Examination reform was explored in Introduction to clinical medicine, and a new evaluation system was constructed which included the combination of formative assessment and sum-mative assessment as well as content system, operation system and monitoring system. The feedback mechanism of formative assessment was put into a full use to improve the teaching effect in this new evaluation system. At the same time, the method of summative assessment was substituted from the traditional closed-book exam to literature translation and presentation carried out by groups. The com-bination of summative assessment and formative assessment could evaluate the teaching efficiency of introduction to clinical medicine more comprehensively and objectively. In addition, it played an ac-tive role in improving students' comprehensive ability and their learning enthusiasm.

BACKGROUNDDicycloplatin is a relatively safe third generation platinum-complex anti-cancer drug. The present study focused on the effects of dicycloplatin on in vitro proliferation and apoptosis of human aortic smooth muscle cells (HASMC) and human aortic endothelial cells (HAEC).

METHODSProliferation of HASMC and HAEC, DNA content, and cellular levels of proliferation- and apoptosis-related proteins were assessed using the (3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium) (MTS) assay, flow cytometry and Western blotting assays, respectively.

RESULTSDicycloplatin at 10 ng/ml significantly inhibited HASMC proliferation, however, 10 µg/ml were required to significantly inhibit HAEC proliferation. Cell cycle analysis showed that dicycloplatin was a non-specific inhibitor of the cell cycle. Although dicycloplatin significantly decreased proliferating cell nuclear antigen (PCNA) expression in HASMC at all concentrations tested, it did not significantly affect PCNA expression in HAEC; Bax and p53 protein expression was upregulated in dicycloplatin groups.

CONCLUSIONSDicycloplatin at nanogram concentrations significantly inhibits HASMC proliferation, although the effect is relatively weaker than that of sirolimus. In contrast, the effect of dicycloplatin on inhibition of HAEC proliferation is much less pronounced than that on HASMC. The latter characteristics point to the potential for use of dicycloplatin in drug-eluting stents.

Aorta ; cytology ; Blotting, Western ; Cell Proliferation ; drug effects ; Drug Combinations ; Drug-Eluting Stents ; Endothelial Cells ; cytology ; drug effects ; Flow Cytometry ; Glutamates ; pharmacology ; Humans ; Muscle, Smooth, Vascular ; cytology ; drug effects ; Organoplatinum Compounds ; pharmacology ; Sirolimus ; pharmacology

Objetives To investigate the outcomes of sirolumus-eluting stent(CypherTM,Cordis/Johnson&Johnson,Warren,NJ,USA)and paclitaxel-eluting stent(TaxusTM,Boston Scientific,Natick,MA.USA)in the treatment of coronary heart disease after a four.year clinical follow-up.Methods 237 consecutive patients were enrolled in this study and treated with Cypher(136 patients)or Taxus(101 patients)from January to October 2003.111e rates of stenosis.stent thrombosis according to ARC definition and major adverse cardiac events(MACE a composite of cardiac death,myocardial infarction and target vessel revascularization)were analysed.Results There was no significant difference on secondary restenosis.target lesion revascularization(TLR)and MACE between Cypher and Taxus groups at six.month angiographic follow-up,but late luminal loss was higher in Taxus group[(0.15±0.43)mm vs(0.42±0.34)mm,P=0.022].At four-year follow-up,TVR-free survival rate was 88.97% in Cypher group versus 82.28% in Taxus group(P=0.158).MACE.free survival rate was 83.8% in Cypher group and 79.2% in Taxus group(P=0.056).The incidence of stent tllrombosis was no difference between the two groups(1.47% vs 1.98%).There was also no difference among early(0 vs 0.99%),late(0.73%vs0.99%)and very late stent thrombosis(0.73%vs 0)between the 2 groups.Conlusions There were nodifference between Cypher and Taxus in the treatment of coronary artery disease:Both Cypher and Taxus have good clinical outcomes except that Taxus had highcr late loss.

Objective: To make long-term comparison of drug-eluting stent (DES) implantation betweenleft internal mammary artery (LIMA) graft and native vessel in patients with previous coronary artery bypass grafting (CABG).
Methods: A total of 151 patients with anterior wall ischemia because of previous CABG induced LIMA graft lesion who received percutaneous coronary intervention (PCI) in our hospital from 2004-07 to 2012-12 were retrospectively studied. The clinical, coronaryangiography (CAG) and follow-up conditions for DES implantation were analyzed;according to the target vessel, the patients were divided into 2 groups:LIMA group, n=40 and Native vessel (NV) group, which meant all segments of left main to left anterior descending arteries, n=111. Primary end points included target lesion revascularization (TLR), target lesion failure (TLF) as cardiac death, target vessel related non-fatal MI with the composition of TLR and major adverse cardiovascular events (MACE).
Results:The median follow-up time was 30 (10-100) months. The rates of TLR and TLF were similar between 2 groups:(15.0%vs 11.7%, log-rank P=0.65) and (17.5%vs 13.5%, log-rank P=0.63). MACE occurrence in LIMA group was higher than NV group (35.0%vs 18.0%, log-rank P=0.043) which was mainly presented by new non-target vessel revascularization as right coronary artery, left circumlfex and saphenous vein graft(17.5%vs 4.5%, log-rank P=0.014). Cox multivariate analysis indicated that target lesion stent length was the only independent predictor for both TLR (HR=1.03, 95%CI1.00-1.06, P=0.01) and TLF (HR=1.03, 95%CI1.00-1.05, P=0.02);whereas, LIMA-PCI was the only independent predictor for MACE occurrence (HR=3.09, 95%CI1.28-7.60, P=0.012).
Conclusion: The chances of TLR and TLF were similar inpatients with previous CABG by either LIMA or NV, while MACE occurrence was higher in LIMA patients which should be further investigated.

Objective To report our experiences in the treatment of recurrent intracranial aneurysms with re-coiling or covered stents.Methods A total of 291 patients with 305 intracranial aneurysms were treated with detachable coils.and 41(28.9%)of 142 patients with aneurysms in the intemal carotid artery had a recurrent aneurysm during the follow-up period.For this study,31 recurrent aneurysms in 31 patients who had angiograms within 6 months following retreatment with detachable coils(group A,n=20)or covered stents(group B.n=11)were analysed.Aneurysms were categorised as complete or incomplete occlusion via angiographic assessment and graded as full recovery,improvement,no change or deterioration via clinical assessment.Data regarding technical success,initial and final angiographic results,final clinical outcome were collected and analysed postoperatively.Results Coil embolisation and covered stent placement.were technically successful in all recurrent aneurysms.The initial angiographic results showed complete occlusion in 11 patients(55%)in group A and in eight(72.7%)in group B(P=0.452),and the final angiographic results exhibited complete occlusion in 10 patients(50%)in group A and in 11(100%)in group B(P=0.005).There were no significant differences in technique success or final clinical outcome between the two groups.Conclusions Recurrent aneurysms after coiling can be successfully treated and occluded with re-coiling or covered stent placement.However,covered stents seem to be more effective than re-coiling with regard to complete occlusion of recurrent aneurysms.

Objective:To observe the effect of acupuncture in regulating ubiquitin-proteasome pathway (UPP),and discuss the action of acupuncture in intervening heroin-induced brain damage.Methods:Thirty male Sprague-Dawley (SD) rats were divided into a control group,a model group and an acupuncture group by using the random number table.Rats in the model and acupuncture groups received intramuscular heroin injection for successive 8 d at a progressively increased dose.Afterwards,the injection was suspended for 5 d for withdrawal.The heroin relapse rat model was established by repeating the drug addiction and withdrawal process for 3 times.The control group followed the step of the model establishment,but was given intramuscular injection of normal saline at the stage of addiction and no intervention at the stage of withdrawal;the model group was given intramuscular heroin injection at a progressively increased dose at the addiction stage and no intervention at the withdrawal stage;the acupuncture group was dealt in the same way as the model group at the addiction stage,but received acupuncture at Baihui (GV 20) and Dazhui (GV 14) at the withdrawal stage,with the needles retained for 30 min each time,1 session a day,for successive 5 d.On the 39th day,brain tissues were extracted from the hippocampus and ventral tegmental area (VTA) of the three groups of rats.The apoptosis of brain nerve cells was detected by using terminal deoxynucleotidyl transferase-mediated nick and labeling (TUNEL).The mRNA and protein expressions of ubiquitin (Ub),ubiquitin protein ligase (E3) and 26S were examined by immunohistochemistry and quantitative real-time polymerase chain reaction (RT-qPCR).Results:Compared with the model group,rat's hippocampus and VTA in the acupuncture group showed significantly fewer cells positively stained by TUNEL staining (P＜0.01),and its mRNA and protein expressions of Ub,E3,26S were significantly lower (P＜0.01).Conclusion:Reducing nerve cell apoptosis and regulating the mRNA and protein expressions of Ub,E3 and 26S in rat's hippocampus and VTA are possibly one of the action mechanisms of acupuncture in intervening heroin-induced brain damage.

Background and purpose:Cyclooxygenase-2 (Cyclooxygenase-2,COX-2) is an important rate-limiting enzyme that is responsible for transformation of arachidonic acid into prostaglandins(PGs).Although Helicobacter pylori(Hp) infection-induced gastric over-expression of COX-2 (COX-2) is an important factor of gastric cancer,the mechanism of COX-2 expression in gastric mucosa cells infected with Hp is still not clear.Our study was to reveal the effect of Hp on expression of COX-2(cyclooxygenase-2),the impact of p38MAPK signaling pathway in human gastric epithelial cancer cells line MKN45,and to investigate the potential mechanisms of expression of COX-2. Methods:The expression of COX-2 mRNA infection by standard Hp NCTC11637 in human gastric epithelial cancer cells line MKN45 was evaluated by real-time fluorogenic quantitative polymerase chain reaction (RFQ-PCR).The effect of infection by Hp on COX-2 expression,activation of p38MAPK and its downstream of the ATF-2 was assayed by Western blot.Results:The expression of COX-2 mRNA in MKN45 cells infected by Hp compared with control group,COX-2 mRNA had 3 fold,7.2 fold,5.1 fold,4.3 fold up-regulation after 3 hrs,6 hrs,9 hrs,12 hrs,respectively. COX-2 mRNA expression in each time group was significantly higher than that in the control group(P

OBJECTIVETo discuss the correlation of tongue manifestation with the site of cerebral infarction in patients with acute cerebral infarction.

METHODSFrom March 2008 to February 2009, 200 cases of hospitalized patients with first unilateral cerebral infarction were chosen in the Department of Neurology, Xuanwu Hospital. The correlation of different tongue color, fur texture, fur color with the site of cerebral infarction was analyzed.

RESULTSThe site of cerebral infarction in patients were compared between different tongue color by Chisquare test (P=0.314), and further correspondence analysis demonstrated that there was correlation between red tongue and cortical-subcortical infarction group. The site of cerebral infarction in patients were compared between thick fur group and thin fur group, cortical-subcortical infarction occurred more frequently in the former (P=0.0008). The site of cerebral infarction in patients were compared between dry fur group, moist fur group and smooth fur group, correspondence analysis demonstrated there was correlation between dry fur and cortical-subcortical group. The site of cerebral infarction in the patients were compared between white fur group, white-yellow fur group and yellow fur group (P=0.010), and correspondence analysis demonstrated there was correlation between white fur and brainstem infarction; white-yellow fur has relationship with cortical infarction; subcortical infarction was weakly related with white-yellow fur; there was closer relationship between yellow fur and cortical-subcortical infarction.

CONCLUSIONThe change of tongue manifestation was associated with the site of cerebral infarction in patients, providing a new combining site for diagnosing cerebrovascular diseases by integrative medicine.

Aged ; Brain ; pathology ; Color ; Humans ; Middle Aged ; Pilot Projects ; Stroke ; pathology ; Tongue ; pathology

Objective: To evaluate the hybrid of drug eluting stent (DES) with bare metal stent (BMS) and exclusive DES implantation for treating the patients with multi-lesion coronary disease.
Methods: A total of 6495 patients with multi-lesion coronary disease received elective PCI in our hospital from 2004-04 to 2006-10 were retrospectively studied. The patients were divided into 2 groups, Hybrid group, n=848 and Exclusive DES group, n=5647. With 1:1 propensity score matching, there were 823 pair of patients were ifnally studied. The clinical outcomes included 1, 2 years post-operative all cause death, myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), major adverse cardiac events (MACE) and in-stent thrombosis. The relative risks of all outcomes were assessed by Cox’s proportional-hazard model after propensity match.
Results: With propensity match, Cox’s proportional-hazard model analysis indicated that compared with Exclusive DES group, Hybrid group had the higher risks of TLR (HR 2.38, 95%CI 1.50-3.70), TVR (HR 1.61, 95%CI 1.15-2.27), MACE (HR 1.37, 95%CI 1.02-1.85), all P<0.01. The all cause death, MI and the ratio of all cause death/MI were similar between 2 groups in 1, 2 years follow-up period, all P>0.05.
Conclusion:Compared with exclusive DES, the hybrid of DES with BMS implantation had the higher risk of TLR, TVR and MACE for treating the patients with multi-lesion coronary disease.

OBJECTIVETo discuss the relationship between tongue manifestation and the degree of neurological impairment in the patients with acute cerebral infarction.

METHODSTwo hundred patients with first unilateral cerebral infarction were recruited. The relationship between different tongue manifestation and National Institute of Health Stroke Scale (NIHSS) were analyzed.

RESULTSNIHSS scores in the patients from different tongue color groups were analyzed and further analysis demonstrated that the NIHSS score was higher in the patients with red or bluish-purple tongue than that of those with the pink (P <0.01). On tongue fur, the NIHSS score in the patients with thick fur was higher than that of those with the thin (P=0.003). NIHSS score in patients with slippery, moist or dry fur was significant different (P=0.003), Further analysis demonstrated that the NIHSS score was higher in the patients with dry fur than that of those with moist fur, and had statistical significance (P=0.01). The NIHSS score was higher in patients from greasy fur group than that of the non-greasy (P=0.002). There was significant difference of NHISS score in the patients with different fur color (P=0.000), and further analysis demonstrated that the NHISS score in white-yellow, yellow fur group were higher than that of the white (P=0.06 or 0.000).

CONCLUSIONThe changes of tongue manifestation might be associated with the degree of neurological impairment in the patients with acute cerebral infarction.

Acute Disease ; Adult ; Aged ; Aged, 80 and over ; Cerebral Infarction ; complications ; physiopathology ; Female ; Humans ; Male ; Middle Aged ; National Institutes of Health (U.S.) ; Nervous System ; pathology ; physiopathology ; Pigmentation ; Pilot Projects ; Stroke ; pathology ; physiopathology ; Tongue ; pathology ; United States