This paper analyzes the reform and challenge of the medical literature retrieval in the new situation and shows the view from teaching target,teaching staff development,course content,course system and teaching methods

Objective To improve the accuracy of diagnosis of the greater omentum blunt trauma(GOBT)by analyzing the MSCT findings and pathological features.Methods The MSCT appearances of 5 1 cases of GOBT with operation and (or)pathological con-firmed were analyzed retrospectively.All patients were underwent MSCT plain scan in whole abdomen.Two experienced radiolo-gists blinded to the clinical diagnosis,reached a diagnosis from the MSCT findings by two ways of plain and plain joint post-process-ing MSCT images.The detection rates of GOBT were compared by two-related-samples Fisher exact probability chi-square test.Re-sults Fifty-one cases of GOBT were distributed over the intestine,in the superior abdominal cavity,the left and the right abdominal cavity,those cases were 27,18,3 and 3 respectively.The MSCT findings of GOBT mainly consist of greater omentum(GO)streak-ing,GO hematoma and fluid around GO.Those detectable rates were 80.3%,68.6%and 90.2 % respectively.The accuracy in di-agnosis of GOBT with MSCT was 94.1%(48/51)in our study.The detection rate of GOBT by two ways was significant (P=0.04).The detection rate of GOBT was increased obviously by the way of plain joint post-processing MSCT images.Conclusion MSCT manifestations of GOBT has some characteristics.A more accurate diagnosis of GOBT could be made according to the MSCT findings by plain joint post-processing MSCT images.

Pancreatic adenocarcinoma ( PAC) is still a refractory human digest malignancies due to multi-faceted causes ,late diagnosis and insensitive to traditional chemo -and radio-therapy .Resistance to apoptosis could be one of the most relevant mechanisms for PAC to escape any non -surgical therapy .This review aims to clear up the main deregulated apoptosis signal pathways over the years and to find out the abnormal molecule tar -get(s),and therefore,provide novel concepts for PAC molecular targeting therapy .

Objective To study the efficacy of transurethral holmium laser resection as well as instant intravesical Pirarubicin instillation for superficial bladder carcinoma.Methods 51 cases with superficial bladder cancer were divided into observation group(A) including 26 cases and control group(B) including 25 cases stochastically.The 26 cases of group A were received transurethral holmium laser resection as well as instant intravesical Pirarubicin instillation therapy whereas 25 cases of group B received transurethral resection therapy.All patients of both groups were treated with intravesical instillation of Pirarubicin therapy regularly at least 1 year and have been followed up for 15 to 39 months.Results Differences were not significant between the two groups in the mean operation time and bladder perforation rate(P ＞0.05 ),but indwelling period of urethral catheter was markedly decreased in group A than group B ( P ＜ 0.05 ).There were 4 cases of recurrence in group A,recurrence rate was 15.4％ (4/26).While there were 11 cases of recurrence in group B,recurrence rate was 44.0％ (11/25 ).Significant difference in cancer recurrence rate was found between two groups ( P ＜ 0.05 ).Conclusion Compared with transurethral resection therapy transurethral holmium laser resection as well as instant intravesical Pirarubicin instillation for superficial bladder carcinoma was more effective and quicker recovery,which has a good applied future in the clinical practice.

Cholangiocarcinoma (CCA) is a common cancer in hepatobiliary system .Because CCA is in sensitive to conventional chemotherapy and radiotherapy ,the current treatment is mainly depending on the surgical operation when diagnosed early .Tumor necrosis factor related apoptosis inducing ligand ( TRAIL) plays a key role in the process of controlling cell proliferation by binding with its receptor and therefore mediated cell apoptosis . Although the characteristic of selectively killing tumor cells by TRAIL makes it become the new direction of clini -cal treatment of cancer ,the condition that CCA cells are resistant to TRAIL mediated apoptosis restricts its scope of application.Nowadays many studies demonstrate that multiple signaling pathways can regulate the sensitive of CCA cells to TRAIL mediated apoptosis .In this review,we summarize the expression and effects of TRAIL and its receptor in CCA , and conclude the mechanism of multiple pathways restoring the sensitivity of CCA cells to TRAIL mediated apoptosis .

ObjectiveTo study the clinical features, arterial involvement, therapeutic strategies and outcomes of Takayasu arteritis (TA). MethodsThe clinical symptoms, arterial images, inflammatory parameters and follow-up information of 173 patients with TA were retrospectively studied. Comparisons between groups were performed by t-test. ResultsThere were 136 female and 37 male patients in this study. The mean age at onset was(26±11 ) years. Hypertension, pulse deficit or asymmetrical pulse, and fever were present in 46.6％, 41.1％, 28.7％ of patients, respectively. The distribution of arterial involvement were 64.7％in aorta, 9.8％ in pulmonary artery, 19.1％ in innominate artery, 65.9％ in common carotid arteries, 65.3％in the subclavian artery, 36.2％ in the renal artery, 12.1％ in the vertebral artery, and 5.8％ in coeliac axis.Elevated erythrocyte sedimentation rate(ESR) was found in 61.0％ patients. Active tuberculosis or history of tuberculosis was implicated in 45 patients(26.0％). Ten patients(5.8％) were hepatitis B virus carriers.Among 105 followed-up patients, 98 patients(94.2％) achieved persistent remission, 17 patients relapsed when corticosteroids were tapered. ConclusionCorticosteroids combined with or steroid alone, supplemented with endovascular intervention procedures or surgical bypass procedures when necessary, can effectively control the clinical symptoms and inflammatory parameters and improve the quality of life of patients.

Objective To investigate the correlation between dynamic contrast-enhanced CT and MRI image findings of intrahepatic mass-forming cholangiocarcinoma(IMCC) and pathologic differentiation.Methods The CT and (or) MRI features of ninety-five patients with IMCC proved by pathologic examination were retrospectively reviewed.Sixty-five patients underwent multiphasic dynamic contrast-enhanced CT scan, twenty-nine underwent multiphasic dynamic contrast-enhanced MRI scan and ten patients underwent multiphasic dynamic contrast-enhanced CT and MRI examination simultaneously.According to the case history and laboratory examination, patients were divided into groups: with chronic hepatitis and without chronic hepatitis and according to the maximum diameter of the tumor, they were divided into＜3 cm, 3 to 6 cm and＞6 cm groups.The imaging features of tumor enhancement were reviewed among groups.The pathologic results and imaging features were compared and patients were divided into well differentiated, moderately differentiated, and poorly differentiated groups.Analyzed by Chi-square test, the difference of tumor enhancement between groups were analyzed.Results The patterns of multiphasic dynamic contrast-enhanced CT and MRI in IMCC patients had five types: type 1:60 cases, peripheral rim and (or) separating enhancement during artery phase, followed by centripetal enhancement progressively and(or) separating enhancement in the equilibrium phase;type 2:11 cases, peripheral rim enhancement in the artery phase and hypointensity (hypoattenuating) during equilibrium phase with central nodular enhancement;type 3:15 cases, no enhancement in the arterial phase and internal heterogeneous enhancement during equilibrium phase;type 4: 6 cases, heterogeneous enhancement in the early phase and wash-out during equilibrium phase;type 5 : 3 cases, no enhancement throughout dynamic enhancement.The results showed that in hepatitis group type1 to 5 had 31, 7, 12, 5 and 1 cases and without hepatitis group had 29, 4, 3, 1 and 2 cases.There was no statistical significance between groups(x2=3.567,P=0.059).The maximum diameter＜3 cm group(28 cases) had 9, 8, 6, 3 and 2 case which showed enhancement type1 to 5;3 to 6 cm group(40 cases) had 27, 2, 7, 3 and 1 cases and＞6 cm group(27 cases) had 24, 1, 2, 0 and 0 cases.There was significant difference in groups(x2=19.582,P＜0.01).Pathological well differentiated and moderately differentiated groups(40 cases) had 24, 7,6, 2 and 1 cases presented enhancement type 1 to 5 and poorly differentiated group(55 cases) had 36, 4, 9, 3 and 3 cases.There was no statistical difference in three differentiated groups(x2=0.296,P=0.586).Conclusions CT and MRI enhancement patterns of IMCC are presented with diversity.The imaging features are associated with focus size and had no relationship with pathological differentiated degree.

Teaching ability is the comprehensive embodiment of expertise and personal cultivation,and it is closely related to teaching results.The teaching ability of teachers in the field of traumatology and orthopedics of TCM is developed in their practice of clinical work and teaching practice,which reflects the efficiency and quality of their classroom teaching and clinical teaching.The elements of teaching ability in the field of traumatology and orthopedics of TCM should be strengthened by approaches such as professionalism,the ability of teaching design,the expertise of modem educational technology and professional dedication.

Aged ; Aged, 80 and over ; Anthracosis ; complications ; microbiology ; Cerebral Infarction ; etiology ; Cross Infection ; complications ; Humans ; Male ; Middle Aged ; Pneumonia ; complications

Acute Disease ; Chromates ; poisoning ; Humans ; Male ; Occupational Diseases ; Young Adult