A series of reforms on the teaching of analytical chemistry experiment has been carried out in accordance with the characteristics of medicine examination and the actuality,which includes the content of course,the teaching method,and the inspection method.Good results have been achieved in the aspect of development of students' comprehensive quality and practical ability.

Objective To study the employment of noninvasive ventilation with nasopharyngeai airway in coma patients with cerebral stroke.Methods One hundred and fifty-five stroke patients treated with noninvasive ventilation admitted from May 2011 to May 2013 were studied.There were 88 male and 67 female,aged 30-95 years with mean age 73 years,The patients suffered from stroke with APACHE Ⅱ score 5-13 and Glasgow coma score 7-13.There were 78 cases in the nasopharyngeal airway group,and 77 cases in oropharyngeal airway group as control.SBP,DBP,HR,SpO2 and PCO2 were observed in the two groups at the time of beginning of noninvasive ventilation with neither airway (T0),and after placement of either airway and noninvasive ventilation for 10 min (T10),20min (T20),and 30 min (T30),respectively.The differences in rate of endotracheal intubation and the incidence of pulmonary infection were compared between the two groups.Results PaO2,SBP,PCO2 were improved after 30 minutes of noninvasive ventilation in the oropharyngeal airway group,and SBP DBP,HR decreased which were associated with improved respiration,less stress response,and then good blood circulation system.The better improvement of respiration was observed in nasopharyngeal airway group after 30 minutes of noninvasive ventilation.More improvements in PaO2,PCO2,SBP,DBP,HR were observed 30 minutes after noninvasive ventilation with nasopharyngeal airway compared with control group (P ＜ 0.05).The endotracheal intubation was used in 31 cases (40.3％) in the oropharyngeal airway group,and among them,19 cases (24.7％) suffered pulmonary infection.But there were 15 cases (19.2％) with endotracheal intubation in the nasopharyngeal airway group and 11 cases (14.1％) with pulmonary infection.The length of ICU stay,incidence of endotracheal intubation,and rate of pulmonary infection were lower in nasopharyngeal airway group (P ＜ 0.05).Conclusions The nasopharyngeal airway used in noninvasive ventilation can effectively ameliorate ventilation dysfunction in stroke patients,correct hypoxia and lessen accumulation of carbon dioxide,also reduce the pulmonary infection and the rate of endotracheal intubation.Nasopharyngeal airway used in noninvasive ventilation is a effective modality to solve upper airway obstruction and offer effective ventilation in stroke patients.

Objective To investigate the long-term programming effects on pubertal reproductive function by immunological challenge in early life. Methods Female Sprague-Dawley rats were administered by endotoxin (lipopolysaccharide, LPS) at a dosage of 50 μg/kg and saline intraperitoneally on postnatal day 3 and 5. Body weight was measured weekly. Puberty onset ( vaginal opening) and oestrous cyclicity were monitored from postnatal day 30. At the age of 6 weeks, bilateral ovariectomy was performed. The histological and morphological change of the ovaries (the thickness of the theca interna and the number of different kinds of follicles) were observed and the immunoreactivity of the ovarian sympathetic nerve markers (low affinity receptor of nerve growth factor, p75NGFR) was evaluated by immune staining. Results Immunological challenge (exposed to LPS) in early life delayed vaginal opening significantly [LPS-treated (40.6 ±0.7) days versus controls ( 38. 6 ± 0. 5 ) days, P ＜ 0. 05], decreased the percentage of normal oestrous cyclicity ( LPS-treated 26. 1% versus controls 66. 8% , P＜ 0. 05 ) , decreased the total number of different types of follicles (primordial follicles: LPS-treated 610 ±47 versus controls 1181 ±57, P ＜ 0. 05; primary follicles: LPS-treated 624 ±41 versus controls 960 ± 30, P ＜ 0. 05 ; preantral follicles: LPS-treated 183 ± 16 versus controls 260 ± 14, P ＜ 0. 05; antral follicles: LPS-treated 32 ± 4 versus controls 79 ± 7, P ＜ 0. 05) and increased the thickness of the theca interna [LPS-treated ( 15. 8 ±0. 4) μm versus controls (11.4 ±0. 3) μm, P ＜ 0. 05]. The immunostaining of p75NGFR was obviously enhanced in the LPS-treated ovaries when compared with that of controls ( P ＜ 0. 05 ) . Conclusions Immunological stress during early critical developmental windows could have long dysfunctional effects on the pubertal reproductive function. It delayed puberty onset, reduced the percentage of the normal oestrous cycles, decreased follicles reserve and increased the thickness of the theca interna which might involve the up-regulation of the local ovarian sympathetic nerve activity.

Objective To evaluate the effects of treatment with different fluids on systemic inflammatory response in newborn rabbits with septic shock. Methods One hundred New Zealand white rabbits (3-5 days, 45-70 kg) were randomly divided into 5 groups (n = 20 each):group Ⅰ sham operation (group S); group Ⅱ sepsis (group CLP); group Ⅲ lactated Ringer's solution (group R); group Ⅳ 6% HES (group HES) and group V (group R+ HES). The animals were anesthetized with intraperitoneal ketamine and midazolam. Sepsis was induced by cecal ligation and puncture (CLP). The animals in group R and HES received lactated Ringer's solution and 6% hydroxyethyl starch (HES) 30 ml/kg infused iv over 1 h respectively immediately after CLP,while group R+ HES received Ringer's solution 20 ml/kg and 6% HES 10 ml/kg. Nio fluid was infused in groups S and CLP. Carotid artery and jugular vein were cannulated for MAP monitoring, blood sampling and drug and fluid administration. MAP was recorded immediately (T1) and at 0.5, 1, 2, 4, 8 h (T2-6) after CLP. Arterial blood samples were collected at T6 for determination of plasma IL-6 and IL-10 concentrations. Results Compared with those at T1, MAP decreased significantly after CLP at T4-6 in group CLP and at T5.6 in group R but hypotension did not develop after CLP in group HES and R + HES. Plasma IL-6 concentration was significantly higher in group CLP and R than in group S. There was no significant difference in plasma IL-6 concentration between group S and group HES and R + HES. Plasma IL-10 concentration was significantly lower in group CLP and higher in group HES than in group S. There was no significant difference in plasma IL-10 concentration between group S and group R and R + HES. Plasma IL-6 concentration was significantly lower, while plasma IL-10 concentration was significantly higher in group R + HES and HES,and plasma IL-10 concentration was significantly higher in group R or6% HES infused iv alone in maintaining the balance between pro-and anti-inflammatory cytolines in newborn rabbits with septic shock.

Objective To investigate the effect of hawthorn leaf flavonoids (HLFs) with the different concentrations in prevention of high blood lipids and fatty liver in quails. Methods Sixty quails were divided into six groups:normal (N),high lipids food model (M),positive control (ZBT),HLF1,HLF2 and HLF3 groups.The animals in the N group were fed with normal food,while the M group was feed with high lipids food to establish the animal model of fatty liver.Besides high-fat diet,HLF1,HLF2 and HLF3 groups were also fed with 1 mL HLFs in the doses of 20 mg/kg,40 mg/kg and 80 mg/kg respectively.The ZBT group was fed with 1 g/kg of ZhiBiTuo and used as the positive control.After the experiments of six months,the serum and liver of the quails were taken and used to evaluate the contents of total cholesterol (TC),triglyceride (TG),high density lipid cholesterol(HDL-C),low density lipid cholesterol (LDL-C),superoxide dismutase (SOD),malondialdehyde (MDA),glutathione (GSH),alanine amino transferase (ALT) and glutamic oxaloacetic transaminase (AST).Meanwhile,the microscopic and electronic microscopic sections were used to observe the pathological changes of the livers of the quails. Results Compared with the M group,HLFs significantly lowered the content of TC,TG,LDL-C,MDA,AST and ALT in the serum and livers of the quails in other groups (P<0.001).However,the levels of HDL-C,SOD and GSH of the other groups were increased markedly (P<0.001).Moreover,the ratios of increase/decrease in the three HLF groups were depended on the concentrations of HLFs.Also,better liver structure and less lipid accumulation were also observed in the HLF groups when compared to the M group. Conclusions These results showed HLFs can lower blood lipid and cholesterol accumulation,improve the antioxidant capacity and protect the physiological function of liver.So,HLFs were effective in preventing and treating high blood lipids and fatty liver induced by high-fat diet.

Objective To investigate the correlation of postoperative platelet counts with liver function recovery after partial hepatectomy in patients with hepatocellular carcinoma.Methods 212 patients with hepatocellular carcinoma were enrolled in this study.The relation between postoperative platelet counts and serum levels of ALT,AST,TB and PT after operation was analyzed.Results There were 78 patients with a low (＜ 100 × 109/L) immediate postoperative platelet count in this series of 212 patients who underwent partial liver resection for hepatocellular carcinoma,and 134 patients with a normal platelet count (≥ 100 × 109/L).Based on the criteria,27 patients were categorized as having delayed postoperative liver function recovery.There was no perioperative mortality in this study.Postoperative peak levels of ALT,AST and TB were significantly higher in patients with low postoperative platelet counts than those with normal platelet counts (P ＜ 0.05).Statistical analysis showed that low postoperative platelet counts after partial liver resection for hepatocellular carcinoma correlated with increased risk of delayed postoperative recovery (x2 =9.112,P =0.003).Conclusions Low postoperative platelet counts were associated with delayed liver function recovery after partial hepatectomy in patients with hepatocellular carcinoma.

Objective To investigate the effects of rhubarb combined with glutamine on repair of gut mucosal barrier injury after gastrointestinal surgery in rats. Methods Fifty male healthy Sprague-Dawley(SD)rats were randomly divided into five groups:control(C group),enteral nutrition(EN group),rhubarb with EN(R-EN group), glutamine with EN(G-EN group)and rhubarb combined with glutamine and EN(R-G-EN group)groups(each n=10). The rats of C group received no treatment and were fed normally. Cecectomy and gastrostomy were performed in EN,R-EN,G-EN and R-G-EN groups,and in 24 hours after surgery,they were interfered with the use of amoxicillin 50 mg/d and metronidazole 20 mg twice a day. From the first day after operation,each group was treated with the same prescription of enteral isocaloric and isonitrogenous nutrition for consecutive 7 days. Seven days later, under anaesthesia,laparotomy was performed,and a specimen of 1 cm intestinal segment was taken from the terminal 5 cm long ileum for all the groups;under the light microscope,the morphological examination of intestinal mucosal epithelial tight junctions(including villus height and mucosal thickness)was carried out. For each group,enzyme-linked immunosorbent assay(ELISA)was used to measure the levels of plasma citruline and D-lactate,and the serum concentration of TNF-αwas detected by utilizing double antibody ABC-ELISA. Results The levels of D-lactate and TNF-αin EN,R-EN,G-EN and R-G-EN groups were obviously higher than those in C group(all P<0.01). The level of plasma citruline(μmol/L:16.13±0.58 vs. 14.52±0.28)of R-G-EN group was remarkably higher than that in R-EN group(P<0.05),and its levels of serum D-lactate(mmol/L:3.12±0.56 vs. 3.62±0.52)and TNF-α(ng/L:2.82±0.62 vs. 3.54±0.49)were markedly lower than those of G-EN group(both P<0.05). The mucosal villus height(μm:126.50±6.31 vs. 175.67±11.91),mucosal thickness(μm:223.67±11.94 vs. 277.00±14.06)and the level of plasma citruline(μmol/L:13.25±0.36 vs. 15.67±0.55)in EN group were obviously lower than those of C group(all P<0.01);the above indexes of R-EN,G-EN and R-G-EN groups were higher than those of EN group (P<0.05 or P<0.01),but in the comparisons of the villus height and mucosal thickness among the three groups there were no statistical significant differences(all P>0.05). Conclusion The application of rhubarb combined with glutamine can protect gut mucosa,reduce the level of inflammatory reaction and elevate the level of plasma citruline, that is beneficial to the repair of gut mucosal barrier injury and its functional recovery after gastrointestinal surgery in rats.

Objective To evaluate the efficacy of lidocaine solid lipid nanoparticles (L-SLNs) for sciatic nerve blockade in rats.Methods Lidocaine-loaded SLNs were prepared using high pressure homogenization.Ninety SPF male Wistar rats,weighing 220-280 g,were randomized into 6 groups (n =15 each) using a random number table:control group (group C),1％ L-SLN group (group L1-SLN),1％ lidocaine group (group L1),2％ L-SLN group (group L2-SLN),2％ lidocaine group (group L2),and blank SLN group (group SLN).In C,L1-SLN,L1,L2-SLN,L2 and SLN groups,normal saline,1％ lidocaine SLN,1％ lidocaine,2％ lidocaine SLN,2％ lidocaine and blank SLN (200 μl) were injected,respectively,around the sciatic nerve.Before sciatic nerve blockade (baseline) and at 10,20,30,60,120,180,240,300,360,420,480,540 and 600 min after blockade,the paw withdraw latency to a thermal stimulus was measured,and maximum possible effect (MPE) was calculated to reflect the degree of sensory block.Before sciatic nerve blockade and at 10,20,30,60,120 and 150 min after blockade,extensor postural thrust (EPT) of the hind limbs was detected to reflect the degree of motor block.The sciatic nerve at the injection site and the tissues around the site were obtained for observation of the pathological changes at 2 days and 1 and 4 weeks after blockade.Results Compared with the baseline value before blockade and group C,the MPE was significantly increased in at 10-30 min after blockade group L1,at 10-60 min after blockade in group L2,at 10-360 min after blockade in group L1-SLN,and at 10-540 min after blockade in group L2-SLN,and the EPT was decreased at 10-30 min after blockade in group L1,at 10-60 min after blockade in group L2 and group L1-SLN,and at 10-90 min after blockade in group L2-SLN.Compared with group L1,the MPE was significantly decreased at 10 min after blockade,no significant change was found at 20-30 min after blockade,and the MPE was increased at 60-360 min after blockade,and the EPT was increased at 10-30 min after blockade,and no significant change was found at the other time points in group L1-SLN.Compared with group L2,no significant change was found in the MPE at 10-30 min after blockade,the MPE was significantly increased at 60-540 minafter blockade,and the EPT was increased at 10-60 min after blockade,and no significant change was found at the other time points in L2-SLN group.In SLN,L1-SLN and L2-SLN groups,no pathological changes were found in the sciatic nerve at the injection site and the tissues around the site,and only mild inflammatory responses were observed.Conclusion L-SLNs can prolong the duration of block when applied for sciatic nerve blockade in rats and biocompatibility is good.

Professor Shi Qi is a famous traditional Chinese medicine doctor specializing in orthopaedics and traumatology, who has formatted a set of systematic protocols for the diagnosis and treatment of chronic musculoskeletal conditions. When it is time for using tonics in winter, he advocates applying herbal paste for treating chronic musculoskeletal diseases. This paper introduces Professor Shi Qi's commonly used prescription for treating chronic musculoskeletal conditions and puts forward demands and understandings in concocting herbal paste, experience in herbal paste for treating chronic musculoskeletal diseases such as cervical spondylosis, lumbar disc herniation, lumbar spinal stenosis, lumbar muscle strain, ankylosing spondylitis, osteoporosis, knee osteoarthritis and avascular necrosis of femoral head, and the advantages of herbal paste for treating chronic musculoskeletal conditions as opposed to alternative treatments.

Objective To improve the early diagnosis and differential diagnosis of adrenal incidentalomas to guide clinical management of this disease. Methods One hundred and twenty-eight cases were diagnosed as adrenal incidentalomas due to health examination or treatment of other than adrenal disease,including 60 males and 68 females,whose ages were between 20 and 75 years,with a mean age of 50 years.Tumor diamer:＜3 cm 63 cases,3-6 cm 6 cases,＞6 cm 10 cases.128 patients all had biochemical and electrolyte examination,adrenal cortex and medulla biochemical testing,abdominal ultrasound and CT examination,6 cases with MRI examination.Surgery and post operative pathological examination were performed in all patients. Results Post operative pathology finally diagnosed adrenocortical adenoma in 85 cases,pheochromocytoma in 13 cases,adrenal cyst in 8 cases,paraganglioma and myeiolipoma in 7 eases respectively,adrenal nodular hyperplasia in 4 cases,adrenocortical carcinoma in 2 cases,adrenoconical oncocytoma,cellular Schwannoma and adrenal liposarcoma in 1 case,respectively.One case of pheochromocytoma patients died of intraoperative hypotension,which is not included in the total number. Conclusions The preperative diagnosis of adrenal incidentalomas is difficult.For adrenal incidentalomas with diameter more than 6 cm and those with endocrine function,early surgicM treatment is recommended.