There are some disadvantages in internal medicine practice teaching now. To find a new teaching model, and implement a teaching reform is the key to improve teaching quality. We try to apply the case introduction to the teaching method of evidence based practice in the department of internal medicine . The new teaching model which combined case base study with evidence-based medicine in internal medicine practice can help put forward questions and guide students to analyze questions by the case. It also helps find evidence and solve questions by evidence-based method. The organic combination of the two, not only can stimulate students' learning enthusiasm and initiative, de-velop the correct clinical thinking, but also can effectively promote students' self-learning ability to update their knowledge. It is worth widely developing in internal medicine practice.

Objective: In order to implement effectively on-scene medical response to a nuclear or radiological emergency, and also keep track of relevant on-scene audio and video information and monitoring data, we have designed and developed a monitoring platform for medical response to nuclear or radiological emergency. Methods:Based on relevant national standards for emergency response and the features of nuclear or radiological emergency, exploiting modern information technology and monitoring equipments, we formulate the design idea, characteristics, functions and framework of the platform. This platform takes treatment centers for nuclear or radiological injuries, designated medical institutions and medical response teams as main users. Results:We have developed the monitoring platform for medical response to nuclear or radiological emergency. Conclusion:Through the application of this platform, we hope to enhance the preparedness and on-scene response capability for nuclear or radiological emergency, and also provide information support for disposal of nuclear or radiological emergency in the future.

Objective To investigate the expression and signification of p63,aromatase P450 (P450arom) and steroidogenic factor-1 (SF-1) in endometrial polyp,and to explore its role in the pathogenesis of endometrial polyp.Methods Specimen were collected from hysteroscopic resection,pathologically confirmed endometrial polyp specimens of 30 cases of endometrial polyp and the adjoining endometrium around endometrial polyp in 20 cases,endometrial tissue of normal control group of 25 patients.Immunohistochemistry SP method and real-time PCR technology were used to detect the three groups in the expression of p63,P450arom and SF-1 protein and gene.Results P450arom gene (0.274±0.082) and protein (1.2± 1.1) expression in endometrial polyp was significantly higher than the adjoining endometrium and normal endometrium (P＜0.05); the expression of SF-1 protein (1.1 ±0.8) and p63 protein (0.8±0.5) were also higher in the endometrial polyp than the other two control groups (P＜0.05); while the expression of SF-1 mRNA (0.105±0.049 versus 0.053±0.043) and p63 mRNA (0.261±0.052 versus 0.180± 0.018) in endometrial polyp had no significant difference between endometrial polyp and the adjoining endometrial (P＞0.05).Conclusion p63,P450arom and SF-1 may play a role in the formation of endometrial polyp.

Multiple myeloma (MM) is a malignant tumor of plasma cells that remains incurable.More attentions have been lately directed to the immunotherapy,which has proven benefits in eradicating minimal residual disease of MM,reducing relapse and improving patients' overall survival.Mucin 1 (MUC1) is a tumor associated antigen of MM,and has attracted increasing interest as a potential target for MM immunotherapy.In addition,MUC1-based vaccines have quickly entered human clinical trials,and some promising responses have been reported.Here,an up-to-date review of MUC1-based immunotherapy of MM is given.

Animals ; Cytotoxicity, Immunologic ; Down-Regulation ; Humans ; Influenza A Virus, H1N1 Subtype ; immunology ; physiology ; Influenza, Human ; immunology ; therapy ; virology ; Killer Cells, Natural ; immunology ; virology

Objective To study the clinical and imaging features of neonatal acute osteomyelitis.Method From 2011 to 2016,the clinical feature,laboratory results,pathogen,imaging features,treatment and prognosis of neonates who were diagnosed with acute osteomyelitis in NICU of People's Hospital of Xinjiang Uygur Autonomous Region were retrospectively studied.Result A total of 13 cases were enrolled during the study period,5 males and 8 females,with onset age of 7 ～30 d.8 cases had different degrees of fever and 5 of them showed dyspnea;8 cases had elevated skin temperature and swelling at the affected area;7 cases presented with irritability;6 cases had anorexia;all cases had elevated white blood cell count.Blood culture were taken immediately after their admission,and culture from the pus were taken for some patients.5 cases had positive blood culture and Staphylococcus aureus was the main pathogen.6 cases had positive pus culture,and 4 cases showed gram positive (G +) bacteria and 2 cases gram negative (G-) bacteria.Humerus and tibia were the main foci of the infection.4 cases had X-ray examination within 7 days of onset showing soft tissue swelling and no sign of bone destruction.13 cases had X-ray examination at 7 to 14 days of disease.Among them only 1 case showed soft tissue swelling,and the rest 12 cases had different levels of bone destruction and periosteal reaction.2 cases had X-ray examination after 14 days of disease,showing stiffening ring,inflammatory changes and periosteal reaction.All patients were treated with broad-spectrum antibiotics after admission,and the affected limbs were immobilized.3 cases had further surgical treatment.11 patients recovered and were discharged,1 patient was treated at local hospital after diagnosis and 1 patient refused further treatment due to serious complications after 35 d of hospital stay and was lost on follow-up.Conclusion The clinical manifestation of neonatal osteomyelitis is atypical,the radiological and pathogen examination should be carried out once osteomyelitis is suspected.Appropriate antibiotics and timely surgery can prevent further damage and long-term sequela.

AIM: To investigate the safety and efficacy of undersurface ablation of the flap ( UAF ) for laser in situ keratomileusis ( LASIK ) retreatment in eyes with regression.
METHODS: Twelve patients ( 22 eyes ) with regression after LASIK were performed undersurface ablation of the flap. The mean of preoperative refractive error was -2. 27±0-88D, the astigmatism was -0. 44±0. 30D, the central corneal thickness was 424. 9±8. 2μm. The follow-up time was 1a, including visual acuity, refractive error, the elevation of posterior cornea, WavScan. The data was analyzed with Student's t test andχ2test.
RESULTS:During the operation, the measured stromal thickness was 275. 4±9. 3μm, the flap thickness 144. 7±7-5μm, the depth of ablation 28. 1±9. 3μm. The mean postoperative uncorrected visual acuity (UCVA) was 4. 99±0. 04, best corrected visual acuity ( BCVA) 5. 03±0. 04, at 1a follow up. There was no patient with postoperative BCVA decreasing, compared to preoperation. Mean spherical refraction decreased to-0. 22±0. 19 D at 1a follow up (t=10. 232, P<0. 001) and the astigmatism decreased to -0. 24±0. 26 D (t=2. 365, P=0. 028). The elevation of posterior cornea changed from 1. 95 ± 1. 68μm preoperatively to 2. 00±1. 88μm after 1a, but there was no statistical significance (t=0. 090, P= 0. 929). The coma changed from 0. 283±0. 112μm preoperatively to 0. 331±0-149μm after 1a (no statistical significance, t=1. 452, P=0. 161) and the spherical aberration changed from 0. 320±0. 119μm to 0. 341±0. 103μm (no statistical significance, t=0. 390, P=0. 674).
CONCLUSION:UAF, as one of a choice, is an effective and safe procedure for the treatment of regression after LASIK, based on the reasonable surgery design.

Objective To study the effects of hypothermia therapy on inflammation level and safety of patients with severe nervous injury.Methods A total of 82 patients with severe nerve injury were divided into study group and control group by random digits table, 41 patients in each group.The patients in these two groups had no statistical dis-parities in inflammatory agent and intracranial pressure (p>0.05).The patients in the control group were treated by routine therapy and those in the study group were treated by cephalic hypothermia therapy additionally.The two groups were compared in terms of the level of TNFα, IL-6 and IL-8 in the cerebrospinal fluid, prognosis and safety.Re-sults Before treatment there was no significant difference in inflammation level between the two groups (p>0.05). After treatment, the TNFα, IL-6 and IL-8 levels in the study group were significantly lower than those in control group (p<0.01).Before treatment there was no significant difference in ICP between two groups (p>0.05).How-ever, after treatment there was a significant difference in ICP between the two groups in all time points (p<0.01). The GOS score in the study group was significantly lower than that in the control group.There was no statistical dis-parities in complications between the two groups (p>0.0).Conclusion The hypothermia therapy has a great clini-cal efficacy and safety on severe never injury patients, which makes it worth clinical application.

Objective Protection afforded by ischemic preconditioning (IPC) against myocardial ischemia in adult heart has been investigated. This study was designed to examine the effects of IPC on myocardial tolerance to ischemia in immature hearts.Methods The aorta of isolated immature rabbit heart (14-21d old) was connected to Langendorff preparation within 30 s after excision. The hearts were perfused with oxygenated (95%O 2:5%CO 2) Krebs-Henseleit buffer(KHB) at 60 cmH 2O. 16 immature rabbit hearts were equally divided into 2 groups: control group and IPC group. In IPC group the hearts were first subjected to IPC stimulus consisting of 5 min global ischemia followed by 10 min reperfusion. The hearts in both groups were made globally ischemic for 30 min(no perfusion) followed by 40 min reperfusion. At the end of 40 min reperfusion the hearts were harvested for ATP analysis. The coronary flow(C), HR, left ventricle developed pressure(LVDP) and ?dp/dt were monitored and recorded before ischemia and at 5,10,20,30 and 40 min of reperfusion, and calculated as % of pre-ischemia levels. Coronary flow was collected before and after reperfusion for CK-MB determination.Results There were no statistically significant differences in the four parameters between the two groups. Arrhythmia scores were also comparable betweeen the two groups. The CK-MB leakage in IPC group was increased but not significantly different from that in control group. The ATP levels of myocardium at the end of reperfusion was significantly lower than that in the control group [(123.85?17.42)?g/g versus (167.21?16.53)?g/g].Conclusions IPC can not protect immature rabbit hearts from ischemia-reperfusion injury. On the contrary it may lead to myocardial injury due to more energy consumption.

Objective To investigate whether ischemic preconditioning( IPC) could protect against ischemia-reperfusion injury in immature rabbit heart and the role of KATP channel in the mechanism of myocardial protection. Methods New Zealand rabbits aged 14-21 days weighing 220-280g were used. The animals were anesthetized and heparinized. Chest was opened and heart was quickly removed and aorta was connected to Langendorff preparation within 30 s. The hearts were perfused with Krebs-Henseleit buffer balanced with gas mixture(O2: CO2 = 95% : 5% ) at 60cmH2O2(perfusion pressure) . IPC consisted of 5 mm global ischimia plus 10 mm reperfusion. Glibenclamide was used as KATP channel blocker. Cardiac arrest was induced with cold(4℃ ) St Thomas Ⅱ cardioplegic solution and heart was made globally ischemic by withholding perfusion for 45 mm followed by 40 mm reperfusion. Thirty immature rabbit hearts were randomly divided into four groups: group Ⅰ( n= 9 control) was subjected to ischemia-reperfusion only; groupⅡ(n= 9 IPC + ischemia-reperfusion); group Ⅲ(n = 6 glibenclamide + ischemia-reperfusion) and group Ⅳ( n= 6 glibenclamide + IPC + ischemia-reperfusion) . Coronary flow(CF), HR, left ventricle developed pressure( LVDP) and ? dP/dt max were monitored before ischemia/IPC/glibenclamide( baseline value) and 5, 10, 20 and 40 mm after reperfusion and were expressed as percentage of their baseline values. Arrhythmia scores were recorded. Coronary effluent was collected at 10 miii after reperfusion was started for determination of CK-MB level. At the end of reperfusion 200mg myocardium was taken from apex for determination of ATP content. Results The group Ⅱ(IPC group) showed best results. The recovery of CF, HR, LVDP and ?dp/dt max, was best among the four groups. The incidence of arrhythmia was low and less CK-MB leaked out. Myocardial ATP content was better preserved. Pretreatment with glibenclamide completely abolished the myocardial protection provided by IPC but did not affect ischemiareperfusion injury. Conclusions IPC can protect against ischemia-reperfusion injury in immature rabbit bean. Activation of KATh channel is involved in the mechanism of myocardial protection of IPC.