In order to meet the needs of new clinical professional training reform,develop practical,clinical thinking,communication and teamwork,the teaching of diagnostics was reformed.We integrated diagnostics,internal medicine,surgery,gynecology,pediatrics and basic practice,reduced the theoretical class hours,increased the teaching hours,innovated and enriched teaching methods,standardized the content of assessment and grading standards,and emphasized formative assessment.The preliminary results showed that the students had a high evaluation of the quality of self learning and teaching satisfaction,which indicates that it met the requirements of the syllabus,and students had good grasp of the basic clinical skills

Objective To investigate the variations of surface protein genes of avian influenza virus (AIV)before and after infecting mouse.Methods Mouse lung tissue was infected with A/Goose/Guangaong/NH/2003(H5N1)and the virus was isolated 12 hours and 9 days after replication in lung tissue of mouse.The isolated strains were amplified in embryonated chicken eggs,anti the virion RNA was transcribed into cDNA by reverse transeriptase.After amplification and purification,dideoxy-mediated chain termination was performed to detect synthetic oligonucleotide primers and DNA sequence was analyzed.Results The homology of nucleotide sequence for HA gene of three isolated strains was 99.6%-99.8%.and that of amino acid sequences was 99.3%-99.6%.The homology of nucleotide sequence for NA gene of three strains was 99.8%-99.9%.all of them were synonymous mutatinns.No variation was found in M gene.Conclusion After replication in mouse lung tissue,no significant mutation was found in the surface protein genes of AIV except some point mutations in HA genes.

OBJECTIVETo study the relationship between gene p53 codon 72 polymorphism and pathological scar formation occurrence after caesarean section.

METHODSThe method of molecular beacon with real-time PCR was applied to detect gene polymorphism of p53 codon 72 in blood samples taken from 303 pregnant women (within a week after caesarea section). The clinical visits were taken 3 times for 12th to 18th months to ascertain clinical formation of pathological scar and its relationship to genotype of p53. The chi-square method was used to analyze the relationship of p53 gene polymorphism and abnormal scar formation occurrence by statistical software SPSS 13.0.

RESULTSTotal of 303 pregnant women were assayed. 30 patients were found with pathological scar by clinical visit in the total 303 pregnant women. The genotype frequencies of total three types (C/C, C/G and G/G) of p53 gene codon 72 in patients with pathological scar are significantly different from that of normal pregnant woman. The frequency of C/C genotype in patients are higher than that of normal pregnant women (P < 0.01). The frequency of C/C genotype in these patients with pathological scar is higher (46.7%, 14/30) than C/G (33.0%, 10/30, P < 0.01) or G/G (20%, 6/30) genotype (P < 0.01). The C allele frequency in the patients is 63.7%. It is also higher than G allele (36.7%, P < 0.01). The OR value is 2.30. Therefore the C allele of p53 gene codon 72 is a risk factor for pathological scar.

CONCLUSIONSThere was a certain relationship between p53 gene codon 72 C allele and pathological scar formation after caesarean section.

Alleles ; Cesarean Section ; Cicatrix ; genetics ; Codon ; Female ; Gene Frequency ; Genes, p53 ; Genotype ; Humans ; Polymorphism, Genetic ; Pregnancy ; Risk Factors

Objective To evaluate the post-operative glucose level and insulin dose of patients undergoing total pancreatectomy.Methods From September 1980 to September 2014, 21 patients underwent total pancrea-tectomy in Peking Union Medical College Hospital, who were enrolled in our study.We reviewed the changes in their insulin dosage and glucose levels after operation, also summarized type and dose of insulin as well as glucose level in stable period.Results The required insulin dose reached peak within 4 days after surgery ( maximum dose 300 U/d).The average dose was (143.5 ±62.8) U/d and decreased gradually.During the perioperative period (needing parenteral nutrition), the blood glucose level fluctuated markedly (1.52-29.06 mmol/L) and the average level was (11.18 ±0.95) mmol/L.During the stable period ( without parenteral nutrition) , patients on average had (5.3 ±2.0) U of preprandial rapid-acting insulin and (8.1 ±2.9) U of long-acting insulin be-fore sleeping;the average fasting blood glucose was (6.69 ±1.48) mmol/L, 2 h postprandial blood glucose was (9.08 ±2.84) mmol/L, bedtime blood glucose was (9.66 ±2.49) mmol/L, and blood glucose level at night was (8.15 ±2.78) mmol/L.67%of the patients had 13 hypoglycemic episodes monthly on average.For those five followed-up patients, the average hemoglobin A1c was (6.15 ±1.20)%.Conclusions Patients undergoing total pancreatectomy may experience marked fluctuation of blood glucose level and short-term increase of insulin need which gradually decreases afterwards.After entering the stable period, the glucose level could be well-con-trolled but with frequent hypoglycemia.There is no diabetic ketoacidosis.

OBJECTIVETo construct a three-dimensional model to demonstrate the relation between the anterior branches of lumbosacral 4,5, lumbosacral trunk, and the pelvis.

METHODSAn formaldehyde-fixed adult cadaver was dissected to expose the anterior branches of the lumbar nerves 4 and 5, lumbosacral trunk and the sacroiliac. The mixture of titanium powder and adhesive was smeared on the surface of the major branches of L4 and L5 nerves, lumbosacral trunk, femoral nerves and obturator nerves. As soon as the mixture solidified, the specimen was scanned by spiral CT at 3 mm intervals to obtain 159 two-dimensional sectional images for three-dimensional model reconstruction on a personal computer using the software 3-D DOCTOR.

RESULTS AND CONCLUSIONThe reconstructed model can well demonstrate the spatial relation between the nerves and the pelvis, and allows rotation in every direction, which at the same time can be conveniently applied for purpose of clinical teaching.

Adult ; Cadaver ; Humans ; Imaging, Three-Dimensional ; Lumbosacral Plexus ; diagnostic imaging ; Lumbosacral Region ; diagnostic imaging ; Male ; Pelvic Bones ; diagnostic imaging ; Pelvis ; diagnostic imaging ; Radiography ; Sacroiliac Joint ; diagnostic imaging ; Spinal Nerves ; diagnostic imaging

DNA, Ribosomal ; genetics ; Genome, Plant ; Phylogeny ; Polymerase Chain Reaction ; methods ; Polymorphism, Single Nucleotide ; genetics ; RNA, Ribosomal, 5S ; genetics ; Sequence Homology, Nucleic Acid ; Species Specificity ; Valerian ; classification ; genetics

Objective To evaluate the value of diffusion tensor imaging(DTI)in cognitive impairment of patients with acute cerebral infarction.Methods Diffusion tensor images were obtained from 30 volunteers who underwent clinical MR imaging and were found to have no abnormalities on conventional MR images and 30 patients who were clinically diagnosed cerebral infarction and were found to have infarction lesions on conventional MR images.Color-coded FA images and three-dimensional color-coded tensor images were reconstructed.For volunteers,average apparent diffusion coefficient(ADC)and fractional anisotropy(FA)were measured in some main white matter structures of peripheral white matter, basal ganglia,and cerebral peduncle,etc.For infarction patients,ADC and FA were measured and compared between infarction lesions and corresponding contralateral normal regions.Pearson correlation analysis was used to determine correlation with cognitive impairment.Results In infarction patients group, FA and ADC of lesions unrecovered declined.Change in ADC and FA had positive correlation with cognitive impairment of patients with acute cerebral infarction.Conclusion DTI has positive correlation with cognitive impairment of patients with acute cerebral infarction.

Objective To investigate the peri-nasopharyngeal invasion patterns of nasopharyngeal carcinoma (NPC) on MRI and its relationship with tumor staging. Methods One thousand five hundred and seventy-three patients with newly diagnosed NPC which were histo-pathologically proved were retrospectively studied. The MRI manifestations and invasion patterns of the NPCs were elevated according to the 2008 Tstaging system of NPC. Z test was used to analyze the rate of adjacent structures invasion in NPCs. Results The structures invaded by NPCs included pharyngobasilar fascia in 1299 cases (82. 58% ); parapharyngeal space, 1090 ( 69. 29% ); nasal cavities, 304 ( 19. 33% ); oropharynx, 49 ( 3. 12% ); carotid space,514(32. 68% ); medial pterygoid muscle, 661 (42. 02% ); lateral pterygoid muscle, 210( 13. 35% ); skull base bones, 943(59. 95% ); cranial nerves, 630(40. 05% ) and paranasal sinuses, 242 ( 15.38% ). The T-stage distribution was T1, 242 cases ( 15.38% ); T2, 288 ( 18. 31% ); T3, 410 (26. 06% ) and T4,633 (40. 24% ). Among the cases with nasal cavities invasion, 90. 46% (275/304)showed the involvement of the structures seen in T3 or T4 stage, which was found in all cases with oropharynx invasion. In addition,69. 14% (457/661) of cases with medial pterygoid muscle invasion and 92. 15% (223/242) of cases with paranasal sinuses invasion showed the involvement of structures seen in T4 stage. As for the invasion patterns of NPC, the lateral invasion of pharyngobasilar fascia was more frequent than upward invasion of skull base (Z = 14. 025, P ＜ 0. 01 ) and downward invasion of oropharynx ( Z = 45.032, P ＜ 0. 01 ), and the downward invasion of oropharynx was less frequent than upward invasion of skull base ( Z = 34. 301, P ＜ 0. 01 ) and forward invasion of nasal cavities ( Z = 14. 404, P ＜ 0. 01 ). Conclusion NPC has a predilection of lateral invasion rather than upward and downward invasion, and its upward and forward invasion are more common than downward invasion.

Objective To guarantee the identification of the chilchen and safety of infusion, and to enhance work efficiency of the nurses. Methods Infusion management system was applied in outpatient infusion room in the department of pediatrics. Results From August to November 2009, 15 212 cases of infusion were completed, without any infusion accident. Real-time and the quantitative management was realized. Conclusions The infusion management system builds a harmonious infusion environment, raises the level of hospital management and the overall image and establishes a high s tandard, high grade and high efficiency infusion service pattern.

OBJECTIVEThis study was to investigate the condom use and its factors on sex workers in Shandong province, and to provide effective suggestions for AIDS prevention strategies and interventions.

METHODSFrom April to July in 2009, 4732 female sex workers were investigated through anonymous questionnaires from 11 cities which were selected based on the AIDS epidemic, geographic location, economic conditions in Shandong province. Serum samples were collected and antibodies were tested by ELISA and TPPA from 4641 people.

RESULTS4732 female sex workers who were 15 - 58 years old were investigated and the majority belonged to the low age group (≤ 24 years old) which accounted for 61.5% (2912/4732). Among the 4732 female sex workers, the unmarried, the divorced, or the widowed females accounted for 72.8% (3441/4725) and 72.0% (3403/4726) of them were poorly educated.42.3% (1994/4719) of them were found from other provinces. The right answers for knowledge of AIDS accounted for 45.7% (2164/4732). 80.6% (3416/4236) of these females were found to used condoms in the most recent commercial sex activity. The rate of consistently using condoms in sex activity during the last month was 58.4% (2467/4221). In this survey, 7.3% (337/4637) of investigated females had been diagnosed with sexually transmitted diseases, 30.7% (1449/4726) of them had received HIV antibody test, 70.4% (3323/4732) of these people had received the AIDS intervention services, and 3.6% (167/4668) of them had ever used drug. Multivariate logistic regression analysis showed that high education level (junior high school or lower vs senior high school or higher, adjusted OR = 0.77, 95%CI: 0.67 - 0.90), having received the HIV intervention (received vs unreceived, adjusted OR = 1.36, 95%CI: 1.17 - 1.58), antibody detection (done vs not done, adjusted OR = 1.33, 95%CI: 1.15 - 1.55), and good knowledge about AIDS (low score group vs high score group, adjusted OR = 0.37, 95%CI: 0.32 - 0.44) were independent factors that increased safe sex behavior; while using drug (drug vs not drug, adjusted OR = 0.22, 95%CI: 0.15 - 0.31) was a negative factor.

CONCLUSIONThe prevalence rate of HIV infection among female sex workers was low in Shandong province. However, the low rate of condom use and the high prevalence of self-reported STD-related symptoms suggested that more attentions should be paid to the factors of risk behaviors, and more targeted interventions are critically needed.

Acquired Immunodeficiency Syndrome ; prevention & control ; Adolescent ; Adult ; China ; Condoms ; utilization ; Female ; Humans ; Middle Aged ; Population Surveillance ; Prevalence ; Safe Sex ; statistics & numerical data ; Sex Workers ; statistics & numerical data ; Sexually Transmitted Diseases ; prevention & control ; Surveys and Questionnaires ; Young Adult