RR and P_(ET)CO_2 were monitored continuously before and in 30 minutes following the administration ,and the arterial blood gas analysises were performed before and 1,2,3,4,5,10,15,20 and 30 minutes after the administration. The results showed that in group Ⅰ, Ⅱ and Ⅲ after the administration separately,the maximal decrease of MAP were 20.0% ,22.8% and 22.20%, and occured in 10.8, 9.3 and 3.5 minutes;HR decreased maximally by 6.3% ,8.7% and 15.5%,TV by 76.6% ,81.3% and 91.3%/00 ,MV by 87.2%,91.6% and 93.6%,RR by 60.3%,67.5% and 83.6%; the incidences and durations of apnea were 37.5%vs 57.5 seconds,31.3%vs 68. O seconds and 76.9%vs 73.0 seconds. The MV recovered to the baseline 5 minutes in group Ⅲ and more than 10 minutes in group Ⅰ and Ⅱ following the administration. The arterial blood pH reduced and PaCO_2 increased significantly in three groups (P

0.05)respectively.Conclusions:Treatment of condylar process fracture should be based on the type of the fracture.

Objective To investigate the hemodynamic and rheological effects of acute hypovolemic hemodilution with 6% hydroxyethyl starch (HES) at different infusion rates. Methods 20 ASA Ⅰ adult patients undergoing elective surgery were randomized to one of two groups with 10 patients each. The patients were premedicated with intramuscular midazolam 0.06 mg/kg and atropine 0.01 mg/kg 30 min before anesthesia. Before anesthesia an intravenous line was established and lacted ringer solution was infused at a rate of 5 ml. kg-1. h-1 . Anesthesia was induced with midazolam 0.2mg/kg , fentanyl 5μg/kg and vecuronium 0. lmg/kg and maintained with inhalation of 50 % N2O and 1% isoflurane. After tracheal intubation the patients were mechanically ventilated and PET CO2 was maintainted between 4.6-6.0 kPa.Swan-Ganz catheter was inserted via right internal jugular vein. The dorsalis pedis artery was cannulated for direct measurement of arterial pressure. 6% HES infusion rates were 10 ml.kg-1.h-1 in group Ⅰ and 20ml.kg-1 .h-1 in group Ⅱ respectively. ECG, heart rate (HR), arterial blood pressure (SBP, DBP and MAP), CO, CL, CVP, PAP, PCWP, SpO2, PET CO2 and inhalation concentrations of N2O and isoflurane were monitored before and 30, and 60 min after infusion was started. Arterial and venous blood samples were taken for blood gas analysis and rheological studies. Results The two groups were comparable with respect to demographic data. During HES infusion HR decreased and CL increased in both groups and there was no significant difference between the two groups. BP increased slightly at 60 min in group Ⅰ , whereas in group Ⅱ it tended to decrease. CVP, PAP and PCWP increased significantly in both groups especially at 60 min. Hct decreased from 36.2% ±4.5% to 30.4% ±4.1% in group Ⅰ and from 39.6%±8.0 % to 30.8% ± 5.9 % in group Ⅱ at 60 min. Hb and K value of erythrocyte sedimentation rate (ESR) equation decreased significantly in both groups especially at 60 min. Conclusions Intravascular volume expansion ismore efficient with increased infusion rate of HES but the influences on hemodynamics would be more significant. HES infused at 20 ml. kg-1 . h -1 is safe in healthy patient during operation with blood loss.[Key Words] Hemodilution; Hydroxyethyl starch; Hemodynamics; Hemorheology

[Objective]To understand the changes of children's blood lead levels and intelligence quotient (IQ) andthe effects of automobile exhaust on the prevelance rates of respiratory symptoms of children. [Methods] 151 pupilsof Y primary school in urban area were selected as exposure group, 160 pupils of Z primary school in Pudong districtwere selected as control group. The health questionaire survey and health examination were carried out amongpupils. The peripheral blood lead levels of the forth finger were determined. The IQ was determined by combinedRaven's Test. The data were statistically analzed by EPI Info and SAS statistic softwares. [Results] Significant differ-ences of blood lead levels were observed between exposure group and control group. The blood lead levels (x) negatively correlated with children's IQ (y) (y= 120. 11--0. 129x) . The prevelance rates of sore and uncomfortable feelings and foreign body sensation in throat and cough of exposure group were significantly higher than those in controlgroup. The ORs of corresponding symptoms were 1.71, 2, 64 and 2. 92 respectively. The multiple linear regressionanalysis showed that exposure to automobile exhaust and the distances from the residential region to street with heavytraffic were the main factors affecting the children's peripheral blood lead levels and the prevelance of respiratorysymptoms. [Conclusion] Further control of the emission of automobile exhaust and reasonable planning of location ofresidential areas were the main measures to control the prevelance of lead poisoning and its related diseases of children.

[Objective]To discuss the mechanism,diagnosis,and treatment of tumoral calcinosis,so as to improve the rate of diagnosis and cure.[Method]The diagnosis and cure course of 10 patients and the following visit were reviewed and analysed,at the same time the pathogeny,development,diagnosis,treatment and prognosis of TC were entirely analysed,combined with ancient literature.[Result]The symptom of pain disappeared with no recurring in all the patients followed up.[Conclusion]The focus of tumoral calcinosis which resemble tumour,always locate near to the great joint.Histopathological biopsy is necessary before operation.As curing,the focus must be excised absolutely,especially when the pedicel of the focus locate near to the bone,the nearby periosteum must be scraped,so as to avoid remnant and recuring.