In view of the clinical graduate students' problems existing in the teaching of evidence-based medicine, such as having little knowledge of the course, lack of interest, not knowing how to retrieve, evaluate evidence and effectively use evidence, Xinjiang Medical University has car-ried on the reform in the curriculum content, teaching process, evaluation content and method of the teaching of EBM for the clinical graduate students. Practice shows that the clinical graduate students have significant improvement in objective examination average score, subjective examination average grades, total score and the students' satisfaction of the classroom teaching, and at the same time their interest in EBM courses and clinical thinking have also improved.

Objective To evaluate the effectiveness of Inditherm warming system on prevention of intraoperative hypothermia in aged patients with transurethral resection of the prostate(TURP).Methods Fifty two aged patients with benign prostate hyperplasia(BPH) undergoing selective TURP were randomly divided into two groups:observation group(n =27) and control group(n =25).Patients in observation group received temperature prevention from hypothermia by using the patient warming system which temperature was set to 38-40 ℃.The control group were not provided with warming mattress and the ambient temperature of operation room was maintained at 21-23 ℃.The changes of the rectal temperature were continuously monitored during the operation and changes of vital signs,part of postoperative indicators were observed.Results The temperature of patients in both groups decreased after anesthesia.The decreasing degree of rectal temperature at 30,45,60,and 90 min after anesthesia and at the end of operation in observation group was less than those in control group[20min:(36.6±0.4)℃ vs(36.3±0.6)℃,t =2.1362;30 min:(36.4±0.5) ℃ vs(35.8±0.4) ℃,t =4.7536;45 min:(36.2±0.3)℃ vs(35.5±0.5)℃ ;t =6.1751;60 min:(36.1±0.4)℃ vs(35.3±0.4)℃,t =7.2057;90 min:(36.0±0.3)℃ vs(35.3±0.6)℃,t =5.3818;at the end of operation:(36.0±0.4)℃ vs(35.3±0.5) ℃,t =5.5948 ; P ＜ 0.05 or P ＜ 0.01].The occurrence rate of hypothermia(rectal temperature ＜36 ℃) after operation in observation group was lower than that in coutrol group[25.93％(7/27) vs 92.00％(23/25),x2=23.218,P ＜ 0.01];The occurrence rate of shiver was significantly lower in observation group than that in control group[14.81％(4/27) vs 64.00％(16/25),x2 =13.267,P ＜ 0.01].The VAS scores assessment of pain in the observation group was significantly less than that in the control group[(2.45±1.88)points vs(3.79±1.63) points,t =2.7362,P ＜ 0.01].The length of stay was shorten[(5.37±±2.31) d vs (7.13±3.06) d,t =2.3518,P ＜ 0.05]and the prognosis was better in observation group.Conclusion The patient warming mattress can effectively prevent the occurrence of hypothermia of aged patients undergoing TURP and reduce the occurrence of associated complication.

Aim To determine what effects propofol exerts on apoptosis in hippocampal neurons caused by anoxia-reoxygenation.Methods Newborn SD rats(0.05).When pretreated with propofol,neurons proliferation increased and apoptosis decreased(P

Macrophages have been identified to play an important role in acute and chronic renal injury through exerting multiple biological effects.This review focus on the origin of macrophages in kidney, mechanism of renal injury and strategy of inhibiting macrophage infiltration. [

Objective To assess the usefulness of contrast echocardiography in differential diagnosing space-occupying lesions of the heart.Methods Contrast echocardiography was assessed for 38 patients of space-occupying lesion of the heart (SOLH).Contrast enhancement of SOLH was assessed visually,comparing with that in the adjacent myocardium:significant contrast enhancement,intensity higher than or equal to the adjacent myocardium; mild or partial contrast enhancement,intensity lower than the adjacent myocardium,or no contrast enhancement.Respectively,malignant tumors,benign tumors,and thrombus were diagnosed.Twenty-eight patients among the 38 cases had gold standard diagnosis.The consistency between visual assessment diagnosis and gold standards were compared with Kappa statistic.Results Visual semi-quantitative diagnosis of contrast echocardiography:thrombus,benign tumors and malignant tumors were diagnosed for 8,8 and 12 cases,separately.Except two highly vascular benign tumors (1rhabdomyoma and 1 paraganglioma) were misdiagnosed as malignant tumors,the rest 26 cases matched gold standard diagnosis.Quantitative analysis of contrast echocardiography,16 cases were suitable for quantitative an alysis,10 cases were diagnosed as benign tumors or thrombus (quantitative analysis could not differentiate the two),the rest 6 cases were diagnosed as malignant tumors.Quantitative analysis got the same 2 misdiagnosis as visual semi-quantitative diagnosis.Kappa value on visual semi-quantitative diagnosis of contrast echocardiography comparing with gold standard diagnosis was 0.892.Conclusions The characteristics of vascularity of SOLH can be accurately determined by the contrast enhancement level in diseased region through visual semi-quantitative analysis with contrast echocardiography.Contrast echocardiography can be mainly used in SOLH except thrombus that has been clearly diagnosed,especially for patients with on going or fore-past malignancy in other organs.

Objective To assess the aorta elastic properties in the procession of atherosclerosis by ultra‐high frequency ultrasound ,and to detect the relationship between the aorta elastic properties and the atherosclerotic plaque burden .Methods Mice deficient for the apolipoprotein E (ApoE‐/‐) with high‐cholestrol diet were studied as an age‐dependent model of atherosclerosis .At 8 ,16 ,24 and 32 weeks of age , the blood pressure in the ascending aorta was measured by catheter ,and the aorta mechanical properties were assessed by measuring aortic elastic modulus of the ascending aorta with ultra‐high frequency ultrasound .The plaque burden was assessed by high‐frequency ultrasound and Masson′s trichrome stain , separately .Results Vessel thickness at the lesion‐prone sites of the lesser curvature of the aorta and the proximal brachiocephalic artery increased with age ,consistent with the Masson′s trichrome staining which showed age‐dependent worsening of atherosclerosis in the mice model .Elastic modulus of the aorta significantly increased from 8 to 32 weeks of age in E‐/‐mice .There was a statistically difference between any two groups .Conclusions With the progression of atherosclerosis and the increased plaque burden ,aorta mechanical properties deteriorated in Apo E‐/‐mice .Ultra‐high frequency ultrasound was a potential tool for assessment of plaque burden and aorta mechanical properties in mouse model .

Objective:To analyze the effect of tanreqing injection on the serum levels of transforming growth factor-β (TGF-β) and matrix metalloproteinases-9 (MMP-9) of patients with chronic obstructive pulmonary disease (COPD).Methods:102 patients with COPD were divided into the control group and the observation group according to random number table method,52 cases in each group.The control group was treated with routine therapy,and the observation group was treated with Tanreqing injection based on the control group.The serum TGF-β,MMP-9 levels,forced vital capacity (FVC),1 s forced expiratory volume (FEV1),partial pressure of carbon dioxide (PaCO2),oxygen partial pressure (PaO2),CD4+,CD86,CD4+/CD8+,syndrome integral,clinical efficacy and incidence of side effects were observed and compared between the two groups.Results:After treatment,the serum TGF-β,MMP-9 levels,PaCO2 and syndrome integral of observation group were significantly lower than those of the control group,the PaO2,CD4+,FVC,FEV1,CD4+/CD8+ and the clinical efficacy of observation group were obviously higher than those of the control group (P＜0.05).There was no significant difference in the incidence of side effects between the two groups (P＞0.05).Conclusion:Tanreqing injection could effectively reduce the serum levels of TGF-β and MMP-9,and improve the arterial blood gas,lung function and immune function in treatment of patients with COPD.

Objective To evaluate left ventricular function in the way of intracavitary vortex by vector flow mapping(VFM),and to demonstrate the formation and variation of the vortex. Methods Twenty-six patients with dilated cardiomyopathy(DCM) and 44 healthy controls were involved. The velocity distribution imagings on the section plane of the flow in the left ventricle were obtained by VFM, the location of the vortex and its variation in every phase of cardiac cycle were focused,and series parameters were measured,such as the diameter of the vortex (transverse diameter, vertical diameter), number of the vertex. Results relaxation(e) period. Vortices were observed mostly during diastolic period, nearby the anterior leaflet of mitral valve,middle upper 1/3 of left ventricle,and their shapes changed 2 - 3 times. The diameters of the vortex (transverse diameter,vertical diameter) , number of the vertices in one cardiac cycle during 7 phases mostly nearby the cardiac apex, middle lower 2/3 of left ventricle, and their shapes changed 4 - 5 times.Compared with control group,the diameters of the vortex (transverse diameter, vertical diameter) during 7 phases in DCM group were bigger,and number of the vertices were more ( P ＜0.01 ). The diameters of the vortex (transverse diameter, vertical diameter), number of the vertices within DCM group in one cardiac cycle during 7 phases were significantly different ( P ＜ 0.01 ). Conclusions VFM can demonstrate the variation of intracavitary vortex. Vortex in DCM group were significantly bigger than those of control group.

Objective:To investigate the relationship between vulnerability of mouse coronary artery plaque and downstream myocardial perfusion and myocardial strain.Methods:Thirteen ApoE knockout mice with stable coronary plaques (stable plaque group)and 13 ApoE knockout mice with vulnerable coronary plaques(vulnerable plaque group) were selected as the experimental group, and 15 sex- and age-matched C57BL/6 mice with the same genetic background as ApoE mice were chosed as the control group. Myocardial contrast echocardiography (MCE) was carried out to quantify regional myocardial perfusion at rest and during adenosine stress using a Vevo 2100 system (Visual sonics). Replenishment curves of myocardial contrast were obtained, and rates of signal rise (β) and plateau intensity (A) were recorded. MBF was estimated by the product of A and β. Speckle tracking imaging combined with adenosine stress test was used to evaluate the longitudinal strain of left ventricular myocardium in mice. The vulnerability of the plaque was assessed by histopathology in serial tissue sections of proximal and middle left coronary artery according to the previously reported method.Results:There were no significant differences in body weight, heart rate, left ventricular end diastolic volume, left ventricular end systolic volume, left ventricular mass and ejection fraction among the three groups( P>0.05). The levels of serum triglyceride, total cholesterol, high density lipoprotein and low density lipoprotein in stable plaque group and vulnerable plaque group were significantly increased when compared with those in control group (all P<0.05). The pathological results showed that the coronary luminal stenosis rates in the stable plaque group and the vulnerable plaque group were (74.3±4.9)% and (75.5±7.1)% respectively, with no significant difference between the two groups( P>0.05). MBF of the middle anterior septum and left ventricular posterior wall in the experimental groups were significantly decreased when compared with that in the control group both in the resting status and during adenosine stress(all P<0.05). There were no significant differences in the MCE parameters between the stable plaque group and the vulnerable plaque group at rest( P>0.05). However, during adenosine stress, MBF of the vulnerable plaque group was decreased more significantly than that of the stable plaque group ( P<0.05). Compared with the control group, the values of longitudinal strain of the left ventricle in both experimental groups were decreased during resting status, without statistical significance (all P>0.05), but decreased significantly during adenosine stress and with more decrease in the vulnerable plaque group (all P<0.05). Conclusions:For the same degree of coronary artery stenosis in mice, the coronary artery vulnerable plaque group has less downstream myocardial perfusion and myocardial strain than the stable plaque group during adenosine stress. That is, the plaque vulnerability can affect the downstream myocardial perfusion and myocardial strain in the mouse model.

This study was aimed to assess the methodological quality of systematic literature reviews on the efficacy and safety ofTong-Xin-Luo(TXL) using the AMSTAR statement. The literatures were searched from major domestic and international databases include the CJFD Database, VIP Database, CNKI database, CBM Database Online, WanFang Data and TCM Database, Medline, Pubmed, ISI Web of knowledge, Web of science, from the database was built to 20th December, 2014. And 5 evaluators screened the literatures independently according to the inclusion and exclusion criteria. Then, all systematic reviews were assessed using the list of AMSTAR statement. The results showed that 22 literatures were finally included, which contained 17 systematic reviews and 5 meta-analysis. In the included literatures, there were different degrees of impairments on the methodological and reporting quality, which were mainly focused on program and registration, retrieving and collecting literatures, inclusion and exclusion criteria, authentic assessment, data processing, funds, and etc. The average reporting rate of AMSTAR statement was 57.02% in all included literatures. It was concluded that the methodological quality of systematic literature reviews on the efficacy and safety of TXL was relatively low from the current level of average reported rate, which affected the quality of the article. It indicated that there were different degrees of impairments in all links of test reports in current systematic reviews, which will be bound to affect the reliability of clinical evidence and the determination of clinical decision. It showed that the methodological quality of writing of such articles should be in compliance with entries of AMSTAR statement to improve its quality.