The training of clinical thinking ability is the key point of obstetrical teaching to medical students in eight-year program.Obstetrical department of the third affiliated hospital of Sun Yat-sen university has put forward specific methods of SP inquiring and PBL case analysis teaching.The well-designed teaching methods have an active role in the training of case history collecting ability,diagnosing and treating ability to medical students in eight-year program.

Objective To analyze CT portal venography (CTPV) manifestations of portal collateral circulation in patients with cirrhosis by using a 16-detector row spiral CT scanner. Methods CTPV was performed in 36 patients with portal hypertension due to cirrhosis, the diagnosis was proved by clinical data, hepatic function findings and imaging signs. By using post-processing reconstruction technique, 3D images of portal venous system and portal collateral circulation were obtained. Results CTPV images displayed the portal venous system and its collateral circulation stereoscopically. Of 36 patients, left gastric varices were seen in 29 (80.6%), lower esophageal varices in 18 (50.0%), short gastric or posterior gastric varices in 15 (41.7%),paraesophageal varices in 9 (25.0%), gastro-renal or splenorenal shunts in 8 (22.2%), sponge-like transformation of portal vein in 7 (19.4%), paraumbilical and abdominal wall varices in 6 (16.7%), congenital cavernous in 6 (16. 7%) and paravertebral venous shunts in 4 (11.1%). Conclusion CTPV can well display the site, extent and severity of the portal collateral circulation in patients with portal hypertension due to cirrhosis, which is of great clinical importance for judging the patient's condition, for selecting therapeutic protocols and for estimating prognosis.

Objective To evaluate the efficacy and safety of radioactive 125 I seed implantation combined with paclitaxel (PTX) for treating senile non‐small cell lung cancer(NSCLC) .Methods The clinical data in 35 patients with NSCLC in our hospi‐tal from June 2013 to August 2014 were retrospectively analyzed ,including 12 cases receiving the lung tumor radioactive 125 I seed implantation therapy(group A) ,10 cases treated with PTX combined with cisplatin (TP scheme)after receiving radioactive 125I seed implantation therapy(group B) and 13 cases only conducted TP scheme(group C) .The 21 d chemotherapy was a evaluation cycle . The adverse reactions were evaluated after 1 cycle and the curative efficacy was evaluated after 2 cycles .Results Thirty‐five cases were followed up for 6 months .The adverse reactions could be evaluated in all the cases .The short‐term efficacy could be evaluated in 34 cases .The group A had no obvious adverse reactions ,the main adverse reactions in the group B and C were bone marrow sup‐pression and digestive tract reactions without statistically significant differences (P> 0 .05) .The effective rates after 4 cycles of chemotherapy in the group A and B were 66 .7% and 80 .0% ,the clinical benefit rates were 83 .3% and 90 .0% respectively ,which were higher than 23 .1% and 53 .8% in the group C respectively ,the differences were statistically significant ( P< 0 .05 ) . Conclusion Radioactive125 I seed implantation therapy and PTX combined with radioactive 125 I seed implantation for treating senile early NSCLC are superior to the simple PTX chemotherapy ,which have high effective rate and benefit rate ,safety ,mini‐invasion and mild adverse reactions ,and can increase the patient′s living quality .

We treated 40 cases of stubborn constipation by puncturing Zhongwan (CV 12),Qihai (CV 6), Tianshu (ST 25, bilateral), Daheng (SP 15, bilateral). After 20 times of treatment, 16 cases were cured(accounting for 45%) ,18 cases were significantly improved(accounting for 45%),4 case were improved(accounting for 10%),2 cases were ineffective(accounting for 5%).The total effective rate was 95%.

Objective: To determine the effects of intravenous anesthetics (fentanyl,midazolam and propofol )on inflammatory responses. Method: We employed carrageenan-sensitized endotoxemic rabbit model. Thirty-two New Zealand rabbits were randomly assigned to one of four groups,control group(no anesthetic was used), fentanyl group, midazolam group and propofol group. Different anesthetics were used intravenously for anesthesia induction and maintenance according to the group classification. Meanwhile, all animals were mechanically ventilated, then, 2?g?kg~(-1) lipopolysaccharide(LPS) were injected for endotoxin challenge. Result:In all groups, serum tumor necrosis factor (TNF)activity began to increase at 30 min,reached its maximal level at 60 min,and tended to decrease at 120 min after (LPS) challenge,and the significant increase of TNF activity was associated with development of hypotension. Meanwhile,serum phospholipase A_2(PLA_2)activity began to increase at 60 min and persisted in going up within 2h. Those animals,with continuous infusion of these three different anesthetics and mechanical ventilation,had much lower peak level of TNF and higher mean arterial pressure (MAP)than control levels, but their changes of serum PLA_2 activity had no significant difference from control level. Conclusion: With mechanical ventilation, intravenous infusion of these anesthetics can reduce LPS induced injury in the acute phase of endotoxemia, probably by the inhibition of TNF production.

Objective:To study the concentrations of fine particulate matters and ultrafine particles and influenced factors during winter in an area of Beijing .Methods:Real-time monitoring of particles ’ mass and number concentrations were conducted in an area of Beijing from February 7th to 27th , 2013.At the same time, the meteorological data were also collected from the Beijing meteorological website .Differences of the particles ’ mass and number concentrations during different periods were analyzed using Mann -Whitney U test.Meanwhile, the influenced factors were also analyzed .Results: The mean concentra-tions of fine particulate matters and ultrafine particles were ( 157.2 ±142.8 ) μg/m3 and (25 018 ± 9 309) particles/cm3, respectively.The particles’ number and mass concentrations in haze days were 1.27 times and 2.91 times higher than those in non-haze days, respectively.The mass concentrations of fine particulate matters in the self-monitoring site were higher than those in the nearest central monitoring sites, and the hourly-average concentrations of particles were significantly consistent with those at the commuter times.Meanwhile, the setting off of fireworks/firecrackers during the Spring Festival could lead to short-term increases of the particles ’ number and mass concentrations .When the wind speed was low and the related humidity was high , the concentrations of particulate matters were relatively high , and the mass concentrations of fine particulate matters were lagged about 1-2 d.Conclusion: The level of the particulate matters in this area was high .Heavy traffic , setting off of fireworks/firecrackers and meteoro-logical factors may be some of the main factors affecting the concentrations of the particulate matters in this area.Among those factors, the effect of setting off of fireworks/firecrackers didn’t last long and the effect of the meteorological factors had a hysteresis effect .

Objective To investigate the clinical features of patients with superinfection of HEV and HBV related acute on chro-nic liver failure(ACLF) .Methods Clinical data of 35 patients diagnosed with superinfection of HEV and HBV related ACLF and 37 patients diagnosed with HBV related ACLF were collected for this retrospective study .The liver and kidney function ,HBV DNA level ,blood platelet count(BPC) ,coagulation function ,model for end-stage liver disease(MELD)score and mortality at 24 weeks were analyzed .Furthermore ,comparison of the clinical data between the survival patients and died patients in superinfection group was made .Unconditioned binary response logistic regression model was used to determine the corresponding risk factors .Results The level of total bilirubin(TBIL) ,MELD score ,incidence rate of hepatic encephalopathy and mortality at 24 weeks were signifi-cantly higher and prothrombin activity(PTA)was significantly lower in superinfection patients(P<0 .05) .The level of serum creat-inine(Cr) ,MELD score and incidence rate of hepatic encephalopathy were significantly higher and PTA was significantly lower in died patients than that of superinfection group(P< 0 .05) .Logistic regression analysis identified TBIL(P= 0 .024 ,OR= 1 .006) , BPC(P=0 .019 ,OR=0 .983) ,PTA(P=0 .001 ,OR=0 .795) ,MELD score(P=0 .005 ,OR=1 .497)and hepatic encephalopathy(P=0 .001 ,OR=4 .147)as prognostic factors for patients with superinfection of HEV and HBV related ACLF .Conclusion The clini-cal features of patients with superinfection of HEV and HBV related ACLF were more serious .The higher level of TBIL ,MELD score and hepatic encephalopathy and the lower level of BPC and PTA ,the worse prognosis .

BACKGROUND:Hip’s anatomy structure is complex, and the traditional two-dimensional imaging, such as X-ray film or CT scan, is susceptible to image overlap and other soft tissue. As a result, there are some limitations in the diagnosis of hip disease. The digital model is built based on reverse engineering and rapid prototyping. It is comprehensive, intuitive and accurate of the stereo configuration of the hip and the spatial relations of other parts’ anatomical structures. This study has a broad application prospect. OBJECTIVE:To reconstruct the personalized three-dimensional entity model of the hip bone with computer aided technology. METHODS: The human hips were scanned with a portable three-dimensional laser scanner, and then the point cloud data of the hips were gotten. The point cloud was processed and the three-dimensional model reconstruction was carried out by using the engineering software Geomagic and the computer aided software CimatronE. Three-dimensional print of hip was completed and the model was gotten, which was consistent with the geometry of hip bone, through the rapid prototyping machine. RESULTS AND CONCLUSION:A model with good geometric similarity and biomechanical characteristics was built by digital modeling method based on reverse engineering and rapid prototyping. This way of digital modeling provided the basis for digital manufacturing of artificial hip, virtual assembly, stress analysis and surgical simulation.

Objective To discuss the risk factors of ventilator-associated pneumonia (VAP) in intensive care unit(ICU).Methods From January 2008 to June 2010,the clinical data of 145 patients with mechanical ventilation over 48 hours in ICU were analyzed prospectively,and the effect was observed.Results There were a total of 53 patients with VAP,and the incidence was 36.6％ (53/145).Thirty-three cases died,and the fatality rate was higher than that in non-VAP patients [62.3％ (33/53) vs.30.4％ (28/92)],and there was significant difference (P ＜0.05).Related factors analysis results showed that indwelling gastric tube,the use of antiacids,mechanical ventilation time,nutritional status,age ≥ 60 years and chronic diseases were the risk factors of VAP (P ＜ 0.05 or ＜ 0.01).Conclusion VAP has many risk factors and higher fatality rate in ICU,and comprehensive prevention measures should be adopted to prevent the occurrence of VAP.

AIM:To explore the characteristics of hepatitis B virus S gene mutation in the vertical transmission after active and passive vaccination .METHODS:Fifteen cases of immunoprophylaxis failure were enrolled in the study . HBV S gene (including pres-S and S) from the mothers, newborns before active and passive vaccination and 7-month-old infants with immunoprophylaxis failure were detected by PCR amplification .The characteristics of HBV S gene mutation were compared among the 3 groups.RESULTS: The genotype of HBV in the newborns and the infants was the same as that in the mothers .The frequencies of mutation in the 2 fragments of the HBV S gene had no significant difference between the 3 groups.The homology tree model based on HBV S gene was analyzed in the 3 groups, in which every group had their own cluster.There were 15 different mutation sites between 7 pairs of mothers and newborns .There were 3 different muta-tion sites between 3 pairs of newborns and infants (nt273A→A/G, nt512C→C/T and nt1139C→A), among which the first 2 were located in the S gene region but not in the “a” determinant , and the latter was located in the overlap region of S and X genes .There were 25 different mutation sites between 9 pairs of mothers and infants , but only 1 case had a differ-ent mutation site between the mother , newborn and infant .CONCLUSION: The HBV species in newborns and infants with immunoprophylaxis failure were transmitted from the mothers .The mutations in the HBV S gene with immunoprophy-laxis failure happened before and after active and passive vaccination , mainly before vaccination .The relationship between HBV S gene mutations and immunoprophylaxis failure should be further explored .