Most content of pathophysiology is built by black-box method.Pathophysiology learning is a process from black-box to grey box and white-box.Therefore,black-box teaching method is a good way to train students efficiently and rapidly.It fits pathophysiology education wel1.During teaching of pathophysilogical theory and experimental classes,we should carefully design various black-boxes,and introduce students try to resolve the black-box problems,so as to interest students in pathophysiology and train them the capability to analyse and resolve problems.

Nursing students in junior college have less class time and weaker foundation com-pared with nursing undergraduates, therefore it is more difficult for them to learn pathphysiology. In order to improve the teaching effect, we adopt the following strategies in pathophysiology teaching:①Guiding clinical nursing practice combining with specific situation in order to give students a deep understanding of pathophysiology knowledge and its significance. ②Urging students to review relevant basic knowledge before class and teacher to briefly introduce the basic knowledge before initiating class in order to reinforce the knowledge. ③Examples of daily life should be combined to make the abstract theory knowledge vivid. Teaching should revolve around the main line and key points should be highlighted. ④Dividing pathophysiology course into three units, and summary must be executed at the end of each unit.

Objective To explore the association between estrogen receptor gene polymorphism and systemic lupus erythematosns in women of Han nationality from Jiangxi province.Methods Whole blood samples were obtained from 95 female patients with SLE of Han nationality (18 with pre-menarche onset and 77 with post-menarche onset) and 100 healthy female controls from Jiangxi province.Genomic DNA was extracted from these samples followed by the analysis of polymorphism at Pvu Ⅱ and Xba I sites of estrogen receptor alpha gene with PCR-restriction fragment length polymorphism (RFLP).The frequencies of alleles and genotypes were compared between the control and patients and between patients with pre-menarche onset and those with post-menarche onset.Results The frequency of P allele was higher in patients with SLE than in the controls (35.8% vs 27%,P<0.05),but lower in patients with pre-menarche onset than in those with post-menarche onset (19.4% vs 39.6%,P<0.05).Further more,an increment was observed in the frequency of Xxpp genotype in patients with pre-menarche onset compared with normal controls and patients with postmenarche onset (16.7% vs 1% and 1.3%,both P<0.05).Conclusions The frequency of P allele in ER alpha gene is increased in female patients with SLE of Han nationality from Jiangxi province.The Xxpp genotype of ER gene may be associated with the susceptibility to pre-menarche onset SLE.

ObjectiveTo explore the mechanism of clopidogrel in human gastric epithelial cell line (GES-1) injury.MethodsSet up GES-1 cells monolayer culture model.Then the GES-1 cells were divided into negative control group,U0126 intervented group,clopidogrel intervented group and combined intervented group (U0t26 treated firstly then clopidogrel intervented).The cell proliferation and apoptosis in each group was examined by methyl thiazolyl tetrazolium (MTT) assay and Flow cytometry.TheexpressionofphosphorylatedERK1/2ineachgroupwasdetectedby immunocytochemistry method,and the expression quantity of phosphorylated ERK1/2 in each group was measured by western blot.ResultsThe result of MTT assay showed that compared with negative control group,the proliferation of GES-1 cells was inhibited in U0126 group,clopidogrel group and combined intervented group,and the inhibition percentage was 21.8％ ±2.7％,46.3％ ± 3.4％ and 82.9 ％ ± 0.8 ％ respectively ( F=615.556,P =0.000 ).The result of immunocytochemistry indicated that the expression of p-ERK in U0126 group,Clopidogrel group and combined intervented group decreased compared with negative control group,which was 10.80±1.64,7.20± 1.64,4.40±0.89and 1.40±0.55 respecitively (F=49.426,P=0.000).The result of western blot and immunocytochemistry was of the same trend.Conclusion In GES-1 cell model,clopidogrel may injureGES-1 cells through MAPK/EPK signal transduction pathway.

Objective To observe the surgical results of prominent malar-complex and to explore the more effective methods by improving the shape of face through operation.Methods Total 80 patients of prominent malar-complex were treated by strengthening reduction plasty of mala and zygoma through intra-oral approach accompanied with minor pre-auricular incision and the midfacial SMAS lift in order to improve the shape of prominent malar-complex and to prevent malar-cheek parenchyma sag.Results The face skeleton and midfacial chalasis of all patients were significantly improved with satisfaction.All the patients obtained good results during the follow-up period of over six months.Of them there was one case of maxillary sinusitis that had been cured by further symptomatic treatment.Conclusions Strengthening reduction plasty of mala and zygoma accompanied with the midfacialSMAS lift can properly and safely improve the facial shape of patients with prominent malar-complex.

Objective To investigate an effective method of treating primary hepatic cancer(PHC) with portal venous tumor thrombosis (PVTT). Methods The clinical data Of 23 patients with PHC and PVTT were retrospectivly analysed. Results Of the 23 patieats after hepatoma resection and PVTT extraction, continuous micro dose infusion chemotherapy or perfusion chemotherapy by DDS was adopted. In 8 patients with main portal vein tumor thrombus, 2 died, 4 recured in 6 months. In 8 patients with the first class branch of portal vein tumor thrombus, 2 recurrd in 6 months and 6 recurred in 12 months. In 4 patients with secondary class branch of portal vein tumor thrombus, l recurred in 12 months (P

Objective To summanrize the operative method and follow-up data of total aortic arch replacement combined with transaortic stented graft implantation into the descending aorta (Sun's procedure) for acute Stanford type A aortic dissection.Methods Between August 2004 and March 2012,73 patients with acute type A aortic dissection underwent this procedure.60 males and 13 females ranging in age from 26 to 79 years (mean age,49,6 years).Right axillary or femoral artery cannulation was routinely used for cardiopulmonary bypass.Cerebral protection was achieved by bilatero-antegrade or selected hrain perfusion.The stented elephant trunk was implanted throuugh the aortic arch under hypothermic circulatory arrest.The stented elephant trunk was a 10cmlong self expandable graft.Patent false lumina were evaluated using computed tomography 3 months and once each year after discharge to evaluate the postoperative time course of the residual false lumen.Results Mean cardiopulmonary bypass time was (248.1±69.8)min,and selected cerebral perfusion time was (38.2±10.5)min.Hospital morality was 6.85 ％ (5/73).Thrombus obliteration of the residual false lumen in the descending thoracic aorta was observed in 9 1.7％ of the aortic dissections 3 months postoperatively.The mean follow-up time was(36.4 ± 31.6)months (range,2 to91 months).Survival at 1,5,7 years was 97％,87％ and 81％,respectively.Conclusion Total aortic arch replacement combined with transaortic stented paft implantation into the descending aorta is an effective treatment and n more promising choice for acute type A aortic dissection.

Objective: To discuss the orbital fat autograft for lower baggy eyelid with tear trough deformity and its therapeutic effect through tranconjunctival approach. Methods: The patients with lower eyelid bag and tear trough deformity were included into the study. The included 32 patients met the following criterias: ①less than 40 years old; ②lower eyelid skin was not relaxed; ③less than 1 s in Snap test; ④Hirmand type Ⅰ and Ⅱ. They were treated with tranconjunctival lower blepharoplasty combined with the tears ligament relaxation. The orbital fat was repositioned on the depression site above orbital periosteum to correct tear trough deformity. The effect was evaluated through Tear Trough Rating Scale (TTRS) and satisfaction degree. Results: Three cases with Hirmand type Ⅱ didn’t have good effect. Among them, the baggy eyelid was corrected in 2 cases, while the tear trough deformity need additional hyaluronic acid injection. One patient underwent secondary lower blepharoplasty through cutaneous incision. Good effect was achieved in the other 29 cases with no depression deformity and eyelid withdrawal. The TTRS scores 6 months after operation was significantly improved(P<0.01). Satisfaction degree was 100%(14/14) and 83.3%(15/18) in type Ⅰ and Ⅱ patients. Conclusions The technique can simultaneously improve lower eyelid bag and the tear trough deformity. It can be applied in periorbital rejuvenation for middle-aged and young patients.

Objective:To investigate multimodality imaging characteristics and clinical features of lymphomatosis cerebri (LC) and reasons for misdiagnosis,with the goal of potentially facilitating an early and accurate diagnosis for this often-missed disease.Methods:Clinical data and cerebral multimodality imaging findings from 11 patients with LC proven basing on pathology in the Affiliated Hospital of Guizhou Medical University from November 30, 2011 to December 28, 2020 were retrospectively extracted, analyzed, and reviewed in combination with the literatures.Results:The common presenting symptoms with subacute onset included cognitive decline (8/11), gait disturbance (9/11), and behavioral disturbance (5/11). Test of cerebrospinal fluid showed that the number of cells and the level of protein increased (8/10), the sugar content (2/10) and chloride (4/10) decreased. The imaging manifestations of 11 patients with LC were diffuse lesions of bilateral cerebral white matter in the both deep and lobar lesion distribution, involving the cerebral cortex and subcortical white matter in eight cases (8/11), basal ganglia in seven cases (7/11), thalamus in five cases (5/11), cerebellum in six cases and brain stem in six cases (6/11). All 11 patients showed equal or slightly low-density shadows on CT plain scan and slightly longer T 1WI and T 2WI signals on magnetic resonance imaging. Six cases (6/11) had no obvious enhancement in the early stage, and five cases and six follow-up cases showed heterogenous spots, patches, nodules or clusters of distinct enhancement. Diffusion-weighted imaging showed non restricted diffusion in nine (9/11) cases initially diagnosed, and restricted diffusion in two cases (2/11) and nine follow-up cases, which were hyperintense on diffusion-weighted imaging and hypointense on apparent diffusion coefficient maps. Five patients (5/5) presented a marked decrease in N-acetyl aspartic acid (NAA)/creatine (Cr) and increase in choline (Cho)/Cr on hydrogen proton magnetic resonance spectrum, including an increase in lipid/Cr in three cases. One case (1/3) showed no abnormal increase in lesion metabolism, and two cases (2/3) showed slightly increased uptake on positron emission tomography/CT. Conclusions:Diffuse bilateral cerebral lesions especially in deep and lobar region, without enhancement or with patchy enhancement, marked decrease in NAA/Cr and increase in Cho/Cr and Lip/Cr are suggestive of LC. Misdiagnosis may be mainly due to insufficient understanding and improper brain biopsy.

Objective:To investigate the effect of expanded polytetrafluoroethylene (E-PTFE) combined with autologous costal cartilage in rhinoplasty.Methods:Forty-two patients who underwent rhinoplasty in the form of E-PTFE combined with autologous costal cartilage in the Department of Plastic Surgery, Jiangsu Province Hospital of Chinese Medicine from January 2017 to December 2018 were selected as the research object. The polytetrafluoroethylene combined with autologous costal cartilage was used for rhinoplasty. The dorsal nasal skin was dissected through an inverted " V" type combined with subalar cartilage incision, and then the costal cartilage was cut into appropriate cartilage slices to build the nasal tip stent. According to the degree of elevation of the nasal dorsum, the sculpted E-PTFE was placed under the nasal dorsal fascia. The rectus abdominis fascia covered the apex of the nose, and the incision was closed by suture.Results:The nasal appearance of the forty-two patients was significantly improved, with good nasal shape and no serious complications. After 6-12 months of follow-up, 40 cases were satisfacted with the effect of the rhinoplasty, accounting for 95.2%.Conclusions:The use of polytetrafluoroethylene combined with autologous costal cartilage can effectively raise the dorsum of the nose, extend the length of the nose, project the nasal tip in the rhinoplasty. This procedure is accurate and safe, reach a favorable long-term shape and own high satisfaction, and it thus is worthy of popularization in clinic.