With the change in the modes of medicine, the traditional educational mode of clinical medicine is unable to meet the development demands of modern medicine. Evidence based medicine, a new mode of medical treatment, reflects the development trends of modern medicine and represents the direction of modern medical advancement. Judging from the perspective of medical education, evidence based medicine is a learning method which differs from the traditional educational mode and represents a new concept of education in clinical medicine. The rise of evidence based medicine demonstrates the direction of reform in medical education in the world today and will also bring about great changes in the mode of medical education in China. It is imperative for us to follow the trend in clinical medical education, update concepts on medical education in line with the basic ideas of evidence based medicine, and push forward reform in the mode of medical education.

Objective To investigate the changes of alveolar epithelial permeability and the capacity of alveolar epithelium to remove alveolar fluid in the rat models of acute lung injury induced by oleic acid.Methods A total of 35 Wistar rats were randomly assigned to the control group(n=7),and the injured group(n=28) in which the lung injury was induced by intravenous injection of oleic acid at the dose of 0.25 ml/kg.The alveolar liquid clearance rate(ALCR),total lung water content(TLW),extravascular lung water content(EVLW) and alveolar epithelial permeability(AEP) were examined in 3,6,12,24 h after injury(n=7 at each time point).Results After lung injury,there was continuous increase of AEP,TLW and EVLW,as well as progressive reduction of ALCR.On 24 h after injury when all changes were most significant,AEP was increased by 68.7%,ALCR was reduced by 49.4%,TLW and EVLW increased by 44.6% and 92.0% respectively,as compared with control group.Conclusion The alveolar epithelial barrier might play a role in the pathogenesis of pulmonary edema in acute lung injury.

Objective To explore the change of alveolar epithelial liquid clearance capacity in lung edema following acute lung injury induced by oleic acid.Methods Forty-eight Wistar rats were randomly divided into 6 groups: the control(C), injury(I), amiloride(A), ouabain(O),amiloride plus ouabain(AO), and terbutaline(T) groups. Acute lung injury was induced with intravenous oleic acid 0.25 mlkg -1. 24h after injury, 5% albumin solution (5 ml?kg -1) was delivered into both lungs via the trachea in C and I groups. In A, O, AO and T groups, amiloride (2?10 -3 mol/L),ouabain (5?10 -4 mol/L), amiloride (2?10 -3mol/L) and ouabain (5?10 -4 mol/L)mixture and terbutaline(10 -4 mol/L),added respectively to the albumine solution,at 5ml.kg -1 were administered intratracheally to both lungs separately. One hour later, the alveolar liquid clearance rate(ALC), total lung water content(TLW), extravascular lung water content(EVLW) and arterial blood gases were measured.Results As compared with those in C group, severe hypoxemia, hypercapnia and acidosis appeared, ALC was reduced by 49.2% ,TLW and EVLW markedly increased in I group(P

Objective It has been shown that fluorinated inhalational anesthetics have various adverse effects on the lungs. The aim of this study was to investigate the effects of different concentrations of isoflurane (ISO) on the lungs in rats.Methods Ninety Wistar rats of both sexes weighing 140-200 g were randomly divided into two groups : (A) control group received only oxygen inhalation ( n = 30) and (B) isoflurane group (n = 60) which was farther divided into 2 subgroups (n = 30):0.6% and 1.4% isoflurane. In each subgroup isoflurane was inhaled for 2 h ( n = 10), 4h (n = 10) or 8 h ( n = 10) . The animals were placed in a glass container and isoflurane was delivered from ISO vaporizer into the container through the inlet. The end-tidal ISO concentration was checked at the outlet. The animals were sacrificed at the end of ISO inhalation. The lungs were immediately removed and blood was collected for determination of (1) lung water content, (2) protein content and neutrophil ratio in broncho-alveolar lavage fluid (BALF) , (3) serum and BALF surfactant protein-A (SP-A) content and (4) microscopic examination. Results There was no significant difference in all variables between control group and 0.6% ISO subgroup. Exposure to 1.4% ISO for 8 h caused an increase in neutrophil ratio and protein content in BALF, and serum SP-A content but a decrease in BALF SP-A content. There was no significant difference in lung water content between control group and 1.4% ISO (8 h) subgroup. Conclusion Isoflurane (1 MAC) inhalation over 8 h may impair the function of alveolar epithelium.

Object To establish an analysis method for determ in ation of irone in Iris tectorum Maxim. f. alba Makino. Methods The three isomers of irone were quantitatively analyz ed by GC-MS. Irone in I. tectorum extract was determinated by GC. Results The three isomers of irone, ?, ?, ?- irone were s p eculated according to the MS splitting decomposition law. Irone contents in the extract were 687, 238 ?g/g (n=6), which h ad much difference. Conclusion The analysis method for irone by GC-MS and GC is hig her efficiency, precise, and the analysis time is acceptable.

AIM To study the effect of ketamine on proliferation,cell cycle in the cultured rat neural stem cells. METHODS The growth inhibition of ketamine on neural stem cell was evaluated by an MTT assay. The effect of ketamine on cell cycle was measured by flow cytometry. RESULTS Ketamine inhibited the growth of cultured rat neural stem cells. Flow cytometry analysis showed that G 0/G 1 phase rate was increased but S phase rate was decreased. CONCLUSION Ketamine can inhibit proliferation of cultured rat neural stem cells,and this inhibitition is associated with cell cycle block.

OBJECTIVETo explore treatment effect of the locking plate percutaneous external fixation to tibial fractures.

METHODSFrom July 2010 to February 2013, 8 cases with pediatric tibial fractures were treated by using unilateral locking plate percutaneous external fixation,including 6 males and 2 females with an average age of 7 years old ranging from 4 to 10. Among them, 5 cases were open fractures involving 1 case of Gustilo-Anderson type II, 3 cases of type III A, 1 case of type III B; and the other 3 cases were closed fractures involving 2 cases of AO type A3, 1 cases of type B2. The postoperative bone healing and gait impact were observed and the function was evaluated by Johner-Wruhs scores.

RESULTSAll fractures healed successfully without infection. The fracture healing time was from 3 to 6 months with an average of 3.9 months. The locking plate removal time was from 4 to 7 months with an average of 4.3 months. Among them, 7 cases were visually normal after walking with stand, 1 case of anterior tibial tendon defect affected gait. The results of Johner-Wruhs assessment were excellent in 7 cases, good in 1 case. No rub contralateral medial calf skin wounds occurenced.

CONCLUSIONThe method is simple, stable and reliable. The fixation strength is suitable for children using locking plate percutaneous external fixation. The postoperative functional recovery was excellent and the walking gait was less affected. But the point of LCP pedicle screw should be carefully selected before installation with good skin coverage.

Bone Plates ; Child ; Child, Preschool ; External Fixators ; Female ; Fracture Fixation ; methods ; Fracture Healing ; Humans ; Male ; Tibial Fractures ; physiopathology ; surgery

Adult ; Arteries ; anatomy & histology ; Asian Continental Ancestry Group ; Female ; Humans ; Larynx ; anatomy & histology ; blood supply ; Male ; Microsurgery

Objective To investigate changes and the significance of Th17/Treg immune imbalance in secondary systemic infection in patients with severeacute pancreatitis.Methods We selected 21 patients with severe acute pancreatitis and secondary systemic infection (infection group),25 patients with severe alone (non-infection group),20 healthy cases undergoing annual health checkup (control group) in this study.The expression levels of Th17/Treg cells and related cytokines were compared between groups.Results There were significant differences in mortality rate and duration of ICU stay between infection group and non-infection group [23.8％ vs.4.0％,(11.3±3.4) d vs.(7.5±2.8) d,x2=3.949,t=2.890,P=0.047 and0.045].The percentages of Th17 cell andTreg cell,Th17/Treg ratio,mRNA expressions of IL-6,IL-17,IL-23,TGF-β and orphan receptor γt were higher in infection and non infection groups than in control group [(26.4 ± 1.2) ％,(12.8 ± 0.9)％ vs.(3.1±0.8) ％;(6.7±1.6)％,(4.2±1.3)％ vs.(1.3±0.4)％;(4.3±1.0)％,(3.2±1.1)％ vs.(2.4±0.9)％;(7.1±0.8)ng/L,(5.3±0.7)ng/L vs.(0.2±0.1)ng/L;(22.9±2.4)ng/L,(15.6±2.8)ng/L vs.(10.3± 1.5)ng/L;(15.7±2.1)ng/L,(10.2± 1.5)ng/L vs.(8.3± 1.4)ng/L;(23.6±2.2)ng/L,(16.3±1.7)ng/L vs.(11.6±1.1)ng/L;(0.052±0.014),(0.035± 0.010) vs.(0.004±0.001);F=15.761,55.745,9.437,102.788,21.038,16.239,36.957,23.924,respectively,P=0.555,0.000,0.014,0.000,0.002,0.004,0.000,0.000].The mRNA expressions of IL-10 and Foxp3-T were lower in infection and non-infection groups than in control group [(6.4±1.1)ng/L,(10.5 ± 2.1) ng/L vs.(15.4±2.0)ng/L;(0.005±0.001),(0.020±0.007) vs.(0.032±0.009),F=18.995 and 20.608,P=0.003 and 0.002].Conclusions The secondary infection can aggravate the Th17 / Treg immune imbalance in patients with severe acute pancreatitis,and extend the ICU hospitalization days.

Objective To investigate the effect of natural killer (NK) cells treated by serum of severe preeclampsia patient on the function of endothelial cells.Methods Fifteen patients with severe preeclampsia and 15 normal pregnant women from the Obstetrics department,Shengjing Hospital,China Medical University were admitted into this case-control study from January 1,2006 to December 31,2008.NK cells from healthy non-pregnant woman were incubated with 20% serum from severe preeclampsia patients or normal pregnant women for 20 hours.Then,human umbilical vein endothelial cells ( HUVEC) and serum-treated NK cells were co-incubated for 24 hours.Apoptosis of HUVEC was checked by flow cytometry and electronic microscope.Endothelin-1 (ET-1) levels in the supernatants of HUVEC and NK cells were examined by radioimmunologic method.Results In severe preeclampsia group,the percentage of early apoptosis cell (Annexin V-FITC+ /PI+ ) was (23.81±4.79)%,that of late apoptosis cell (AnnexinV-FITC+/PI+ ) was (3.29±1.04) %,while those were (16.59±5.13)% and (2.24±0.72)% respectively in normal pregnant group (P＜0.01).There was no significant difference in dead cells (Annexin V-FITC- /PI+ ).Under electronic microscope,typical morphologic changes of apoptosis were shown in severe preeclampsia group.Level of ET-1 in