Teaching reform is the strong requirement of the times and social development.Immunology department inTaishan Medical College integrated teaching and a variety of extra-curricular teaching,broke the constraints of traditional teaching model in time and space,played the leading role of teachers and inspired students' independent learning,thus improving the teaching effectiveness in immunology.

This paper illustrates the immunology teaching reform of higher medical education to meet demands of the 21st century. The teaching reform includes cultivating students’humanities quality,scientific consciousness,ability to research and the following-up of immunology progress. According to the teaching practice and the results from the questionnaire,the new teaching model is better than traditional teaching model and is approved by the students.

Objective To explore the methods of Y-V vascular pedicle lengthening technique for cover-age of the defect of great toe after wrap-around flap transfer, and decrease the morbidity of donor site in great toes. Methods Fifteen patients received three kinds of flap for immediate resurfacing of donor defect of the great toes during wrap-around flap transfer, all flaps were harvested with Y-V vascular pedicle lengthening technique. Among them, 9 cases received the free lateral tarsal flaps transplantation for coverage of defect in donor great toes, 5 cases was repaired by medial tarsal flaps, and only one was treated by the medial plantar flap. Results All the flaps survived postoperatively. The medial plantar flap encountered the venous crisis in postoperative 3 days, and regained the normal blood supply after continuous bleeding for 2 days. All patients were satisfied with cosmetic and functional outcome in average 10- month follow-up. The appearance and sensory function of donor toe repaired by medial tarsal flaps was best among three ones. Conclusion Depending on the Y-V vascular pedicle lengthening technique, the local pedical flaps of foots are enlarged scope for coverage of great toe after wrap-around flap harvest, which can decrease the complication of donor site at the most.

Objective To report a 33-year-old man with post-headache stroke-like episodes,with whom ischemic changes were found in basal ganglia and occipital-temporal lobe and muscle biopsy revealed abnormal mitochondrial structure and function without regular mutations detected in mtDNA.Methods Gene chip technique was used to detect the mutation of whole sequence of mtDNA,and direct sequencing technique was used to confirm the mutations.Results Three mutations were found.A new mutation in the mitochondrial cytochrome C oxidase subunit 1 (MTCO1),a T→C transition at nucleotide position 6253 resulted in conservative methionine transferring to threonine.His mother also held the mutation,which was not found in 98 control samples.So T6253C was considered the nosogenetic mutation.Conclusion This is the first time to report a mutation in MTCO1 responsible of MELAS.

Objective:To explore the reasons of secondary fracture after percutaneous vertebroplasty (PVP) for osteo-porotic vertebral compression fractures (OVCFs) and discuss the measure of prevention and cure. Methods:From January 2011 to January 2013,the clinical data of 180 patients with primary OVCFs treated by PVP were retrospectively analyzed. There were 75 males and 105 females,aged from 68 to 95 years old with an average of (79.50±5.45) years. The involved ver-tebrae were identified according to the clinical symptoms and imaging data. PVP were performed in 362 vertebrae and the pa-tients were followed up with an average of 12 months. Subsequent vertebral fractures were found through the pain ’s reappearance and MRI or bone scan. The patients were divided into secondary fracture group and no secondary fracture group according to the subsequent fractures or no. Secondary fracture group was divided into two groups according to gender ,and the patients with sec-ondary fracture were also categorized into the original surgical vertebral fractures ,adjacent vertebral fracture and remote verte-bral fractures. The age,gender,the cement volume,the cement leakage,secondary fracture site,the incidence and type of sec-ondary fracture were observed and compared among different groups. Results:Among the 362 vertebrae of PVP,there were 109 vertebrae in male and 253 vertebrae in female. And 27 vertebrae (10 in male and 17 in female) of 22 cases (9 males and 13 fe-males) occurred secondary fracture. The second PVP were performed in 13 cases (16 vertebrae) and the third PVP in 2 cases (4 vertebrae);7 cases (7 vertebrae) were treated with conservative therapy. There was no statistically significant difference on age , gender,cement volume and leakage between secondary fracture group and no secondary fracture group (P>0.05). There was no statistically significant difference on the incidence and type of secondary fracture between male and female (P>0.05). No signifi-cant difference was found on the adjacent and remote vertebral fractures (P>0.05). Most of secondary fracture occurred in 6 months,and whether the single and double side injection,cement leakage had no obvious relation. Conclusion:There is no significant difference in the subsequent fracture after PVP for the OVCFs different gender and fractured site ,and also no signif-icant difference in the adjacent and remote vertebral fractures. The report didn't support the biomechanical viewpoint that verte-bral body stiffness increasing after PVP would lead to adjacent vertebral stress increasing and result easily in adjacent vertebral fracture. Secondary fracture occurs always in 6 months after operation ,which is the natural course of osteoporosis.

Objective To evaluate the outcome of health education program on drowning prevention among primary and secondary school children in rural areas. Methods A township was selected and all the students from grade 3 to 5, grade 7 to 8, and grade 10 to 11 were selected to take part in the program. Twelve intervention measures on natural water safety and drowning prevention were carried out for one year. Information was collected using the same questionnaire before and after the intervention program. Results One year after the intervention was carried out, children's knowledge on drowning prevention improved significantly (13.21, 95% CI: 12.51-13.90) , and a positive effect was also noticed among boys (12.77, 95%CI: 11.77-13.77), girls (13.80, 95%CI: 12.82-14.78),and among primary school children (15.51,95%CI: 14.30-16.72), senior high school children (10.78,95%CI: 9.50-12.05) and junior high school children (12.77,95%CI: 11.84-13.71). Overall rates on risk behaviors dropped from 41.4% to 32.2% (by 22.2%) including 15.6% for boys, 35.2% for girls and 13.8%, 29.3%, 26.3% for primary school children, senior high school children, junior high school children, respectively. The incidence rates for non-fatal drowning decreased by 58.9% (from 5.6% to 2.3%). The person-times for treatment on sight, in emergency settings, in outpatient clinic or in the hospitals had a reduction from 399, 78, 36 to 175, 32, 14, respectively. Conclusion Health education program could improve children's perception on water safety, and reduce their risk behaviors as well as on the incidence of non-fatal drowning in the rural areas.

Objective To evaluate the clinical efficacy of anterior single segmental decompression and instrumentation through Endoring self-support retractor-assisted minimally invasive small incision approach in the treatment of Denis type B thoracolumbar burst fractures.Methods A retrospective case series study was made on 26 cases (14 males and 12 females,mean age of 48.5 years) of Denis type B thoracolumbar burst fractures treated by anterior single segmental decompression and instrumentation through Endoring self-support retractor-assisted minimally invasive small incision approach from January 2007 to June 2009.Age was 18-68 years (mean,48.5 years).The fractured vertebrae included T1 in three cases,L1 in 18 and L2 in five.The neurological status was Grade C in eight cases,Grade D in 12 cases and Grade E in six cases according to American Spinal Injury Association (ASIA) classification.The operation duration,blood loss and incision length were recorded.The neurological function,lower back pain were evaluated by visual analogue score (VAS),correction of kyphosis and restoration of the fractured vertebral body height followed and documented at 3,6 and 9 months and annually after surgery.The healing of the graft was assessed using Brantigan method based on 3-dimensional computed tomography at final follow-up.Results All patients were successfully managed with this approach.The operation duration was (214.6 ± 30.5)min,and the intraoperative blood loss was (389.7 ± 57.1) ml.The length of incision was (8.5 ± 1.3) cm.All patients were followed up for (6.3 ± 0.4) years.At final follow-up,the neurological functions of all patients with incomplete neurological deficit were improved for at least one grade.The VAS of lower back pain was improved from preoperative (7.8-± 1.6) points to (2.1 ± 0.8) points at final follow-up (P ＜ 0.05).The height of the intervertebral body was restored from preoperative (29.8 ± 5.3) mm to (35.2 ± 2.4) mm at final follow-up (P ＜ 0.05).The kyphosis was corrected from preoperative (20.4 ± 11.7) ° to (11.3 ± 5.5) ° at final follow-up (P ＜ 0.05).Bone fusion was achieved in all patients,with no looseness,breakage or displacement of internal fixation at follow-up.Conclusions Anterior single segmental decompression and instrumentation through Endoring self-support retractor-assisted minimally invasive small incision approach can reduce the surgical trauma,achieve complete spinal canal decompression,adjust kyphosis,fix segment,obtain high rate of bone graft fusion and hence is a safe and effective method with minimal invasion for Denis type B thoracolumbar burst fractures.

Objective To study the relationship between serum UA level and early outcome in acute ischemic stroke (AIS) patients. Methods Four hundred and twenty-one AIS patients admitted to the First Affiliated Hospital of Xi'an Jiaotong University from March 2015 to March 2016 were divided into good outcome group (n = 232) and poor outcome group (n = 189) according to their modified Rankin scale (mRS) score. Their demographic data, risk factors for vascular disease, laboratory testing parameters, imaging and clinical data and NIHSS score were recorded and compared. The relationship between serum UA level and early poor outcome in AIS patients was analyzed by unconditioned logistic regression analysis. Results The incidence of AF and cerebral infarction in the territory of anterior cerebral artey and middle cerebral artery, SBP, serum TC,LDL and urea levels,NIHSS and mRS score, and mortality were significantly higher and the hospital stay time was significantly longer while the serum UA level and GCS score were significantly lower in poor outcome group than in good outcome group (P＜0.05,P＜0.01). Unconditioned logistic regression analysis showed that SBP,NIHSS score and serum UA level were the major risk factors for the early poor outcome in AIS patients (OR = l.017,95％CI:1.003-1.031,P = 0.018;OR = 1.274,95％CI:1.178-1.378,P=0.000;OR=0.993,95％CI:0.989-0.996, P = 0.000). Conclusion The low serum UA level is related with the early poor outcome in AIS patients.

Objective:To evaluate the effect of muscle oxygen saturation (SmtO 2) guidance on the quality of early recovery after spinal surgery in the patients. Methods:One hundred and twenty patients of either sex, aged 18-64 yr, with body mass index of 18-35 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ, with Hb concentration>100 g/L, undergoing elective spinal surgery, were selected.Routine anesthesia induction and maintenance were performed.SmtO 2 monitoring was carried out, and electrodes were applied to bilateral thenar in group S. When unilateral or bilateral SmtO 2 dropped to 70% of the baseline level for more than 60 s, the sensor position was checked, fluid infusion was accelerated, vasoconstrictors was used, and the inhaled oxygen concentration was improved and blood was transfused for treatment.In group C, only electrode sheets were applied, without monitoring.The Quality of Recovery-15 scale was used to evaluate the recovery quality of patients at 1 day before operation (T 0), 1 day after operation (T 1) and 3 days after operation (T 2). The tracheal extubation time, post-anesthesia care unit stay time and postoperative length of hospital stay were recorded.Immediately before anesthesia induction and at the end of operation, arterial blood was collected for blood gas analysis, and the lactic acid level was recorded.Postoperative hypotension, constipation, spinal nerve injury, postoperative nausea and vomiting and incisional infection were recorded. Results:Compared with group C, the level of postoperative lactic acid was significantly decreased, the incidence of postoperative constipation, postoperative nausea and vomiting and incisional infection was decreased, the extubation time and post-anesthesia care unit stay time were shortened, and the Quality of Recovery-15 scale score at T 1, 2 was increased in group S ( P<0.05). Conclusions:SmtO 2 guidance can improve the early recovery quality of patients after lumbar surgery.

Background and Objectives: Chronic periodontitis can lead to alveolar bone resorption and eventually tooth loss. Stem cells from exfoliated deciduous teeth (SHED) are appropriate bone regeneration seed cells. To track the survival, migration, and differentiation of the transplanted SHED, we used super paramagnetic iron oxide particles (SPIO) Molday ION Rhodamine-B (MIRB) to label and monitor the transplanted cells while repairing periodontal bone defects. Methods: and Results: We determined an appropriate dose of MIRB for labeling SHED by examining the growth and osteogenic differentiation of labeled SHED. Finally, SHED was labeled with 25 μg Fe/ml MIRB before being transplanted into rats. Magnetic resonance imaging was used to track SHED survival and migration in vivo due to a low-intensity signal artifact caused by MIRB. HE and immunohistochemical analyses revealed that both MIRB-labeled and unlabeled SHED could promote periodontal bone regeneration. The colocalization of hNUC and MIRB demonstrated that SHED transplanted into rats could survive in vivo. Furthermore, some MIRB-positive cells expressed the osteoblast and osteocyte markers OCN and DMP1, respectively. Enzyme-linked immunosorbent assay revealed that SHED could secrete protein factors, such as IGF-1, OCN, ALP, IL-4, VEGF, and bFGF, which promote bone regeneration. Immunofluorescence staining revealed that the transplanted SHED was surrounded by a large number of host-derived Runx2- and Col II-positive cells that played important roles in the bone healing process. Conclusions SHED could promote periodontal bone regeneration in rats, and the survival of SHED could be tracked in vivo by labeling them with MIRB. SHED are likely to promote bone healing through both direct differentiation and paracrine mechanisms.