Mini-clinical evaluation exercise(Mini-CEX) is a new tool used to evaluate clinical skill of internal residents.Through necessity,operation and practice of Mini-CEX applied in internal residents' clinical teaching,the paper makes it known that Mini-CEX is consistent with six requisitions of resident competence raised by Accreditation Council of Graduate Medical Education (ACGME).It increases medical and directorial quality,and is combined with doctor training abroad.Mini-CEX should be spread in training and examination of internal residents.

78 min,HCT

Objective To observe the effects of Kuijiening Plaster point application on the levels of pro-inflammatory cytokines IFN-γ, IL-12 and anti-inflammatory cytokines IL-4, IL-10 in serum and colonic tissue of ulcerative colitis (UC) rats with spleen-kidney yang deficiency; To investigate the possible mechanism of Kuijiening for the treatment of UC with spleen-kidney yang deficiency. Methods Sennae Folium solution gavage, ice water stimulation and trinitrobenzene-sulfonic acid ethanol combinative methods were applied to establish the models of UC rats with spleen-kidney yang deficiency. Rat models were randomly divided into control group, model group, application group and SASP group, 10 in each group. The control group and model group were given medicine-free cataplasm matrix point application and perfused with NS. The application group was given Kuijiening Plaster point application and perfused with NS. SASP group was given medicine-free cataplasm matrix point application and perfused with SASP. The courses were 28 days. General conditions of rats in each group were observed during treatment. The general morphology and pathological form of colonic tissue were observed with naked eye and light microscopy through HE staining respectively in each group post-treatment. Pathological features were observed and scored by HE dyeing. Levels of IFN-γ, IL-12, IL-4 and IL-10 in serum and colonic tissue of rats in each group were detected with ELISA. Results The general conditions, gross morphology and optical microscope pathological morphology of colonic tissue improved and scores decreased in application group and SASP group. Compared with the model group, levels of IL-4 and IL-10 significantly increased, while the levels of IFN-γ and IL-12 decreased in serum and colonic tissue in application group and SASP group, with statistical significance (P<0.01). Moreover, levels of IL-4 and IL-10 in application group decreased not as much as those in SASP group, while IFN-γ and IL-12 concentration increased higher than SASP group, without statistical significance (P>0.05). Conclusion Kuijiening Plaster point application can play a role in treating UC with spleen-kidney yang deficiency through partially restoring the balance between pro- and anti-inflammatory cytokines in serum and colon tissue of rats.

The pathological subtypes of breast cancer can be further divided into different molecular subtypes based on their immunohistochemical staining, such as estrogen receptor (ER) , progesterone receptor (PR) , human epidermal growth factor receptor2 (HER2) and Ki67 expression, including luminal subtype, HER2 overexpression subtype and triple negative subtype. The luminal subtype is defined as ER and/or PR positive. In molecular mechanism, the expression activity of ER can regulate the expression of PR, so the expression of ER and PR is usually consistent. However, in the process of detection, some breast cancers with inconsistent ER/PR expression often appear, especially those with ER (-) /PR (+) . There is still controversy about whether such cases are true. Patients with this type of breast cancer should be subjected to ER and PR immunohistochemical staining again, and then reclassified according to HER2 status. The expression of ER/PR is closely related to the efficacy of endocrine therapy for breast cancer, so its test results will directly affect the treatment options of clinician. This article will review and discuss the research progress of the causes and mechanisms of ER (-) /PR (+) breast cancer.

Bronchoalveolar Lavage ; methods ; Humans

11.1mmol/L were treated by 2 weeks CSⅡ.The elements of 2 hours postprandial,insulin,C-peptide, HbAlc,HOMA-?,and HOMA-IR were analyzed and compared before and after treatment,and the control of post- prandial of patients for 2 years was observed.Results The excellent control of FPG and 2h PG in 36 patients were achieved stably in(5.6?0.4)mmol/L and(8.2?1.4)mmol/L below the condition of(13.6?1.5)mmol/L and (20.1?4.0)mmol/L before treatment(P

Objective To study the anti-neuroglioma effect of methyl-mercuric chloride(MMC) by observing the morphological changes of apoptotic neuroglioma cells induced with MMC in rats with brain neuroglioma.Methods The rat models of neuroglioma were established,and divided into two groups.The rats in experimental group were lavaged with MMC 1 week after injected with C6 glioma cells,10 mg?kg-1every day,the rats in control group were treated with sodium chloride at the same dose.24 d after inoculation all rats were sacrificed except natural death,the brain tissues were obtained,and the pathohistological changes were observed under light microscope and transmission electron microscope.Results The macropathological result showed that the tumor volume in experimental group was smaller than that in control group.Under light microscope,in experimental group the growth density of C6 ghioma cells was lower than that in control group,and the apoptotic cells with smaller volume and karyopyknosis were found.The result of transmission electron microscope showed that in experimental group,the glioma cells had some changes such as karyopyknosis,chromoplasm margination,nuclear fragmentation and vacuolar degeneration and so on.Conclusion MMC has inhibitory effect on the proliferation of C6 glioma in rats in vivo,its mechanism may be related to inducing the apoptosis of neuroglioma cells.

AIM:By analyzing optical coherence tomography angiography (OCTA) characteristics of central serous chorioretinopathy (CSC) and comparing the differences of CSC between OCTA and indocyanine green angiography(ICGA), to explore if OCTA can substitute ICGA for diagnosis of CSC patients, and guide the treatment of photodynamic therapy (PDT).METHODS: We reviewed 30 eyes of 30 patients with CSC, who were diagnosed by fluorescein angiography (FFA) and ICGA at Beijing Tongren Eye Center from November 2015 to March 2016.All patients underwent best-corrected visual acuity (BCVA) measurement, intraocular pressure, slit-lamp examination, indirect ophthalmoscope, color fundus photography, FFA, ICGA and OCTA.FFA and ICGA were captured by Spectralis HRA + OCT (Spectralis HRA + OCT;Heidelberg Engineering, Heidelberg, Germany).OCTA was performed by RTVue XR Avanti device (OptovueInc, Fremont, CA) with 6mm×6mm Angio Retina mode.The software (version 2017.100.0.1;OptovueInc) automatically segmented the tissue into four layers, the characteristics of choriocapillaris layer were analyzed.At the same time, the differences between OCTA and ICGA images were compared among CSC patients.The maximum diameters and areas of both choroidal hyperperfusion in ICGA and high flow signal in OCTA were measured.Then, the paired t test was used to analyze the differences between the maximum diameter and area of OCTA and ICGA measurement.RESULTS: Among 30 cases, high blood flow signals of OCTA were clearly visible in 27 cases, namely the coarse grain region;the inner low flow signals surrounded by high blood flow signals were seen in 21 cases;the outer low flow signals surrounding high blood flow signals were seen in 7 cases.High blood flow signals of OCTA were corresponded with the choroidal hyperperfusion of ICGA images;among these 30 cases, there were low reflection shadows in choroidal hyperperfusion with ICGA for 22 cases, for 21 cases out of these 22 cases, low flow signals inside of high flow signals of OCTA could be seen;9 out of 30 cases, there were low reflection halo outside of choroidal hyperperfusion of ICGA, and 7 out of these 9 cases, low flow signals outside of high flow signals of OCTA could be seen;still for those 30 cases, leakage point in late ICGA could be seen with 14 cases, however, special flow signals in OCTA could not be seen for them.For ICGA, the maximum diameter of choroidal hyperperfusion was 1.589±0.295mm, whose area was 0.705±0.131mm2;while for OCTA, the maximum diameter of high flow signal was 1.576±0.293mm, whose area was 0.745±0.138mm2.By using paired t test, there was no statistical difference between the maximum diameter of choroidal hyperperfusion in ICGA and the maximum diameter of high flow signal in OCTA, nor difference between the area of ICGA and OCTA.CONCLUSION: The high flow signals can be clearly visible in OCTA, which are corresponded with choroidal hyperperfusion in ICGA.OCTA can substitute ICGA for diagnosis of CSC patients, and guide the treatment of PDT.

Objective To investigate ultrasonographic features of primary and metastatic ovarian yolk sac tumors.Methods Ultrasonographic features of 19 primary lesions and 33 metastatic lesions in 35 patients were retrospectively analyzed.Results Primary tumors were sized (14.6±3.6)cm in maximum diameter,manifesting as cysti-solid masses.Solid components of primary tumors were mainly hypoechoic or isoechoic(16/19)with rich blood supplies.Thirty-three metastatic lesions were located in pelvoceliac cavity(26/33) and liver parenchyma(7/33),sized (9.4±4.5)cm,(9.2±4.9)cm and (5.6±1.6)cm in maximum diameter respectively.Metastatic lesions in pelvoceliac lesions mainly demonstrated as hypoechoic masses(21/26), however lesions in the liver were mainly hyperechoic(5/7).Anechoic regions could be found in 9/26 of the pelvoceliac lesions.Blood supply was found less rich in metastatic masses than that in primary ones.Elevated serum level of alpha fetoprotein (AFP) was observed in all patients; ranging from 217 to 211 682 μg/L.Conclusions Primary and metastatic lesions of ovarian yolk sac tumor have obvious ultrasonographic characteristics.Combined with serum AFP level,the accuracy of diagnosis could be improved.