Smart classroom as the basis support of classroom teaching, should set the function of smart teaching, real-time interaction, environmental control, video monitoring and remote control, teaching reform, evaluation feedback and other functions into an organic whole, and by using new technology integration and development, to achieve the optimization of the teaching effect. In view of the characteristics of practice and complexity of medical teaching, The spatial structure of smart class-room should provide long-distance education, remote operation, live classroom group discussion, group exhibition, HD recording, classroom attendance voting and other functions, and by choosing the appro-priate teaching mode in teaching to promote the innovation and development of medical teaching.

Objective To observe the effects of long term injection sodium salicylate on the auditory brain-stem response(ABR)and expression of glutamic acid decarboxylase -67(GAD67) in rat inferior colliculus .Methods Eighteen healthy Wistar rats were randomly divided into three groups :the sodium salicylate group (intramuscular injection of 10% sodium salicylate ,175 mg/kg ,twice daliy for 28 days) ,the saline group (intramuscular injection with saline on same does at the same time) ,the control group (without any treatment) .The rats received ABR after modeling ,then were decapitated and inferior colliculus tissues were stripped .Western blot was used to study the dif-ferent expression of GAD67 protein levels in the three groups .Results Compared with the saline group and control group ,ABR thresholds of the sodium salicylate group were significantly elevated and latency of wave Ⅲ was aslo sig-nificantly prolonged(P<0 .01) ,while there was no significant difference between the saline group and the control group(P>0 .05) .The inferior colliculus GAD67 protein expression level of sodium salicylate group was significantly higher than the saline group and control group(P<0 .01) ,while there was no significant difference between the saline group and the control group(P>0 .05) .Conclusion Long term injection of sodium salicylate can cause a change in the inferior colliculus of GAD67 protein expression and the up regulation of GAD67 expression may occur as a com-pensatory response to increase inhibiting effect .The change of GAD67 protein expression is likely as a compensatory and regulatory mechanisms for sodium salicylate ototoxicity .

Objective To study changes of auditory brainstem evoked potentials (ABR)and the expression of glial fibrillary acidic protein (GFAP)during the critical period of the development of the auditory cortex in rats. Methods Fifty Sprague - Dawley (SD)rat pups were divided into five groups(n=10 per group):postnatal 14 days group,postnatal 21 days group,postnatal 28 days group,postnatal 35 days group and postnatal 42 days group.The rats were decapitated after the evaluation of ABR.The auditory cortex was taken and immunohisto-chemical staining was used to detect the expression of GFAP in rat auditory cortex in each group.The protein ex-pressions of GFAP in rat auditory cortex in each group were tested by western blot methods respectively.ResuIts The ABR thresholds gradually decreased along with the increasing days after the birth.The average ABR thresholds in postnatal 14 days group,postnatal 21 days group,postnatal 28 days group,postnatal 35 days group and postnatal 42 days group were (84.5 ± 4.97)dB SPL ,(70.5±3.69)dB SPL ,(58.5±5.80)dB SPL,(37.0±4.83)dB SPL and(35.5±3.69)dB SPL,respectively.There were no significant differences in ABR thresholds between the postnatal 35 days group and the postnatal 42 days group (P>0.05),whereas,significant differences were found among the other groups(P<0.05 or P<0.01.GFAP expression in auditory cortex gradually increased in all five groups.The average integrated optical density (IOD)of postnatal 14 days group,postnatal 21 days group,postnatal 28 days group,postnatal 35 days group and postnatal 42 days group were 474.36±234.56,1465.93 ±474.96,2163.06 ± 353.36,6572.01±808.88 and 7244.37±932.90,respectively.The differences among all five groups were statisti-cally significant (P<0.05 orP<0.01 ).The protein levels of GFAP in the auditory cortex of postnatal 14 days group,postnatal 21 days group,postnatal 28 days group,postnatal 35 days group and postnatal 42 days group were 1.00±0.06,3.07±0.07,4.92±0.05,6.88±0.03 and 8.92±0.04.The differences among all five groups were sta-tistically significant (P<0.05).ConcIusion The ABR threshold gradually decreased and GFAP expression in audi-tory cortex gradually increased from postnatal 14 days to postnatal 42 days ,suggesting that astrocytes may promote the development and maturation of the auditory cortex and the auditory central system in rats.

Objective To study the expression of TrkB and c-fos in rat auditory cortex after long -term ad‐ministration of sodium salicylate and the mechanisms of salicylate ototoxiclty .Methods Normal adult rats were di‐vided into three groups :normal group without any treatment ,long -term treatment group given i .m .injections , 175 mg/kg ,twice daily at 9:00 am and 6 :00 pm for consecutive 14 days and the recovered group using the same method as the chronic group except that they were sacrificed 28 days after salicylate treatment ceased .After the de‐tection of ABR ,rats were sacrificed after deep anesthesia ,and the auditory cortexes were dissected rapidly .Real-time PCR and Western-blot were explored to detect the expression of TrkB and c-fos .Results The average ABR threshold of normal rats was 36 ± 2 .23 dB SPL .The average ABR threshold of long -term group was 41 .3 ± 3 .31 dB SPL ,which was significantly increased than normal group(P<0 .01) .The average ABR threshold of the recoveredgroup was 38 .6 ± 5 .51 dB SPL .There were no differences between the recovered group and normal group(P>0 . 05) .The expression of c-fos mRNA(1 .24 ± 0 .09)and protein(0 .70 ± 0 .12)in the long -term group were signifi‐cantly increased ,when compared with the normal group .The c-fos mRNA(1 .23 ± 0 .04)and protein(0 .68 ± 0 .08) expression in the recovered group were also significantly increased compared with the normal group .The expression of TrkB mRNA(1 .26 ± 0 .10)and protein(1 .85 ± 0 .17)in the long -term group were significantly increased ,when compared with the normal group .The TrkB mRNA(1 .23 ± 0 .07)and protein(1 .80 ± 0 .08)expression in the recov‐ered group were also significantly increased compared with the normal group .Conclusion The inereased expression of c-fos in the long -term group may be related to the enhancement of central auditory function .The inereased ex‐pression of Trk-B in the long -term group might be involved in instability of synaptic plasticity in tinnitus .

The prognostic value of phosphatidylinositol-4,5-bisphosphate 3-kinase,catalytic subunit alpha (PIK3CA) in patients with esophageal squamous cell carcinoma (ESCC) is controversial.We aimed to investigate the prognostic significance of PIK3CA mutation in patients with ESCC.EMBASE,PubMed,and Web of Science databases were systematically searched from inception through Oct.3,2016.The hazard ratios (HRs) and 95％ confidence intervals (CI) were calculated using a random effects model for overall survival (OS) and disease-free survival (DFS).Seven studies enrolling 1505 patients were eligible for inclusion of the current meta-analysis.Results revealed that PIK3CA mutation was not significantly associated with OS (HR:0.90,95％ CI:0.63-1.30,P=0.591),with a significant heterogeneity (I2=65.7％,P=0.012).Additionally,subgroup analyses were further conducted according to various variables,such as types of specimen,the sample size,technique and statistical methodology.All results suggested that no significant relationship was found between PIK3CA mutation and OS in patients with ESCC.For DFS,there was no significant association between PIK3CA mutation and DFS in patients with ESCC (HR:1.00,95％ CI=0.47-2.11,P=0.993,I2=73.7％).Publication bias was not present and the results of sensitivity analysis were very stable in the current meta-analysis.Our findings suggest that PIK3CA mutation has no significant effects on OS and DFS in ESCC patients.More well-designed prospective studies with better methodology for PIK3CA assessment are required to clarify the prognostic significance of PIK3CA mutation in ESCC patients.

OBJECTIVETo investigate the effects of fluoride on activities of tartrate-resistant acid phosphate (TRAP) and matrix metalloproteinase-9 (MMP-9) in rat osteoclasts cultured in vitro.

METHODSOsteoclast was isolated mechanically from long bones of neonatal rats and cultured in vitro. Histochemical stain was applied to detect the effects of fluoride on activities of TRAP and in-situ hybridization was used to study the expression of MMP-9 mRNA in rat osteoclasts in vitro.

RESULTSNumber of TRAP positive cells was 154.2, 160.0, 170.6, 179.0 and 180.0 per cm(2), respectively for the rats with varied doses of fluoride, in a dose-response pattern but without statistical significance. The expression of MMP-9 mRNA increased with elevating dose of fluoride, especially in the rats with 1.00, 2.00 and 4.00 mg/L of fluoride, to 94.50, 94.64 and 104.97, respectively, significantly different from those in control group.

CONCLUSIONSFluoride can enhance the MMP-9 mRNA expression in cultured osteoclasts of rats.

Acid Phosphatase ; metabolism ; Animals ; Animals, Newborn ; Biomarkers ; Cells, Cultured ; Dose-Response Relationship, Drug ; Fluorides ; pharmacology ; Isoenzymes ; metabolism ; Matrix Metalloproteinase 9 ; biosynthesis ; genetics ; Osteoclasts ; cytology ; drug effects ; enzymology ; RNA, Messenger ; biosynthesis ; genetics ; Rats ; Rats, Wistar ; Tartrate-Resistant Acid Phosphatase

Objective:To investigate the current situation of insomnia in patients with acute coronary syndrome (ACS), and analyze the influencing factors of insomnia in the ACS patients, so as to provide information on the development of new strategies for the treatment of insomnia in ACS patients.Methods:This is a multicenter and prospective observational study. A total of 771 ACS patients who met the criteria were selected from March 2013 to June 2015. The baseline social demographic information, sleep quality questionnaire, general anxiety disorder scale-7(GAD-7),patient health questionnaire-9(PHQ-9), short-form 12 health survey questionnaire(SF-12), and enhancing recovery in coronary heart disease patients social inventory(ESSI) were completed within 7 days after admission. Logistic regression analyses were used to analyze the influencing factors of insomnia in ACS patients.Results:A total of 741 subjects with valid questionnaires were collected, including 510 males (68.8%) and 231 females (31.2%). Among them, 487 (65.7%) subjects had at least one insomnia symptom: 308 (41.6%) subjects had difficulty in falling asleep, 369 (49.8%) subjects were easy to wake at night, 116 (15.7%) subjects woke up earlier than they expected, 74 (10.0%) subjects experienced both woke up earlier and difficulty in falling asleep, and 53 (7.2%) subjects woke up earlier, woke up at night and had difficulty in falling asleep at the same time. Logistic regression analyses showed that before admission physical activity ( OR =0.636, 95% CI 0.411-0.984), depression ( OR=1.908, 95% CI 1.101-3.305) and low social support ( OR=0.278, 95% CI 1.198-3.301) were independent factors of insomnia in ACS patients. Conclusions:Nearly 2/3 ACS patients have symptoms of insomnia. Difficulty in falling asleep and easy to wake up at night are the most common manifestations. Physical activity, depression and social support independently are associated with insomnia.

Modern Chinese medicine studies have confirmed that the interaction between traditional Chinese medicine(TCM)and intestinal flora is the key to the treatment of diseases with tradi-tional Chinese medicine.This interplay includes such activities as:traditional Chinese medicine can be metabolized by intestinal flora into effective components with different biological activities from its precursors;TCM chemicals improve the composition of gut microbiota,consequently ameliorating its dysfunction as well as associated pathological conditions;and gut microbiota mediate the interactions between the multiple chemicals in TCM.There-fore,it becomes an important way to understand the modern sci-entific connotation of traditional Chinese medicine theory to study the pharmacological mechanism of the efficacy of traditional Chi-nese medicine by targeting Gut microbiota.

OBJECTIVETo investigate a patient featuring a complex neuromuscular disease phenotype.

METHODSA comprehensive analysis integrating clinical investigation, electrophysiological testing, pathological analysis and mutation screening was carried out.

RESULTSThe patient has presented clinical and pathological manifestations mimicking Duchenne muscular dystrophy. However, genetic analysis has identified no deletion in 21 exons of Dystrophin gene, no pathologic expansion of CTG repeats in DMPK gene or CCTG repeats in ZFN9 gene. Instead, a homozygous deletion of exons 7 and 8 in SMN gene was discovered.

CONCLUSIONA rare case of spinal muscular atrophy (SMA) was verified by genetic diagnosis. SMA is a group of neuromuscular disorders with great phenotypic heterogeneity and sometimes cannot be diagnosed by clinical manifestations, electrophysiological and pathological changes alone. Genetic diagnosis has become indispensable for accurate diagnosis for patients suspected to have the disease.

Adult ; Diagnosis, Differential ; Humans ; Male ; Muscular Atrophy, Spinal ; diagnosis ; genetics ; pathology ; Myotonic Dystrophy ; diagnosis ; genetics ; pathology ; Myotonin-Protein Kinase ; Phenotype ; Protein-Serine-Threonine Kinases ; genetics ; SMN Complex Proteins ; genetics ; Young Adult

OBJECTIVETo study the clinical effects of Achillon for the treatment of acute Achilles tendon rupture (AATR).

METHODSFrom April 2009 to April 2010, 19 patients with AATR who were treated with Achillon were retrospectively analyzed. There were 17 males and 2 females, with an average age of 40.2 years (30 to 58 years). There were 9 cases of sports injury, and 2 case of fall injury. The time from injury to surgery ranged from 0 to 8 days (2.2 days on average). The results of Thompson test and single heel rise test were positive in 19 cases. Clinical data were assessed with the patient satisfaction and the AOFAS hindfoot score during follow-up.

RESULTSAll the patients were followed up, and the duration ranged from 12 to 28 months (19.9 months on average). The average operation time was 41 minutes. There were no wound infections, recurrent rupture, or sural nerve complications. At the latest follow-up, 18 patients were totally satisfied with the surgical result, 1 patient feel generally due to mild pain when running. None of the patients were dissatisfied with the final results the latest follow-up. At the latest follow-up, the AOFAS score was 98.42 +/- 3.29 (89 to 100). All the patients regained normal range of motion and were able to resume their previous activities at six months after operation, with a high rate of satisfaction. Average decreased of mid-calf circumference was (0.82 +/- 0.85) cm (ranged from 0 to 3 cm).

CONCLUSIONTreatment with Achillon is safe, effective for AATR with low incidence of complications and early active rehabilitation can be carried out. It is a good method to treat AATR.

Achilles Tendon ; injuries ; surgery ; Acute Disease ; Adult ; Female ; Humans ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; instrumentation ; Retrospective Studies ; Rupture ; Suture Techniques ; instrumentation ; Tendon Injuries ; surgery