With the changes of lifestyle, the incidence of colorectal cancer is increasing year by year.Though the surgical techniques and adjuvant therapy means are continuously improving, the overall prognosis of patients is still poor. Micrometastasis of colorectal cancer is the main reason leading to recurrence and metastasis. Timely detection of micrometastasis is meaningful to accurately determine the condition, formulate reasonable treatment and improve survival time. With the development of medical detection and sophisticated means, the micrometastasis of coloroctal cancer detection has become the research hot spots. In this paper, the current status of micrometastasis of colorectal cancer detection methods, detection means and choice of marker are introduced.

?Objective: To study the effects of endogenous bone morphogenic protein 2(BMP 2) and 6(BMP 6) in rat facial nerve after injury. Methods: Facial nerve trunk was cut and then anastomosed in 30 adult male Sprague Dawley rats,another 6 rats without operation were used as the controls. Every 6 rats were killed 6 ,72 h,1, 2 and 4 weeks respectively after operation and nerve specimens were immunohistochemically examined for BMP 2 and BMP 6 expression. Result:In the control nerve the gray level of BMP 2 and BMP 6 were 210.89?8.21 and 232.03?9.25 respectively. 6, 72 h,1, 2 and 4 weeks after operation the gray level of BMP 2 were 242.83?11.01,240.67?7.91,234.46?5.28,232.12?7.27 and 220.71 ?10.19;that of BMP 6 210.75?5.19,204.08?10.85,198,91?8.58,186.37?4.11 and 184.62? 8.45 ,respectively. Conclusion: BMP 2 may play a role in the early irritable actions when facial nerve was injured. However, BMP 6 might have functions in the regeneration of facial nerve during later period after injury.

Objective To explore the expression of small GTP-binding protein TC10 during nerve injury and construct eukaryotic expression vector carrying rat TC10 cDNA. Methods Total RNA was extracted from rat facial nucleus, and the change of rat TC10 full-length cDNA was investigated by RT-PCR. PCR product was inserted into eukaryotic expression vector pcDNA3 to construct the pcDNA 3-TC10. The plasmid was identified by restriction enzyme analysis and sequencing analysis. Results After injury, the expression of TC10 rapidly increased, Restriction enzyme assay and sequencing assay showed that the construct we got was rat TC10 full-length cDNA construct.

Objective To study the relationship between oxidative stress and endothelial cell apoptosis in patients with obstructive sleep apnea-hypoventilation syndrome (OSAHS). Methods Sixth-seven patients definitely diagnosed by potysomnography (PSG) as OSAHS were divided into three groups according to their apnea-hypoventilation index (AHI), 14 in mild group (5 < AHI≤20), 21 in moderate group (20 < AHI≤40) and 32 in severe group (AHI 40). And, 18 healthy persons (AHI <5) were recruited as controls. Blood samples were obtained form all of them after PSG performance for measuring apoptotic endothelial cells (CD146AnnV+) and serum levels of superoxide dismutase (SOD) and malondialdehyde (MDA). Results Serum level of MDA and CD146AnnV+ in moderate and severe OSAHS group were significantly higher than those in control group (all P < 0.05). Serum level of SOD in moderate and severe OSAHS group was significantly lower than that in control group (P < 0.05). CD146AnnV+ correlated positively with AHI, the longest apnea time (LAT) and oxygen desaturation index (ODI) (r = 0.778, 0.609 and 0.689, respectively, all P < 0.05) and correlated reversely with saturation of arterial blood oxygen at night (SaO2min) (r =-0.635, P < 0.01). CD146AAnnV+ correlated positively with serum level of MDA (r = 0. 698, P < 0.01), and correlated reversely with serum level of SOD (r =-0.705, P < 0.01). Results of linear multivariate regression analysis showed that AHI, serum levels of SOD and MDA were independent risk factors for endothelial cells apoptosis in patients with OSAHS. Conclusions There existed oxidative stress due to intermittent hypoxia in patients with OSAHS, which could be one of the major causes in exacerbating endothelial damage.

Objective To evaluate the assessment index system of internal medicine, and to analyze the factors of practical effects on internal medicine. Methods The assessment index system of clinical skills was developed by expert group based on the clinical syllabus and objectives. Internal medicine index system was divided into four items such as history-taking, physical examination, hos-pital records and case questions. 49 five-year clinical interns who took internal medicine exams were researched. Reliability, validity, discrimination, difficulty were used to analyze the quality of assess-ment index system. Gender, teaching hospital and the preparation of postgraduate examination were used to explore the influencing factors of practical effects with independent t-test and Wilcoxon signed rank tests. Results The reliability, discrimination, difficulty of the assessment index system were 0.50, 0.15 and 0.85, respectively. The removing item coefficient of history collection, physical ex-amination, hospital records, case questions were 0.38, 0.26, 0.47 and 0.53, separately, and the discrimination were 0.18, 0.17,0.27 and 0.37, separately, and the difficulty were 0.87, 0.89, 0.79, and 0.78, respectively. The scores of assessment index system of girls were higher than those of the boys(P<0.05). Moreover, the girls scored higher in history collection and physical examination, compared with the boys(P<0.05). The discrepancy scores were not statistically significant among teaching hospitals (P>0.05). The students who prepared the postgraduate examination scored lower than the others(P<0.05). Conclusions The assessment index system of internal medicine is reason-able and reliable, but the assessment of case questions still needs to be standardized. Teaching hospi-tals have little effect on internship while gender and the preparation for postgraduate examination influence practice effects in internal medicine.

BACKGROUND:Endothelial progenitor cels are widely used in the treatment of various vascular diseases, and early exercise training contributes to restore motor function after spinal cord injury. However, the therapeutic effects of endothelial progenitor cel transplantation or early exercise training alone are unfavorable. OBJECTIVE:To observe the influence of transplantation of endothelial progenitor cels combined with early exercise training on blood vessel regeneration and hind limb function in rats after spinal cord injury. METHODS:Eighty adult Sprague-Dawley rats were enroled to establish spinal cord injury models using the modified Alen’s method, and then randomly divided into four groups. Rats were respectively given culture mediumvia the tail vein, injection of endothelial progenitor cels (3×106)via the tail vein, roler and treadmil trainings for 2 weeks, or injection of endothelial progenitor celsvia the tail vein folowed by 2 weeks of roler and treadmil trainings in the model, cel transplantation, exercise and combined groups. RESULTS AND CONCLUSION:At 2 weeks after transplantation, the hindlimb motor function of rats in the combined group was better than that in the cel transplantation group and exercise group, and moreover, the percentage of CM-Dil positive cels, the number of horseradish peroxidase-positive nerve fibers, capilary density and expression of vascular endothelial growth factor and brain-derived neurotrophic factor were also significantly higher in the combined group than the cel transplantation group and exercise group. These findings indicate that early exercise training has a neuroprotective role in spinal cord injury; endothelial progenitor cel transplantation combined with early exercise training can promote regeneration of synapses and blood vessels and improve hindlimb motor function of rats, probably by increasing expression levels of vascular endothelial growth factor and brain-derived neurotrophic factor.

BACKGROUND:Studies have shown that neural stem cel transplantation combined with exercise training can promote the recovery of hindlimb motor function from spinal cord injury in rats, but its mechanism of action has not been fuly elucidated. OBJECTIVE:To investigate the effects of early exercise training combined with neural stem cel transplantation on the recovery of hindlimb motor function in rats with spinal cord injury. METHODS:Sixty Sprague-Dawley rats with spinal cord injury were randomly divided into three groups: control group (n=20, given conventional treatment after injury), cel transplantation group (n=20, given neural stem cel transplantation after injury), experimental group, (n=20, given neural stem cel transplantation combined with early exercise training after injury). Recovery of the hindlimb motor function was assessed by Basso, Beattie and Bresnahan scale and inclined plane test before and at 1, 7, 14, 21 days after injury. Western blot assay was used to detect caspase-3 and myeloperoxidase expression. Hematoxylin-eosin staining was done at 21 days after injury to observe the structure changes of the injured spinal cord. RESULTS AND CONCLUSION:(1) Scores of Basso, Beattie and Bresnahan scale and inclined plane test were significantly better in the experimental group than the cel transplantation group folowed by the control group (P < 0.05). (2) In the control group, the expression of caspase-3 and myeloperoxidase was significantly increased at 14 days after injury. In the cel transplantation, the expression of caspase-3 and myeloperoxidase was significantly higher than the experimental group (P < 0.05). (3) Pathological inflammation was reduced most in the experimental group folowed by the cel transplantation group. In the experimental group, the structure of injured spinal cord was improved and became relatively clear and intact. These findings indicate that neural stem cell transplantation combined with early exercise training can effectively promote the recovery of hindlimb motor function from spinal cord injury in rats, by reducing the expression of caspase-3 and myeloperoxidase and alleviating secondary lesion of the spinal cord.

Objective To investigate the incidence of genotypes related to analgesia and muscle relax effects,and to review the genetic polymorphism of OPRM1,CYP3A4 * 1G,SLCO1B1 and ABCB1 in Han population in North-western China.Methods The genotypes of OPRM1,CYP3A4 * 1G,SLCO1B1 and ABCB1 in patients born in North-western China between September,2016 and May,2017 were reviewed.North-western China was defined as Shaanxi,Gansu,Ningxia,Qinghai and Xinjiang Provinces.The distribution of genotypes was recorded.And the differences between male and female patients were compared.Results The frequency was 42.11％ for AG genotype and 12.14％ for GG genotype of OPRM1 (118A＞G).For CYP3A4 * 1G,the frequencies of CC,TT,TC and CT were 29.69％,4.17％,65.67％ and 0.47％,respectively.For ABCB1,the frequencies of CC,TT,TC and CT were 13.07％,44.60％,0.28％ and 42.05％,respectivsly.For SLCO1B1,AG genotype appeared in 37.44 ％ of the patients,GG genotype appeared in 55.21％ of the patients.There was no difference between the male and the female patients.Conclusion Genotypes related to change of susceptibility to opioids including fentanyl and rocuronium were detected in high percentage of patients in North-western China,indicating that SNP assay for instruction of anesthetic practice be of value.

Objective:To explore the application of Bloom target teaching theory combined with PBL teaching mode in standardized residency training of respiratory.Methods:A total of 44 residents of Batch 2019 who had been in respiratory department of our hospital for 2 months on rotation were selected as the control group, and traditional teaching training was adopted in the group. In addition, 41 residents of Batch 2020 who were enrolled in the respiratory department of our hospital for a 2-month residency training rotation were selected as the research group, and Bloom target teaching theory combined with PBL teaching mode was applied in the group. After the residency training, the teaching effect of the two groups of training residents was evaluated by theoretical examination, practical skill operation examination and questionnaire survey. SPSS 22.0 was used to conduct t test. Results:The results of theoretical assessment and practical skills operation assessment of students in the study group were better than those in the control group, and the difference was statistically significant ( P<0.05). The subjective satisfaction of the training residents and the tutors were scored respectively. The results showed that the scores of residents in the study group were higher than those in the control group, the difference was statistically significant ( P<0.05). The subjective satisfaction score of residents on the assessment results of this stage showed that residents in the study group had higher scores than the control group, with statistical significance ( P<0.05). The tutor's subjective satisfaction score of the assessment results at this stage showed that the scores of the residents in the study group were higher than those in the control group, and the difference was statistically significant ( P<0.05). Conclusion:The combination of Bloom target teaching theory and PBL teaching mode can improve the theoretical and practical operation ability of students in respiratory department, improve their learning initiative, enthusiasm and teaching satisfaction, and then improve the teaching quality.

Objective:To construct an evaluation system for clinical thinking ability of general practitioners in the treatment of multimorbidity.Methods:This was a cross-sectional study. The draft of evaluation indexes for clinical thinking ability of general practitioners in treatment of multimorbidity was preliminary developed through literature review, collation, analysis and discussion. Nineteen clinical and teaching experts of general practice were selected for consultation via anonymous convenient sampling. From January to June 2022, 2 rounds of expert consultation were conducted using the Delphi method. During the first round of consultation, according to the survey feedback, we modified and improved the evaluation system of general practitioners′ clinical thinking ability for multi-disease co-treatment. During the second round, experts were asked to assess the importance of each index, and to calculate the weight of each index accordingly. Questionnaires were sent to experts via letters. The content of the questionnaires encompasses the basic information of experts, evaluation for various indexes and relevant opinions. The mean value of importance assignment ≥3.5, coefficient of variation ≤0.25 and the full score frequency ≥30% were taken as the criteria. Indexes unsatisfying the criteria were removed, so that the final index system could be constructed.Results:The average age of 19 experts was 50.2 years old, 9 of them were male. A total of 2 rounds of expert consultation were conducted, 19 questionnaires were issued in each round, and 19 effective questionnaires were received afterwards. In the first round of consultation, 10 experts put forward revised opinions, and some indexes were adjusted according to the definition criteria and the discussion of the research group. In the second round of consultation, 3 experts put forward suggestions for modification. According to the definition criteria, no need to delete the indexes. After discussion by the research group, some indexes were adjusted, and finally an evaluation system of clinical thinking ability for multi-disease co-treatment of general practitioners was established, including 4 first-level indexes and 30 second-level indexes. The weights of the 4 first-level indexes in descending order were "overall thinking ability" (38.01%), "diagnostic thinking ability" (33.96%), "evidence-based thinking ability" (14.75%), and "critical thinking ability" (13.28%). Among the 30 secondary indexes, the top 5 were "ability to identify and handle priority emergency incidents" (5.04%), "risk assessment and critical illness identification ability" (4.63%), "emergency referral ability" (4.61%), "communication and expression ability" (4.57%), and "standardized diagnosis and treatment ability" (4.23%).Conclusion:This study successfully constructed an evaluation system for clinical thinking ability of general practitioners in the treatment of multimorbidity.