The multi-media teaching mode is more and more widely used in all kinds of teaching activities. This paper describes multi-media teaching and its development.It focuses on discussing the multi-media materials and their collecting methods, collecting tools as well as the common document formats.

Objective To study the clinical significance of C-reactive protein(CRP),neutrophil granulocyte ratio(N% ) in acute exacerbations of hospitalized patients with chronic obstructive pulmonary disease ( COPD ). Methods The serum CRP levels,the gross of N% were detected of the same 71 patients with acute exacerbations of COPD before treatment and after getting better. And the correlations among above-mentioned indexes,the days counter before getting better and the days counter during hospitalization were observed. Results (1) The levels of CRP and N% of patients after getting better were significantly lower than those before treatment(P ＜0. 01). (2) There was a significant correlation between N% and the days counter before getting better(r =0.240,P ＜0.05) and also a significant correlation between the days counter before getting better and the days counter during hospitalization (r = 0. 567, P ＜0.01). Conclusion The serum CRP level and N% were objective markers in estimating pulmonary infection in COPD patients with acute exacerbations. And N% was a reliable indicator of judging the days counter before getting better and better than CRP.

Objective To investigate the impact of cavoplasty on the piggy back liver transplantation and on the prevention of hepatic outflow block. Methods Three patients received modified piggy back liver transplantation with venacavoplasty under single veno venous bypass. Results All the recipients had stability of dynamic circulation, short anhepatic phase and decreased hemorrhage during operation. Postoperatively all the patients recovered quickly with good liver function without any complications. Conclusions Venacavoplasty may overcome outflow block in piggy back liver transplantation and the technique can shorten anhepatic phase and decrease complications.

Objective To investigated the prevalence of obesity and metabolic syndrome (MS) and the relationship of non-alcoholic fatty liver disease (NAFLD) with MS in Hangzhou of Zhejiang province. Methods A total of 3500 subjects who were negative for hepatitis B surface antigen marker were selected to take physical examinations. Body height, body weight, blood pressure, alanine aminotransferase,fasting blood glucose,high-density lipoprotein cholesterol,and triglyeerides were recorded. B-ultrasonography of the liver and gallbladder was undertaken. Results The prevalence of MS in the NAFLD or normal control group was 25.49% and 8. 61%, respectively ( P ＜ 0. 05 ). In multivariate logistic regression analyses, MS patients were 3. 927 times more likely to be NAFLD-related. Increased body mass index (BMI) and triglyceride were significantly associated with NAFLD among MS patients. Conclusion BMI and triglyceride level may be the main risk factors of NAFLD-related MS.

Aim To investigate the expression of CD31 , CD105 , HIF-1αand VEGF in xenografts tumor of HT-29 tumor cells during different stages of growth. Methods HT-29 tumor cells were transplanted into nude mice, the tumor was removed when the tumor volumes reached <100 mm3 , 100 ~300 mm3 and >300 mm3 respectively. Immunochemical method was a-dopted to detect the expression of CD31 , CD105 , HIF-1α and VEGF. Results HT-29 xenografts tumor vol-umes <100 mm3 , 100 ~300 mm3 , and >300 mm3 showed expressions with CD31-MVD at 37.40±4.17 , 18.80±1.72 and 14.20±2.23 respectively; CD105-MVD at 22.80 ±3.54 , 15.60 ±1.35 and 10.20 ±2.48; positive expression rate of VEGF was 26.20%
±0.83%,40.73% ±6.29% and 13.41% ±1.20%respectively; while positive expression rate of HIF-1αwas 3.20% ± 2.97%, 11.89% ± 1.94% and 80.62% ±3.47% respectively. On the other hand, for different volumes group, CD31-MVD, CD105-MVD, VEGF and HIF-1αexpression ratios had signifi-cant differences ( P <0.01 ) . Conclusions The ex-pression of MVD and vascular-related factors within the tumor caused by HT-29 xenografts tumor in nude mice at different growth stages was varied. There was a cer-tain correlation between tumor volume and MVD, VEGF, HIF-1α.

Objective To investigate the value of D‐dimer (D‐D) ,cardiac troponin T(cTnT) and myocardial enzymogram detec‐tions in clinical diagnosis of acute myocardial infarction (AMI) .Methods 36 cases of AMI patients (AMI group) and 20 cases of healthy people (control group) were selected as study subjects .The plasma levels of D‐D ,cTnT and myocardial enzymogram of two groups were detected ,and the sensibility and specificity of these indexes were analyzed .Results The levels of D‐D ,cTnT ,CK ,CK‐MB ,AST and LDH in AMI group were significantly higher than those of control group (P<0 .05) .The positive rates of cTnT ,D‐D and myocardial enzymogram in AMI patients were 91 .67% ,69 .44% ,and 66 .67% ,respectively .The positive rate of cTnT was significantly higher than those of D‐D and myocardial enzymogram (P<0 .05) .Both of the diagnosis sensibility and specificity of plasma cTnT were significantly higher than those of D‐D and myocardial enzymogram (P<0 .05) .Conclusion Comparing with D‐D and myocardial enzymogram ,plasma cTnT has better diagnosis sensibility and specificity .Joint detection of kinds of indexes could improve the accuracy .

Objective To develop a new method for detection of anti-dsDNA antibodies Methods Plasma double stranded DNA were used as antigen substrate and derived with fluorescence thiazole orange homodimer Capillary electrophoresis with laser induced fluorescence was used for the detection of anti dsDNA antibodies of patient with Systemic lupus erythematosus (SLE) Results 23 out of 40 patients with SLE were positive(57 5%); 1 out of 25 patients with other autoimmune disease were positive; none of 45 controls were positive Comparison of this assay with Farr and dot immunobinding assay(DIBA)shows that CE LIF was more sensitive than DIBA and more specific than Farr Conclusions The assay was rapid, simple and reproducible CE LIF may become a routine assay for determination of anti dsDNA antibodies

BACKGROUND:Thoracic vertebrae connected with the ribs of corresponding segments constitute the thorax. Because of thoracic vertebrae deeply and complicated structure, it is difficult to operate or to expose thoracic vertebrae completely. The traditional anterior ways can thoroughly remove the focus and achieve a good internal fixation, but this treatment needs to cut the rid. The surgeon discovered in years of clinical practice that distraction of intercostal space without cutting off the ribs could completely remove the focus and achieve fixation and fusion. OBJECTIVE:To explore the feasibility, advantages and disadvantages of anterior plate fixation and autologous bone graft fusion in the repair of thoracic spinal tuberculosis.
METHODA total of 30 cases of thoracic spinal tuberculosis were enrol ed. On the base of traditional thoracic spinal anterior surgical approach, the rib was reserved. Anterior distraction device was used to open the ribs for clearance and to move the focus of thoracic spinal tuberculosis. Autologous ilium was obtained and subjected to fusion and anterior plate fixation. Visual Analog Scale, Oswestry Disability Index, Frankel grade and Bridwel bone healing rating were used before and after treatment.
RESULTS AND CONCLUSION:A total of 30 patients were fol owed up for 3-60 months. The bone healing (class A) was seen, but no fistula formation was visible. Nerve compression symptoms were improved, without aggravating cases. Postoperatively, the average Cobb angle correction was 10.32°. After 6 months, imaging revealed bone fusion of affected vertebral body. After 18 months, the vertebral height was not lost obviously, no recurrence of vertebral tuberculosis. These results indicated that anterior intercostal space without cutting ribs exposed clearly, showing a large space, where can meet the requirement of first-stage debridement fixation and fusion in the repair of thoracic tuberculosis. The pathological changes were visibly clear;the focus was thoroughly removed, and the ribs were reserved. The outcomes are identical to rib resection. Simultaneously, autogenous iliac trilateral cortex has good supporting effects. Loose cancellous bone mesh has good osteogenesis and is helpful to bone healing.

We detect the effect of soil drought stress on part physiological activities of Masson pine of different family.The dark respiration rate of Masson pine will decrease with different range of the decrease of leaf water potential.The photosynthesis rate will increase with the descendant leaf potential and soil potential,which demonstrates that Masson pine has much higher productivity of drought stress.Meanwhile,the relative plasma membrane permeability plasma will be enlarged and the membrane will be hurt more deeply when Masson pine meets with higher drought stress.The relationship between relative plasma membrane permeability and leaf potential shows significant linear correlation.

Objective To assess the clinical value of retroperitoneoscopic pyelolithotomy (RPPL) and retroperitoneoscopic ureterolithotomy (RPUL) in treating renal pelvis or ureteral calculus. Methods A total of 81 patients with renal pelvis or ureteral calculi underwent RPPL and RPUL on 88 sides. Of them 30 were women and 51 were men. Their age ranged from 12 to 65 years (mean,36 years).The calculi were found on left side in 41 cases,on right side in 33,and on both sides in 7.The calculi were 0.8 to 3.0 cm in diameters.Pyelolithiasis occurred in 11 cases,upper ureteral calculi in 68 cases and middle in 2 cases.Of them 3 had radioparent calculi in ureter.In these patients,21 had experienced unsuccessful ESWL,or ureterorenolithotripsy (URL),or both;2 had undergone conversion to retroperitoneoscopic surgery when the procedure failed in minimally invasive percutaneous nephrolithotomy (MPCNL) or perforation occurred during URL. Results All the stones were completely removed by single procedure.The operation time was between 30 and 210 min with a mean of 65 min.The intra-operative mean bleeding volume was 25 ml (range,10 to 60 ml).30 cases with other urinary tract diseases were cured by retroperitoneoscopic surgery at the same time.The hospital stay was from 4 to 10 days.During the follow-up (1 to 16 months) for the 60 cases,no recurrent calculus was found. Conclusions In selected patients with large,hard,radioparent,chronically impacted pelvis or upper ureteral stones,especially in solitary kidney,RPPL and RPUL may be considered as the first-line treatment and as a salvage procedure for failed ESWL and endoscopy.With these procedures the urinary tract complications can be treated concomitantly.