Nutritional anemia is mainly including the iron deficiency anemia and the megaloblastic anemia.The highlights of the two kinds of nutritional anemia on the differential diagnosis are compared associated with the clinical practice,and the commonly used treatment protocol at present are briefly expounded.

Objective To compare the results of emergency clinical training for medical students and to put forward some suggestions.Methods Toatlly 207 medical students of Grade 4 studied in the first people' s hospital of Shanghai Jiaotong university from 2009 to 2011 were divided into the traditional group (n =90 ) and the experimental group (n =117 ).The students in the experimental group participated in emergency clinical training in summer vacation while those in the traditional group did not.Questionnaires about their self-learning ability,clinical communicating ability and critical thinking ability after training the were conducted and the data were analyzed by descriptive statistical analysis.Results One hundred and five effective questionnaires were recovered from the experimental group,with the recovery rate 89.7％ and 62 effective questionnaires were recovered from the traditional group,with the recovery rate 68.9％.The scores about clinical communicating ability and critical thinking ability of the experimental group were significantly highcr than those of the traditional group [ (79.45 ± 9.354)vs.(75.87 ± 9.926),(263.38 ± 30.925 ) vs.(251.36 ± 23.679),P ＜ 0.05 ].However,there was no significant difference in scores about self-learning ability between the two groups [ ( 153.97 ± 23.725 ) vs.( 149.83 ± 13.891 ),P ＞ 0.05].Conclusion Emergency clinical training is helpful to improve medical students' clinical communicating ability and critical thinking ability.It is worth popularizing.

Objective To understand the work content of community nurses in general practitioners team model in Chongqing.Methods A questionnaire was carried out among 210 community nurses from 12 communityhealth service centers in Chongqing city.Results The work content of community nurses most often did in general practitioners team model were health management,health care of elderly people,health education,chronic disease management and basic medical service.However,the work content of women's health care and inquiry of death cause were relatively done less.Conclusions There are both basic medical service and public health service in the work content of community nurses in Chongqing.The “Six in One” function of community nursing is gradually improved.

Objective To investigate the effect of batroxobin on the plasma levels of endothelin (ET) and calcitonin gene-related peptide(CGRP) in patients with acute cerebral infarction(ACI). Methods 60 patients with ACI were randomly divided into therapy group(n = 30) and control group(n = 30),500 ml of 5% GS plus 1.0g ramme of Troxerutin was intravenously dripped par day and ticlopidine 250mg/day in the control group. Based on the control group therapy,Batroxobin was intravenously dripped with 10U on the 1st day and 5U on the 3rd and 5th day for seven days. The plasma levels of ET and CGRP were detected pre and post treatment by radioimmunoassay. Results Plasma levels of ET and CGRP in batroxobin therapy group post treatment ( 81.25±27.38 ) ; ( 44. 13±13.30) ng/L were significantly different from those pre treatment(109. 83±38.24) ; (24. 73±13.59) ng/L (all P＜0. 01 ) ,and were also significantly different from those post treatment in the control group(98.07±30. 39) ; (37.02±12. 41 )ng/L (all P＜0. 01 ). Conclusion Batroxobin can accommodate the equilibration between ET and CGRP, and protect brain cell and blood vessel endothelial cell.

Objective To observe the curative effects of metformin combined with cyproterone therapy on polycystic ovary syndrome(PCOS). Methods Ninety diagnosed PCOS patients were treated. The serum luteinizing hormone(LH), luteinizing hormone and follicule stimulating hormone(LH/FSH) ratio and T, waist hip ratio(WHR) of the patients before therapy were compared with using merformin combined with- cyproterone three cycles. Results A significant reduction(P<0.05 or P<0.01) in LH,LH/FSH,T and WHR of patients after the therapy was observed. Menses became regular after the therapy, and ache and hirsutism mitigated. Conclusion Metformin com- bined with cyproterone is a perfect means to treat polycystic ovary syndrome(PCOS).

[Objective] To observe analgesic action produced by electvoacupuncture (EA) of different intensity in adjuvant arthritis (AA) rats. [Methods] AA rat models were induced and the rats were randomized into 3 groups: group A, group B and group C. Group A and group B were treated with EA on points of Kunlun (BL60) and Yangtingquan (GB34) at the same wave type and wave frequency but at different electric current (3.5mA and 5.5mA respectively). Group C was performed with mimic EA. Pain threshold (PT) in the three groups before and after EA was observed. [Results] After EA, PT of the affected limb in group A and group B was increased (P0.05). [Conclusion] Analgesic action of EA at the same wave type and wave frequency while at different electric current is different: analgesic action at middle-intensity current is superior to that at large-intensity current; its possible mechanism is related to the participation of central nervous system.

ObjectiveTo analyze the results of implementing the tutorial system for medical interns, and to put forward some suggestions. MethodsThe medical interns and the doetors selected as tutors were asked to do questionnaires to study the tutorial system's feasibility and effectiveness. Simultaneously, we adopted the Objective Structured Clinical Examination ( OSCE ) to assess its process and resuits. Results74.3％ of the students and 75.5％ of the doctors think that they need the tutorial system,73.2％of the students think that this system can train better clinical skills,67.9％ of the doetors think that they can review the knowledge learned through teaching. Implemented after one year, students' OSCE scores are improved. ConclusionTutorial system for medical interns has achieved preliminary success, and the preparatory work and related-system building need to be further improved.

Objective To explore influence of antibiotics and Jiuyi Dan combined with incision-thread-drawing procedure on perianal abscess patients' level of activin A (ACTA) and C-reactive protein (CRP).Methods120 cases of perianal abscess patients in our hospital during March 2015 to December 2016 Coloproctology were selected, they were divided into the experiment group and the control group by random number method.All of patients were taken incision-thread-drawing procedure.Then the experimental group were given nine one antibiotics and Jiuyi Dan, the control group were given antibiotics.The cure rate, 6months after the recurrence rate, average healing time of the wound, and wound edema rate of two groups were observed.Levels of ACTA and CRP expression levels of two groups of patients before and after operation were analyzed.ResultsPatients in the experimental group cure rate was 96.7% higher than that of the control group (P<0.05), the recurrence rate of patients in the experimental group than in the control group, the difference was not statistically significant;the patients in the experimental group the average healing time was (20.67±3.22) d shorter than the average healing time of patients in the control group (29.48±3.15) d, patients in the experimental group wound edema rate of 5% was significantly lower than in the control group 20% (P<0.05);3D ACTA, the expression level of CRP was significantly higher than the preoperative 7 d levels after operation in the two groups (P<0.05);after 7d, the expression level of the two groups of patients with ACTA and CRP were significantly lower than the preoperative level of expression of 7d (P<0.05), experimental group levels of ACTA were significantly lower than the control group, the difference was statistically significant (P<0.05);postoperative 14d patients, ACTA levels of two groups were significantly lower than the levels before operation (P<0.05).ConclusionPerianal abscess can be treated effectively and patients levels of Acta and CRP were obviously dereased by Jiuyi Dan combined with incision-thread-drawing procedure combined, postoperative inflammatory reaction could be importantly alleviated, it was worth clinical promotion.

Objective To analyse the effect of hedyotisdiffusa on expressions of apoptosis related protein Fas , caspase3 and caspase7 in Renca renal cell carcinoma of model mice.Methods One hundred and twenty BALB/C male mice were randomly divided into normal control group, model control group, interleukin group, hedyotisdiffusa group, 30 mice in each group, half male and female.Excepted for normal control group , renal cell carcinoma models were established in the other groups , and were given corresponding drug treatment.The tumor size and weight , and the tumor inhibition rate of all mice were observed, and the expression levels of Fas,FasL,caspase3 and caspase7 were detected.Results Compared with model control group, the tumor size and weight were lower , the tumor inhibition rate were higher , the positive expression rates and protein levels of Fas were higher , the positive expression rates and protein levels of FasL were lower, the positive expression rates and expression levels of Caspase3,Caspase7 protein were higher in the mice of interleukin group and hedyotisdiffusa group, all with significant differences ( P<0.05 ).The above indicators in hedyotisdiffusa group were significant improved compared with interleukin group (P<0.05).Conclusion The hedyotisdiffusa can effectively promote the expressions of apoptosis related protein Fas,caspase3 and caspase7 in renal cell carcinoma of model mice, inhibit the expression of FasL protein, improve the tumor suppression rate.

Objective To investigate the levels of IL-33 in the lung induced by Aspergillus fumigatus (A.fumigatus) exposure in bronchial asthmatic rats and the effects of dexamethasone.Methods Twenty-four Wistar rats were randomly and equally divided into group A (normal control),group B (asthma group),group C (A.fumigatus-exposed group),and group D (dexamethasone-treated group).B,C and D group were sensitized and challenged with ovalbumin (OVA) to establish asthmatic models.Then,group C and D were given A.fumigatus spores intranasally.Group D was pre-treated with dexamethasone during ovalbumin challenge.Group A was sensitized and challenged intranasally with normal saline as control.Airway hyperresponsiveness,eosinophils percentage and serum IgE levels were measured to confirm the establishment of asthmatic model.Expression of IL-33 in the lung were quantified by ELISA and qRT-PCR.Lung tissues and blood were plated on the potato dextrose agar (PDA) medium and cultivated for 24 h to measure the number of colony.Results Eosinophils percentage in bronchoalveolar lavage fluid (BALF),IgE levels in serum and IL-33 levels in the lung in group B and C were much more higher than in group A (P＜0.05),and the increasing range in group C was more obvious than group B.However,the changes of sRaw values in these groups had no statistical significance.Esosinophils percentage in BALF and IL-33 levels in the lung were significantly decreased (P＜0.05),and IgE levels in serum was slightly decreased (P＞0.05) in group D when compared with group C,but the ratio of A.fumigatus colonization in the lung was higher than group C.Conclusions Dexamethasone can inhibit the expression of IL-33 in the lung induced by A.fumigatus exposure in an asthmatic rat,but it also increases the risk of fungal colonization in the airway.Anti-IL-33 antibody treatment needs further research.