The main teaching methods for medical students and residents are didactic teaching,rote learning and apprenticeship.Although these teaching methods can be good for imparting knowledge,they are obviously insufficient for the training of technical skills,team cooperation and complex decision making.Application of biomedical engineering simulation in the anesthesia teaching can partially compensate for the insufficiency.The progress of biomedical engineering simulation in anesthesia teaching is reviewed and the educational trend was explored.

OBJECTIVETo compare the efficacy differences between fire needling therapy and oxycycline tablets for the treatment of moderate to severe acne vulgaris.

METHODSSixty cases of moderate to severe acne vulgaris were randomly divided into a fire needling group and a medication group, 30 cases in each one. The pricking method of fire needling at Ashi points around damaged skin was applied in the fire needling group, once every five days for totally 4 times. The oral administration of oxycycline tablets, 100 mg, was applied in the medication group, twice daily for 20 days, also external application of adapalene gel before sleep was adopted. The fading time of skin damage, including papule, pustule, nodule and cyst in the two groups was recorded and clinical efficacy was compared. After the treatment, two-month follow-up was performed to observe the recurrence rate in the two groups.

RESULTSThe curative rate was 69.0% (20/29) in the fire needling group, which was statistically different from 40.0% (12/30) in the medication group (P < 0.05). The fading time of each type of skin damage in the fire needling group was shorter than that in the medication group [papule: (2.67 +/- 0.66) d vs (4.36 +/- 0.61) d; pustule: (2.47 +/- 0.57) d vs (4.27 +/- 0.55) d; nodule: (7.76 +/- 1.06) d vs (9.88-1.30) d; cyst: (11.81 +/- 1.54) d vs (14.79 +/- 0.89) d, all P < 0.05]. The recurrence rate was 46.4% (13/28) in the fire needling group, which was not significantly different from 44.0% (11/24) in the medication group (P > 0.05).

CONCLUSIONThe acne vulgaris could be fast and effectively treated by fire needling therapy, which has shorter fading time than oxycycline tablets. However, the preventive effect is not different between the two theraies.

Acne Vulgaris ; therapy ; Acupuncture Therapy ; Adolescent ; Adult ; Female ; Humans ; Male ; Middle Aged ; Treatment Outcome

Objective To explore the value of three antibodies in the differential diagnosis of papillary thyroid carcinoma ,by de‐tecting the expression of HBME‐1 ,CK19 and CD117 in papillary thyroid cacinoma ,thyroid follicular adenoma and Hashimoto′s thy‐roiditis tissues .Methods Totally 85 cases were collected from January 2013 to December 2015 ,including papillary thyroid cacino‐ma ,thyroid follicular adenoma and Hashimoto′s thyroiditis .They were immunohistochemical stained by HBME‐1 ,CK19 and CD117 .SPSS16 .0 software was used to analyze the relationship between the staining results with different pathological changes . Results The positive rates of HBME‐1 ,CK19 and CD117 were 87 .3% ,98 .2% ,and 7 .3% ,respectively .The positive expression of them in benign and malignant groups had significant difference (P< 0 .05) and their consistency checking Kappa were 0 .582 , 0 .551 ,and 0 .874 ,respectively .Conclusion In the differential diagnosis of papillary thyroid carcinoma and benign lesions ,CD117 is better than HBM E‐1 and CK19 .It′s possible to use a combination of them in practice .

Objective To evaluate the value of real time three-dimensional ultrasound in differentiating benign and malignant breast tumors. Methods One hundred and fifty-three patients with breast tumors were examined with real time three-dimensional ultrasound. The results were compared with post-operative pathological results. Results A sign of malignancy on the coronal plane was observed by three-dimensional ultrasonography,named “sun-like symptom”,because the sign looked like a shining sun:striated hyperechoic or iso-echoic images scattered radially around cancers,together with the distortion of normal tissue.The accuracy of the sign in differentiating benign and malignant breast tumors was 86.93 %( 133/153 ), the sensitivity was 78.38 %( 58/74 ), and the specificity was 94.94 %( 75/79 ). Conclusions Real time three-dimensional ultrasound is a valuable and new technique in differentiating benign and malignant breast tumors.

Objective To investigate effects of inhalation of sevoflurane at different time on pulmonary function and oxidative stress in patients with one lung ventilation.Methods 80 patients who needed external surgery according to the random grouping principle,were divided into sevoflurane preconditioning group(OLV for 30min after inhalation of sevoflurane),sevoflurane treatment group(OLV inhalation of sevoflurane),sevoflurane inhalation group(inhalation of sevoflurane),total intravenous group(propofol and remifentanil anesthesia) four groups,20 patients in each group,each group was treated accordingly.The differences of serum malondialdehyde(MDA),superoxide dismutase(SOD),lactate dehydrogenase(LDH) and intrapulmonary shunt(Qs/Qt) in the four groups were observed and compared at different time points.Results Compared with the other three groups,the intrapulmonary shunt fraction of the sevoflurane preconditioning group were significantly lower[(4.9±0.6)% vs.(6.1±0.5)%,(6.3±0.6)%,(5.9±0.4)%](x2=5.415,5,882,4.977,all P<0.05).The serum levels of MDA,SOD,LDH in the sevoflurane pretreatment group were significantly lower than those in the other three groups[(5.06±2.10)nmol/mL vs.(13.04±3.27)nmol/mL,(12.40±4.28)nmol/mL,(13.13±2.30)nmol/ml],[(58.7±5.9)U/L vs.(84.9±13.8)U/L,(93.9±21.1)U/L,(84.2±11.2)U/L],[(16.3±2.1)U/L vs.(43.1±7.2)U/L,(45.4±6.7)U/L,(35.8±5.1)U/L](t=8.076,7.448,8.277;12.917,15.506,12.586;11.375,12.239,8.220,all P<0.05).Conclusion Thoracic surgery in patients with one lung ventilation during anesthesia,using sevoflurane preconditioning anesthesia surgery can effectively improve the patients with intrapulmonary shunt rate,reduce the level of oxidative stress and improve the prognosis,it is worthy of further clinical application.

Several studies have demonstrated that heparin can significantly inhibit the P-selectin-mediated interaction of platelets and tumor cells during metastasis as a P-selectin ligand. However, little information is available about the specific oligosaccharide structures of heparin in recognition by P-selectin. Two chemically modified heparins, CR-heparin and SCR-heparin were prepared, to explore if such heparin derivatives can reduce the P-selectin-mediated A375 tumor cell adhesion. The results indicated that CR-heparin with low anticoagulant activity could significantly inhibit the P-selectin-mediated A375 tumor cell adhesion, demonstrating that 6-carboxyl group of the glucuronic acid in heparin may not be crucial for recognizing by P-selectin. In contrast, SCR-heparin reduced the inhibiting activity dramatically, suggesting that the recognition of P-selectin to heparin depend on not only densities of negative charge. These results provide valuable experimental evidence for clarifying the molecular mechanism of P-selectin-mediated tumor cell adhesion.

Objective: To study the attenuating effect of angiotensin I type 1 receptor antagonist losartan and an-giotensin converting enzyme inhibitor captopril on aortic atherosclerosis in rabbits. Methods: Thirty-one male New Zealand rabbits were randomly divided into 5 groups:control group,high cholesterol diet group,losartan group, captopril group and combined drug administration groupdosartan+captopril). The animals were killed after 16 weeks and the serum total cholesterol ,triglyceride, high and low density cholesterol .atherosclertic ratio,endothelin,NO,plaque area percentage,aortic cholesterol content and vascular smooth muscle cell (VSMC) apoptosis were determined. Results:The plaque area percentage,aortic cholesterol contents and endothelin levels of 3 drug treatment groups were significantly lower than that of high cholesterol group,NO contents and VSMC apoptosis were significantly higher. Conclusion:Losartan and captopril can attenuate aortic atherosclerosis induced by high cholesterol diet .combined administration of the 2 drugs at low doses are more effective. The mechanism may be related to the protection of endothelial function and the effect on apoptosis of VSMC.

Objective To investigate the effect of sevoflurane intravenous inhalational anesthesia and remifentanil intravenous anesthesia for single lung ventilation in the department of thoracic surgery operation .Methods 80 patients using thoracic surgery were randomly divided into the two groups with 40 cases in each group according to the number table methods ,the study group were treated with sevoflurane inhalation anesthesia while the control group were treated with remifentanil intravenous anesthesia .HR,MAP and SBP of the two groups before induction of anes-thesia(T0),1min before intubation(T1),10min after ventilation(T2),30min after ventilation(T3) and 1min before extubation(T4) were compared,and recovery time,extubation time,directional force the recovery time were recorded of the two group.Results The HR in the two groups at T1,T2,T3,T4 time did not change significantly than T0 time, while MAP decreased significantly than T0 time,with significant difference (t =8.12,7.82,8.14,8.05,all P <0.05),and there was no statistically significant difference between the two groups (P >0.05);The SBP in the study group did not change obviously at each time while the SBP in the control group at T 1 decreased significantly than T0 time,while it increased significantly at T 2 time than T1 time,with a significant difference ( t=10.51,5.34, 5.05,5.06,all P<0.05);The patients in study group were elevated blood pressure during anesthesia or decreased more than 30% occurred in 8 cases while the control group occurred in 24 cases,there was significant differences between the two groups (χ2 =13.33,P<0.05);The postoperative recovery time ,extubation time and orientation recovery time of the study group patients were (11.4 ±5.1)min,(13.4 ±6.8)min,(18.9 ±5.8)min,which were significantly lower than (19.5 ±5.2)min,(26.5 ±7.6)min,(21.9 ±7.8)min of the control group(t=5.34,6.12, 6.15,all P<0.05).Conclusion Sevoflurane intravenous inhalational anesthesia has a better anesthetic effect for single lung ventilation in the department of thoracic surgery operation than remifentanil intravenous anesthesia ,and it can effectively maintain hemodynamics stability .

Objective To investigate the correlation between the plasma homocysteine (Hcy) level and intra/extracranial artery stenosis in patients with ischemic stroke.Methods The medical history,baseline clinical data,imaging and Hcy and other laboratory test results in patients with ischemic stroke were collected.The patients were divided into either a stenosis group or a non-stenosis group according to magnetic resonance angiography.The artery stenosis group was further redivided into an isolated intracranial stenosis group,an isolated extracranial stenosis group,and combined extracranial and intracranial stenosis group.The relationship between plasma Hcy level and intra/extracranial stenosis was analyzed.Results A total 147 patients with ischemic stroke were enrolled,including 115 patients in the stenosis group and 32 in the non-stenosis group.There were significant differences in age (t =4.577,P ＜ 0.001),the plasma levels of Hcy (t =3.65,P ＜ 0.001),C-reactive protein (t =2.06,P =0.041),low-density lipoprotein cholesterol (LDL-C) (t =1.896,P =0.046),high-density lipoprotein cholesterol (HDL-C) (t =-4.261,P ＜ 0.001),as well as the proportions of diabetes mellitus (x2 =5.772,P =0.016),hypertension (x2 =10.507,P =0.001) and smoking (x2 =12.282,P ＜ 0.001) between the stenosis group and the non-stenosis group.Multivariate logistic regression analysis showed that age ≥60 years (odds ratio [OR] 3.374,95％ confidence interval [CI] 1.351-8.426; P=0.009),Hcy ＞15 mmol/L (OR 2.274,95％ CI 1.147-8.173; P=0.025),hypertension (OR 5.782,95％ CI 2.045-16.345; P =0.001),and smoking (OR 3.514,95％ CI 1.200-10.293; P=0.002) were the independent risk factors,while HDL-C ＞ 1.0 mmol/L was an independent protective factor for intra/extracranial stenosis (OR 0.166,95％ CI 0.054-0.511; P =0.002).The stenosis group was redivided into an isolated extracranial stenosis group (n =24),an isolated intracranial stenosis group (n =61) and a combined extracranial and intracranial stenosis (n =30) according to the sites of stenosis.The comparison of the clinical data and risk factors among the three groups showed that there were significant differences in the proportions of patients with hypertension (x2 =7.024,P=0.003),as well as the plasma levels of LDL-C (F =3.276,P =0.042) and C-reactive protein (F =3.645,P =0.029).Multivariate logistic regression analysis showed that hypertension was the common independent risk factor for isolated intracranial stenosis (OR 3.795,95％ CI 1.261-11.424; P =0.018),isolated extracranial artery stenosis (OR 18.490,95％ CI 3.117-10.966; P=0.001) and combined extracranial and intracranial stenosis (OR 9.178,95％ CI2.211-38.094; P=0.002),and the increased HDL-C level was the common protective factor for isolated intracranial artery stenosis (OR 0.150,95％ CI 0.043-0.523; P =0.003),isolated extracranial artery stenosis (OR 0.078,95％ CI 0.012-0.488; P=0.006) and combined extracranial and intracranial stenosis (OR 0.089,95％ CI 0.021-0.385; P=0.001).Age was an independent risk factor for isolated intracranial stenosis (OR 6.351,95％ CI 2.277-17.717; P ＜ 0.001).The increased LDL-C level was an independent risk factor for isolated extracranial stenosis (OR 6.021,95％ CI 1.212-29.917; P =0.028).The increased Hcy level was an independent risk factor for isolated extracranial stenosis (OR 4.376,95％ CI 1.026-18.671; P-0.046) and combined extracranial and intracranial stenosis (OR 4.951,95％ CI 1.378-17.783; P =0.014).Conclusions The increased plasma Hcy level correlated with extracranial stenosis.

Objective To evaluate the early diagnosis value of procalcitonin (PCT) in severe brain damage combined with pul‐monary infection .Methods The brain injury patients in the hospital from January to October 2014 were enrolled in the study and divided into infectious group whose infection had occurred within 5 days after admitting to hospital and non‐infectious group who had not suffered from infection .The blood samples of the patients were collected within 2 h and 3 days after admitting to hospital and detected for PCT concentration .The Early diagnosis value of PCT in brain damage combined with pulmonary infection was e‐valuated and compared with white blood cells (WBC) ,neutrophile granulocyte(N)and hypersensitive C‐reactive protein(hs‐CRP) . Results The incidence of pulmonary infection within 5 days of severe brain injury was 22 .9% (41/179) .There were statistically differences of PCT ,WBC ,N and hs‐CRP between infectious group and non‐infectious group(P< 0 .05) .The areas under curve (AUC) of PCT ,WBC ,N and hs‐CRP were 0 .83 ,0 .80 ,0 .78 and 0 .82 respectively .The combination of PCT+WBC+ hs‐CRP had the highest diagnostic value since its AUC was 0 .87 .PCT had a satisfied diagnostic veracity since it had good sensitivity ,specificity and positive predictive value in the diagnosis of brain damage combined with pulmonary infection .Conclusion PCT could be an ear‐ly diagnosis indicator in severe brain damage combined with pulmonary infection ,and the diagnostic veracity is higher when com‐bined with WBC and hs‐CRP .An antimicrobial treatment is recommended when PCT concentration of brain damage patient rises , especially when combined with WBC and hs‐CRP concentration elevating .