Case based learning/problem-based learning ( CBL/PBL ) is a new teaching method based on traditional medical education methods.In order to conquer the deficiency of traditional education methods in autonomous study motivation and ability of knowledge integration, CBL/PBL has been introduced into vascular surgery teaching procedure since 2006.The quality and effort of CBL/PBL compared with lecture-based learning ( LBL ) were evaluated and scored. The outcome of this teaching innovation shows CBL can arouse students' desire in autonomous study and enhance their ability in clinical analysis.But, its superiority is difficult to develop in the current medical education system.

Hepatic eosinophilic granuloma (HEG) is a rare benign liver disease,which belongs to histocytosis.Preoperative diagnosis of HEG was difficult because its clinical manifestation was not characteristic.In this article,the clinical data of 1 patient with HEG who was treated at the Jinhua Municipal Central Hospital of Zhejiang Province in September 2012 were retrospectively analyzed,and the diagnosis,differential diagnosis and treatment for HEG were investigated.

Objective To investigate the functional and structural changes of connectivity of default mode network (DMN) in relapsing-remitting multiple sclerosis (RRMS) by functional MRI (fMRI) and diffusion tensor imaging (DTI) and to study the relationship between them.Methods Twenty-seven RRMS patients(clinically diagnosed as RRMS)and 27 healthy volunteers (matched to the patients in age and gender) were selected to participate in this study.All the subjects underwent 3.0 T MR scanning.Softwares such as DPARSF,MICA,TrackVis were used for data post-processing.Medial prefrontal cortex (mPFC) and posterior cingulate cortex(PCC) of DMN were chosen as ROIs,and functional and structural changes of DMN and the relationship between them were analyzed.Values of r reflecting the functional connectivity and fractional anisotropy(FA) of two groups were obtained.Then statistical analysis was performed by using student t test and Pearson correlation analysis.Results The DMN space pattern of the RRMS patients was mostly identical to that of controls,but with specific difference in the connectivity strength with respect to that of controls.Particularly,the patient group showed increased DMN connectivity in the mPFC,but decreased connectivity in the inferior parietal lobule (IPL) and PCC.Compared with controls,the r value (0.695 ±0.151 vs.0.796±0.085),FA value(0.261 ±0.012 vs.0.285 ±0.017) between mPFC and PCC in RRMS patients were decreased (t =-3.020,-6.206,P ＜ 0.05).In addition,functional connectivity (r value) was found to correlate with structural connectivity(FA value) between the PCC and mPFC (r =0.704,0.735,P ＜ 0.01).The number of MS lesion,had no correlation with r value or FA value (P ＞ 0.05).Conclusions The functional connectivity and structural connectivity of DMN change in RRMS patients.The functional connectivity and structural connectivity between mPFC and PCC are both decreased in RRMS patients compared with the controls.The injury of structural connectivity may be the structural basis of the decrease of functional connectivity.

OBJECTIVE:To analyze the utilization of different dosage forms of essential drugs in the clinical practice in our sanatorium and the tendency of drug use of patients.METHODS:The utilization of essential drug in our sanatorium were analyzed statistically in respect of drug category,constitution ratio of drug use.A questionnaire survey was carried out to survey the tendency of drug use of patients.RESULTS:Tablet was the most common dosage form in the clinic.Antibiotics and drugs for clinical therapy had complete dosage forms.The common dosage forms used patients were tablets and capsule,etc.CONCLUSIONS:Patients of our sanatorium select drugs tendentiously.The tendentious selection of drug is no difference in each age group.

Artemisinin is a key anti-malarial drug and few clinically meaningful resistant cases about its application have so far been reported. The World Health Organization (WHO) officially recommended the use of ACT (Artemisinin-based Combination Therapy) as the first line antimalarial application to increase its inhibitory efficacy and prevent the likely resistance development. Based on our current understanding of artemisinin, a set of compounds were selected to study their interaction with artemisinin by using the yeast (S. cerevisiae) model, in the hope that knowledge gained might provide some references for clinical investigations. In this research, yeast strain (BY4742) was cultured in the nonfermentable YPGE solid medium with 4 μmol · L(-1) artemisinin and one of the selected compounds for 48 hours, and the combined drug efficiency was evaluated by the inhibition of yeast growth. The compounds belong to the categories of oxygenants, antioxidants, metal ions, ion chelators and uncouplers. Among them, 0.2 mmol L(-1) FeCl3, 60 μmol · L(-1) BPS, 1 mmol · L(-1) CuCl2, 0.75 mmol · L(-1) VE and 1 mmol · L(-1) VC antagonized the action of artemisinin, while 40 μmol · L(-1) DNP, 0.1 μmol · L(-1) CCCP and 0.25 mmol · L(-1) H2O2 had synergistic effects. These results suggested that redox-active and mitochondria-dysfunctional compounds could affect artemisinin's potency, supporting our prior proposed mitochondrial model for artemisinin's action. This research in addition provided a convenient method to screen likely artemisinin-interacting compounds.
Artemisinins ; pharmacology ; Drugs, Chinese Herbal ; pharmacology ; Saccharomyces cerevisiae ; drug effects ; growth & development

Objective To explore significance of alpha‐fetoprotein isoform L2(AFP‐L2) in the screening of Down syndrome in pregnant women ,so as to provide references for clinical application .Methods A total of 250 healthy pregnant women and 22 preg‐nant women with Down syndrome were enrolled in this study .Serum specimens were collected and AFP‐12 was separated and cap‐tured by using the magnetic bal ,time‐resolved fluorescence immunoassay was used to detect levels of AFP and AFP‐L2 ,and the percentage of AFP‐L2 (AFP‐L2% ) was calculated .Results The serum level of AFP of pregnant women with Down syndrome [(20.2±4.2)ng/mL]was lower than that of healthy pregnant women[(46.7±19.9)ng/mL],and had statistically significant difference(P<0 .05) .Serum AFP‐L2% of pregnant women with Down syndrome was higher than that of healthy pregnant women , and had statistically significant difference(P<0 .05) .Conclusion Detection of AFP level and AFP‐L2% could be an indicator for Dow n syndrome screening .

Objectives To investigate the prenatal diagnosis method of spinal muscular atrophy with amniotic fluid sample.Methods Totally 1 064 amniotic fluid samples from mid-trimester pregnant women were enrolled during January 2015 and January 2016 in 4 hospitals.Genetic analysis was performed for detecting potential contamination of maternal tissue by a genetic technique based on short tandem repeat ( STR) markers.Deletion of SMN1 gene was detected in 1 062 uncontaminated amniotic fluid samples by real-time PCR and multiplex ligation-dependent probe amplification ( MLPA) respectively.Results Two contaminated amniotic fluid samples were detected within 1 064 mid-trimester pregnant women by STR genotyping.The other 1 062 uncontaminated amniotic fluid samples were tested by real-time PCR.There were 37 samples with heterozygous deletion of Exon 7 of SMN1 gene ( 3.67%) , 34 samples with heterozygous deletion of Exon 8 of SMN1 gene (3.2%) and two samples with homozygous deletion of Exon 7 and Exon8 of SMN1 gene ( 0.19%) respectively , while other samples observed with no deletion of Exon 7 and Exon8 in SMN1 gene.Totally 41 samples with heterozygous or homozygous deletion of SMN 1 gene and 55 samples with undetected deletion of SMN 1 gene were confirmed by MLPA and the results showed 100%consistence with that of real-time PCR.Conclusions Both real-time PCR and MLPA are suitable for detecting the deletion of SMN 1 gene with amniotic fluid sample . Real-time PCR exhibits less sample requirement and time compared with MLPA .

Objective To analyze quantitatively the iron deposition in deep brain gray nucleus and frontal white matter in healthy population and to explore its correlation with age using ESWAN with 3.0 Tesla scanner.Methods 157 healthy subjects (age 20 to 85)had been manned with routine sequences and ESWAN sequences.The subjects were divided into 6 groups according to their ages:Group A (age 20-29),Group B (age 30-39),Group C (age 40-49),Group D (age 50-59),Group E (age 60-69)and Group F (age ≥70).T2 ?value was measured in both sides of the frontal white matter,red nucleus,substantia nigra pars reticulate,substantia nigra pars compacta,putamen,globus pallidus,head of caudate nucleus and thalamus,and the correlations between the T2 ? value and age were also analyzed.Results The T2 ? value of globus pallidus and substantia nigra pars reticulata were the lowest.The highest T2 ?value was observed in the frontal white matter.The difference of T2 ? value among some age groups had statistical significance in red nucleus putamen,globus pallidus,head of caudate nucleus and thalamus (P <0.05).Obvious negative correlations between age and T2 ? value was shown in red nucleus (r=-0.258),substantia nigra pars reticulate (r=-0.229),substantia nigra pars compacta (r=-0.231), putamen(r=-0.584),globus pallidus (r=-0.320),and head of caudate nucleus (r=-0.437,P <0.001),while positive correlation was displayed in thalamus (r=0.31 9),frontal white matter (r=0.161,P <0.05 ).Conclusion ESWAN can clearly display the morphology of cerebral nuclei,evaluate the brain iron content accurately and present the age-related iron concentration changes.

Objective To evaluate the curative effect of stretching therapy combined with oral administration of Chinese herbal medicine Tongjing Powder in treating dysmenorrhea patients with Qi stagnation and blood stasis. Methods Sixty dysmenorrhea patients were randomly divided into two groups, 30 cases in each group. Treatment group was given oral use of Tongjing Powder (mainly composed of Radix Angelicae Sinensis, Rhizoma Chuanxiong, Radix Paeoniae Alba, Rhizoma Cyperi, Aspongopus, Radix Salviae Miltiorrhizae, Pollen Typhae, Faeces Trogopterori, Rhizoma Curcumae, and Semen Persicae) combined with stretching therapy. The control group was given oral use of Tongjing Powder alone. Each group was treated for 3 menstrual cycles. Visual Analogue Scale (VAS) scores of dysmenorhea were observed during the treatment and 3-month follow-up after treatment. Before and after treatment, pulse index (PI), resistance index (RI), the ratio of systolic peak value to the diastolic peak value (A/B) of uterine artery blood flow in the two groups were detected. And the clinical efficacy of the two groups was evaluated after treatment. Results (1) The VAS scores of the two groups after treatment and at the end of the third menstrual cycle after treatment were significantly lower than those before treatment(P<0.05), and the decrease in the treatment group was superior to that in the control group(P < 0.05).(2) After treatment for 3 menstrual cycles, the total effective rate was 96.7％ in the treatment group, which was higher than that in the control group(76.7％). And the difference was statistically significant(P < 0.05). (3) The color Doppler energy (CDE) imaging results showed that PI, RI, A/B of uterine artery blood flow in the two groups were decreased after treatment (P < 0.05 compared with those before treatment) , but the differences between the two groups were insignificantly(P > 0.05). Conclusion Stretching therapy combined with oral administration of Chinese herbal medicine Tongjing Powder exerts certain short-term and long-term effect in treating dysmenorrhea patients with Qi stagnation and blood stasis, with good safety and feasibility.

Objective To establish the clinical pharmacokinetics research method for Bawei Jiangu Tablet.Methods Drug blood concentration was estimated through analyzing the ingredients and preclinical pharmaceutical research results of Bawei Jiangu Tablet.Results Corresponding cardiac glycoside value in serum of animals treated with oral use of Bawei Jiangu Tablets and cortex periplocae extracts can be detected by drug monitor system of digoxin immunoreaction, which was similar to that in animals treated with digoxin.Corresponding cardiac glycoside value had also been detetected in serum of subjects in phaseⅠclinical tolerance trial,which was related to the time and dosage of administration.Clini- cal negative control trial showed that the reaction was specific.Conclusion Pharmacokinetics study on target of toxic components with cross-reaction of periplocoside is feasible through drug monitor system of digoxin immunoreaction.