The combination of lecturing and Problem-based Learning(PBL)teaching method is adopted in medical genetis. It is conducive to the development of self-directed learning skills, team skills,and problem-solving skills.

Objective To investigate the effect of propofol or sevoflurane on the quality of neuromuscular blockade with cisatracurium during comparable depth of anesthesia in elderly patients.Methods A total of 60 patients aged over 60 years [classified as American Society of Anesthesiologists (ASA) physical status Ⅰ-Ⅱ] were selected.Patients were randomized into 2 groups:propofol group (induction of anesthesia with propofol) and sevoflurane group (induction of anesthesia with sevoflurane) (n=35,each).Neuromuscular blocking effect was monitored by muscle response to ulnar nerve stimulation.The rates of cisatracurium injection at different time points,time of loss of consciousness and the onset time of cisatracurium neuromuscular block were compared between the two groups.Results The rate of cisatracurium injection was significantly decreased at 60 minutes,90 min,120 min in sevoflurane group(29.82％,42.28％,37.15％),and the onset time of cisatracurium neuromuscular block was significantly shorter in sevoflurane group than in propofol group [(148.62±28.54)s vs (96.53±23.69)s,P＜0.05].Conclusions Compared with propofol,sevoflurane can greatly shorten the onset time of cisatracurium and enhance the effect of cisatracurium neuromuscular block with stable hemodynamics.

To investigate the clinical characteristics of hypertension in patients with primary aldosteronism (PA), 112 cases of PA confirmed by pathological examination after operation were studied retrospectively. These included 111 cases of PA with unilateral adrenal adenoma and 1 case of bilateral adrenal adenoma. Incidence of hypertension in patients with PA was 100%. 14 3%, 37 5% and 48 2% of patients were at stage 1, 2 and 3 of hypertension, respectively. No relationship between hypertension and the age or duration of hypertension and the size of tumor. Complications of hypertension were found in 31 3% of patients with PA. Stroke was found in 4 5% patients, 3 6% patients with cerebral hemorrhage and 0 9% patients with cerebral infarction. Coronary artery disease as myocardial infarction was found in 1 8% of patients. Proteinuria and renal insufficiency were found in 22 3% of patients and 2 7% of patients, respectively. Complications of hypertension were independent of the age, duration of hypertension, the size of tumor, or preoperative highest systolic pressure and diastolic pressure. 83 9% of patients had taken antihypertensive drugs before operation, and 46 5% of patients still had persistent hypertension after operation. The results suggested that the incidence of hypertension in patients with PA was extremely high, and the majority of patients were suffering from moderate and severe hypertension. Complications of hypertension were common in patients with PA. Hypertension was difficult to control by using antihypertensive drugs before operation, and still persisted after operation in some of the patients with PA.

Objective: To evaluate fracture resistance of teeth restored with inlay restorations of direct and indirect composite resin. Methods:Three dimensional finite element analysis (3D FEA) was used in present research. Two types of load were applied to investigate the change of tooth fracture resistance after restored with MOD inlay. Group 1,2,3,and 4 were restored with four kinds of materials:group 1,indirect composite resin inlay( Tescera, Bisco USA);group 2, direct composite inlay(Renew Bisco USA);group 3,ceramic; and group 4, Co-Cr alloy. Defect tooth or intact one was served as the control group. Results:Tooth fracture resistance in group 1,2,3 and 4 were improved, Fracture resistance in group 1 and 2 were similar to intact tooth group, while the fracture resistance in group 3 and 4 was different effect when compared to intact tooth. Conclusion: Both direct and indirect composite resin inlay could strengthen fracture resistance of restored teeth. No obvious difference between direct and indirect composite resin on tooth resistance was found.

Objective To discuss the indication,technique,effect,and safety of colonoscopic resection of colorectal submucosal tumor(SMT).Methods A total of 33 patients with SMT,which was diagnosed colonoscopically and pathologically,were treated by endoscopy.The sizes of the tumors were 0.2-2.2 cm in diameter,and 0.2-1.2 cm in the diameter of the roots.After injecting adequate adrenalin saline deeply into the root of SMT,the mass of those,who had negative nonlifting sign,was attracted,snared,and then cut using high frequency electrotome.In 7 cases of smaller SMT,the tumor was gripped.Results No perforation,large amount of hemorrhage,or burns of the colorectal wall was found.Complete resection was achieved(no tumor tissue was detected on the edge or bottom of the SMTs after endoscopic resection,or pathological examination found no tumor tissue after open surgery) in 29 cases,including 18 carcinoids,6 leiomyomas,2 hamartomas,2 lipomas,and 1 neurofibroma.Except 3 patients with leiomyoma were lost,26 of the patients were followed up for a median of 44.5 months(3 months to 12 years and 7 months).No recurrence was found during the follow-up.The 4 carcinoids were resected partially(there were tumor tissues remained on the edge or bottom of the SMTs after endoscopic resection,or the pathological examination after open surgery showed tumors).Two of the 4 were transferred to open surgery(one was followed up for 2 years and 3 months,the other was lost).The other two patients refused operation and received a followed-up of 5 months and 2 years and 4 month respectively.None of the 4 patients had recurrence during follow-up.Conclusions Colonoscopic treatment can be applied to the patients with SMT sized ≤1.2 cm at the root and negative nonlifting sign.The method is safe,effective,and minimal invasion.Pathological examination is recommended after the colonoscopic resection,open surgery is necessary for the partially resected SMTs.

Objective To resolve the problem of low speed and high failure rate of SMS.Methods The SMS module was separated,and the appointment registration system and SMS device were taken apart.Results The separate SMS platform for appointment registration system was established.Conclusion The response speed of the appointment registration system is enhanced greatly.

Objective To study the clinical therapeutic effect of Yifumin Capsule in treating type 2 diabetic insulin resistance and its effect on relevance indexes.Methods Two hundred and forty cases of type 2 diabetic insulin resistance with deficiency of qi-yin and stagnation of phlegm and toxin were divided randomly into two groups,120 cases in each group.The treatment group was given orally Yifumin Capsule,and the control group was given orally pioglitazone.The treatment course of the two groups was 12 weeks.Clinical symptoms,blood glucose,blood lipid,CRP,ISI,FINS,HOMA-IR,liver and kidney function were detected respectively.Results Chinese medicine symptoms and signs were all improved.The total effective rate of clinical effect was 88.1% in treatment group and 52.9% in control group.The clinical therapeutic effect of the treatment group was obviously better than the control group.Both groups had a notable seducement in HOMA-IR,FINS,FPG,2 h PG,HbA1c,TG and LDL-C with an obviously improvement in ISI after the treatment.Compared with the control group,the treatment group had a significant decrease in TC and CRP with notable difference.Conclusion Yifumin Capsule can effectively improve the insulin resistance of type 2 diabetic patients.

Objective To observe the clinical efficacy of hydroxyfasudil in senile heart failure caused by coronary heart disease (CHD). Methods 110 Patients with heart failure caused by CHD were randomly divided into two groups. 55 patients in control group were given conventional treatment, whereas the remaining patients were assigned into hydroxyfasudil group in the base of conventional treatment. After 6 months, we observed and compared the changes in cardiac function of the two groups. Results The effective rate of treatment group was 96.36% and the control group was 85.45%. There was statistical difference between the two groups (P < 0.05). Then we compared the degree of improvement of left ventricular diastolic function using ultrasonic cardiogram and Tei index. Left ventricular ejection fraction of treatment group improved significantly but biochemical indicators of two groups had no statistical difference. Conclusion In patients with heart failure caused by CHD, supplementation of hydroxyfasudil based on conventional therapy could improve diastolic function , potentiate left ventricular remodeling and enhance the life quality. Furthermore, it′s more sensitivity and reasonable to assess cardiac function using Tei index as compared with using ultrasonic cardiogram.

s: Recently, following the development of basic experimental research, great progress has been acquired in the fields of the understanding and management of the acute coronary syndromes (ACS). This review summarizes the molecular and cellular bases, the management of the unstable plaque, risk stratification and the management of ACS.