This paper intends to explore a method which can arouse the students'interests,improve their study efficiency and develop their creativity by applying the delightful teaching mode during the pharmacology teaching in medical vocational colleges.When applying the de-lightful teaching mode,it is important for us to take advantage of different delightful materials,use various flexible teaching skills and emphasize the attractive education,and only in this way can we obtain good results.

Objective To investigate the evolution of pancreaticoduodenectomy and its significance in different time periods. Methods The clinical data of 165 patients from 1988 to 2008 in the department of general surgery, Zhangzhou Municipal Hospital with pancreaticoduodenectomy were retrospectively analyzed.Among 165 cases, simple pancreatoduodenectomy (PD) were performed in 138 cases, pylorus preserving pancreatoduodenectomy (PPPD) were performed in 14 cases, and extended pancreaticoduodenectomy were performed in 13 cases. The methods of pancreato-enteric reconstruction in pancreaticoduodenectomy included 68 cases with binding pancreaticojejunostomy (Peng's type Ⅰ ); 61 cases with pancreaticogastrostomy; 30 cases with traditional pancreaticojejunostomy; and 6 cases with duct-to-mucous pancreaticojejunostomy.Results From 1988 to 1998 (the first 10 years), 50 patients underwent pancreaticoduodenectomy, including 42 cases of PD and 8 cases of PPPD, and no case of extended pancreaticoduodenectomy. The mean amount of blood loss was (620 ± 180)ml, mean amount of blood transfusion was (530 ± 120)ml, the mean operation time was (6.5 ±3.5)h. Anastomotic fistula occurred in 7 cases, the incidence of anastomotic fistula was 14.0%(7/50); and 2 cases died during perioperative period with a mortality rate of 4.0% (2/50). From 1999 to 2008 (the latter 10 years), 115 patients underwent pancreaticoduodenectomy, including 96 cases of PD, 6 cases of PPPD, and 13 cases of extended PD. The mean amount of blood loss was (360 ± 110)ml, mean amount of blood transfusion was (400 ± 6 ) ml, the mean operation time was ( 3.0 ± 2.5 ) h, Anastomotic fistula occurred in 4 cases with an incidence of 3.5% ( 4/115 ); and one case during perioperative period with a mortality rate of 0.61%. The postoperative follow up time was ranging from 6 months to 5 years in 109 patients, the 1, 3,5 year survival rate was 87.2%, 54.1% and 39.5%. Conclusions In the latter 10 years, the amount of blood loss, the operation time, the mortality, and the incidence of pancreatic fistula have decreased significantly compared to the first 10 years.

BACKGROUND:Transforming growth factor β1 (TGF-β1) and interleukin 1β (IL-1β) have been reported to play an important role in the occurrence and development of primary osteoarthritis. OBJECTIVE:To investigate the association between gene polymorphisms of TGF-β1 and IL-1β and primary knee osteoarthritis. METHODS: Han and Uyghur elderly populations in Xinjiang Uygur Autonomous Region, China were surveyed on the prevalence of osteoarthritis, followed by allotted to osteoarthritis and health groups according the symptoms and radiography. Genotyping TGF-β1-509C/T and -1348C/T and IL-1β-511C/T was performed to analyze the relationship between the gene polymorphisms of TGF-β1 and IL-1β and osteoarthritis. RESULTS AND CONCLUSION:Alleles T and C with genotypes CC, CT and TT were detected in both two groups. In the Uygur population, the genotype frequency of TGF-β1-509C/T and IL-1β-511C/T showed significant difference between osteoarthritis and health groups (P < 0.05). In the Han population, the genotype frequency of TGF-β1-1348C/T showed significant difference between two groups (P < 0.05). These results suggest that the Uygur individuals carrying TT genotype of TGF-β1-509C/T and IL-1β-511C/T, and Han people carrying the TT genotype of TGF-β -1348T are more susceptible to osteoarthritis.

Objective To evaluate the efficacy andtolerability of continuous low-dose cyclophosphamide and prednisone treatment of relapsed and refractory multiple myeloma. Methods84 relapsed and refractory multiple myeloma patients were enrolled, including 46 males and 38 females, the assess patients of 81 cases with average age of 69.7 (45-91)years. They were treated continuous with oral cyclophosphamide (50 mg/d) and prednisone (15 mg/d) and monthly follow-up.ResultsAverage follow-up time were 23.5(1-71)months.The assessed patients were 81 cases,with 52 cases (64.2 ％) responded.There were 2 cases(2.5 ％)CR,21 cases(25.9 ％) of PR,29 cases(35.8 ％)MR,19 cases(23.5 ％)NC and 10 cases (12.3 ％)PD.The median time to response was 2 months.In the patients who responded to the treatment,the median progression-free survival(PFS)and overall survival (OS) were 18(95 ％CI 12.8-23.2),29(95 ％CI 24.1-33.9)months.In the non-responding patients,the PFS and OS were 4(95 ％ CI 2.2-5.8) and 6(95 ％ CI 4.9-7.1)months.Two groups were statistically significant(P＜0.05).The most common toxicities included fatigue,nausea, neutropenia, hyperglycemia and lung infection. No patient withdrew from the study because of toxicity. Conclusions Continuous low-dose cyclophosphamide combined prednisone is a treatment options for relapsed and refractory MM patients.

OBJECTIVE： To stu dy the improvement effects of Astragalus complanatus total flavonoids （TFA） on adenine-induced reproductive dysfunction model male rats and its mechanism. METHODS ：Male SD rats were divided into blank group，model group ，positive group （Wuzhi yanzong pill ，2 g/kg），TFA high-dose，medium-dose and low-dose groups （0.05， 0.1，0.2 g/kg），with 12 rats in each group. Male rats in each group were given the corresponding drugs intragastrically at 9：00 a.m. every day ，while the model of reproductive dysfunction was reproduced by intragastric administration of adenine suspension （except for blank group ）at 3：00 p.m. on the same day ，for consecutive 35 days. After medication ，male rats in each group were mated with female rats by ratio of 1∶1 in cages ；7 days later ，inducing-pregnancy rate of male rats were measured. ELISA assay was used to detect the serum levels of T ，E2，FSH，LH，GSH-Px，SOD，MDA，Scr and BUN in male rats ；the testis ， epididymis，seminal vesicle ，thymus and kidney of male rats were extracted and the organ index was calculated ；HE staining was used to observe the pathological changes of testis ，epididymis and kidney ；the protein expression of Bcl- 2，Bax，Caspase-3 and Caspase-9 in the renal tissue of male rats were detected by immunohistochemistry. RESULTS ：Compared with blank group ，the inducing-pregnancy rate of male rats ，the testis ，epididymis，seminal vesicle gland ，thymus indexes ，the serum levels of T ，E2， SOD and GSH-Px ，the protein expression levels of Bcl- 2 in renal tissue were reduced significantly in model group （P＜0.01）；the renal index ，the serum levels of FSH ，LH，MDA，Scr and BUN ，the protein expression levels of Bax ，Caspase-3 and Caspase- 9 in renal tissue were increased significantly （P＜0.01）；the diameter of seminiferous tubules in testis became thinner ，the spacing was wider ，and the arrangement of seminiferous cells was disordered ；the wall of epididymis was thickened ，the arrangement was loose，the stroma was enlarged ，the lumen was proliferated and atrophied ，and the sperm in the lumen wass aggregated ；in renal tissue，interstitial fibers was proliferated ，and a large number of yellow crystals were seen in renal tubules. Compared with model group，the inducing-pregnancy rate，the testis ，epididymis，seminal vesicle gland ，thymus indexes ，the serum levels of T ，E2， SOD and GSH-Px ，the protein expression levels of Bcl- 2 in renal tissue of male rats were increased significantly in the positive group，TFA medium-dose and high-dose groups （P＜0.05 or P＜0.01），while the renal index ，the serum levels of FSH ，LH， MDA，Scr and BUN ，the protein expression levels of Bax ，Caspase-3 and Caspase- 9 in renal tissue were decreased significantly （P＜0.05 or P＜0.01）；there was the same chage trend and most with significant difference in above indexes of TFA low-dose group （P＜0.05 or P＜0.01）；the pathalogic changes of testis ，epididymis and renal tissue were improved significantly. CONCLUSIONS：TFA can significantly improve adenine-induced reproductive dysfunction model male rats. The mechanism may be associated with reducing hormone FSH and LH level ，the expression of apoptosis-related proteins in renal tissue ，while increasing the level of hormone T and E 2 and improving oxidant stress level.

The ABRACL protein, the regulator of actin and cell motility, belongs to the HSPC280 family, and its conserved hydrophobic groove can interact with other proteins to facilitate actin motility and cellular activity. ABRACL is upregulated in tumor tissues and is closely linked with the proliferation and migration of tumor cells. A deeper understanding of the role of ABRACL in tumorigenesis and development may provide new ideas and insights for ABRACL to prevent or reverse tumor progression.

Objective To compare the analgesic effect and the effect on the success rate of reduc-tion of three doses of remifentanil combined with dexmedetomidine in the clamping reduction of cricoarytenoid joint dislocation.Methods Fifty-one patients with cricoarytenoid joint dislocation,30 males and 21 females,aged 18-80 years,BMI 18.5-30.0 kg/m2,ASA physical status Ⅰ-Ⅲ,were selected from April 2021 to December 2022 in the department of otolaryngology,head and neck surgery.The patients were randomly divided into three groups according to remifentanil dose:remifentanil 0.5 μg·kg-1·min-1 group(group A,n=17),remifentanil 1.0 μg·kg-1·min-1 group(group B,n=18),and remifentanil 1.5 μg·kg-1·min-1 group(group C,n=16).After admission,dexmedetomidine 0.6 μg·kg 1·h-1 was injected intravenously,and an ear,nose and throat anesthetic spray(2％lidocaine 2 ml)was used to administer surface anesthesia to the base of the tongue.A second surface anesthesia was administered to the throat at 5 minutes,and dexmedetomidine was stopped at 10 minutes.The supraglottic and periarticular cri-coarytenoid joints were subjected to superficial anesthesia for a third time under visual laryngoscope,and then remifentanil at corresponding doses was injected intravenously in three groups for 5 minutes,and the reduction operation began after the pumping was stopped.The success of the first reduction,the anesthesia quality satisfaction score of the surgeon and the recovery of remifentanil during the operation were recorded.VAS pain scores were recorded at the time of entry,3 minutes,30 minutes,and 6 hours after operation.The adverse reactions during operation and recovery were recorded.Results Compared with group B,the success rate of first reduction and the score of anesthesia quality satisfaction were significantly decreased in groups A and C(P＜0.05).Compared with group A,the ratio of additional remifentanil supplementation in groups B and C was significantly reduced,and the VAS pain score 3 minutes after surgery was significant-ly decreased(P＜0.05).Compared with group C,the proportion of mandibular manipulation ventilation in groups A and B was significantly reduced(P＜0.05).There was no significant difference in the incidence of bradyheart rate,nausea and vomiting,agitation,delirium and laryngeal spasm between the three groups.Conclusion Compared with remifentanil 0.5 and 1.5 μg·kg-1·min-1,remifentanil 1.0 μg·kg-1·min-1 combined with dexmedetomide sequential pumping provided good analgesic effect for the clamping reduction of cricoarytenoid joint dislocation,improved the success rate of the first reduction,more stable respiratory circulation and fewer perioperative adverse reactions.

Objective To establish the distribution zoning of Ziziphus jujuba var.spinosa in Shanxi Province;To help the development of Z.jujuba var.spinosa industry in Shanxi Province.Methods Combined with the information of longitude and latitude of sample points from the forth national survey resources and environment factors data in Grid Database of Spatial Information of TCM Resources,the MaxEnt model and ArcGIS were applied to analyze the main environmental factors affecting the suitability distribution of Z.jujuba var.spinosa.Results Dominant ecological factors for the suitability distribution of Z.Jujuba var.spinosa were vegetation type,lowest temperature of coldest month,monthly precipitation in November,monthly precipitation in October,altitude,and slope.The reclassified suitability grid data of ArcGIS software showed that Z.jujuba var.spinosa suitability distribution area including 0.73×104 km2 of high suitability area,1.41×104 km2 of medium suitability area and 4.33×104 km2 of low suitability area.The potential suitable distribution areas of Z.jujuba var.spinosa were mainly concentrated in the central and southern Shanxi Province.Conclusion This study shows that the most suitable growth area of Z.jujuba var.spinosa is mainly located in central and southern Shanxi Province,which can provide reference for the development,utilization and standardized planting of wild resources of Z.jujuba var.spinosa.

The Huangdi Neijing proposes the " using bitter herbs to nourish or purge" theory to guide clinical prescription and formulation of herbal remedies based on the physiological characteristics and functions of the five zang viscera, along with the properties and flavors of medicinal herbs. This study explored diabetic kidney disease pathogenesis and treatment based on the " using bitter herbs to nourish or purge" theory. Kidney dryness is a key pathological factor in diabetic kidney disease, and the disharmony of kidney dryness is an essential aspect of its pathogenesis. Strengthening is the primary therapeutic principle, and kidney dryness is a persistent factor throughout the occurrence and progression of diabetic kidney disease. In the early stage, the pathogenesis involves heat-consuming qi and injuring yin, leading to kidney dryness. In the middle stage, the pathogenesis manifests as qi deficiency and blood stasis in the collaterals, resulting in turbidity owing to kidney dryness. In the late stage, the pathogenesis involves yin and yang deficiency, with kidney dryness and disharmony. This study proposes the staging-based treatment based on the " need for firmness" characteristic of the kidney. The aim is to provide new insights for clinical diagnosis and treatment in traditional Chinese medicine by rationally using pungent, bitter, and salty medicinal herbs to nourish and moisturize the kidney. This approach seeks to promote precise syndrome differentiation and personalized treatment for different stages of diabetic kidney disease, thereby enhancing clinical efficacy.

Objective:To analyze the clinical and imaging features of patients with COVID-19-related osmotic demyelination syndrome (ODS).Methods:COVID-19-related ODS cases diagnosed in the Department of Neurology, Peking Union Medical College Hospital from January 2020 to September 2023 were retrospectively reviewed. And their past medical history, possible triggers, clinical manifestations, imaging manifestations, treatment and prognosis were summarized.Results:A total of 5 patients with COVID-19-related ODS were included. Electrolyte disturbances acted as an inducement of ODS in all patients (5/5),4 of whom with hyponatremia. Four of 5 patients first presented with disturbance of consciousness, followed by predominant dystonia. Imaging of all patients (5/5) showed isolated extrapontine myelinolysis (EPM). With the prolongation of the course of disease, such signal intensity could return to normal, and lesions showed atrophic changes in some patients. The patients′ clinical symptoms were partly relieved within a few days to a few months after treatment.Conclusions:COVID-19-related ODS is mostly associated with hyponatremia, and EPM is more common. COVID-19 should be considered as a risk factor for ODS.