Compared with traditional medical education, distance learning on continual medical education has many unique characteristics. We analyzed the characteristics of distance learning on continual medical education from educational goal and objective, content, method and learners.

Objective To investigate the functions of blood plasma homocysteine (Hcy) and high sensitivity C-response protein (hs-CRP) in the chronic obstructive pulmonary disease (COPD) in pathogenesis plays,and observe whether there was associations with disease severity and the correlations.Methods Forty-one patients with COPD were collected from August 2010 to February 2011,and 35 healthy persons as control group.Blood plasma Hcy,hs-CRP,forced expiratory volume in one second account predicted (FEV1％ predicted),and arterial pressure of oxygen (PaO2,arterial blood gases analysis) were measured in COPD patients and controls.Results Plasma Hcy concentration was (22.07 ± 12.13) μmol/L in COPD patients,but (9.89 ±4.41) μmol/L in controls,there were significant differences between two subjects (t =1.674,P ＜0.01).COPD patients had a higher serum hs-CRP concentration (8.60±3.85) mg/L than control's (4.24 ±0.57) mg/L (t =1.682,P ＜ 0.01).Along the descent of FEV1％ predicted,plasma Hcy and hs-CRP were elevated gradually,both sides show a negative correlation (r =-0.45,-0.49,P ＜ 0.05).And plasma Hcy and hs-CRP present a positive correlation in COPD patients (r =0.68,P ＜ 0.01).Conclusion Plasma Hcy was significantly elevated in COPD patients,positive correlation related to COPD severity and positive correlation related to serum hs-CRP.

Objective To investigate the alterations of SHP-2 mRNA of thymus cells of mice with ? ray-induced leukemia. Methods BALB/c mice were randomly divided into canceration group, non-canceration group, and control group. The gene mutation and content of SHP-2 mRNA in thymus cells were detected by PCR-SSCP, DNA sequencing, and real time fluorescence quantitative PCR (FQ-PCR). Results PCR-SSCP showed there was gene mutation within 700～1 096 bp of SHP-2 mRNA in thymus cells of mice in the canceration group, which was not supported by DNA sequencing. No significant difference in change of SHP-2 mRNA content was found in thymus cells in canceration, non-canceration, and control groups. Conclusion There is translational abnormality of SHP-2 mRNA in thymus cells of mice with ? ray-induced leukemia, which is presented as translational enhancement.

Objective The purpose of this work was to compare the efficacy of narrow band imaging-assisted transurethral resection of bladder tumour (TURB) with conventional white light imagingassisted TURB in primary non-muscle-invasive bladder cancer.Methods Several databases were searched,including Cochrance Libarary,PubMed,Embase,Wanfang,VIP,CNKI and CBM.The endpoints were biochemical failure in 3 months,1 year and 2 years.We performed a meta-analysis of the published data.The results are expressed as risk ratio (RR),with the corresponding 95％ confidence interval (CI).Results The final analysis included seven trials comprising 1889 patients.Biochemical failure in 3months (RR0.73,95％ CI 0.55-0.96;P =0.02),1 year(RR 0.69,95％ CI 0.58-0.80;P ＜ 0.01) and 2 years (RR 0.58,95％ CI 0.41-0.82;P =0.002) were fewer in patients who received narrow band imagingassisted TURB.The recurrence rates of 3 months,1 year and 2 years were 14.44％,29.35％ and 30％ in white light imaging group.The recurrence rates of 3 months,1 year and 2 years were 3.61％,9.35％ and 12.59％ lower in narrow band imaging group compared with white light imaging group.Conclusions Narrow band imaging-assisted TURB was superior to conventional white light imaging-assisted TURB in primary non-muscle-invasive bladder cancer in 2 years.

BACKGROUND:There is a lack of study on material properties and parameters of foot finite element models in China. Vernier caliper is a common method for measuring the width and thickness of ligaments and tendons to calculate the cross-sectional area.
OBJECTIVE:To design a new ligament cross-sectional area measuring instrument to improve the measurement accuracy.
METHODS:The cross-sectional area of the five fresh cadaver ankle ligaments was respectively measured using the new instrument and vernier caliper, and then a comparative analysis of the two measurement methods was performend.
RESULTS AND CONCLUSION:The cross-sectional area of anterior talofibular ligament, calcaneofibular ligament, tibionavicular ligament and calcaneotibial ligament was (20.61±7.52), (22.38±11. 49), (33.09±9.91) and (28.20±10.88) mm2, respectively measured by the vernier caliper, and (17.59±4.03), (20.77±7.91), (28.08±8.14) and (30.39±7.98) mm2 by the new ligament cross-sectional area measuring instrument. These results suggest that this new measuring instrument is accurate, reliable and easy to operate, which can be used as a special instrument to measure ligament cross-sectional area, but further studies wil be necessary.

Objective To compare the changes of plasma lipid indexes and coronary artery atherosclerotic plaque in TaqI B genotypes in CHD patients with impaired glucose tolerance (IGT) before and after statin therapy. Methods A total of 196 CHD with IGT and 160 controls were included. The changes of plasma lipid indexes and coronary artery atherosclerotic plaque in TaqI B genotypes were analyzed before and after Rosovastatin therapy. Sequenom Mass ARRAY platform was used to detect the CETP TaqI B SNPs. Results The genotype frequency of the B1B1, B1B2 and B2B2 in CHD with IGT group was 35.7%, 48.0% and 16.3% respectively, while in control group was 31.3%, 53.1% and 15.6% respectively. HDL-C, PA and MLA levels increased after Rosuvastatin therapy, while LDL-C, TG, TCH, Lpa, PA, EEMA and PB levels decreased. Conclusions CETP gene polymorphisms TaqI B would have association with the effects of Rosuvastatin therapy in the CHD with IGT.

Objective To explore the method of demonstrating main operative section of facial recess approach with multi-slice CT by using double oblique muttiplanar reconstruction.MethodsSimilarly as surgical procedure of facial recess approach,30 (60 eras) normal temporal bones in cadavers were reconstructed to observe main operative sections and anatomical marks.Main images of operative section of facial recess approach were reconstructed using double oblique multiplanar reconstruction on multislice CT.With the reference of operative anatomical marks,the ratios of visibility of anatomical marks on the transverse plane,coronal plane,sagittal plane and double oblique were calculated and compared.The degree,of which major anatomical landmarks were displayed on the same plane ( axial,coronal,sagittal,or doubleoblique sagittal plane),was classified using the following criteria: level 4: 100％ of anatomical landmarks were presented in the same plane; level 3: 90％ to 99％ of anatomical landmarks were presented in the same plane; level 2: 80％ to 89％ of anatomical landmarks were presented in the same plane; level 1: 70％ to 79％ of anatomical landmarks were presented in the same plane ; level 0: ＜ 70％ of anatomical landmarks were presented in the same plane.Classification data were tested by chi-square test.Results Four key operative section were involved in facial recess approach,which were of oblique sagittal orientation.The central mark of the first key operative section was semicircular canal by using double oblique multi-planar reformation.On reconstructed images of the first key operative section,horizontal reference line was short process of incus,and the angle adjusting the reference line on the transverse plane was 22.15° ±5.22°.On the reconstructed images of the first key operative section,coronal reference line was tympanic segment of facial canal,and the angle adjusting the reference line on the coronal plane was 14.35° ± 4.02°.On the reconstructed images of the second key operative section,the central mark was fossa incudis,the horizontal reference line was short process of incus and the angle was 20.15° ± 5.52°,while the coronal reference line was tympanic segment of facial cana,and the angle was 13.15° ± 3.33°.On the reconstructed operative images of the third key section,the central mark was pyramidal eminence,the horizontal reference line was the horizontal portion of the facial nerve and the angle was 32.53° ±5.22°,while the coronal reference line was the tympanic segment of facial nerve,and the angle was 15.05° ± 4.43°.On the fourth reconstructed images of the key operative section,the central mark was the posterior border of round window,the horizontal reference line was the superior border of oval window,and the angle was 50.15° ± 8.02°,while the coronal reference line was the tympanic segment of facial nerve,and the angle was 15.25° ± 4.12°.For the four planes (double-oblique sagittal,axial,coronal,or sagittal plane),the results of the degree to which they could include the major anatomical landmarks in the same layer of the first section were: level 4 in 60 sides,level 2 in 12 sides and level 3 in 48 sides,level 2 in 15 sides and level 3 in 45 sides,level 3 in 10 sides and level 4 in 50 sides,respectively.The results of the second section were: level 4 in 60 sides,level 2 in 11 sides and level 3 in 49 sides,level 2 in 13 sides and level 3 in 47 sides,level 3 in 11 sides and level 4 in 49 sides,respectively.The results of the third section were: level 4 in 60 sides,level 2 in 10 sides and level 3 in 50 sides,level 2 in 11 sides and level 3 in 49 sides,level 3 in 9 sides and level 4 in 51 sides,respectively.The results of the fourth section were: level 4 in 60 sides,level 2 in 9 sides and level 3 in 51 sides,level 2 in 8 sides and level 3 in 52 sides,level 3 in 5 sides and level 4 in 55 sides,respectively.The four planes differed significantly in the degree to which they could include the major anatomical landmarks in the same layer ( x2 =123.3200,121.4231,122.4011,125.4213,all,P ＜ 0.05 ).The visibility ratio of every section is 100％ (60/60).Conclusion Double oblique multi-planar reformation is a new method to demonstrate landmarks of operative section of facial recess approach in one slice.The reconstructive images of operative section with double oblique multi-planer reconstruction may provide valuable information for operation.

Objective To observe the effect of integrated therapy of Chinese medicine and chemical drugs on adverse reaction and curative effect of initial treatment of secondary pulmonary tuberculosis. Methods Totally 1404 patients with secondary pulmonary tuberculosis and TCM lung consumption diagnostic criteria (syndrome of lung yin deficiency, qi-yin deficiency, yin-deficiency caused excessive fire) were chosen for single blind, randomized, controlled, multicenter clinical trials. Trial group was given 2HRZE/4HR, 1 time/day with Chinese medicine 2 or 3 times/day, and control group was given 2HRZE/4HR only for six months. The adverse reactions and clinical symptoms were observed to evaluate clinical efficacy and safety. Results In terms of reducing liver damage and other adverse reactions, the ratio of trial group had statistical difference with that of control group (P<0.001). In symptom scores of lung yin deficiency syndrome treated for 2, 4, 6 months, yin-deficiency caused excessive fire syndrome treated for 6 months, qi-yin deficiency syndrome treated for 4, 6 months, the differences between the two groups were significant (P<0.001). TCM syndrome curative effect between the two groups was statistical different (P<0.001). Safety evaluation result between the two groups was statistical different by tratified analysis (P<0.001). Conclusion Integrated therapy of Chinese medicine and chemical drugs can improve the symptoms and reduce adverse reactions caused by chemical drugs. It can enhance the curative effect and safety.

Objective To detect the level of plasma microRNA-1 (miR-1) in acute myocardial infarction (AMI) and compare the diagnostic values of it with that of cardiac troponin T (cTnT).Methods During 2011-05 to 2012-05,there were fifty-six plasma samples taken from patients with AMI and twenty-eight plasma specimens got from non-AMI controls were analyzed.The expression of plasma miR-1 was measured by quantitative reverse transcription-polymerase chain reaction (qRT-PCR),and the level of plasma cTnT was measured by using electrochemiluminescence-based methods on the Elecsys 2010 Immunoassay Analyzer.Then,the SPSS 16.0 was used for the statistical analysis.Data were presented as means ± standard deviation unless otherwise described.The differences about clinical characteristics between AMI patients and controls were tested using Student' s t-test or Fisher' s exact test.The Mann-Whitney test was conducted to compare the expression of microRNAs between the AMI patients and controls.The comparison of microRNAs expression between different intervals of AMI patients was done using Wilcoxon signed rank test.The receiver operating characteristic (ROC) curve was established to discriminate AMI patients from controls.Results The expression of plasma miR-1 was significantly increased in AMI patients (P ＜ 0.01) compared with healthy controls.The contents of the plasma miR-1 in AMI patients fell down nearly to the normal level at 14 days (P ＞ 0.05).There was no relevance between the expression of plasma miR-1 and the clinical characteristics of the study population (P ＞ 0.05).Moreover,ROC curve analyses demonstrated that miR-1 had the specificity and sensitivity for the diagnosis of early AMI,but was not superior to cTnT.Conclusions Our results showed that plasma miR-1 had the capacity in early diagnosis of early AMI,and can be biomarker for AMI,however,miR-1 is not superior to cTnT for the diagnosis of AMI.

Objective To evaluate the diagnosis and surgical treatment of parathyroid carcinoma (PTC). Methods Clinical data of 8 PTC cases were analyzed retrospectively. Results PTC accounted for 5. 7% of patients with primary hyperparathyroidism (PHPT) in our hospital. There were 4 men and 4 women. Male patients had younger mean onset age compared with female patients. The disease history of PTC was shorter than PHPT of benign causes. Six patients were admitted for acute hypercalcemia. Seven patients complained of palpable neck mass. Calcium level was 3.75?0.34 mmol/L,and PTH level was 1429.47?841.75 pg/ml. Frozen section established diagnosis in only one case. Four patients underwent radical en bloc resection. Other 4 cases received routine simple parathyroidectomy, 3 patients developed recurrence in 12 - 18 months postoperatively. Conclusions Acute hypercalcemia is common in PTC. Frozen biopsy diagnosis is not satisfactory. An initial en bloc resection of tumor and adjacent structures contributes most to the prognosis.