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.

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 summmrize the clinical characteristics complications,antimicrobial resistance and prognosis in 15 children with streptococcus pneumoniae meningitis so as to improve the diagnosis and treatment of this disease.Methods A systematic retrospective analysis was carried out in the Qilu Children's Hospital of Shandong University from Jan.2010 to Jan.2013,and clinical data from 15 children with streptococcus pneumococcal meningitis were retrospectively analyzed and followed up for 6 months in order to observe the prognosis.Results Eleven cases of streptococcus pneumoniae meningitis occuned in the winter and spring.And it often occuned in children less than 2 years of age who lived in rural areas (13 cases).The clinical manifestations showed diverse characteristics,severe symptoms,obvious changes in symptoms and cerebrospinal fluid were observed.Severe or death cases had low temperature,low leukopenia or low blood platelet.Common complications of streptococcus pneumoniae meningitis included anemia (10 cases),hypoalbuminemia (9 cases),sepsis (8 cases).Multi-drug resistance and complications in streptococcus pneumoniae meningitis led to the therapeutic difficulties.In this study,3 cases were cured,9 cases had varying degrees of sequences,such as left languages,sports,hydrocephalus and cognitive dysfunction,and 3 cases died,and the main cause of death was multiple organ dysfunction syndrome.Conclusions Streptococcus pneumoniae meningitis mainly occurred in the winter and spring.And the children under 2 years of age who lives in rural areas were often attacked.Clinical characteristics and cerebrospinal fluid changes obviously; severe cases are common with low temperature,low leukopenia or blood platelet.And there aye often diverse complications and multi-sequelae; the problem of multi-drug resistant and complications can lead to great difficulties in the clinical treatment.

Objective To explore the changes of serum nitric oxide(NO) and trace element Zinc in children with pneumonia and their clinical significance.Methods The observing group contained 48 patients with pneumonia in our hospital from Oct.2005 to May 2006,who were collected 3 mL of blood sample on empty stomach on the second day.Twenty-six of them had been collected serum during their convalescence stage.The control group contained 20 children,who were healthy in the same stage.The levels of NO of 48 pneumonia,26 convalescence stage(recovery group) and 20 healthy patients were determined by UV-2100 spectrophotometer.The Zinc in serum was determined by P-E503-mode atomic absorption spectrophotometric analysis antigenic in those patients.Blood viscosity was measured and analyzed with the statistic analysis SPSS 10.0 software.Results The levels of NO in pneumonia children[(57.76?19.41) ?mol/L] were significantly higher than that in control group [(25.09?5.51) ?mol/L] and recovery group[(30.08?8.05) ?mol/L](P_a

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 observe the application effect of layered cooperation teaching in clinical teaching in intensive care unit (ICU).Methods The master graduate students who practiced in ICU of Fangcun branch of Guangzhou Provincial Hospital of Traditional Chinese Medicine form September 2013 to July 2014 were divided into two groups according to the rotation cycle.Diagnostic test was conducted to all the above students.The new teaching group (21 people) was determined according to the diagnostic test results and students' majoring to frm study group and the layered cooperation teaching was adopted,while the traditional teaching was used in the traditional clinical education group (19 cases).In the end of the rotation training,a theoretical examination was conducted among the two groups of students,and the questionnaire of teachers' teaching quality was issued.The related data were processed by SPSS 17.0,and the data between groups were compared by t test.Results The examination result in the layered cooperation teaching group (78.35 ± 3.13) were better than those in the traditional clinical education group (70.21 ± 4.58) and the difference was statistically significant (P=0.041).Survey results showed that the new teaching group students' evaluation to teaching content,teaching methods and teaching effectiveness was higher than traditional teaching group,and the score difference was statistically significant (P＜0.05).Conclusion The layered cooperation teaching in the clinical teaching in intensive care unit (ICU) to mobilize the students' subjective initiative,so that students of different knowledge structure can be integrated into the clinical practice of ICU,and enhance their ability of clinical analysis of ICU disease.