Objective To discuss the importance of the clinic skill learning center in diagnostics teaching.Methods The experiment group was taught in the clinic skill learning center with the reformed method,while the control group was taught in the traditional laboratories with the traditional one.Results The experiment group's two average scores of diagnostics and skill examine are higher than the control group's,and the difference between the two group's average scores are significant in the statistics analysis.Conclusion The applications of the clinical skill learning center in medicine teaching is the need of developing the medical education business and fostering standardized medical talents.

Objective To discuss the meaning of the method of two-step pattern case teaching in image diagnostics. Methods The experiment group was taught by the two-step pattern case teaching,while the control group by the traditional method. Results The experiment group’s image diagnostics exam average score is higher than the control group’s,and the average scores of other major clinical courses are all higher. Conclusion The applications of the two-step pattern case teaching in medicine teaching is the need of developing the medical education business and improving the medical teaching quality.

Objective To survey the knowledge requested by patients with coronary artery disease (CAD) after stent implantation.Methods A survey on CAD and stent-related knowledge requested by CAD patients with stent implantation was conducted with a self-designed questionnaire from September 2013 to November 2013.Total 362 patients (235 males and 127 females) aged (67 ± 12) years participated in the survey in Yuetan Community Health Service Center and Fuxing Hospital in Beijing.Open questions and heuristic questions were used together during the survey.Results The knowledge requested by patients were:diet management(255,70.4％),side effects of medication(241,66.6％),management of physical activity (221,61.0％),prevention of CAD(181,50.0％),withdrawal of medication(176,48.6％),the life of stents (168,46.4％),post-operation check-up items (162,44.8％),the causes of CAD (156,43.1％)and drug mechanisms(134,37.0％).Patients with stent implantation less than one year requested more knowledge about the cause of CAD (x2 =37.4,P ＜ 0.001),life-time of stent (x2 =39.9,P ＜0.001),prevention of CAD (x2 =13.4,P =0.001),post-operation check-up items (x2 =21.2,P =0.001) and requested less knowledge about withdrawal of medication (x2 =9.56,P =0.008),diet management (x2 =6.49,P =0.04) than those with more than one year.Patients aged ＜ 70 years requested more knowledge about the cause of CAD (x2 =31.6,P ＜ 0.001),prevention of CAD (x2 =9.99,P =0.007),life-time of stent (x2 =79.1,P ＜ 0.001),side effects of medication (x2 =7.84,P =0.02) than patients aged ＞ 70 years.Patients with education higher than junior high school requested more knowledge about the cause of CAD (x2 =26.6,P ＜ 0.001),prevention of CAD (x2 =14.4,P =0.001) and life-time of stents (x2 =7.82,P =0.02) than those with education lower than junior high school.Patients with education higher than junior college requested more knowledge about the cause of CAD (x2 =26.6,P ＜ 0.001) and post-operation check-up items (x2 =10.7,P =0.005) than those with education lower than junior college.Conclusion Some factors affect the knowledge requested by patients with coronary artery disease (CAD) after stent implantation,which should be considered in health education for CAD patients.

Objective To evaluate the prevention and treatment effect of butylphthalide injection in delayed encephalopathy after severe carbon monoxide poisoning(DESCMP).Methods One hundred and fiftyeight cases with severe carbon monoxide poisoning (SCMP) were randomly assigned to 2 groups.Observation group (n =83), butylphthalide treatment when SCMP was diagnosed;Control group (n =75), with no butylphthalide therapy.Incidence rate in 3 month, drug amount and the clinical effects of butylphthalide were observed.Results Observation group occurred 5 DEACMP, with the incidence rate of 6.58％, and control group occurred 14 cases,with the incidence rate of 18.67％ ,significant difference was observed in two groups(x2 =154.204,P＜0.05).There were also significant differences in the glasgow coma scale(14.00±1.89 vs.13.00 ±3.30,t =1.780, P＜ 0.05) and mini-mental state examination (26.20± 2.89 vs.19.57 ± 7.12, t =2.003, P＜0.05) between the two groups.Conclusion Early treatment with butylphthalide can decrease the incidence rate of DEACMP.

Objective To explore the intervention effect of emodin on organophosphorus poisoning induced respiratory failure.Methods 60 male Wistar rats of clean grade were randomly divided into:normal control group, model control group, positive drug group and emodin group, with 15 rats in each group.Except the normal control group rats were given intraperitoneal anesthesia, the right common carotid artery intubation, when rats stayed awake began a septic model.Blood gas analysis and serum level of oxygen free radicals and respiratory rate were compared before poisoning, respiratory failure, intervention of 5, 10, 30 min.Results Mouth breathing, slow respiratory frequency and cyanosis, appeared after exposure.Respiratory frequency decreased after exposure , compared with the positive drug group, respiratory frequency of emodin group 10 min and 30 min was higher ( P<0.05), PaO2, SaO2, BE decreased, PaCO2 increased after respiratory failure, Compared with the positive drug group, PaO2, PaCO2, SaO2 and BE of emodin group for the treatment of 10 min, 30 min was higher,(P <0.05).The level of oxygen free radicals in rats of each group had no significant difference before the exposure and the respiratory failure.Compared with the positive drug group, SOD and MDA of emodin group in 30 min after intervention were higher,( P<0.05 ) .Conclusion Emodin can improve the respiratory frequency of organic phosphorus poisoning induced respiratory failure ,improve blood gas analysis of the indicators and the level of oxygen free radicals.

Objective:To evaluate the endothelial functions and autoregulation capacity of cerebral blood flow in patients with Fabry disease .Methods:Brachial artery vasodilation was assessed in 8 pa-tients with Fabry disease and 14 healthy controls by means of flow-mediated dilation ( FMD) and Nitro-glycerin-mediated dilation ( NMD) .Cerebrovascular reactivity was calculated in terms of breath-holding index ( BHI) and vascular motor reactivity ( VMR) by TCD-CO2 test in 4 patients and 14 healthy con-trols.Results:Compared with the controls , brachial artery vasodilation experiment showed no difference (the patients:FMD 15.94%±5.03% and NMD 23.92%±7.23%, the controls: FMD 14.57%± 5 .84% and NMD 22 .64%±6 .96%) , there was no relationship between FMD or NMD and the age , course of disease , MSSI or enzyme activity .In respect of cerebrovascular autoregulation capacity , there was no difference in anterior circulation , while cerebrovascular reactivity tended to be impaired in posteri-or circulation .Conclusion:Endothelial function showed no decline in patients with Fabry disease , but cerebrovascular autoregulation capacity tended to be impaired in posterior circulation .

Objective To investigate the cerebral vascular autoregulation in patients with mitochondrial encephalomyopathy with lactic acidosis and strokc-like episodes (MELAS) during the remission of stroke-like episodes,including cerebrovascular CO2 reactivity and vascular endothelial function.Methods Twenty-nine MELAS patients confirmed by genetic analysis were recruited in this study. They underwent the examination at least 2 weeks after the onset of last stroke-like episode.Twenty-eight healthy people were collcctcd as healthy controls. Carotid ultrasound and brain magnetic resonance angiogram (MRA) were done to evaluate the cervical and intracranial appearance of large arteries. Evaluation of vascular autoregulation included: (1) the cerebrovascular CO2 reactivity with breath-holding test by transcranial Doppler and calculating breath holding index (BHI),and ( 2 ) flow-mediatcd dilation ( FMD )and nitroglycerin-mediated dilation with ultrasound assessment of humeral artery.Independent-samples t test was done between the results of two groups.Results Carotid ultrasound and cranial MRA revealed no abnormalities in both MELAS patients and healthy controls.The BHI of MELAS patients was significantly decreased than that of normal controls ( 1.36 ± 0.52 vs 1.81 ±0.26,t =- 3.693,P ＜ 0.01 ),and the FMD of MELAS patients was also significantly lower than that of normal controls (11.0％ ±4.8％ vs 15.8％ ±5.8％,t =-3.390,P ＜0.01).Conclusion The function of vascular autoregulation,including cerebrovascular CO2 reactivity and FMD,is impaired in MELAS patients.

Objective Our study was performed to design a drug-sustained capsular tension ring (CTR) to evaluate its potentiality on prevention of PCO in the swine capsular bag model in vitro.Methods Following the continuous capsule curvilinear capsulorhexis ( CCCC),Phacomulsification with capsular tension ring implantation was pedormed.CTR-supported swine capsular bag models were prepared and divided into two groups,group CTR ( n =13 ) implanted with the original CTR without any modification and group CTR-PLGA-MG132 ( n =13) implanted with the CTR covered with PLGA and MG132.The CTRsupported capsular bags were cultured in vitro for up to 3 weeks.The area of lens epithelial cells (LEC) coverage over the posterior capsule surface was quantified every day under microscope.The capsules were treated for histological examination.The change of fibronectin was assessed by ELISA assay kit.Results After 2 ～ 3 days,outgrowth of LEC across the posterior capsule was observed,and the posterior capsule was totally covered by a confluent monolayer of cell after (9.06 ± 1.61 ) days in group CTR.Capsular wrinkles became increasingly apparent as time progressed.An increase in capsular thickness was also observed.In contrast,there was less LEC deposition in group CTR-PLGA-MG132.Histological examination showed LEC layers were closely arranged on the posterior capsular surface in group CTR.In group CTR-PLGA-MG132,there was comparatively looser cell arrangement.Compared with group CTR,the mean fibronectin level of posterior capsule by week 3 in group CTR-PLGA-MG132 was 25.14 μg/ml and 106.09 μg/ml respectively.Statistical analysis showed a significant difference ( P ＜ 0.01 ).Conclusions LEC migration,proliferation,and synthesis of EMT markers were inhibited in Group CTR-PLGA-MG132,compared with Group CTR.Drug-sustained capsular tension rings can effectively inhibit the migration,proliferation of LEC and the change of EMT ( epithelial-to-mesenchymal transition) in swine capsular bag models.Drug-sustained capsular tension rings might be a potential therapy to prevent the posterior capsular opacification in the future.

Objective To report the clinical and peripheral neuropathological findings in two patients with autosomal recessive Charcot-Marie-Tooth disease 2K(AR-CMT2K).Methods Case one was a nine year-old girl.She had distal weakness of lower limbs for six years, with calf atrophy and contracture of Achilles tendon for three years.Case two was an eight year-old boy.He had distal weakness of lower limbs with contracture of Achilles tendon and calf muscle atrophy for three years, and proximal weakness of low limbs for two years.The motor nerve conduction velocities in median nerves were 48.1 m/s in case one and 47.6 m/s in case two.The compound motor action potential amplitude of median nerves decreased by 46% in case one and 69% in case two.Sural nerve biopsies and gene targeted next-generation sequencing were performed in both patients.Results Density of myelinated fibers was 8 407/mm2 in case one and 7 714/mm2 in case two.The ratio of myelinated fibers with diameter over 8 μm was 2.6% in case one and 0 in case two.Both patients had small regenerating cluster of myelinated fibers.Thin myelinated fibers appeared in case one.In case two, atypical onion bulb formations with focal folded myelin appeared, and electromicroscopy revealed mitochondrial aggregate in axons.Compound heterozygous mutations of ganglioside-induced differentiation associated protein 1 gene were detected in both patients, including c.767A>G(p.H256R) and c.466G>A (p.A156T) in case one and c.767A>G and 845G>A(p.R282H) in case two.Conclusions Contracture of Achilles tendon may appear in early childhood of AR-CMT2K patients.The main pathological changes in sural nerve are loss of large myelinated fibers, mitochondrial aggregate in axons and myelin abnormalities.

Objective To investigate the effect of α-galactosidase A (GLA) gene mutation on cell autophagy and to elucidate its mechanism preliminarily.Methods Two families were diagnosed by ultrastructural pathological examination,GLA gene activity test and GLA gene mutation screening.Mutant type recombinant expression plasmid of two pedigrees (pcDNA3.1-GFP-ex1 (EX1 group),pcDNA3.1-GFP-ex3 (EX3 group)) and wild type recombinant expression plasmid of GLA (pcDNA3.1-GFP-GLA,GLA group) were constructed.Hela cell line (control group) was transiently transfected with recombinant expression plasmid according to lipofectin transfection.The relative gene expression of Beclin-1 was measured with real-time PCR,and protein expression level of LC3-Ⅱ/LC3-Ⅰ,Beclin-1 and P62/SQSTM1 was examined by Western blotting.Results The LC3 protein values of groups EX1,EX3,GLA and control were 1.495 ± 0.064,1.490 ± 0.020,1.285 ± 0.021,1.260 ± 0.042,respectively;P62/ SQSTM1 values were 0.555 ± 0.086,0.480 ± 0.084,0.785 ± 0.439,0.980 ± 0.278,respectively;Beclin-1 mRNA 2-△Ct values were 0.011 ±0.003,0.008 ±0.002,0.005 ±0.001,0.003 ±0.001,respectively;Beclin-1 protein values were 1.178 ±0.098,1.209 ±0.092,0.931 ±0.100,0.796 ±0.184,respectively.Compared with the wide type group,the level of LC3-Ⅱ/LC3-Ⅰ protein was significantly higher in the mutant type groups(t =5.118,4.984;P =0.007,0.008),though no statistically significant difference was found in the expression levels of P62/SQSTM1 (t =1.052,1.400;P =0.323,0.199).Besides,the expression levels of Beclin-1 mRNA (t =3.800,2.445;P =0.005,0.040) and protein (t =2.424,2.729;P =0.042,0.026) were significantly higher in the mutant type groups.Conclusions GLA gene mutation can induce cell autophagic dysfunction,and signaling pathway of autophagic activation may be Beclin-1 dependent.