Objective Analysis of the teaching effect of the micro-classroom in the experimental teaching of diagnostics.Methods In the 50 classes of undergraduate clinical specialty of 2014 level of guangdong medical mniversity,2 classes were selected as the control group (n=67) by random number table method,2 classes were selected as the experience group (n=65).Theoretical knowledge and clinical skills were calculated.Recognition of two groups of students on two kinds of teaching methods.The data of two groups were compared using t-test and chi-square test.Results The results of the theoretical knowledge and clinical skills of the experimental group were significantly higher than the control group (P< 0.05).There was a significant difference between the two groups (P< 0.05),which was found to be able to deepen the understanding of theoretical knowledge,to improve the ability of clinical skills operation,to cultivate clinical thinking and to mobilize the enthusiasm of independent learning.Conclusions Micro classroom teaching can significantly improve the quality of experimental training of diagnoses.

Objective To investigate the CT features of nodular or mass-like type pulmonary cryptococcosis(PC). Methods A total of 52 cases with nodular or mass-like type PC confirmed by pathological examinations at Fuzhou Pulmonary Hospital of Fujian from January 2008 to December 2012 were studied. Each patient underwent a breath-hold MSCT scan and contrast enhanced CT was performed in 19 patients. The data including lesion size, number, distribution, density, performance of enhanced CT scan and accompanying signs were analyzed. Each CT accompanying sign was compared between nodular lesions and mass-like lesions using χ2 test,continuous correction χ2 test or Fisher exact test. Results Of all the 52 patients, pulmonary cryptococcosis was consisted single nodules/masses (21 cases) and multiple of nodules/masses (31 cases). There were total 206 lesions with 172 nodules and 34 masses. The lesions were mainly found in lower lobe(73.3%, 151/206)and outer zone or subpleura(87.4%, 180/206)of lung. Plain CT scan showed the densities of most lesions were solid and uniform(74.7%, 154/206). A total of 95 lesions were detected in the 19 patients with contrast enhanced CT, in which 61 lesions (64.2%) showed homogeneous enhancement and 86 lesions (90.5%) showed moderate enhancement. Nodular or mass-like lesions accompanied by many CT signs including halo sign (59.2%, 122/206), air bronchogram (32.0%, 66/206), pulmonary cavity or vocule sign (15.0%, 31/206), lobulation sign (25.2%, 52/206), spicule sign (13.1%, 27/206), pleural indentation(7.8%, 16/206) and vascular cluster (1.9%, 4/206). Compared with mass-like lesions, lobulation sign was more frequently observed in nodular lesions(χ2=13.750, P=0.001), whereas air bronchogram and pulmonary cavity orvocule sign were less frequently observed(χ2=19.957, P=0.001; χ2=5.295, P=0.021, respectively). No significant statistically differences were detected in other CT signs between them (P>0.05). Conclusions PC lesions usually occur in right lung, lower lobe and close to the pleura. Halo sign and air bronchogram are the characteristic findings of CT manifestations in nodular or mass-like type PC.

Objective To innovate an early, rapid and efficient approach to the pmgnestic evaluation of sep-sis in order to lower the mortality. Method Forty-five septic rats, induced by cecal ligation and puncture, were divided into surviving group (n=23) and non-survival group (n=22) on six days after onset of sepsis. Serum samples were taken from septic and sham-operated rats (n=25) at 12 hours after surgery. HPLC/MS assays were performed to acquire the serum metabolic profiles, and radial basis function neural network (RBFNN) was em-ployed to build predictive model for prognostic evaluation of sepsis. Results The principal component analysis al-lows differentiating the rots of survive,non-survive and sham-operated from one another in respect of the pathologic characteristics. Six metabolites, linolenic acid, linoleic acid, oleic acid, stearic acid, docosahexaenoic acid and do-cosapentaenoic acid, related to the outcomes of septic rats were then structurally identified. A RBFNN model for outcome predication was built based upon the metabolic profile data from rat sera with the sensitivity of (96.1 ±3.6)% (n=10) and specificity of (91.0±4.3)% (n=10). Condusions HPLC/MS-based metabonomic approach combined with pattern recognition permits accurate outcome prediction of septic rats in the early stage. The proposed approach has advantages of rapid, low-cost and efficiency, and is isph-ing to be applied in clinical prognostic evaluation of septic patients.

AIM To establish an ultra-performance liquid-chromatography tandem mass spectrometry (UPLC-MS/MS) method for the simultaneous content determination of five constituents in Jiangzhi Huoxue Tablets (Polygoni multiflori Radix,Astragali Radix,Chuanxiong Rhizoma,etc.).METHODS The 50％ methanol extract of this drug was performed on a 40 ℃ thermostatic Restek UItra BiPh column (100 mm × 2.1 mm,5 μm),with the mobile phase comprising of acetonitrile (containing 0.1％ formic acid)-0.1％ formic acid flowing at 0.4 mL/min in a gradient elution manner.RESULTS Stilbene glycoside,tanshinone Ⅱ A,emodin,ferulic acid and puerarin showed good linear relationships within the ranges of 4.01-1 027,0.7-187,1.48-380,3.98-1 020 and4.285-1 097 ng/mL (r ＞0.994 0),whose average recoveries were 98.57％-101.0％ with the RSDs (n =6) of less than 4.79％.CONCLUSION This specific and sensitive method can be used for the quality control of Jiangzhi Huoxue Tablets.

Objective To compare expression of Toll?like receptors 7 and 9(TLR7, TLR9)as well as their regulatory molecules myeloid differentiation factor 88(MyD88)and nuclear factor?κB(NF?κB)in peripheral blood mononuclear cells(PBMCs)between patients with vitiligo and healthy individuals, and to explore their significance. Methods Flow cytometry was performed to measure expression of TLR7 and TLR9 in PBMCs among 36 patients with vitiligo and 22 healthy controls, and real?time fluorescence?based quantitative PCR(RT?PCR)was conducted to determine mRNA expression of MyD88 and NF?κB in the above blood samples. Results Compared with healthy controls, patients with vitiligo showed higher expression of TLR7 and mRNA expression of MyD88 and NF?κB, but lower expression of TLR9. However, significant differences were only observed in the mRNA expression of NF?κB(t=2.814, P=0.008), but not in the expression of TLR7 and TLR9 or the mRNA expression of MyD88 between patients and controls (t = 1.477, 1.761, 0.058, all P > 0.05). Conclusion NF?κB, as a key signaling molecule of TLR7 and TLR9 regulation pathways, increases obviously in patients with vitiligo, suggesting that NF?κB may be involved in the pathogenesis of vitiligo.

OBJECTIVETo intervene the health behavior of lead exposed workers by setting down and implementing a series of measures and evaluating the effects of these measures so that the occupational lead poisoning would be decreased.

METHODS105 lead exposed workers in a factory were chosen as subjects. Blood lead concentration and rate of cognition on relevant health knowledge were examined before and after intervened measures.

RESULTSThe cognition rate raised from 56.6% to 97.3% after training. Lead concentration in blood decreased by 17.7% (t = 4.10, P = 0.000) and delta-ALA in urine decreased by 23.9% (t = 4.248, P = 0.000) 12 months after intervention. The prevalence of occupational lead absorption and poisoning also decreased. The number of workers with blood lead content > 2.41 mumol/L was decreased from 6 to 3, and > 1.93 mumol/L from 14 to 10.

CONCLUSIONTo develope occupational health promotion, enhance health education and improve health behavior are the effective way to prevent from occupational lead poisoning.

Health Behavior ; Health Education ; Health Promotion ; Humans ; Lead ; blood ; Lead Poisoning ; prevention & control ; Occupational Diseases ; prevention & control ; Occupational Exposure

Objectives To evaluate the relationship between body mass index (BMI) and the incidence risk of papillary thyroid microcarcinoma (PTMC).Methods This retrospective study included 1210 PTMC patients who underwent surgery between November 2013 and October 2014 in Peking Union Medical College Hospital,China Academy of Medical Science.A population-based 1∶1 matched case-control study was conducted,and each PTMC patients was matched with one who received thyroid function and ultrasonic to confirm that there was no disease in the thyroid.The clinical profiles of these patients were collected.According to Guidelines for Prevention and Control of Overweight and Obesity in Chinese Adults,all subjects were divided into three groups:underweight (BMI ≤ 18.5 kg/m2),normal(18.5 kg/m2 ＜ BMI ≤ 23.9 kg/m2),overweight (24.0 kg/m2 ＜ BMI ＜ 27.9 kg/m2) and obese group(BMI≥28.0 kg/m2).The relationship between BMI and PTMC incidence risk was analyzed by casecontrol study.Univariate and multivariate logistic regression analysis was applied to analyze the relationship between BMI and PTMC severity.Results The BMI of PTMC patients was significant higher than in normal control [(24.30 ±3.33) kg/m2 vs (23.31 ± 3.50) kg/m2,P ＜ 0.0001].Compared with BMI normal group,the incidence risk of PTMC in underweight group was significantly lower (OR =0.449,95 ％ CI:0.270-0.747),which is higher in overweight and obese group (OR =1.559,95％ CI:1.261-1.928;OR =2.059,95％ CI:1.501-2.823).Histopathological review of 1210 PTMC patients with surgical resection revealed.The proportions of underweight,normal,overweight and obese group of the patients with extrathyroid extension (3.1％,48.0％,36.7％,12.2％) have significant differences with those in the patients whose tumor are limited to the thyroid (0.7％,45.2％,36.0％,18.1％) (P =0.0090).The proportions of 4 group of the patients with multiple lesions (3.2％,49.0％,35.6％,12.2％) were significantly differences to those in the patients with single lesion (0.8％,43.3％,38.7％,17.2％) (P =0.0050).Multivariate analysis showed that underweight is a protective factor of extrathyroidal extension (OR =0.219,95 ％ CI:0.051-0.932;OR =0.279,95 ％ CI:0.085-0.935) and mulifocality,and obese is an independent risk factors(OR =1.556,95％CI:1.047-2.312;OR =1.764,95％CI:1.204-2.584).Conclusions This study identified that the incidence risk of PTMC is positive related with BMI.In PTMC patients,obesity increases the risk of mulifocality and extrathyroidal extension.Attention should be paid to the effect of obesity on the incidence risk of PTMC and the diagnosis and treatment in clinical practice.

Taohe Chengqitang is a classical prescription published in The Catalogue of Ancient Classic Recipes (The First Batch). This study systematically summarized traditional Chinese medicine (TCM) ancient books and modern clinical reports on Taohe Chengqitang and investigated its origin， composition， basis, and historical evolution in processing requirements， dosage， preparation and administration， and functions. The findings indicated different opinions on drug basis， preparation of decoction pieces, and drug dosage conversion. Based on sufficient literature review, the actual development needs of classical prescriptions, and the usage habits of modern clinical practice， this study recommended dried mature seeds of Prunus persica or P. davidiana for Persicae Semen， dried twigs of Cinnamomum cassia for Cinnamomi Ramulus， honey-fried Glycyrrhiza uralensis for Glycyrrhizae Radix et Rhizoma, raw Rheum palmatum, R. tanguticum, or R. offìcinale for Rhei Radix et Rhizoma, and mirabilite for Natrii Sulfas. In terms of drug dosage， the doses directed converted from weights and measures in the Han dynasty were large. According to the common doses in modern clinical practice, conversion was carried out based on 6 g of Cinnamomi Ramulus, 6 g of Natrii Sulfas, 6 g of Glycyrrhizae Radix et Rhizoma, and 12 g of Rhei Radix et Rhizoma. The weight of Persicae Semen should be determined according to the actual measurement. In terms of preparation and administration, the drugs in the pot were decocted with 1 400 mL of water to obtain 500 mL of decoction, which was filtered and slightly boiled in the presence of Natrii Sulfas. About 100 mL of warm decoction was taken before meals， three times a day. It was recorded in the ancient books that Taohe Chengqitang was indicated for the syndromes of heat invading the bladder and accumulating inside in the case of released exterior syndrome in Taiyang. After symptom-based flexible application by doctors, it is currently commonly used in the treatment of diabetic nephropathy， constipation， chronic renal failure, and other diseases.