According to teaching outline and clinical training characteristic of psychophy-laxis speciality(including Psychiatry and Medicopsychology),we explored how to strengthen the clinical thinking ability and clinical skill training for clinical medicine students based on cultiva-tion of elementary knowledge and theory,and we also established a set of more appropriate item system of clinical skills assessment so as to improve the practice quality in psychiatry and medical psychology departments.

BACKGROUND:Polysulfone membrane holds good anti-biodegradation ability, but how to use it to prepare hol ow fiber dialysis membrane and its blood compatibility have not been ful y understood. OBJECTIVE:To study the preparation, transfer property and biocompatibility of hol ow fiber dialysis membrane. METHODS:With polysulfone as the film material, diethylene glycol as the porogen, polyvinyl pyrrolidone as the modifier, N, N-dimethylacetamide as the solvent, and the hol ow fiber dialysis membrane was prepared using nonsolvent-induced phase separation. The performance was measured using scanning electron microscopy, ultra-depth three-dimensional microscope imaging and porosity test;the transfer parameters including reject rate and water flux were detected by ultrafiltration device;the blood compatibility was determined through hemolysis test, dynamic clotting time test and platelet adhesion test. Type II medical polyurethane material served as negative control. RESULTS AND CONCLUSION:The section of hol ow fiber dialysis membrane was asymmetric. 17%dialysis membrane showed a porous middle layer, while 19%, 21%and 23%membrane showed a sponge-like middle layer. Under the same membrane area, the density of fiber dialysis membrane was significantly lower than that of the negative control material, and the porosity of fiber dialysis membrane was significantly higher than that of the negative control material (P<0.05). The water volume and water flux of the hol ow fiber dialysis membrane were significantly higher than those of the negative control material (P<0.05). Results from three hemolytic tests showed that the average absorbance values and hemolysis rate of the hol ow fiber dialysis membrane were significantly higher than those of the negative control material (P<0.05). The dynamic clotting time test and the platelet adhesion test revealed that the dynamic clotting time of hol ow fiber dialysis membrane at 20, 40 and 70 minutes was significantly shorter than that of the negative control material (P<0.05). These results suggest that polysiloxane can be used as the membrane material to prepare hol ow fiber dialysis membrane using nonsolvent-induced phase separation, and holds a good biocompatibility, blood compatibility and transfer efficiency.

Small intestinal neuroendocrine carcinoma is poorly differentiated,highly malignant,and originated from the diffuse neuroendocrine system.It diffusely expresses the general neuroendocrine differentiation markers.The disease can be manifested as carcinoid syndrome,but most of the patients were with occult onset and absence of specific clinical symptoms,which led to difficult diagnosis before operation.On June 18,2012,a patient with manifestation of recurrent vague abdominal pain received capsule endoscopy at the Northern Jiangsu People's Hospital.The capsule endoscope was retained in the distal small intestine,and malignant ileum lesion was revealed during the surgical exploration.Finally,poorly differentiated neuroendocrine carcinoma with abdominal wall metastases was identified by pathological examination.

Objective To explore the effects of Jin's Three-needle Acupuncture combined with occupational therapy on function of upper limbs for stroke patients with hemiplegia. Methods 90 patients with stroke were randomly divided into control group (n=30), observation group (n=30) and experiment group (n=30). The control group received routine rehabilitation, the observation group received occupational therapy in addition, and the experiment group received Jin's Three-needle Acupuncture and occupational therapy in addition. They were assessed with Fugl-Meyer Assessment (FMA) of upper limbs and Barthel index (BI) before and 4 weeks after treatment. Results The scores of FMA and BI improved in all the groups after treatment (P<0.001). The difference of scores of FMA and BI before and after treatment were more in the experiment group than in the observation group (P<0.001), observation group than the control group (P<0.001). Conclusion Jin's Three-needle Acupuncture combined with occupational therapy can further improve the motor function of upper limbs and activities of daily living for stroke patients with hemiplegia.

Objective To investigate the clinicopathological significance of expression of insulin like growth factor 1 receptor (IGF1R) protein in primary gastrointestinal stromal tumors (GIST) and their impacts on prognosis.Methods Between January,2005 and January,2011,84 primary GIST patients underwent surgery.Immunohistochemical analysis was performed based on tissue microarray to estimate expression pattern of IGF1R in tumor cells and nomal controls.Association of IGF1R expression with clinicopathological features and relapse-free survival (RFS) were also analyzed.Results The negative,weakly positive,positive,and strong positive expression rates of IGF1 R protein in GIST group were 20％,14％,48％ and 18％,respectively;while in the control group were 32％,40％,20％ and 8％,respectively (x2 =30.663,P ＜ 0.001).The 5-year overall survival (OS) rate was 93％.1-year,3-year and 5-year RFS rate were 99％,76％ and 60％,respectively.As shown by univariate analysis the following factors were poor prognostic indicators for RFS,non-gastric tumor location (P =0.017),large tumor size (P =0.022),high mitotic index (P ＜ 0.001),high cellularity (P =0.012),tumor rupture (P =0.013),absent or low expression of IGF1R (P =0.022).Tumor size (HR5.1-10 ≤5 cm =1.86,95％ CI:0.67-5.15;HR＞10 ≤5cm =6.71,95％ CI:0.67-5.15,overall P =0.023),and mitotic index (HR5.1-10/50HPFsvs.≤5/50HPFs =5.72,95％ CI:2.09-15.64;HR＞10/50HPF ≤5/50HPFs =3.44,95％ CI:1.13-10.45,overall P =0.002) were negative independent risk predictors by multivariate analysis.Conclusions High expression of IGF1R may be involved in the occurrence,development and poor prognostic of primary GIST.Expression of IGF1 R is correlated with high risk potential and may predict early recurrence.

Objective To investigate the potential benefits of hepatic resection for patients with hepatic metastasis of gastroenteropancreatic neuroendocrine tumors.Methods A search in Cochrane Library,PubMed,Medline,Embase,CBM,Wanfang Databases for identifying randomized trails.Criteria for inclusion were established based on validity criteria by Cochrane Methods Group on screening and diagnostic tests,and correlated indexes of 10 articles including 1 567 patients were extracted for Meta-analysis.Results Compared with non-surgical treatment group,the 3-year survival rate (OR:0.07,95 ％ CI:0.02,0.22 ; Pheterogeneity =0.93,P ＜ 0.00001),the 5-year survival rate (OR:0.19,95 ％ CI:0.15,0.24 ; Pheterogeneity ＝ 0.11,＜ 0.00001) were significantly increased in the surgical group.Conclusions Surgical resection is the preferred treatment of gastroenteropancreatic neuroendocrine tumors in patients with liver metastasis.Surgery is safe and effective,furthermore it takes the advantages of significantly extend the surgical live time.

Objective:To evaluate the relationship between changes in Golgi apparatus morphological structure and endotoxin-induced acute lung injury (ALI) in mice.Methods:Twenty healthy male C57BL/6J mice, weighing 18-20 g, aged 6-8 weeks, were divided into 2 groups ( n=10 each) using a random number table method: sham operation group (group Sham) and endotoxin-induced ALI group (group ALI). Lipopolysaccharide (LPS) 10 mg/kg was injected intravenously in group ALI, while the equal volume of normal saline 0.5 ml was given instead in group Sham.The animals were sacrificed at 12 h after LPS injection and the lung tissues were taken for detection of the content of reactive oxygen species (ROS) and wet to dry weight ratio (W/D ratio), for observation of the pathological changes (using HE staining) and Golgi apparatus morphological structure (with a transmission electron microscope) and for determination of expression of Golgi matrix protein 130 (GM130), Golgin97 and mannosidase alpha class II member 1 (MAN2A1) and its mRNA (by Western blot and quantitative polymerase chain reaction). Results:Compared with group Sham, ROS content and the W/D ratio in lung tissues were significantly increased, GM130, MAN2A1, Golgin97 protein and its mRNA expression were down-regulate ( P<0.01), the pathological changes of lung tissues were accentuated, the Golgi cisternae was swollen, and Golgi fragments were dispersed in the cytoplasm in group ALI. Conclusion:The mechanism of endotoxin-induced ALI may be related to the changes in Golgi apparatus morphological structure.

Objective To investigate CT and MRI features of hepatic sclerosed hemangioma (HSH).Methods CT and MRI findings were retrospectively reviewed in 20 cases of HSH,all of which were confirmed pathologically after hepatic surgery.Twenty patients underwent CT scan,4 patients underwent MRI.Meanwhile,the enhancement pattern and signal intensity were analyzed either.Results Twenty patients showed main part of tumor was hypo-attenuating on CT plain scanning,and 16 patients showed the central area of tumor was markedly more hypo-attenuating on CT plain scanning.After administration of intravenous contrast media,multifocal linear or small nodular enhancement in the peripheral area was seen during the arterial phase on 16 patients of HSH.Venous phases showed centripetal enhancement or spread around the nodules enhancement which continued to delayed phases with low density of no enhancement in the lesion area.Four patients showed no obvious enhancement on arterial phases and slight separation sample enhancement at the edge or inside of the lesions with a wide range of non enhancement areas on venous phase and delayed phase.Four patients were performed MRI examination,the lesions demonstrated hypointensity with a lower signal area on T1WI,hyperintensity with a higher signal intensity area on T2WI.The DWI sequence of b value were 0,150,800 s/mm2,all of which were obviously hypointensity.The edge of lesions showed small nodular enhancement on arterial phase,irregular concentric enhancement on venous phase and delayed phase,and there was no enhancement area with lower signal in the center of the lesion.Conclusions The enhancement pattern of HSH different from cavernous hemangioma,with a larger non enhancement area in the center of the lesions and similar to other hepatic masses with central scar,differential diagnosis dependence on CT and MRI dynamic enhanced scan.

Objective:To assess the validity and reliability of the depression and somatic symptoms scale among patients with coronary heart disease.Methods:Totally 246 patients with coronary heart disease were assessed with depression and somatic symptoms scale (DSSS), Hamilton depression rating scale for depression (HAMD) and patients’ health questionnaire depression scale-9 item (PHQ-9). The structural validity was evaluated with exploratory factor analysis and confirmatory factor analysis. The validity as a screening tool was evaluated with the gold standard diagnosed by psychiatrists who were trained with the mini international neuropsychological interview (MINI) according to ICD-10. Receiver operating characteristic (ROC) curve was used to identify cutoff scores for depression. Cronbach α coefficient was used to evaluate the internal consistency.Results:Exploratory factor analysis yielded two factors: depression factor and somatic factor, and the cumulative variance was 51.8%. The fitting indexes of confirmatory factor analysis were as follows: χ2/ df=3.636, RMR=0.077, RMSEA=0.104, IFI=0.804, TLI=0.781, CFI=0.802. The intraclass correlation coefficient of DSSS and HAMD was 0.54. The area under ROC curve (AUC) was 0.828, and the best boundary value was 17 points (sensitivity and specificity: 81% and 75%, respectively). The total scores and subscale scores for internal consistency of DSSS were higher in the depression group than those in the non-depression group ( P<0.01). Cronbach α coefficient for internal consistency of DSSS was 0.917. Conclusion:The DSSS has good validity and reliability among patients with coronary heart disease for screening depression, and can be used to screen depression among patients with coronary heart disease in general hospital.