Currently, medical ultrasound teaching focuses on the delivering the image infor-mation itself, while its connection with basic medicine and clinical medicine is neglected. Such a teaching method is not good for students to establish a systemic view. To conduct the ultrasound medi-cine education effectively in undergraduate students, we have tried some reforms, including: perform-ing diseases or problem based teaching, integrating basic medicine, ultrasound medicine and clinical medicine throughout the whole teaching process, providing as many practice opportunities as possible for the graduates and integrating the ultrasound imaging with other medical imaging modalities. The practice shows that with the reform, the students have a better understanding of ultrasonic knowledge itself, a better grasp of the whole medical knowledge structure, and also have a preliminary impression on how to diagnose the disease through reasonable application of different treatments. In addition, students have more passion for study.

ObjectiveTo observe and quantify the effec ts of respiration on hemodynamics in patients with pericardial effusion (PE) and to verify our new proposed hypothesis about the mechanism of respiratory effects on cardiac function from clinical point of view. MethodsPulsed-wave Doppler spectra of the four cardiac valves were recorded with Acuson Sequoia 512 and 128 XP/10 in 10 patients with PE and 18 healthy control subjects with no apparent cardiac and pulmonary abnormalities. Electrocardiogram and respiratory tracing by a nasal thermistor were recorded simultaneously with the echocardiograms. The blood flow velocities of each valve during inspiration and expiration were averaged separately and those were again averaged for 5 consecutive respiratory cycles, and the respiratory variation indices (RVI) were calculated both in the patients and the control groups. ResultsThe peak E velocity across the mitral valve and that across the aortic valve significantly increased during expiration and decreased during inspiration, while that across the tricuspid valve and that across the pulmonary valve increased remarkably during inspiration and decreased during expiration in all of the subjects. The RVI of the velocities across the mitral and the aortic valves increased significantly in the patients with PE compared with the control subjects [MV: ( 14.57 ? 7.89 )% vs ( 9.71 ? 3.39 )%, P

0.05). Conclusions Ultrasound contrast agent Levovist improves signal of blood flow obviously. It increases the diagnostic accuracy for intracranial aneurysms and the level of confidence.

Objective To observe characteristic imaging of traumatic arteriovenous fistulas(TAVF) and to evaluate the methods of differential diagnosis of TAVF by Doppler ultrasonography. Methods Eleven patients suffering from TAVF were selected to have the examination of Doppler ultrasonography. The blood flow of arteriovenous fistulas, diameter, morphology and blood flow character of affected vessels were observed. Spectral of fistula and affected vessels were analyzed and compared with the healthy side. Results Localization of arteriovenous fistulas was observed directly in eight patients, which presented as intercepted wall of the affected vessels and irregular mosaic flashes flowing towards enlarged vein from artery. Pulsed wave Doppler showed unilateral continuant spectral with maximum velocity 300-390 cm/s when sampled in the fistula. Spectral analysis of proximal arteries of the fistula revealed high velocity and low resistance. Arterialized flow pattern was observed in affected veins. Proximal veins of the fistula revealed arterialized spectral with high velocity and low resistance. Reversed centrifugal blood flow was observed in the distal veins of the fistulas in 4 cases. Conclusions Unilateral shunt in both diastole and systole in the fistula and arterialized flow with high velocity in veins are characteristic presentation of TAVF. Color Doppler ultrasonography has great value in confirming diagnosis and differential diagnosis of TAVF.

Objective To evaluate the clinical effect and safety of umbilical cord ligation in the fetocide of complicated monochorionic multiple gestations.Methods From January 2009 to December 2012,clinical data of 18 women with complicated monochorionic multiple gestations who experienced intrauterine percutaneous umbilical cord ligation in Peking University Third Hospital were collected.Among the patients,6 were selective intrauterine growth restriction (1 with type Ⅰ,4 with type Ⅱ,1 with type Ⅲ) ; 4 were acrania or hydropic twins; 4 were aeardiac twins,2 were complicated triplet gestation; 1 was twin-twin transfusion syndrome with right ventricular dysplasia and 1 was monochorionic diamniotic (MCDA) with caesarean section history.The procedure was performed under both endoscopic and sonographic guidance.The gestational age at the time of the procedure were 17-27 +6 weeks.The procedure and perinatal outcome were analyzed.Results (1) The procedure was performed successfully in all the 18 cases.The average duration of the procedure was 63 min (24-156 min).The blood loss was 7.6 ml (5-20 ml).The mean gestational age at the time of the procedure was 20 weeks (17-27 +6 weeks).The average birth weight of the neonates was 2441 g(1000-3400 g).(2) There were 20 fetuses survived.Two fetuses had cardiac anomalies and were terminated in the following 2-3 weeks.Intrauterus fetal demise occured in 3 twin reverse arterial perfusion syndrome (TRAP) cases 3-14 weeks after the procedure.1 case delivered as early preterm birth at 28 weeks and the neonate died of respiratory distress syndrome (RDS) and hypoxie-ischemicencephalopathy (HIE).Fourteen neonates were in healthy and normal development by 3-51 months' followup.(3) Fourteen cases delivered at more than 28 weeks (28-38 weeks,averagely 33 + 1 weeks).The gestational weeks were prolonged by 5-21 weeks (averagely 13 +4 weeks).Among them,3 case were early preterm birth (28-33 weeks) and 3 were late preterm birth (34-36 weeks).Conclusion Percutaneous umbilical cord ligation is a reliable technique for the fetocide of complicated monochrionic mutilple gestations,especially for monochronic monoamniotie pregnancies.

Objective To investigate the role of NF-κB activation in the inflammatory mechanism of chronic obstructive pulmonary disease (COPD).Methods Monocyte were collected from patients with COPD and were cultured,and stimulated with lipopolysaccharide (LPS) ; NF-κB p65 activation was measured by immunohistochemistry; SOD ,MDA and IL-8 and lung function were determined synchronously.Results The NF-κB p65 was induced by LPS in monocyte in all subjects, but it was most markedly done in COPD patients with exacerbateions; There was positive correlation between the NF-κB p65 activation of monocytes and levels of IL-8 and MDA in circulation, but it was negative correlation to SOD.Conclusion NF-κB plays a vital role in regulating product of IL-8 in monocyte in COPD.

Objective To explore the feasibility and safety of single-port laparoscopic surgery in the treatment of incarcerated inguinal hernia in children. Methods The clinical efficacy of single-port laparoscopic and epidural anesthesia needle treatment for incarcerated inguinal hernia in children of 32 cases were analyzed retrospectively. Results Thirty-two children were operated successfully. The operation time was (16.24 ± 4.67) min for unilateral hernia (in 25 cases) and (21.69 ± 5.85) min for bilateral hernia (in 7 cases). The blood loss was (2.50 ± 0.56) ml. The recovery time of intestinal peristalsis was (16.42 ± 4.86) h after surgery, and the postoperative hospital stay was (3.25 ± 0.82) d. Intraoperative exploration found 7 cases had concealed contralateral hernia;incarcerated hernia contents included bowel in 27 cases, ovaries in 3 cases, and greater omentum in 2 cases. All the incarcerations were successfully restored by hand and no-damage clamp assistance. The incarcerated organ had good blood flow in all the 32 cases. The follow-up time was (15.62 ± 5.34) months, and there was no recurrence and atrophy of testis or ovaries. Conclusions The single-port laparoscopic surgery for incarcerated inguinal hernia in children has advantages of preservation of anatomy of the inguinal canal easily to perform high ligation of hernial sac, and reduction under direct visual control. Meanwhile, occult inguinal hernia in the opposite side can be cured. It was a safe, effective, and minimally invasive procedure, being worthy of further clinical application.

Objective To investigate the feasibility and safety of umbilical single- port laparoscopic surgery in the treatment of children ovarian cysts. Methods The clinical efficacy of umbilical single-port laparoscopic surgery in the treatment of children ovarian cysts of 36 cases was analyzed retrospectively. Results Thirty-six children successfully completed surgery. The operative time was (27.8 ± 8.6) min, the diameter of ovarian cysts was (7.2 ± 2.4) cm, and the blood loss was (6. 5 ± 1.6) ml. All the children were confirmed to have benign ovarian cysts by pathological examination. Thirty-four children retained ovarian tissue after removal of the cyst, and 2 children underwent oophorectomy because of ovarian necrosis. The anus exhaust was recovered (18.4 ± 4.6) h after surgery, and the postoperative hospital stay was (4.2 ± 1.3) d. The children began to diet after anesthesia conscious. All the children recovered well, and no surgical complications occurred. The followed-up time was (24.6 ± 6.3) months, and no recurrence occurred. Conclusions Umbilical single-port laparoscopic surgery in the treatment of children ovarian cysts is easy, minimally invasive, no scar formation, quickly recovered and reliable. It is worth of further clinical application.

Tianjin Medical University set up the module of Early Clinical Practice in the 2012 year's new curriculum system which takes the teaching mode of combining the in-class curriculum and the extracurricular scientific research as well as the social practice.The in-class curriculum refers to the early contact clinical curriculum,namely making the early contact clinical practice training as a compulsory course,which focuses on the cultivation of students' medical professional ethics and the cultivation of doctor-patient communication ability,health promotion and preventive medicine consciousness,to strengthen students' clinical thinking,clinical research ability and basic skills training.The extracurricular part mainly takes the innovation credit project as the instruction,which will make the social practice,scientific and technological innovation activity project,clinical basic skills training comprehensive,and train students' ability of organization plan,communication and coordination,word expression and scientific research ability.

Objective To study the expression of GRHL-3 in diffuse large B-cell lymphoma (DLBCL) tissues and its clinical significance.Methods One hundred and sixty-eight pathology paraffin-embedded diffuse large B-cell lymphomas tissues were collected from January 2006 to September 2011.Immunohistochemistry was used to detect the expression of GRHL-3 protein in the above tissues.Results The positive expression rate of GRHL-3 protein in the GCB type tissues was higher than that in the non-GCB type tissues [84.87 ％(101/119) vs 14.29 ％ (7/49), P ＜ 0.01].Further analysis indicated that in the non-GCB type tissues,the positive expression rate of GRHL-3 in the latter stage group was significantly higher than that in the early stage group [90.00 ％ (63/70) vs 77.56 ％ (38/49), P ＜ 0.01].The positive expression rate of GRHL-3 in the lactatede hydrogenase increased group was significantly higher than that in the normal lactated hydrogenase [91.67 ％ (77/84) vs 68.57 ％ (24/35), P ＜ 0.01].The positive expression rate of GRHL-3 in the extranodal involvement status ≥ 2 group was significantly higher than that in the extranodal involvement status 0-1 group [96.29 ％ (26/27) vs 81.52 ％ (75/92), P ＜ 0.05].The positive expression rate of GRHL-3 in the IPI score 4-5 group was significantly higher than that in the IPI score 0-1 group [91.30 ％ (65/69) vs 66.67 ％ (18/27), P ＜ 0.01] and IPI score 2-3 group [91.30 ％ (65/69) vs 79.96 ％ (18/23), P ＜ 0.05].However, the expression of GRHL-3 had no correlation with the gender, age, and performance status of DLBCL.Conclusion The positive expression rate of GRHL-3 protein in the GCB type tissues is higher than that in the non-GCB type tissues.The positive expression rate of GRHL-3 in the DLBCL is correlated with the Ann Arbor stage, lactate dehydrogenase, extranodal involvement status and IPI score.