Advanced schistosomiasis is the most serious clinical type of schistosomiasis. Its diagnosis and treatment are relat?ed to many special departments,such as gastroenterology,general surgery,neurology,endocrinology,radiology,traditional Chinese medicine,blood purification,endoscopy,intervention,and ICU. It is necessary to apply a multidisciplinary treatment (MDT)mode. However,the mode has no universal standard and guide in practice. It is very important for the implementation of MDT mode of advanced schistosomiasis to form a treatment expert team,formulate the formal working procedures,and standard?ize the treatment schedules. The standardized implementation of MDT mode will be important to provide a more effective clinical decision on advanced schistosomiasis.

Objective To evaluate 11C-MDA,a cardiac sympathetic nerve presynaptic molecular probe,in acute myocardial ischemia (AMI) and to compare with 13N-Ammonia myocardial perfusion imaging.Methods Twelve Bama miniature pigs were used to establish AMI models.11C-MDA and 13N-Ammonia PET/CT were performed before and after model establishment.The defect fraction,ratio of defect to normal region,defect volume of 11C-MDA and 13N-Ammonia PET/CT were calculated.Paired-t test and twosample t test were used.Results Eight models were established successfully and 4 pigs died.The defect fractions on 11C-MDA and 13N-Ammonia myocardial imaging were significantly different (13.4±3.3 vs 7.4±1.0,18.8±4.4 vs 4.8±1.0,10.5±4.2 vs 4.4±0.9;t values:4.901,8.864,4.030,all P＜0.001) at the first,third and sixth month post-model establishment.The ratios of defect to normal region on 11C-MDA and 13N-Ammonia PET/CT myocardial images were significantly different (0.47±0.14 vs 0.59±0.10,0.43±0.13 vs 0.61±0.09;t values:-2.166,-3.415,both P＜0.05) at the first and third month post-model establishment.The defect volumes on 11C-MDA and 13N-Ammonia PET/CT were significantly different ((4.20±0.34) vs (2.55±0.11) cm3,(10.66±0.71) vs (2.46±0.12) cm3,(5.95±0.50) vs (2.44±0.11) cm3;t values:12.925,32.149,19.440,all P＜0.001) at the first,third and sixth month post-model establishment.Conclusions Myocardial ischemia-reperfusion and cardiac sympathetic restoration might occur at different times.The recovery of myocardial ischemia-reperfusion is earlier than that of the cardiac sympathetic nerve.

Objective To investigate the diagnostic and prognostic value of neutrophil-to-lymphocyte rate ( NLR) in acute pancreatitis related acute kidney injury patients .Methods Peripheral blood specimens and clinical information of 98 acute pancreatitis patients in Wenzhou Center Hospital were collected .The WBC, neutrophils , lymphocytes were detected and NLR were calculated when they were admitted .The patients were divided into two groups by their NLR and whether they were with AKI respectively .Besides, ALT, Hct, TC, TG, blood calcium concentration , serum creatine and urea nitrogen , C reactive protein were detected and patients′APACHEⅡ score were also recorded to analyze the difference between the two groups .Results There is no significance in the age , BMI, Hct, TG, TC, ALT and blood calcium between AP patients with and without AKI.The blood creatinine, BUN, CRP, APACHEⅡscore were (395 ±122)μmol/L, (28.2 ±5.2) mmol/L, (34.0 ±8.2)mg/L, (11.5 ±3.8) score, respectively in AP patients with AKI, and which were (79 ±17 )μmol/L, ( 7.3 ±2.0 ) mmol/L, ( 14.8 ±2.9 ) mg/L, ( 6.9 ±2.4 ) score, respectively in AP patients without AKI.The blood ALT, blood creatinine, BUN, CRP, APACHEⅡscore were (257 ±76)U/L, (159 ±62)μmol/L, (20.5 ±6.6)mmol/L, (24.8 ±5.5)mg/L and (12.4 ±4.6) score in the patients with higher NLR respectively , and which were ( 165 ±30 ) U/L, ( 98 ±23 )μmol/L, ( 14.3 ±5.2 ) mmol/L, (19.5 ±3.0)mg/L and (5.4 ±2.1) score in the patients with lower NLR respectively .NLR was 4.97 ±0.19 in AP patients with AKI, and was 9.62 ±0.81 in AP patients without AKI.The difference between the two groups was significant(P=0.0001).The area under ROC curve of diagnosing AP by NLR was 0.895 (95%CI 5.75).the sensitivity was 89.5%and the specificity was 77.2% when using 5.75 as the cut-off value to diagnose AP related AKI with NLR .Conclusions NLR can be a potential predictive index of the severity and relate to renal function in acute pancreatitis related acute kidney injury patients .

Objective To investigate the effect of H 2 S and its synthetase inhibitor propargylglycine ( PAG) on the autophagic function in caerulein-induced acute pancreatitis ( AP) mice.Methods A total of 60 male BALB/c mice were randomly divided into control , AP, NaHS and PAG group using random number method.AP was induced in mice via hourly intraperitoneal injection of caerulein (50 μg/kg) continuously for 6 hours.NaHS and PAG group received NaHS (10 mg/kg) or PAG (50 mg/kg) 1 h before the AP induction . A equal volume of normal saline solution was injected in control group and AP group .All the mice were killed at 12 h after the first caerulein injection and blood sample was collected for the detection of serum amylase and lipase content.Deproteinization spectrometry was used to detect serum H 2 S content, and pancreatic tissue was pathological examined and scored . Real-time PCR detected mRNA expression of CSE , and the protein expression of LC3-Ⅱ/LC3 Ⅰand p62 was measured using Western blot .Results Serum amylase, lipase, H2S, CSE mRNA, LC3Ⅱ/LC3Ⅰand p62 were (2 700 ±100)U/L, (70 ±20)U/L,(22.9 ±1.7)mmol/L, 1.0 ±0.1,0.419 ±0.080, 0.227 ±0.140 in control group; (17 290 ±500)U/L,(520 ±40)U/L, (31.3 ± 3.0)mmol/L, 5.4 ±0.4, 1.184 ±0.120, 1.985 ±0.210 in AP group; (27 784 ±1 200)U/L, (900 ± 80)U/L,(38.6 ±3.3)mmol/L, 6.9 ±0.9,1.600 ±0.210, 4.229 ±0.050 in NaHS group; (13 750 ± 2 000)U/L,(370 ±20)U/L, (24.5 ±2.1)mmol/L, 4.2 ±0.5, 0.745 ±0.130, 1.203 ±0.080 in PAG group.All those biomarkers detected above in AP group significantly increased compared with control group , which were much lower than those in NaHS group , but higher than those in PAG group , and the differences were statistically significant (all P<0.05).Pancreatic histological damage in NaHS group was more severe than that in AP group , which in PAG group was less severe than that in AP group .Conclusions PAG could greatly decrease serum amylase and lipase level , and reduce the damage on autophagy and the severity of AP .

This paper summarizes the clinical diagnosis and treatment of imported African schistosomiasis,in order to make the therapeutic standards. Imported African schistosomiasis includes mainly schistosomiasis haematobia and schistosomiasis mansoni in China. In order to set up the operational standards,enhance diagnostic and cure rates,and reduce the complica?tions,we review the related literature combined with our experience over years,and summarize,in this paper,the pathogenic mechanism,and key points of clinical diagnosis and treatment of schistosomiasis haematobia and schistosomiasis mansoni,so as to provide the reference for clinical doctors.

Objective To study the effect of precise locating technique of C?arm fluoroscopy in order to reduce the radia?tion exposure during the surgical procdure for thoracolumbar fracture. Methods From March 2010 to Octorber 2012, a total of 92 cases with thoracolumbar fracture underwent postierior internal fixation procdures with pedicle instrumentation. C?arm fluoros?copy was used in 44 cases with precise locating technique, while in 48 cases with traditional methods. In precise locating group,C?arm fluoroscopy was used after anesthesia. Once an ideal view was got, the position parameters of C?arm fluoroscopy machine were recorded. The machine was positioned according to the recording for the secondary fluoroscopy. Pre?operative and intra?operative number of times of exposure, length of exposure time, time for fluoroscopy and total operating time were recorded and compared be?tween two groups. Results Pre?operative number of times of exposure, exposure time, and time for fluoroscopy in precise locating group were (5.51±2.47), (2.26±1.05) s and (9.83±3.67) min,which were higher than those of (4.02±2.42), (1.78±0.98) s and (8.29± 3.52) min in traditional group. However, intra?operative number of times of exposure, exposure time, and time for fluoroscopy in precise locating group were (5.26±3.64), (2.24±1.24) s and (10.39±4.82) min,which were lower than those of (9.74±4.38), (4.21± 2.38) s and (24.69±6.35) min in traditional group,and total number of times of exposure, exposure time, time for fluoroscopy and total operating time in precise locating group were(10.77±4.16), (4.50±1.83) s, (20.22±5.03) min and(70.52±18.33)min,which were also lower than those of (13.76±5.31), (5.99±3.27) s , (32.98±7.83) min and(81.86±21.57)min in traditional group. Conclu?sion Precise locating technique of C?arm fluoroscopy reduces the radiation exposure during the surgical procdure for thoracolum?bar fracture.

Gastritis, Hypertrophic ; Humans

Objective To observe the influence of swimming training on the expression of nerve growth factor (NGF) and neurotrophins-3 (NT-3) in rats with cerebral infarction,and to explore the underlying neuroprotection mechanism of exercise training on cerebral infarction.Methods Forty-five healthy male Sprague-Dawley rats were randomly divided into a sham-operation group,a control group and a training group,with 15 rats in each group.Each group was further divided into a 3-day,7-day and 14-day subgroups,which amounts to 9 groups.To establish animal model of cerebral ischemia-reperfusion in rats,the intraluminal thread method was applied to cause left middle cerebral artery occlusion (MCAO) for 2 h before reperfusion.The rats of the training group were given swimming training for 10 min,once daily,while those of the sham-operation and control groups were not given any training.Neurological deficits were assessed using Bederson scores.The expression of NGF mRNA and NT-3 mRNA in the ischemiareperfusion pallium was examined using reverse transcription-polymerase chain reaction (RT-PCR).Results The rats of the sham-operation group showed no neurological deficits.At the same time points,the average Bederson scores of the training group were significantly lower than the control group,but significantly higher than the sham group.Moreover,the 14 d training group had the lowest Bederson score (1.20 ±0.45),compared to the value 3 and 7 days after modeling.The expression of NGF mRNA and NT-3 mRNA of ischemic cerebral cortex in the training group was significantly improved when compared to the sham-operation group or the control group.On day 14,the expression of the NGF mRNA (0.66 ± 0.07),and the NT-3 mRNA (0.79 ± 0.06),were significantly higher than those on day 3 and 7.Conclusions Swimming training could increase the expressions of NGF mRNA and NT-3 mRNA in the ischemic cerebral cortex.It might be one of the key mechanisms that exercise training could promote the recovery of damaged neurological function in rats with cerebral infarction.

Objective To observe the effect of electrical stimulation on the movement of rabbits esophagus, and to promote effective esophageal peristalsis and determine the best electrical pacing parameters. Methods After anesthesia, 24 healthy rabbits underwent open surgery and the lower esophagus was exposed. The esophagus was stimulated with the multi-channel signal generator, and the changes of esophagus pressure and the length of esophageal contraction with high resolution manometry were recorded. (1) The effects on contraction pressure of esophagus body and lower esophageal sphincter (LES) after single site electrical stimulation under different parameters were observed. The stimulation modes utilized were electric current 3 mA, 5 mA and 8 mA, frequency 5 Hz, 10 Hz and 20 Hz, pulsewidth 0. 25 ms, 25 ms and 50 ms, waveform of single phase and double phase. (2) The esophagus was sequentially stimulated. The stimulation mode utilized was electric current 5 mA, frequency 20 Hz, pulsewidth 25 ms, stimulation duration 3 s, single phase square wave. Results At electrical stimulation on the esophagus body and LES, contraction delay was 13. 00±1. 54 ms and 12. 00±0. 73 ms respectively. The contraction pressure of esophageal body was significantly positively related tothe electric current (R=0. 968, P<0. 01), the pulse width(R=0. 971, P<0. 01), and the frequency (R =0. 947, P <0. 01). The length of contraction in 10 Hz group was shorter than that of the 20 Hz group(1. 33±0. 06 cm VS 1. 80±0. 00 cm, P<0. 05). The contraction pressure of LES was also significantly positively related to the electric current(R=0. 965, P<0. 01),the pulse width (R=0. 973, P<0. 01), and the frequency (R=0. 842, P<0. 01). The pressure of lower esophageal sphincter of single phase square wave was greater than that of the double phase square group (P<0. 05). Under the same parameters, the contraction pressure of LES group was lower than that of the esophageal body group (27. 33±1. 15 mmHg VS 104. 00±6. 00 mmHg, P<0. 05). Esophageal sequential contraction was induced by multi-points sequential electrical stimulation. Conclusion Single point electric stimulation can cause esophageal contraction immediately without obvious delay. Within a certain range, the esophageal contraction pressure is positively correlated with electric current, frequency and pulse width. The contraction pressure of single square phase wave is greater than that of the double square phase wave. The contraction pressure of esophageal body is greater than that of LES after electric stimulation. Multi-points sequential electrical stimulation can promote sequential movement of esophagus.

The Chinese clinical medical national licensing examination is the profession ad-mittance exam, which is undertake the responsibility of selecting qualified physicians. It also promotes the medical education in China. The standard for examination, the examination content, methods for measuring the Chinese clinical medical national licensing examination as well as the reform and de-velopment, has a certaln guiding role to China's medical education and medical education reform. While reviewing the medical students' performance in the examination, we can discover the weakness in medical education, which is then conducive to the promotion of teaching reform and innovation. The competence based medical licensing examination reform in China, advocating the cultivation of clinical comprehensive ability as the core content to tralning and evaluating, is conducive to continuously im-proving the quality of medical education in China, and to tralning more qualified physicians in the country.