In clinical practice,we have adopted the methods such as intensifying the knowledge of preclinical medicine,learning to collect case history,training medical check-up,understanding the significance of auxiliary examination and encouraging the students to form the clinical thinking ability,and thus achieved satisfactory effect and obtained the positive opinion of students.

Purpose: To investigate the efficacy ofmassotherapy plus warming acupuncture for treatment of patellar malacia. Methods: Seventy-two patients with patellar malacia were randomly divided into observation and control groups, treated by massotherapy plus warming acupuncture and simple medication, respectively. Results: The effective rate was 83.3% in the observation group and 56.7% in the control group. There was a significant difference in curative effect between the two groups (P＜0.01). Conclusion: The curative effect of massotherapy plus warming acupuncture on patellar malacia is superior to that of simple medication.

Post-stroke infection mainly includes stroke-associated pneumonia and urinary tract infection.It is one of the major causes of increasing disability and mortality in patients with stroke.Its occurrence and development is associated with the basal state,stroke location,infarct volume,severity,dysphasia,aphasia and other factors of the whole body system in patients with stroke.In recent years,stroke-induced immunosuppression is receiving increasing attention.

Objective To investigate the effect of adenosine on pulmonary injury after extracorporeal circulation. Methods Twelve mongrel dogs were randomly divided into two groups, the test group and control group. The model of extracorporeal circulation was established. In the test group and control group, adenosine(50μg/kg*min) and normal saline were infused before extracorporeal circulation respectively. Hemodynamics, right cardiac function and arterial blood gas were assessed. Lung water and malondialdehyde content were assessed. Histological evaluation was also made. Results　There were no differences between the two groups with respect to heart rate, mean systemic artery pressure, left atrial pressure, and central venous pressure. In the test group, pulmonary vascular resistance was lower and right cardiac function improved remarkably; arterial oxygen pressure (PaO2) was also higher, less lung water was observed and the malondialdehyde content in the pulmonary tissue was lower (P＜0.05,P＜0.01). Histological evaluation of the test group revealed normal pulmonary architecture without abundant intra-alveolar neutrophils. Conclusion Adenosine can attenuate ischemia-reperfusion lung injury and right cardiac insufficiency caused by extracorporeal circulation. At a proper dose, there was no significant effect on systemic hemodynamics.

Objective To screen single nucleotide polymorphism(SNP)of DNA methyltransferase 1 gene in patients with systemic lupus erythematosus(SLE).and to investigate the significance of abnormal expression of DNA methyltransferase in the pathogenesis of SLE.Methods Peripheral blood mononuclear cells(PBMCs)were obtained from 11 patients with SLE and 12 normal human controls.DNA was extracted from the PBMCs.and PCR was performed to amplify some exons(1 to 7)and corresponding introns followed by direct sequencing.Results There was a 21397T/C SNP in the intron 7 between exon 7 and exon 8 of DNA methyltransferase 1 gene in patients with SLE.The frequency of CC homozygote increased in patients with SLE compared with that in normal controls(5/11 vs 1/12,X~2=4.10,P＜0.05).Conclusions There is a 21397T/C SNP in DNA methyltransferase 1 gene in patients with SLE.which may be a component of genetic background underlying the abnormal expression Of DNA methyltransferase 1.

Objective To explore the possibility of bone marrow mesenchymal stem cells (MSCs) differentiating into active melanocytes in vitro.Methods Bone marrow stromal cells were harvested from femoral marrow of 6-week-old black male C57BL/6 mice,and subjected to a primary culture.After 6-passage subculture,an induction medium containing hydrocortisone,recombinant human insulin,transferrin and fibroblast growth factor was used to induce the differentiation of MSCs into melanocytes.Inverted light microscopy was applied to observe the process of cell differentiation,transmission electron microscopy to observe melanosome formation and maturation,and immunocytochemistry to determine the expression of melanocyte-associated epitopes,and flow cytometry to analyze cell cycles and yield of differentiated melanocytes.Results The total number of MSCs was close to 109 after 6 passages of subculture,and immunofluorescent studies showed an expression rate of 94.3％ for CD44 and 82.3％ for CD105 in these MSCs.After 180-day cultivation in the induction medium,the MSCs showed a morphological similarity to melanocytes with an increase in dendrites,formation of melanosome-like structures,and cell growth cycle was shortened to 3-4 days.Brown/black cell sediments were visualized by naked eyes.Electron microscopy revealed that intracellular melanosomes were mainly in Ⅳ phase.Immunofluorescence studies of the differentiated melanocytes showed a positive staining for tyrosinase related protein-1 (TRP-1),TRP-2,and microphthalmia-associated transcription factor (MITF).Flow cytometric analysis showed that most of the melanocytes differentiated from the MSCs were in G1 and S phases,and TRP-1-positive melanocytes amounted to 80％ of gate cells.Conclusions Bone marrow MSCs can be largely differentiated into melanocytes with a close similarity to normal melanocytes in morphology,ultrastructure and specific epitopes and a certain degree of proliferative activity.

Objective:To investigate the effects of epidermal growth factor (EGF)on cell cycle and cell cycle-related regulatory factors of human esophageal squamous cell carcinoma (ESCC) cell line Eca109.Methods: Serum starved Eca109 cells were treated with 20 ng/ml recombinant human EGF(rhEGF)for 24 h.The cell cycle phase distribution was detected by flow cytometry.The mRNA and protein expression levels of p21CIP1/WAF1(p21) and p27KIP1(p27) were detected by real-time quantitative reverse transcription polymerase chain reaction(qRT-PCR)and Western blot,respectively.Results: The proportions of G1 phase cells in EGF group and control group were ( 54.90 ±0.82 )% and ( 65.94 ±0.74 )%.The mRNA and protein expression levels of p 21 in EGF group was significantly higher ,and p27 was significantly lower than that in control group ( P<0.01 ) .Conclusion: EGF facilitates G1-S phase transition,and promotes the proliferation of Eca 109 cells,which may be associated with the up-regulation of p21 and down-regulation of p27.

Objective To explore the impact of iodine nutrition on pregnant women after adjusting the iodine content in iodized salt in Hangzhou and provide a scientific basis for supplementation of iodine to pregnant women.Methods After adjusting the iodine content of salt from 2012 to 2014,proportional probability sampling method was used to select 300 families and 100 pregnant women from every county (area,city) of Hangzhou City,and the household salt and urine samples were collected to detect iodine.Results Totally 3 904,3 900 and 3 900 samples of household salts were collected with the medians of salt iodine concentration of 23.77,22.75 and 23.30 mg/kg of each year from 2012 to 2014,respectively.The qualified rate of iodized-salt was 95.87％ (3 550/3 703),97.04％ (3 510/3 617) and 96.53％ (3 564/3 692) and the consuming rate of qualified iodized salt was 90.92％ (3 550/3 904),90.01％ (3 510/3 900) and 91.38％ (3 564/3 900),respectively,from the year 2012 to 2014.Totally 1 300,1 217 and 1 315 urine samples of pregnant women were collected and the median of urinary iodine (MUI) of each year from 2012 to 2014 was 119.90,136.40 and 124.00 μg/L,respectively.Conclusion After adjusting the iodine content of salt in Hangzhou,the salt iodine consumption levels of pregnant women's family are stable,but the level of urinary iodine is low,which should be pay attention to.

Objective To compare the clinical safety and efficacy of simultaneous bilateral total knee arthroplasty (TKA) and staged bilateral TKA in treatment of both knee osteoarthritis.Methods A total of 119 patients (14 males,105 females) with both knee osteoarthritis who underwent TKA from March 2005 to March 2012 were retrospectively analyzed.Their ages ranged from 30 to 81 years with the average age of 65.23±6.33 years.The patients were divided into three groups according to different treaments:simultaneous bilateral TKA group,staged bilateral TKA group during the same hospitalization period and staged bilateral TKA group in two separate hospitalization periods.All the procedures were performed by the same surgeons and the same type of prostheses (LPS-Flex,Zimmer,US) were implanted.Differences of preoperative factors (age,height,body mass in dex and complications),treatment factors (preoperative hemoglobin,operation time,drainage volume,blood transfusion volume,total hospitalization time and total hospitalization costs) and postoperative curative effects (HSS scores,WOMAC scores and ROM)among three groups were compared.The analysis of viariace,LSD-t test and x2 test were used for data analysis.Results The differences of gender composition,body mass index,preoperative hemoglobin were not statistically significant among three groups (P＞0.05).The patientsin simultaneous bilateral TKA group were younger,and havelower incidence ofpreoperative complications (P＜0.05).The differences of post-operative HSS scores,WOMAC scores and ROM were not statistically significant among the three groups (P＞0.05).Although the total hospitalization time,operation time were shorter,and the hospitalization costs were significant ly lower in simultaneous bilateral TKA group,the total drainage volume,the total blood transfusion volume and incidence of postoperative complication rate were higher in this group than those of the other two grops (P＜0.05).Conclusion Due to great impact on patients' physiological conditions,more postoperative complication occurrence and high risk of periprosthetic infection,the decision of simultaneous bilateral TKA should be made cautiously.