Objective To explore the decision-making process of medical students who turned the major from the medicine to other majors,and the related factors that hindered them continuing to study the medicine.Methods According to the design of interpretative phenomenon logical analysis,semi-structured in-depth interviews were used to collect the data.Participants were six undergraduate students who had moved from medical major to another major.Interviews were recorded on audio-tape with the students' permission and then transcribed verbatim.The transcribed interviews were analyzed according to six steps of interpretative phenomenological analysis.Results Even if the participants had left the medical major,they still expressed a strong sense of professional identity for the doctor.However,they also admitted that the professional process of medicine students was very hard and tired,and couldn't get the equal return for their payment.They thus were lack of confidence for the future.Some of the participants talked about the fact that they had been curious about the future of medical students.Internet and seniors were the main avenues for obtaining job-related information,but they were often plagued by the negative information.Education about career adaptation should be carried out as soon as possible,to strengthen the professional identity of medical students,and enhance their ability to defend against negative information,which could help to deal with the status of high turnover rate for medical students.Conclusion Based on the students' perspective,exploring the decision-making process of turning major for medical students will contribute to the educators taking effective strategies to improve the students' career identity,stabilize their professional thought,and reduce the loss of the medical students.

Objective To evaluate the value of ghrelin on predicting prognosis in patients with chronic heart failure (CHF) after hospital discharge.Methods Totally 145 patients withCHF (age≥60 years,83 males and 62 females) were divided into 3 subgroups by New York Heart Association classification (NYHA):class Ⅱ (n=48),class Ⅲ(n=57) and class Ⅳ(n =40).According to the basic diseases,the CHF group was divided into five subgroups.All patients were followed up for about 2 years.The study included 55 healthy control subjects (30 males and 25 females).Results Plasma ghrelin level was lower in CHF cases (1.66±0.28) μg/L than in control subjects (2.27±0.26) μg/L (t 3.77,P＜0.01).The ghrelin level in NYHA Ⅱ(1.85±0.13) μg/L were higher than in NYHA Ⅲ (1.56±0.28) μg/L,the latter were higher than in NYHA Ⅳ (1.27±0.24) μg/L (P＜0.05).The plasma ghrelin level of patients after treatment (1.98±0.25) μg/L was increased compared with that of before treatment (1.66±0.28) μg/L (P＜0.05).No significant difference was found among the five basic disease groups (P＞0.05).During the follow up periods of (637±97)days,plasma ghrelin level was decreased in patients with cardiovascular event (1.26±0.38) μg/L than in patients without cardiovascular event (1.86±0.34) μg/L.The plasma ghrelin was negatively correlated with left ventricular end-diastolic diameter (LVEDD) and left ventricular ejection fraction (P＜0.05).Conclusions The plasma ghrelin in elderly patients with CHF is decreased than in healthy adults,and its level is lower in patients with severe heart failure.The plasma ghrelin is a predictor of cardiovascular event and death in elderly patients with CHF.

Objective To evaluate the quality of the examination paper of the theory of Clinical Diagnostics,to explore and reflect on the teaching methods,so as to improve the quality of teaching.Methods Finals results of Clinical Diagnostics including 40 clinical undergraduates of Capital Medical University were analyzed.SPSS 20.0 was used to make analysis of the frequency,means statistics and normality of the examination paper.Kuder Richardson/Cmnbacha formula,percentage unification methods and so on were used to calculate confidence,validity,difficulty and degrees of distinction.Acquisition of relevant knowledge was assessed according to score distribution,while test paper quality was evaluated based on indicators including confidence,validity,difficulty and degrees of distinction.Results Test scores of 40 students were between 61 to 96 (83.64 ± 8.07).The degree of confidence (γ) for choice questions and subjective questions was 0.65 and 0.59 respectively;The validity (V) was 0.27;The overall difficulty (P) of the examination was 0.84;The degrees of distinction (D) were between 0.16 to 0.30.And the total points losing rate was 16.36％.Conclusion The examination is of medium difficulty and good degree of distinction,but the teaching strategies still need further adjustment in order to improve the students' ability of flexible application of the basic knowledge.

Objective To explore the expressions of interleukin (IL)-17A and its receptor IL-17RA in different degrees of malignant gliomas. Methods Fifty patients with glioma were collected in this study. Accordance to the World Health Organization Classification System, patients were classified by malignancy grade, including gradeⅠ(n=12), gradeⅡ(n=18), gradeⅢ(n=13) and gradeⅣ(n=7). The glioma tissue and peripheral blood samples of patients were obtained for detecting the expression levels of IL-17A and IL-17RA mRNA by using immunohistochemistry, quantitative real-time PCR. Western blot assay was used to detect expressions of IL- 17A and IL- 17RA in both the macroscopic (immunohistochemistry) and molecular levels (mRNA and protein). Results Immunohistochemical staining showed that the expression levels of IL-17A and its receptor IL-17RA increased with the increase of the malignant degree of gliomas. The mRNA levels of IL-17A and IL-17RA receptors in peripheral blood were up-regulated with the increasing malignancy grade of glioma (F=8.96, P<0.05;F=10.34, P<0.05). The mRNA levels of IL-17A and IL-17RA in glioma tissues were up-regulated with the increasing malignancy grade of glioma (F=11.21, P<0.05;F=14.11, P<0.05). The protein levels of IL-17A and IL-17RA in peripheral blood and glioma tissues were also up-regulated with the increasing malignancy grade of glioma (in peripheral blood:F=9.90, P<0.05;F=11.80, P<0.05;and in gliomas tissues:F=8.15, P<0.05;F=14.46, P<0.05). Conclusion The expressions of IL-17A and IL-17RA receptor are positively correlated with malignancy grade of glioma. These results provide some reference for clinical diagnosis of malignant gliomas.

AIM:To explore the effects of pGRIM-19-si-survivin co-expression plasmid carried by human at-tenuated Salmonella on prostate cancer subcutaneous xenograft growth in nude mice .METHODS: Prostate cancer xeno-graft model was established in nude mice .Co-expression plasmids carried by attenuated Salmonella were introduced by in-traperitoneal injection .The xenograft volumes were monitored timely .Immunohistochemical staining , RT-PCR and TUNEL assay were applied to investigate the related mechanisms that pGRIM-19-si-survivin inhibited tumor growth in vivo.RE-SULTS:Compared with psi-survivin and pGRIM-19 carried by attenuated Salmonella ( control groups ) , the tumor volumes were reduced markedly in pGRIM-19-si-survivin plasmid group .The mean shrinkage rates were 2.36 and 3.02 times. pGRIM-19-si-survivin co-expression plasmid carried by attenuated Salmonella inhibited survivin expression but strengthened GRIM-19 expression obviously (P<0.05).The mRNA expression of apoptosis-related proteins such as Bcl-xL, Stat3, cy-clin D1 and c-Myc was inhibited , and the vascular endothelial growth factor ( VEGF) mRNA and Ki67 protein were also in-hibited, but the caspase-3 mRNA expression was up-regulated ( P<0.05 ) with significant cell apoptosis .CONCLU-SION:pGRIM-19-si-survivin co-expression plasmid carried by human attenuated Salmonella inhibits the growth of prostate cancer subcutaneous xenografts in nude mice by promoting cell apoptosis and inhibiting prostatic cancer proliferation .

Objective To study the effect the edaravone on the expressions of ICAM-1,TNF-α after focal cerebral ischemia reperfusion in male rats.Methods 45 male SD rats were selected and randomly assigned into 3 groups:sham operation group(SO),ischemia reperfusion group(I/R),and edaravone treatment group(ED),each group had 15 rats.The expression of ICAM-1,TNF-α were checked by immunohistochemistry.All data in the groups were analyzed with t test.Results The expression of ICAM-1 and TNF-α in the I/R group and ED group were higher than the SO group(t=21.919,27.758,26.576,17.395,32.821,43.021,14.195,31.828,21.201,10.195,25.768,17.900,all P＜0.05)at reperfusion 3 hours,6 hours,and 12 hours.The expression of ICAM-1 and TNF-α in the I/R group were higher than the ED group(t=9.623,13.845,7.201,11.313,all P＜0.05)at reperfusion 3 hours and 6 hours.Conclusion Edaravone may exert the neuroprotective effect against the cerebral ischemia in rats by decreasing the expression of ICAM-1 and inhibiting the activation of TNF-α.This process could inhibit free radical generation.

Objective To investigate the effects of hypoxic preconditioning on learning and memory and the possible protective mechanism in mice with cerebral ischemia-reperfusion injury.Methods Healthy adult male Kunming mice were randomly divided into five groups by Random number table:normal group( N group),hypoxic preconditioning group (HPC group),sham operation group (C group),ischemia-reperfusion group(O group),hypoxic preconditioning and ischemia-reperfusion group(HPC+O group).HPC+O group were given hypoxic preconditioning before 24h of ischemia-reperfusion.The escape latency was detected by Morris water maze and the neuron apoptosis of CA 1 area of hippocampal was determined by immunofluores-cence techniqueR.e sults The escape latency in HPC+O group on the second,third and fourth day of MWM was (39.92±4.52)s,(30.98±2.44)s,(19.69±4.27)s,and significantly lower than that in O group((54.35± 3.66)s,(46.31±4.81)s,(36.81±3.86)s).Mice in HPC+O spent longer time in the target quadrant than that in O group((36.44±5.33)%and(24.5±2.59)%,respectively, P<0.05).Immunofluorescence showed that the apoptotic ration of nerve cells in hippocampal CA 1 was significantly lower than that in O group ( 11.7 ± 0.14 and 1.35±0.14, P<0.05).Conclusion Hypoxic preconditioning can increase hippocampal CA1 neurons hypoxia tolerance of ischemia reperfusion injury in mice,and reduce the incidence of neural cell apoptosis.

Based on the analyses of the status of humanistic medicine education both at home and abroad, the article emphasized the need for the implement of medical humanities education with the whole process and multidisciplinary integration. In combination with practice, from the three modules of the ex-plicit curriculum, implicit curriculum and integrated curriculum, the author discussed the specific conno-tation of the whole course of medical humanities education. The article also summarized the main points of the course system in teaching practice from the aspects of training objectives, teaching staff construction, teaching methods improvement and innovation, and humanistic quality evaluation of medical students.

To explore the relationships between traditional Chinese medicine (TCM) constitutional types and overweight or obesity so as to provide evidence for adjusting constitutional bias and preventing and treating obesity.

Objective:To investigate the characteristics of the sleep quality and health-related quality of life (HRQoL), and analyze the different effects of sleep quality on HRQoL among young and middle-aged people.Methods:A cross-sectional study recruited 1 976 participants.All participants completed a self-designed questionnaire for the adults' general condition, the Pittsburgh sleep quality index (PSQI) and Short-Form health survey (SF-36). All participants were divided into 3 age groups: 18-29-year-old group( n=1 148), 30-44-year-old group( n=586) and 45-59-year-old group ( n=242). SPSS 23.0 software was used for statistical analysis.Chi-square test was used to analyze the general characteristics of the three age groups.Non-parametric test was used to analyze the scores of the three age groups in different dimensions of sleep quality. One-way ANOVA was used to analyze the mean scores of the three age groups in different dimensions of HRQoL. Stepwise regression analysis was used to analyze the effect of sleep quality on HRQoL among the three groups after control the confounding factors such as marital status, education, smoking, drinking and exercise habits and past medical history. Results:In terms of sleep quality, the total PSQI scores of 18-29-year-old, 30-44-year-old and 45-59-year-old groups(4(2, 6), 4(2, 6), 4(2, 6)) showed statistically significant differences ( Z=10.951, P=0.004). In terms of HRQoL, there were statistically significant differences in physical component summary scores (18-29-year-old: 82.51±12.62, 30-44-year-old: 80.72±13.63, 45-59-year-old: 82.04±13.07, F=3.667, P=0.026) and mental component summary scores(18-29-year-old: 76.09±15.46, 30-44-year-old: 77.20±16.14, 45-59-year-old: 81.82±14.14, F=13.649, P<0.001) among young and middle-aged people in different age groups.Regression analysis found that daytime dysfunction was an independent influencing factor for HRQoL in young and middle-aged population ( β=-0.308--0.425, all P<0.01). Sleep disorders significantly decreased Physical Component Summary of HRQoL in young-aged people ( β=-0.127--0.215, all P<0.01). The use of hypnotic drugs significantly reduced the scores in the physiological field in the young adults aged 30-44 ( β=-0.076, P<0.05). The duration of sleep significantly decreased the scores in the mental domain of young adults aged 30-44 ( β=-0.112, P<0.01). Subjective sleep quality was an independent factor that significantly decreased HRQoL in young adults aged 18-29 and 30-44 years ( β=-0.089--0.169, all P<0.01). Conclusion:Sleep quality and HRQoL of young and middle-aged people in different age groups show different characteristics.The effect of sleep quality on HRQoL is different among people in different ages.Taking targeted interventions for people of different ages to improve the sleep quality may be an effective way to improve their HRQoL.