‘Guided Learning Plan Module’uses learning plans as studying materials,designs students’studying targets as learning plans,transfers teachers’teaching targets to students’studying targets and then teachers assign their learning plans to students.Students study and discuss by themselves according to the learning plans,and teachers guide,explain,regulate and control.This module emphasizes teachers’guidance,students’self-study and develops students’studying abilities,creative sensations and comprehensive qualities.Applying "Guided Learning Plan Module" to physical teaching can have a fairly effective effect on teaching.

BACKGROUND:Pathogenesis of osteoarthritis is poorly understood,however,studies have demonstrated that vascular endothelial growth factor(VEGF)Is involved in the progression of osteoarthritis.OBJECTIVE:To detect the changes of VEGF mRNA expression of synovium in rabbit osteoarthritis and to evaluate the effect of sodium hyaluronate on its expression.METHODS:Twenty four white rabbits were divided into the normal control,physiologic saline,and sodium hyaluronate groups.The unilateral anterior cruciate ligament transection(ACLT)was performed in the physiologic saline and sodium hyaluronate groups.At weeks 4 after operation,rabbits in the physiologic saline group were injected 0.3 mL physiologic saline and in the sodium hyaluronate group received 10 g/L sodium hyaluronate injection,once per week for 5 successive weeks.All the animals were sacrificed at week 10 after operation.The cartilage changes on the medial femoral condyles were graded separately VEGF express Jon of synovium was detected by using teal time polymerase chain reaction(RT-PCR).RESULTS AND CONCLUSION:The macroscopic score showed that the cartilage degeneration in the physiologic sailne group was significantly more severe than that of the normal control and sodium hyaluronate groups(P＜0 05)The expression of VEGF mRNA was obviously decreased in the physiologic saline group than that of the normal control group(P＜0 05).of which was increased in thesodium hyaluronate group,but still smaller than the normal control group(P＜0 05).The results demonstrated that the decreased VEGF expression in synovium may involved in the progression of osteoarthritis,and sodium hyaluronate has protective effect on articular cartilage by up-regulating the VEGF expression.

BACKGROUND: Traumatic osteoarthritis (OA) resulted from the injury of joints and postoperation of joints is commonly observed. Intra-articular injection of sodium hyaluronate (Na-HA) has been considered as effective method for OA. OBJECTIVE: To observe the influence of intra-articular injection of NaHA on mRNA expression of inducible nitric oxide synthase (iNOS) in cartilage of traumatic OA induced by transection of anterior cruciate ligament. DESIGN: Randomized controlled animal experiment. SETTING: Department of Orthopaedics, Renmin Hospital, Wuhan Uni ersity. MATERIALS: The experiment was performed in Laboratory of Depart ment of Orthopaedics, Renmin Hospital, Wuhan University from April to December 2003, in which, 16 clean healthy flat-eared white rabbits, aged 5-6 months were employed. The rabbits were randomly divided into Na- HA injection group and saline control group with 8 rabbits in each group. Na-HA (2000, No 366095) was provided by Shanghai Jiahua Fine Biologi- cal Products Co. METHODS: ①OA model was established in rabbits of the two groups. Each rabbit was anesthetized intravenously with 1.0 mg/kg ketamine hy- drochloride and underwent unilateral anterior cruciate ligament transection. ②5 weeks after transection, Na-HA injection group rabbits received 0.3 mL of intra-articular 10 g/L Na-HA injection, once a week for 5 weeks. Ani mals in saline controlled group were treated with saline of the same vol ume. ③The rabbits were killed at week 10 after operation, general morphology and histopathological changes of articular cartilage degeneration of medial femoral condyle were evaluated (0 points as smooth articular surface with normal color and luster; 1 point as minimal fibrillation or a slight crevice and dark grey color of the surface; 2 points as erosion extending into superficial or middle layers of cartilage; 3 points as ulceration and erosion extending into the deep layers, and 4 points as denudation of cartilage, erosion extending to the sub-chondral bone). The mRNA expression of iNOS in cartilages was examined with reverse transcription-polymerase chain reaction (RT-PCR). MAIN OUTCOME MEASURES: ①Observation of articular cartilage degeneration of medial femoral condyle, ②observation of articular cartilage degeneration of medial femoral condyle at light microscopic level, ③expression of iNOS in cartilages of each group. RESULTS: A total of 16 clean healthy rabbits entered the result analysis. ① Result of articular cartilage degeneration of medial femoral condyle: Pathological change of articular surface of femoral condyle was observed under anatomic microscope. Cartilage degradation in experimental group was significantly less severe than that in saline control group. ②Histological changes of articular cartilage degeneration of medial femoral condyle at light microscopic level: The Na-HA injection group showed cartilage changes: Membrane of cartilage presented denaturalization and abscission. Chondrocytes of superficial zone presented denaturalization, necrosis, turbulence and erosion. Animals treated with saline showed denaturalization, necrosis and disorder of chondrocytes, ulceration penetrating into the middle or deep zone of the cartilage. New hyperplasia of capillary vessels and fibroblasts were more obvious. Proliferation of fibrous tissue appeared at the bottom of ulcer. ③Expression of iNOS in cartilages of two group:The gene expression of iNOS in cartilage of Na-HA injection group was(1.09±0.18) and the expression of saline control group was (1.26±0.23). Nosignificant difference of iNOS expression was found between the two groups(P ＞ 0.05).CONCLUSION: Intra-articular injection of Na-HA has protective and repairing effect on cartilage with early OA and can significantly reduce the severity of cartilage degradation during early stage of traumatic OA. Intra-articular injection of Na-HA does not down-regulated iNOS expression in cartilage.

Objective To observe the protective effect of sodium hyaluronate (Na-HA),and its effects on mRNA expression of peroxisome proliferators-activated receptor gamma (PPAR-γ) in cartilage of rabbit osteoarthritis (OA) model.Methods Forty eight white rabbits were divided into A,B,C groups randomly.Group A were normal controls,groups B and C were underwent unilateral anterior cruciate ligament transection (ACLT).The rabbits in group B were injected normal saline after ACLT;Group C rabbits received intra-articular 1% sodium hyaluronate (HA) injections 5 weeks after surgery,0.3 ml once a week.At week 11 after the surgery,all rabbits were sacrificed.The cartilage changes on the medial femoral condyles were graded.Cartilage sections were stained with safranin-O and HE,mRNA expression of PPAR-γ was detected by real time polymerase chain reaction (Real Time-PCR).Results Cartilage degeneration in group B was significantly more severe than in groups A and C.The grey value of Safranin-O of B group were higher than groups A and C.Expression of PPAR-γ mRNA in group B was higher than that in groups A and C.Conclusion NaHA has a protective effect on articular cartilage degeneration,and the inhibitory effect on PPAR-γ mRNA expression may be one of the therapeutic mechanism of Na-HA.

Objective:To analyze the effect of interleukin 2(IL-2) on immunoglobulin G(IgG) expression in cervical cancer cell line HeLaS3.Methods:By immunofluorescence-flow cytometry(FCM),we detected membrane and cytoplasmic IgG expression variation of HeLaS3 after IL-2 stimulation.By western blot,we detected IgG expression variation of HeLaS3 after IL-2 stimulation.Meanwhile,by RT-PCR with primers designed to amplify four subclasses of IgG,we detected ? transcript variation in HeLaS3 after IL-2 stimulation at mRNA level.Results:The result of immunofluorescence-FACS showed that after IL-2 stimulation for 48 hours,membrane and cytoplasmic IgG expression elevated in HeLaS3.The result of Western blot showed after IL-2 stimulation for 48 hours,IgG expression elevated in HeLaS3.Meanwhile,the result of RT-PCR showed that ?1 transcript mildly elevated after IL-2 stimulation for 48 hours.Conclusion:IL-2 can promote IgG expression in cervical cancer cell line HeLaS3.

Objective To observe the effect of intra-articular injection of sodium hyaluronate (Na-HA) on mRNA expression of inducible nitric oxide synthase (iNOS) in cartilage of osteoarthritis (OA). Methods Sixteen white rabbits were underwent unilateral anterior cruciate ligament transection and were divided into 2 groups randomly 5 weeks after transection. Experimental group rabbits received 0.3 ml of intra-articular 1% Na-HA injection once a week. Animals in control group were treated with the same conditions using normal saline. All animals were sacrificed 10 weeks following surgery. The aritcular cartilage degeneration of medial femoral condyle was evaluated at mascroscopically and microscopically. The mRNA expression of iNOS in cartilages was analyzed by reverse transcription-polymerase chain reaction (RT-PCR). Results Cartilage degradation in experimental group was significantly less severe than that in control group. No significant difference of iNOS mRNA expression in cartilage was found between the experimental group and the control group. Conclusion Na-HA can significantly reduce the severity of cartilage degradation of OA. Na-HA dose not show definite effect on iNOS expression in cartilage during early stage of OA.

Objective To observe the influence of intra-articular injection of sodium hyaluronate (HA) on mRNA expression of matrix metalloproteinase (MMP) -1, -3 and tissue inhibitor of metalloproteinase (TIMP)-1 in cartilage and synovium of osteoarthritis (OA) . Methods Sixteen white rabbits underwent unilateral anterior cruciate ligament transection and were divided into 2 groups randomly 5 weeks after transection. Experimental group rabbits received 0.3 ml of intra-articular 1% HA injection once a week. Animals in control group were treated under the same condition using saline. At death, 10 weeks following surgery, histological changes of articular cartilage of medial femoral condyle were evaluated by microscopy. The mRNA expression of MMP-1, MMP-3 and TIMP-1 in cartilage and synovium was analyzed using reverse transcription-polymerase chain reaction (RT-PCR) . Results Cartilage degradation in experimental group was significantly less severe than that in the control group. The expression of MMP-3 mRNA in synovium was significantly suppressed in experimental group compared with the control group (0.40?0.10 vs 0.62?0.13). HA treatment had no effect on MMP-3 expression in cartilage. No significant difference of MMP-1 and TIMP-1 expression in cartilage and synovium was found between experimental group and control group. Conclusion HA can alleviate the degeneration of articular cartilage of OA. One possible mechanism of the therapeutic effect of HA may be inhibition of expression of MMP-3 in synovium during early stage of OA.

Objective To analyze the difference of laboratory test results between early-onset and late-onset severe preeclampsia and to investigate their clinical application values.Methods Totally 108 blood samples were collected from patients with severe preeclampsia who were diagnosed according to the Diagnostic Standard of Obstetrics and Gynecology(7th Edition) published by People′s Medical Publishing House,in Shandong Provincial Hospital affiliated to Shandong University from March to November 2016,which consisted of 64 early-onset severe preeclampsia before 34 weeks gestation(early onset group) and 44 late-onset severe preeclampsia after 34 weeks gestation(late onset group).In addition,42 women with normal pregnancies as the control group were selected.General clinical data were collected,and the blood sample was analyzed through detecting Hb,PLT,fibrinogen (FIB),D-dimer,AST,ALT,urea,creatinine (Cr),uric acid,CRP,urine protein.The tested results were analyzed and compared.Flow cytometry was used to analyze the proportion of T helper 1 cells(Th1) and T helper 2 cells(Th2),and the ratio of Th1/Th2 was also calculated.All data and F test were performed by use of statistical software SPSS19.0.Results The pre-pregnancy body mass index(29.55±4.49,30.66±5.13,26.62±3.17,F=9.829,P<0.05),diastolic blood pressure[(105.17±14.46)mmHg(1 mmHg=0.133 kPa),(99.80±12.56)mmHg,(74.36±8.42)mmHg,F=82.088,P<0.05],Hb[(123.22±14.38)g/L,(117.03±16.48)g/L,(112.62±11.24)g/L,F=7.133,P<0.05],urea[(6.56±2.36)mmol/L,(4.51±1.35)mmol/L,(3.04±0.87)mmol/L,F=51.733,P<0.05],Cr[(68.47±18.05)μmol/L,(61.37±14.37)μmol/L,(48.54±8.73)μmol/L,F=23.737,P<0.05],CRP[(7.68±8.76)mg/L,(5.88±6.03)mg/L,(3.56±2.41)mg/L,F=4.735,P<0.05],urine protein[(3.66±0.76)g/L,(2.20±1.05)g/L,(0.19±0.40)g/L,F=249.714,P<0.05]had a statistically significant difference among the early-onset,late-onset and control groups.The flow cytometry results demonstrated that the proportion of Th1 in early-onset group(19.83±3.04)was higher than that in both late-onset (14.49±2.79)and control groups(11.78±1.17),on the contrary,the result of Th2 was much lower(early-onset:1.02±0.12,late-onset: 1.11±0.12,control: 1.56±0.11),there was statistical significance among these three groups(Th1: F=135.110,P<0.05;Th2: F=293.687,P<0.05).Conclusions It′s necessary to real-time monitor the laboratory indicators,such as liver and kidney function,especially the immunologic function indicators for evaluating the disease of early-onset and late-onset severe preeclampsia and personal treatment,and for ensuring the health of mother and fetus and improving the prognostic of mother and fetus.

Objective Taking typical cases of Western medicine as an example,this paper explores the connection between Chinese and Western medicine on the understanding of tongue elephants.Methods After collecting the literature with tongue diagram attached to the clinical imaging column published in NEJM magazine,extracting the symptoms,signs and Western medicine disease information recorded in the literature,the tongue diagram was diagnosed from three aspects:tongue quality,tongue moss and sublingual meridians,and whether the symptoms and signs of tongue correspond to a certain diagnosis result,and the results were analyzed.Results A total of 48 articles were included,including 6 literature on abnormal tongue dynamics,which could correspond to abnormal tongue morphology in traditional Chinese medicine.Thirty-four cases of abnormal tongue shape were found.Among them,12 cases could be diagnosed with corresponding TCM tongue diagnosis,including 7 cases of abnormal tongue shape and 5 cases of abnormal coating.The remaining 22 cases were secondary changes in tongue structure.There were 8 articles on abnormal tongue color,including 1 abnormal tongue color,1 abnormal sublingual chord,and 6 abnormal lichen color.Conclusion Starting from the form and function,explore the connection between Chinese medicine and Western medicine in their understanding of tongue diagnosis,and promote the objectification and standardization of Chinese medicine tongue diagnosis.

Ankylosing spondylitis (AS) combined with spinal fractures with thoracic and lumbar fracture as the most common type shows characteristics of unstable fracture, high incidence of nerve injury, high mortality and high disability rate. The diagnosis may be missed because it is mostly caused by low-energy injury, when spinal rigidity and osteoporosis have a great impact on the accuracy of imaging examination. At the same time, the treatment choices are controversial, with no relevant specifications. Non-operative treatments can easily lead to bone nonunion, pseudoarthrosis and delayed nerve injury, while surgeries may be failed due to internal fixation failure. At present, there are no evidence-based guidelines for the diagnosis and treatment of AS combined with thoracic and lumbar fracture. In this context, the Spinal Trauma Academic Group of Orthopedics Branch of Chinese Medical Doctor Association organized experts to formulate the Clinical guideline for the diagnosis and treatment of adult ankylosing spondylitis combined with thoracolumbar fracture ( version 2023) by following the principles of evidence-based medicine and systematically review related literatures. Ten recommendations on the diagnosis, imaging evaluation, classification and treatment of AS combined with thoracic and lumbar fracture were put forward, aiming to standardize the clinical diagnosis and treatment of such disorder.