Taking the application of integration teaching in neurology curriculum as an example, by analyzing the Harvard Medical School , the University of Toronto School of Medicine and the Shanghai Jiaotong University School of Medicine on the course curriculum, the issues related to neurology curriculum integration has been explored. The results show that the integration of teaching mode reflects the two major characteristics of multi discipline integration, clinical and basic integration, and it emphasizes the organ system as the center, the problem based learning (problem-based learning, PBL), Problem-Based Learn-ing, Case-based Learning and other teaching methods will play an important role in the medical educa-tion reform in the important position.

Objective To explore the possibility of gelatin sponge as supporter of central nervous tissue engineering. Methods Primary NSCs were isolated from forebrain of neonatal Sprague Dawley rats and cuhured in serum-free medium for long-term survival in vitro. Neural stem cells were divided into absorbable gelatin sponge group and control group.Observe their morphology and proliferation.Immunofluorescence technique were used to test the results of differentiation of two groups of neural stem cells. Resultes NSCs in absorbable gelatin sponge group and control group survived and there was no conspicuous change in shape and quality. The rates of survival cell were 91.6％ and 92.8％ respectively, which was no significant difference between them.NSCs could adherented to the surface of the gelatin sponge and well-grown.After induced differentiation,NSCs started to shrink and stretch,axons grown and connected with each other,till form network structure.The expression of neuroglia cell marker GFAP and neuron cell marker NSE could be detected by immunofluorescence assay. Couclusion Neural stem cells and gelatin sponge can mixed and cultivating together in vitro.NSCs is no conspicuous change.It is suggested that absorbable gelatin sponge can serve as the carrier of the tissue engineering of central nervous system.

Objective To study the expressive levels of galectin-3 (gal-3) and sambucus nigra agglutinin(SNA) and to detect their clinicopathological significances in benign and malignant lesions of the gallbladder. Methods EnVisonTM Immunohistochemistry for assaying gal-3 expressive levels and ABC cytochemistry for determining SNA expressive levels were used in conventional paraffin-embedded sections from the specimens of adenocarcinoma (n = 108) , peritumoral tissues (n=46) . Adenomatous polyp (n=15), and chronic cholecystitis (n = 35). Results The positive rates of gal-3 and SNA were significantly higher in adenocarcinoma (62. 0%, 66. 7%) than in peritumoral tissues (39. 1%,45.6%), adenomatous polyp (26.7%, 33.3%) and chronic cholecystitis (11.4%, 11.4%)(P<0. 05 or P<0. 01). The positive gal-3 and SNA in benign cases showed atypical hyperplasia of the epthelium. The positive rates of gal-3 and SNA expression were significantly lower in well-differentiated adenocarcioma, mass with a maximal diameter of <2 cm, absence of lymph node metastasis,and absence of invasion to adjacent tissues than in poor-differentiated adenocarcinoma, mass with a maximal diameter of ≥2 cm, lymph node metastasis and invasion to adjacent tissues. (P<0. 05 or P<0. 01). There was a significant correlation between the expressive levels of gal-3 and SNA in gallbladder adenocarcinoma (x2=9. 51, P<0. 01). Conclusions The expressive levels of gal-3 and SNA lectins had important effects on carcinogenesis, progression and biologic behaviors of gallbladder cancer. Patients with positive gal-3 and /or SNA expressions had poor prognosis.

Objective To study the effectiveness of subfascial endoscopic communicating branch vein ablation in treating communi cating branch vein insufficiency.Methods Fifty-seven cases of primary lower ext remity vein valve insufficiency complicated by communicating vein insufficiency diagnosed by venography and color duplex were treated with subfascial endoscopic communicating branch vein ablation, and their information was analyzed retrosp ectively.Results Swelling was observed in leg of 7 cases after operation, and disappeared within one week spontaneously. Incision infec tion occurred in 2 cases and skin ambustion happened in 2 cases. Superficial vei n varicosis disappeared in all case, skin pigmentatin declined significantly and ulcers healed in 2-3 weeks.Conclusion Subfascial endoscopic communicating branch vein ablation is an excellent choice in treating communicating branch ve in insufficiency.

Objective To analyze the plasma free fatty acid (FFA) composition in patients with T2DM. Methods All subjects were from Zhongnan hospital of Wuhan university, and they were divided into three groups: normal control ( n = 94 ), T2DM ( n = 101 ) and T2DM with hyperlipidemia ( n = 77 ). Fasting blood samples were taken from the participants, and plasma FFA were separated using a modified Doles method with the bromoacetophenone, pre-column-derivative. The quantitation of FFA was performed on were (355.63 ± 100. 35) μmol/L, (421.21 ± 200. 83 ) μ mol/L, ( 473.04 ± 213.40 ) μmol/L in healthy controls, T2DM group and T2DM with hyperlipidemia group, respectively. The significant differences were observed among the 3 groups(x2 = 13.08, P <0.01 ). However, there was no significant difference of UFA concentrations among the 3 groups [(206.29± 61.94) μ mol/L, (218.11 ± 110.28) μmol/L and ( 240.94 ± 116.79 ) μmol/L, x2 = 2.17, P > 0.05]. Compared to normal control [( 355.63 ± 100.35 )μmol/L], the FFA concentration[(421.21 ±200.83) μmol/L] in T2DM has significantly increased (x2 =FFA concentrations were higher in T2DM with hyperlipidemia [(473.04 ±213.40) μmol/L] (x2 =27.93,P <0.01 ). The RSD values for intra- and inter-day precision were less than 5%, and the minimal detection limits ranged from 0.05 μmol/L to 0.35 μmol/L The recoveries of high, intermediate and low-level materials were 96.4% -104.8%. Conclusions The total FFA concentration in T2DM has increased, most of which are saturated FFA. The unsaturated FFA has not significantly increased. They seem to be related to the development of T2DM, and might be a new biomarker for clinical monitoring of metabolic disorder of T2DM.

Biopsy, Needle ; methods ; Bronchoscopy ; Child ; Humans ; Pediatrics ; methods

Objective To investigate the distribution and change in antimicrobial resistance of pathogens causing blood-stream infection,so as to provide reference for rational antimicrobial use.Methods The isolation and antimicrobial resistance of major pathogens from blood culture specimens from a tertiary first-class hospital in 2012-2015 were analyzed statistically.Results A total of 4 780 isolates were detected,the top five species were Escherichia coli (n = 1 008, 21.09%),Klebsiella pneumoniae (n = 624,13.05%),Acinetobacter baumannii (n = 452,9.46%),Staphylococcus aureus (n=437,9.14%),and Pseudomonas aeruginosa (n=247,5.17%).The percentage of gram-negative bacilli, gram-positive cocci,fungi,and others were 62.05%,29.31%,7.76%,and 0.88% respectively.The resistance rates of Klebsiella pneumoniae to ertapenem and imipenem increased from 4.50% in 2012 to 46.79% and 33.94% in 2015(both P<0.01).The resistance rates of Acinetobacter baumannii to cefepime,ceftazidime,tobramycin,gentamicin,and imipenem were 86.50%,80.56%,78.10%,79.87%,and 84.29% respectively;resistance rates to amikacin in 2012-2015 were 0, 10.22%,39.85%,and 21.30% respectively(P<0.01);resistance rates to minocycline in four years were 0-7.52% (P<0.01 ).Conclusion The main pathogens causing bloodstream infection are gram-negative bacilli,Acinetobacter baumannii is highly resistant to cephalosporins and carbapenems,resistance rates of Klebsiella pneumoniae to carbapenems increased rapidly.Broad-spectrum antimicrobial agents must be used cautiously to reduce the selective pressure of antimicrobial agents.

Objective To explore the clinical characteristics of IgG4-related disease (IgG4-RD) in Chinese by detailed clinicopathological and laboratory assessments.Methods The baseline features of 36 patients with biopsy-proven disease were reviewed.The diagnosis was confirmed by pathology review according to consensus diagnostic criteria and clinicopathologic correlation.Disease activity and damage were assessed by the IgG4-RD responder index (RI).Results Thirty (83.3％) of the patients were male,while six were female,and the average age of onset was 65.1 years.All of the 36 patients had active disease,in which submandibular gland,lymph nodes,retroperitoneal tissue were the most common affected organs in this group of patients.Among 36 patients,77.7％ had elevated serum IgG4 concentrations and 44.4％ had hypocomplementemia.Patients with elevated serum IgG4 had a higher RI,a greater number of organs involved (P ＜ 0.01 for all comparisons).The correlation between serum IgG4 level and RI (r=0.737,P ＜ 0.01) was stronger than IgG,ESR,CRP and serum complement levels.The incidence of hypocomplementemia in IgG4-RD patients with renal involvement was higher than that in IgG4-RD patients with other organs involvement (P ＜ 0.01).Twenty-eight patients received glucocorticoids therapy,and had lower RI and serum IgG4 concentration after therapy (P ＜ 0.05).Conclusions Both IgG4-RD RI and IgG4 concentration may be regarded as assessment markers of disease activity and therapeutic effect of IgG4-RD.The diagnosis of IgG4-RD should be supported by histopathology and clinical features.

Objective To explore the effect of repetitive transcranial magnetic stimulation(rTMS) treatment on the brain derived neurotrophic factor(BDNF) serum levels in depressive patients.Methods Sixty-eight unipolar depressions treated with venlafaxine were randomly assigned to the real rTMS group(n =34)and the sham rTMS group(n =34),which were accepted the real or the shame rTMS treatment on the left dorsolateral prefrontal lobes respectively.The Hamilton Rating Scale for Depression (HAMD) and BDNF serum was assayed before and after 4 weeks' treatment.Results 1) A significant increase of serum BDNF((12.2 ± 1.3) μg/L vs (5.6 ± 0.8) μg/L,t=-9.167,P=0.000;(11.4 ± 1.5)μg/L vs (6.0± 1.0)μg/L,t=-7.421,P=0.000)and a significant decline of HAMD((11.6 ± 1.7) score vs (32.6 ± 2.5) score,t =14.654,P =0.000 ; (4.2 ± 2.8) score vs (31.8 ± 3.2)score,t=12.089,P =0.000) were found after the treatment in the real and the shame group,and the real group changed more significantly than the shame group ((6.7 ± 0.8) μg/L vs (5.1 ± l.2) μg/L,t =2.690,P =0.009 ; (21.0 ± 2.1) score vs (17.6 ± 2.6) score,t =2.693,P =0.000).2) A negative correlation was found between the serum BDNF levels and the HAM D scores before the treatment(r =-0.530,P=0.003; r =-0.490,P =0.004),and a positive correlation between changes of BDNF levels and HAMD scores changes(r =0.439,P =0.006 ; r =0.454,P =0.005).Conclusion The rTMS treatment can increase serum BDNF levels in depressive patients.

Objective To analyze the characteristics of the genotype, phenotype, and follow-up of Gitelman's syndrome (GS) in the largest group of Chinese patients. Methods Sixty seven patients with GS underwent SLC12A3 gene analysis. Clinical characteristics and biochemical findings at the first presentation as well as follow-up were reviewed. Additionally, the associations of genotypes and phenotypes were explored. Results Forty-one different SLC12A3 mutations were identified in 67 patients with GS, including 11 novel ones, and 5 recurrent ones. 3 families (5. 7% ) had triple SLC12A3 mutations. Typical hypocalciuria and hypomagnesemia were not found in 6(9% ) and 8 (11. 9% )patients, respectively. In addition, male patients had an earlier age of onset and a higher urinary fraction excretion of electrolytes. 2 patients presented with chronic kidney disease, 13 (19. 4% ) with type 2 diabetes, 14 (20. 9% )with impaired glucose tolerance, and 5(7. 5% ) with impaired fasting glucose. Conclusion This study revealed 41 mutations in 67 Chinese patients with GS, including 11 novel variants and 5 high-frequency ones. Fraction excretion of electrolyte in urine may be more sensitive in the evaluation of phenotype compared with those of blood. It is difficult to correct hypokalemia and hypomagnesemia in GS. Patients with GS are at higher risk of the development of diabetes than ordinary people.