Objective To investigate the efficacy and safety of long guidewire exchange technique in performing cerebral angiography via radial artery approach.Methods The clinical data of 257 patients,who received cerebral angiography during the period from June 2014 to May 2016 at Daxing Hospital of Capital Medical University,Beijing,China,were retrospectively analyzed.Among the 257 patients,186 had type Ⅱ or type Ⅲ aortic arch.According to the different looping technologies for Simmons-2 catheter used in the performance of cerebral angiography,these 186 patients were divided into the study group (n=90) and the routine group (n=96).The success rate of radial artery puncturing,the success rate of Simmons-2 catheter looping formation,the success rate of supra-arch arterial catheterization,the time spent for angiography,the radiation exposure time,complications,etc.were recorded.Results The success rate of radial artery puncturing was 100％ in both groups.The success rate of Simmons-2 catheter looping formation in the study group was 97.8％,which was significantly higher than 72.9％ in the routine group (P＜0.05).The success rates of catheterization for the left subclavian artery,left common carotid artery and right carotid artery in the study group were 97.8％,97.8％ and 97.8％ respectively,which were remarkably higher than 72.9％,72.9％ and 72.9％ respectively in the routine group (P＜0.05).No statistically significant difference in the success rates of catheterization for right subclavian artery and for right vertebral artery existed between the two groups (P＞ 0.05).The time spent for angiography in the study group and the routine group was (22.5±9.4) min and (28.3±8.3) min respectively.The radiation exposure time in the study group was (8.9±4.5) min,which was obviously lower than (12.6±6.5) min in the routine group (P=0.017 and P=0.035,respectively).The incidences of complications in the study group and the routine group were 4.4％ and 5.2％ respectively,the difference was not statistically significant (P＞0.05).No severe complications,such as intracranial arterial embolie events,puncture bleeding,arterial occlusion,etc.,occurred in all patients of both groups.Conclusion The use of long guidewire exchange technology can improve the success rate of Simmon-2 catheter looping formation and the success rate of supra-arch arterial catheterization,it can also shorten the time for angiography procedure and reduce the radiation exposure time.This technique is very effective with higher safety.Therefore,this long guidewire exchange technique should be used as a common method for cerebral angiopraphy via radial artery approach in patients with type Ⅱ or type Ⅲ aortic arch.

A century ago the Flexner Report facilitated the process of modern medical education reform.Half a century ago,Problem-based learning initiated the student-centered medical education model.At present training medical students' competency will usher in the third reform in medical education.Over 100 years' development and in the global context of current medical education reform,China's medical education has become an important part of the world medical education.Harbin Medical University conducted an all-around reform through international cooperation and received the accreditation referenced according to global standards in medical education,which is an epitome of the medical education reform in China.

Objective To investigate the safety and clinical effect of combined anterior and posterior surgeries approach for the treatment of lumbosacral tuberculosis .Methods There were 31 cases of low lumbar and sacrum spinal tuberculosis in this se‐ries .All cases that anti‐tuberculosis treatment lasted 3 weeks before the operation received posterior transpedicular screw system in‐ternal fixation ,anterior radical focus debridement and auto‐grafting with iliac bone .Bed rest was for 6-12 weeks after surgery and no brace was needed .Anti‐tuberculosis treatment lasted 12 -18 months .Results The period follow‐up was 12 -43 months and there was one case of the formation of the sinus and bilateral abscess after surgical resection of re‐healing ,and there was no cases of bone block displacement .All tuberculosis lesions were healing .13 cases with neurological symptoms had recovery .There was no spondylolisthesis postoperative follow‐up;The heigh ,kyphosis correction and restore stability of vertebral body were satisfied .The patients had solid bony fusion without internal fixation loosening and rupture after 5-9 months .Conclusion It is a safe and effec‐tive method to treat lumbosacral tuberculosis by posterior transpedicular screw system internal fixation and anterior radical focus debridement with interbody autografting .which can thoroughly clear focus of spinal tuberculosis ,decompress sufficiently spinal cord ,correct effectively the kyphosis deformity and achieve the stability of a strong three‐column .

Objective A preliminary study was conducted on the measuring tool for teachers' attitude in the medical schools towards curriculum integration of medical program.Methods Literature review and expert interview were conducted to design a questionnaire which comprised 56 items to investigate teachers' attitude towards medical curriculum integration.The method of factor analysis and Pearson correlation coefficient were used to evaluate structure validity,the content validity index I-CVI and S-CVI were used to evaluate the content validity and Cronbach's alpha coefficient and split-half reliability were used to evaluate the reliability of the questionnaire.Results Three principal components were extracted by factor analysis,which explained 59.219％ of the total variance.After rotation,the factors 1-3 were respectively defined as value recognition,participation initiative and emotional tendency.Cronbach's alpha coefficient of the three factors and all the items is 0.922,0.903,0.728 and 0.862 respectively.Conclusion The reliability and validity of the measurement tool is acceptable,and can be used as a reference for similar domestic survey

Objective To investigate the effect of lipid emulsion on mitochondrial energy metabolism during bupivacaine-induced myocardiotoxicity in rats.Methods H9c2 cells were inoculated in 96-well plates at a density of 1 × 105cells/ml, and were randomly divided into 4 groups (n =18 each) using a random number table: control group (group C) , bupivacaine group (group B) , lipid emulsion group (group LE) , and bupivacaine + lipid emulsion group (group B + LE).The cells were incubated in the normal culture medium in group C.In group LE, the cells were incubated in the culture medium containing 1％ lipid emulsion.In group B, the cells were incubated in the culture medium containing 1 mmol/L bupivacaine.In group B + LE, the cells were incubated in the culture medium containing 1 mmol/L bupivacaine and 1％ lipid emulsion.After 24 h of incubation, the contents of ATP, ADP, and AMP were measured by high-performance liquid chromatography, and apoptotic rate was calculated by Hoechst33342/ PI staining.Results Compared with group C, the contents of ATP, ADP and AMP were significantly decreased, and apoptotic rate was increased in group B (P＜0.05), and the contents of ATP and ADP in group LE and ATP content in group B + LE were increased, and no significant changes were found in apoptotic rate in LE and B+LE groups (P＞0.05).Compared with group C, the contents of ATP, ADP and AMP were significantly increased, and apoptotic rate was decreased in LE and B+LE groups (P＜ 0.05).Compared with group LE, the contents of ATP, ADP and AMP were significantly decreased (P＜ 0.05), and no significant change was found in apoptotic rate in group B+LE (P＞0.05).Conclusion The mechanism by which lipid emulsion reduces bupivacaine-induced myocardiotoxicity may be associated with improved mitochondrial energy metabolism in rats.

Objective:This paper studied the electromagnetic-driven pressure control system in the automatic measurement of intraocular pressure (IOP).The accuracy of pressure control directly impacts on the accuracy of IOP measurements,so it calls for precise pressure to achieve closed-loop control.Methods:According to the actual needs of IOP measuring,we got the structural and electromagnetic parameters of the electromagnetic drive system by combining the methods of numerical calculation and ANSYS simulation.Using the FC bus and digital-analog conversion,the microcontroller module controlled the drive current digitally and precisely in order to achieve closed-loop control of pressure.Results:The experimental results showed that in the electromagnetic pressure control system,the pressure range was 0 N～0.48982 N,the accuracy 0.00058 N,the drive current control error about 1% on average.Besides,the electromagnetic force and the excitation current showed a good linear relationship in the same stroke.Conclusions:The electromagnetic pressure control system achieved a good result in closed-loop control of pressure.The control pressure range and control accuracy were in line with the standard of Goldmann applanation tonometer.According to the results,this study laid the foundation for the further development of IOP automatically measuring instruments.

Objective:To probe the therapeutic effects of Butylphthalide Injection in the elderly patients with acute cerebral infarction (ACI) and its influence in cerebral hemodynamics and cerebral vascular reserve (CVR),and to clarify the pharmacological action mechanism of butylphthalide in treatment of ACI.Methods:A total of 100 cases of elderly patients with ACI were selected as the subjects and divided into observation group and control group according to the serial number on admission.Fifty cases were included in each group.The patients in control group were treated with the conventional treatment, while the patients in observation group were treated with Butylphthalide Injection on the basis of the conventional treatment.The National Institute of Health Stroke Scale (NIHSS) score, the brain hemodynamics indexes of the peak velocity (Vp), the mean velocity (Vm) and the differences of the velocity (DVp, DVm) as well as pulsatility index (PI), CVR of bilateral middle cerebral artery (MCA)of the patients in two groups were observed and compared.The therapeutic effects of the patients in two groups were evaluated and compared.Results:The NIHSS score of the patients in observation group after treatment was significantly lower than that in control group (t=15.420, P<0.05).The therapeutic effects and the clinical efficiency of the patients in observation group were significantly better than those in control group (U=2.225, χ2=5.005, P<0.05).The Vp and Vm of the patients in observation group after treatment were significantly higher than those in control group(t=10.819,t=7.259, P<0.05)and the DVp and DVm were significantly lower than those in control group (t=16.438,t=19.055, P<0.05).The CVR of the patients in observation group after treatment was significantly higher than that in control group(t=6.884, P<0.05)and the PI was significantly lower than that in control group (t=4.979, P<0.05).Conclusion:Butylphthalide Injection can effectively correct the abnormality of brain hemodynamics in the ACI patients, enhance the ability of body in maintaining the stability of cerebral vascular perfusion, improve the neurological symptoms in the patients with ACI, and improve the therapeutic effects.

Objective To evaluate the effect of mitochondrial permeability transition pore (mPTP) in lipid emulsion-induced inversion of bupivacaine myocardiotoxicity in rats.Methods H9c2 cells were inoculated in 6-well plates at a density of 105 cells/ml, and were randomly divided into 4 groups (6 wells in each group, 2 ml/well) using a random number table: control group (group C) , bupivacaine group (group B) , lipid emusion + bupivacaine group (group LB) , and lipid emusion + bupivacaine + atractyloside group (group LBA).Phosphate buffer solution 100 μl was added to the culture medium in group C.In group B, bupivacaine was added to the culture medium with the final concentration of 1 mmol/L.In group LB, lipid emusion and bupivacaine were added to the culture medium with the final concentrations of 1％ and 1 mmol/L, respectively.In group LBA, lipid emusion, bupivacaine and atractyloside (an mPTP opener) were added to the culture medium with the final concentrations of 1％, 1 mmol/L and 30 μmol/L, respectively.All the cells were incubated for 24 h.After the end of incubation, the expression of Bcl-2, Bax, phosphorylated Bad (p-Bad) , caspase-3, activated caspase-3, caspase-9,activated caspase-9 and cytochrome c (Cyt c) was detected using Western blot.The expression of Bcl-2 mRNA, Bax mRNA, Bad mRNA, caspase-9 mRNA and Cyt c mRNA was detected using real-time reverse transcriptase polymerase chain reaction.The ratios of Bax/Bcl-2, activated caspase-3/caspase-3, activated caspase-9/caspase-9, and Bax mRNA/Bcl-2 mRNA were calculated.Results Compared with group C,the ratios of Bax/Bcl-2, activated caspase-3/caspase-3, activated caspase-9/caspase-9, and Bax mRNA/ Bcl-2 mRNA were significantly increased, the expression of p-Bad was down-regulated, and the expression of Cyt c, Bad mRNA, caspase-9 mRNA and Cyt c mRNA was up-regulated in group B (P＜0.05) , and no significant change was found in the parameters mentioned above in group LB (P＞0.05).Compared with group B, the ratios of Bax/Bcl-2, activated caspase-3/caspase-3, activated caspase-9/caspase-9, and Bax mRNA/Bcl-2 mRNA were significantly decreased, the expression of p-Bad was up-regulated, and the expression of Cyt c, Bad mRNA, caspase-9 mRNA and Cyt c mRNA was down-regulated in LB and LBA groups (P＜ 0.05).Compared with group LB, the ratios of Bax/Bcl-2, activated caspase-3/caspase-3, activated caspase-9/caspase-9, and Bax mRNA/Bcl-2 mRNA were significantly increased, the expression of p-Bad was down-regulated, and the expression of Cyt c, Bad mRNA, caspase-9 mRNA and Cyt c mRNA was up-regulated in group LBA (P ＜ 0.05).Conclusion The mechanism underlying lipid emulsioninduced inversion of bupivacaine myocardiotoxicity is related to inhibited mPTP opening in rats.

Objective To study classroom teaching quality evaluation standards from two perspectives of teachers and students,and comparatively study difference of evaluation standards for teachers and students.Methods Questionnaire survey method is adopted.Classroom teaching quality evaluation entry questionnaire is distributed to 320 teachers and 560 students.SPSS 18.0 software is utilized for statistical analysis on the collected data.Expert consultation method is applied to determine membership degree on the analysis results.Finally,14 experts and 20 students are invited to sequence the importance of each dimension obtained after membership determination.Expert evaluation method is used for calculating the weight of each dimension thereof.Results Generally,the results show that all the teaching quality evaluation standards which have been selected by teachers and students can be assorted into 5 dimensionalities,namely teaching content,teaching method,teaching norm,teaching organization and students' learning condition.Particularly,teachers maintain that 23 indicators can be chosen to assess the classroom teaching quality while students think that 24 items are qualified for evaluating the room teaching quality,and they reach a consensus in 13 items.Besides,there is a big difference in their weight of the 5 dimensionalities.Conclusions By comparing and analyzing the choices and opinions about the classroom teaching quality evaluation standard between teachers and students,we learn that the two relative groups' assessments and comments are far different mainly attributing to their different evaluation perspectives on classroom teaching quality.Therefore,we advise different evaluation indicator systems should be adopted respectively for evaluation subjects in classroom teaching quality evaluation.

Objective To explore the effect of Acorus gramimeus and its major components ?-asarone on N-methyl-D-asperate recepter 1 (NMDAR1) mRNA levels of hippocamp neurons in epileptic animal models induced by pentylenetetrazol (PTZ). Methods PTZ 60 mg/kg was injected to the abdominal cavity of three weeks Wistar rats to prepare epileptic animal models. The animal models were randomly divided into three groups: epilepsy control, A. gramimeus and ?-asarone as well as the normal control. Each group was administered through intraperitoneal injection. Both of two control groups were injected physiologic saline 1.0 mL/d, and the rest groups were injected A. gramimeus 2 350 mg/(kg?d) or ?-asarone 29 mg/(kg?d) for 7 d, respectively. All rats were treated by PTZ 60 mg/kg through intraperitoneal injection next day. After their behaviors were observed for 24 h, animals were sacrificed. The expressions of NMDAR1 mRNA in hippocamp CA1 and CA3 of all rats were detected by in situ hybridization and semiquantitative RT-PCR. Results The results of in situ hybridization showed that positive staining granules were located in the cyptoplasm of hippocamp neurons. The number of positive cells and average absorbance of A. gramimeus group or ?-asarone group was markedly less than that of epilepsy control (P