Objective To examine the efficacy of applying clinical pathway (CP) teaching model in orthopedics clinical teaching.Methods Totally 64 medical undergraduates were randomized into 2 groups.The traditional teaching method and CP model were separately preformed on them.Their scores of theoretical,manipulation and case analysis exams at the end of internship were compared.Meanwhile the questionnaire of satisfaction degree also was conducted.Results Scores of exams and satisfaction degree were better in CP group than in classical group (P ＜ 0.05).Conclusions The novel CP model can promote the standardization and systematization of clinical teaching in orthopedics.It is conducive to evaluating teaching effect and performing teaching reform.Meanwhile,it is in accordance with the problem-based learning and can improve clinical teaching effect and satisfaction degree.

Objective To investigate whether tumor necrosis factor-? (TNF-?) enhance the expression of vascular endothelial growth factor (VEGF) and matrix metalloproteinase-9(MMP-9) in hepatic cancer cell line HepG2 or not. Methods Cultured HepG2 cells were treated by TNF-? with various concentration and time. The morphological changes of HepG2 cells were studied microscopically and the proliferation of HepG2 were detected by methyl thiazolyl tetrazolium (MTT). The expression of VEGF and MMP-9 mRNA in cultured HepG2 were determined by relative quantitative reverse transcription polymerase chain reaction. The VEGF and MMP-9 protein level in supernatants and in cytoplasm were determined by enzyme-linked immunosorbent assay (ELISA) and by immunocytochemical staining, respectively.Results There was a little morphological changes in HepG2 with TNF-? treatment, but no change of cell proliferation in corresponding time. The expression of VEGF and MMP-9 mRNA was enhanced gradually with the TNF-? concentration increasing, the VEGF and MMP-9 protein level in supernatants and in cytoplasm was elevated gradually with the concentration increasing. There was a dependance on the concentration when the concentration of TNF-? was lower than or equal to 10~4 U/L. Furthermore, the effect of promotion was close to peak when the TNF-? concentration up to 10~4 U/L; but no time-effect pattern observed. Conclusion TNF-? can enhance the expression of VEGF and MMP-9 at the level of mRNA and protein in hepatic cancer cell line.

0.5). Conclusions There is an increasing trend of resistin level in healthy volunteers and patients with obesity, diabetes mellitus and hyperthyroidism in order Resistin also was a positive and an inverse correlation with BMI and resistance index respectively. These results support the hypothesis of Steppan that resistin causes insulin resistance and links obesity to diabetes, and that the high level of resistin in hyperthyroidism can help to explain the phenomenon of its insulin resistance.

Objective To compare the clinical effect of valsartan/amlodipine combination or irbesartan/hydrochlorothiazide(HCTZ)combination in very elderly hypertensives.Methods After a 4-week placebo period,94 hypertensives,aged 75-89 years were random given valsartan 160 mg/amlodipine 5 mg or irbesartan 300 mg/HCTZ 12.5 mg for 24 weeks according to a rospective study.After 4 weeks,amlodipine or HCTZ was doubled in non-responders.Patients were checked every 4 weeks.At each visit,sitting,lying and standing blood pressure(BP),systolic BP(SBP)and diastolic BP(DBP)were measured. At the end of placebo period and treatment period,electrolytes and uric acid were evaluated.Results Blood pressure was significantly decreased in both treatment groups,however,there was no statistical significance between two groups.BP changes from lying to standing position were significantly greater in the irbosartan/HCTZ group(-17.2/-9.1 mmHg)than that in the valsartan/amlodipine group(-10.1/-1.9 mmHg,t=2.14,P＜0.05 for SBP and t=3.11,P＜0.01 for DBP vs.irbesartan/HCTZ).Potassium significantly decreased and uric acid significantly increased(-0.4 mmol/L,t = 2.33,P＜ 0.05 and+29.7μ mol/L,t =2.54,P＜0.05 vs.baseline,respectively)only in the irbesartan/HCTZ group.Conclusions Both combinations had similarly effective in reducing clinical BP in very elderly hypertensives.However,valsartan/amlodipine offered some advantage and less pronounced BP orthostatic changes and absence of metabolic adverse effects.

Objective To study whether mechanical noise acting on the sacculus could enhance the SNR of the 8th nerve’s response.Methods Driving PZT by adding white noise of various level to periodic signals(f=100 Hz),the directly mechanical stimuli was give to the five sacculus submerged in a solution containing perilymph-like, and the afferent activity the 8th nerve was recorded.Results The SNR of the nerve signal was improved by addition nanometer-level noise to the periodic stimuli in all responsive animal(4.1 dB, on average).It was found that 2.3 nm of mechanical noise enhanced the response of the saccular nerve.Conclusion The addition of a few nanometers of noise to a periodic stimuli leads to a substantial improvement in the SNR of the nerve’s response.

BACKGROUND:Previous studies have shown that calcitonin gene-related peptide can be released from cardiac sensory afferent terminals fol owing coronary artery occlusion in rats, indicating the involvement of calcitonin gene-related peptide during pathological process of acute myocardial ischemia.
OBJECTIVE:To investigate the effect of calcitonin gene-related peptide on neonatal rat cardiomyocytes apoptosis induced by oxidized low-density lipoprotein and hypoxia/reoxygenation.
METHODS:Twenty wel s of primary cultured neonatal rat myocardial cel s were randomly divided into five groups:normal control group, oxidized low-density lipoprotein group, oxidized low-density lipoprotein hypoxia/reoxygenation group, calcitonin gene-related peptide group and calcitonin gene-related peptide 8-37 group. The cel s in the last four groups were incubated with oxidized low-density lipoprotein for 24 hours before establishing the myocardial hypoxia/reoxygenation model. At 30 minutes prior to hypoxia/reoxygenation, 10-8 mol/L calcitonin gene-related peptide were added into the culture fluid in calcitonin gene-related peptide group;10-7 mol/L competitive antagonist calcitonin gene-related peptide 8-37 of calcitonin gene-related peptide-1 receptor were added at 30 minutes before calcitonin gene-related peptide administration in calcitonin gene-related peptide 8-37 group. Myocardial apoptotic rate and caspase-3 activity were detected respectively.
RESULTS AND CONCLUSION:Calcitonin gene-related peptide could significantly attenuate apoptosis of neonatal rat myocardial cel s through inhibiting the caspase-3 activation induced by oxidized low-density lipoprotein and hypoxia/reoxygenation. And this effect could be partial y reversed by competitive antagonist calcitonin gene-related peptide 8-37 of calcitonin gene-related peptide 1 receptor, indicating that calcitonin gene-related peptide has anti-apoptotic effect in combination with the calcitonin gene-related peptide 1 receptor to inhibit cardiomyocyte apoptosis in neonatal rats induced by oxidized low-density lipoprotein and hypoxia/reoxygenation.

Purpose To investigate the effect of sensitivity on image quality and radiation dosage of digital chest radiography. Materials and Methods A total of 300 healthy people undergoing chest X-ray examination were randomly enrolled and divided into two groups according to body weight (150 people with normal weight and 150 overweight), which were further randomly divided into three subgroups (S200 subgroup with low-sensitivity, S400 subgroup with mid-sensitivity, S800 subgroup with high sensitivity, each subgroup contained 50 people). With other parameters unchanged, digital chest photography with different sensitivities was performed to each subgroup (S200, S400 and S800, respectively), and then uploaded the data to PACS and recorded mAs value and dose area product (DAP) value for each time. Then the image quality was assessed by three doctors in terms of mAs value, DAP, image quality score and noise score. Results In all subgroups of normal weight, differences on mAs and DAP were significant (F=1443.191-1829.895, P<0.05) whilst differences on image quality score and noise score were not significant (F=0.686-2.516, P>0.05). In all overweight subgroups, differences in mAs, DAP, image quality score and noise score were significant (F=163.358-290.656, P<0.05). According to one-factor analysis of variance, mAs value was S200>S400>S800 (F=0.626-3.210, P<0.05), DAP value was S200>S400>S800 (F=0.416-1.416, P<0.05), there was no difference in image quality score and noise score (F=0.001-0.100, P>0.05). In overweight group, there was no difference between subgroups of S200 and S400 (F=0.120-0.145, P>0.05); whilst differences between subgroups of S200 and S800 were significant, the same appeared in subgroups of S400 and S800 (F=1.655-2.360, P<0.05). Conclusion Radiation dose can be effectively controlled by regulating sensitivity with image quality unaffected. It is advisable to choose high-sensitivity photography for patients with normal weight and low or mid-sensitivity photography for overweight patients.

Objective To compare the clinical effect of valsartan/amlodipine combination with valsartan only in primary hypertension patients.Methods After 4 weeks wash-out,90 patients (18-65 years) with primary hypertension were randomized to valsartan 160 mg/amlodipine 5 ng or valsartan 160 mg for 24 weeks according to a prospective study.Patients were checked every 4 weeks.At each visit clinical sitting blood pressure (SeDBP) were evaluated.weeks.The primary endpoint was to evaluate the improvement of SeDBP at the end of 24-week treatment.There were 83 patients(the combination therapy group n =43,monotherapy therapy group n =40) completed the 24h ambulatory blood pressure monitoring which was included in the final efficacy analysis.Results The randomized,single-blind treatment for 24 weeks.the mean value of SeDBP reduction,the reaching target blood pressure rate and total successful response rate to the treatment (a SeDBP ＜90 am Hg or a decrease of 10 mmHg or more from baseline) were (12.3 ±5.9)mmHg,64.9％ and 87.8％ in the combination therapy group,respectively,and were (7.9 ± 6.2) mmHg,34.8％ and 64.5％ in the monotherapy group,respectively.There were statistically significant difference between the combination therapy and the monotherapy groups in all the 3 indexs (P ＜ 0.01).The combination significantly reduced systolic blood pressure (SBP) and diastolic blood pressure (DBP) values throughout the 24h,the trough to peak ratios of DBP/SBP in the combination and valsartan alone were 82.8％/75.7％and 85.4％/78.8％ (P ＜ 0.05),respectively.Conclusion The combination therapy with valsartan/amlodipine was superior to valsartan monotherapy and was well tolerated in patients with essential hypertension and allowing a satisfactory BP control for 24 hours.

Objective To explore the influencing factors of gastrointestinal bleeding(GB) in secondary prevention patients with cerebral ischemic stroke(CIS).Methods A total of 616 patients were divided into bleeding group and control group according to the status (yes,no) of suffering GB during the 2years follow-up.Single factor analysis and Logistic regression analysis was used to explore the influencing factors of GB in CIS patients.Results The proportion of age≥65,a history of GB,gastric disease,renal insufficiency,sudden onset,NIHSS ≥12 and CIS ≥2 in the bleeding group was significantly higher than that in the control group (P ＜ 0.05) ; The proportion of combined with statins,proton pump inhibitors and gastric mucosal protective agent in the bleeding group was significantly lower than that in the control group (P ＜0.05) ; The Logistic regression analysis showed that age≥65,a history of GB,gastric disease,renal insufficiency,sudden onset,NIHSS≥12 and the times of CIS≥2 were risk factors of GB; however,combined with statins,proton pump inhibitors were protective factors.Conclusions Aging,a history of GB,gastric disease,sudden onset,higher NIHSS score and the times of CIS ≥ 2 were the risk factors of GB,combined with statins and proton pump inhibitors could reduce the risk of GB.

Objective To compare the effect of thoracoscopic and laparoscopic surgery with conventional thoracic surgery on esophageal cancer and its influence on pulmonary function. Methods Ninety?four patients with esophageal cancer treated in the Second Affiliated Hospital of Chengdu Medical College from March 2010 to March 2016 were selected and were divided into the control group ( 54 cases) and the study group ( 40 cases) according to operation methods. The control group received traditional thoracotomy. The study group received thoracoscopic and laparoscopic surgery. The operation and pulmonary function indexes were compared. Results The operation time of the patients in the study group was significantly longer than that in the control group ( (218. 1±35. 8) min vs. (192. 3±40. 1) min,t=3. 23,P<0. 05). Intraoperative blood loss of the patients in the study group was significantly less than that in the control group ( (286. 4±83. 5) ml vs. (343. 7 ±96. 7) ml,t=3. 01,P<0. 05) . The number of lymph nodes cleared of the patients was significantly higher in the study group ( (18.0±5.4) node vs. (15.5±4.6) node,t=2.42,P<0.05).Thoracic drainage of the patients in the study group was significantly less than that in the control group ( (650. 3±61. 3) ml vs. (1153. 5 ±133. 7) ml,t=22. 12,P<0. 05). Chest tube pull out time in the study group was significantly earlier than that in the control group ( (5. 1±1. 3) d vs. (8. 0±1. 8) d,t=8. 65,P<0. 05). First exhaust time in the study group was significantly earlier than that in the control group ( (33. 2±6. 7) h vs. (40. 7±7. 3) h,t=5. 10,P<0. 05). Hospital stay in the study group was significantly shorter than that in the control group ( ( 13. 8 ± 2. 8 ) d vs. (18. 2± 3. 6) d, t=6. 42, P<0. 05) . Postoperative complications occurred in 4 cases in the study group, accounting for 10%, significantly lower than that in the control group, 15 cases, 27. 8%, the difference was statistically significant (χ2=4. 50,P<0. 05) . VC,FEV1 and MVV in the study group were significantly higher than those in the control group ( VC:( 81. 5 ± 15. 6 )% vs. ( 42. 3 ± 8. 1 )%;FEV1: ( 85. 7 ± 9. 1 )% vs. ( 43. 6 ±6. 8)%;MVV:(76. 0±8. 9)% vs. (48. 3±7. 6)%,t=15. 83,25. 68,16. 24,P<0. 05). 3?year survival rate of the study group and the control group were 45. 0% (18/40) and 44. 4% (24/54),respectively. There was no significant difference between the two groups (χ2 = 0. 01, P> 0. 05 ) . Conclusion Thoracoscopic and laparoscopic surgery for esophageal cancer has the advantages of small trauma,rapid recovery and low incidence of complications and obvious protective effect on pulmonary function. It is safe and feasible.