Science of Meridians and Acupoints is the bridge between basic medicine and clinical medicine of acupuncture and moxibustion. This teaching practice was conducted in reference to the teaching mode of problembased learning (PBL), in association with the clinical design problems, by taking as the students as the role and guided by teachers. In order to stimulate students' active learning enthusiasm, the writers implemented the class teaching in views of the typical questions of clinical design, presentation of study group, emphasis on drawing meridian running courses and acupoint locations, summarization and analysis, as well as comprehensive evaluation so that the comprehensive innovative ability of students and the teaching quality could be improved.
Acupuncture ; education ; Acupuncture Points ; Humans ; Meridians ; Problem-Based Learning ; Science ; education ; Teaching

Objective To analyze the resistant profile and genotypes ,as well as susceptibility to tigecycline in carbapenemase‐producing K lebsiella pneumoniae for better clinical management of such infections .Methods Nine strains of carbapenemase‐producing K .pneumoniae were isolated from clinical specimens during the period from February 2012 to May 2013 in our hospital .Bacterial identification and antimicrobial susceptibility testing were carried out with VITEK 2 Compact automatic microbiological assay systems .The phenotype of carbapenemase‐producing K . pneumoniae was detected by modified Hodges test .The genotype of carbapenemase was identified by PCR method .The susceptibility to tigecycline was tested by E‐test . Results All the 9 strains of carbapenemase‐producing K . pneumoniae were resistant to the 19 antibiotics tested .Modified Hodges test was positive for 7 strains (77 .8% ) .Target band of carbapenemase gene was identified in all the 9 strains of K . pneumoniae ,and all were confirmed as KPC‐2 gene .All the 9 strains were susceptible to tigecycline .Conclusions The resistance of carbapenemase‐producing K .pneumoniae is still serious .Tigecycline has shown good in vitro activity against such strains .

Objective: To establish a method of HPLC for determination of paeoniflorin in Yifu Capsules. Methods: HPLC analysis was carried out on ALLIMA C 18 column with acetonitrile water(15:85) as a mobile phase and detection wavelength at 230nm. Results: The linear range was 0.0798～0.7980?g (?=0.9998,n=6), and the average recovery was 99.00%(RSD=2.17%,n=5). Conclusion: The method is simple, accurate,highly sensitive and reproducible. It can be used for determination of paeoniflorin in Yifu Capsules.

Objective To describe the distributions of FCGR polymorphisms in human immunodeficiency virus (HIV)-uninfected patients with cryptococcosis,and to investigate the association of FCGR polymorphisms with the susceptibility to cryptococcosis.Methods The distributions of the four functional polymorphisms,including FCGR2A 131H/R,FCGR3A 158F/V,FCGR3B NA1/NA2,and FCGR2B 232I/T were compared between 198 cryptococcosis patients and 190 healthy controls.The polymorphisms distribution patterns were also compared between patients with central nervous system (CNS) infection and those without CNS infection.Genotyping of eight single nucleotide polymorphism (SNP) in FCGR were performed by multiplex SNaPshot technology using DNA extracted from blood samples.The comparison between patients and controls was performed by chi square test or Fisher exact test.Results Compared to healthy controls,the frequency of FCGR2B 232I/I increased (65％ vs 53％,x2 =4.27,P=0.039,OR=1.652,95％CI:1.02-2.67) and that of FCGR2B 232I/T decreased (27％ vs 40％,x2 =5.77,P=0.016.OR=0.542,95％CI:0.33-0.90) in patients with cryptococcal meningitis.Among immunocompetent patients,the frequency of FCGR2B 232I/I was also over-presented (69％ vs 53％,x2=4.53,P =0.033,OR=1.958,95％CI:1.05-3.66) and the FCGR2B 232I/T genotype was also less frequently observed (24％ vs 40％,x2=5.14,P=0.023,OR=0.467,95％CI:0.24-0.91) compared to healthy controls.There were 117 cases with CNS infection and 81 non-CNS infection cases.The genotype of FCGR2A 131R/Rwas over-presented (19％ vs 6％,x2 =6.48,P=0.011,OR=3.52,95％CI:1.27-9.73) and the FCGR2B 232I/T genotype was under-presented (27 ％ vs 46 ％,x2 =7.56,P =0.006,OR=0.431,95％CI:0.24-0.79) in patients with CNS infection compared with those without CNS infection.Furthermore,the frequency of FCGR2B 232I/I genotypes increased (69％ vs47％,x2 =5.47,P=0.019,OR=2.479,95％CI:1.15-5.34) and the frequency of FCGR2B 232I/T decreased (24％ vs 51％,x2 =8.66,P=0.003,OR=0.307,95％CI:0.14-0.68) in immunocompetent patients with CNS infection compared with those without CNS infection.Conclusions FCGR2A 131H/R and FCGR2B 232I/T are associated with the susceptibility to cryptococcal CNS infection,which suggests that FcγRⅡA and FcγRⅡB may contribute to the pathogenesis of cryptococcosis.

Objective To determine the influence of P-glycoprotein (P-gp) inhibitor on the blood brain barrier (BBB) transport of amphotericin B (AmB)..Methods An in-vitro BBB model was established with brain capillary endothelia cells (BCEC). AmB was chosen as the test drug and verapamil was chosen as the inhibitor of P-gp.Cellular uptake of AmB at different time points and with series of verapamil concentrations were performed respectively after the determination of appropriate incubation time and drug dosage by the cytotoxicity assay. The AmB concentrations of series of samples were detected using high performance liquid chromatography (HPLC) method. One-way ANOVA analysis and Bonferroni test were used for data analysis.Results The cellular transport of AmB was accumulated as the time prolonged.The inhibitor group had a significant higher cellular uptake levelsof AmBat the time point of 90 min (t=6.753,P=0.001),120 min (t=3.574,P=0.016) and 150 min (t=4.759,P=0.005) as compared with the control group.The AmB cellular uptake level increased significantly when BCEC were incubated with verapamil of 2 μmol/L (P=0.000),5 μmol/L (P=0.014),10 μmol/L (P=0.000),50 μmol/L (P=0.014),75 μmol/L (P=0.000) and 100 tμmol/L (P=0.000),respectively,compared with the control group.Conclusion The P-gp inhibitor verapamil can enhance the cellular uptake of AmB which indicates that P-gp is involved in the BBP transport of AmB.

Objective To understand the clinical epidemiology of nosocomial candidemia in Huashan Hospital during a 10-year period. Methods One hundred and nine cases of nosocomial candidemia in Huashan Hospital affiliated Fudan University during the period of 1998- 2007 were retrospectively reviewed. The underlying conditions, risk factors, clinical manifestations, treatment and outcome were described. The prognostic factors were analyzed by chi square test or Fisher exact probability test. Multivariate analysis was done by multiple Logistic regression. Results The average annual incidence of nosocomial candidemia during the study period was 0.28/10 000 patients per day.The most common pathogen was C. albicans (59/109,54.1%), followed by C. tropicalis (20/109,18.3%), then C. parapsilosis (11/109, 10. 1%), C. glabrata (11/109, 10.1%), and other Candida spp. (8/109, 7.3% ). Underlying diseases frequently identified included diabetes (50,45.9%), solid malignancy (32, 29.4%), head trauma (13, 11. 9%) and stroke (12, 11.0%).There were 37 cases who died or deteriorated. The overall mortality was 34.0% and the attributable mortality was 22. 0% (24/109). In multivariate prognostic analysis, retention of central venous catheters (OR: 5.42, 95% CI: 1.68-17.41, P＝0.005), corticosteroid medication (OR: 3.69,95% CI: 1.10-12.34, P=0. 034), and severe sepsis on the day of candidemia (OR: 2.94, 95% CI:1.72-15. 21, P = 0. 003) were factors independently correlated to increased mortality. Furthermore,adequate antifungal therapy was the only independent predictor of decreased overall mortality (OR: 0. 27,95% CI: 0. 09-0. 78,P=0.015). Conclusions The incidence of nosocomial candidemia in our hospital has been increasing during the past decade. Timely diagnosis and treatment plays a key role in the management of nosocomial candidemia,

Objective To evaluate the significance of the level change of urinary conductivity (Cond) on the disease progress in the patients with type 2 diabetic nephropathy(DN) .Methods 138 patients with type 2 diabetes mellitus (T2DM) in our hospital were selected and divided into the normoalbuminuria (NUA) ,microalbuminuria (LUA) and macroalbuminuria (MUA) group;then among them 107 cases were re‐divided into the DN group and the diabetes mild renal injury (DC) group .The levels of urinary Cond were measured by using the Sysmex UF‐1000i urine flow cytometer .The urine specific gravity (SG) was detected by the ARKRAY AUTION MAX AX‐4280 analyzer ,and the urine albumin (U‐Alb) was tested by the Siemens BNⅡ automatic protein analyzer .Re‐sults The Cond level in the MUA group was (14 .1 ± 4 .5)ms/cm ,which was lower than (15 .7 ± 4 .3)ms/cm in LUA group(P<0 .05) ,while the Cond level in the LUA group was significantly lower than (17 .6 ± 5 .7) ms/cm in the NUA group(P<0 .05);the SG levels in the NUA group and the LUA group were 1 .014(1 .010-1 .019) and 1 .015(1 .010 -1 .020) respectively ,both were higher than 1 .011(1 .009-1 .012) in the MUA group SG (P<0 .05) .Cond was positively correlated with SG (r=0 .63 ,P<0 .05) and negatively correlated with 24 h‐UAE (r= -0 .183 ,P<0 .05) .The Cond level in the DN group was(13 .2 ± 4 .3)ms/cm ,which was significantly lower than (15 .0 ± 4 .4) ms/cm in the DC group (P<0 .05) ,there was no statistically significant differences in the SG level between the DN group and DC group (P>0 .05) .The area under curve (AUC) of ROC for Cond was 0 .612 (0 .502-0 .723) .When setting the cut‐off vales of Cond as 11 .85 ms/cm ,then the sensitivity was 43 .8% ,and the specificity was 78 .0% . Conclusion The urine Cond level change can reflect the disease progress of DN in T 2DM ,but can not be used as its early screening indicato r .

Objective To summarize the SPECT/CT manifestation of spondylitis caused by Brucells infection and to evaluate the diagnostic value.Methods From June 2012 to October 2015,a total of 28 patients (14 males,14 females,average age 46.4 years) with Brucellosis spondylitis confirmed by laboratory test and pathology were included.The images of whole-body bone scan and SPECT/CT fusion imaging were retrospectively analyzed.According to the pathological and serologic test results,the diagnostic efficacy of imaging was calculated.x2 test was used.Results Most of the Brucellosis spondylitis happened in the lumbar(76.7％,43/56),and the most common locations were L3,L4,L5 (72.1％,31/43).Two or more involved consecutive vertebra were found in 71.4％ (20/28) of the patients.Moderate radioactive distribution was showed in 89.2％ (50/56) of lesions,high radioactive distribution was showed in 5.4％ (3/56) of lesions,and mild radioactive distribution was showed in the rest 3 lesions.Thirty-three lesions(58.9％,33/56) had diffuse increased radioactivity uptake in the affected vertebra,and 32.1％(18/56) showed diffuse increased radioactivity at the superior and inferior margin of the vertebra;only 8.9％ (5/56) of lesions were on one side of the vertebral bodies.The SPECT/CT results were as follows:(1) Bone destruction was showed in 80.4％ (45/56) of lesions,and the edge of the lesion was clear.(2) For 66.7％ (30/45) of lesions,bone hyperplasia was seen along with bone destruction and moderate radioactivity concentration on the edge of destruction area.(3) The damage of the intervertebral disc was mild,and the vertebral abscess was relatively rare (5.4％,3/56).The diagnostic accuracy of SPECT/CT was statistically higher than that of whole-body bone scan:67.8％(38/56) vs 96.2％(54/56);x2=13.1,P＜0.05.Conclusion SPECT/CT imaging has a higher diagnostic efficiency than whole-body bone scan in Brucellosis spondylitis.

Objective To explore the diagnostic value of whole?body bone scan combined with SPECT/CT imaging for osteofibrous dysplasia( OFD) . Methods A total of 30 patients ( 14 males, 16 fe?males, age range 10-48 ( average age 29.2) years) with OFD confirmed by pathology from June 2007 to De?cember 2014 were included. The images of whole?body bone scan and SPECT/CT imaging were retrospec?tively analyzed. Results Nineteen patients (63.3%, 19/30) showed monostotic OFD, which mainly in?volved extremities (n=18), especially the femur. Eleven patients(36.7%, 11/30) showed polyostotic OFD, which frequently be seen unilaterally (n=7). Highly or obviously abnormal uptakes of radiotracer were shown in most lesions (95.3%, 81/85) on whole?body bone planar images, the ribs and extremities showed abnormal uptake along the backbone orientation, while the cranium, pelvis and spine showed irregu?lar bulky uptake of radioactivity. On SPECT/CT images, the lesions of high or obvious abnormal uptake of radiotracer mainly showed cystic expansion growth, ground glass, vegetable sponge and mixed appearance;and the higher the radioactive aggregation degree was, the more the morphological changes were. The density and morphological changes on CT were not obvious for lesions with moderately and mildly abnormal uptake of radiotracer. Conclusion The whole?body bone scan combined with SPECT/CT imaging is an effective diag?nostic method for OFD.

Objective To describe the distribution of mannose binding lectin (MBL) genetic polymorphisms in non-acquired immunodeficiency syndrome (AIDS) patients with cryptococcosis in China and to verify the association of MBL polymorphisms with susceptibility to cryptococcosis.Methods The case-controlled genetic association study was conducted and 167 non-AIDS patients with cryptococcosis and 208 healthy controls were recruited. Genome DNA was extracted from the peripheral blood and MBL gene was amplified by polymerase chain reaction (PCR). Six singlenucleotide polymorphisms ( SNP) of MBL gene were sequenced. The association of MBL polymorphisms with susceptibility to cryptococcosis were analyzed. The comparison between patients and controls was performed by chi square test or Fisher's exact test. The differences of MBL plasma concentrations between groups with different MBL genotypes were compared by single factor variance analysis. Results There were no differences between patients and controls in terms of MBL genotype frequencies, haplotypes and genotypes (all P>0. 05). Compared with healthy control, the deficient MBL-producing genotypes were strongly associated with cryptococcal meningitis (16. 5% vs 8. 7%,χ2=4.25, P=0.0392, OR = 2.09), particularly in patients without underlying immunocompromised conditions (21. 4% vs 8. 7%, χ2 =7. 15, P = 0. 0075, OR = 2. 88). Individuals with MBL deficiency genotypes showed significantly higher rates of central nervous system (CNS) cryptococcal infection rather than non-CNS cryptococcosis (16. 5% vs 3. 1%, Fisher's exact test, P = 0. 010, OR = 6. 13).The difference was even more significant in the immunocompetent patients (21. 4% vs 4. 0%, P =0.009, OR= 6. 55). Conclusion MBL deficiency is associated with cryptococcal meningitis and may play a role in CNS Cryptococcus infection.