This paper discussed the innovative thought on multi-media teaching for pathophysiology from three angles.

Objective To detect the genetic diversity and prevalent strains of Mycobacterium tuberculosis isolates from Tibetan patients in Tibet and to analyze factors associated with prevalent strains.Methods A total of 577 Mycobacterium tuberculosis isolates were genotyped by spacen oligonucleotide typing (spoligotyping) and the results were analyzed with BioNumerics software (Version 5.0) and compared with the international spoligotype database of SITVIT2.Results Among the 577 cases of Tibet patients,329 were male and 248 were female.Based on spoligotyping,23 different spoligotypes were identified among 577 Mycobacterium tuberculosis isolates,with a genetic diversity of 3.99 ％.The majority (97.57％,563/577) of the isolates belonged to four known families,such as Beijing family,T family,CAS family and MANU2 family.The remaining 14 isolates had 11 novel spoligotypes.522 (90.47％)isolates belonging to Beijing family presented with 7 spoligotypes,resulting in the genetic diversity of Beijing family of 1.34％.With high similarity,Beijing family strains could be clustered into one genotype;among non-Beijing family strains,strains belonging to T family and MANU2 family were similar and could be clustered into one genotype.Changdu had the highest prevalence (97.83％) of Beijng family strains.In this study,the occurrence of Beijing family strains was not associated with age,sex,bacillus CalmetteGuerin vaccination or treatment history (P=1.00,0.36,0.83 and 1.00,respectively).Conclusions In this study,the genetic diversity of Tibetan Mycobacterium tuberculosis is low and Beijing family strains are highly prevent in Tibet,by classical spoligotyping.

Objective To explore the effect of Tracer Methodology on the physical restraint management of the elderly patients. Methods The idea of Tracer Methodology was based on a case study of physical restraint, and then complementary tracking and system tracking. The key problem, which was founded in using Tracer Methodology on the physical restraint management of the elderly patients, could be continuously improved from the regulations, procedures, training, implementation, inspection, feedback, rectification, the implementation and the effectiveness. The normative rate of physical restraint was compared before and after the implementation of this method. Results After using the Tracer Methodology, the rate of physical constraint in the elderly patients was 82% (41/50), which was significantly increased (χ2=5.877,P=0.015) compared with before implementation of this method, which was 60% (30/50). Conclusions Tracer Methodology could improve the normative rate of physical restraint in elderly patients. Meanwhile, it was beneficial for nurses to participate in quality management, and strengthen the team cooperation.

Objective To study the histopathologieal features,growth pattern and distribution on the uterine cervix of high-grade cervical intraepithelial neoplasia(CIN).Methods Cone biopsy and hysterectomy specimens of 592 women with hish.grade CIN(CIN Ⅱ or Ⅲ)were reviewed morphologically.Of all cases.the gross appearance of the external os was recorded,and the frequency of eervical quadrants involved in hish-grade CIN was assessed.Two hundred specimens were selected randomly to observe micrographieal changes,including the extent,depth,growth pattern and cell types of hish-grade CIN and the alteration of stroma surrounding CIN.Results Of 592 specimens,external os showed smoothness in 46 cases(7.8%),mild erosion in 151 cases(25.5%),moderate or severe erosion in 395 cases(66.7%),hypertrophy in 48 cases(8.1%),and neoplasm in 4 cases(0.7%).Higll-grade CIN involvement was equally frequent on each quadrant of cervix(P>0.05).Of 200 cases of hish-grade CIN reviewed micrographically,the depth of the deepest involred crypt was le88 than 3 mm in 188 specimens (94.O%).between 3 to 5 nnn in 12 specimens(6.O%),and more than 5 mm in none.High-grade CIN with isolated endocervieal crypt involvement was detected in 77 cases(38.5%),multiple crypt involvement in 143 cases(71.5%).and confluent crypt involvement in 73 cases(36.5%).Hish-grade CIN showed explanate in 81.0%(162/200)of cases,endophytie in 49.0%(98/200)of cages,and exophytic in 6.5%(13/200)of cases.Abrupt transition between CIN and normal epithelia were found in 167 specimens (83.5%),whereas gradual transition in 66 specimens(33.0%).A variety of cell types,but basaloid type predominantly.were observed in hiSh-grade CIN.In 28.5%-45.0%of ca8es,the stroma surroundin CIN displayed oedema,desmoplastic and lymphocytic responses.Conclusions Our data suggest that gross examination is of little importance for diagnoses of CIN.CIN trend to spread horizontally and Mong the endocervical crypts,and are mainly distributed to a depth less than 3 nLrn.These data also suggest that there are a variety of cell types of CIN,and stroma responses to CIN may exist in part of high-grade CIN.

Objective To investigate the effects of puerarin on levels of thromboxane A 2 (TXA 2) and prostaglandin I 2 (PGI 2) in plasma of rats with hyperlipidemia. Methods A total of 48 Wistar juvenile rats were randomly divided into four groups: normal diet, high fat and high cholesterol diet (HFD), HFD supplemented respectively with 1 g/kg puerarin (puerarin group Ⅰ) or 2 g/kg puerarin (puerarin group Ⅱ). After eight weeks of feeding, the rats were sacrificed for detection of the levels of lipid, TXA 2, and PGI 2. Results The blood triglycerol, total cholesterol, LDL C, TXA 2, and TXA 2/PGI 2 were significantly lower in puetarin Ⅰ and puerarin Ⅱ groups than those in HFD group, but the concentration of HDL C was significantly increased in the supplemented group( F =109 163, P =0 000; P

Background and purpose:Advanced pancreatic cancer is characteristic of poor treatment eff icacy and short survival time. Gemcitabine is considered as front-line therapy for advanced pancreatic cancer. Gemcitabine combinations have shown a favorable impact on survival. We compared gemcitabine-based combination cheme therapy and gemcitabine(GEM) alone in patients with advanced pancreatic cancer through Meta analysis in phase Ⅲ clinical trials. Methods:MEDLINE and EMBASE searches were supplemented by information from trial registers of phase Ⅲ randomized controlled trials(RCTs) for GEM-based combination therapy and GEM alone for advanced pancreatic cancer. A quantitative meta-analysis was carried out by two reviewers based on the inclusion criteria from all available RCTs. The Meta-analysis involved 6-months and 1-year survival rate and objective remission rate(ORR) . Results:The Meta-analysis included 20 RCTs. The result of our Meta-analysis showed that there was signifi cant improvement in the GEM combination group with regard to the 1-year survival rate(RR:0.87,95%:(0.78,0.96) ,P=0.008) . The other result of our meta-analysis showed no signifi cant difference between two groups. Conclusion:GEM-based combination therapy may be effective with regard to the survival rate compared with GEM alone.

Objective To study the relationship of fatty acid binding protein-2(FABP2)and apolipoprotein E(ApoE)with coronary heart disease(CHD)in type-2 diabetes mellitus(T2DM)patients.Methods FABP2 and ApoE gene polymorphisms were detected by PCR-RFLP.At the same time all CHD in T2DM patients' serum triglyceride(TG),total cholesterol(TC),high-density lipoprotein cholesterol were(HDLC),low-density lipoprotein cholesterol(LDLC)were detected.Results The T-allele frequencies of FABP2 were higher(P

Cerebral venous thrombosis (CVT) refers to thrombosis of the intracranial veins and sinuses, which is a rare type of cerebrovascular disease.Due to this highly variable and nonspecific clinical presentations, CVT can be difficult to diagnose.Understanding the pathophysiology and etiology of CVT helps to understand its clinical symptoms and imaging findings and guide the treatment.This article reviews the related advances in the pathophysiology and etiology of CVT.

Objective To determine if the cardiac index (CI) measured by transesophageal echocardiography (TEE) through the mitral valve (MV) agrees with that measured by transesophageal echocardiography through the ascending aorta (AA).Methods Sixteen ASA Ⅱ or Ⅲ patients (NYHA Ⅱ or Ⅲ),aged 18-70 kg,weighing 46-72 kg,undergoing mitral valve replacement under cardiopulmonary bypass (CPB),were studied.Total intravenous anesthesia was used for induction and maintenance of anesthesia.After tracheal intubation,the TEE probe was placed in the esophagus.CI was measured by transesophageal echocardiography through the MV (CIMV)and AA (CIAA) at 15,30 and 60 min after termination of CPB and recorded.All the data were compared by Bland-Altman analysis.Results CIMV values were significantly lower at each time point than CIAA values (P ＜0.01).The results of Bland-Altman comparison:CIMV 1.29-5.52 L· min-1 · m-2,mean was (2.6 ± 0.9)L·min-1·m-2,and CIAA 2.7-8.8 L·min-1·m-2,mean was (4.9± 1.7) L·min-1 ·m-2,bias was-2.3 L·min-1 ·m-2,and limit of agreement was-5.62-1.03 L· min-1 · m-2 resulting in r =-0.577,P ＜ 0.01.Conclusion CI values obtained through the MV agrees well with that measured through the AA using TEE in patients undergoing mitral valve replacement,but CIAA values are significantly higher than CIMV values,there is a large difference between them for clinical use,and both methods for CI measurement cannot replace each other.

Objective To evaluate the clinical significance of the serum β2-microglobulin (β 2-MG) and lactic dehydrogenase (LDH) in multiple myeloma (MM) patients.Methods The serum levels of β2-MG and LDH in 63 MM patients (MM group) and 20 healthy person (control group) were measured by biochemical assay.Results The serum levels of β 2-MG and LDH in MM group were higher than those in control group[(3.81 ± 0.62) mg/L vs.(2.43 ± 0.91) mg/L and (296.4 ± 34.7) U/L vs.(145.5 ±17.8) U/L,P ＜ 0.05].Furthermore,the serum levels of β 2-MG and LDH increased gradually with MM clinical staging (P ＜0.05).After VAD chemotherapy,the serum levels of β 2-MG and LDH in clinical response MM patients(54 cases) were significantly decreased [(2.51 ± 1.36) mg/L vs.(3.57 ± 0.82) mg/L and (159.1 ± 35.2) U/L vs.(285.3 ± 87.6) U/L,P ＜ 0.05],while those in no response patients (9 cases)were unchanged (P＞ 0.05).Conclusion The serum levels of β 2-MG and LDH can be taken as a clinical index to classify the clinical phase,prognosis and effectiveness of chemotherapy in MM patients.