Based on the basic requirement of medical education criteria,we reform courses by improving the goal,content,form and teaching method,and search for the method of improving the quality of teaching and cultivating.

Objective To investigate the surgical treatment of coronary malperfusion due to acute type A aortic dissection.Methods The clinical data of 305 consecutive patients with type A aortic dissection, who were hospitalized and underwent operation between 2004 and 2015, were analyzed retrospectively.Among that, there were 37 cases with coronary malperfusion due to aortic dissection.Results The right coronary artery was involved in 33 cases, the left in 2 cases, and both coronary arteries in 2 cases.There were 22 coronary bypass grafting using saphenous vein in 21 patients, including 20 patients with the right coronary bypass grafting and 1 patient with the left.Six patients died postoperatively, with the mortality of 16.22％.Conclusion Acute type A aortic dissection with coronary involvement is associated with high mortality rate, which is necessary to restore the coronary revascularization as soon as we can.The methods to reconstruct the involved coronary is depend on the patients' condition and experience of surgeon.

IgA nephropathy is the most common primary glomerular disease in China without any specific treat-ment. Corresponding treatments are usually adopted according to different clinical types. Referred to the clinical classification principles and the experiences of his own, Professor Huang Chunlin presented traditional Chinese medicine (TCM) medication experiences for different clinical types of IgA nephropathy which had some clinical instructive significance .

This paper summarized Professor Huang Chunlin's traditional Chinese medicine (TCM) medication expe-riences for patients with hypoalbuminemia in refractory nephrotic syndrome (RNS). This paper was divided into three parts. The first part was the overview of hypoalbuminemia in RNS. The second part was the TCM medica-tion experiences for patients with hypoalbuminemia in RNS which included the integrated application of tonifying the spleen, nourishing the liver and reinforcing the kidney. The third part was the explanation of the comprehen-sive application of Professor Huang Chunlin's TCM medication experiences for patients with hypoalbuminemia in RNS through the introduction of a typical case. TCM medication experiences for RNS treatment based on experi-ences of famous TCM doctors provided theoretical and practical basis for therapeutic regimen.

A method for the determination of bisphenol A, octyphenol, nonylphenol in water samples was developed using stir bar sorptive extraction (SBSE) based on poly (vinylimidazole-divinylbenzene) monolithic material (SBSEM) combined with high performance liquid chromatography with diode array detection.To achieve the optimum extraction performance, several main extraction parameters, including extraction and desorption time, pH value and contents of inorganic salt in the sample matrix, were investigated.Under the optimized experimental conditions, the method showed good linearity and repeatability, low detection limits (S/N = 3) and quantification limits (S/N = 10) of the proposed method for the target compounds were achieved within the range of 0.13-0.66 and 0.44-2.19 μg/L, respectively.The extraction performance of SBSEM to the target compounds was also compared with commercial SBSE which used polydimethylsiloxane as coating.The proposed method was successfully applied to the determination of the target compounds in water samples.The recoveries of spiked target compounds in real samples ranged from 37.8%-101.1%.The results indicated that the developed method possessed advantages such as sensitivity, simplicity, low cost and high feasibility.

Objective Deletion detection of Duchenne muscular dystrophy(DMD).Methods Totally 135 patients were tested through polymerase reaction of amplification with 12 dystrophin exons,polyacrylamide gel electrophoresis make gene analysis.Results The deletion of different region was found in 54 patients.Conclusion The deletion region is concentrated in 45～53 exons,the deletion of 48 exons is the peak.

Objective To investigate the changes in the surface-associated protein expression of streptococcus rnutans (Sm) isolated from clinical samples at pH7.0 and pH5.0. Methods The proteins were extracted from cells at pH7.0 and pH5.0 by Homer method. The proteins were separated by sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) and two-dimensional gel electrophoresis followed by image analysis. Proteins were identified by matrix-assisted la?ser desorption ionization time of flight mass spectrometry and computer-assisted protein sequence analysis. Results Image analysis revealed that four high expression levels of protein loci and two specific protein loci were existed in two strains at pH7.0. Two high expression levels of protein loci and two specific protein loci were existed in two strains at pH 5.0. Three high expression levels of protein loci and six specific protein loci were existed in Sm593 at pH5.0. Two-component system histidine kinases Lyts and glyceraldehyde-3-phosphate dehydrogenase were highly modulated, and NADH oxidase were modulated specifically. Conclusion The two clinical isolations in acid have high expression of some special proteins, which are presumed to be the resemblance of acid reaction.The difference of protein expression of two clinical isolations in acid may represent their distinct acid resistance.

Objective This report is to compare the difference outcome between total arch replacement and hemi-arch replacement for Stanford type A aortic dissection.Methods The subjects were 208 consecutive patients,including 121 who received total arch replacement(group A) and 87 who had hemi-arch replacement(group B) for Stanford type A aortic dissection from August 2001 to July 2013 in Nanjing Hospital Affiliated to Nanjing Medical University.The cardiopulmonary bypass (CPB) time,average cross-clamping time,selective cerebral perfusion(SCP) time,complications,in-hospital mortality and follow-up after surgery were retrospectively compared between the A and B groups.Results The age,sex ratio,preoperative complications do not show a significant difference between the A and B groups.The CPB time [(247.68± 58.65) min vs (212.68±60.75) min,P =0.000],cross-clamping time[(154.85±45.96) min vs(137.83± 38.91) min,P =0.000] and SCP time [(36.98± 10.62) min vs(29.85± 13.46) min,P =0.000] of group A are all longer than group B.The incidence of postoperative complications(14.0％ vs 10.3％,P =0.619) and in-hospital mortality(9.1％ vs 8.0％,P =0.791) between the A and B groups do not have a significant difference.The mean time of follow-up differed significantly between two groups [(21.86± 18.89) months vs(61.23± 38.57) months,P =0.000] and did not differ in the rate of follow-up(94.5％ vs 96.3％,P =0.585).The rate of false lumen thrombosed at the proximal descending aorta showed a significant difference between the twogroups(91.8％ vs 23.8％,P =0.000),but the rate of secondary surgical intervention (0 vs 2.3 ％,P =0.095) and follow-up death (6.4％ vs 6.3 ％,P =0.975) do not.Conclusion For the Stanford type A aortic dissection patients,surgery is the only treatment that can save lives.Total arch replacement need more time in CPB,cross-clamping and SCP,but the complications,in-hospital mortality and follow-up death do not show a significant difference compared with hemi-arch replacement,and higher rate of false lumen thrombosed have been showed in total arch replacement.

Objective To discuss the value of leukocyte-targeted myocardial contrast echocardiography (MCE) as a tool in observing the degree of acute rejection after heart transplantation. Methods Abdominal heterotopic cardiac transplantation was performed on 32 rats successfully, among which 8 isografts served as group A, and groups B, C and D involved 8 allografts respectively. The rats in groups B and C were treated with cyclosporine A (CsA) at a high dose (10mg· kg-1 · day-1 ), a low dose (3 mg · kg-1 · day-1 ) from 3rd day before transplantation respectively.The rats in groups A and D were untreated with CsA. MCE was performed during continuous intravenous SonoVue injection postoperatively on the third day after operation. We performed 2 types of MCE: perfusion imaging and leukocyte-targeted imaging. The images were obtained at 20 s and 5 min after injection of contrast agent. The value of the contrast image grayscale (GS) was measured by image analyzer (GS20s, GS5 min). GStarget was calculated as the GS5min minus the GS20s in the same rat.Postmortem histology was performed after observation. The degree of myocardial rejection was determined by HE-stained graft myocardium. Immunohistochemistry was performed to quantify the CD3-positive cells, and correlation analysis was performed between CD3-positive cell count and GS20s,GS5min, GStarget. Results Perfusion imaging showed no significant difference in myocardial GS20s of each group. Leukocyte-Targeted imaging exhibited a clear gradient in these groups (P＜0. 05). There was significant difference in GStarget of each group (P＜0. 001). Postmortem histology showed 0- Ⅰ grade rejection in group A, Ⅰ -Ⅱ grade rejection in group B, Ⅱ-Ⅲ grade rejection in group C, Ⅲ-Ⅳ grade rejection in group D. Immunohistochemistry revealed the CD3-positive cell infiltration was increased in turn from the group A to the group D. There was a significantly positive correlation between the CD3-positive cell count and GStarget ( r = 0. 86, P ＜ 0. 001 ). Conclusion Leukocyte-targeted contrast echocardiography may thus offer a noninvasive and effective ultrasound imaging technique for detecting the degree of acute cardiac transplant rejection.

BACKGROUND:Condylar fracture can occur under direct and indirect forces, and however, its risk and correlation with the impact site are rarely reported. OBJECTIVE:To quickly establish normal mandible three-dimensional finite element model and to analyze the strain conditions of the condyle under force at different parts of the mandible. METHODS: An adolescent volunteer was examined by multilayer spiral CT scans, whose mandible was normal and oral cavity was healthy. We used the reverse engineering software Mimics and large finite element software MSC.Patran to establish the three-dimensional finite element model of the mandible and to verify the feasibility of the model in the impact test at the body of the mandible, chin, mandibular angle and condyle. RESULTS AND CONCLUSION:A rapid establishment of mandible dimensional finite element biomechanical model could reproduce the morphology of the mandible, which was able to obtain the overal visual impression of the mandibular condyle. Geometric model included 80 044 nodes and 18 441 units. The mandibular chin, one side of the body, mandibular angle and condyle were given 100 N force respectively. The maximum equivalent stress of the bone cortex appeared in condylar region. So the mandibular condylar fractures were at the greatest risk. Experimental results contribute to mechanicaly analyze the condylar fracture type and to judge the severity of fractures.