Objective To investigate the use of cardiopulmonary auscultation model in clinical skills teaching, and students' feeling about this teaching form. On the basis of this teaching model, we have reflected on the teaching mode. Methods Through the questionnaire survey, 145 medical stu-dents of grade 2009 were asked to investigate their learning experience about cardiopulmonary aus-cultation model and other aspects of it. Results There are 71.7% students liking cardiopulmonary auscultation model in teaching; 96.5% students can establish contacting abnormal cardiopulmonary auscultation signs with cardiovascular diseases after the training; There are 91.7% students thinking teaching hours about auscultation model is not enough. For the open question “what do you think is the difficulty of cardiopulmonary auscultation learning?” The representative answer is: I think car-diopulmonary auscultation is unable to recognize visual things. Conclusion Cardiopulmonary aus-cultation model can successfully improve the students' clinical skills and achieve good teaching effect. Students have a positive and supportive attitude to it.

Objective To evaluate the effect of situational health education in glycemic control in type 2 diabetes patients.Methods A total of 98 patients with type 2 diabetes was randomly assigned to the control(n=49)and the study group(n=49).The control group received conventional diabetes education,while the study group received situational health education.Fasting blood glucose(FBG),2-hour plasma glucose (2 hPG),HbAlc and the self-care behaviors were observed at baseline and 1-year after the intervention.Paired t test was used for data analysis.Results FPG,2hPG,HbA1c and self-care behavior scores were not significantly different between the two group at baseline.After 1-year intervention,FPG,2hPG and HbA1c of the two groups were significantly decreased,and FPG,2hPG and HbA1c of the study group were significantly lower than those of the control group(t values were 2.71,3.35 and 2.90,respectively; all P＜ 0.05).In comparison with the control group,self-care scores of the study group were increased(t values were 7.36,6.51,5.24,5.07,6.57 and 6.77,respectively; all P＜0.05).Conclusion Situational health education could improve self-management and glycemic control of type 2 diabetic patients.

AIM: To observe the protein expression of vascular endothelial growth factor 1 (VEGF-1) in pulmonary arterial endothelial cells and VEGF-1 gene expression in lung tissue in rats with hypoxia-induced pulmonary hypertension and treated with heparin. METHODS: Twenty four male adult SD rats were randomly divided into three groups (8 rats each): a control group (group A), a group with hypoxia for 4 weeks (group B) and a group with hypoxia for 4 weeks and injected with heparin to abdominal cavity simultaneously (group C). Mean pulmonary arterial pressure (mPAP), right ventricle hypertrophy index (RVHI) and vessel morphometry were measured. The morphology of pulmonary artery was observed by HE staining. The expression of VEGF-1 protein in pulmonary arterial endothelial cells was determined by immunohistochemistry. The level of VEGF-1 mRNA in lung tissue was measured by reverse transcription polymerase chain reaction (RT-PCR). RESULTS: mPAP, RVHI, pulmonary artery remodeling parameters, VEGF-1 protein expression in pulmonary arterial endothelial cells and VEGF-1 gene expression in lung tissue of the three groups from high to low were group B, group C and group A. It was statistically significant when compared between either two groups of the three (P<0.01). Linear correlation analysis showed that VEGF-1 protein was positively correlated with pulmonary artery remodeling parameters (r=0.974, P<0.01), and VEGF-1 mRNA was positively correlated with VEGF-1 protein (VEGF 120 mRNA, r=0.919, P<0.01; VEGF164 mRNA, r=0.896, P<0.01). CONCLUSION: Heparin may down-regulate the expression of VEGF-1 at the levels of transcription and translation, resulting in the inhibitory effect on rats with hypoxia-induced pulmonary hypertension.

Obj cetive A large number of recent studies show that sevoflurane anesthesia may cause learning and memory dysfunction.The aim of this study was to explore changes of learning and memory ability and hippocampal volume in infantile rats after neonatal interrupted and repeated inhalation of 2.6% sevoflurane through detecting the learning and memory ability by Morris water maze and the hippocampus volume by MRI.Method s Thirty two neonatal SD rats were randomly devided into two groups (n=16):experimental group and control group.Rats inhalated 2.6%sevoflurane in the experimental group and 1 L/min O2 +1 L/min Air in the control group at the postnatal days of 7, 14 and 21 (P7, P14, P21). The learning and memory ability was determined by the Morris water maze test from P31 to P37;The brains of rats were scanned by mag-netic resonance imaging ( MRI) machine under anesthesia with 1%sodium pentobarbital at P37, and the brain and bilateral hippocampal volumes were measured. Results ①In the place navigation test, the escape latency had no significant difference between the two groups (P>0.05).In the spatial probe test, the dwelling time, movement distance and number of entering times in platform quadrant decreased slightly in experimental group compared with those in the control group, while there was no significant difference (P>0.05).②The brain volume [(1.53 ±0.18) cm3 vs (1.60 ±0.13) cm3] and right hippocampal volume [(16.15 ±1.76)mm3 vs(16.46 ±1.71)mm3] had no significant difference between the two groups (P>0.05).The left hippocampal volume [(16.46 ±1.71)mm3] was decreased in the experimental group compared with the control group [(18.10 ±2.53)mm3](P<0.05). Conclusion The learning and memory ability has no significant changes in in-fantile rats after neonatal interrupted and repeated sevoflurane inhalation and MRI examination of hippocampal volume is not sufficient for the diagnosis of cognitive dysfunction.

Objective To evaluate the neurotoxicity induced by multiple exposures to sevoflurane anesthesia in the neonatal rats.Methods Thirty-two healthy SPF Sprague-Dawley rats of both sexes,aged 7 days,weighing 15-20 g,were randomly divided into 2 groups (n=16 each) using a random number table:control group (group C) and multiple exposures to sevoflurane anesthesia group (group Sev).On postnatal day 7,14 and 21,2.6％ sevoflurane was inhaled for 2 h in group Sev,while the mixed gas of oxygen and air was inhaled instead of sevoflurane in group C.Morris water maze test was carried out on postnatal day 32-36 to assess the cognitive function.On postnatal day 21 and 36,8 rats in each group were selected and anesthetized,and the cerebrospinal fluid was collected for determination of the concentrations of amyloid β-protein by enzyme-linked immunosorbent assay.Results Compared with group C,no significant change was found in the escape latency,movement time spent in the effective region of the platform,movement distance,the number of entries into the effective region,percentage of residence time,percentage of movement distance,and percentage of the number of entries (P＞0.05),and the concentrations of amyloid β-protein in the cerebrospinal fluid were significantly increased on postnatal day 36 in group Sev (P＜0.05).Conclusion Multiple exposures to sevoflurane anesthesia can induce central neurotoxicity,but do not induce changes in the cognitive function in the neonatal rats.

Objective To investigate the technique,safety and efficacy of percutaneous chemoablation of single and multiple confluent metastatic lymphatic nodes (LNs).Methods Forty six patients of malignant metastatic LNs were treated with percutaneous chemoablation with CT guidance,and they were divided into two groups,including 30 patients of single isolated metastatic LN (group A) and 16 patients of multiple and/or confluent metastatic LNs (group B).A mixture of 5 ml absolute ethyl alcohol,2 ml iodized oil and 10 mg epirubicin was injected into the lymph node(s).The average tumor diameter was (2.0 ± 0.5) cm in group A and (3.8 ± 0.6) cm in group B.The intratumoral drug coverage rate and the occurrence of reflux were recorded.Enhanced CT scans were performed to observe the therapeutic effects at the intervals of 3,6 and 12 months.Results The coverage rate was 100％ in group A,which was significantly higher than group B (70％ to 80％).The occurrence of reflux was 70％ for group A versus 40％ for group B.For group A,a complete response (CR) patients of 14,21,28 and a partial response (PR) patients of 16,9,2 were obtained at 3,6 and 12 months after therapy respectively.For group B,a CR patient of 0,0,0 and PR patients of 3,8,9 were observed at 3,6 and 12 months after therapy respectively.Standardized rate by direct method was performed and the CR rate (74.4％) for group A was higher than that for group B (0) (P =0.0001).The tumor FDG uptake was lower compared with the preoperative images.No serious complications were observed.A few patients had mild pain during the procedure,which was relieved after 2.0 to 3.0 ml of 2％ lidocaine injection adjacent to the tumor.No needle tract seeding or infection were observed.There was no effect on patients' overall survival.Conclusions CT-guided chemoablation is an effective,low-cost and minimally invasive procedure,which is better for treating single metastatic LN than multiple and/or confluent oues.

Aim To evaluate the effect and mecha-nism of vitexin in a mouse model of DSS-induced ulcer-ative colitis (UC).Methods C57BL/6 mice were randomly placed into three groups: normal control group,DSS group and DSS +Vitexin group.Mice coli-tis was induced by adding 4% dextran sulphate sodium (DSS)into the drinking water for seven days.Vitexin was administered once a day along with DSS treatment. Mice were monitored daily with body weight change and diarrhea symptoms.After sacrifice,colon was re-moved and fixed in 1 0% (W/V)buffered formalin for hematoxylin-eosin (H&E)staining.Histological dam-age was assessed as a combined score of inflammatory cell infiltration and mucosal damage.The remaining colon pieces were collected to measure the activity of myeloperoxidase (MPO)by ELISA method and to de-termine the mRNA expression of TNF-α,IL-6 and COX-2.Results None of the mice receiving vehicle alone exhibited body weight loss and mucosal disrup-tion at any point during the study.Vitexin treatment significantly ameliorated DSS-induced body weight loss and histological score.The activity of MPO and the mRNA expression of TNF-α,IL-6 and COX-2 were markedly inhibited by vitexin treatment.Conclusion Vitexin ameliorates DSS-induced colitis through sup-pressing leukocyte infiltration and pro-inflammatory mediators production.

ObjectiveTo investigate the technique,safety and clinical value of CT-guided percutaneous interstitial brachytherapy for metastatic carcinoma of lymph nodes in mediastinum.Methods Eight patients with metastatic carcinoma of lymph nodes in mediastinum were treated by CT-guided interstitial implant of radioactive seeds in our department.Anterior approach were performed on all cases,125I radioactive seeds were implanted by setting CT Gantry at an oblique angle,three-dimensional reconstruction with SCT and separation the narrow gap between aortic arch and superior vena cava with fiatscalp core.Dose distributions were checked by TPS after operation.The improvement in clinical symptoms and lymph node sizes were documented in order to investigate the therapeutic effects.ResultsThe particle coverage rate was 93.5％ ± 1.5％.According to the CT scans two months later,3 patients ( 37.5％ ) had complete ablation,4 (50％) partial ablation,and 1 ( 12.5％ ) stable disease.Overall response rate (CR + PR) for this group of patients was 87.5％.The symptoms of all patients including shortness of breath (5 patients),cough (4 patients),dysphagia (4 patients) showed varying degree of improvement.No edema of head-and-neck and upper extremity was observed.There was no major vascular,tracheal and esophageal injury.A small amount of pneumothorax was observed in one patient.ConclusionsCT-guided percutaneous interstitial brachytherapy,a minimally invasive procedure associated with favorable therapeutic results,is a promising technique for treatment of metastatic carcinoma of lymph nodes with local pressure symptoms which may not respond to conventional therapy.

Objective To investigate the preparation of biodegradable vena cava filter(BVCF) with poly-l-lactic acid (PLLA),and to evaluate its mechanical properties,delivery performance,the ability of capturing thrombus and the degradation property.Methods Three-dimensional design software was used to design the shape of BVCF.The BVCF was prepared by using PLLA with molecular weight of 100 000 unit.Twelve minipigs were used to test the feasibility of this BVCF.They were randomly divided into four groups.At first the BVCFs were placed into the inferior vena cava of pigs in three experimental groups.The fourth group was used as a blank control group.The thrombi were injected into all pigs after 1 week,and CT examinations were performed at different time points to observe the filter locations and pulmonary artery.The animals were sacrificed according to a fixed time table for histopathological assessment.Results The BVCF was successfully designed and produced,which could expand by stretching the center-thread.In vitro test results showed the radial force of BVCF was approximately 1.6 N and could capture the thrombus more than 5 mm in diameter,and it was easy to release.Through the animal experiment confirmed that the filter could capture the lethal thrombus and all 9 pigs of experimental groups were survived,two of those had the symptoms of respiratory frequency and heartbeat accelerated slightly in the operation.In control group,the symptoms such as accelerate of respiratory rate,shortness of breath were observed in varying degree.The pig which was injected with 8 strips of thrombus died in the same day after surgery.Postoperative CT and pathological examinations showed that 2 pigs in the experimental group developed peripheral pulmonary embolism,while the dead pig in the control group developed central pulmona-y embolism.Histological findings showed that the intima covered the BVCF lateral branch partly after one week,and thoroughly after six weeks.The vessel wall structure remained normal and no signs of the obvious inflammatory cells infiltration were detected.Twelve weeks after the implantation,the vessel wall structure was normal,and the lumen was unobstructed,and the collateral of the filter was partly degradated.Conclusions The BVCF has the advantage of good mechanical strength and good biocompatibility.It is easy to release and can capture the lethal thrombus,but its degradation performance remains to be studied.

Objective To analyze the etiology of fever of unknown origin (FUO).Methods A total of 372 patients with FUO who hospitalized in Capital Medical University Affiliated Beijing Friendship Hospital were retrospectively analyzed from January 2003 to August 2013.All the patients were divided into two groups:group A (January 2003-December 2007) and group B (January 2008-August 2013).Diagnosis rate,duration of hospitalization (days) and time to diagnosis between the two groups were artificially compared.Results Of the 372 FUO cases,336 were positively diagnosed with a diagnosis rate of 90.3％.Infectious diseases were still the primary causes of FUO (60.2％),including 72 cases (32.1％) of tuberculosis.Connective tissue diseases accounted for 12.9％ of the FUO cases,malignancies were 8.3％,and miscellaneous diseases were 8.9％.Yet thirty six patients (9.7％) could not be confirmed until they were discharged from hospital.The duration of fever in patients with malignancies was longer than that with infectious diseases [60.0 (30.0,90.0) days vs 30.0 (20.0,60.0) days,P =0.003].Time to diagnosis of connective tissue disease and malignancies was longer than infectious diseases [(12.0 (7.3,18.8) days and 11.0 (7.0,18.0) vs 5.0 (3.0,8.0) days,both P values =0.000].The duration of hospitalization in group A was longer than that of group B [17.0(12.0,30.0) days vs 14.0(10.0,20.0) days,P =0.000].The diagnosis rate and time to diagnosis of group A were similar with those of group B.The proportion of connective tissue diseases in group A was higher than group B(18.1％ vs 9.2％,x2 =6.201,P =0.013).The proportion of infectious disease,malignancies and miscellaneous diseases was not significantly different between the two groups.Conclusions Infectious diseases are the major causes of FUO,and the most common cause is tuberculosis.Connective tissue diseases and malignancies are the second and third causes of FUO.The duration of fever and time to diagnosis are significantly different between the different origins.