The emphasis and basic target of medical education is to cultivate medical students with high qualities. The qualities of medical students include professional ethics, self-cultivation, medical knowledge and physical-psychological quality, which is critical to the medical education. It has been proven that the teaching of Clinical Pathway is one of the most important factors to promote the improvement of comprehensive qualities of medical students.

Ophthalmology is a clinical course which requires students to have practical skills. The traditional clinical teaching method lacks varied means resulting in unsatisfactory teaching effects. Application of multimedia technology not only changes the teaching model, enriches the teaching contents but also improves the quality of ophthalmology teaching. By analyzing the advantages and disadvantages of multimedia application in clinical teaching based on our practice, the paper raises some methods for improvment in order to achieve the best teaching effects.

Adult ; Female ; Hematometra ; pathology ; Humans ; Uterine Neoplasms ; pathology ; Uterus ; pathology

Objective To investigate the correlation of platelet activating factor(PAF)with cortisol(Cor) ,as well as their rela-tionship with patients after sepsis prognosis .Methods 102 patients with sepsis admitted in the ICU of Chongqing Emergency Med-ical Center from April 2012 to August 2013 were enrolled into sepsis group ,and 40 cases of volunteers served as control group .All the patients were divided into survival group and non-survival group ,according to their prognosis during hospitalization .Plasma PAF and Cor level in control group ,survival group and non-survival group were compared with each other ,and acute physiology and chronic health evaluationⅡ(APACHEⅡ)in survival group and non-survival group were compared .The correlations of plasma PAF with Cor level in control group ,survival group and non-survival group were analyzed ,respectively .Results Plasma PAF and Cor level in survival group and non-survival group were significantly higher than that in control group(P<0 .05) .Plasma PAF ,Cor lev-el and APACHEⅡ scores were higher in non-survival group than that in survival group(P<0 .05) .The correlation of plasma PAF with Cor level in control group was not significant(P>0 .05) ,while the plasma PAF level positively correlated with Cor level in survival group and non-survival group(P<0 .05) .Curves of receiver operating characteristics(ROC)showed that PAF ,Cor and A-PACHEⅡ score could be used as predictors of mortality during hospitalization(Area=0 .708 ,0 .715 ,0 .787) .Conclusion The plas-ma PAF level positively correlates with Cor level in patient with sepsis .PAF ,Cor and APACHEⅡ score have certain guiding signif-icance for the assessment of prognosis during hospitalization in patients with sepsis .

BACKGROUND: Thermosensitive hydrogel materials present stability at human body temperature, which is necessary for its application as a medical implant, thus the lower critical solution temperature (LCST) of thermosensitive hydrogel should be beyond the human body temperature by adjustment.OBJECTIVE: To prepare a thermosensitive hydrogel poly-N-isopropylacrylamide-co-N-hydroxymethylacrylamide P(NIPAAm-co-NHMPA) with over 37 ℃ LCST, and primarily appraise its safety as a medical implant in vivo.DESIGN: Random, non-blind, group control, animal experimental study.SETTING: Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology(HUST).MATERIALS: The experiments were carried out in the Central Laboratory, Union Hospital, Tongji Medical College, HUST and the Key Laboratory of Biomedical Polymer Materials of the Ministry of Education, College of Chemistry, Wuhan University between January and October in 2007. NIPAAm monomer and NHMPA monomer were purchased from Aldrich Company, crosslinking agent N, N'-methylene bisacrylamide from Fluka Company, and initiator ammonium persulfate and accelerating agent tetramethyl ethylene diamine from Sigma Company.METHODS: ①Taking ammonium persulfate and tetramethyl ethylene diamine as oxidation-reduction initiation system, while N, N'-methylene bisacrylamide as cross-linking agent, P-NIPAAm-co-NHMPA was prepared with the addition of NHMPA in the reaction system. LCST was determined by shrinking tests.②A series of biocompatibility tests such as sensitization test, acute systemic toxicity test, genetic toxicity test and implantation test were conducted in several experimental animals to evaluate the safety of the implant. MAIN OUTCOME MEASURES: The erythema and edema of stimulated lesions were recorded in sensitization test; the general state of each animal in acute systemic toxicity test were recorded 4, 24, 48 and 72 hours after injection; in genetic toxicity test, mouse bone marrow polychromatic erythrocyte (PEC) micronucleus was counted six hours after injection under microscope; sections after implantation were observed under light microscope.RESULTS: ①Synthesized hydrogel showed thermosensitive character and the LCST was 38 ℃.②In sensitization test, there was no erythema and edema occurred after leaching liquor and saline were injected; acute systemic toxicity test result revealed no symptom of toxicity; the genetic toxicity test suggested no difference of PEC frequency between experimental group and negative control group; in vivo implantation test, the inflammation around the material was mild and limited.CONCLUSION:P(NIPAAm-co-NHMPA) shows good biocompatibility and can be potentially used as an implant material.

AIM: To prepare and evaluate the biocompatibility of a thermosensitive hydrogel poly-(N-isopropylacrylamide-co-N-hydroxymethylacrylamide) (P-NIPAAm-co-NHMPA) in vivo so as to appraise its safety as a medical implant in clinical use. METHODS: The experiments were carried out in the Central Laboratory, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology(HUST) and the Key Laboratory of Biomedical Polymer Materials, Ministry of Education, College of Chemistry, Wuhan University between January and October in 2007. ① Preparation of thermosensitive hydrogel P-NIPAAm-co-NHMPA: Taking ammonium persulfate and tetramethyl ethylene diamine as oxidation-reduction initiation system, while N, N'-methylene bisacrylamide as cross-linking agent, P-NIPAAm-co-NHMPA was prepared with the addition of NHMPA in reaction system. Low critical solution temperature was determined by shrinking tests. ②A series of biocompatibility tests such as sensitization test, acute systemic toxicity test, genetic toxicity test and implantation test were conducted to evaluate the safety of the implant. RESULTS: ①Synthesized hydrogel showed thermosensitive character as expected, and the low critical solution temperature was 38 ℃.②In sensitization test, there was no sensitization proved in the material; in acute systemic toxicity test, the symptom of toxicity was not found; the genetic toxicity test suggested no teratogenic or mutagenic effects; in vivo implantation test showed that the inflammation around the material was mild and limited. CONCLUSION: Thermosensitive hydrogel P-NIPAAm-co-NHMPA has good biocompatibility and is a potential medical implant.

Objective To discuss the characteristics and management of pregnancy on cesarean section scar. Methods Five women with pregnancy on cesarean section scar were reviewed from Apr. 2000 to Mar. 2003. Results All of the five patients had cesarean section before and suffered from painless,irregular vaginal bleeding after 6～8 weeks of amenorrhea. The pregnancy could be misdiagnosed as invasive mole or cervical pregnancy. All had better outcome by uterine suction under ultrasound monitoring without massive bleeding or hysterectomy. Conclusions Women who had cesarean section before are in the risk of pregnancy on the old scar. Clear diagnosis should be made before any treatment. Ultrasound monitoring,local MTX injection and packing can be utilized to prevent perforation during suction. Patients should be monitored continuously after operation with serum hCG level and ultrasound. The principle prevention of pregnancy on cesarean section scar is to reduce the cesarean section rate and effective contraception.

Objective To investigate roles of superoxide dismutase-1(SOD1),phosphatidylinositol 3-kinase (PI3K) /serine/ threonine protein kinase (AKT) signal transduction pathway in protection of propofol on spinal cord ischemic reperfusion injury (SCIRI) in rabbit model before and after ischemia. Methods Sixty Japanese male rabbits were randomly divided into 3 groups (n=20),namely sham-operation group (Group S),ischemia-reperfusion group (Group I/ R) and ischemia-reperfusion group with propofol treatment (Group P). Abdominal aorta of the rabbits in group I/ R and group P were blocked by clamp for 40 min and then the clamp was removed. Propofol (30 mg·kg-1 ) was intravenously infused 10 min before blocking the aorta and at the time of reperfusion. Normal saline was intravenously infused at the same time points in the other two groups. Four rabbits of each group were randomly executed 1,2,3,5,7 days after surgery. Spinal cord tissues at L3-L4 levles were harvested. Bioactivity of SOD1 was detected by ELISA and mRNA expression levels of SOD1,PI3K and AKT were detected by RT-PCR. Results On the 1st day after the surgery,the bioactivity of SOD1 increased significantly in Group I/ R and Group P as compared with that in Group S (P<0. 05). On the 2nd day,compared with Group S,the bioactivity of SOD1 increased significantly in Group P (P<0. 05),but there was no change in Group I/ R (P>0. 05). On the 3rd,the 5th and the 7th day,compared with Group S,the bioactivity of SOD1 decreased significantly in Group I/ R (P<0. 05),but there was no change in Group P (P>0. 05). Linear regression analysis indicated that there was a positive correlation between the changes of SOD1 activity and the mRNA expression of SOD1,PI3K and AKT respectively in spinal cord tissues. Conclusion Pre- and post-ischemic conditioning with propofol shows potent protective effects against SCIRI in the rabbit model. The mechanisms may be related to increased expression of SOD1 in the spinal cord tissues by activating PI3K/ AKT signal transduction pathway.

Objective To discuss the effect and related mechanism on epithelial?mesenchymal transition(EMT)process and invasive ability of the trophoblasts JEG?3 by targeted silencing of Notch?1 gene. Methods Notch?1?siRNA interference fragment was designed and synthesized to sta?bly transfect JEG?3 cells. Changes in the invasive ability of trophoblasts were detected by Transwell chamber invasion assay. The expressions of Notch?1 ,E?cadherin ,vimentin and EMT transcriptive regulators slug ,snail ,twist were analyzed in transfected trophoblasts by Western blot. Results The relative expression of Notch?1 protein in JEG?3 and the invasive ability of JEG?3 were significantly decreased after transfection with Notch?1?siRNA,the expression of the epithelial indictor E?cadherin was significantly increased while the mesenchymal indicator vimentin was de?creased with the reduction of EMT transcriptive regulators slug,snail and twist. Conclusion The invasion of trophoblasts was affected by targeted si?lencing of Notch?1 gene and Notch?1 can reduce the invasion of trophoblasts through influencing EMT process.

Objective: To observe the efficacy of contralateral needling combined with Maitland ankle mobilization in the treatment of chronic ankle sprain.Methods: A total of 106 patients with chronic ankle sprain were included in the study. They were numbered according to their order of visit, with odd numbers assigned to the control group and even numbers assigned to the observation group, with 53 cases in each group. Patients in the control group were treated with Maitland ankle mobilization, while those in the observation group were given additional contralateral needling treatment. After treatment, we observed the indicators including, ankle circumference, range of motion (ROM) of dorsiflexion, ROM of plantar flexion, thickness of ankle ligaments, and the changes in Baird-Jackson ankle score, American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, and visual analog scale (VAS) score to compare the efficacy between the two groups. Results: After treatment, the total effective rate of the observation group was 94.3％ and was significantly higher than that of the control group (81.1％), indicating statistical significance (P<0.05). After treatment, the ankle circumference of both groups decreased, and the ROM of dorsiflexion and the ROM of plantar flexion increased (P<0.05). The changes in the observation group were more significant, indicating inter-group statistical significance (P<0.05). After treatment, the thickness of the anterior talofibular ligament, calcaneofibular ligament, and posterior talofibular ligament, as well as the VAS scores decreased in both groups; the changes in the observation group were more significant, indicating inter-group statistical significance (P<0.05). After treatment, the Baird-Jackson ankle score and the AOFAS ankle- hindfoot score increased in both groups, and the scores in the observation group were higher than those in the control group, indicating inter-group statistical significance (P<0.05). Conclusion: The efficacy of contralateral needling combined with Maitland ankle mobilization in the treatment of chronic ankle sprain is superior to that of Maitland ankle mobilization alone.