This article expatiated the development trend of the 21st century, analyzed the problems that medical edu-cation of the 21st century faces and the necessity of cultivating the young teachers' creative ability in medical educationand put forward the countermeasures.[

Objective To study the analgesic effects of combination of fortanodyn and verapamil. Methods Used the model of the acetic acid induction writhing in mice and the method of hot-plate in mice, then observe the action of the mice after treatment with combination of fortanodyn and verapamil. Results Low dose Verapamil com-bined AP237 (40 mg/kg, 80 mg/kg)could enhance the threshold of pain of the mouse ache response obviously, and postponed the time which the mouse ache appeared (comparing using simply AP237 P <0.05 with controlled group P <0. 01) ;Low dose Verapamil combined AP237 (20 mg/kg,40 mg/kg) had the obvious inhibitory action in the body turning times of the mouse. Conclusion Verapamil can strengthen the analgesia function of AP237.

Objective To investigate the clinical significance of antiendothelial cell antibodies (AECA) in systemic vasculitis. Method With Human umbilical vein endothelial cell (HUVEC) as substrate cell, sera from 129 systemic vasculitis patients [including 59 Behcet′s disease(BD), 28 Takayasu arteritis (TA), 20 Wegener′s granulomatosis (WG), 8 polyarteritis nodosa (PAN), 9 microscopic polyangiitis (MPA), 5 Churg-Strauss syndrome (CSS)] were screened for the presence of AECA by ELISA. Sera from SLE, RA and healthy donors were examined as controls. The association of AECA to clinical disease activity was analyzed. Result The prevalence of AECA by HUVEC cell-ELISA was 59% in systemic vasculitis [48% in BD,79% in TA, 65% in WG, 63% in PAN, 44% in MPA, 80% in CSS], 46% in SLE, 4% in RA, and 2.4% in control group. Compared with patients with RA and control group, AECA were more frequently found in patients with systemic vasculitis and SLE (P

Objective To analize the clinical features of patients with hemophagocytic syndrome (HI'S). Methods The underlying diseases, clinical characteristics, laboratory findings, responses to therapy as well as their outcomes of 45 patients with HPS were analyzed retrospectively. Results The underlying diseases included virus infection (n = 9) , tuberculosis (n =2), rheumatic fever (n =4) , malignancies (n =22) , unknown diseases (n =8). HPS was clinically characterized by high fever(93. 3% ) , hepatomegaly (77. 8% ) , splenomegaly(80% ) , lymphadenopathy (55. 6% ) , skin rash(24.4% ), gastrointestinal hemorrhage(22. 2% ) , renal (35. 6% ) and central nervous systern involvement( 15. 6% ) , five patients presented with disseminated intravascular coagulation( DIC) (11. 1% ). Laboratory data mainly manifested with cytopenia ( 100% ) , liver dysfunction ( 77. 8% ) , hypofibrinogenemia (62. 8% ), hypertriglyceridemia (71. 1% ) , serum ferritin >500 p,g/L(87. 5% ) , low NK-cell activity(92. 9% ) and hemophagocytosis in bone marrow (100% ). Based on treating underlying diseases and use of corticosteroids and immunosuppressive agents in combination with intravenous immunoglobulins(IVIG) therapy, 14 patients recovered , 19 patients died in the hospital, and other 12 cases give up treatment be cause of exacerbation of the disease.Conclusion There are various underlying diseases and clinical manifestations for HPS. HPS is always extremely dangerous with high mortality. Treatment of underlying diseases, corticosteroids, immunodepressant and IVIG may improve the prognosis of HPS.

The human atrial muscle cells were investigated by ultrastructural CMPase cytochemistry and atrial natriuretic factor (ANF) immunocytochemistry. The primary lysosomes and ANF were labelled by these techniques, respectively. ANF was localized in the atrial specific granules, these granules were similar in size and 0.20? 0.051?m in diameter, distributed over the entire cytoplasm, preferentially being located in the subsarcolemmal and perinuclear region and forming clusters. Primary lysosomes were various in size, 0.30?0.191?m in diameter, significantly larger than atrial specific granules (P

Objective To study the clinical, laboratory, radiological and pathological findings of patients with hypertrophic cranial pachymeningitis (HCP) in Wegner's granulomatosis (WG) to improve the recognition of the disease, even when it occurs in limited form. Methods Three patients were described and English literatures of biopsy-proven pachymeningitis in WG were reviewed. Results The features of WG-associated pachymeningitis included: ① Frequently occurred early in the course of active limited WG; ② Commonly presented with sever headache and cranial neuropathies in the absence of other meningeal irritative signs; ③ Variable cerebrospinal fluid findings with mild predominantly lymphocytic pleocytosis and elevated protein concentration were major laboratorg findings; ④Elevated ESR and positive serum anti-neutrophilic cytoplasmic antibody (ANCA) could be found in most patients; ⑤ Gadolinium-enhanced brain MRI is very senitive in the detection of pachymeningitis; ⑥A dural biopsy showed granulomatous necrotizing inflammation, giant cell, and evidence of vasculitis;⑦ A favorable response to standard treatment with corticosteroid, cyclophosphamide or other cytotoxic drugs could be observed. Conclusion HCP may be the initial or cardinal manifestation of the limited form of WG. Early diagnosis by ANCA, MRI and dural biopsy may facilitate diagnosis Corticosteroid and immunosupressant are the choices of treatment.

Objective To investigate the prevalence,their autoantigen and the clinical significants of antiendothelial cell antibodies(AECAs) in systemic vasculitis.Methods Western blotting was performed to detect specific AECA in serum of systemic vasculitis,SLE,RA,SS and healthy donors.Then to analyze the relationships of AECA with the disease manifestation.Results(1)The prevalence of AECA was 77.7% in systemic vasculitis,87.5% in SLE,66.7% in SS,7.14% in RA and 10% in normal group respectively.(2)AECA reacted with a heterogeneous series of endothelial proteins which ranged in molecular size from 16 to 120 ku Furthermore,AECA against a 47 ku endothelial cell antigen were more frequently found in a variety of systemic vasculitis and SLE.(3)Compared with those in AECA-negative patients,the mean levels of ESR in AECA-positive patients with TA and the mean levels of BVAS in patients with WG,MPA and CSS were both significantly higher in AECA-positive patients.Patients with BD who have AECA against 47 ku endothelial cell proteins were more frequently found to have neuropathy than those 47 ku-AECA-negative patients,and the prevalence of inhanced CRP are also more frequent.Conclusion AECA showed to be correlated with the disease manifestation,and the same molecular sizeantigen could be found in a variety of systemic vasculitis and SLE.

Objective To understand time-effect relationship in prehospital emergency care of trauma patients so as to cut down mortality. Methods The data of pre-hospital deaths of trauma pa-tients were collected from 67 Shenzhen Emergency Network Hospitals during 2002-2004 and input into a database established by using Foxpro 6.0.Then, the data were analyzed by software SPSS 11.0. Re-sults A total of 161 364 trauma patients received prehospital emergency call service during 2002-2004 and 3 967 patients died prehospital or in hospital.There were 360.528 and 645 trauma patients died pre-hospitsl in 2002, 2003 and 2004 respectively, accounting for 32.57%, 37.69% and 44.25% respec-tively of whole trauma emergency patients in corresponding year.In 2002, 2003 and 2004 respectively, pre-hospital mortality was 1.15%, 0.88% and 0.99%, ratio of male to female 79.17/20.83, 77.65/22.35 and 71.63/28.37, the death age(29.04 ±13.98), (27.84±18.54)and(29.25±17.06)years old, ratio of traffic trauma to non-traffic trauma 48.33/51.67.26.14/73.86 and 37.98/62.02, the median response time of ambulance in hospital 2, 2 and 1 minute, the median time of ambulance arri-ving at the accident scene 5, 8.5 and 7 minutes and the median time of ambulance to and fro was 15.35 and 30 minutes. Conclusions There is a tendency that the number of the pre-hospital deaths of trauma patients increases, but that the ratio of traffic to non-traffic trauma and mortality decrease.The average age of dead trsuma patients is 10 years younger than that of whole emergency patients in the city of Shenz-hen.The response time of ambulance in hospital shortens, but the time of ambulance arriving accident 8cene and to and fro time of ambulance prolong.

Objective To investigate the secretory capacity and apoptosis of interleukin ( IL)-21 induced normal B cells by co-culture with serum from patients with systemic lupus erythematosus (SLE). Methods Serum from twenty new-onset SLE patients and 20 healthy donors were collected .CD1+9 B cells from the normal controls were co-cultured with serum from SLE patients in the presence or absence of IL-21-R-FC(4 μg/ml).Supernatant IgG and IgM concentration were measured by immunoturbidimetric assay on day 5.Supernatant anti-dsDNA level was determined by ELISA .The percentage of apoptotic cells was detected by flow cytometer.Results IgG,IgM and anti-dsDNA levels in normal B cells with SLE serum were significantly higher than those in the serum of SLE patients alone [ ( 5.84 ±1.79 ) g/L vs ( 4.25 ± 1.48)g/L,P=0.000;(0.46 ±0.21)g/L vs (0.43 ±0.21)g/L,P=0.003;(127.76 ±70.24)IU/ml vs (115.15 ±63.88) IU/ml,P=0.014 respectively].However, no significant differences were found in the group of normal B cells with non-homologous serum from normal controls (P>0.05).Supernatant IgG, IgM and anti-dsDNA levels in normal B cells with SLE serum significantly decreased while IL-21R-fusion protein was added [(5.26 ±1.62)g/L vs (5.84 ±1.79)g/L, P=0.006;(0.42 ±0.20)g/L vs (0.46 ±0.21)g/L, P=0.002;( 118.00 ±69.62 ) IU/ml vs ( 127.76 ±70.24 ) IU/ml, P =0.012 respectively ] .The apoptotic rate of B cells with SLE serum was significantly higher than that with normal serum [ ( 47.88 ± 12.65)%vs (38.86 ±10.32)%,P =0.004].But adding IL-21R-fusion conversed the apoptotic rates [(42.08 ±12.52)%vs (47.88 ±12.65)%,P=0.001].Conclusions SLE serum could induce normal B cells to form immunoglobulin secreting cells and producing autoantibodies , or apoptosis in pathological conditions.IL-21 might be considered as a potential therapeutic target of SLE .

Objective To observe the effects of constant light exposure on the obesity in high fat diet rats. Methods Thirty-two male SD rats were randomly divided into four groups:rats on a normal chow exposed to standard light-dark cycle ( group A) , rats on a normal chow exposed to constant light ( group B) , rats on a high fat diet exposed to standard light-dark cycle ( group C) , and rats on a high fat diet exposed to constant light ( group D) . Body weights and food intakes were recorded weekly throughout the 12-week study. Body weight, fat mass, visceral adipose tissue weight, intraperitoneal glucose tolerance test ( IPGTT) results, insulin resistance parameters, serum lipids and levels of interleukin 6 (IL-6), tumor necrosis factor-α(TNF-α) were compared among groups. Epididymal adipose tissues mRNA expression of circadian clock genes, i. e. clock, bmal1, rorα, rev-erbα, cry1, per1, and per2 were analyzed by realtime PCR. Results From the 9th week, body weights of rats in group D were significantly higher than those in group C (all P<0. 05). At the 12th week, area under curve of IPGTT (AUC-IPGTT) in groups B, C, and D were significantly higher than that in group A. AUC-IPGTT in group D was significantly higher than that in group C (all P<0.05). Compared with group C,asignificant increase in fat mass,visceral adipose tissue weight,homeostasis model assessment for insulin resistance, serum cholesterol, TNF-α levels were observed in group D ( all P<0. 05). And a significant decrease in quantitative insulin sensitivity check index ( QUICKI) and high density lipoprotein-cholesterol were observed in group D in comparison with group C (both P<0. 05). Circadian clock genes (clock, rorα, rev-erbα, cry1, per1) mRNA expressions in group B and D were significantly different from those in group A (all P<0. 05) . Expression of cry1 in group D was significantly higher than that in group C. In group C, rev-erbαmRNA expression was significantly down-regulated in comparison with group A (P<0. 05). Conclusion Constant light exposure exaggerates obesity, glycolipid metabolism abnormality, inflammation, and insulin resistance in high fat diet rats.