Guiding"Physiology"teaching to unify with the clinical practice by the CBS method, which may enhance students study interest and enthusiasm effectively.The teacher who uses CBS in the teaching may further promote the combination of Physiology teaching and clinical practice by thoroughly mastering knowledge,carefully choosing cases,properly using some other methods and adopting different teaching method to different students to get good teaching effect.

Objective To investigate the clinical efficacy of bronchoscopic MMC topical spraying for the treatment of tuberculous cicatricial stenosis of the central airway. Methods 45 patients with t tuberculous cicatricial stenosis of the central airway were randomly divided into a control group (14 patients), treatment group 1 (group1, 15 patients), or treatment group 2 (group 2, 16 patients), who received bronchial balloon dilatation alone, bronchial balloon dilatation combined with topical MMC spraying for one time, and for twice, respectively . The clinical efficacy was observed by using the MRC score and measuring airway diameter at the time points before treatment, end of treatment, and 3, 6, and 12 months after treatment, respectively. Results For the MRC scores at different time points, the MRC scores in group 2 (0.06 ± 0.25) and group 1 (0.33 ± 0.617) were significantly lower than those in the control group at 3 months after treatment (P < 0.05 for all comparisons);there were nosignificant differences at the other time points among the three groups. For the airway mean diameters at the different time points, the airway mean diameter was higher in group 2 than in the control group at 3 and 6 months after treatment (P < 0.01), and in group 1 at 3, 6, and 12 months (P < 0.05). No statistical differences were found in the other time points among three groups (P > 0.05). Conclusions Bronchial balloon dilatation combined with topical MMC spraying has certain short-term and long-term efficacy for improving dyspnea and maintaining the airway diameter after dilatation.

Objective To explore the role of genetic factors in development of esophageal cancer by studying the association of XRCC1,P53 and COX-2 genetic polymorphisms with susceptibility of esophageal cancer in Hakka population. Methods A case-control study was performed with molecular epidemiological methods. A total of 122 patients with esophageal cancer(esophageal cancer group)and 123 healthy people(control group) were randomly selected from Hakka people in Meizhou area. The genotypes and alleles of XRCC1 rs25487,P53 rs1042522,and COX-2 rs689466 in both groups were detected,and the distribution characteristics were analyzed. Results The polymorphisms of XRCC1 rs25487(A/G),P53 rs1042522(C/G)and COX-2 rs689466(A/G)were found in Hakkan people in Meizhou area ,but there were no significant differences in the genotype and allele fre-quencies between the two groups. And after such as sex,age,stratified analysis showed also no significant results. Conclusions The study shows that the genetic polymorphisms of XRCC1 gene rs25487,P53 gene rs1042522 and COX-2 gene rs689466 are possibly not related with the susceptibility of esophageal cancer in Hakka population in Meizhou area.

Objective To investigate the effect of comprehensive rehabilitation exercise on the rehabilitation of upper limb function and quality of life in patients with breast cancer. Methods From January 2014 to December 2017,68 cases received breast cancer surgery in Hangzhou Red Cross Hospital were chosen in the research. The patients were randomly divided into observation group (34 cases) and control group (34 cases). All the patients were given routine rehabilitation training,and the observation group was given latissimus dorsi muscle strengthening exercise and simplified 24 Style Taijiquan exercise. The upper limb function rehabilitation and quality of life of the two groups were compared and analyzed. Results At 2 months after operation, the angle of extension, the angle of internal rotation and the adduction strength in the observation group were (39. 43 ± 5. 82)°,(150. 7 ± 10. 34)° and (145. 24 ± 10. 35) N,respectively,which in the control group were (33. 71 ± 5. 28)°,(134. 10 ± 39. 43)° and (119. 57 ± 9. 46)N,respectively,which were significantly improved compared with those before discharge (t=12. 041,3. 883, 11. 807,4. 906,21. 904,11. 617,all P<0. 05),which in the observation group were significantly higher than those in the control group (t=4. 244,6. 166,10. 674,all P<0. 05). The pain,ADL and ROM scores in the observation group at 2 months after operation were ( 13. 27 ± 4. 51 ) points, ( 16. 48 ± 4. 22 ) points and ( 31. 46 ± 5. 64 ) points,respectively,which in the control group were ( 10. 73 ± 4. 15 ) points, ( 12. 05 ± 4. 13 ) points and ( 26. 57 ± 5. 16)points,respectively,which were significantly higher than before discharge (t=5. 238,2. 503,10. 953,5. 531, 12. 872,9. 160,all P<0. 05),which in the observation group were significantly higher than those in the control group (t=2. 417,4. 375,3. 730,all P<0. 05). The WHOQOL-BREF scores in the observation group at 2 months after operation were (17. 24 ± 2. 81) points,(16. 74 ± 3. 18) points,(17. 45 ± 2. 56) points,(33. 48 ± 5. 15) points, (3. 97 ± 1. 05)points and (3. 87 ± 1. 18)points,respectively,which in the control group were (14. 21 ± 3. 08)pionts, (13.81 ±3.28)points,(13.45 ±2.83)points,(28.81 ±4.82)points,(3.26 ±1.16)points,(3.18 ±1.28)points, respectively,compared with those before discharge,the differences were statistically significant(t =9. 669,4. 965, 8. 327,4. 857,10. 522,4. 198,11. 487,7. 132,5. 572,2. 688,5. 178,2. 727,all P<0. 05),which in the observation group were significantly higher than those in the control group(t=4. 238,3. 740,6. 112,4. 638,2. 646,2. 311,all P<0. 05). Conclusion A positive comprehensive rehabilitation exercise for the patients with breast cancer is helpful to the recovery of the function of the upper limb and the improvement of the quality of life of the patients.

Objective To observe the effects of a 1 470 nm semiconductor laser on vaporization cutting,coagulation,and thermal injury of ex vivo animal tissues,aiming to explore the feasibility of its application in the treatment of benign prostatic hyperplasia.Methods The experimental group and control group were treated with HANS-D1 and ML-DD01FI 1 470 nm semiconductor laser therapy equipment,respectively.Fresh ex vivo pig bladder tissue was exposed to lasers with the optical fiber placed at distances of 0.5 cm and 1 cm from the tissue for 5 s.The effects of layers at powers of 60,90,120,150,and 160 W on tissue injury were observed.Ex vivo dog prostate and pig kidney tissues were used for vaporization ablation and cutting to observe the effects of lasers at the same power levels on tissue vaporization and cutting thermal injury.Additionally,in coagulation mode,the effects of 30,40,and 50 W semiconductor lasers on tissue coagulation were observed after irradiating ex vivo pig kidney tissue for 5,10,and 15 seconds.Results When the optical fiber was placed 1 cm away from the tissue,the 1 470 nm semiconductor lasers did not cause accidental damage to adjacent normal bladder tissue.However,at a distance of 0.5 cm,the 120 W,150 W,or 160 W lasers caused slight damage to the bladder tissue.In addition,with the increase in output power,the vaporization ablation efficiency of 60-160 W lasers on dog prostate tissue gradually increased,showing a good linear correlation between vaporization volume and total energy consumption(P＜0.001).Histopathological HE staining results indicated that the coagulation layer thickness in the experimental group was 292.20-309.98 μm,and the vaporization layer depth was 1.49-4.52 mm.In the control group,the coagulation layer thickness was 289.91-303.53 μm,and the vaporization layer depth was 1.88-4.43 mm.There was no significant difference between the two groups(P＞0.05).Moreover,when performing vaporization cutting on ex vivo pig kidney tissue with a cross-sectional area of 1 cm2,the efficiency of vaporization cutting by the 60-160 W 1 470 nm semiconductor lasers increased with the increase in output power(P＜0.05).The coagulated layer thickness in the experimental group was 496.04-514.47 μm,while that in the control group was 489.39-518.53 μm.Additionally,in coagulation mode,when ex vivo pig kidney tissue was irradiated for 5,10,and 15 s with 30,40,and 50 W semiconductor lasers,the coagulation diameter,groove depth,and coagulation efficiency gradually increased with the increase in laser output power(P＜0.05).The coagulation layer thickness in the experimental group and control group was 399.10-449.98 μm and 392.97-447.65 μm,respectively,and the vaporization layer depth was 3.05-7.09 mm and 2.70-7.14 mm,respectively.There was no significant difference between the two groups(P＞0.05).Conclusion The 1 470 nm semiconductor laser shows good vaporization ablation,cutting,and coagulation effect on ex vivo tissues,with a good linear correlation between the effect and the output energy.

Objective To evaluate the effectiveness of a 1470 nm semiconductor laser therapeutic instrument(referred to as a curestar therapeutic instrument)for prostatectomy in Beagle dogs.Methods Twenty-eight adult male Beagle dogs were randomly divided into three groups:sham(n=3),experimental(n=15),and control(n=10).The experimental group was further divided into three subgroups:120 W/50 W,150 W/50 W,and 160 W/50 W for vaporization cutting/coagulation hemostasis.The control group was divided into two subgroups:120 W/50 W and 150 W/50 W with five in each subgroup.Experimental and control groups underwent canine prostatectomy through the entrance of the bladder neck under electrocision.The operational suitability and effectiveness of the product during surgery were assessed.After the operation,the general condition of the dogs was observed,and blood biochemical and hematological indicators were measured before,immediately after,and at 3,7,and 28 days after the operation.At 1 h and 4 weeks after surgery,B-ultrasound and electric resection were performed under anesthesia to observe the conditions of the urethra and prostate,and prostatic tissue was subjected to HE staining for pathological observations.The thickness of the coagulation layer at 1 h after the operation and repair of the urothelial epithelium at 4 weeks were analyzed.Results During the operation,experimental and control groups had good operability and showed good vaporization cutting and coagulation hemostasis performance.After the operation,no significant effects were observed on the general condition,and blood biochemical and hematological indicators of the dogs.Ultrasound showed that the urethral expansion was visible immediately after the operation,and the echo of the urethral epithelium was slightly enhanced.At 4 weeks,the prostate tissue had a slightly low echo with uniformly distributed small point-like echoes inside,and the capsule had a linearly high echo,consistent with the sham group.The weight of the vaporized prostate tissue in experimental and control groups was 0.91～1.33 g with a resection rate of 17.11％～20.27％.As the power of vaporization cutting increased,the laser emission time gradually decreased,while the vaporization cutting speed and efficiency both increased.However,no significant difference was found between experimental and control groups(P＞0.05).Under the electrocision microscope,a burn-like change was observed in the surgical wounds of the prostate urethra in experimental and control groups at 1 h after surgery,and the boundary between the wound and normal urothelium was visible.At 4 weeks,the urothelium of the prostate had been repaired and flattened,and the boundary with the surrounding normal urothelium was blurred.Similarly,pathological observations showed that experimental and control groups had significant damage to the prostate urethral orifice at 1 h after surgery with a small amount of carbonization and coagulative necrosis on the surface of the wound,a small amount of inflammatory cell infiltration,and a coagulation layer thickness of approximately 0.4 mm.At 4 weeks,the prostate urethral morphology of the sham group was normal,whereas experimental and control groups showed new epithelial growth covering the wound with a uniform thickness and no coagulative necrosis tissue attached to the wound.A mild inflammatory reaction was still present in the surrounding area,fibroblast proliferation was obvious,and stromal and epithelial cell proliferation was visible in the surrounding prostate,some of which showed squamous metaplasia.The prostate capsule was intact and the morphology of the surrounding nerves and blood vessels was normal.Conclusions The curestar therapy instrument is effective for prostatectomy in Beagle dogs with good vaporization cutting and coagulation hemostasis performance.No significant difference was found in postoperative physiological indicators compared with the sham group.

Objective:To study the distribution and antibiotics resistance of the main pathogens of neonatal purulent meningitis in different regions of China.Methods:A retrospective descriptive clinical epidemiological study was conducted in children with neonatal purulent meningitis which admitted to 18 tertiary hospitals in different regions of China between January 2015 to December 2019. The test results of blood and cerebrospinal fluid, and drug sensitivity test results of the main pathogens were collected. The distributions of pathogenic bacteria in children with neonatal purulent meningitis in preterm and term infants, early and late onset infants, in Zhejiang Province and other regions outside Zhejiang Province, and in Wenzhou region and other regions of Zhejiang Province were analyzed. The chi-square test was used for statistical analysis.Results:A total of 210 neonatal purulent meningitis cases were collected. The common pathogens were Escherichia coli ( E. coli)(41.4%(87/210)) and Streptococcus agalactiae ( S. agalactiae)(27.1%(57/210)). The proportion of Gram-negative bacteria in preterm infants (77.6%(45/58)) with neonatal purulent meningitis was higher than that in term infants (47.4%(72/152)), and the difference was statistically significant ( χ2=15.54, P=0.001). There were no significant differences in the constituent ratios of E. coli (36.5%(31/85) vs 44.8%(56/125)) and S. agalactiae (24.7%(21/85) vs 28.8%(36/125)) between early onset and late onset cases (both P>0.05). The most common pathogen was E. coli in different regions, with 46.7%(64/137) in Zhejiang Province and 31.5%(23/73) in other regions outside Zhejiang Province. In Zhejiang Province, S. agalactiae was detected in 49 out of 137 cases (35.8%), which was significantly higher than other regions outside Zhejiang Province (11.0%(8/73)). The proportions of Klebsiella pneumoniae, and coagulase-negative Staphylococcus in other regions outside Zhejiang Province (17.8%(13/73) and 16.4%(12/73)) were both higher than those in Zhejiang Province (2.9%(4/137) and 5.1%(7/137)). The differences were all statistically significant ( χ2=14.82, 12.26 and 7.43, respectively, all P<0.05). The proportion of Gram-positive bacteria in Wenzhou City (60.8%(31/51)) was higher than that in other regions in Zhejiang Province (38.4%(33/86)), and the difference was statistically significant ( χ2=6.46, P=0.011). E. coli was sensitive to meropenem (0/45), and 74.4%(32/43) of them were resistant to ampicillin. E. coli had different degrees of resistance to other common cephalosporins, among which, cefotaxime had the highest resistance rate of 41.8%(23/55), followed by ceftriaxone (32.4%(23/71)). S. agalactiae was sensitive to penicillin, vancomycin and linezolid. Conclusions:The composition ratios of pathogenic bacteria of neonatal purulent meningitis are different in different regions of China. The most common pathogen is E. coli, which is sensitive to meropenem, while it has different degrees of resistance to other common cephalosporins, especially to cefotaxime.