This paper expounds that the construction of a clinical teacher's teaching ability model is an urgent problem to be solved in medical colleges and universities, and analyzes that the current clinical teaching concepts and methods are constantly improving, and the clinical teaching environment is more informatized and intelligent. This paper summarizes the clinical teachers' teaching ability models at home and abroad, such as the ability and quality iceberg model, teacher growth model, inquiry-based teaching model, Molenaar three-dimensional teaching ability model, etc., and discusses the practice research progress of current clinical teacher teaching ability models such as student-centered guided teaching, bedside teaching, micro-teaching and BOPPPS (bridge-in, objective, pre-assessment, participatory-learning, post-assessment, and summary) method, medical simulation teaching, etc., hoping to provide guidance for further constructing models of teacher's teaching ability suitable for Chinese medical colleges and universities.

Objective To analyze the efficacy and tolerance of methotrexate(MTX)in remission maintenance of Crohn′s disease (CD).Methods From June 2012 to August 2015 ,49 CD patients who received MTX as mainly treatment medication to maintain remission were enrolled.The pre-medication history,efficacy,dosage and side effects of MTX were analyzed.The effects of inducing strategy on disease recurrence were analyzed.Chi-square test and t test were used for statistical analysis.Results Among the 49 patients,34 (69.4%)received steroids for remission inducing,nine (18.4%)received infliximab for remission inducing and six (12.2%)achieved remission after operation.In the 44 patients treated with azathioprine (AZA)before,the median treatment time was one month and the dosage for withdrawal of AZA was (42.0 ± 14.8)mg/d.The most common reason was leucopenia (81 .8%, 36/44).Till the time point of follow-up,46 of the 49 CD patients still took MTX orally with a median treatment time of 16 months,and the weekly dosage was (12.7 ±2.0)mg.Thirty-one cases (67.4%) achieved clinical stability,while 15 cases (32.6%)underwent clinical recurrence.The median Crohn′s disease activity index (CDAI)was 123.5 ± 66.6.The weekly dosage of clinical stability group was (12.5 ±2.1)mg,and that of clinical recurrence group was (13.0 ±1 .7 )mg,there was no statistically significant difference between the two groups (t =0.802,P =0.426 ).The recurrence rate of steroids-induced remission group was 41 .2% (14/34 ),which was higher than that of infliximab and surgery-induced remission group (1/15),and the differnce was statistically significant (χ2 =5 .177,P =0.023 ). The common side effects were gastrointestinal reaction (26.5 %, 13/49 ), impaired liver function (20.4%,10/49)and leukopenia (12.2%,6/49).Only three cases could not tolerate the side effects and underwent medication withdrawal.Conclusions As a second-line immunosuppressant for maintanence remission in CD,MTX is effective and well-tolerated in patients.So it can be an important option during the long course of CD.

OBJECTIVE:To provide reference for rational use of anti-tumor essential medicine in the clinic. METHODS:The application of anti-tumor essential medicine in 39 hospitals from Chongqing area during 2012-2014 was analyzed statistically in re-spects of consumption sum,DDDs,DDC and B/A. RESULTS:The total consumption sum of anti-tumor essential medicine in 39 hospitals from Chongqing area during 2012-2014 increased from 10 083.65 ten thousand yuan to 15 186.65 ten thousand yuan,with annual increase rate of 22.72%. 3-year total consumption sum was 37 952.45 ten thousand yuan,and the sum of consumption sum of top 10 medicines was 36 742.24 ten thousand yuan,accounting for 96.81%;top 3 medicines were paclitaxel,oxaliplatin and flu-orouracil. During 2012-2014,DDDs had changed to certain extent,and the front medicines contained tegafur,paclitaxel and cyclo-phosphamide,etc;the most increment medicine was paclitaxel (oral),whose annual growth rate was 59.63%;that of tamoxifen decreased year by year,with annual decrease rate of 5.14%. DDC of paclitaxel,oxaliplatin and etoposide were the higher others. Annual B/A of oxaliplatin,fluorouracil and cytosine arabinoside were all lower than 1.00. CONCLUSIONS:The lonsumption sum and DDDs of anti-tumor essential medicine had increased reasonably in 39 hospitals from Chongqing area during 2012-2014,while their DDC had kept stable. Main medicines used in the clinic are suitable for numerous indications,and are expensive.

Objective To evaluate the validity of Community Extremity Disability Assessment Schedule (CEDA) in community rehabilitation. Methods 313 patients with hemiplegia after stroke were divided into rehabilitation group and control group. The rehabilitation group received community-based rehabilitation (CBR) for 3 months, and was assessed with Community Extremity Disability Assessment Schedule before and 1 month, 2 months and 3 months after rehabilitation respectively. And it was compared with Fugl-Meyer Assessment (FMA). The control group received the same evaluation only. Results The scores of CEDA and FMA improved more in the rehabilitation group than in the control group 2 months after rehabilitation (P<0.01). The score of CEDA positively correlated with the FMA (r=0.643, P<0.01). Conclusion CEDA can be used to evaluate the efficacy of community rehabilitation.

Objective To investigate the effects of locomotor training on improving locomotor function after spinal cord injury(SCI)and the mechanism of spinal cord plasticity.Methods A model of complete thoracic cord transection was established using 84 adult female rats divided into sham,SCI and treadmill training(BWSTT) groups.The hind limb locomotor function of all the rats was evaluated.The fluorescence intensities due to (EphA4),vesicular glutamate transporter 2(VGluT2)and EphA4/VGluT2 double-positive neurons in the ventromedial area of the anterior horn of the lumbar COrd were detected using immunofluorescence double labeling and laser confocal microscopy.Results The rats in the BWSTT group showed better functional recovery in their hind limbs than those in the SCI group.BWSTT was correlated with markedly increased EphA4.VGIuT2 and EphA4/VGluT2 intensities in the ventromedial area.Conclusion BWSTT improves hind limb locomotor function in rats with thoracic cord transections by elevating the expression of EphA4/VGluT2,promoting neuronal plasticity in the lumbar anterior horn.

OBJECTIVE To understand the pathogens and their drugs resistance in general surgery department and provide rational suggestion of antibiotics use for clinic treatment.METHODS A total of 158 cases with nosocomial infection among the general surgery department inpatients from Jun 2006 to Oct 2008 were retrospectively analyzed and summarized.RESULTS The common nosocomial infection sites were the lower respiratory tract,gastrointestinal tract,urinary tract and surgical sites.The G-bacilli of nosocomial infections in turn were Escherichia coli(18.02%),Acinetobacter baumannii(11.26%),Pseudomonas aeruginosa(7.66%),and Klebsiella pneumoniae(4.50%).The main G+cocci were Staphylococcus aureus(21.62%),Enterococcus faecium(5.86%)and E.faecalis(3.15%)in turn.In G-bacilli,the sensitivity to imipenem was the highest from 58.82% to 100.00%.The sensitivity to amikacin were more than 70.00% except A.baumannii,and to sulbactam/cefoperazone were more than 50.00% except Pseudomonas aeruginosa.In G+ cocci,the sensitivity to vancomycin of S.aureus and E.faecium was 100.00% and 84.62%.CONCLUSIONS Investigating the pathogens and their drug resistance in general surgery department is very important to prevent and control nosocomial infections.

Objective To explore the effect of body-weight support treadmill training(BWSTT)on lower extremity muscle atrophy and ambulatory capacity in complete spinal cord injured(SCI)patients.Methods 20 patients with complete SCI at the thoracic level were divided into control and BWSTT group.They all received comprehensive rehabilitation,and patients in BWSTT group also received BWSTT for 3 months when the physical condition was permitted.They were assessed before and after treatment with measurement of thigh girth,ambulatory capacity measure of Functional Independence Measure(FIM),10 meters ambulatory velocity and activity of daily living(ADL)evaluation.Patients in BWSTT group also received middle thigh MRI examination before and after BWSTT.Results The muscles at the mid-thigh of the BWSTT group looked larger after BWSTT than before.The scores of FIM ambulatory function,the 10 miters ambulatory velocity of BWSTT group improved significantly when compared with that of the control group(P<0.05).The thigh girth and the scores of ADL were no different between these two groups before and after treatment(P<0.05).Conclusion BWSTT may ameliorate lower extremities skeletal muscle atrophy and improve ambulatory capacity for SCI patients.

Skeletal muscle contractile properties are determined by their myosin heavy chain (MHC) expression profiles partly. Spinal cord injury induced the adaptation change in MHC isoform mRNAs and protein expression of skeletal muscle below the injured level, leading to the increased expression of fast and decreased expression of slow MHC isoforms. The adaptations in the MHC-mRNAs preceded the changes in proteins. The degree and velocity of MHC isoform adaptation were dependent on differenrt muscle and animal species. Short-term training could not induce the significant change of the transformation of MHC isoform, whereas long-term stepping training which emphasized load bearing could attenuate the MHC shift from slow toward faster isoforms.

BACKGROUND: The rehabilitation outcome varies in stroke patients,and there are differences in the literatures about the influence of factors on the functional recovery in such patients.,OBJECTIVE: To evaluate the pre-rehabilitative and post-rehabilitative effects of stroke patients by functional independence measure (FIM) that is widely used, and analyze the influence of gender, age, motor and cognitive functions at admission, time interval from stroke onset to arrival at rehabilitative admission, comorbidity occurrence, laterality of lesion on the functional recovery of stroke patients.DESIGN: Before-after control observationSETTING: Center of Rehabilitation Medicine, Shandong Provincial Hospital; Faculty of Rehabilitation Medicine, Capital University of Medical SciencesPARTICIPANTS: From March 2000 to December 2002, 55 stroke patients were selected from Shandong Provincial Hospital. They were all first episode, and patients whose bilateral cerebral hemisphere were involved were excluded.METHODS: After the vital signs were steady, the stroke patients got through risk phase (31-75 days) and were treated with medicine improving microcirculation and providing neurotrophic factor for nerves. In addition, they accepted comprehensive rehabilitation training of Bobath technique, PNF technique and Rood method mainly, with 1-2 hours per day and five times per week.MAIN OUTCOME MEASURES: The patients were evaluated within 7days after admission and reassessed 3 days before discharge using FIM,including 18 items of motor and cognitive functions and 126 total scores (108-126 as elementarily or completely independent, 72-107 as mildly dependent, 54-71 as moderately dependent, 36-53 as severely dependent,18-35 as extremely or completely dependent). Multiple stepwise regression equation was applied to analyze the relation of above factors and functional recovery (increased value of FIM total score).RESULTS: Totally 55 patients were involved into the result analysis.①FIM total score of patients was significantly higher at discharge than at admission (93.8±12.0, 68.8±11.6, P ＜ 0.001), and motor function and cognitive function at discharge also increased compare with at admission (P ＜ 0.001).②Mean value of FIM motor score increased everyday was identical with that of total score (0.56±0.21, 0.59±0.21), and higher than mean value of cognitive score (0.03±0.03).Multiple stepwise regression analysis showed,scores of motor and cognitive status at admission, age, time interval from stroke onset to arrival at rehabilitative admission all affected the increased value of FIM total scores. No significant association between gender, comorbidity, laterality lesion of paralysis and functional recovery was observed (P ＞ 0.05). The most influential factors were orderly motor function,cognitive function at admission, age and time interval from stroke onset to arrival at rehabilitation admission.CONCLUSION: Motor and cognitive function at admission, age and time interval from stroke onset to arrival at rehabilitative admission have a no table relationship with functional recovery of stroke patients, especially motor function at admission is positively related. Thus we should not neglect the influence of these factors when conducting rehabilitative treatment.

OBJECTIVE To study the cause of bacterial infection of ventilator-associated pneumonia(VAP) in intensive care unit(ICU) and summarize effective methods to prevent and control the infection.METHODS Epidemiologic study on 300 patients with VAP in ICU from Dec 1,2003 to Jul 13,2006.Preventing and controlling strategy was as follows.RESULTS Pathogenic bacteria of VAP in ICU mostly were multidrug-resistant ones,of which the G-were 56.3%,G+ were 23% and fungi were 13.7%.CONCLUSIONS To control VAP in ICU proper technique and method are important.Management of hospital infection and related training of staff in ICU are the basic way.