The level of clinical practice skills in medical students is one of the most important markers to evaluate themedical educational quality. We have designed a new integrative assessing scheme which chiefly evaluates the practicalskills, that is: clinical skills account for 50%, oral test of professional knowledge accounts for 20% ,case analysis 20%,medical history writing 5%, and medical ethics and work discipline 5%. Through the nearly two years' implement,theproject greatly accelerates the cultivation of clinical practice abilities in medical students, enormously promotes thestudents' initiative and consciousness in clinical practice training, and roundly improves the teaching quality of clinicalpractice.

Background and purpose:In order to look for the new biomarker with higher specificity and sensitivity, we investigated the relationship between expression of MGB-2 and chemotherapy response, and tried to find out whether MGB-2 may sever as a prognostic factor for the patients with ovarian carcinoma. Methods:The expression of MGB-2 was detected by flow-cytometry technology in ovarian carcinoma tissue. We analyzed the correlations among MGB-2 expression and clinical pathological factors, therapeutic effect and prognosis of the patients with ovarian carcinoma.Results:Positive detection of MGB-2 was 78%.(66/885). For the patients whose serum CA125 level did not drop to normal level after two courses of chemotherapy, the MGB-2 positive rate was significantly higher than in those whose serum CA125 level decreased markedly ( 85% vs. 62%, P=0.018). The positive rate was also higher in patients with recurrent disease than in those without recurrence (83% vs. 67%, P=0.097). In univariate survival analysis, the expression of MGB-2 was significantly associated with median survival time (P=0.021).Conclusions:MGB-2 expression is correlated with chemotherapy response and poor prognostic for the patients with ovarian carcinoma.

This paper analyzed the system,methods,content,scope and standards of last two competition in order to further improve the clinical skills competition for national medical students in China.According to the characteristics of medical education,the paper proposed several opinions and suggestions as follows:repechage should be cancelled in competition system and objective structured clinical examination should be used in competition; the content,scope and criteria of the competition should take the actual ability of the medical students at graduation into consideration.

Objective:To study the fingerprint of Radix Salviae Miltiorrhizae of Xiangdan Injection. Methods : HPLC with UV detector was used to analyze the patterns of the Radix Salviae Miltiorrhizae of Xiangdan Injection. Protocatechuic aldehyde was used as internal standard substance. Results : The fingerprint of Radix Salviae Miltiorrhizae of Xiangdan Injection was set up and the fingerprint of them showed an excellent correlation. Conclusion : The study is helpful for the quality control of Xiangdan Injection.

Objective To investigate the efficacy and safety of endoscopic submucosal dissection (ESD) for removal of gastrointestinal stromal tumors (GISTs). Methods Data of 22 patients with GISTs,who underwent ESD, were reviewed in terms of personal situation, location and size of lesions, clinical manifestation, managements, pathology, complications and follow-up findings. Results The procedure was successfully performed in all patients and all lesions were removed by one procedure. The lesion size ranged from 0. 8 to 4. 0 cm and the operation time was 35-150 min ( mean 64. 5 min). Mild bleeding occurred in all cases, which was successfully managed by argon plasma coagulation, hot biopsy probe or endoclip. Perforation occurred in 4 patients (18. 1%), which were closed with endoclip. Abdominal distension was relieved with decompression, acid suppression with proton pump inhibitors and antibiotics in 3 cases, additional trans-abdominal puncture was needed in the other case. No severe hemorrhage occurred. The average length of hospitalization was 4. 5 days (3-10 d). The patients were followed up for 3 to 18 months, and no tumor residue or recurrence was observed. Conclusion ESD is an effective and safe endoscopic procedure to remove GISTs. The main complications are bleeding and perforation, which, however, can be cured.

OBJECTIVE To investigate the effect of mono-2-ethylhexyl phthalate(MEHP) on proliferation of primary neural stem cells(NSCs)of rats and NE-4C cells of mice and on the migration of NE-4C cells and the mechanism. METHODS NE-4C or NSCs were treated with MEHP 1,10,100 and 1000 μmol · L-1 for 72 h,respectively. The cytotoxicity was estimated with the cell counting kit-8 (CCK-8). Cell proliferation was analyzed by EdU assay. The mRNA expression levels of the glucocorticoid receptor(GR),signal transducer and activator of transcription 3(Stat3)and sex determining region Y (SRY)-box 2(Sox2) were detected by qRT-PCR. The protein expression levels of total GR,GRβ, Sox2,Stat3 and p-Stat3 were measured by Western blotting. RESULTS Cell viability of NE-4C cells and NSCs at MEHP 1000μmol·L-1 was significantly decreased,which was 70.3%and 40.0%of the control group, respectively. EdU assay showed that MEHP 100 μmol · L-1 decreased NE-4C cells and NSCs by 74.8%and 12.0%(P<0.05)compared with control. The effect of MEHP on the cell migration of NE-4C was evidenced by the fact that the migration was obviously reduced to (63.4±2.0)%(P<0.05)after treatment with MEHP 100μmol · L-1 for 72 h. The mRNA expression levels associated with proliferation and migration in NE-4C of GR,Stat3 and Sox2 in MEHP 100 μmol · L-1 group were down-regulated to 49.8%,26.0% and 14.0%of control(P<0.05). At MEHP 100μmol · L-1,mRNA of GR, Stat3 and Sox2 in NSCs declined to 10.0%,14.0% and 15.3% of normal control. Western blotting results revealed that protein expressions of GR,GRβ,Sox2 and p-Stat3 were remarkably inhibited by MEHP 100 μmol · L-1 in that the relative expression of NE-4C was 0.92 ± 0.17,0.87 ± 0.35,0.81 ± 0.22 and 0.62 ± 0.24(P<0.05). The corresponding protein expression in NSCs was 0.82 ± 0.20,0.56 ± 0.12,0.84 ± 0.36 and 0.53 ± 0.20(P<0.05)when the cells were treated with MEHP 100μmol · L-1 for 72 h. CONCLUSION MEHP can inhibit the proliferation and migration of NE-4C cells and NSCs possibly by decreasing Stat3 and Sox2 that are mediated by GRβ.

The dynamic changes of synchronous 12-lead ECG signal's correlation dimension (D2) of an anesthetized rabbit were investigated primarily under three different pathologic conditions. The results showed that the D2 derived from different lead signals was not a constant whether the rabbit was in normal state or in emergent myocardial infarction condition, it demonstrated distribution characteristic. Compared with the same lead signal, D2 of limb lead almost kept constant, D2 of chest lead got higher when the sphere of emergent ischemia extended larger. D2 showed the potential application in the diagnosis of coronary heart disease.
Animals ; Electrocardiography ; Myocardial Infarction ; physiopathology ; Nonlinear Dynamics ; Rabbits ; Signal Processing, Computer-Assisted

OBJECTIVE: To evaluate the mid-term prognostic value of procalcitonin (PCT), endotoxin and common inflammatory markers combining the model for end-stage liver disease (MELD) score in patients with chronic severe hepatitis. METHODS: A total of 124 chronic severe hepatitis patients were enrolled, who were hospitalized in the Department of Infectious Diseases, Xiangya Hospital, Central South University from May 2011 to December 2011. Indexes of inflammation, liver and kidney function tests and MELD were determined within 24 h after the admission, and blood samples were collected for measurement of endotoxin , procalcitonin (PCT), and C-reactin protein (CRP). The outcome was confirmed after discharge follow-up at the end of the 3rd month. According to the outcome, the 124 patients were divided into a survival group (n=58) and a death group(n=66). RESULTS: 1) Of the 124 patients, 66 died and 58 survived, with statistical difference in age, MELD score, white blood cell (WBC), polymorphonuclear (PMN), CRP and PCT by single factor analysis between the 2 groups(P<0.05). Binary logistic regression analysis indicated that age, MELD scores and PCT were highly correlated with the outcome (OR=1.07, 1.42 and 1.02 respectively, P<0.05), which could be used to predict the 3 month mid-term mortality of chronic severe hepatitis. 2)There was significant correlation between the MELD scores and the mid-term mortality. Age was positively correlated with the MELD score, and Pearson's correlation coefficient was 0.21 (P<0.05). PCT was also positively correlated with the MELD, and Spearman's correlation coefficient was 0.54 (P<0.01). 3)According to the receiver operation characteristic (ROC) curve analysis , the area under the curve (AUC) of MELD score and PCT were 0.91 and 0.77 respectively, higher than those of other indexes (P<0.01). When the MELD score was up to 30.09 or higher, the predicted mortality risk among these tested patients was the highest(82.26%). The mortality risk predicted by PCT combining MELD score and PCT alone was lower than by MELD score alone (75.00%), but the specificity of MELD score combining PCT was 100%, and the positive prediction value was 1.00. CONCLUSION Endotoxin and common inflammatory markers (WBC, PMN, and CRP) are not reliable indicators to predict the prognosis in patients with chronic-severe hepatitis. MELD score is significantly correlated with the outcome of mid-term chronic severe hepatitis, PCT and age are both positively correlated with the MELD score. PCT and age combining MELD score can be used to predict the 3 month mid-term mortality of chronic severe hepatitis. MELD score has better prognostic value than PCT. MELD score combining PCT can improve the specificity of prediction.
Adult ; Age Factors ; C-Reactive Protein ; metabolism ; Calcitonin ; blood ; Calcitonin Gene-Related Peptide ; End Stage Liver Disease ; diagnosis ; mortality ; Endotoxins ; blood ; Female ; Hepatitis, Chronic ; diagnosis ; mortality ; Humans ; Male ; Middle Aged ; Predictive Value of Tests ; Prognosis ; Protein Precursors ; blood ; ROC Curve ; Severity of Illness Index ; Survival Analysis

OBJECTIVETo evaluate the effect of different immune status on the incidence of hepatic lesions in patients with hepatitis B virus (HBV) infection undergoing anti-tuberculosis therapy.

METHODSThe PubMed (1966-2013), Embase (1966-2013), Wanfang (1998-2013), Chinese National Knowledge Infrastructure (CNKI; 1997-2013), and Chinese Biomedical (CBMdisc; 1860-2013) literature databases were searched for case-control studies of hepatic lesions in patients undergoing anti-tuberculosis therapy with or without concomitant HBV infection. The HBV patients were divided into subgroups according to hepatitis B e antigen (HBeAg) positivity or negativity, all members of the control group were HBsAg⁻. The data from all 7 studies included in the meta-analysis were extracted and analysed using RevMan5.2 soft-ware.

RESULTSPatients with HBV infection who were undergoing anti-tuberculosis therapy had a higher risk factor than the control patients (OR =5.81, 95% CI =[4.26, 7.39]). The HBV patients with HBeAg positivity who were undergoing anti-tuberculosis therapy had a high risk factor than the HBV patients with HBeAg negativity (OR =2.56, 95% CI=[1.90, 3.44]).

CONCLUSIONHBV infection is a risk factor for hepatic lesions when undergoing anti-tuberculosis therapy, and HBeAg-positive status may put a patient at higher risk.

Antitubercular Agents ; adverse effects ; therapeutic use ; Hepatitis B ; complications ; pathology ; Hepatitis B e Antigens ; blood ; Humans ; Liver ; drug effects ; pathology ; Tuberculosis ; complications ; drug therapy ; pathology

OBJECTIVES: A variety of causes can lead to cholestasis, however, cholestasis caused by Graves' disease is usually overlooked clinically. Here we analyze the clinical characteristics of Graves' disease associated cholestasis so as to have a better understanding for the disease. METHODS: We retrospectively collected 13 inpatients' data who suffered from the Graves' disease associated cholestasis in the Department of Infectious Disease of Xiangya Hospital from January 2000 to December 2018. The characteristics of the patients' age, gender, liver function, thyroid function, coagulation function, the special cardiac examination, treatment, and follow-up data were analyzed. RESULTS: Thirteen patients, including 10 males and 3 females with the age range from 33 to 55 (median 43) years old presented cholestasis, pruritus, and hypermetabolic symptoms. The levels of total bilirubin (TBIL), direct bilirubin (DBIL), glutamic-pyruvic transferase, glutamic-oxaloacetic transferase, alkaline phosphosphatase, and gamma glutamyl transpeptidase were 170.4-976.7 (median 388.8) µmol/L, 93.2-418.1 (median 199.2) µmol/L, 25.1-182.1 (median 106.4) U/L, 38.2-265.7 (median 59.7) U/L, 105.3-332.0 (median 184.5) U/L, and 20.7-345.1 (median 47.6) U/L, respectively. The levels of free triiodothyronine (FT CONCLUSIONS Graves' disease can cause cholestasis, with the low incidence. The symptoms of cholestasis can be improved or even eradicated with the cure of the Graves' disease. The cholestasis may be idiopathic. For patients with cholestasis and hyperthyroidism, Graves' disease should be considered for differential diagnosis.
Adult ; Cholestasis/etiology* ; Female ; Graves Disease/complications* ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Thyroid Function Tests ; Thyroxine ; Triiodothyronine