Aiming at status of training the rural order directed free medical educational talents, we should improve the understanding of training the free medical students, perfect the relevant management system, strengthen medical ethics education of students, pay attention to humanistic care of students,strengthen the continuing education of students, standardize the access system of students, reform the medical distribution system, to ensure the quality of training free medical students.

Objective To characterize the effects of AQP1 expression on kidney damage in rat disseminated intravascular coagulation(DIC) caused by lipopolysaccharide(LPS) dosing. Method Fifty male Wistar rats (clean grade) were randomly assigned into 5 groups of 10 rats. The 10 control rats were dosed with 10 ml of 0.9%NaCl solution by a drip via the vena caudalis within 4 h, and blood and tissues were obtained after treatment completion. In the DIC groups, the rats were dosed with LPS (30 mg/kg body weight in 10 ml of 0.9% NaCl solution) by a drip via the vena caudalis within 4 h, and blood and tissues were obtained at 4, 6, 8 and 10 h. The blood platelet(PLT) count, prothrombin time(PT) , activated partial thromboplastin time(APTT), fibrin(FIB) and D-dimer(D-D) were detected. Hematoxylin and eosin(HE) staining was used to examine the pathologic changes in the lung and kidney tissues of each group (both hematologic parameters and tissue pathologic changes were used to judge the course of DIC). The AQP1 gene expression levels in the kidney tissues from the groups were evaluated by the mRNA levels using RT-PCR. Statistical analyses were performed by the SNK- q method. Results The PLT count, PT, APTT, FIB and D-D examinations revealed remarkable changes in all DIC groups compared with the control group (P < 0.01). The AQP1 mRNA level was significantly decreased in the DIC group at 4 h compared with the control group (P < 0.01) , and further decreased to the minimum level in the DIC group at 6 h. Moreover, cloudy swelling of renal tubular cells was observed at 6 h and cell degeneration and necrosis were observed at 8 h among the DIC groups. Conclusions Downregulation of AQP1 mRNA expression occurred before damage to the renal tubular cells in DIC, indicating that AQP1 expression may be involved in the kidney damage observed in rat DIC.

Objectives To evaluate the values of notched on R wave in inferior leads of electrocardiogram in infant with secundum atrial septal defect. Methods To observe and compare the prevalence of notch on R wave in inferior leads combined with incomplete right bundle branch block (IRBBB) in 162 cases with secundum atrial septal defect (group I) and 162 cases without heart disease (group II). Results The prevalence of notch on R wave in all the three inferior leads, in at least one inferior lead with IRBBB and in all the three inferior leads with IRBBB were 27.16%, 14.20%and 10.49%respec-tively in group I, and were 3.09%, 1.85%and 0.62%in group II respectively, and the differences between two groups were statistically significant (P<0.005). The specificities of notch on R wave in diagnosis of atrial septal defect were 96.91%, 98.15% and 99.38% respectively. Conclusions Notch on R wave in inferior leads is an independent electrocardiographic sign of secundum atrial septal defect in infants, and thus can be used as a diagnostic parameter.

Objectives To evaluate the clinical value of heart rate variability (HRV) analysis in school-age healthy chil-dren with functional ST-T changes in electrocardiogram (ECG). Methods In 143 school-age children (50 cases of functional ST-T changes, 43 cases of myocarditis children with ST-T change, 50 cases of healthy controls without ST-T changes), HRV time domain value was measured in three groups with 24 dynamic electrocardiogram. Results Compared with healthy controls, PNN50, rMSSD and SDSD were decreased while the heart rate, SDNN and SDANN were increased in children with functional ST-T changes (P all<0.05). Meanwhile, compared with children with functional ST-T changes and healthy controls, the heart rate was increased while PNN50, rMSSD, SDSD, SDNN and SDANN were decreased in the myocarditis children with ST-T change (P<0.05). Conclusions The autonomic nervous system of school-age children is not stable. The functional ST-T changes are related with the imbalance between sympathetic and vagus nerve activities. HRV analysis has important diagnostic signifi-cance in the functional ST-T changes.

Objective To investgate the value of various parameters obtained from monoexponential, biexponential, and stretched exponential diffusion?weighted imaging models in the differential diagnosis of breast lesions. Methods A retrospective study performed in 54 patients with pathologically confirmed malignant tumors(n=30), benign lesions(n=34) and normal fibroglandular tissues (n=30). All patients underwent T1WI, T2WI, dynamic enhancement and diffusion weighted MRI with multi?b values at a 3.0 T magnetic resonance imaging unit. All parameters were measured at a workstation. ADC was calculated by using monoexponential analysis(b=0, 800 s/mm2). Slow apparent diffusion coefficient (ADC?slow), fast apparent diffusion coefficient (ADC?fast), and perfusion fraction (f) were calculated using the biexponential model. Distributed diffusion coefficient (DDC) and water molecular diffusion heterogeneity index (α) were obtained from diffusion?weighted images using the stretched exponential model. All parameters were statistically compared among normal fibroglandular tissues, benign lesions and malignant tumors using Kruskal?Wallis rank sum test. Mann?Whitney U test were used for further comparisons between specific group pairs. ADC values were compared with ADC?slow and DDC for different groups by paired Wilcoxon test. Correlations between ADC?value, ADC?slow and DDC were assessed by using Spearman rank correlation coefficient. Receiver operating characteristic curve was used to analyze and compare the ability of these parameters in differentiation of benign and malignant breast lesions. Results The ADC, ADC?slow, f, DDC and α values were significantly different among the normal fibroglandular tissues, benign tumors and malignant tumors (P<0.05). Further differential comparisons of the four parameters between each pair showed that the ADC, ADC?slow, f, DDC and α values were significantly lower in malignant tumors than both in normal fibroglandular tissues and benign tumors(P<0.016 7). The ADC values of normal fibroglandular tissues, benign tumors and malignant tumors were significantly higher than ADC?slow and DDC (P<0.05). The f and DDC had higher area under the receiver operating characteristic curve (0.688 and 0.657 respectively). The optimal cutoff values for ADC, ADC?slow, f, DDC and α were 1.235 × 10-3mm2/s, 0.428 × 10-3mm2/s, 57.8%, 1.175 × 10-3mm2/s and 0.721, respectively. Theαvalue showed higher specificity (65.5%) and the f value had higher sensitivity (82.9%). Conclusion The parameters derived from biexponential and stretched exponential DWI could be helpful for differentiation between benign and malignant breast tumors.

Objective To explore and evaluate the hemostatic effects of hemocoagulase in elderly surgery bleeding. Methods 150 cases (60~75 years old)admitted to Affiliated Hospital of Chuanbei Medical College for abdominal operation from June 2011 to June 2012 were used as subject. They were divided radomly into hemocoagulase group (50 cases),reptilase group (50 cases)and physiological saline solution group (50 cases). The hemostatic time,hemorrhagic volume,hemorrhagic volume per square unit,and body coagulation parameters in three groups were observed and compared. Results The hemorrhagic volume in hemocoagulase group was (9.2 ±2.7 )g,average hemostatic time was (124.5 ±45.7 )s,and hemorrhagic volume per square unit was (0.3 ±0.1 )g,which were similar with reptilase group,but significantly different with those in physiological saline solution group (P<0.05 ). In hemocoagulase and reptilase groups,the hemorrhagic and hemoagglution time decreased in 30 minutes and 1 day after operation, the differences were statistically significant when compared with physiological saline solution group (P <0.05 ).Conclusion Hemocoagulase has better hemostatic effect on hemorrhagic capillary in elderly surgery.

Objective To explore the relationship between 5-minute Apgar score and heart rate variability (HRV) in severely asphyxiated neonates. Methods A total of 103 severely asphyxiated neonates with 1-minute Apgar score of 0 to 3 points were selected. They were divided into Group A (>7 points, n=50) and Group B (≤7 points, n=53) based on 5-minute Apgar score. Meanwhile, 40 full-term neonates with 1-and 5-minute Apgar score greater than 7 points were selected as control group. 24-hour dynamic electrocardiogram was performed and HRV was analyzed on the third day after birth in three groups. Results PNN50, rMSSD, SDSD were decreased and SDNN, SDANN were increased in group B as compared with group A and control group (P<0.05). No signiifcant difference of HRV was observed between group A and control group (P>0.05). Conclusions Neonatal asphyxia can cause damage to autonomic nervous system. 5-minute Apgar score and HRV can be joint-ly used as a non-invasive index in autonomic nervous damage and its prognosis in asphyxiated newborns.

Photodynamic therapy (PDT) has been wildly used in the treatment of tumors and dermatologic diseases,especially,when the traditional therapies are ineffective or bring side effects.Moreover,with the deepening of the studies,its effects in anti-microbial has been found.PDT in the treatment of infectious diseases has attracted more and more attention of scholars.In this review,we discussed the mechanism of the PDT,studies in the sterilization of a variety of oral pathogenic bacteria by the PDT and its potential applications in clinic.

Objective To investigate clinical effect of combined laparoscopic and endoscopic submucosal resection for the gastric antrum-body tumors originated from the muscularis propria.Methods A total of 8 patients with gastric antrum-body tumors originated from the muscularis propria were treated by combined laparoscopic and endoscopic submucosal resection from Jan 2013 to Apr 2014.All patients were diagnosed as having gastric antrum-body tumors originated from the muscularis propria by preoperative endoscopic ultrasonography.Endoscopy showed that the surface mucosa of tumors were normal in all patients.Tumors were found in the gastric antrum-body front wall in 4 cases,and in the back wall in 2 cases,and in the lesser omental bursa in 1 case,and in the greater omental bursa in 1 case.The tumors size was from 1.5 to 3.5 cm,averaging (2.4 ± 0.7) cm.The therapeutic procedure included three phases.The lesion was first exposed with laparoscopy.Then,the fluid was injected into the submucosa in the part of tumor by endoscopy.Finally the tumor was resected by laparoscopy.These patients were followed up and analyzed retrospectively.Results Combined laparoscopic and endoscopic submucosal resection was successfully performed in all patients.All tumors were resected completely.Sever bleeding,infection or death were not found in any patients.Postoperative pathology and immunohistochemistry staining confirmed 6 stromal tumors and 2 neurofibroma.All patients were followed up for 6 months,and there was no recurrent case.Gastric mucosa and function were normal in all patients.Conclusion Combined laparoscopic and endoscopic submucosal resection is a simple,safe and effective method for gastric antrum-body tumors originated from the muscularis propria,and leads to little complication.

Objective To investigate current status of cognitive behavior on chronic obstructive pulmonary disease (COPD) to provide evidence for targeted intervention.Methods A questionnaire survey on COPD was conducted at 12 settings of 4 prefectures that were sampled from Ningxia Province using multistage stratified cluster random sampling method,and 4268 residents at least 40 years old were interviewed.Multivariate linear regression method was used for data analysis.Results A total of 4056 valid questionnaires were returned from 4200 participants with an effective response rate of 96.57％.Only 6.51％(264/4056) had an idea of COPD,13.88％ (563/4056) regarded cigarette smoking as a risk factor of chronic bronchitis and emphysema,and 6.39％ (259/4056) knew pulmonary function tests.Home income,living area,education level and ethnicity were main factors influencing COPD awareness.The percentage of current cigarette smoking was 28.80％ (1168/4056) with 20.40％ in Hui (Muslim) ethnic group and 34.63％ in Han ethnic group (P ＜ 0.05 ) ; smoking index and severe smokers were not significantly different between the two groups ( P ＞ 0.05 ).Conclusion Our data suggest a considerably poor knowledge and prevention awareness of COPD in Ningxia Province.In spite of relatively lower cigarette smoking rate,the problem that Hui (Muslim) ethnic people are lack of COPD awareness should not to be neglected.