Objective To know about the research status of clinical teaching management and provide guidance for establishing and perfecting the clinical teaching management system.Methods We summarized the research progress on clinical teaching management at home and abroad,including clinical training mode,qualification requirement,core competence,assessment criterion and training for clinical adviser of Master of Nursing Specialist students.Results Our country has not formed a standard and unified system on clinical teaching management so far.Conclusions We should actively learn from foreign advanced management experience,combined with China's national conditions to establish clinical adviser management mechanism.

Objective:To evaluate the effects of different nutritional supports in gastric cancer patients undergoing radical resection.Methods:Sixty patients with gastric cancer were randomly divided into three groups: parenteral nutrition(PN)group,enteral nutrition(EN) group and parenteral nutrition combined with enteral nutrition(PN-EN) group.The rate of complication, recovery time of the gut function,average post-operative hospital stay,changes of liver function,levels of blood glucose,serum albumin,prealbumin and transferrin,levels of nitrogen balance and change of body weight were observed in the three groups.The therapeutic effects of post-operational nutritional support were studied.Results:There are no significant difference in the rate of complication,average post-operative hospital stay,changes of liver function and level of blood glucose.The recovery time of the gut function in EN group was shorter than that in PN and PN-EN groups(P

Thymosin ?1 is a multiple peptide of hormone and protein isolated from thymus gland,and it has many biological functions.It has been reported that it plays an important role in immune response,neuroendocrine modulation and gene expression.The article is to review the progress of thymosin ?1 and its mechanisms.

The etiology of Crohn's disease is not clear as yet,many evidences has shown that the dysfunction of the immune system is the internal cause of inflammation and tissue damage.It is identified that many immune diseases can be anticipated,monitored and therapeutic through detecting some specified serological markers.To identify some high specific sensitive and predictable markers and groups,the research of searching an ideal and non-incursive method for differentiating inflammatory bowel diseases from other disease is still undergoing.The current research of five serum immune markers that are usefulness in the diagnosis and management of Crohn's disease are summarized.

Estrogen is involved in the process of postmenopausal osteoporosis, and the main functional cells are osteoclasts. However, the mechanism of estrogen on the osteoclasts is not yet fully understood. Here we demonstrate the effects of estrogen on osteoclasts in three aspects: morphology and structure, apoptosis of osteoclasts and differentiation of preosteoclasts, which give an overall explanation for effects of estrogen on osteoclasts.

Objective To summarize the experiences in treating 30 cases of skin soft tissue defects in head and neck by applying repeated expansion, and to explore an effective and satisfactory method of massive defect repair in head and neck. Methods Skin soft tissues were repeatedly expanded for 1 to 3 times after the first expansion. Massive skin defects in head and neck were repaired several times by useing repeated expansion of flap. The size of the skin defects ranged from 29cm?24cm to 10cm?8cm. The indications, complications and experiences in the treatment were discussed. Results A total of 30 cases were treated. Complication incidences of every expansive procedure were 27%, 15%, 14% and 0% respectively . After 6～12 months postoperative follow-up, the appearance and functional restoration was satisfactory. Conclusion Repeated expansion is an excellent method of repairing massive defects in head and neck.

OBJECTIVE:The pathophysiology of myocardial fibrosis during hypertension is complicated.Recently,it has been shown that inflammatory response plays an important role in the pathophysiology of myocardial fibrosis.This review describes the relationships among hemodynamic stress,hormonal factors and inflammatory factors,and emphasizes the important position of inflammation during the progress of myocardial fibrosis.DATA SOURCES:Using the terms of "hypertension,myocardial fibrosis,inflammatory response,angiotensin,cytokines" in English and Chinese respectively,we searched Medline database,Chinese Biological Medicine Database (CBM) and CNKI to identify English and Chinese articles of clinical researches and experiments related to the effects of inflammatory response on myocardial fibrosis during hypertension published from January 1991 to May 2007.STUDY SELECTION:The articles were primarily checked.Only articles that reported inflammatory response and myocardial fibrosis were included.The repeated researches and experiments and Meta analysis were deleted.DATA EXTRACTION:A total of 641 articles have been selected.The titles of all the articles and most of the abstracts have been read,and 162 articles met the inclusive criteria whereas the other 479 articles were deleted.42 articles have been analyzed.DATA SYNTHESIS:During hypertension,the extracellular matrix expands because of reactive and reparative fibrosis,which at last results in myocardial fibrosis.Previous clinical and experimental studies showed that hemodynamic stress and hormonal factors affected the progress of myocardial fibrosis.While recently,there are growing evidences indicating that the immune system.related with hemodynamic stress and hormonal factors is activated during hypertension in the progress of myocardial fibrosis.Then the recruitment of inflammatory cells and factors,including chemoattractant proteins,adhesion molecules and cytokines,informing cytokines cascade response,in turn accelerate the progress of myocardial fibrosis.CONCLUSION:Inflammatory response may play an important role in the pathophysiology of myocardial fibrosis during hypertension and then accelerate the progress of heart failure.

With the rapid development of biotechnology such as NGS and proteomics , bioinformatics has seen an explo-sion in diversity and complexity in terms of data , tools and demands .The traditional computing environment , including ded-icated workstations and virtual machines , are no longer suitable under such circumstances .As a rising container technolo-gy, Docker, which is characterized by light weight , openness and security ,has provided an innovative solution to analysis and processing of biological big data and attracted increasing attention from bioinformatics developers and users .Consider-ing the demands and features of development , deployment and application of bioinformatics tools in the age of big data , this paper analyzes the advantages of Docker in this field , introduces some actual cases and discusses current deficiencies and future improvement .

Objective To study the probability of other autoimmune diseases in primary biliary cirrhosis (PBC),autoimmune hepatitis (AIH) and primary sclerosing cholangitis (PSC) and explore its effects on the prognosis.Methods From January 1994 to March 2014,the data of 232 patients with autoimmune liver diseases (AILD) were collected.The type and case number of coexisting with other autoimmune diseases of patients with PBC,AIH and PSC were analyzed and compared.Cox regression model was performed to analyze the effects of coexisting with autoimmune diseases on the prognosis of AILD.Results Among 135 PBC patients,there were 64 cases that coexisted with Sjogren's syndrome (SS),seven cases with systemic lupus erythematosus (SLE),seven cases with rheumatoid arthritis (RA),nine cases with systemic sclerosis (SSc),three cases with polymyositis and/or dermatomyositis (PM/DM) and one case with Crohn's disease.Among 55 AIH patients,threre were 19 cases that coexisted with SS,10 cases with SLE,one case with RA,two cases with SSc and two cases with PM/ DM.Among 24 PSC patients,there were seven cases combined with ulceric colitis,one case with Crohn's disease and one case with RA.Among 18 patients with PBC AIH overlap syndrome,there were five cases with SS and one case with RA.Compared with PBC patients,the risk of pulmonary interstitial fibrosis increased in PBC patiento coexisting with SS (OR =34.0,95 ％ CI 8.9 to 130.1).After gender,age,disease course and medicine intervention were adjusted,the prognosis of AILD which included death,liver transplantation and liver cirrhosis complications was not affected by the coexistence with other autoimmune diseases.Conclusions AILD patients coexisting with other autoimmune diseases is common,most of which are SS,SLE,SSc and RA.PBC patients coexisting with SS is the risk factor of pulmonary interstitial fibrosis,and coexisting with other autoimmune disease does not independently affect the prognosis of AILD.

ObjectiveTo explore the diagnostic value of plasma (1, 3)-β-D-glucan test (G test) in diagnosis of invasive fungal infections (IFI) and the influence of albumin on G test.Methods A prospective observational study was conducted. 267 patients admitted to medical intensive care unit (MICU) of Dalian Municipal Central Hospital from January 21st, 2012 to October 31st, 2014 were enrolled. According to IFI guideline, the patients were divided into without IFI group (n= 35), possible IFI group (n = 70), hypotheticle IFI group (n = 145) and proven IFI group (n = 17). G test was examined routinely using microbiology kinetic rapid reader MB-80.The different threshold values were calculated on G test. The difference among G tests, fungal culture and clinical diagnosis were compared. The results of G test ahead of and post albumin administration in each group were compared, and the value of G test for diagnosis of IFI during albumin infusion was evaluated.Results When the cut-off value was 20 ng/L for IFI diagnosis, higher sensitivity (79.8%), specificity (87.9%), and Youden index (67.7%) were found. The positive rates of G test, fungal culture and clinical diagnosis of IFI were 57.7% (154/267), 60.7% (162/267) and 54.3%(145/267) respectively, without showing significant differences (allP> 0.05). The result of G test (ng/L) was not obviously changed after albumin administration compared with that before in without IFI, possible IFI, hypotheticle IFI, and proven IFI groups (without IFI group: 11.25±2.33 vs. 10.99±1.07,t= -1.723,P= 0.085; possible IFI group: 53.14±5.53 vs. 49.22±8.11,t= -0.395,P= 0.693; hypotheticle IFI group: 90.30±9.38 vs. 85.41±10.11, t= 710.500,P= 0.860; proven IFI group: 100.98±19.24 vs. 103.21±17.66,t= 653.000,P= 0.449). Prior to the administration of albumin, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and Youden index were 79.8%, 87.9%, 45.6%, 96.7%, 67.7%, respectively. However, after the administration of albumin, they were 81.5%, 85.7%, 44.8%, 96.5%, and 67.2%, respectively, without significant difference.Conclusions G test is method for early diagnosis of IFI. The sensitivity and specificity are higher with 20 ng/L as the critical value. The result of G test is not interfered by albumin administration.