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.

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.

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.

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 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 To study the changes of serum levels of adiponectin and tumor necrosis factor-?in the first-degree family relatives of patients with type 2 diabetic mellitus and the relationship of adiponectin and TNF-?with insulin resistance.Methods 45 families with type 2 diabetes were recruited.The observation group comprised 83 first-degree relatives who were with normal glucose tolerance(NGT).The normal control group comprised 76 NGT spouses of the probands and his/her siblings.The levels of fasting blood glucose,insulin,proinsulin,lipid,adiponectin and TNF-? were measured among two groups.Insulin resistance was calculated using the homeostasis assessment(HOMA).Results The levels of TG,fasting insulin(FINS),fasting proinsulin(FPI),TNF-? and HOMA-IR in first-degree relatives were significantly higher(P

Objective To investigate whether diazoxide preconditioning can exert protective effect on myocardium against ischemia-reperfusion injury in immature rabbits and the possible mechanism. Methods Twenty-one healthy 3-4 week old white rabbits of either sex were randomly divided into 3 groups : group Ⅰ control ( n = 8) ; group Ⅱ diazoxide preconditioning ( n = 8) and group Ⅲ diazoxide + 5-HD preconditioning ( n = 5) . The animals were anesthetized with intraperitoneal pentobarbital 50 mg?kg-1 and heparized (150 IU?kg-1). The hearts were excised and connected to Langendorff apparatus and passively perfused with normothermic (37℃), oxygenated (95% O2 , 5% CO2) Krebs-Henseleit buffer (KHB) at a constant perfusion pressure of 70cmH2O. A latex balloon was inserted via left atrium into left ventricle and filled with water. The left ventricular end-diastolic pressure (LVEDP) was maintained at 10 mm Hg. In group I cardiac arrest was induced with St Thomas Ⅱ solution after the heart was perfused with KHB for 30 min. In group 11 after being perfused with KHB for 15 min, the hearts were perfused with diazoxide 100?mol?L-1 for 5 min followed by 10 min wash-out with KHB , then cardiac arrest was induced as in group Ⅰ . In group Ⅲ after being perfused with KHB for 15 min, the hearts were perfused with diazoxide 100?mol?L-1 and 5-HD 100?mol?L-1 for 5 min, followed by 10 min wash-out with KHB, then the cardiac arrest was induced as in group Ⅰ and Ⅱ . All hearts were subjected to 30 min ischemia followed by 45 min reperfusion after cardiac arrest. Coronary flow (CF), HR, left ventricular developed pressure (LVDP) and dp / dt max were measured after the hearts were perfused with KHB for 15 min (baseline) and at 5, 10, 15, 30, 45 min after reperfusion was resumed. Coronary effluent was collected at 5 min after reperfusion was resumed for determination of myocardial enzymes, CK, LDH and AST. At the end of experiment myocardial specimen was obtained for determination of ATP content and ultrastructure examination. Results There was no significant difference in the baseline hemodynamic parameters among the three groups. The rates of recovery of LVDP and ? dp / dt max after reperfusion were significantly higher in group Ⅱ than those in group I and Ⅲ ( P 0.05 ) , Conclusion Diazoxide can protect myocardium from ischemia-reperfusion injury by opening the mitochondrial KATP channel in immature rabbits.

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.