Problem-based learning(PBL)brought many changes in the teaching model of medical education.This article explored the clinical application of PBL combined with picture archiving communicate system(PACS)in medical imaging education.Through comparing the results before and after periodic study,PBL was verified to motivate the students'learning interest.Enthusiasm of autonomic learning and problem analysis ability of students increased evidently,which provided a substantial basis for continued learning.

Objective To study the MRI findings of HE and the pathological mechanism and to improve the diagnosis and differential diagnosis of HE. Methods Five patients of HE diagnosed by clinical and laboratory examination were examined with conventional MRI scan. Additional DWI, MRA and enhancement MRI scan were performed on 3 patients in which abnormal findings was detected on the conventional MRI. The distribution of lesions and signal characteristics were analyzed. The ADC values of the lesions and of the contralateral non-lesion area were measured. Moreover, the possible pathological mechanisms of HE were discussed on the basis of changes of clinical and imaging manifestations in the two cases with serial clinical and MRI data. Results Of 5 patients, brain abnormalities were found in 3 cases,which showed scattered spotted supratentorial white matter lesions of isointensity on T1 WI and DWI, and high signal intensity on T2WI and fluid-attenuated inversion recovery (FLAIR). Meanwhile, multiple plaque-like lesions involving both white matter and gray matter were found, mainly located at the basal ganglia nuclei, hippocampus and cingulate cortex. The lesions demonstrated iso-or hypo-intensity on T1 WI,and iso-or hyper-intensity on T2 WI, FIAIR and DWI at the initial stage. No enhancement was found in these lesions and MRA disclosed no remarkable findings. The ADC value of the lesions [ (0. 449 ± 0. 092) ×10-3 mm2/s] was decreased significantly compared with the contralateral noninvolved area [ (0. 838 ±0. 062) × 10-3 mm2/s] at the early onset. In 2 cases with glucocorticoid therapy, together with symptom relief, MRI follow-up scan demonstrated the reduction of lesion volume, the signal change to hyperintensity on T1 WI and hypo-intensity on DWL The ADC of the lesions increased significantly. Conclusion The MRI could be one of the effective tools for diagnosis, differential diagnosis, and judging the prognosis and therapeutic results of HE. Meanwhile, it may be a non-invasive method to study the pathological mechanism of HE.

Objective To compare the similarities and differences of the five detection methods used in the detection of fungi in vaginal secretions,and find the most sensitive、the most specific、the fastest、the most cost effective and the simplest method used in the detection of fungi in vaginal secretions.Methods A total of 442 patients were selected from the Department of Gynecology of Shenzhen OCT Hospital from May 2016 to August 2016.The vaginal secretion of 442 specimens was detected by using the methods of fungi culture、saline and KOH suspension method,Gram stain,Wright''s stain and Vaginitis Multi Test Kit.In these five methods,Fungi culture were using as gold standard to evaluate the specificity,sensitivity,negative predictive value,positive predictive value and accuracy of the other four methods.Results Using the fungus culture method to detect 442 cases of vaginal secretion,we found the positive rate of mycotic infection was 34.8%(154/442).Compared with the fungi culture method,the Specificity of saline and KOH suspension method was 97.9%,the sensitivity was 64.9%,the negative predictive value was 83.9%,the positive predictive value was 94.3% and the accuracy was 86.4%;the Specificity of Gram stain was 96.5%,the Sensitivity was 83.1%,the negative predictive value was 91.4%,the positive predictive value was 92.7% and the accuracy was 91.8%;the Specificity of Vaginitis Multi Test Kit was 84.7%,the Sensitivity was 46.8%,the negative predictive value was 74.8%,the positive predictive value was 62.0% and the accuracy was 71.5%;the Specificity of Wright''s stain was 96.9%,the Sensitivity was 78.6%,the negative predictive value was 89.4%,the positive predictive value was 93.1% and the accuracy was 90.5%.Conclusion Gram stain could be the most sensitive and specific method in the four methods,with highest accuracy,and the the fastest,the most cost effective and the simplest method for the detection of fungi in vaginal secretions.The accuracy of detecting fungi in vaginal secretions could be improved by the combination of Gram stain method in clinical work.

Based on the clinical skill competition of college students of the advanced medical colleges and universities nationwide,we aimed at the analysis on the weaknesses of medical emergency clinical practical teaching and emphasis on the theoretical education and neglect the practical education,and humanistic care,etc.In the clinical practice teaching of emergency,we combined the clinical skill training with physician occupation quality training,pay attention to the practice of advanced simulation exercises,gradual transition,clinical thinking,training medical students hands-on,team cooperation ability and humane accomplishment,to improve their ability of analyzing and solving problems and eventually optimize medical emergency clinical practical teaching,formulate the clinical practice standards as well as promote the reform and innovation of clinical teaching.

Objective To observe the curative effect and adverse reactions of intercostals nerve block combined with fentanyl transdermal system in treatment of post-thoracotomy pain syndrome (PTPS). Methods Intercostals nerve block combined with fentanyl transdermal system was used for treatment of 141 patients with PIPS. The degree of pain relief was evaluated by numerical rating scale (NRS),the quality of life of patients was evaluated by the quality of life score standard,and the adverse reactions were also observed. Results The overall remission rate was 97.85%,there were 51 cases (36.43%)with complete remission, 80 cases (57.14%)with significant remission,and 6 cases (42.85%) with moderate remission. The adverse reactions included nausea,vomiting, constipation,dizziness,skin pruritus and dysuria,no serious liver and kidney function damage and respiratory inhibition. The quality of life of all patients was improved. Conclusion Multimodal analgesia has better curative effect and less adverse reactions in treatment of PTPS,so it deserves clinical promotion.

Objective To observe the effects of repetitive transcranial magnetic stimulation (rTMS) combined with abdominal muscle electrical stimulation on the pulmonary ventilation of patients with cervical spinal cord injury.Methods Twenty-five patients with cervical spinal cord injury were randomized into an experimental group (n =13) and a control group (n =12).The control group was given comprehensive rehabilitation treatment,including upper limb movements,standing training and training of respiratory function,while the experimental group was given repetitive transcranial magnetic stimulation and abdominal muscle electrical stimulation in addition to the comprehensive rehabilitation treatment.The patients' maximum lung capacity (VC),forced expiratory volume for 1 second (FEV1),peak expiratory flow rate (PEF) and tidal volume (VT) were measured at the outset and after 3 months of treatment.Results The lung function indexes increased in both groups after treatment,but each index improved significantly more in the experimental group,on average,than in the control group.Conclusion As a supplement to routine respiratory function training,repetitive transcranial magnetic stimulation combined with abdominal intermediate frequency electrical stimulation can improve the pulmonary ventilation function of patients with middle and lower cervical spinal cord injury.

Objective To observethe efficacy of mice infected with Sparganum mansoni by using different dosages of praziquantel.Methods A total of 156 Kunming mice were divided into 2 batches.each of them wag orally infted with 5 spargana.Thirty-six mice in the first batch were equally divided into 6 groups.the mice in group 1-5 were inoculated with spargana cultured in different concentrations of praziquantel for 3 days,the group 6 served as a control.One hundred and twenty mice in the second batch were equally divided into 12 groups,each mouse was inoculated with spargana obtained from frogs or tadpoles,group 1-9 were treated by different desages of praziquantel 1 or5 weeks post infection.group 10-12 served as controls.All of the mice wore sacriftced and dissectedl or 2 weeks after the treatment.the mean number of worms recovered was cmculated and worm reduction rates were determined.Results The number of worm recovered from mice infected with spargana cultured in 10-40 μg/ml of praziquantel had no significant difference with that of the control(P>0.05).The worm reduction rate wag 16.60%while the spargana beins cultured in 50 μg/ml of praziquantel.The worm reduction rates of the mice that sacrificed 1 week or 2 weeks after being treated by the same dosage of praziquantel had no significant difference(P>0.05).When being treated with 200.400 or 800 mg/kg of praziquantel 1 week post infection,the number of worm recovered from mice infected with spargana from frogs had no significant difference with those of the control 1 and 2 weeks after the treatment(P>0.05).The worm reduction rates between the groups with the same dosage 1 week and 2 weeks post treatment had no significant difference(P>0.05).When being treated with 200 or 400 mg/kg of praziquantel 1 week post infection,the number of worm recovered from mice infected with spargana from tadpoles had no statistically difference with that of the control 1 week after treatment (P>0. 05). The worm reduction rate of mice was only 17.02% while being treated with 800 mg/kg of praziquantel. The worm reduction rates among groups with different dosages had no significant difference (P>0.05). Compared with the mice infected with spargana from frogs treated with 1 200 or 1 800 mg/kg of praziquantel 5 weeks post infection, the difference between the numbers of worm recovered from mice 1 week and 2 weeks after treatment had no statistically significance (P > 0.05), but they were significantly higher than those of the controls (P<0.05 ). The worm reduction rates among the groups with the same dosage had no significant difference (P>0.05). ConclusionsPraziquantel (10-50 μg/ml) has no evident killing effect on spargnna in vitro, but when the dosage is higher(1 800 mg/kg), it has certain efficacy for treating the mice infected with spargana by oral inoculation.

Objective To estimate the consistency between the diagnostic criteria for dermatomyositis (DM) and polymyositis (PM) developed by Bohan and Peter criteria (B/P criteria) and ENMC criteria.Methods The clinical,laboratory and pathological data from 86 patients who were initially diagnosed with idiopathic inflammatory myopathy were collected retrospectively.These patients were diagnosed according to B/P criteria and ENMC criteria,and the similarities and differences between these two criteria were compared.The data were analyzed with Mann Whitney U test and Kappa test by SPSS 13.0 software.Results Thirtyseven DM and 49 PM were diagnosed using B/P criteria.Forty-six DM and 14 PM were diagnosed using ENMC criteria,and 1 was diagnosed as eosinophilic myositis,9 were diagnosed as sporadic inclusion body myositis (sIBM),11 cases were diagnosed as limb-girdle muscular dystrophy type 2B,and the diagnosis of 5 patients could not be clarified.Agreement for DM between these two sets of criteria was very good by Kappa test (κ=0.79),but the corresponding between the two tests for PM was poor (κ=0.26).Conclusion Our study has demonstrated that B/P criteria may cause over-diagnosis and misdiagnosing for PM.ENMC criteria involves immunohistochemical pathology,stratified clinical and pathological exclusion criteria.The diagnostic accuracy of ENMC criteria is much improved.

Altitude ; Altitude Sickness ; Animals ; Hypoxia ; Iron ; Mice ; Spleen

Objective To explore the effect of spinal 360°circumferential resection decompression combined with bone cement fill-separation and pedicle screw fixation instrumentationb for patients suffering from spinal metastases.Methods Retrospectively analyzed the clinical data of 42 patients suffering from spinal metastases and underwent spinal 360°circumferential resection decompression combine with bone cement fill-separation and pedicle screw fixation instrumentation in our hospital from April 2012 to October 2016.The pain level were assessed by visual analogue scale(VAS),the functional impairment was classified by Karnofsky score(KPS) and the neurologic deficit was evaluated by Frankel grade before preoperation,1 week after operation and 3 months after operation.Results Through the following-up of 3 months,there was no neural symptoms relapse in primary segment.The VAS score was (0.57 ±0.79) points,and the KPS was (72.61 ± 19.12) points 3 months after operation,which were significantly improved compared with the data before operation (P ＜ 0.05).The VAS score improvement rate was (91.09％ ±13.73％),and the Frankel grade improvement rate was 80％.Conclusion Circumferential resection decompression combined with bone cement fill-separation and pedicle screw fixation instrumentationb for patients suffering from spinal metastases can effectively improve the neural symptoms and life-quality of patients and prevent neural symptoms relapsing in primary segment after operation.