‘Two-way’ training of teaching basic skill and medical education method was conducted for young and middle-aged teachers according to characteristics of clinical teachers in teaching hospitals.After two years of training,clinical teachers' teaching ability and teaching enthusiasm and the quality of classroom teaching have obviously improved based on the analysis of related data.Clinical teacher training strengthen the teaching faculty quantitatively.This thesis discussed the importance of clinical teachers' training and further explored the improvement of clinical teacher education mode.

Objective To study the relationship between analgesic effect of total alkaloids in Papaver nudicaule(TAPN) and prostaglandins(PGs) with opium receptors.Methods The analgesic effect of TAPN was studied by hot-plate, writhing,electric-evoked methods of mice.The analgesic mechanisms of TAPN and PGs with opium receptors were studied by the writhing numbers induced by different substances(Ach,AA,MgSO_4),the PGE_2 level in celiac fluid in mice after treated by AA writhing test and the antagonistic experiment of Naloxone.Results The inhibitory effect of TAPN on the writhing induced by Ach and AA in mice was stronger than that induced by MgSO_4.TAPN could also lower the PGE_2 level in celiac fluid.In the antagonistic experiment of Naloxone,no antagonism to the analgesic effect of TAPN had been found by ip or icv Naloxone.Conclusion It may be the mainly peripheral analgesic mechanism that TAPN could lower the PGE_2 level in celiac fluid.Its central analgesic mechanisms are not related to opium receptors.

Objective To evaluate the clinical efficacy of local intra-arterial thrombolysis (LIT) with urokinase in patients with acute ischemic stroke.Methods One hundred and sixty two patients with acute ischemic stroke were treated with LIT by using urokinase and relationship of reconalization for different occluded arteries with the Glasgow outcome scale (GOS) scores three months later was analyzed. Results Angiography showed occlusion of the cerebral artery in 162 patients, among which 119(73.5%) patients showed the sites in the internal carotid artery system, with 27 occlusions in the internal carotid artery (ICA)trunk, 63(38.89%) in the middle cerebral artery (MCA)and 29(17.9%) in the anterior cerebral artery (ACA), and the remaining 43(26.5%)patients of vertebrobasilar artery (VBA); successful recanalization was achieved in 103 (63.58%)patients, including 11 (40.7%), 49(77.8%), 20(69.0%) and 23(53.3%), respectively, after intraarterial infusion of urokinase. Unsuccessful recanalization occurred in 59patients (36.42%). Followed up for 90 days, 90 (55.6%) patients obtained a good outcome; 72(44.44%) had poor prognosis including 20(12.35%) deaths. 8 patients associated with hemorrhage (4.9%) 73 with reperfusion injury (45.1%) and 5 arterial re-occlusion (3.1%). Based on statistic analysis, ICA trunk and VBA had low ratio of successful recanalization with poor clinic prognosis MCA and ACA possessed high ratio of successful recanalization and good clinic outcomes. There was a significant relationship between arterial recanalization rate and clinic prognosis (r=0.86).Conclusions Successful recanalization of cerebral occlusive artery by using intra-arterial thrombolysis could improve clinic prognosis in patients with acute ischemic stroke. Clinical prognosis has a significant relationship with both initial treatment time and arterial recanalization rate.

Objective To explore application value of blood flow ratio indexes in the diagnosis of Hashimoto's thyroiditis(HT) with different thyroid functions.Methods One hundred and four patients who were diagnosed clinically as HT were enrolled in the study.The patients were classified into three groups according to thyroid functions:the hyperthyroidism group,the hypothyroidism group and the euthyroidism group.Thirty-two volunteers with normal thyroid functions were enrolled as control group.All the cases were examined with ultrasound and five blood flow ratio indexes were calculated automatically.Their differences in the four groups were compared.Results ①Among the five blood flow ratio indexes,three indexes(mean ratio,maxratio and minratio) had significant differences between each two groups(P ＜ 0.001),the other two indexes didn't have any differences among the four groups.②Two receiver operating characteristic (ROC) curves on meanratio were drew:a)HT with hyperthyroidism and HT with euthyroidism;b) HT with euthyroidism and HT with hypothyroidism.The cutoff value as a result of the ROC analysis of HT with hyperthyroidism and HT with euthyroidism was 0.235 with the maxim of specificity and sensitivity.The cutoff value of HT with euthyroidism and HT with hypothyroidism was 0.113 with the maxim of specificity and sensitivity.Both Bland-Altamn scatter diagrams and high intraclass correlation coefficient(ICC) showed that blood flow ratio indexes have high repeatability.Conclusions Blood flow ratio indexes are promising quantitative indexes in reflecting the vascularity of thyroid parenchyma,and they are helpful in the differential diagnosis of HT with different thyroid functions.

This paper introduced the concept and prevalence of frailty, as well as the concept and mechanism of exercise therapy. For the frailty, there were various modes of exercise therapy, and several exercise prescriptions were reported.

Aim To explore the influence of atorvastatin on the ultramicrostructure of the membrane surface of the rabbit endothelial cells in rabbit atherosclerosis(AS)in the nanometer level.Methods A total of 44 male New Zealand white rabbits were randomly divided into 3 groups:control group consisting of 12 rabbits,AS group consisting of 16 rabbits and atorvastatin group consisting of 32 rabbits.By the end of 2nd,6th week 6~8 rabbits of each group were sacrificed and the middle segments of thoracic aortas were obtained to be observed with atomic force microscope.Results The control group vascular endothelial cells(VECs)were fusiform in shape and aligned regularly.Their size were about 11.96 ?m?3.72 ?m and their macroaxis were in parallel with the direction of hemokinesis.VECs in the atherosclerotic group were in deformity and bigger than those of the control group.They aligned irregularly and their volumes changed to be swelled.The membrane protein of VECs in the control group was composed of many round and elliptical eminences,which were almost in the same size.and with distinct boundary lines.The membrane protein of VECs in the atherosclerosis group was composed of many irregular eminences in different size.It was vague among the eminences in which there were many holes.But the VECs of atorvastatin group were better than those of atherosclerosis group.The ultramicrostructure of the membrane surface of the atorvastatin group VECs was obviously improved.Meanwhile,the mean roughness(Ra)of membrane protein of three groups was compared.The Ra of the atherosclerosis group was significantly higher than that of the control group and the atorvastatin group(P

In view of the fact that blood vessels can reflect, to a certain degree, the pathologic changes of cardiovascular diseases, research workers count it necessary to take quick and accurate segmentation of neointimal ultrasound images. The segmentation is faster owing to the reconciled signed distance function added into the classical C-V mode, thus avoiding the step of re-initialization. Moreover, the curve evolution is controlled by external energy item. The displacement of boundary points is calculated. The result shows that the improved model can effectively and accurately extract the contour of neointimal ultrasound images. The curve can not only assess the extracted boundary but also reflect the abnormality of vascular or cardiac rhythm.
Algorithms ; Artifacts ; Humans ; Image Processing, Computer-Assisted ; methods ; Models, Biological ; Tunica Intima ; diagnostic imaging ; Ultrasonography

Objective To explore the methods of Y-V vascular pedicle lengthening technique for cover-age of the defect of great toe after wrap-around flap transfer, and decrease the morbidity of donor site in great toes. Methods Fifteen patients received three kinds of flap for immediate resurfacing of donor defect of the great toes during wrap-around flap transfer, all flaps were harvested with Y-V vascular pedicle lengthening technique. Among them, 9 cases received the free lateral tarsal flaps transplantation for coverage of defect in donor great toes, 5 cases was repaired by medial tarsal flaps, and only one was treated by the medial plantar flap. Results All the flaps survived postoperatively. The medial plantar flap encountered the venous crisis in postoperative 3 days, and regained the normal blood supply after continuous bleeding for 2 days. All patients were satisfied with cosmetic and functional outcome in average 10- month follow-up. The appearance and sensory function of donor toe repaired by medial tarsal flaps was best among three ones. Conclusion Depending on the Y-V vascular pedicle lengthening technique, the local pedical flaps of foots are enlarged scope for coverage of great toe after wrap-around flap harvest, which can decrease the complication of donor site at the most.

Objective To investigate safety and efficiency of anti-coagulation therapy in patients with high-risk of bleeding and multiple organ dysfunction syndrome (MODS) during continuous veno-venous hemofiltration (CVVH). Meth-ods Forty patients with high-risk bleeding MODS during CVVH in our hospital were divided into heparin-free group (A group) and low-dose heparin group (B group). Blood coagulation function, platelets counts, blood urea nitrogen, serum creati-nine, PaO2/FIO2 and Apache Ⅱ scores in two groups were tracked before treatment and 24 h, 48 h after treatment. Filter lifespan, median ventilation time, ICU admission time and bleeding complications were observed. Results (1)There was significant difference in levels of blood urea nitrogen, serum creatinine, PaO2/FIO2 and ApacheⅡscores at 24 h, 48 h after treatment between in low-dose heparin group and those in heparin-free group (P＜0.05). (2)Levels of activated partial thromboplastin time(APTT), thrombin time (TT) were prolonged. Platelets count were significantly lower at 24 h after treat-ment than that before treatment in low-dose heparin group. Levels of APTT, TT and platelets count had no changes with pro-longed time of CVVH therapy.(3)Average ventilation time, ICU admission time were obviously shorter in low-dose heparin group than that in heparin-free group. Filter lifespan was significant longer in low-dose heparin group than that in heparin-free group, (P＜0.05).(4)Bleeding in skin and mucosa was observed in 1 case in low-dose heparin group without other se-vere bleeding complications. Conclusion The results of monocentric study show that low dose of heparin ensure smooth op-eration of CVVH in patients with MODS and high-risk bleeding. The clinical application is safe and efficient.

Objective To investigate the expression level of immunoglobulin G (IgG)4 cells in patients previously diagnosed as unexplained liver injuries,and to analyze whether these patients could be diagnosed as immunoglobulin G4-related disease (IgG4-RD).The clinical characteristics of patients with IgG4 positive cells infiltration in liver tissues who did not met IgG4-RD diagnosis criteria were also analyzed.Methods From August 2010 to July 2016,33 patients with unexplained liver injuries even after liver biopsy were enrolled.Immunostaining of IgG and IgG4 in liver tissue slices was performed.Whether the patients met the IgG4-RD diagnosis criteria was analyzed.Also,the relation between IgG4 positive cell infiltration in liver tissues and serum parameters (alanine aminotransferase (ALT),aspartate transaminase (AST),alkaline phosphatase (ALP),γ-glutamyl transpeptadase (GGT),IgG),the classification of liver inflammation and stage of liver fibrosis were analyzed.Chi-square,Fisher exact probability method,t test and Wilcoxon rank and inspection were used for statistical analysis.Results Among 33 patients with unexplained liver injuries,average age of onset of the disease was (50.48 ± 14.52) years old.Ten patients (30.3 ％) presented with different degree of IgG4 positive cells infiltration in liver.In one patient,the IgG4 positive cell number in liver tissue was over 10/high-powered field (HPF),IgG4+ / IgG+ ratio was over 40％,the serum IgG4 increased and low density nodules in the left hepatic lobe level,which met the diagnostic criteria of IgG4-RD.Serum parameters of liver function of this patient were as follows:ALT 948 U/L,AST 658 U/L,ALP 176 U/L,GGT 197 U/L,TBil 21.5 μmol/L,DBil 10.0 μmol/L.According to whether there were IgG4 positive cells infiltration in liver tissues,33 patients were divided into IgG4 positive cells infiltration group (IgG4 positive group,10 cases) and no IgG4 positive cells infiltration group (IgG4 negative group,23 cases).The medium levels of ALT,AST,ALP and GGT in the IgG4 positive group and the IgG4 negative group were 26.0 U/L vs 31.0 U/L,28.5 U/L vs 32.0 U/L,114.0 U/L vs 77.0 U/L,65.0 U/L vs 36.0 U/L,respectively and there were no statistically significant differences (Z=-0.098,-0.216,-0.862,-0.705;all P＞0.05).The serum IgG level of the IgG4 positive group was higher than that of the IgG4 negative group (17.15 g/L vs 13.65 g/L),and the difference was statistically significant (Z=-1.776,P =0.035).Conclusions IgG4-RD may be the reason of liver injury.There are no significant differences in clinical charateristics,serum parameters and inflammation degree in liver tissue between patients with or without IgG4 positive cells infiltration.