It is essentially indispensable to use multimedia methods in teaching "Clinical Medicine Outline". Such usage can diversify the teaching approaches and play a very important role in improving teaching methods and deepening students’ comprehension of course knowledge. Some problems existing in application of multimedia in the teaching process need to be settled.

ObjectiveTo investigate the risk factors in ischemic stroke following total hip replacement. MethodsThe clinical data of 18 patients who suffered ischemic stroke following total hip replacement were compared with other 142 patients without ischemic stroke following total hip replacement who were randomly selected as control. ResultsThe incidence rate of ischemic stroke following total hip replacement in our hospital was 1.8%. Age,hypertension, history of stroke,falling of systolic pressure and diastolic pressure during opereration were significantly different between patients and controls(P<0.05).There was no significantly different in sex,previous cardiac diseases, diabetes, hyperlipemia,and the bleeding in operation between patients and controls(P>0.05).ConclusionAge,hypertension, history of cerebrovascular disease,falling of systolic pressure and diastolic pressure during opereration are the important risk factors of ischemic stroke following total hip replacement.

Objective To determine the methylation status and expression of Ras association domain family 1A (RASSF1A), and the possible effect between promoter aberrant methylation and pathogenesis of pancreatic cancer. Methods The methylation status of RASSF1A promoter CpG island (CGI) pancreatic cancer cell line BxPC3 was detected in 5 cases of normal pancreatic tissue and 13 pairs of pancreatic cancer tissues (tumor and peri-tumor) by using COBRA (combined bisulfite restriction analysis) and the methylation rate was calculated. The RASSF1A mRNA expression of BxPC3 was compared between pre- and post-treatment of the inhibitor of DNA methyltransferase (5-Aza-2-deoxycitydine, 5-Aza-dC). Results The average methylation rate of RASSF1A promoter CGI was 62.90% in BXPC3, 9.14% in normal pancreas, 53.79% in peri-tumors (TP), and 55.82% in tumors. The methylation rates in port-tumors and tumors were significantly increased when compared with that of normal pancreas (P < 0.01), while there was no significant difference between in peri-tumors and tumors (P > 0.05). After 5-Aza-dC treatting BxPC3 cells, the methylation rates decreased to 42.5% (P < 0. 05) and RASSF1A mRNA expression was enhanced. Conclusions Aberrant hypermethylation of RASSF1A promoter CGI could be considered as an early event in the process of pancreatic cancer and participates in the pathogenesis of pancreatic cancer.

Objective: To discuss the procedure and clinical effect of retroperitoneal laparoscopic nephropexy (RLN).Methods: From August 2001 to June 2006, RLN was performed on 28 female patients aged 26-45 years old (mean, 34±2.5) with symptomatic nephroptosis, including 15 with the right kidney, 12 with the left, and 1 with both. The preoperative complaint of patients included subjective symptoms (constant and recurring pain in 28 patients) and objective symptoms (upper urinary infections in 16, hematuria in 12, and upper tract obstruction in 12). One patient underwent nephropexy via the transperitoneal approach and the others underwent nephropexy via the retroperitoneal approach. A retroperitoneoscopic procedure was performed after positioning the patients in the flank position. Digital preparation of the retroperitoneal space was made and standardized trocar was placed. The key step of the surgery was complete exposure of the kidney within Gerota' fascia, which was aimed to separate the potential adhesions between the colon and kidney or between the inferior blood vessels of the kidney. Nephropexy was performed between the fibrous capsule at the lower pole of the kidney and the dissected psoas muscle, using three sutures placed by intracorporeal technique or the percutaneous needle both for introduction and removal of the suture; the sutures were separately tied over the sacrospinalis fascia. Results: The mean operative time was (125±9) min (ranging 115-240 min); the mean postoperative hospital stay was (9±1.2) days, largely owing to the required 5-12 days' bed rest. During a mean follow-up of (24±4.2) months(ranging 3 to 70 months), 3 patients had paresthesia, 5 had constant and recurrent ache, 20 were completely free of pain, and 4 had micro-hematuria. One patient had further episodes of pyelonephritis and upper tract obstruction after operation. Intravenous pyelogram(IVP) revealed that the ptosis incorporated into more than one vertebral body in 2 patients. Postoperative renal function test showed an improvement in renal function. Conclusion: RLN is mini-invasive and has less complication. The procedure should be considered as one of the optimal therapy for nephroptosis.

Objective To investigate the expression and methylation status of HOXA7 gene in human pancreatic cancer cell lines, and to explore the relationship between them.Methods HOXA7 mRNA expression of human pancreatic cancer cell lines BxPC3, CFPAC1, PANC1 and SW1990was detected by RT PCR.Bisulfite sequencing PCR (BSP) and combined bisulfite restriction analysis (COBRA) was used to test promoter methylation status.All the cell lines were treated by 5-aza-2-deoxycytidine (5-aza-dC), and HOXA7mRNA expression, methylation status was detected before and after this treatment.Results HOXA7 mRNA was expressed in BxPC3, CFPAC1 and SW1990, while there was no expression of HOXA7 mRNA in PANC1.HOXA7 promoter methylation rates of CFPAC1, BxPC3, PANC1 and SW1990 were 93.16%, 90.65%,90.09% ,52.30%.HOXA7 promoter methylation rate of SW1990 was significantly lower than those in other 3cell lines ( P ＜0.01 ).After 5-aza-dC treatment, HOXA7 mRNA of PANC1 was expressed again, and HOXA7mRNA of BxPC3 was increasingly expressed;while the expression of HOXA7 mRNA in CFPAC1 and SW1990was not significantly changed after 5-aza-dC treatment.Conclusions The expression of HOXA7 mRNA in BxPC3 and PANC1 was closely correlated with promoter hypermethylation, while there was no obvious relation in CFPAC 1 and SW1990.

Objective To evaluate the effectiveness of several methods in eliminating Mycoplasma contamination in cell culture of human hepatoma-derived cell line C3A. Methods PCR was performed to detect the Mycoplasmas contamination in cell cultures. The contaminated samples were treated by ciprofloxa-cin, heating, Plasmocure or co-culturing with macrophages. Transmission electron microscope ( TEM) and Q-PCR were used to comparatively analyze the cell morphology and gene expression before and after Plas-mocure treatment. Results Plasmocure succeeded in eliminating Mycoplasma contamination, while cipro-floxacin showed temporary efficacy. Heating and co-culturing with macrophages failed to eliminate Mycoplas-ma contamination. No Mycoplasma contamination in the Plasmocure-treated group was observed under TEM and the expression of ALB, TF and CYP3A4 genes were higher than the genes expressed in the contaminated group (P<0. 01). Conclusion Plasmocure treatment was effective in eliminating Mycoplasma contamina-tion in cell culture. Moreover, the cell morphology and gene expression in Plasmocure-treated group were re-stored to normal.

Objective To investigate the relationship between family function and unhealthy mood in patients with vascular dementia (VD).Methods 120 VD patients were investigated by the Family APGAR index (APGAR),Hamilton Depression Scale (HAMD),Hamilton Anxiety Scale (HAMA),and Mini-Mental State Examination (MMSE).Results 98 cases (81.7％) were in depression with anxiety.Family dysfunction was presented in 83.3％ of 120 VD patients.The mild and moderate cognitive impairment were present in 55.8％ and 44.2％.The score of MMSE,the total score and factors scores of APGA were negatively related to the score of HAMD and HAMA.The score of MMSE was positively related to the total score and factors scores of APGA.The family dysfunction,self-reported financial burden and cognitive disorder were the risk factors of unhealthy mood (OR＞1).Conclusions The results suggest that improvement of VD patients' family function,reducing the economic burden and enhancing cognitive function can possibly relieve the unhealthy mood of patients.

Objective To explore the changes of QRS combined data and myocardial enzymes during ischemia-reperfusion in rabbits,and observe the changes of ST segment and T wave of lead Ⅱ,and arrhythmias.Methods The models of ischemia-reperfusion(A,B,C and D group)were made by ligating the left circumflex territory for 10,20,30,40 min and then reperfusion for 60 min.The sham-operated control was designed.The changes of the QRS combined data,ST segment and T wave and rises of arrhythmias about electrocardiogram of lead Ⅱ were observed.Meanwhile,the activity of serum myocardial enzymes was measured.Results The QRS combined data of the group D was higher significantly than the sham-operated control,group A and group B(P<0.05).T waves of different groups were not significantly different(P>0.05).The J spot elevation of lead Ⅲ in 19 rabbits of the ligating group and 5 rabbits of the sham-operated control was observed before operation.The changes of ST segment were clearly observed in the ligating group after operation:apparent mono-phasic curve elevation in 21 rabbits,level type depression in 2 and no change in 1.ST segment of other animals was declined more than 0.2 mV in 60 min reperfusion,except ST segment of 2 rabbits elevated again more than 0.1 mV,2 rabbits were normal and 1 rabbit was depressed.Two rabbits of the group D respectively died of sinus bradycardia in reperfusion 40 min and 43 min,and two rabbits appeared premature ventricalar contraction during reperfusion 3-5 min.The activity of serum aspartate aminotransferase(AST)and lactate dehydrogenase(LDH)obviously increased in the group D(P<0.05).Creatine kinase(CK)was high significantly except the sham-operated control(P<0.05).The activity of serum CK-MB of the groups C and group D was significantly higher than that of the sham-operated control(P<0.05).Conclusion The rising of LDH,CK-MB and QRS combined date in the group D is related with ischemia-reperfusion injury.

Fecal microbiota transplantation (FMT) technology originated in China during the Eastern Jin Dynasty and has rapidly developed over the past two decades, becoming a primary method for studying the causal relationship between gut microbiota and the occurrence and progression of diseases. At the same time, the therapeutic effects of FMT in the field of gastrointestinal diseases have gained widespread recognition and are gradually expanding into other disease areas. The FMT procedure is relatively complex, and there is currently no standardized method; its success is influenced by various factors, including the donor, recipient, processing of the fecal material, and the method of implantation. Given the increasingly recognized relationship between gut microbiota and various diseases, FMT has become a research hotspot in both scientific studies and clinical applications, achieving a series of significant advancements. To help researchers better understand this technology, this paper will outline the development history of FMT, summarize common operational methods in research and clinical settings, review its application progress, and look forward to future development directions.

Objective To evaluate the clinical efficacy and safety of laparoscopic nephron sparing surgery in the treatment of T1 renal cell carcinoma. Methods Thirty-two patients (24 males and 8 females) were diagnosed with T1 N0 M0 renal cell carcinoma by ultrasound, CT or MRI and un derwent laparoscopic nephron sparing surgery. The mean age was (49±2)years old (from 31 to 72 years old). The mean tumor diameter was (2.8±0.8)cm. There were 21 tumors in left kidney, 11 in right kidney. Of them, 10 tumors were in upper pole, 13 in lower pole, 5 in kidney center, 4 close to renal hilum, 18 in dorsal side and 14 in ventral side of the kidney. Tumor masses were resected with the surgical margin of 0. 5 cm. Twenty-five cases were done through retroperitoneal approach and 7 cases was done through transperitoneal approach. The pathological results showed that there were clear cell renal carcinoma in 28 cases, granule cell renal carcinoma in 3 cases and oncocytoma in 1 case. Renal function was examined by ECT before and after the surgery. Results Thirty-one cases under went laparoscopic nephron sparing surgery successfully and only one case converted to open surgery due to excessive intra-operative bleeding. The mean renal pedicle blocking time was (24±4)min (from 19 to 52 min). There were 3 cases having blocking time longer than 30 min (38 min, 45 min and 52 min) and accepted secondary blockage during the procedure. The mean operative time was (105 ± 15) rain. The mean estimated blood loss was (120±22)ml. Only 6 cases accepted 400 ml blood transfusion. D-J stents were placed in 5 eases with the tumor in kidney center before operation. In 3 cases with intra-operative exposure of renal calyx, D-J stems were placed after operation. Urine leakage in 2 eases were noted at 2 and 3 days and recovered at 15 and 21 days after operation. The mean hospital stay was (9±2)days. There was no recurrence in a mean follow-up time of (23±5)months. There were 3 cases with local hematoma (1 case of 4 cm × 3 cm, 2 cases of 2 cm×3 cm) in the surgical site confirmed by ultrasound or CT scan 1 month after surgery and they disappeared 3 months after the operation. Serum creatinine and urea nitrogen were all in normal range after operation. Compared with renal blood flow of the operated kidney before operation, there were 9 cases decreased by 10 %- 15 and 3 cases decreased by 20% at 15 days, 7 cases decreased by 10%-15% at 1 month and 3 cases decreased by 10%- 15% at (23 ± 5) months after operation. Conclusion Laparoscopic nephron sparing surgery is one of feasible and safe options for the treatment of T1 renal cell carcinoma.