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.

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.

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 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 diagnostic approaches of cervical glandular intraepithelial neoplasia (CGIN) for improving the diagnostic levels of CGIN.Methods Clinical data of 106 cases with CGIN admitted in hospital from Jan.2008 to Dec.2010 were analyzed retrospectively.All data from preoperative thin-prep cytologic test (TCT),cervical biopsies and postoperative pathological examination of the excised cervical tissues were reviewed.Results Among 106 patients,62 cases (58.5％,62/106) were low grade CGIN (L-CGIN),44 cases (41.5％,44/106) were high grade CGIN (H-CGIN) ; 25 cases (23.6％,25/106) were pure CGIN and 81 cases (76.4％,81/106) were CGIN mixed with cervical intraepithelial neoplasia (CIN).Fifteen cases (14.2％,15/106) were found atypical glandular cell (AGC)by TCT..In the 15 cases,there were 4 cases (6.5％,4/62) L-CGIN,and 11 cases (25.0％,11/44)H-CGIN,there was significant difference between the two groups (P ＜ 0.05) ; among 15 cases with AGC,11 cases of them (44.0％,11/25) were pure CGIN,4 cases (4.9％,4/81) mixed with CIN,in which there were significant difference (P ＜0.01).Seven cases (25.0％,7/28) were detected glandular lesions in 28 cases by endocervical curettage (ECC).Totally 23 cases (22.8％,23/101) were detected CGIN by colposcopy-directed biopsy,11 cases (19.0％,11/58) were with L-CGIN,12 cases (27.9％,12/43)H-CGIN,there was no significant difference between them (P ＞ 0.05).Among the 23 cases,13 eases(52.0％,13/25) were pure CGIN,10 cases (12.3％,10/81) CGIN mixed with CIN,which showed significant difference (P ＜ 0.01).All 106 patients were treated,101 cases treated with cervical conization and 5 cases performed hysterectomy; 23 cases were diagnosed CGIN preoperation,the ratio of preoperative diagnosis was 21.7％ (23/106),83 cases (80.3％,83/106) diagnosed postoperatively.Conclusions Routine diagnostic methods of CGIN were not satisfaction,most CGIN were diagnosed after cervical resection.Cervical conization may play a very important role in diagnosis of CGIN.The positivity of TCT in H-CGIN was higher than L-CGIN.There was no different in diagnosing different CGIN grades by colposcopy-directed biopsy.The ratio of preoperative diagnosis of pure CGIN was higher than those with CGIN mixed with CIN.

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.

Objective To investigate the prevalence of thyroid disease in early pregnancy women of Hangzhou,and further to discuss the necessity of screening thyroid function in early pregnant women.Methods From March to October 2013,1 165 cases of women in the center of community health service (or health) for routine prenatal care during early pregnancy were used as research subjects.Household salt,fasting morning urine and serum samples were collected.The salt iodine level was measured by direct titration of sodium thiosulfate.The urinary iodine level was measured by arsenic-cerium contact process method.The levels of serum TSH,FT4,and thyroid peroxidase antibody (TPOAb) were measured by chemiluminescence method.Results The median of urinary iodine of the early pregnancy women was 135.2 μg/L,and only 26.7％ of early pregnancy women' s iodine-nutrition status were optimal.These were no significant difference in median urinary iodine as well as the frequency distribution between urban and suburban(P＞0.05).The abnormal rates of TSH and FT4 in early pregnancy women with negative TPOAb were 6.8％ (71/1 039) and 8.9％ (92/1 039),and the abnormal rates of TSH and FT4 in suburban areas were higher than those in urban areas(P=0.035,P =0.001).The prevalences of hypothyroidism,subclinical hypothyroidism,and hypothyroxinemia in early pregnant women of Hangzhou were 0.3％ (3/1 165),2.0％ (23/1 165),and 4.8％ (56/1 165) respectively,and the prevalence of hypothyroxinemia in suburban areas was significantly higher than that in urban areas (6.1％ vs 3.5％,P =0.040).The positive rate of TPOAb was 9.9％ (114/1 153).The early pregnant women with positive TPOAb have an increased risk of thyroid dysfunction,the ratio of TSH over the reference values was significantly higher than that in the negative group and more prone to subclinical hypothyroidism (OR =3.34,95％ CI 1.29-8.65).Conclusion The early pregnant women in rural areas or with positive TPOAb have an increased risk of abnormal thyroid function,thyroid function and iodine nutrition screening or monitoring should be highlighted.