The flipped classroom teaching model plays an important role in promoting the teaching work and improving the teaching level. Its design, implementation steps, results assessment and existed problems were thus analyzed with suggestions proposed for its further improvement in this paper.

Objective To quantify Contribution to LE at Birth from Mortality Variation for Some Diseases in Shanghai.Methods Health problem for population was classified into 5 group: infectious group,tumor,cerebrovascular group,injury and others.Cause elimination life table methods was employed to analyze the mortality registry data for Shanghai residents during 1953 to 1999.Chisquare for trend was used to analyze the variation for ASMR and Pearson correlation was used to describe the relationship between the variation of LE at birth and social economic factors.Results During 1953 to 1999,crude mortality rate(CMR),mortality rate by area,age-specific mortality rate(ASMR) from infectious group diseases showed obvious trends of descending.Also CMR and ASMR from injury for urban residents showed obvious trends of ascending.However,for suburb residents,CMR from injury had a trend of decline but ASMR had no significant trend.CMR from tumor and cerebrovascular group for Shanghai residents showed a rising trend but mortality rate by area and ASMR not.After 1979,the proportion of contribution for the rise of LE at birth for Shanghai urban residents from infectious group was about 33%,which was much higher than that of other 3 groups.The proportions of contribution in suburb male group from injury and cerebrovascular were 40.26% and 25.18%,respectively.The variation of mortality risk from tumor for urban male residents gave a negative contribution to respondent rise of LE at birth.Besides,the proportions of contribution in suburb female group from infectious disease(21.60%) and injury(12.55%) were largest.Compared to the mortality in 1996,among infectious group,injuries,tumor and cerebrovascular group,potential decline of mortality from tumor contribute the most to the rise of LE at birth,cerebrovascular group has the second,injury had the third and infectious group has the least.Development of Shanghai medical service resource showed a significant correlation with the rise of LE at birth.Conclusion Shanghai has successfully prevented and controlled the infectious disease group.The future strategy for disease prevention and control ought to focus on tumor,cerebrovascular diseases and injury.Based on the theory of risk competing,cause elimination life table method help greatly to set proper LE aims for public health plan.

Objective:To observe the efficacy and safety of PGE1 combined with PHGF in the treatment of patients with moderate or severe chronic hepatitis.Methods:110 patients with chronic hepatitis were randomly divided into two groups:60 in test group and 50 in control group.The patients of test group received the PGE1 combined with the PHGF for 30 days and the control group only received the most in using PGE1 for 30 days.Results:At the end of treatment,the total effective rates were 93.3% in the test group and 80% in control group.No severe side effect was observed in both groups.Conclusion:The PGE1 in conjunction with the PHGF is an effective and safe therapeutic intervention for patients with moderate or severe chronic hepatitis.

Objective:To Study the efficacy and satety of lamivudine in the treatment of CHB and HBV carrier.　Methods:All patients were divided into three groups. 21 patients with CHB were classified CHB test group(namely groupⅠ), 16 HBV carries were classified ASC test group(namely Group Ⅱ), 40 patients with CHB were CHB controlled group(namely controlled group). Both group Ⅰ and group Ⅱ received lamivudine, group Ⅰ was added protecting liver therapy. The controlled group only received protecting liver therapy. The treatment courses of three groups were one year. 　Results:The effective rates of group Ⅰ and group Ⅱ were higher than the controlled group in turning into negative HBeAg and HBV-DNA, both the negative-turning rate of liver functions and hepatic serology target declining fibrosis in group Ⅰ was more significant than the controlled group without severe side effect. 　Conclusion:Lamivudin is efficient and safe medicine in the treatment of CHB and HBV carrier.

Objective To investigate the clinical efficacy of TongluoShu Liquid in treating rheumatoid arthritis at early stage. Methods 100 cases were randomly recruited into a control group and a treatment group with 50 cases in each group. The treatment group was given TongluoShu liquid, 150ml / time, twice a day; and the control group was given Diclofenac Sodium Sustained Release Tablets (Deegan), one granule for each time, twice a day, and Methotrexate 7.5mg / time, once per week. Results In the treatment group, symptoms, signs and biochemical indicators were significantly improved, and the swelling of the soft tissue around the joints in stage Ⅰ and Ⅱ were also reduced. Besides, osteoporosis was controlled and the progress of destruction to the cartilage of stage Ⅲ was detained, though there was no statistical difference between the two groups after the treatment. Conclusion ShuTongluo liquid is a safe and effective medicine with less adverse reactions in treating rheumatoid arthritis.

Objective:To optimize and improve the content determination method for nitroglycerin ointment. Methods:An HPLC method was used,the column was Hypersil ODS(150 mm × 4. 6 mm,5 μm),the mobile phase was acetonitrile ∶water(50 ∶50),the detection wavelength was set at 220 nm,the flow rate was 1 ml·min-1 ,the column temperature was 30℃,and the injection volume was 20 μl. Results: The results showed a good linear relationship within the concentration range of 0. 020 3-0. 203 3 mg · ml-1 ( r =0. 999 9),and the average recovery was 99. 51%(RSD=1. 06%,n=9). Conclusion: The method is rapid,accurate and reproduci-ble,and can be used to determine the content of nitroglycerin in nitroglycerin ointment.

Objective To analyse the routes and MRI characteristics of disseminated intracranial gliomas after operation. Methods 10 patients of intracranial gliomas confirmed by pathology and intracranial dissemination after operation underwent MRI examina-tions including T_1 WI, FSE T_2 WI, FLAIR and fat-suppressed T_1 WI after intravenous injection of Gd-DTPA. In addition, 4 cases were also examinated with DWI, 1 case with SWI and DTI. Results In 10 cases,there were glioblastoma in 7 cases,grade Ⅱ astro-cytoma in 2 and grade Ⅲ astrocytoma in one. The disseminated tumors were found by MRI in 4 to 56 months after operation. The le-sions in all patients were confirmed with the comparison of contrast-enhanced MRI positive signs between preoperation and post-operation. Plain MR scanning showed line-like thicking with isointensity in 1/7 case/time (C/T)and multiple noduli in 5/7 (C/T) on T_1 WI respectively;shallowed cortical sulci and cistern in 2/7(C/T) and nodular in 5/7(C/T) on T_2 WI;shaUowed cortical aulci and cistern in 2/7 (C/T) and nodular in 6/7(C/T) on FLAIR. The signal intensity of noduli of disseminated tumors in 7 cases were in complete consistency with that of primary neoplasm , however, in 3 cases, it was inconsistent. Enhanced scanning showed 7 ca-ses with the signs of line-like thicking, 7 cases with noduli , 6 cases with :cast-like shape" sign and 6 cases with different extent of hydrocephalus. Conclusion Enhanced MRI can be used as a most useful and reliable monitoring tools for detecting dissemination of brain glioma.

Objective To investigate the association of the expressions of glomerular nephrin, vascular endothelial growth factor (VEGF) and its receptor (VEGFR) with proteinuria in preeclampsia rats. Methods A rat model of preeclampsia was developed by inhibitor of nitric oxide synthase (L-NAME). The systolic blood pressure (SBP) and 24 h urine protein were compared among the normal female group (n=6), the normal pregnant group (n=8), nonpregnant control group (n=6) and preeclampsia group(n=8). The kidney biopsies of each group were observed by light and electron microscopy. The glomerular nephrin was detected by Western blotting and real-time PCR. Immunofluorescence was used to detect the expression of WT1. The level of glomerular VEGF and VEGFR (Flt-1 and Flk-1) were evaluated by Western blotting. Results The level of glomerular nephrin protein in the rats with preeclampsia (0.0726±0.0074) was significantly lower compared with normal female group (0.3795±0.0509), normal pregnant group (0.2361±0.0437) and nonpregnant control group (0.7265±0.0503) (P＜0.01, respectively), while the levels of nephrin mRNA were not significantly different among 4 groups. The expression of WT1 was not significantly different among 4 groups as well. The level of glomerular VEGF in preeclampsia group (1.5429±0.0898) was significantly higher compared with normal female group (1.1870±0.1160), normal pregnant group (1.3741 ±0.1165) and nonpregnant control group (1.0155±0.0742)(P＜0.01,respectively). VEGFR (Flt-1 and Flk-1) was also significantly higher in preeclampsia rats compared with other control groups (P＜0.05, respectively). Conclusions In preeclampsia rats, nephrin is decreased significantly and the glomerular VEGF-VEGFR is increased significantly compared with the other control groups. The abnormal expression of nephrin and VEGF-VEGFR may be involved in the preeclampsia proteinuria. The underlying mechanism of this phenomenon needs further research.

Objective To discuss effect of fasting and taking food on hemostasis effect of patients with gastric ulcer and bleeding. Methods 160 patients with gastric ulcer and bleeding were divided in-to the experimental group and the control group, the experimental group was allowed to take lower ho-moiothermy water gruel (liquid), the control group was required absolute fasting (not medication), until bleeding stop. The two groups adopted identical treatment and nursing. The lienable stomach tube was placed respectively, everyday pH value monitor and occult blood test were carried out by taking out gas-tric juice when fasting and 2 hours after meals. Continuous monitoring tests continued till occult blood test of gastric liquid became negative for 3 times. Stool was kept for occult blood test, at the same time the gastrointestinal tract symptom and bleeding condition were observed, routine blood test was carried out one every other day. The data underwent statistical analysis with SPSS13.0 statistics software package, compari-son between two groups used t test. Results The inner stomach pH value of the experimental group in-creased obviously, the average pH value and percentage of pH above 4 was evidently higher than those of the control group. The time of occult blood test of gastric liquid and stool turning to negative in the experi-mental group was shorter than those of the control group. Conclusions Taking food can elevate pH of gastric liquid, reduce damage caused by gastric acid to gastric mucosa, thus hasten hemostasis process and promote healing.

Objective To investigate the risk factors of multiple recurrent bile duct stones in patients with common bile duct (CBD) stones and received endoscopic sphincterotomy (EST ) treatment . Methods From June 1st ,2007 to June 1st ,2011 ,the patients received EST treatment were followed up , the follow‐up time was three to seven years .A total of 2 738 patients were successfully followed up , including 24 patients with two or more than two times of recurrent bile stone after EST who were enrolled in multiple recurrence group .One hundred patients without recurrence were randomly selected by table of random number as control group .The clinical data of two groups were compared by t test or Chi‐square test .The factors were analyzed with multivariate Logistic regression analysis and try to find out the risk factors of multiple recurrence .Results The comparative analysis between two groups showed that the three factors of juxtapapillary duodenal diverticula [17 .0% (17/100 ) vs 41 .7% (10/24 )] ,history of biliary tract surgery [13 .0% (13/100) vs 45 .8% (11/24)] and the angle enclosed between the horizontal portion of the CBD and the horizontal plane (angleofbile duct) less than 45° [2 .0% (2/100) vs 20 .8% (5/24)] were statistically significant (χ2 = 6 .914 、13 .37 、9 .595 ,all P < 0 .01 ) . Furthermore , logistic regression analysis indicated that juxtapapillary duodenal diverticula (B = 1 .421 ,OR = 4 .142 ,P = 0 .01) , history of biliary tract surgery (B = 1 .612 ,OR = 5 .011 ,P= 0 .004) and the angle of bile ductless than 45° (B= 2 .661 ,OR= 14 .31 ,P= 0 .005) were risk factors of multiple recurrence .Conclusion Juxtapapillary duodenal diverticula , history of biliary tract surgery , and the angle of bile duct less than 45° are independent risk factors of multiple recurrence of CBD stones .