The clinical application of acupoints in Huangdi Neijing was analyze by evidence-based medicine. The results showed that 202 acupoints were recorded,the clinical usage rate was 81.28%,the first 10 acupoints with highest clinical usage rate were Yangming of foot,Taiyin of foot,Shaoyin of foot,Yangming of hand,ST36,Taiyin of hand,Taiyang of foot,shaoyang of foot,BL40,Taiyang of hand. But meridian acupoints with highest clinical usage rate were ST36,BL40,KI2,KI1,ST45,BL10,LR1,ST42,SP3 and PC9.

Combining with traditional medical ethics for medical students to carry out the cultivation of core so -cialist values is a specific and realistic path .Virtue ethics features of traditional medical ethics are good for medical students to internalize core socialist values .Normative characteristics of traditional medical ethics are good for med-ical students to be cultivated of social responsibility , sense of responsibility to life , dedication and integrity aware-ness .By demonstrating the role of ethics and ancient doctors′model in classic literature , students can not only un-derstand the rich connotations of traditional ethics of traditional culture , but also get the cultivation and practice of core socialist values .

Objective To explore the relationship between 24 h ambulatory blood pressure monitoring (24h-ABPM) parameters, circadian rhythm and urinary albumin to creatinine ratio (UACR), urineβ2 microglobulin (β2-MG) in elderly patients with hypertension. Methods One hundred and forty-eight patients with essential hypertension (≥60 years old) were included in this study. 24h-ABPM was performed, and nocturnal blood pressure decline rate (BPR) was calculated. The patients were divided into two groups according the BPR:dipper group with 40 cases and non-dipper group with 108 cases. The levels of 24h-ABPM parameters, UACR and β2-MG were compared between two groups, and the relationship between UACR and 24h-ABPM parameters were analyzed. Results The levels of 24hSBP, dSBP and 24hDBP in two groups had no significant differences (P>0.05). Compared with those in dipper group, the levels of nSBP, nDBP in non-dipper group were significantly increased, and the level of dDBP was significantly decreased, P<0.01 or <0.05. The level of 24hPP in non-dipper group was significantly higher than that in dipper group (P<0.01). The levels of UACR andβ2-MG in non-dipper group were significantly higher than those in dipper group (P<0.05). The levels of BUN and SCr in two groups had no significant differences (P>0.05). The result of Sspearman analysis showed that UACR had significant correlation with 24hDBP, nDBP, 24hSBP, nSBP and 24hPP (P<0.05 or<0.01). The result of multivariate linear regression analysis showed that UACR was independently correlated with nSBP (P<0.05). Conclusions The abnormal circadian rhythm in elderly hypertensive patients is closely related to early renal damage.

Objective To summarize the nursing experience during removing the upper gastrointestinal foreign bodies in special patients by painless endoscopy. Method Retrospective analysis was done to investigate the clinical records on endoscopy for removing the upper gastrointestinal foreign bodies in 69 special patients. Result The foreign bodies in 67 patients were removed by endoscopy successfully, without severe complications such as bleeding and perforation; one patient was removed with duodenum lateral telescope; one patient turned for sugery . Conclusion Sufficient preoperative preparation and skilled surgical nursing cooperation are promising for the successful removal of upper gastrointestinal foreign bodies in special patients.

Objective Pleural effusion of patients with tuberculous pleurisy was analyzed by ultra high performance liquid chromatography-mass spectrometry (UPLC-MS).Orthogonal partial least squares discriminant analysis (OPLS-DA) model was established for searching and analyzing the potential metabolic biomarkers to provide new ideas for the early diagnosis of tuberculosis pleurisy.Methods Totally 166 cases of pleural samples were collected from November 2012 to September 2013 in Tianjin Haihe Hospital (tuberculosis pleurisy 83 cases,bacterial pleurisy 31 cases,lung cancer 30 cases and heart failure 22 cases)and metabonomics quantitative analysis was conducted.Quantitative analysis of metabolic methods was enrolled.Orthogonal partial least squares discriminant analysis (OPLS-DA) model was constructed by the pattern recognition method.Based on the OPLS-DA model,potential biomarkers was filtered preliminary by variable importance in the projection (VIP) and VIP confidence interval value.The specific metabolites were determined by applying non-parametric test(Kruskal-Wallis H test)by using SPSS 17.0,and potential metabolic biomarkers were screened.Results The prediction accuracy of OPLS-DA model was 100％ (38/38),which illustrated that the model could verify the tuberculous pleurisy group and the control group accurately.Based on the data of metabolites,46 potential metabolites were finally screened and 5 metabolites were identified with statistically significant differences (P ＜ 0.05).The data of tuberculosis pleurisy group showed a significant increase in 17a,20a-Dihydroxy cholesteryl,phospholipid [20∶4 (8Z,11Z,14z,17Z)] (1 188 670.00),tocotrienols (1 051 760.00) and phospholipid(O-18:0) (434 394.00) compared with the lung cancer group(735 615.00,336 815.00,324 563.00,193 055.00),bacterial pleurisy group (1 678 805.00,598 256.50,699 384.00,343 866.00),and heart failure group(535 842.00,253 503.00,234 503.00,130 185.00) (H =26.787,18.680,26.193,21.024,P ＜0.01),and a significant decrease in L-phenylalanine(245 976.00)compared with the lung cancer group(753 033.50),bacterial pleurisy group (357 278.00),and heart failure group(586 678.00) (H =13.635,P ＜ 0.01).Conclusions The OPLSDA model constructed on the basic of UPLC-MS technology platform can verify the tuberculous pleurisy group and the control group accurately,and the study provides new ideas and methods for identifying features of tuberculous pleurisy markers and early diagnosis.

Objective To explore the diagnostic value of combined detection of the liquid array technology, interfer-on (IFN)-γand IFN-γ-inducible protein (IP)-10 in the rapid, accurate diagnosis and differential diagnosis of tuberculous pleural effusions. Methods Patients with transudative pleural effusions were divided into tuberculous pleural effusion group (n=52) and malignant pleural effusion group (n=38). The method of T-SPOT.TB was used to detect the number of effec-tor T cells sensitized to Mycobacterium tuberculosis and spot forming cells (SFCs). The liquid array technology was used to detect the level of IFN-γand IP-10. Logistic regression was used to analyze and compare the diagnostic value of the two-method combination. Results The diagnostic sensitivity, specificity and the area under the ROC curve (AUC) of T-SPOT. TB were 90.38%, 84.21%, and 0.938 (95%CI:0.867-0.978), respectively. The diagnostic sensitivity, specificity and AUC of combined detection of IFN-γand IP-10 were 98.08%, 97.37%, and 0.995 (95%CI:0.951-1.000), respectively. There was no significant difference in the diagnostic sensitivity and specificity between the two methods, and the diagnostic agreement for the two diagnostic methods was fine (Kappa=0.703). The difference of AUC between the methods was significantly differ-ent (Z=1.996, P<0.05). The method of combined detection of IFN-γand IP-10 showed the larger AUC (AUC=0.995). Con-clusion The combined diagnosis meets the clinical needs of rapid, accurate diagnosis and differential diagnosis for tuber-culous pleural effusion by simultaneously assaying the level of IFN-γand IP-10 using the liquid array technology.

Objective To observe the changes of N-methyl-D-aspartate (NMDA) receptor 2B subunit (NR2B) expression in the striatum of chronic alcohol exposured rats at different withdrawal time.Methods 72 male Wistar rats were randomly divided into withdrawal 2h group,withdrawal 6h group,withdrawal 12h group,withdrawal 1d group,withdrawal 3d group and control group,and 12 rats in each group.In the 5 withdrawal groups,ethanol was administered in drinking water at the concentration of 6％ (V/V) for 16 weeks,and rats in control group were maintained with water.After 16 weeks ethanol was removed and ethanol withdrawal syndromes were evaluated.The expression of NR2B protein in the striatum was measured by immunofluorescence and western blot and the expression of NR2B mRNA in the striatum was measured by realtime PCR.Results Compared with withdrawal scores of control group((1.50±0.80)),scores of withdrawal 2h,6h,12h,1d,3d groups ((10.42±2.50),(15.42± 1.93),(9.25±2.01),(7.67± 1.92),(2.25±0.87) respectively) were higher,and the withdrawal scores of withdrawal 6h group were the highest.Compared with the expression of NR2B fluorescence intensity (2210.00± 178.20),the expression of NR2B protein(0.150±0.009) and the expression of NR2B mRNA(0.006±0.001) in the striatum of control group,the expression of NR2B fluorescence intensity (2710.56 ± 194.21),(5035.16 ± 234.41),(3326.23 ± 378.16),(2570.64 ±177.88),the expression of NR2B protein (0.192±0.008),(1.649±0.205),(0.783±0.109),(0.180±0.009) and the expression of NR2B mRNA (0.026±0.002),(0.351±0.034),(0.248± 0.023),(0.024±0.003) of withdrawal 2h,6h,12h,ld groups were significantly higher (P＜0.05),and with the extension of the withdrawal time,the expression was gradually increased.The expression of withdrawal 6h group was the highest,then began to decline,and returned to baseline levels at withdrawal 3 d(P＞0.05).Withdrawal scores were positively correlated with the expression of NR2B protein(r=0.719,P＜0.01),the expression of NR2B protein was positively correlated with the expression of NR2B mRNA(r=0.937,P＜0.01),and the expression of NR2B mRNA was positively correlated with withdrawal scores(r=0.673,P＜0.01).Conclusion The expression of NR2B was up-regulated in the striatum of chronic alcohol exposured rats at different withdrawl time.NR2B protein and NR2B mRNA expression is positively correlated with the withdrawal scores,suggesting that regulating the expression of NR2B may be a new target for the treatment of ethanol withdrawal symptoms.

Objective To investigate the value of muhi-detector CT (MDCT) low tension dynamic enhanced scanning on the preoperative assessment of advanced gastric cancer.Methods MDCT low tension dynamic enhanced scanning,tumor diagnosis and staging and prediction of surgery operation were performed on 43 cases of advanced gastric cancer.And the above results were compared with pathology results.Results The 36 cases were treated with resection,while 7 cases were treated by gastrointestinal anastomosis.The MDCT had 76.7 ％ (33/43) of accuracy for the preoperative T staging and 74.4 ％ (32/43) of accuracy for the preoperative N staging,respectively.The stomach wall thickness was closely related to serosal invasion (x2 =20.170 9,P ＜ 0.001).Conclusions The MDCT low tension dynamic enhanced scanning can improve the comprehensiveness and accuracy of preoperative staging of T and N in advanced gastric cancer.It is valuable for the preoperative diagnosis and treatment of gastric cancer.

Objective To study clinical application of Bard automated disposable instrument for percutaneous transtheracic biopsy guided by CT in diagnosis of pulmonary lesions. Methods Percutaneons transthoracic biopsy was performed with CT-guided Bard automated disposable instrument for 95 patients with pulmonary lesions but without established diagnosis by clinical and imaging procedures in order to obtain pathological diagnosis. Results Tissue specimens were obtained from all the 95 patients by Bard automated disposable instrument for percutaneous transthoracis biopsy, with a hundred percent of success. After the procedure, 68 of 95 were pathologically diagnosed as lung cancer (including adenocarcinoma in 44,squamous carcinoma in 19, alveolar cell carcinoma in three and small cell carcinoma in two), 10 as chronic inflammatory lesions, eight as tuberculosis, two as inflammatory pseudotumor, one as metastatic cancer, two as fungal infection, and four without an established diagnosis, with an overall diagnosis rate of 95.8%.Pneumothorax occurred in eight and mild haemoptysis in six of 95 patients, respectively, by the procedure.Conclusion Percutaneons transthoracic biopsy with Bard automated disposable instrument is an effective diagnostic procedure for patients with pulmonary lesions but their diagnoses were not established by routine examinations.

Objective To establish a diagnostic model of multiple cytokines for differential diagnosis of tuberculous pleural effusion , and compare its diagnostic accuracy with tuberculosis infected T cells detection ( T-SPOT.TB ) in order to evaluate its diagnostic performance.Methods Case-control study.Totally 147 patients with pleural fluid in Tianjin Haihe Hospital were enrolled and categorized as tuberculous pleural effusion group ( n=95 ) and malignant pleural effusion group ( n=52 ) from December 2011 to June 2013.Pleural effusion cytokines including interferon-γ( IFN-γ) , C-X-C motif chemokine 10 (CXCL-10), tumor necrosis factor-α(TNF-α), vascular endothelial growth factor (VEGF), IL-2, IL-16, IL-17, IL-27 and IL-33 were tested by liquid chip technology and analyzed by Binary Logistic regression and receiver operating characteristic curve (ROC), and the pleural effusion was also detected by tuberculosis infected T cells detection ( T-SPOT.TB) as a control.Results The comparison of the AUC of cytokines is:CXCL-10>IL-27>IFN-γ>IL-33 >IL-17>IL-16>TNF-α>VEGF>IL-2; After that, CXCL-10, IFN-γ, IL-27 and IL-33 were included the Binary Logistic regression model.The regression equation is P=1/1+e-( -16.851+0.390 ×IFN-γ+0.006 ×IL-27+0.020 ×IL-33).The AUC, sensitivity and specificity of the diagnostic model were 99.5%, 96.84%, and 98.08%, respectively.Both AUC and sensitivity of the diagnostic model were superior to those of any single index.Compared with T-SPOT.TB (0.995 ±0.003), the AUC of the diagnostic model (0.921 ±0.023) was significantly greater ( Z=3.235, P <0.01), but no significant difference was found when it comes to diagnostic results consistency (χ2 =0.062 5, P>0.05).The Kappa of the two methods was 0.795, which meant fine agreement of the evaluations of the two raters.Conclusion The application of liquid array technology of high sensitivity and repeatability with high throughput provided a novel insight and method in the clinical diagnosis , treatment and prevention for tuberculous pleural effusion scientifically and accurately.