In view of the goal of postgraduate education , we point out the contradiction between clinical work and research on the basis of analysis of the status quo of academic degree education of clinical medicine .Then we analyze the major manifestations of the contradiction and causes , and then discuss ways and methods to solve the contradiction in the hope of improving the quality of academic degree education of clinical medicine .

<正>临床医学是一门实践性和经验性极强的应用学科。作为一名优秀的临床医师,除了要具备系统、扎实的专业及相关基础理论知识外,熟练的临床技能操作和良好的医疗职业道德培养也是必须的。临床实践训练应该贯穿于临床医师在职培训全过程。临床医师通过不断实践,积累经验,逐步提高自身医疗诊治水平。随着现代医学的迅猛发展,应用于临床的各种新医疗诊治技术在提高医疗水平中发挥了重要作用。因此,我们医师需要尽快地熟悉和掌握各种医疗新技术和各种医疗急救技术。随着职业医师

Objective To screen multidrug-resistant genes in human small cell lung cancer by chromosome microdissection.Methods After the microdissection of specifically abnormal chromosomal fragments of NCI-H446/CDDP cells and construction of micro-DNA library,Dot blot,reverse Northern Blot and Northern Blot were used to screen and identify MDR-related genes.Results Totally,there were 25 DNA fragments or genes which were found to be up-regulated in NCI-446/CDDP cells.Among 20 fragments sequenced,3 fragments were chromosome BAC sequences respectively and no homologs were found in GenBank.We thought the three sequences maybe belong to the 3' ends of certain genes where exited highly variable sequence and it was difficult to identify their homolog in GenBank.Other 17 sequences were found to be similar to several known genes with 95%～100% similarity.The known genes include Trx、Bcl-2、TRAF and Ceramide.Conclusion Many genes were involved in the development of MDR of human SCLC and the genes came into being a complex network which regulates the MDR.While,so far,the regulation mechanism was still unknown and many researches were need to be done.

Objective To develop a consistent and effective gene diagnostic method for Duchenne/Becker muscular dystrophy(DMD/BMD),so as to provide a clinical reference for the differential diagnosis of DMD/BMD diseases.Methods Clinical data of sixty-four male DMD/BMD patients,Han nationality,aged from 0.7 to 45(9.34±1.13)years,were collected between May 2008 and May 2010 from the Departments of Neurology,Pediatrics,and Gynaecology and Obstetrics of affiliated hospitals of Third Military Medical University.Genomic DNA was extracted from 5ml of peripheral blood of each patient.Determination of exon deletion in DMD gene of DMD/BMD patients was performed by amplifying 18 exon in hotspot deletion regions of DMD gene with multiple PCR(mPCR),and then the deletion type of DMD gene exon was confirmed.Results Deletions of varied exons in hotspot deletion regions of DMD gene were found in 31(48.4%)out of 64 patients with DMD/BMD,among which exon 50 deletion ranked the top(35.5%,11/31),followed by exon 47 and 43 deletion,accounting for 32.3%(10/31)and 25.8%(8/31),respectively.Exon 45 deletion was found in 6 out of the 31 patients(19.3%),while exon 49 deletion existed in same number of patients.Exon 19 deletion,as well as the 48 deletion,was respectively found in 5 out of the 31 patients(16.1%).In summary,the exon deletion happened mainly in the central and 5-end hotspot deletion region of DMD gene.Conclusions Multiple PCR,extensively used domestically and abroad,plays a vital role in assisting clinical diagnosis of DMD/BMD.It still is worthwhile to explore the other deletion hotpot,duplicated mutational hotpot and point mutation hotpot of DMD gene,and,based on them,new methods for DMD/BMD gene diagnosis can be established,thereby the diagnostic rate of DMD/BMD disease can be elevated.

现在国际社会呈现多元化的格局,经济建设与和平发展是当今社会的主题.但是,人类社会发展也同时面临着严重的挑战,恐怖主义盛行,局部战争不断,"天下还不太平".在高科技局部战争中,战场的环境变化,比如高原低氧、高寒、深海等条件,对军事医学,尤其是对内科学与野战内科学的医疗救护体系和救护技术带来很多问题和严重挑战[1,2].

目的探讨野战内科疾病的调查研究方法,促进本学科的建设与发展。方法创建野战内科疾病调查的基本方法和资料收集方法,包括伤(病)员症状自评方法、病历、医嘱和护理记录表等。结果采用量表方法能保证资料收集的稳定性、简便性和经济性。结论在野战内科疾病的调查研究中采用量表方法可提高工作效率。

Objective To prepare the coating of dexamethasone-eluting intravascular stent and observe the features of its delayed release in vitro.Methods Spray painting and dipping coating were used respectively to prepare stent coating,and then high performance liquid chromatography(HPLC)was used to detect the drug loading.The stents prepared by dipping coating were set in a flow of 50 ml PBS buffer at a velocity of 20 ml/min,and 0.5 ml buffer was collected at 6 h and 1,2,4,6,8,10,12,15 d respectively with another 0.5 ml fresh PBS being added immediately.The drug content of the 0.5 ml buffer was detected by HPLC for drug sustained release in vitro.Results The drug loading of stents prepared by spray painting was(24.26±5.23)μg,while that stents prepared by dipping coating for 4 d was(93.15±7.83)μg.Drugs were released slowly and the release rate reached 84% at 15 d.Conclusion The dipping coating-prepared stents have evident effect of sustained release.

Objective To study the relationship between FEF75% and positive rate of bronchial provocation tests.Methods A total of 249 patients with chronic cough,choking sensation in chest,and gasp underwent bronchial provocation tests and were divided into four groups:Group A(FEF75%%Pred<40%),Group B(40%≤FEF75%%Pred<60%),Group C(60%≤FEF75%%Pred<80%),and Group D(FEF75%%Pred≥80%).The relationship between FEF75% and positive rate of bronchial provocation tests was analyzed.Results There was no significant difference in bronchial provocation tests between Group A and Group B(P>0.05)but significant difference between Groups A,B and Groups C,D.The difference between Group C and Group D was also significant(P<0.05).The positive doses in Group A were significantly different from those in other groups.Conclusion The positive rate of bronchial provocation tests may be related with the reduced FEF75%.

Background and purpose:Recent studies show that apoptosis induced by chemotherapeutic drugs may be involved in the different steps of nuclear metabolism.Whether small cell lung cancer(SCLC) cells apoptosis induced by cisplatin(DDP) associated with the same molecular mechanism is still under investigation.The purpose of our study was to discover the mechanism of human SCLC cell line H446 cell apoptosis induced by DDP.Methods:Apoptosis induced by DDP in human SCLC cell line H446 was detected by cell morphology,flow cytometry analysis and DNA end labeling,respectively.Results:H446 cells were treated with the concentrations of 0.1, 0.5,1.0,2.0 and 5.0 μg/ml DDP for 48 hr,respectively.Apoptotic index were 1.47±0.03,8.28±0.54,11.02±1.05,12.74±1.08,27.16±1.15,respectively and apoptosis was induced in both a concentration dependent manner and gradually in a time dependent pattern from 12 to 72 hr with a final concentration of 2.0 μg/ml;H446 cells were blocked either at G2 by the final concentration of 0.1,0.5,1.0 and 2.0 μg/ml DDP or at S phase with the final concentration of 5.0 μg/ml DDP.Conclusions:Cell apoptosis induced by DDP may play an important role in the mechanism of DDP antitumor effect.

Compares and analyzes the results of residual volume(RV) tested with two different methods.The results show that there is no significant difference in RV tested with two different methods when FEV1% Pred is normal(p0.05) but significant difference when FEV1% Pred was between 80% and 60%(p0.05),and most significant difference when FEV1% Pred was lower than 60%(p0.01).

血红素氧合酶 1(HO-1)为诱导型,生理状态下,在网状内皮细胞系统和骨髓表达,在肝脏、脾脏中以高浓度存在,而又以脾脏组织活动最高,约为肝脏的10倍.可以被多种物质或刺激因素诱导表达,如热休克、缺血、辐射、低氧、高氧、重金属盐等.HO-1基因内含有HSE元件,是一种热休克蛋白,又称HSP32.目前研究证实HO系统有三种同工酶:HO-1、HO-2和HO-3.HO-2为结构型,除了化学诱生剂肾上腺皮质激素有诱导作用外,一般处于稳定状态不能被其他因素诱导,主要分布在脑组织、睾丸组织中,由CO发挥神经递质的功能,也与精子的产生和成熟有关.

Objective:To observe the effects of augmentin and erythromycin on pseudomonas aeruginosa biofilm in vitro.Methods:polyethylene film and pseudomonas aeruginosa were co-cultured in LB medium for 48 hours until pseudomonas aeruginosa biofilm formed on polyethylene film.After that ,polythylene films were washed and transferred to LB medium containing different concentration of Augmentin and Erythromycin for further culture.polyethylene films were examined by scanning electric microscope to confirm if there were pseudomonas aeruginosa biofilms on it 24 hous later and LB media were vaccinated in LB agar plate to observe if pseudomonas aeruginosa were still alive in the cultured medium.Results:pseudomonas aeruginosa biofilm was formed on polyethylene film under scanning electric microscope after pseudomonas aeruginosa and polyethylene film were co-cultured in LB medium for 48 hours,howe ver,the biofilm disappeared after polyethylene film was cultured in media containing 100μg/ml,300μg/ml,500μg/ml of augmentin and 50μg/ml,100μg/ml,300μg/ml of Erythromycin.Conclusion:pseudomonas aeruginosa biofilm can be formed after polyethylene film and pseudomonas aeruginosa were co-cultured in LB medium for 48 hours.Adequate high concentration of augmentin and erythromycin can kill pseudomonas aeruginosa covered with biofilm in vitro.

肝病在我国是常见病和多发病,肝病患者院外自我调理对于肝病治疗具有重要意义,通过情志调养、起居宜忌、饮食疗法、按摩调治、体育锻炼,促进肝病患者早日康复.

胃肠动力紊乱,可见于慢性胃炎、胆汁返流性胃炎、功能性消化不良、尿毒症、糖尿病胃轻瘫及胃神经官能症等疾病过程中[1],常使用促胃肠动力剂胃复安、吗丁啉及胃起搏等治疗.

本文主要介绍慢性阻塞性肺部疾病(COPD)社区护理的国际国内最新进展.加强营养疗法.生活质量(QOL)与营养状况密切相关,对56例运用QOL测评表,提示营养不良QOL降低,易并发呼吸道感染,故须摄入适量碳水化合物、蛋白质及动植物油合用的低脂低饮食.因COPD致膈肌的重量及组织生化改变,呼吸肌力和耐力下降,故应训练腹式呼吸,加强膈肌活动,以减轻呼吸困难.凡PaO2≤6.3Kpa或SaO2≤88%长达三周者应进行家庭氧疗.用中医方法具有简便易行的优点,可选择易筋经、太极拳等运动养生疗法.加强戒烟、保暖等宣传教育.最后要培养具有敬业精神,能独立判断病情、无私奉献的社区护理专家.对COPD患者进行社区护理,是人口老龄化医疗保健体制向社区分散化、青年人占养意识发生变化的必然,以后我们应发展社区护理的优势,扩大护理职业功能,培养护理专家,开拓新的格局.

患者,女,77岁,因间断咳嗽、痰血6个月,经抗炎、止血等治疗,效果时好时坏.近10 d出现痰中带鲜红色血丝和血块,每次大约40～100 ml,胸片及CT检查示"右侧肺门新生物合并右上叶肺不张",为确诊而住院,拟行支气管镜检查.

目的探讨两种护理措施对糖尿病性眼病手术患者的影响.方法选择63例糖尿病性眼病手术患者,随机分为两组,分别予以整体护理和常规护理,测定患者血糖、焦虑及眼压波动范围.结果实验组患者术前一天及术后第一天的血糖值及焦虑均低于对照组(P＜0.05).结论整体护理有利于降低患者血糖,减少焦虑,巩固手术疗效.