Based on the characteristics of BOPPPS mode,this article discussed its application.Following the teaching mode of BOPPPS,teachers can adjust teaching objectives and plans according to the students' needs.With the modularization of the teaching mode of BOPPPS,the students' interests can be stimulated so as to explore things initiatively,which was conducive to training students' ability of ethical decision-making and professional spirit.Finally,the teaching mode of BOPPPS assessed the learning effect with post-tests so as to enhance the effectiveness of medical ethics teaching.

Short stature refers to the individual of the same race,gender and age,whose height is lower than the average height for about 2 standard deviations or under the 3rd percentile in the similar living environment.Its etiology mainly includes growth hormone deficiency,hypothyroidism,idiopathic short stature,Turner syndrome and so on.Short stature can be treated in childhood with recombinant human growth hormone (rhGH).Clinical evidence suggests that doctors should pay attention to thyroid hormone levels before and after rhGH therapy,so that they can offer thyroxine timely and maintain normal thyroid function for the children with hypothyroidism,which can improve the efficacy of rhGH in children with short stature.

Objective To explore the association between the tumor necrosis factor receptor-associated factor 1(TRAF1)/com-plement component 5(C5)single nucleotide polymorphism and rheumatoid arthritis patients.Methods Two groups of people were included in the study:300 rheumatoid arthritis(RA)patients(RA group)and 300 healthy individuals(control group).Real-time PCR was used to test the single nucleotide polymorphisms rs3761847 and rs10818488 of TRAF1/C5.Results There was no signifi-cant difference (P >0.05)of TRAF1/C5 rs3761847 and rs10818488 polymorphism between the two groups.The linkage disequilib-rium analysis results showed that there was strong linkage disequilibrium between rs3761847 and rs10818488.For the RF,anti-CCP and anti-Sa negative RA patients,the difference in the frequency of A allele of rs3761847 between the RA patients and matched con-trols was statistically significant(P =0.001,OR =0.57,95%CI :0.41 -0.79;P =0.001,OR =0.51,95%CI :0.35 -0.76;P =0.02,OR=0.72,95%CI :0.55-0.94).Significant difference for the frequency of G allele of rs10818488 between RF positive RA patients and control groups was observed(P =0.01,OR=1.40,95%CI :1.09-1.81).Conclusion TRAF1/C5 gene polymorphism may not associate with susceptibility of RA patients in Han population in Guizhou.

Objective: To observe the therapeutic effect of scalp-acupuncture on post-apoplectic depression.Methods: Twenty-nine patients with depression due to cerebral apoplexy were treated by scalp-acupuncture and compared with 28 cases of medicine group chosen randomly. Results: In scalp-acupuncture group, the total effective rate was 89. 6%. In medicine group (control group), the total effective rate was 71.4%. Conclusion:The result showed that the therapeutic effect in scalp-acupuncture group was obviously better than that in medicine group (P＜0.05).

Syndrome attribute determined by signs and symptoms of an animal model through intervening in the clini-cal and animal syndrome differentiation standards is not standardized, objective or rigorous. The signs and symptoms of people are difficult to be expressed fully and accurately in the animal body correspondingly. The signs and symptoms of animals are mostly without any syndrome information. There are no difference of signs and symptoms among differ-ent modeling methods. Hence, it is difficult to determine the syndrome-attribution of an animal model based on signs and symptoms. There are two problems in drug reduction to determine syndrome-attribution of animal models. Firstly, for drug reduction, only one group is used in the animal subject. There are no other two groups or multi-groups of drugs compared with each other to confirm the syndrome-attribution of animal models. Lots of research results indicat-ed that multiple drugs with different functions can change the state and the objective index of the same animal subject. Secondly, employing the control principle, adjusting and improving the best drug for the animal subject were used to determine the syndrome-attribute. However, these studies cannot be operated, because the preliminary studies, such as the essence of syndrome, have not provided generally recognized effect indexes and index groups.

Studies showed that animal model of the so-called simple syndrome currently have corresponding modern medical disease without exception. Even such animal model is called simple syndrome model, its properties is a cer-tain modern medicine disease. There is no specific corresponding relationship between the syndrome-attribution and the syndrome. The signs and symptoms differentiation and abnormal physical and chemical detection indices after pathogen-modeling of traditional Chinese medicine (TCM) cannot be determined since there are no specific corre-sponding relationships. The study on disease-syndrome combination model contains both modern medical modeling method and TCM modeling method. This type of modeling method has its own existing shortcomings. Meanwhile, two modeling methods used in the model establishment have uncertain relationship. The disease-syndrome combination model is usually not established in the comparison among different syndromes of one disease. Therefore, it has no ex-clusive attribute. There are many problems existed in the TCM modeling method, disease-syndrome combination modeling method, and syndrome-attribute evaluation methods. The basic reasons are the wide difference between symptoms and signs for diagnosis in modern medicine disease. There are a few symptoms and signs for diagnosis in modern medicine. But there are much more symptoms and signs for syndrome differentiation of the same disease. Many symptoms for syndrome differentiation are unknown for its source of origin existed in a virtual state. It caused that many virtual syndromes abstracted by virtual symptoms, and was reflected by the relevant standards. It leads to devastating consequences for the development of animal modeling method.

ObjectiveTo study the influences of fetal umbilical cord around neck on foetus、newborn infants and the choices of delivery mode during delivery.Methods220 cases of cephalic delivery pregnant women with fetus who had fetal umbilical cord around neck symptom and 220 cases of cephalic delivery pregnant women with fetus who didn't have fetal umbilical cord around neck symptom,were selected to make a contrast observation.ResultsThe foetus who had fetal umbilical cord around neck symptom had higher rate of fetal distress and neonatal asphyxia.The maternal cesarean section would be much higher,too.The rate is 18.5％,8.6％,49.6％ which were higher than the foetus who didn't have such kind of symptom,the rate is 5.4％,1.8 ％,26.4％ ( all P ＜ 0.05 ).The rate of fetal distress and neonatal asphyxia was proportional to the number of circles around neck.One circle around neck is 12.6％,1.4％ ;two circles around neck is 27.1％,17.0％ ;three and more than 3 circles around neck is 69.2％,53.8％.ConclusionWe should enhance perinatal B-mode ultrasonic examination and fetal monitoring circle around neck,pay close attention to the factor of umbilical cord around neck and select suitable delivery mode so that we can reduce the incidence of fetal distress and neonatal asphyxia.When B-mode ultrasonics displays that the number of the umbilical cord around the fetus' neck is three and more than 3 circles,the incidence of neonatal asphyxia is high and the cesarean section is the best choice under such circumstances.

Two hundred and forty patients with primary hypertension in Weifang Community were randomly sampled as contract group and another 240 hypertensive patients were sampled as control group.Patients in contract group signed service contract with general practitioners (GPs),who provided individualized service for hypertension management.Patients in control group receive conventional outpatient service for hypertension management.The clinical data of patients before and one year after contracted services were documented and compared with those in control group.The results showed that in contract group the average systolic pressure decreased from 134.60 mm Hg (1 mm Hg =0.133 kPa) to 130.62 mm Hg (P =0.000),reaching-the-target-BP rate increased from 56.3％ to 85.5％ (P =0.000),serum total cholesterol and triglyceride decreased significantly one year after receiving contracted services (P =0.000) ; while these indicators were not significantly changed in control group (all P ＞ 0.05).The results indicate that the contracted services of GPs can improve the effectiveness of hypertension management in community.

Objective:To evaluate the analgesic effect of botulinum toxin type A (BTX-A) in osteoarthritis model and the changes of Nav1.8 protein expression in spinal ganglia changes.Method:Animal model of knee osteoarthritis (KOA) was established by intra-articular injection of 4％ papain solution 0.3ml into SD rat right knee.After the formation of arthritis,they were randomly divided into two groups at the 2nd day:BTX-A group (n=10):intra-articular injection of 5μl BTX-A 0.1IU;WFI group (n=10):intra-articular injection of 5μl water.No papain or BXT-A was given to the sham group (n=10).At the 1st,3rd,5th day after injection,we tested the pain behavior,thermal pain threshold,and sodium channel 1.8 (Nav1.8) protein expression in spinal ganglion by using immunohistochemistry.Result:Analysis of spontaneous pain behavior showed abnormal gait caused by rat osteoarthritis.Comparing with the WFI group,abnormal gait caused by osteoarthritis improved significantly in BTX-A group.At day 5 it improved more significantly than day 1 and day 3.Thermal pain threshold of BTX-A group increased more than that of WFI group (P＜0.05) at any time point.Abnormal high Nav1.8 protein in model rats decreased in spinal ganglia for BTX-A group.Conclusion:The intra-articular injection of BTX-A may play the analgesic effect in the model of KOA by down-regulating of the expression of Nav1.8 protein in spinal ganglia and reduction in the central sensitization to pain stimulation.

Glucocorticoids are among those most important hormones that maintain the energy metabolic homeostasis within body.The actions of glucocorticoids on target tissues,such as liver and adipose tissue,are not only dependent on circulating glucocorticoid levels but also on glucocorticoid receptor expression.The elevated level of circulating glucocorticoid caused by exogenous or endogenous reasons may contribute to insulin resistance and the other metabolic syndrome such as dyslipidemia,visceral obesity and hypertension.This review summarizes recent advances in the study of glucocorticoid receptor-mediated insulin resistance and its antagonists.