To analyze the problems in teaching regulation of gene expression in biochemistry and investigate the teaching method which can improve the teaching of the contents.

Introduction Leprosy is a chronic granulomatous infection caused by Mycobacterium leprae. Drug treatment is effective in eradicating the bacilli but does not prevent lepra reaction. Despite much attention being focused on the problem of lepra reactions, very limited data has been published on the epidemiology of lepra reactions especially this part of the world. The aim of the study is to improve the understanding of lepra reaction and to determine the demographics and clinical patterns of lepra reactions in Penang General Hospital. Materials and Methods This retrospective study covers a 10-year period from 1997 to 2006. Demographic characteristic and clinical patterns of lepra reactions were analysed with SPSS 13.0 version. Results Of the 95 patients who were enrolled in the study, 67 (70.5%) were male and 28 (29.5%) were females. The mean age at presentation was 40.4 ± 17.9 years (range 3-91 years). There were 35 Malays (36.8%), 34 Chinese (35.8%), 5 Indians (5.2%) and 21 foreigners (22.2%). 35.8% of patients presented with LL (n=34), 18.9% BT (n=18), 17.9% TT (n=17), 13.7% BB (n=13) and 13.7% BL (n=13). In our series, the lepra reaction rate among leprosy patient was 51.6% (n=49). Among those with lepra reaction, 53.1% cases were type 1 reaction (n=26), 44.9% cases were type 2 reaction (n=22) and 2.0% cases were Lucio phenomenon (n=1). Common manifestations observed in lepra reaction were worsening of skin lesions (100%), inflammatory oedema of hands, feet and face (53.1%), nerve pain (46.9%), fever (20.8%) and nerve tenderness (20.4%). Only 4 cases had involvement of other organs like the eye and joint. 30.6% of the reactions observed in our cohort were severe. Type 1 reaction commonly involved those in borderline spectrum whereas type 2 reaction commonly involved those in the lepromatous spectrum. Lepra reactions occurred before treatment (24.5%), during treatment (71.4%) or even after treatment has been stopped (4.1%). Most of the lepra reactions occurred during the treatment period especially the first 12 months of therapy. Conclusion Our study showed a more severe and higher reaction rate compared to other studies. Lepra reaction is a common presentation of leprosy. Type 1 reaction commonly involved those with borderline disease but type 2 reaction commonly involved those with lepromatous spectrum of disease. Lepra reaction occurred before, during and even after the treatment has stopped. Most of the lepra reactions occurred during treatment period especially the first 12 months of therapy.

ObjectiveTo assess the relationship between central obesity and metabolic syndrome (MS) in community population.MethodsOne thousand and fifty-three individuals aged≥18 (mean,45.6),including 542 men and 511 women,were recruited for questionnaire survey and medical exarmnation from 4 communities of Hangzhou during March and November 2007.Their blood pressure,waist circumference,serum glucose,lipid profile,and other biochemical markers were measured.All data were used for variance analysis.ResultsThe prevalence of MS,central obesity,hypertension,and diabetes mellitus (DM) was 11.2%,23.6%,30.5%,and 8.5%,respectlvely.The prevalence of MS,DM,and hypertension was increased with waist circumference(P<0.05).Waist circumference was positively correlated to body mass index (BMI).systolic blood pressure(SBP),diastolic blood pressure(DSP),fasting blood sugar,total cholesterol,and triglyceride (r=0.812,0.649,0.712,0.657,0.598,and 0.676,respectively),although negativelv with high-density lipoprotein cholesterol(r=-0.578).Waist circumference also showed positive rclationship with the number of lipid metabolism abnormity(r=0.658,P<0.01).CondusionFor Hangzhou community population.central obesity might be one of the risk factors of MS.

Background Leprosy is a chronic granulomatous infection caused by Mycobacterium leprae. The principal manifestations are skin lesions and peripheral neuropathy. The aims of the study is to improve the understanding of leprosy cases managed in Penang General Hospital and to analyse the demographics, clinical patterns, treatment regimen and outcome of leprosy in Penang Hospital. Materials and Methods This retrospective study covered a 10-year period from 1997 to 2006. Demographic characteristics, clinical patterns, treatment regimen of leprosy and outcome were analysed. Results A total of 95 patients were diagnosed to have leprosy (prevalence rate of 0.68 per 100,000). The mean age at presentation was 40.4 years ± 17.9 (range from 3 to 91 years old). There were 35 Malays (36.8%), 34 Chinese (35.8%), 5 Indians (5.2%) and 21 others. Patients experienced symptoms for a mean of 21.4 months before being referred to our clinic. Only 29 patients (30.5%) had a family history of leprosy. 34 patients (35.8%) presented with lepromatous leprosy. 95 patients (100%) presented with skin lesions, 61 patients (61.2%) with nerve lesions, 17 patients (17.9%) with deformities and 12 (12.6%) with reactions. The skin lesions occurred predominantly over the lower limbs, face and trunk. 95.8% of skin lesions were hypo/anaesthetic. Common thickened nerves observed were ulnar nerve (40.0%), great auricular nerve (38.9%) and posterior tibialis nerve (25.3%). The lepra reaction rate was 51.6%. Type 1 reaction commonly involved those with borderline spectrum but type 2 reaction commonly involved those with lepromatous spectrum. Common side effects observed with MDT were dapsone induced hemolytic anaemia (10.5%), cutaneous adverse drug reaction (8.4%) and drug induced hepatitis (2.1%). None of them experienced severe drug toxicity. In terms of treatment for leprosy, 71.6% of patients had completed their treatment and 18.9% were still on treatment. 24.1% of patients had their regimen changed because of side effects and drug resistance. 6 patients died (due to unrelated cause) and another 3 patients defaulted treatment. Conclusions Our study showed similar epidemiological findings as other studies except for a higher reaction rate. There was a significant delay in diagnosis in our cohort. Identification of the reasons of delay in diagnosis, and the risk factors of lepra reaction are important in the management of leprosy. Anti-leprotic treatment is relatively safe and effective in treating leprosy.

Objective To present the experience of surgical treatment of 12 patients with advanced carcinoma of esophagus involving aorta. Methods Resection of esophageal carcinoma and cervical esophago-gastrostomy or supraaortic esophago-gastrostomy were done in 12 patients. In all 12 patients, the resection of limited aortic adventitia was performed in 2 patients, excision of aorta and simple suture in 2 patients and aortoplasty with Gore-Tex patch in 7 patients, the resected segment was replaced with artificial vessel in 1 patient. Results Complete recovery was achieved in 2 weeks in 12 patients, without severe complications such as aortic fistula. Conclusion Surgical treatment expands the operative indications for patients suffering from esophageal carcinoma involving aorta and improves their life quality.

Objective To summarize and evaluate the clinical feature and misdiagnosis of pulmonary granulomatosis with polyangitis (GPA).Methods The clinical data of 47 patients of pulmonary GPA were analyzed retrospectively.The clinical feature and misdiagnosis were summarized.Results These patients were most commonly misdiagnosed as pulmonary infectious disease (61.8％,34/55) and pulmonary malignancy (27.3％,15/55) was the next in line.70.2％(33/47) patients had nose and sinus involvement,40.4％(19/47) patients had kidney involvement,25.5％ (12/47) patients had rash,19.1％(9/47) patients had eyes involvement,6.4％ (3/47) patients had peripheral neuritis,6.4％ (3/47) patients had gastrointestinal bleeding,4.3％(2/47) patients had pericardial effusion,87.2％(41/47) patients had positive for antineutrophil cytoplasmic(cANCA),76.6％(36/47) patients had positive for proteinase-3.Conclusions Almost all pulmonary GPA patients have extra-pulmonary multi-systemic involvement.They are often misdiagnosed as pulmonary infectious diseases and malignancy.Educating doctors on GPA constantly and screening possible patients with cANCA testing may help reduce the misdiagnosis.

Objective To investigate the value of vessel size index(VSI) in grading oligodendroglioma by vessel size imaging technique. Methods Twenty-four histologically confirmed oligodendroglioma cases were enrolled (13 gradeⅡand 11 gradeⅢ) . All patients underwent conventional MRI scanning, followed by multi gradient-echo spin-echo sequence from dynamic susceptibility contrast perfusion to generate VSI maps. Region of interests were contoured on VSI color maps to obtain hot-spot value of mean VSI of microvasculature (VSImean) and maximum VSI of microvasculature (VSImax). Paraffin sections of each case was stained with CD34 to acquire microvascular caliber (VShis). Pearson correlation analysis was used to evaluate the correlation between VSImean, VSImax and VShis respectively. Mann-Whitney U test was used to compare VSImean, VSImax and VShis between grade Ⅱ and Ⅲ oligodendrogliomas. ROC analysis was performed to assess the effectiveness of VSImean, VSImax and VShis in grading oligodendrogliomas. Results Both VSImean and VSImax were strongly correlated with VShis (r=0.738, 0.705,P<0.05). For gradeⅡand Ⅲ oligodendrogliomas, VSImean were 38.93(17.96 to 81.18)μm and 91.49(36.94 to 144.68)μm, VSImax were 45.12(22.30 to 89.65)μm and 121.19(57.29 to 164.00)μm, VShis were 8.51(5.25 to 12.76)μm and 11.03(7.59 to 21.96)μm respectively. VSImean, VSImax, and VShis showed significant difference (Z=-3.505,-3.911, -2.729,P<0.05) between grade Ⅱ and Ⅲ oligodendrogliomas. ROC analysis revealed that the optimal cutoff value, sensitivity, specificity and AUC of VSImean was 52.58 μm, 90.91%, 92.31%, 0.923 respectively, 81.18μm, 90.91%, 100.00%, 0.972 for VSImax, and 9.01μm, 90.00%, 84.62%, 0.838 for VShis respectively. Conclusions Vessel size imaging derived VSI correlated well with histopathology. It could provide valuable information in the pre-operative grading of oligodendroglioma.

Objective To investigate the effects of 4 °C hypertonic saline (HTS) on S100 protein in serum and brain tissues of rats after cardiac arrest (SCA). Method Thirty SD male rats were randomly divided into shame-operated group (A), NS group (B) ,4℃ NS group (C), HTS group (D) and 4℃. HTS group (E), in e-qual number ( n = 6). Drugs were given to the rats of all groups at the initiation of CPR except group A. The rat model of CA was induced by asphyxia. Over 24 hours after restoration of spontanous circulation ( ROSC), venous blood sample was drawn to detcect the concentration of serum S100 protein in each group, and the rats were sacrificed and their brain tissues were taken for comparing the expressions of S100 protein in hippocampus. One-way analysis of variance and q -test were used for comparison among groups. P < 0.05 was considered significant. Results Compared with group A, the concentration of serum S100 protein in other groups were much higher ( P < 0.01). Compared with group B,the concentrations of serum S100 protein in groups C, D and E were also much lower ( P < 0.01). Compared with groups D and E, the concentration of serum S100 protein in group C was much higher ( P < 0.01). Compared with group D, the concentration of serum S100 protein in group D was higher ( P < 0.05). Compared with group A, the expressions of S100 protein in rats brain tissues of groups B,C and D were much higher ( P < 0.01). The expression of S100 protein in brain tissue of rats in group E was also higher than that in rats of group A ( P < 0.05). Compared with group B, the expressions of S100 protein in brain tissues of rats in groups C,D and E were lower (P < 0.05 and P < 0.01). Compared with group C, the expressions of S100 protein in brain tissues of rats in groups D and E were lower (P < 0.01). Compared with group D, the expression of S100 protein in brain tissue of rats in group E was lower (P < 0.05). Conclusions After CA the 4℃ HTS can decrease serum S100 protein level and inhibit the expression of S100 protein in hippocampus, then protecting the brain tissue.

ObjectiveThe psychologic health level of college and secondaryschool students and the relevant fac- tors were investigated to scientific basis and guidance for school mental health work. MethodsStandard 1251 cases were drawn from 1% of students in colleges and middle schools of Shaanxi province. Taking 14 psychic health level indexes in SCL-90 as dependent variable and 109 indexes of psychic health back ground as in-dependent variable, multi-factor analyses have been made. Results22.6 % of students had relatively serious psychological problems. The score of SCL-90 in females was a little bit higher than that in males. The scores of students at both universities and se- nior middle schools were higher than that in junior middle schools students. The score of SCL-90 of students who came from the countryside was higher than that of city students. The score of the whole students was higher than that of the normal. The students with psychic problems showed obsession, interpersonal sensitivity, depression, anxiety, paranoia and hostility. Factor-analysis showed that influencing factors included history of positive individual risking behavior, physical conditions,grade,address, family influences, menses and sexual prombles, bad relation with others, poor self-assessment. ConclusionThe psychologic health level of the students investigated is lower than that of the whole society. The factors, which hamper psychic health of students, are biological ,psychological and social in nature.

Background Cutaneous tuberculosis (TB) is a form of extrapulmonary tuberculosis. Diagnosis of cutaneous TB is often difficult because of the diverse clinical presentations. The positive yields from cultures are often low. To describe the demographic, clinical, histopathological and bacteriological aspects of cutaneous TB. Materials and Methods This retrospective review looked at cases of cutaneous tuberculosis treated at the Respiratory and Dermatology unit, Penang Hospital from 1996 to 2007. Data were analysed with SPSS 13.0 version. Results A total of 23 cases of cutaneous tuberculosis were reviewed. The male to female ratio was 2.3 to 1. The mean age was 37.7 ± 20.7 years. There were 10 Malays, 9 Chinese, 2 Indians and 2 Indonesian. The types of cutaneous tuberculosis observed were lupus vulgaris (47.8%), tuberculides (17.5%), tuberculosis verrucosa cutis (13.0%), scrofuloderma (13.0%) and primary inoculation TB (8.7%). 43.5% of patients had systemic involvement. Mantoux tests were positive in 85.0% of cases. Skin biopsies were performed in 91.3% of patients and 71.4% of them showed classical histopathologic findings suggestive of tuberculosis. Mycobacterium tuberculosis was isolated in the culture from 28.6% of patients. Localized diseases were found more often in BCG-vaccinated individuals. Regional lymphadenopathy was noted more often in patients with disseminated disease. No correlation was found between Mantoux reactivity and the extent of disease. Conclusion Lupus vulgaris was the commonest form of cutaneous tuberculosis. Cultures were positive in only a small proportion of patients. Almost half of our patients had systemic involvement. The presence of regional lymphadenopathy often indicates disseminated disease. Patients without BCG vaccination were at higher risk of disease dissemination.