This article introduces how to use debate in clinical teaching and explains the organization,training,choosing the debate topics,making the rule and implementation of debate.Debate is advantageous to raise and enhance the medical students' abilities of study independent,clinical thought,consult,analysis and application literatures,oral expression,team cooperation and so on.

Abstract: Superior mesenteric veinous thrombosis (SMVT) is a rare complication that often occurs in conjunction with intra-abdominal diseases such as diverticulitis, appendicitis, inflammatory bowel disease, etc. Its clinical symptoms are non-specific and include fevers, abdominal pain; it has no specific symptoms, and the diagnosis depends on clinical laboratory tests and imaging studies. The occurrence of superior mesenteric veinous thrombophlebitis is related to septic phlebitis caused by the sloughing of the embolus containing bacteria into the portal vein with blood flow. Due to the nonspecific clinical features of this disease, diagnosing it based on clinical characteristics and microbiological aspects is a challenge. A case of superior mesenteric veinous septic thrombophlebitis caused by Bacteroides fragilis infection is reported and to provide a reference for the diagnosis and treatment of such diseases. The patient was a 34-year-old man who was admitted the hospital with intermittent abdominal pain and fever. Computed tomography (CT) showed partial thrombosis of the superior mesenteric vein, colonoscopy revealed diverticulitis in the ileoceca, and the blood culture grew Bacteroides fragilis. The patient was treated with anti-infection (ceftazidime 2.0 g q12h intravenous infusion for 11 days; metronidazole 0.5 g, q8h intravenous infusion for 3 days) and anticoagulation (rivaroxaban 20 mg qd orally for 8 days. On the 11th day of hospitalization, the patient's condition improved, and he was discharged. In this case, for patients with fever and abdominal pain, superior mesenteric venous thrombophlebitis should be included in the differential diagnosis. Through auxiliary examination, blood sample culture and other technologies, clear diagnosis should be made in time to improve patient outcomes.

ObjectiveTo investigate advantage and disadvantage of different rehabilitation therapies used for cerebral palsy (CP) children complicated with epilepsy (EP).Methods140 CP children complicated with EP screened from 1402 CP cases, were analyzed for CP and EP types, MRI or CT, brain stem auditory evoked potentials (BAEP). All cases were treated with anti-epilepsy drugs (AEDs). Different rehabilitation therapies, including electrotherapeutic modalities, acupuncture, point injection, cerebroprotein hydrolysate injection, manual therapy, functional training, Chinese herb braising therapy, and cattle encephalon glycoside and ignotin injection were assessed.ResultsIn all 140 cases, a majority of EP types were myoclonic seizure and west syndrome, CP type was spasticity. Abnormality showed in MRI or CT (98%) and BAEP (90%). AEDs were effective for all 140 cases. Electrotherapeutic modalities, acupuncture, point injection, and cerebroprotein hydrolysate injection could make EP severely, but manual therapy, functional training, Chinese herb braising therapy, cattle encephalon glycoside and ignotin injection had no adverse effects on EP cases.ConclusionThe principles of rehabilitation treatment for the CP children complicated with EP are taking AEDs early and in a long term, avoiding electrotherapeutic modalities, acupuncture, point injection, and cerebroprotein hydrolysate injection, using manual therapy, functional training, Chinese herb braising therapy, and cattle encephalon glycoside and ignotin injection.

To providing evidence about nitrogen adequate application of Platycodon grandiflorum, the pot culture experiment was conducted to study the effect of nitrogen on the growth, physiological metabolism and the quality of P. grandiflorum. The activity of NR, GS and SOD, POD and CAT were determined. And the nitrate and ammonium nitrogen content, photosynthetic characteristics, active components of P. grandiflorum were determined. The results showed that the nitrate nitrogen content and P. biomass reached its maximum value, when NH4(+)-N/NO3(-) -N was 0: 100, the activity of NR. The activity of GS was the highest at the NH4(+) -N/NO3(-) -N ratio of 25:75 and ammonium nitrogen content was the highest at 75:25. The activity of SOD decreased and then increased with the increasing of NO3(-) -N. At the NH4(+) -N/NO3(-) -N ratio of 25: 75, the activity of CAT had its maximum value and the content of MDA had the minimum value. At the same time, the content of platycodon D was the highest at this treatment. The studies had shown that different nitrogen forms and ratio had a significant effect on the characteristics of photosynthetic physiology, nitrogen metabolism and resistance adjustment, growth and the quality of P. grandiflorum. The NH4(+) -N/NO3(-) -N ratio of 25: 75 was a suitable ratio of nitrogen forms for the growth of P. Grandiflorum and accumulating the content of platycodon D.
Ammonium Compounds ; metabolism ; Biomass ; Drugs, Chinese Herbal ; analysis ; metabolism ; Nitrates ; metabolism ; Photosynthesis ; Plant Leaves ; chemistry ; growth & development ; metabolism ; Platycodon ; chemistry ; growth & development ; metabolism

Humans ; Infant ; Male ; Tuberous Sclerosis ; Twins

Objective To evaluate the clinical effect of ultrasound-guided percutaneous transhepatic cholangial drainage (PTCD) combined with endoscopic retrograde cholangio-pancreatography (ERCP) in treating malignant obstructive jaundice, and to discuss its technical points. Methods A total of ten cases with malignant biliary obstruction were enrolled in this study. After the failure of ERCP treatment, the patients had to be treated with ultrasound-guided PTCD immediately. The guide-wire was inserted into the duodenum through intrahepatic bile duct and common bile duct to connect with ERCP, which was followed by the biliary stent implantation or the removal of physical factors causing obstruction. The clinical results were analyzed. Results Technical success was obtained in all 10 cases. In the patients who underwent a successful guide-wire docking with ERCP the postoperative serum bilirubin was significantly decreased. The main complications were fever, elevation of amylase and transient bloody bile. Conclusion With the help of docking technique the combination use of ultrasound-guided PTCD and ERCP is a new tentative treatment for malignant obstructive jaundice after the failure of initial ERCP treatment. This technique carries promising value in clinical practice as it can significantly increase the success rate of ERCP.

Objective:The study focuses on the distinct distributions of γδT cells in various tissues and the changes after Sal-monella typhimurium infection,and attempts to explore the physiological significance of γδT cell distribution and the role of γδT cells in infectious diseases .Methods:Flow cytometry and PCR technique were used to detect the proportion of different γδ T cell subsets among thymus,spleen,lymph nodes,liver,skin,and intestinal intraepithelial lymphocytes .Flow cytometry was applied to detect the secretion of IFN-γand IL-17a.The changes of various γδT cell subsets in liver and intestinal intraepithelial lymphocytes were analyze after Slamonella typhimurium infection.Res ults: γδ T cells were rich in the intestinal epithelium , skin and liver, but poor in the thymus,spleen and lymph nodes .The distribution of different subsets was quite dissimilar .Vγ5+γδT cells chiefly existed in skin ,and Vγ1+,Vγ4+,Vγ7+γδ T cells largely existed in small intestine.γδ T cells in liver mainly secreted IL-17a;however,γδ T cells in intestinal intraepithelial secreted IFN-γ.After infection by Salmonella typhimurium , the proportion of γδ T cells in intestinal intraepithelial increased significantly ,particularly Vγ1 +γδT cells.In Liver,there was no significant change of total γδT cell ratio,but the ratio of Vγ1 +γδT cells reduced ,Vγ4 +γδT cells raised.Conclusi on:γδT cells are rich in the intestinal epithelium ,skin and liv-er.The distribution of different subgroups has specificity .There are large differences in the ability of cytokine secretion among various subgroups of γδT cells.The distribution of γδT cell subgroups in small intestine and liver changes during Salmonella typhimurium in-fection.

At present,transplantation has been the predominant way to solve most of the end-stage diseases,ensued by the use of immunosuppressive drugs.Since the immunosuppressive drugs have narrow therapeutic index,the blood drug concentration is needed to mornior.Pharmacogenetics is one subject which focuses on the interaction between gene and the metabolism of the drug,providing great help for designing the regime of achieving the target drug concentration.Meanwhile,it facilitates the realization of individual therapy.This review thus focuses on the latest advancement on the pharmacogenetics of those immunosupprressants,hoping to provide help for the treatment.

Surgical resection remains the only curative option of treatment for hepatocellular carcinoma,but centrally located tumors remain problematic.Extended right or left hepatectomy removes 60％ to 85％ of the hepatic parenchyma and is associated with more hepatic failure.Mesohepatectomy,resection of central hepatic segments (Couinaud's segments Ⅳ,Ⅴ,Ⅷ) and leaving the right and left segments in situ,preserves more functional hepatic tissues than extended hepatectomy.Despite its technical demands,mesohepatectomy should be considered as an alternative treatment for central huge hepatic tumors.

Objectives To study the efficacy of the two-compartment peritoneal dialysis fluid with low glucose degradation products in peritoneal dialysis (PD) patients.Methods Pubmed,EBMASE,Cochrane Library,Wanfang,VIP,CNKI,CBM and other databases were searched,at the same time the information form relevant literatures until December 2013 were searched by hand.To be eligible,studies had to be randomized controlled trials that allocated PD patients to two-compartment peritoneal dialysis fluid with low glucose degradation products (low-GPDs group) or to traditional dialysis fluid (control group).The qualities of included articles were assessed and then a meta-analysis was conducted by using RevMan 5.2 software.Results A total of 12 documents,11 studies met the inclusion criteria,and 1 059 cases were included.Meta-analysis results were as follows:(1)the low-GPDs group had higher level of CA125 in peritoneal dialysis effluent,higher residual renal function compared with that in the control group and the weighted mean difference were 19.61 (95％CI 12.04-27.18,P ＜ 0.01) and 0.78 (0.14-1.43,P=0.02),respectively; (2)There was no statistically significant difference between control and low-GPDs group in the ultrafiltration,peritonitis and plasma bicarbonate (all P ＞ 0.05); (3)Four studies showed no difference in peritoneal dialysis technique survival between the two group (P ＞ 0.05).Conclusions The two-compartment peritoneal dialysis fluid with low glucose degradation products is effective and safe,has no negative effects on the frequency of peritonitis,patient' s peritoneal member transport function and plasma bicarbonate,but it causes less mesothelial damage and has higher residual renal function in patients than conventional ones,and does not affect the technique survival time.