The flip classroom,as a new teaching form,has innovated the traditional teaching model.Although the flip classroom has its superiority,it will encounterchallenges in practice.This paper firstly analyzed the feasibility and necessity of medical ethics education based on the flip classroom.Then,it introduced the teaching model of medical ethics flip classroom based on three aspects:the basic pattern design,learning resources design and teaching process design.Finally,it discussed the application and effects of the flip classroom on the teaching of medical ethics.

Objective:To observe the clinical efficacy of Ba-pulling and Qian-traction manipulation with neck suspension and movement for acute cervical radiculopathy. Methods: A total of 85 patients who met the inclusion criteria were randomized into an observation group and a control group by random numbers, with 43 cases in the observation group and 42 cases in the control group. The observation group was treated with Ba-pulling and Qian-traction manipulation with neck suspension and movement;while the control group was treated with Bashen-pulling and stretching manipulation in a supine position. The treatment was performed once a day, 10 times as a treatment course. The therapeutic efficacy was evaluated after 1 treatment course, and the changes in the scores of visual analog scale (VAS) and neck disability index (NDI) were observed. Results: The total effective rate was 97.7% in the observation group, and 83.3% in the control group, and the difference between the two groups was statistically significant (P＜0.05). After treatment, the VAS and NDI scores of both groups were significantly decreased (both P＜0.01), and the differences in the VAS and NDI scores between the two groups were statistically significant (both P＜0.01). Conclusion: Both Ba-pulling and Qian-traction manipulation with neck suspension and movement and Bashen-pulling and stretching manipulation in a supine position can relieve pain and improve cervical function in patients with acute cervical radiculopathy, and Ba-pulling and Qian-traction manipulation with neck suspension and movement can produce more significant efficacy than Bashen-pulling and stretching manipulation in a supine position.

Aim To study the anticonvulsive and antiepileptic mechanism of ?-asarone.Methods ?-asarone was intraperitoneally injected (ip) in mice and acute epileptic mouse models were made after 30 min.Change of ATPase,index of antioxidation,and variation of amino acid (AA) contents in brain of epileptic mice were used to investigate ?-asarone′s anticonvulsive and antiepileptic mechanism.Results For ?-asarone treated epileptic mice,when compared with model group,glutamate/gamma-aminobutyric acid (Glu/GABA) was greatly decreased (P

BACKGROUND:Central pancreatectomy is a surgical treatment for tumors at the neck or the middle part of the pancreas, which can reserve more normal pancreas, not cut adjacent organs, and reduce the incidence of postoperative internal and external pancreatic secretion deficiency with respect to the expanded proximal and distal pancreatectomy. OBJECTIVE: To systematicaly evaluate the clinical efficacy of the central pancreatectomy and distal pancreatectomy. METHODS: A computer-based search of Chinese and English databases was performed, and then 15 controled clinical trials were included and systematicaly evaluated using RevMa5.2 software. RESULTS AND CONCLUSION: Totaly 1 079 cases were included in this study, which consisted of 436 central pancreatectomy cases and 643 distal pancreatectomy cases. Meta-analysis showed that compared with the distal pancreatectomy group, the incidences of postoperative pancreatic fistula and complications were significantly higher, the risk of postoperative endocrine and exocrine insufficiency were significantly lower, while the surgical time (SMD: 59.23, 95%CI: 22.41-96.05, P < 0.01) and hospital stays (SMD: 7.01, 95%CI: 1.94-12.09,P< 0.01) were longer in the central pancreatectomy group. These findings indicate that although the central pancreatectomy has a high postoperative complication incidence, it can be accepted clinicaly, which may be a reasonable operation method to preserve pancreatic exocrine and endocrine function.

Objective To observe the results of visual functional MRI(fMRI)of injury side with those of uninjured side,in patients with visual field defects and retrochiasmastic tumor.The potential clinical usefulness of visual fMRI data during functional examination on visual centre,defining the tumor field and surgery,was evaluated in patients with occipital lobe tumour.Design Case series.Participants Two patients with occipital lobe tumor and homonymous visual field defects,injury sides contrast with uninjured ones.Methods Patients were studied with fMRI using monocular checker stimulation(5Hz).The data obtained were analyzed with statistical parametric maps software(P

To investigate the effects of oleanolic acid (OA) on the proliferation, migration and the formation of tube-like structure in human vascular endothelial cells (HUVECs). MTT assay, flat plate scarification, Transwell plates and matrigel-induced tube formation assay were performed to detect the effects of OA on proliferation, migration and tube formation. MTT assay showed that the inhibition rates of HUVECs treated with 60 and 100 microg x mL(-1) of OA for 24 h were 19% and 83% respectively. Treatment of HUVECs significantly inhibited the cell migration in a dose-dependent manner. The vascular indexes of HUVECs treated with 40 and 60 microg x mL(-1) OA were 33% and 20% respectively. Western blotting analysis showed that treatment of the cells with OA significantly attenuated the expression and secretion of VEGF. Additionally, VEGF could in part reverse the effects of OA on migration and tube formation of HUVECs. In conclusion, OA inhibits the proliferation, and VEGF plays an important role in OA induced decreased migration and tube formation of HUVECs.

A reverse transcription polymerase chain reaction (RT-PCR) and single-strand conformation polymorphisms (SSCP) assay were applied to rapidly detect the molecular variability in CP and SP genes among seven isolates of Rice stripe virus in China. The PCR results showed that the CP gene of JD isolate and SP gene of PJ isolate could not be amplified. SSCP analysis showed that there were completely different electrophoretic pattern of CP gene among six isolates. To SP gene, SSCP results also discovered polymorphisms. There were five patterns among these isolates, and the pattern of YL and BS isolates were same.

Objective To explore the clinical value of applying digital technology to make the course of toe vein clear before toe free flap transplantation for thumb reconstruction.Methods Before operation,scan the donor and recipient site by CT,and apply digital three-dimensional CT angiography reconstruction technology to got threedimensional images of the arteries and veins in the donor site for 22 various defected thumbs which were going to have toe free flap transplantation operation,thus indentifyed the types of FDMA and the distribution and course of the toe vein from June,2012 to March,2013.Used computer assisted anatomical modeling to analyze three-dimensional images of blood supply of the donor site and degree of defect of the recipient site and guide the operative design in the donor site according to the digital three-dimensional reconstruction technology.Conducted toe free flap transplantation for thumb reconstruction in accordance with the design.Results It shows that 64-slice dual-source spiral CT could well display the size,distribution and course of toe vein.The toe veins were clarified to two groups,deep one and superficial one whose diameter was larger and was the main reflux vein of the toe.Dorsal vein of the toe origind from venous plexus in the nail bed and it travels along the back of the toe to reach to the near side of metatarsophalangeal joint.And then it beeomes three to four dorsal metatarsal veins to infused dorsal venous arch of foot.The rule of its course was:centralize-decentralize-connect-decentralize again.The great saphenous vein origins from the inner side of dorsal venous arch of foot,rises along the crus before malleolus medialis and collect three larger tributaries:medial malleolar branches-anterior crural branch-outside crural branch.The small saphenous vein derives from the outside of dorsal venous arch of foot and winds behind lateral malleolus up to the back of the curs and infuses to the vein.Conclusion It is useful for venous return,reducing the incidence of vascular crisis by applying toe flap to reconstruct thumbs and clarifying the course and distribution of toe vein with the aid of digital three-dimensional technology to design operation,thus improving the survival rate of toe flap transplantation.

Objective To investigate the clinical efficacy of open abdomen management for severe abdominal infection.Methods The clinical data of 36 patients with severe abdominal infection who were admitted to the General Hospital of Lanzhou Military Command from January 2009 to January 2014 were retrospectively analyzed.After examination,patients received resuscitation and debridement according to the principle of damage control surgery.The surgery was divided into 2 stages.Open abdomen management was applied during the first stage,and 14 days later second stage surgery for abdominal closure was carried out when the abdominal infection was under control.Abdominal pus was collected during the operation for bacterial culture.Antishock,anti-infection,organ function protection,nutritional support and symptomatic treatment were applied after the operation.Patients were followed up via phone call and out-patient examination till March 2014.Results All the patients successfully received the first and the second stage surgeries.Six patients died of septic shock and multi-organ dysfunction syndrome,and 30 patients were cured.Eight patients underwent operation for 2 times.The operation time,volume of intraoperative blood loss,time for gastrointestinal function recovery,duration of postoperative hospital stay were (157 ±26) minutes,(230 ±64)mL,(44 ± 7) hours and (16 ± 5) days,respectively.Forty-eight bacterial strains were separated,including 31 gram-negative bacterial strains and 17 gram-positive bacterial strains.According to the results of drug sensitivity test,antibiotics including imipenem and cefoperazone were selected.Thirty patients were followed up with the median time of 6 months.Six patients were complicated with adhesive intestinal obstruction and 2 with incisional hernia,and they were cured after enterodialysis and hernia repair.No complications were detected in the other 22 patients.Conclusion The efficacy of open abdomen management and debridement is satisfactory for the treatment of severe abdominal infection in patients who can bear surgery.

Objective To investigate upper esophageal sphincter (UES)abnormalities in patients with achalasia (AC),and to analyze the correlation between UES abnormalities and clinical symptoms, treatment efficacy.Methods From February 2012 to December 2014,158 patients with AC and received high resolution manometry (HRM)examination were retrospectivly analyzed.According to whether with UES abnormalities,patients were divided into UES normal group and UES abnormal group.Patients of UES abnormal group were sub-divided into UES hypotensive group (UES resting pressure<34 mmHg, 1 mmHg=0.133 kPa),hypertensive group (UES resting pressure>104 mmHg)and impaired relaxation group (residual pressure>12 mmHg).Analysis of Variance,Kruskal-Wallis H test and Chi square test were performed to compare the clinical data and dynamic characteristics of the patients in each group. Results A total of 74 (46.8%)AC patients had UES abnormalities,the majority of whom were impaired relaxation (35 cases,47.3%).The age of patients in hypotensive group ((60.6 ± 10.1 )years)was significantly older than that of hypertensive group ((43.9 ±11 .1 )years)and impaired relaxation group ((46.8±16.3)years),and the disease course (10 years,4 to 30 years)was obviously longer than that of hypertensive group (6 years,1 to 10 years)and impaired relaxation group (8 years,3 to 15 years),and the differences were statistically significant (F = 7.983,H = 13.816,both P < 0.01).There was no correlation between UES abnormalities and clinical symptoms (P >0.05 ).The results of AC subtyping indicated that type Ⅱ AC accounted 55 .7% (88/158).Type Ⅱ AC cases number of UES normal group and abnormal group was 46 and 42 cases,both was majority (54.8% and 56.8%).Among these patients,123 patients finally received peroral endoscopic myotomy (POEM),47.2%(58/123 )of whom had abnormal UES.More than 85 % patients were satisfied at one month after the operation.And Eckardt scores significantly decreased.There was no significant difference in treatment efficacy between the two groups.Conclusions Most AC patients are with UES abnormality,and impaired relaxation is more common.There is no correlation between UES abnormalities and major symptoms.There is no predictive role of UES abnormalities in treatment efficacy of POEM in AC patients.