In the basic skill teaching of "Diagnostics Foundation"in Chinese medicine colleges and universities, the standardized patients are used to strengthen students’ clinical basic skill,let them consolidate their theoretical knowledge and change it into their skills,which is an effective way to guarantee the students to enhance their"double-base"ability,namely the elementary theory and clinical basic skill,and their self-confidence and shorten the time from the classroom to the clinical practice running-in period.

Objective To investigate the safety and efficacy of long-term low doses of Azithromycin combined with Budesonide/Fomoterol in the treatment of stable Ⅲ to Ⅳ COPD patients. Methods Collect the confirmed COPD patients of our hospital, they were randomly divided into two groups: the control group (160μg/ 4.5 μg, Bid), the joint group (160 μg/ 4.5 μg/ Bid + azithromycin 250 mg qd). Then Observe the PEF, FEV1, FEV1/FVC, mMRC, 6 MWT, AECOPD of the two groups after treatment for 3 months and 6 months. Results the index of PEF, FEV1, FEV1/FVC of joint group improved more significantly (P < 0.05) than control group after 6 months; the mMRC, 6 MWT, AECOPD, of the two groups improve the similar degree in terms of 3 months (P > 0.05), joint group improved more significantly than control group after 6 months (P < 0.05). Conclusion the therapy of Long-term low doses of azithromycin combined with Budesonide/Fomoterol can more significantly improve lung function index , as the treatment time extended , it can significantly improve clinical symptoms ,reduce the number of exacerbations than single inhaled Budesonide/Fomoterol .

Aim: To establish a method for the determination of pantoprazole sodium and its related substances. Methods: A column packed with octadecylsiance bonded silica gel (250 mm × 4. 6 mm, 5 pjn) was used. The 0. 01 mol/L monopotassium phosphate solution( adjusted with phosphoric acid to pH 7. 0) -acetonitrile were adopted as the mobile phase, a gradient elution was programmed as follows: 0→30 min(90:10-60:40), 30→45 min(60: 40→15: 85); the detection wavelength was 289 nm; the column temperature was 40 ℃; the flow rate was 1. 0 mL/min. Results: Pantoprazole sodium, the intermediates and its related substances could be well separated. A good linear relationship was obtained over the range of 6. 96-48. 72 μg/mL( r =0. 999 9). The limit detection and quantisation of pantoprazole sodium were 8.51 ng and 17.0 ng, respectively. Conclusion: This method can be applied to control the related substances of pantoprazole sodium and determine pantoprazole sodi-um.

Objective To explore the value of 18F-fluorodeoxyglucose（18F-FDG）PET-CT and CT in diagnosing bronchioloalveolar carcinoma （BAC）.Methods The PET-CT and CT findings of 15 patients with BAC pathologically confirmed were retrospectively analyzed.Results According to 18F-FDG PET-CT,there was definite diagnosis of malignant in 8 cases（53.3 %）,no exclusion of malignancies in 2 cases （13.3%）,definite diagnosis of benign tumors in 5 cases（33.3%）.The misdiagnosis rate of 18F-FDG PET-CT is higher.According to CT,there was definite diagnosis of malignant tumors in 11 cases（73.3 %）,no exclusion of malignancies in 2 cases（13.3%）,definite diagnosis of benign tumors in 2 cases（13.3%）.Conclusion The false negative rate and the misdiagnosis rate are high when SUVmax as 2.5 was employed as criteria in the diagnosis of BAC.To improve diagnosis accuracy and decrease misdiagnosis of BAC,we should be familiar with the CT images of different BACs and adjust the SUVmax as a diagnosis value.

0.05).Both HMGB1 mRNA expression and HMGB1 protein level were remarkably higher in LPS treatment group than that in control group(P0.05).CONCLUSION:RPM inhibits HMGB1 expression not only by directly suppressing STAT3 activation,but also by indirectly reducing TNF-? level.

BACKGROUND: Primary progressive aphasia(PPA) is a degenerative disease of nervous system, which is very rare in clinics. Only 3 cases have been reported in our country. There is very little clinical information regarding the characteristics of PPA in linguistics and imageology.OBJECTIVE: To report the language disorder and the characteristics of imageology of one PPA patient for the clarification of the clinical features of PPA.DESIGN: A case analysis.SETTING: Department of Neurology, Beijing Tiantan Hospital; Faculty of Psychology, Beijing Normal University.PATICIPANT: Male, 56 years old, senior high school graduate, businessman before the onset of the disease. The case visited the department of Neurology,Tiantan Hospital, Beijing due to the complaint of three years of progressive decreasing in language skills, which was then diagnosed with PPA.METH ODS: Spoken language fluency evaluation in Chinese Aphasia Examination Set of the First Affiliated Hospital of Beijing Medical University was used to evaluate this patient, the type of Aphasia was judged by Western Aphasia Examination Set, and the severity gradation was classified by the Boston Diagnostic Aphasia Examination(BDAE) . Memory, intelligence screening and imageology examination were performed as well.MAIN OUTCOME MEASURES: The fluency of spoken language, the type of aphasia, and the severity of aphasia of the patient were judged, and whether the patient suffered from memory and intelligence disorder were observed as well as the features of imageology.RESULTS: The patient had fluent spoken language, which was evaluated as sensory aphasia(SA) with the aphasia severity of level 4, and had no memory or intelligence disorder. MRI showed atrophy in left frontal lobe and temporal lobe, which was more significant in left side. MRI also showed that left temporal and frontal lobes had low metabolism and low perfusion.CONCLUSION: PPA is a disease with language disorder as its dominant clinical manifestation, which no other cognitive disorder at its initial stage,and with its main pathological changes in left temporal and frontal lobes.

Objective To evaluate the changes and clinical significance ot the serum levels of homocysteine (Hcy) in gastric cardia cancer patients before and after surgery.Methods Serum Hcy concentrations of 102 patients with gastric cardia cancer (including 69 case of males) and 50 healthy human were measured by enzymatic cycling assay.Results Total Hcy levels were significantly increased in male patient group compared with the levels in control group (t =5.143,P =0.001).Hcy levels were significantly lower in postoperative group compared with preoperative group [(17.08±5.31) μmol/L vs (20.34±9.26) μmol/L,(14.07±4.87) μmol/L vs (20.34±9.26) μmol/L,P ＜ 0.05].Compared with Ⅳ stage group and other TNM stage groups,significantly lower levels of Hcy were detected in patients with gastric cardia cancer (t =2.306,3.285,P =0.030,0.002).Hcy levels in patients with gastric cardia cancer were also significantly higher than those in the tumor length ＜ 3 cm,3-5 cm and ＞ 5 cm groups (t =2.461,2.147,P =0.017,0.038).Multiple logistic regression analysis indicated a statistically significant association between serum Hcy concentration and gastric cardia cancer incidence (OR =1.136,95 ％ CI 1.010-1.278,P =0.033).Increasing serum Hcy levels were significantly associated with a decreasing risk of metastatic lymph node (OR =0.865,P =0.010).Conclusion Serum Hcy levels are directly associated with risk of male patients with gastric cardia cancer,and play important roles in the development of gastric cardia cancer.

Objective To carry out the clinical validation of a domestic HBsAg kit to evaluate its application value. Methods 543 serum samples with HBsAg ELISA values of S/CO ≥ 0. 7 were tested by HBsAg confirmatory test. Specific anti-HBs reagent and control reagent were added separately into duplicate wells of HBsAg ELISA plate, in which test sample was also added. After incubation at 37℃, HBsAg was detected by routine ELISA, and the inhibition rate was calculated using absorbanee (A) result of anti-HBs reagent well and control reagent well according to the provided formula. The sample was confirmed as HBsAg positive when the inhibition rate was≥50%. For HBsAg weakly positive samples, "prolonged confirmatory test" (conjugate reaction time was prolonged to 120 rain) was applied to increase the sensitivity. 39 samples were randomized selected for testing and comparison with Abbott Murex confirmatory test. Results 543 serum samples in total were tested by the confirmatory test. Among the 504 cases which showed positive reaction in screening HBsAg ELISA, 89 ( 17. 7% ) were confirmed as negative. According to their S/CO value of the screening HBsAg test, the ratio of negative cases / tested eases in the group were:S/CO≤<5.0, 87/143 (60. 8% ) ;5.0 < S/CO ≤ 10. 0,0/25 (0) ;10. 0 < S/CO ≤ 15.0, 1/21 (4. 8% ) ;15.0 < S/CO ≤ 20. 0, 1/23 (4. 4% ) ;S/CO 20. 0, 0/292(0). Among 39 cases with negative HBsAg (0. ≤