CCM is an important part of modern medicine while the teaching of clinical medicine is the most poor one currently. Due to the discipline establishment in university,it’s necessary to arm the students with knowledge about CCM during their practice period and to have them set an overall viewpoint of medicine. In order to complete the clinical teaching better,a strict teaching management system should be established and the capability and quality of teachers should be improved.

Objective To observe the therapeutic effect of Xingnaojing Injection ( XI) combined western medicine for the treatment of septic encephalopathy (SE) . Methods A total of 60 SE patients were evenly randomized into treatment group and control group. Both groups were given routine western medicine therapy such as anti-inflammation, immunological and cerebral preventive treatment, or even mechanical ventilation, sub-hypothermia therapy, and insulin intensification therapy if necessary. Additionally, the treatment group was given intravenous drip of XI. The treatment for both groups lasted one week. Glasgow Coma Scale ( GCS) scores were observed before and after treatment for the evaluation of therapeutic effect of both groups. Moreover, the serum levels of C-reactive protein (CRP) and procalcitonin (PCT) , and the hospitalization fee and time in Intensive Care Unit were compared in both groups. Results ( 1) After treatment for one week, the improvement of GCS scores in the treatment group was superior to that in the control group ( P<0.05); the total effective rate was 90.0% in the treatment group and was 56.7% in the control group, the difference being significant ( P<0.05). ( 2) After treatment for 24 hours, serum CRP and PCT levels were decreased obviously in both groups (P<0.05), and the decrease in the treatment group after treatment for 24, 48, and 72 hours and for one week was superior to that in the control group ( P<0.05). ( 3) Hospitalization fee was less and hospitalization time in ICU was shorter in the treatment group than those in the control group ( P<0.05). Conclusion XI shows satisfactory effect on relieving illness and increasing cure rate, and on decreasing hospitalization fee and time in ICU.

Objective To explore into the relationship between the hepatolithiasis and the intrahepatic cholangiocarcinoma, and summarize the experience of early diagnosis and surgical treatment of these disease. Methods A retrospective clinical analysis was made in 28 cases of hepatolithiasis complicated by intrahepatic cholangiocarcinoma from September 1998 to December 2008. Results It was found that the incidence of cholangiocarcinoma in hepatolithiasis was 5.9%. The correct rate of preoperative ultrasonic diagnosis was 57.15% ( 16/28 ) ,and that of CT diagnosis was 46.43 % ( 13/28), and that of MRCP diagnosis was 40.00% (6/15). 12 cases were radically resected,12 cases were treated by palliative therapy, and 4 cases were examined only with biopsy, and all cases were followed up. The 1-,2-,and 3-year survival rate in radical surgery were 83.34% ,58.34% ,25.00% respectively. And the 1-year,and 2-year survival rate in palliative surgery group were 66.67% ,8.33% respectively. And all the cases examined only with biosy died in 6 months after the biosy. Conclusion Cholangiocarcinoma is related to hepatolithiasis. In patients of hepatolithiasis who were older than 40 years and have a long history of recurrent cholangitis, weight-loss in a short period, progressive jaundice, or intractable abdominal pain,the possibility of accompanying cholangiocarcinoma should be considered. The key of improving the therapeutic effectiveness was early diagnosis ,early treatment and striving for radical operation.

The effects of arginine vasopressin (AVP) on the contents of ir-?-EP and ir-Dyn A1-13 in ischemic brain regions of Mongolian gerbils were observed with radioimmunoassay in this study.The results showed that the contents of ir-?-EP were significantly increased and those of ir-Dyn A1-13 were decreased in ischemic cortex and hypothalamus after injection of AVP into the lateral ventricle. However, the contents of ir-?- EP were markedly decreased and those of ir-Dyn A1-13 were unchanged significantly in the ischemic cortex and hypothalamus after intraventricular infusion of AVP antiserum.

The purpose of this experiment was to study the role of arginine vasopressin (AW) in acute cerebral ischemic edema in mongolian gerbils. The results showed that intracerebroventricular injection (ICV) of AVP exacerbated the ischemic brain edema, while ICV of AW antiserum significantly decreased the ischemic brain edema. Nimodipine couldn't block this role of AW in ischemic brain edema. The cortical Na+ -K+ ATPase activity was significantly decreased, the contents of cAMP in the ischemic cortex and hypothalamus and the contents of cGMP in the hypothalamus were remarkably increased after ICV of AW. These suggest AW was involved in the pathophysiologic process of acute ischemic brain edema. And its mechanism might be the effect of AW on AW receptor mediated by cAMP, cGMP, and that in turn inhibited the Na+ -K+ ATPase activity of brain cell membrane, then exaggerated the formation of ischemic brain edema.

Hypoxiaisoneofthemostimportantfactorsinfluencingcancertherapyandclinicalprogno-sis.With positron emission tomography (PET)widely adopted in clinical practice,the development and appli-cation of PET hypoxia imaging agents has been much popular in the field currently.PET hypoxia imaging can detect tumor hypoxia region noninvasively,which has important significance for optimizing cancer treatment decisions and improving the prognosis of cancer.

Objective To investigate the expression of thiredoxin domain containing 5 (TXNDC5) in the synovial tissues and blood samples of various arthritic conditions and autoimmune diseases to further confirm the previous findings, investigate the relations between the expression level of TXNDC5 and clinical parameters of RA. Methods The expression of TXNDC5 in the synovium was quantitatively analyzed by immunohistochemistry, real-time quantitative PCR and Western blotting. The levels of TXNDC5 in blood and synovial fluid was determined using sandwich ELISA in patients with RA, osteoarthritis (OA), systemic lupus erythematosus (SLE), ankylosing spondylitis (AS) and normal controls. One-way ANOVA, LSD test and Spearmen' s correlation were used for statistical analysis. Results Immunohistochemistry indicated that TXNDC5 expression was significantly higher in the synovial tissues of RA (100%, 40±9) than in those of OA and AS(200%,4±4). Real time PCR and western blotting confirmed the above findings (P<0.01). Sandwich-ELISA indicated significantly elevated level of TXNDC5 in the blood and synovial fluid of patients with RA (A=1.31±0.37), but not in those of OA, SLE, and AS, the healthy controls (P<0.01). The level of TXNDC5 in the blood of RA patients (A=0.8185±0.299) was positively correlated with the level of anti-CCP (r=0.350, P =0.027). Conclusion The results suggest that the pronounced increase of TXNDC5 expression may stimulate synovial pannus formation in the hypoxic environment of RA.

Objective To investigate the protective effect of Shen Fu Injection (SFI) on cardiac function in sepsis rats and to explore the possible mechanism.Methods Forty SD male rats were randomly divided into 4 groups,namely normal control group,sham operation group,model group,SFI group.The sepsis model was established by cecal ligation and puncture (CLP).Thirty-six hours later,the arterial blood and left ventricular myocardium tissues were collected,and then the serum levels of tumor necrosis factor(TNF)-α and interleukin(IL)-1 were detected and the levels ofphosphorylated p38-mitogen-activated protein kinase (p-p38MAPK) and p38-mitogenactivated protein kinase (p38MAPK) in the supernatant of myocardial homogenate were detected.Results Thirty-six hours after modeling,left ventricular ejection fraction (LVEF) and left ventricular fractional shortening(LVFS) of the rats in the model group were significantly lower than those in the sham operation group (P ＜ 0.05).The heart function in SFI group was much improved compared with the model group (P ＜ 0.05).The serum TNF-α and IL-1 levels as well as p-p38/p38MAPK level in the supernatant of myocardial tissue of SFI group were lower than those in the model group (P ＜ 0.05).There were no significant differences of the above indexes between the sham operation group and the normal control group (P ＞ 0.05).Conclusion SFI has protective effect against sepsis myocardial injury.The mechanism may be related with the inhibition of p38MAPK phosphorylation in the myocardium,thereby reducing the release ofinflammatory cytokines in the pathway.

ObjectiveTo investigate the correlation between the methylation status of HLA class Ⅰ genes(HLA-A, -B and -C) in psoriatic epidermis and disease severity in patients with psoriasis vulgaris. MethodsDNA specimens were obtained from the lesional and nonlesional epidermis of 46 patients with psoriasis vulgaris and from the normal skin of 28 human controls. Methylation specific PCR (MSP) was conducted to detect the methylation status of CpG islands in the promoter region of HLA-A, -B and -C genes. The severity of psoriasis was evaluated by psoriasis area and severity index(PASI) scores. ResultsThe percentage of promoter methylation of HLA-B and HLA-C genes was 4.35％(2/46) and 21.74％(10/46), respectively in nonlesional epidermis, 4.35％ (2/46) and 4.35％ (2/46), respectively in lesional epidermis from these patients. No methylation was observed for the promoter of HLA-A, -B or -C gene in the normal control epidermis or for that of HLA-A gene in the nonlesional or lesional epidermis from the patients. The frequency of HLA-C gene promoter methylation in the nonlesional epidermis was significantly higher than that in the lesional epidermis and control epidermis, but was uncorrelated to the disease severity. No significant difference was observed for the methylation frequency of HLA-A or -B gene promoter among the three groups of specimens. Conclusion Abnormal methylation of HLA-C gene promoter is observed in patients with psoriasis vulgaris.

AIM: To observe the change of TNF-? mRNA in hypertrophic cardiac myocytes induced by pressure overload in rats and the effect of captopril. METHODS: Serum and heart were collected 42 days after the cardiac hypertrophy model made by pressure overload by abdomen aorta-constriction (AC). Hypertrophic parameter and the concentration of TNF-? in serum and left ventricle were determined by ELISA. TNF-? mRNA in cardiac myocytes was determined by in situ hybridization and analyze by ELIA image analysis system. The orientation of (TNF-?) mRNA in cardiac myocytes was also observed. RESULTS: Left ventricle hypertrophy was observed 42 days after operation. TNF-? mRNA in AC group elevated 98% compared to sham-operated group and descended 64.14% by captopril ((P