In order to improve the teaching quality of epidemiology and better serve the situation of disease prevention and control,problem-based learning (PBL) teaching method was applied in the teaching of epidemiology. This paper introduced the implementation of PBL and its advantages and disad-vantages. PBL teaching method can improve students' self-learning ability,communication skills,team cooperation,practical ability and capability of integrating knowledge of many subjects.

ObjectiveDouble-outlet right ventricle,which often associated with total anomalous pulmonary venous connection and complete endocardial cushion defects,has been considered a risk factor for biventricular repair procedure.To reviewed cases treated by biventricular repair for endocardial cushion defects with double outlet right ventricle.MethodsFrom July to November of 2009,6 patients (3 males and 3 females) aged from 7 to 24 (16.17±5.98) years and with endocardial cushion defects and double outlet right ventricle underwent operation of biventricular repair The duration of follow-up ranged from 10 days to 2 years(median,16 months).Endocardial cushion defects were repaired with a 2-patch technique.The artificial vascular patch was implanted to connect the ventricular septal defects and the aorta for draining the blood stream from the left ventricle to the aorta.The other patch was used to repair the ostium primum atrial septal defects.Right ventricular outflow tract obstructions was released and reconstructed by transplanting a bovine pericardium patch.If the size of pulmonary valve annulus was far more below the normal,a transannular pericardial patch was used.Rastelli procedure with a valved conduit between the right ventricle and the pulmonary artery would be performed if the obstruction in the right ventricular outfolw tract was severe.ResultsOne death occurred 2 days after the operation,resulting in a mortality rate of 16.6%.The case,a boy of 7 years old,had a mirror-image dextrocardia,complete endocardial cushion defect ( C type),anomalous pulmonary venous drainage and single atrium.In this case,the operation lasted for 8 hours,acute renal failure happened next day to the operation,the effect of CRRT was unsatisfied,and eventually cardiac arrest occurred as a result of hyperkalemia.The remaining cases had survived.Follow-up examinations showed that the systolic pressure gradients across the pulmonary valves decreased,with a range of 14 to 40 mm Hg,(23.9 ± 11.03) mm Hg.Mild mitral and tricuspid regurgiration were identified in 4 cases and moderate mitral regurgitation was identified in one case.The cardiac function in all patients was classified as NYHA class Ⅰ/Ⅱ,Conclusion Endocardial cushion defects with double outlet right ventricle can be corrected by means of biventricular repair procedure.The procedure was associated with a low mortality,The interim life quality of patients may be improved.The longterm outcomes should be further studied.

Objective To summarize the technique and managements of complications in endovascular embolization on intracranial aneurysm with Guglielmi detachable coils(GDC),and to evaluate the effect of the treatment.Methods One hundred and thirty six cases with Aneurizym were treated using GDC to embolize the aneurismal sac via femoral artery approach.Results One hundred and thirty six aneurysms were cured.Of them 132 cases recovered clinically,4 patients died.The mortality was 2.9%. The sac of 123 aneurysms were embolizied at 100%,8 cases with 95% embolization,5 with 90% embolization.3 aneurysms reptured during the embolization,cerebral vasospasm happened in 7 eases. microcoil escaped in 2 case.Three recurring cases were cured after second GDC embolization.The technique-related complications occured in 13 cases.No re-bleeding occurred during the 6 to 54-month follow-up.Conclusion Endovascular embolization of intracranial aneurysm with coils is a safe and effective treatment for intracranial aneurysm.Advances in Techniques and treating the complications correctly would decrease the complications and improve future outcomes.

Objective To observe the effects of casein and excessive iodine on histomorphalogY and ultrastructure of mouse thymicL Methods Based on 2 × 3 factorial design,the experimental mice were divided into 6 groupg Animal models were estabhshed by feeding the mice with different levels of iodine water and casein food.The levels of iodine were 50,600 μg/L in drinking water and 0(Ⅰ),10%(Ⅱ),20%(Ⅲ)of casein in food respectively.After 12 months,the thyroid weight was measured and the morphology of thyroid was observed under optical and electron microscope.Results Factorial analysis showed that iodine factors obviously affected the thyroid absolute and relative weiights of mice(F=16.23,9.47,P＜0.01),and there was interaction between casein and iodine(F=5.29,4.68,P＜0.01 or＜0.05).Compared wiht 150Ⅰ[(5.91±0.82)rag,(117.0±22.2)mg/kg]and 50Ⅲ[(4.90±0.63)rag,(106.1±13.3)mg/kg]groups.thyroid absolute and relative weights of the mice increased in 600 Ⅰ[(7.60±2.40)mg,(143.3±43.2)mg/kg]and 600Ⅲ[(8.63±1.88)mg,(166.2±39.4)mg/kg]groups(P＜0.05 or＜0.01),respectively.But compared with 600 Ⅰ and 600Ⅲ groups.they were reduced obviously in 600Ⅱ[(5.76±1.13)mg,(109.8±16.5)mg/kg]group(P＜0.05 or＜O.01).Colloid goiter,lymphocyte infiltration were found,some of the follicles epithelial cells appeared active under light and electron microscope in iodine excels group,which,however,decreased obviously along with the increase of casein dose.Conclusions Long-term excessive iodine may cause colloid goiter and inflammation injury of mice,possibly leading the development of thyroiditis in mice,which may be partly reduced by casein.

Objective:To study the application value of electroencephalograph bispectral index (EEG-BIS) monitor in precision anesthesia and its effect on postoperative awakening time.Methods:A total of 100 patients who prepared to undergo thyroid surgery were randomly divided into observation group (n=50) and control group (n=50) .Under the same anesthesia way of the two groups, observation group adopted the results from EEG-BIS monitor to adjust the depth of anesthesia for patients, and control group adopted routine monitoring included weight, blood pressure and heart rate to adjust the depth of anesthesia.The amount of anesthetic and the awakening time of the patients in the two groups were observed and recorded, and the incidence of postoperative adverse events between the two groups were further compared.Results:The amount of propofol of observation group was significantly larger than that of control group (t=2.72, P<0.05) .And the awakening time, extubation time and the time of leaving PACU of observation group were significantly less than those of control group (t=4.45, t=4.83, t=5.92, P<0.05) .The differences of blood pressure at 20 min, 30 min and 60 min after patients underwent thyroid surgery between the two groups were significant (t=2.87, t=3.90, t=2.76, P<0.05) .Conclusion:BIS monitor can guide the adjustment for the depth of anesthesia during operation, and reduce the amount of general anesthetics of patients and shorten the awakening time in PACU, which is worthy in clinical application.

OBJECTIVETo retrospectively review the experience in repair of interrupted aortic arch (IAA) and associated cardiac anomaly.

METHODSFrom January 1997 to January 2008, 36 patients with interrupted aortic arch and associated cardiac anomaly underwent surgical treatment. There were 22 male and 14 female. Mean age of the 35 children patients was 2.8 years, with a range from 2 months to 7 years. There was a 31 years old adult patient. Types of interrupted aortic arch include 30 cases of type A and 6 cases of type B. In all 36 patients, 33 cases had patent ductus arteriosus (PDA) and intracardiac abnormality, including 28 cases of simple anomaly as ventricular septal defect and 5 cases of complex anomaly, two cases were single IAA arch without PDA and other cardiac defect, one case had no intracardiac anomaly but PDA. For 33 patients with PDA and intracardiac anomaly, median sternotomy was used to simultaneously repair interrupted aortic arch and intracardiac defect in 31 cases, left thoracotomy and median sternotomy were applied to repair IAA and intracardiac anomaly respectively in one case, one patient had palliative repair. For three patients without intracardiac anomaly, left thoracotomy was applied in two cases, median sternotomy and abdominotomy were used in one adult patient. Techniques of operation for interrupted aortic arch include 16 cases of conduit connection, 9 cases of direct anastomosis, 9 cases of direct anastomosis with patch augmentation, 1 case of subclavian flap aortoplasty. In all 31 cases of one-stage operation through median sternotomy, selective cerebral perfusion was used in 17 patients, deep hypothermia and low flow were applied in 8 cases, deep hypothermia circulatory arrest was performed in 6 patients.

RESULTSThere were 5 hospital deaths. Three cases died of pulmonary infection, 1 case died of of pulmonary hypertension crisis, and another case died of postoperative low cardiac output, which was misdiagnosed before operation. Seven cases had other main postoperative complications. Thirty-one survivors were followed up from 3 months to 5 years, there was no late death and reoperation.

CONCLUSIONOne-stage repair through median sternotomy using selective cerebral perfusion or deep hypothermia and low flow can be applied to most of the cases with associated cardiac anomaly.

Aorta, Thoracic ; abnormalities ; Child ; Child, Preschool ; Female ; Follow-Up Studies ; Heart Defects, Congenital ; surgery ; Humans ; Infant ; Male ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo review the experience in repair of aortic coarctation with intracardiac anomaly in infants and toddlers.

METHODSFrom January 2000 to December 2006, 84 infants and children diagnosed as aortic coarctation with intracardiac anomaly underwent surgical treatment. Mean age of the patients was 13.5 months, with a range from 1 month to 3 years. Mean body weight was 7.3 kg, with a range from 3.3 to 15 kg. Twelve patients complicated with complex intracardiac anomaly. Seventy-two patients complicated with ventricular septal defect and other simple anomaly. Twenty-one patients had hypoplasia of the aortic arch. Sixty-two patients had one-stage repair. Median sternotomy was used to simultaneously repair coarctation and intracardiac defect in 49 patients. Left thoracotomy and median sternotomy were applied to repair aortic coarctation and intracardiac anomaly respectively in 13 patients. Twenty-two patients had staged repair. Operational techniques for aortic coarctation include 42 patients of patch aortoplasty, 30 patients of resection and end-to-end anastomosis, 6 patients of subclavian flap aortoplasty, 3 patients of vascular bypass, and 1 patient of balloon dilation. In all 49 patients of one-stage operation through median sternotomy, selective cerebral perfusion was used in 43 patients, deep hypothermia low flow was applied in 4 patients, deep hypothermia circulatory arrest was performed in 2 patients.

RESULTSThere were 8 hospital deaths. The mortality is 9.5%. Among 8 deaths, 3 patients were misdiagnosed.

CONCLUSIONSSurgeries for aortic coarctation with intracardiac anomaly have satisfactory short-term results in infants and toddlers. One-stage repair through median sternotomy can be applied to most of the patients. Selective cerebral perfusion with deep hypothermia and circulatory arrest in lower body can protect the brain and other vital organs.

Aortic Coarctation ; complications ; surgery ; Child, Preschool ; Female ; Heart Defects, Congenital ; surgery ; Humans ; Infant ; Male ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo investigate the prevalence of hyperuricemia with hyperlipaemia, high blood sugar and hypertension among elderly people.

METHODSSerum uric acid (SUA), cholesterol, triglycerides, blood sugar and blood pressure were detected in 1320 elderly people and 6107 people at young and middle age.

RESULTSThe mean SUAs in elderly male and female groups were significantly higher than that in young and middle aged male groups respectively (P < 0.05). The prevalence rates of hyperuricemia in elderly male and female groups were significantly higher than in young and middle aged male groups respectively (P < 0.05). The prevalence rates of hyperlipaemia, high blood sugar and hypertension in the elderly people of hyperuricemia were significantly higher than that in the elderly people of normal serum uric acid (P < 0.05). The prevalence rates of hyperuricemia in the elderly people were complicated by hyperlipaemia, high blood sugar and hypertension which was significantly higher than that in young and middle aged people of hyperuricemia (P < 0.05).

CONCLUSIONHyperuricemia is a common disease in elderly people and more attention should be paid to the closer relations among hyperuricemia with hyperlipaemia, high blood sugar and hypertension among the elderly.

Aged ; Aged, 80 and over ; Blood Glucose ; analysis ; Blood Pressure ; China ; epidemiology ; Cholesterol ; blood ; Female ; Humans ; Hyperlipidemias ; epidemiology ; Hypertension ; epidemiology ; Hyperuricemia ; epidemiology ; Male ; Mass Screening ; Middle Aged ; Prevalence ; Triglycerides ; blood

Objective To investigate the occurrence of new cretinism cases and the prevalence of endemic goiter, and the reason of lower coverage rate of iodized salt in the iodine deficiency disorders(IDD) high-risk areas of China, so as to put forward target prevention measures for these areas. Methods A hundred and one counties from 11 provinces(autonomous regions, municipality), such as Tibet, Qinghai, Xinjiang, Gansu, Ningxia, Sichuan, Hainan, Chongqing, Yunnan, Guangxi, Inner Mongolia, were chosen into the survey by simple random sampling. In the counties of high risk, typical sampling principle was used. In the selected townships, searching for new cretinism cases were carried out in the children under 10 years old, the thyroid volume of children aged 8-10 years old were determined by B-ultrasonography methods and their urinary iodine (UI) were determined by As3-Ce<'4+> catalytic spectrophotometry, the intelligence quotient(IQ) values of children aged 8-10 years old were measured by the combined Raven Test in China. In the household survey, the housewives were asked to fill in the questionnaire, the iodized salt coverage rates and the UI levels of child-bearing age women were investigated, the salt iodine content was determined using self-quantitative kit. Epi Info software was used to analyze the determination results. Results In the 101 high-risk counties, 249 were diagnosed as new cretinism cases from 4122 suspected cases searched. The goiter rate of children aged 8-10 years old by B-ultrasound was 8.28% (4434/53 541), 44 counties had goiter rates in the range of 5%-20%, 5 counties had goiter rates in the range of 20%-30%, and 3 counties had goiter rates of 30%. The mean IQ of children was 85.44, and the percentage of IQ value less than 70 was 16.52%(8713/52 745). The median urinary iodine(MUI) of children was 154.69 μg/L, the percentage of UI less than 50 μg/L was 17.26% (9069/52 558). Twenty-five counties had a MUI of children less than 100 μg/L. The MUI of housewives was 107.14 μg/L, the percentage of UI less than 50 μg/L was 27.50% (3722/13 534). MUI of housewives in 46 counties were less than 100.0 μg/L. The coverage rate of iodized salt at household level was 77.85%(13 150/16 891). The coverage rate of iodized salt was 52.80%(1585/3002), 44.72% (631/1411) and 72.82% (1850/2506) in Tibet, Hainan and Qinghai, respectively. More than 10% residents of Tibet, Sichuan, Hainan, Gansu and Qinghai complained that iodized salt was not convenient to buy. There were 71.39%(7652/10 719) of observed people ate crude salt. The average price of crude salt price(0.30-1.20 Yuan/kg) was lower than iodized salt(1.20-3.00 Yuan/kg). Conclusions In these IDD high-risk areas, the risk of endemic goiter and cretinism prevalence is threatening. The IDD monitoring should be carried out successively in these high-risk areas. The prevention measures, increasing iodized salt coverage rate and establishing the sustainable mechanism for eliminating IDD should be strengthened. Emergent iodine fortification measure for high risk region people should be implemented as soon as possible, a long term effective mechanism of eliminating IDD should be established.

Objective To observe the effects of casein on iodine metabolism in blood,urine and thyroid of mice under excessive iodine.Methods A 2 by 3 factorial design was used in the experiment.The levels of iodine and casein were 50 and 600 μg/L in drinking water and 0( Ⅰ ),10％( Ⅱ ),20％( m ) in food,respectively.After six and twelve months,iodine content in serum,thyroid gland and urine was determined by arsenic-cerium catalyzed spectrophotometry.Results In six months,the levels of serum iodine in 50 Ⅰ,50 Ⅱ,50Ⅲ,600 Ⅰ,600 Ⅱ,and 600Ⅲ groups were (85.59 ± 8.78),(64.59 ± 9.06),(72.53 ± 11.69),(110.04 ± 9.37),(81.06 ± 9.94),(86.63 ± 19.59)μg/L,respectively; the levels of iodine content in thyroid gland were (0.21 ± 0.09),(0.29 ±0.08),(0.24 ± 0.05),(0.50 ± 0.10),(0.37 ± 0.13),(0.42 ± 0.12)g/kg,respectively; the levels of urinary iodine median were 87.5,68.1,105.5,746.5,828.3,1014.2 μg/L,respectively.The variance analysis results of factorial design showed iodine and casein significantly influenced the serum iodine level(F =27.95,18.52,all P ＜0.05),however,there was no interaction between the two(F =0.81,P ＞ 0.05); iodine significantly influenced the iodine content in thyroid gland(F =31.35,P ＜ 0.05),the presence of iodine interacted with casein(F =3.34,P ＜0.05).In twelve months,the levels of serum iodine were (88.54 ± 12.33),(72.45 ± 7.73),(72.93 ± 13.61),( 106.26 ± 12.00),(90.03 ± 7.90),( 104.88 ± 11.67)μg/L,respectively; the levels of iodine content in thyroid gland were (0.58 ± 0.12),(0.40 ± 0.14),(0.69 ± 0.16),(0.84 ± 0.13),(0.89 ± 0.13),(1.02 ± 0.11 )g/kg,respectively;the levels of urinary iodine median were 104.8,121.5,102.7,829.1,1080.8,895.2 μg/L,respectively.The variance analysis results of factorial design showed iodine and casein significantly influenced the iodine content in serum and thyroid gland (F =42.78,7.42 and 66.62,7.90,all P ＜ 0.05),however,there was no interaction between the two(F =1.93,2.31,all P ＞ 0.05).Conclusions Long-term intake of iodine can significantly increase the iodine content in serum,thyroid gland and urine,but casein may accelerate iodine excretion and partly reduce the effect.