Objective To evaluate the effect of modern comprehensive three-dimensional teaching method in clinical practice of respiratory medicine. Method The problem based teaching method PBL (problem-based learning), the standardized patient-based practice SPE/Xs (standardized patient experiences/exam) and Mini clinical examination practice Mini-CEX (Mini clinical examination exercise) method and other methods were organically combined and used in respiratory medicine clini-cal practice, and it was named“modern comprehensive three-dimensional teaching mode”. 60 students were randomly divided into the modern comprehensive three-dimensional teaching method group (30 students) and the traditional teaching method (SBL) (30 students), using the modern com-prehensive three-dimensional teaching method and the SBL breathing internal medicine practice teaching respec-tively. After the teaching, the methods of performance testing and questionnalre survey were used to evaluate the teaching effect of two groups of students. SPSS software was used to compare t test. Results The test results of modern three-dimensional integrated teaching method group was (86.91±4.77), higher than that of the control group (79.00±7.51) points (t=12.4, P=0.026 0). In the subjective questions (such as discourse analysis problem and case), modern three-dimensional integrated teaching group (47.63± 2.14) points is obvi-ously superior to the traditional group (36.00±6.71) points (t=21.6, P=0.001 9). According to the results of the survey, the modern comprehensive teaching method can improve students' subjective initiative and enthusiasm for learning, improve students' ability of comprehensive analysis, promote the formation of clinical thinking, and help students master the basic knowledge and basic skills of respiratory diseases. Conclusions In the respiratory medicine teaching, implementation of modern comprehensive three-dimensional teaching method is helpful to improving the teaching effect.

Objective:To study the therapeutic effect and mechanism of autologous platelet-rich plasma (PRP) on rabbit traumatic optic neuropathies (TON) and retina.Methods:Forty adult New Zealand white rabbits were selected to establish the optic nerve clamp injury model in their right eyes.According to the random number table method, 36 New Zealand white rabbits with effective model were randomly divided into model control group, normal saline control group and PRP group, 12 for each group.Another 12 healthy rabbits served as the normal control group.Rabbit autologous blood was collected to prepare PRP.The retrobulbar 20 μl PRP/20 μl saline solution injection was administered every two days near the injury after modeling according to grouping.The injection was carried out for 10 times.There was no other interference administrated to the model control group except the normal anti-infective treatment.No interference was given to the normal control group.At 30 and 60 days after modeling, the eyeballs and optic nerves of right eyes were harvested through sacrificing the animals by anesthetic overdose, three eyes for each time.Histopathological assessments were performed to observe the morphological changes of retina and optic nerve, and to evaluate the changes of retinal ganglion cells (RGCs) density and retinal nerve fiber layer (RNFL) thickness.Immunohistochemistry was used to assess the expressions of apoptosis factors caspase-3 and B cell lymphoma-2(Bcl-2). Quantitative real-time PCR and Western blot were used to detect the mRNA and protein expressions of brain-derived neurotrophic factor (BDNF) and growth associated protein-43 (Gap-43). This study protocol was approved by the Experimental Animal Ethics Committee of Wuhan University (No.E2019072805). The use and care of animals complied with ARVO statement.Results:The thickness of RNFL and number of RGCs at 30 days and 60 days after modeling were (6.60±1.16) μm, (6.89±1.21) μm, (13.00±1.00)/field of vision, (20.00±2.65)/field of vision in the PRP group, respectively, and were (4.80±0.43)μm, (2.18±0.23)μm, (6.33±0.58)/field of vision, (10.33±1.53)/field of vision in the model control group, respectively.The number of RGCs in the PRP group at 60 days was higher than that at 30 days after modeling, the number of RGCs in the PRP group was higher than that in the model control group, the thickness of RNFL in the PRP group was higher than that in the model control group; and the differences were statistically significant (all at P<0.05). At 30 and 60 days after modeling, the positive expression A value of caspase-3 protein in the normal saline group and model control group were higher than those in the normal control group and PRP group, while the positive expression A value of Bcl-2 protein in the PRP group was higher than those in the model control group and normal saline group, and the differences were statistically significant (all at P<0.05). The mRNA level and protein content of BDNF and Gap-43 in the retina and optic nerves at 30 days and 60 days after modeling in the PRP group were higher than those in the model control group, and the differences were statistically significant (all at P<0.05), but the mRNA and protein expression levels of BDNF and Gap-43 in different tissues in the PRP group at 60 days after modeling were lower than those at 30 days after modeling ( P<0.05). Conclusions:PRP can effectively inhibit the apoptosis of RGCs and the secondary injury of the retina after optic nerve injury, promote cell anti-apoptosis effect of RGCs, thereby retard the damage of the retina and optic nerve after TON, and also promote the repair of optic nerve and retina through upregulating the expression of nerve growth factors.

Objectives:To analyze the prevalence and risk factors of chronic nephropathy among hospitalized gout patients.Methods:537 hospitalized gout patients in Tianjin Medical University Chu Hsien-I Memorial Hospital were enrolled. According to the levels of glomerular filtration rate (eGFR>90 ml/min, 60-90 ml/min and <60 ml/min), patients were divided into normal group, mild chronic nephropathy group and moderate-severe chronic nephropathy group. The height, weight, waist, hip and blood pressure of the patients were measured. Blood samples from elbow vein were collected to measure biochemical indexes. The 24-hour urine was collected to measure creatinine and uric acid. Multivariate regression analysis was used to analyze the related factors that may affect eGFR.Results:The prevalence of chronic nephropathy among gout patients was 46.76%(251/537), which the prevalence of mild chronic nephropathy was 34.82%(187/537), and moderate severe chronic nephropathy was 11.92%(64/537). With the decline of eGFR, the older the patients, the longer the course of gout and hypertension, the more the number of joints involved, the higher the blood uric acid, urinary microalbumin, urinary protein, white blood cell count, uric acid excretion fraction (FeUA), and the lower the red blood cell count, hemoglobin and serum albumin. Pearson correlation analysis of eGFR showed that age, duration of gout and hypertension, number of involved joints, hemoglobin, serum albumin, serum uric acid, urinary microalbumin, and FeUA were correlated with eGFR ( r=-0.43, -0.238, -0.25, -0.128, 0.155, 0.138, -0.169, -0.29, -0.372, respectively, P<0.01). Multivariate regression analysis showed that age, the course of gout, serum uric acid, microalbuminuria and FeUA were independent risk factors for eGFR decline ( P<0.01). Conclusions:Eldly, long course of gout, poor control of serum uric acid and increased excretion of uric acid and microalbumin are risk factors of gout.

Objective To observe the cerebral activation pattern in patients with cervical dystonia (CD) during finger movements and the changes caused by botulinum toxin injection by functional MRI.The possible etiological mechanism of CD and effect of peripheral botulinum toxin treatment on the level of central nerves system are investigated.Methods A designed functional MRI block with complex finger movements was applied and 11 patients with CD as well as 11 age and gender matched controls were scanned.Compare the activation pattern of CD pre/post treatment groups versus health controls.Evaluate and compare the symtom severity with Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS).Make a correlation analysis between activation pattern alteration and TWSTRS change in CD pre/post treatment groups.Results An reduced extent of activation in patients with CD was demonstrated compared to healthy controls in ipsilateral putamen,prefrontal cortex and contralateral somatosensory cortex to the direction of the head deviation,while an elevated extent of activation in ipsilateral precuneus and fusiform with statistic significance.At the time point of 4 weeks after botulinum toxin treatment patients showed no evident difference with healthy controls except for the decreased activation in contralateral precuneus to the direction of the head deviation.TWSTRS of patients with CD decreased from (20.02 ± 5.52) to (4.11 ± 4.34) with statistic significance (t =11.71,P =0.000) after botulinum toxin treatment.There was a positive correlation between cerebral activation pattern change in some cerebral areas (ipsilateral primary somatosensory cortex,premotor cortex,supplementary motor cortex,insula,fusiform,hippocampus with parahippocampa as well as contralateral middle temporal cortex and hippocampus with parahippocampa to the direction of the head deviation) and TWSTRS score decrease.Conclusions There are widespread abnormalities in cortical and subcortical activation pattern in patients with CD,which might due to dysfunction of sensory-motor integration.We speculate a basic pre-dystonic state is present in affected body parts prior to clinical symptoms appear.Botulinum toxin fulfills its subsequent central effect by reorganizing and normalizing the cerebral cortex in patients with CD.

Objective To investigate the effects of curcumin on UVB-induced elevation of cellular ROS level and cell death and to explore the involvement of transcription factor Nrf2.Methods Mouse embryonic fibroblasts (MEFs) were pretreated with or without curcumin then irradiated with UVB.The cell viability,cellular ROS level and protein levels of Nrf2 and HO1 were determined by MTT assay,DCFH fluorescence and Western blotting,respectively.These measurements were also performed in Nrf2 (-/-) MEFs.Results UVB irradiation elevated cellular ROS level and decreased cell viability of MEFs(t =16.65,15.89,P ＜ 0.05),while the curcumin pretreatment significantly attenuated the deleterious effects of UVB(t =11.88,3.77,P ＜ 0.05).UVB irradiation moderately increased the protein levels of Nrf2 and HO1 and activated JNK and ERK.The curcumin pretreatment led to more remarked elevation of Nrf2 and HO1 proteins,while inhibited UVB-activated JNK and ERK,but it had little effect on p38MAPK.In contrast,Nrf2 (-/-) MEFs showed significantly decrease in Nrf2 and HO1 expressions and were more susceptible to UVB-induced damages.Interestingly,the protective effects of curcumin were also greatly compromised in Nrf2 (-/-) MEFs (t =16.73,-8.23,P ＜ 0.05).Conclusions Curcumin can attenuate UVB-induced oxidative damages in MEFs by activating Nrf2 signaling.

Objective To assess the diagnostic value of anti-mutated citrullinated vimentin (MCV)antibody for rheumatoid arthritis (RA).Methods Meta analysis.The databases,including PubMed,The Excerpta Medica Database (Embase) and China National Knowledge Infrastructure (CNKI),from January 1990 to January 2013,were employed to search for the studies related to diagnostic value of anti-MCV for RA.The software Meta-Disc1.4 was used to perform Meta-analysis,investigate the sources of heterogeneity and draw the summary receiver operating characteristic (SROC) curve.The Begg's test was applied to evaluate the publication bias by use of Stata1 1 software.Results A total of 27 studies were included.Pooled sensitivity was 0.74[95％ confidence interval (CI) 0.73 to 0.76] and pooled specificity was 0.83 [95％ CI (0.82 to 0.85)].The area under the summary receiver operating characteristic curves was 0.896.Twenty-three literatures which detected both anti-MCV antibody and anti-cyclic citrullinated peptide(antikCCP) antibody show that:the area under curre of anti-MCV antibody and anti-CCP antibody were 0.887 and 0.924 respectively,but there was no significant difference (Z =1.525,P =0.064).Conclusions Results of the meta-analysis demonstrated that the MCV antibody may be a useful parameter in diagnosing RA as it shows high sensitivity and specificity.But there was no statistical difference between the results of anti-MCV antibody and anti-CCP antibody for the RA diagnosis.

To explore the clinical efficacy of Herba Saxifragae cream (HS), a compound of traditional Chinese herbal medicine, on chronic eczema.

Objective To explore the effect of health education through different postoperative follow-up method, including telephone、Email and QQ, on patients with indwelling D-J stents. Methods 319patients with indwelling D-J stents were divided into the control group(88 cases), the telephone group(89 cases), the Email group (70 cases) and the QQ group (72 cases). M1 patients received rourine health education during hospitalization and before discharge, the latter three groups received follow-up by telephone、Email and QQ after discharge respectively. The rehabilitation effect was observed in the four groups. Results The complication rates of the telephone group, the Email group and the QQ group was significantly less and the mastering of knowledge about prevention and handling of complication was better than the control group during the follow-up. Conclusions Different types of follow-up can be selected by patients according to their actual status. Decreasing complication rate, favorable social benefit and approval of the patients family members will be seen due to involvement of the patients family in health education.

Objective:To investigate the association between age and cardiac tamponade after radiofrequency ablation of atrial fibrillation(RAAF).Methods:Clinical data of patients undergone de novo AF ablation procedures at Beijing Anzhen Hospital from January 2013 to December 2016 were retrospectively collected.Patients were divided into an elderly group(age ≥60 years)and a non-elderly group(age <60 years). Logistic regression analyses were used to evaluate the association between old age and the risk of cardiac tamponade complicating RAAF.Results:A total of 5 313 patients were involved in this study, including 41 patients(0.77%)with cardiac tamponade.The proportion of cardiac tamponade was higher in the elderly group than in the non-elderly group(1.1% or 32/2 950 vs.0.4% or 9/2 363, χ2=8.489, P=0.004). One patient with cardiac tamponade in the elderly group required immediate surgical repair whereas none in the non-elderly group did.No patient died in hospital.Multivariate Logistic regression analysis showed that the risk of cardiac tamponade increased in the elderly group, compared with the non-elderly group( OR=2.570, 95% CI: 1.190-5.570, P=0.017). Stratified analysis revealed that among females and patients with oral anticoagulants, left atrium dimension < 40 mm or procedure duration≥ 120 min in the elderly group carried a higher risk of cardiac tamponade than those in the non-elderly group( OR=1.011, 2.914, 3.922 and 3.244, P<0.05). Conclusions:Old age(age ≥60 years)is an independent risk factor for cardiac tamponade complicating RAAF.

Objective To evaluate the effect of decompression suction drainage treated mandibular cystic lesions,and compared with the othertreatments such as surgery,decompression,and suction drainage.In order to explore its value in the field of mandible conservative treatment.Methods 36 cases of mandibular cystic lesions were performed decompression and suction drainage.Compared the cystic size before and after the treatment to evaluate the clinical effect.Results According the pathology,29 cases are cyst and 7 cases are mural-ameloblastoma.28 cases which X-ray show a remarkable lessen,6 cases have no change and 2 cases deteriorated.Conclusion decompression suction drainage is one of the ideal treatment for mandibular cystic lesions.