The clinical skills competitions for national medical students in China have been well organized for five times.Experience has been accumulated,and much has been emphasized on the low assessment efficacy throughout the competitions.However,few solutions has been brought about to conquer such problem.This article mainly focused on introducing a computerized clinical skill assessment system based on current clinical skills competition assessment.The system realizes functions such as team management,online marking,score calculation,data analysis,and real-time result presentation.Such appliance of computer,internet and information technology on conventional clinical skills evaluation could hopefully replace the traditional manual calculating procedures,improving the efficiency of the future competitions,to ensure their openness,impartiality,and equitability,as well as to deliver observatory appeal among audience.

Objective To investigate the difficulties in posterior approach lumbar microendoscopic discectomy (MED). Methods We retrospectively analyzed records of 42 cases of lumbar disc protrusion (totally 45 interspaces) treated by MED from February 2002 to October 2003. Results Conversion to open surgery was required in 3 cases.No intra- or post- operative complications were seen.Follow-up survey for 2 ～ 22 months (mean,8 months) found the "good" or "excellent" results in 95 2% of the patients (40/42).Surgical difficulties were mainly classified into two aspects: technical and etiological,including 8 cases of failure of collimation between the passage and the interspace,5 cases of excessive bleeding disturbing the operation,3 cases of incomplete surgical apparatus,2 cases of incorrect passage localization,2 cases of hyperplasia in tiny joints,1 case of ossification of the posterior longitudinal ligament,1 case of nerve root edema,1 case of accretion,and 1 case of laceration,respectively. Conclusions Treatment of lumbar disc protrusion with MED gives satisfactory efficacy.Proper selection of patients and careful performance during surgery are essential to a successful procedure.

0.05). The BHR distribution was slight 31.9%, mild 43.5%, moderate 24.6%, no severe BHR were found in this study, showing less correlation between the percentage of predicted FEV 1 and the PD 20FEV 1-His in the elderly (r=0.277, P

Objective To observe the clinical efficacy of different kinds of insulin combined with Metformin in the treatment of T2DM.Methods 120 T2DM patients were selected and divided into three groups according to different therapies of reducing blood sugar with 40 cases in each group.Group A was treated with insulin glargine combined with Metformin;Group B with insulin detemir combined with Metformin and Group C with protamine zinc insulin combined with Metformin .The time for reaching the standards of blood sugar and the corresponding usage amount of insulin of three groups were observed;After 6 months, the three groups were com-pared in terms of FBG, PBG HbA1c, HOMA-IR, TC, TG and LDL-C.Meanwhile, the incidence rate of hypoglycemia after treat-ment was observed.Results Time for reaching the standards of blood sugar in Group A, Group B and Group C was (6.9 ±2.3)d, (4.1 ±3.0)d and (3.8 ±1.5)d, respectively;the corresponding dosages of insulin of the three groups was (19.0 ±7.8)U, (12.1 ±5.9)U and (11.9 ±5.3)U, respectively, with significant difference between Group A and Groups C, D (p<0.05) and insignifi-cant difference between Group B and Group C (p>0.05).After 6 months, FBG, PBG, HbA1c, HOMA-IR in Group B, Group C and Group A were significantly reduced (p<0.05);with insignificance between Group B and Group C (p>0.05).6 months follow-ing the treatment, TC, TG and LDL-C in Group B, Group C and Group A were significantly different (p<0.05), with insignificant difference between Group B and Group C (p<0.05).The incidence rate of hypoglycemia in Group A, Group B and Group C was 22.5%, 20.0% and 5.0%, respectively, with those in Group B and Group C significantly lower than Group A (p<0.05) and in-significant difference between Group B and Group C (p>0.05).Conclusion The insulin detemir and protamine zinc insulin com-bined with Metformin has a better clinical efficacy in the treatment of T2DM.It can promptly control the blood sugar level and lead to a lower incidence rate of hypoglycemia.Therefore it is worthy of promotion.

Objective To explore the relationship of neutrophil and interleukin-8(IL-8)with exercise-induced asthma(EIA).Methods From May 15,2001 to Dec 19.2005 the levels of peripheral neutrophil superoxide anion and IL-8 in the blood and the induced sputum from patients with EIA,non EIA and normal control subjects were measured respectively before and after exercises,meanwhile a comparison was made among them.Results Before exercise:the level of neutrophil superoxide anion was slightly higher in EIA group and non EIA group than that in control group;however,the differences were insignificant;the IL-8 and MDA levels in blood and induced sputum were higher in EIA group and non EIA group than those in control group,but there was no significant difference between EIA group and non EIA group;however,they were significantly different between EIA group and control group,non EIA group and control group respectively( P 0.05).Conclusion Oxyradical produced by neutrophil and IL-8 has significant effect on the production of EIA.

Objective To study the interference effects of tetramethylpyrazine (TMP) on calcinuerin (CaN), c-fos and the nuclear antigen of proliferating cells in the proliferation of vascular smooth muscle cells (VSMCs) treated by angiotensinⅡ(Ang Ⅱ). Methods A cell proliferating model of VSMCs induced by Ang Ⅱ was established; the effects of TMP on CaN was detected by enzyme reaction phosphorus measurement; the effects of TMP on c-fos gene and PCNA expression were observed by immunocytochemical staining and image analysis technique (A value). Results The rats’ aortic smooth muscle cells were cultured in vitro successfully. CaN activities, cell proliferation activity and the expression levels of c-fos and PCNA increased significantly in VSMCs proliferation induced by Ang Ⅱ (P

Objective To discuss the application of role reversal teaching in the clinical course of rehabilitation medicine. Methods 64 students of a vocational college under clinical practice were divided into traditional teaching group (n=30) and role reversal teaching group (n=34). The achievement of knowledge and practice tests were compared after course. Results There was no significant difference in the score of knowledge test between the groups before clinical practice (P>0.05), however, the scores of both knowledge and practice tests were higher in the role reversal teaching group than in the traditional teaching group (P<0.001). Conclusion The role reversal teaching may improve the achievement of students for clinical course of rehabilitation medicine.

Objective To observe the effect of TanshinoneⅡA( TanⅡA) on endometriosis( EMS) rat model and study the possible mechanism. Methods EMS rat model was established by autologous endometrium transplantation. EMS rats were randomly divided into five groups: high-, medium-, low-dose TanⅡA group, mifepristone group and model control group( n=10), the other ten normal rats as normal control group.The rats in the model control group and normal control group were given 0.9% sodium chloride solution. The rats in the mifepristone group were given 25 mg . kg-1 . d-1 mifepristone. The rats in the high-, medium-, low-dose TanⅡA groups were given 30, 20 and 10 mg.kg-1.d-1 TanⅡA, respectively.Four weeks after the treatment, the volume of endometriotic implants in each rat was measured. Pathological changes of ectopic endometrium were observed under light microscope.Expression levels of Bcl-2, Bax and Caspase-9 in ectopic endomembrane of rats were determined by Western blotting. Results High and medium dose TanⅡA and mifepristone significantly reduced the volume of ectopic lesions(P<0.05).As compared with model control group, the inhibition rate of the ectopic lesions in low-, medium-, high-dose TanⅡA groups and mifepristone group was 17.81%, 57.78%, 58.88% and 64.12%, respectively.High and medium dose TanⅡA and mifepristone promoted atrophy of ectopic endometrium, inhibited the expression of Bcl-2 protein and promoted the expression of Bax and Caspase-9 in ectopic tissues( P<0.05) . Conclusion TanⅡA significantly decreases the size of ectopic lesions in rats, possibly through reducing the expression of Bcl-2 and increasing the expression of Bax and Caspase-9 to regulate cell apoptosis.

Objective To observe the clinical efficacy ofTong Yuan(short forTong Du Tiao Shen,Yin Qi Gui Yuan, referring to unblocking the Governor Vessel, regulating mind, and guiding qi back to the origin) needling method plus Letrozol and human chorionic gonadotropin (HCG) in treating refractory sterility caused by polycystic ovary syndrome (PCOS).Method Sixty clomiphene citrate-resistant PCOS-induced sterility patients were recruited and randomized into two groups. The treatment group was intervened byTong Yuanneedling plus Letrozol and HCG, while the control group was intervened only by Letrozol and HCG, both for 3 months. Prior to and after the treatment,the levels of estradiol (E2), follicle stimulating hormone (FSH), luteinizing hormone (LH), and testosterone (T) were detected; the endometrium, ovulation and pregnancy rates were also observed.Result After 3 menstrual cycles, the level of FSH increasedsignificantly (P<0.05), LH decreased significantly (P<0.05), LH/FSH declined significantly (P<0.05), and the level of T also dropped significantly (P<0.05) in both treatment group and control group; the level of E2also dropped significantly after the treatment in both groups (P<0.05), and the decrease in the treatment group was more significantly than that in the control group (P<0.05). The ovulation and pregnancy rates in the treatment group were significantly higher than those in the control group (P<0.05).Conclusion Tong Yuanneedling plus Letrozol and HCG can significantly down-regulate the levels of LH, E2and T, up-regulate the level of FSH, effectively improve the internal reproductive environment of refractory PCOS patients, and enhance the ovulation and pregnancy rates.

Objective To summarize clinical experience of emergent surgery for severe liver trauma with rupture of major blood vessels. Methods The clinical data of 12 cases suffering from severe liver trauma with rupture of perihepatic and intrahepatic large blood vessels were retrospectively analyzed. These cases were from Dec 2000 to May 2008. All the cases underwent emergency operation, 6 cases were treated with liver lobectomy: among those 1 case with right posterior lobe liver resection, 1 case with irregular right lobe liver resection, 3 cases with left hemihepatectomy, and 1 case with left lateral lobectomy. Seven cases with rupture of major blood vessels were treated by repair or ligature and/or packing including repair of posthepatic inferior vena though the middle fissure in 2 cases, and through retrahepatic space in one case, interrupted suture of the portal vein in 2 cases, interrupted suture of the right hepatic veins in 2 cases. Mattress suture was applied to the ruptured hepatic veins in 7 cases including mattress suture of the branch of right hepatic vein and middle hepatic vein in 1 case, mattress suture of right hepatic vein in 1 case, suture of middle hepatic vein in 2 cases, and suture of left hepatic vein in 3 cases. One case was treated with ligation of hepatic artery and 3 cases with gauzes packing. Results Among all the 12 cases, 9 cases were cured, 3 cases died: two were caused by severe trauma together with hemorrhagic shock, one by sever brain injury together with hemorrhagic shock. Conclusions Prompt operation, precise stop bleeding and correct operation style are the key for successful rescue of patients suffering from severe liver trauma and massive bleeding.