Objective To observe the effect of Tianteng Jiangya decoction on vascular endothelial function in essential hypertension.Methods 70 patients with essential hypertension were enrolled in this study,they were divided into study group(35 cases)and control group(35 cases)according to the random number table.The control group was treated with levamlodipine for 8 weeks,the study group was treated with Tianteng Jiangya decoction on the basis of the control group for 8 weeks.Then,the DBP and SBP were observed before and after treatment.The ET-1 and nitric oxide(NO)were measured by radioimmunoassay and spectrophotometry.The curative effect and symptom of both two groups were evaluated.Results The levels of DBP and SBP in the study group and the control group were(80±4)mmHg and(88±5)mmHg,(118±13)mmHg and(131±15)mmHg,respectively,which were significantly lower than those before treatment(t=7.263,4.488,9.227,4.422,all P<0.05).The levels of DBP and SBP in the study group were significantly lower than those in the control group(t=4.776,5.527,all P<0.05).The NO level in the study group was(80.37±7.27)μmol/L,,which was significantly lower than that before treatment(t=4.167,P<0.05).The ET-1 level in the study group was(94.26±9.08)ng/L,which was significantly lower than that before treatment(t=3.819,P<0.05).There was no significant change in endothelium function between before and after treatment in the control group(t=1.686 and 1.612,all P>0.05).The total effective rates of dizziness,headache,five upset hot,forgetfulness in the study group and the control group were 89.47% and 64.71%,90.00% and 63.16%,88.89% and 50.00%,82.35% and 47.37%,respectively,the differences were statistically significant(x2=6.422,6.585,6.247,6.456,all P<0.05).The total effective rate of the study group was 94.29%,which was significantly higher than 71.43% of the control group,the difference was statistically significant(x2=9.622,P<0.01).Conclusion Tianteng Jiangya decoction can effectively control the blood pressure of patients with essential hypertension,improve the efficacy of traditional Chinese medicine and vascular endothelial function,has obvious advantages,it is worthy of clinical use.

Objective To reseach the time point of the highest percentage of neural precursor cells derived from adipose stromal cells (ADSCs) in vitro, and to observe the ultrastructure features of neural precursor cells. Methods Used the β-mercaptoethanol to induce ADSCs to differentiate into neural precursor cells and neuron-like cells. The morphology of the uninductedcells and inducted cells were observed with inverted phase contrast microscope. The expression of nestin which was the marker of neural precursor cell in each group was detected using immunofluorescence staining method. The ultrastructural feature of cells which was induced for 3 hours were observed. Results The highest ratio of positive expression of nestin was 3 hours following induction,with the ratio ( 86.25 ± 4.82) %. There were many protuberance on the cell membrane under transmission electron microscopy.There were plenty of organelles in the neural precursor cells. The neural precursor cells had a large size nucleus,large nucleoplasmic index, much extended chromatin,and less condensed chromatin. The nucleus had double-layer nuclear envelope, more nuclear pore on the nuclear envelope. Conclusion The time point of the highest percentage of neural precursor cells derived from ADSCs is 3 hours,and the ultrastructral feature of induced neural precursor cells confirm that cells at this time point are in a state of split active period.

Objective To investigate the effect of the abnormally accumulated iron ions in the perihematoma tissue lesions and the impact of deferoxamine intervention. Methods A total of 135 SD rats were randomly assigned to sham-operation (n = 15), intracerebral hemorrhage (n =60) and deferoxamine (n =60) groups. A rat model of intracerebral hemorrhage was induced by the infusion of autologous blood. The neurological deficit score, brain water content (dry/wet weight method), blood-brain barrier permeability (Evans blue extravasation method), DNA fragmentation (TUNEL staining), and the impact of deferoxamine intervention were observed at different time points in all groups.Results One to seven days after intracerebral hemorrhage, the neurological deficit score, perihematomal water content, the blood-brain barrier permeability, and the numbers of TUNEL positive cells in the intracerebral hemorrhage group were significantly higher than those in the sham-operation group (P ＜0.01, P ＜0.05, P ＜0.01, and P ＜0.05). All the observation indexes in the deferoxamine and intracerebral hemorrhage groups showed the same trend, however, the neurological score, perihematomal water content, the blood brain barrier permeability, and the numbers of TUNEL positive cells were significantly lower than those in the intracerebral hemorrhage group (P ＜ 0.05, P ＜ 0.05, P ＜ 0.05, and P ＜ 0.05). Conclusions The abnormal accumulation of iron ions involves in the pathological injury of perihematoma tissue after intracerebral hemorrhage, and deferoxamine may reduce this injury.

Objective To induce adult adult adipose-derived stem cells(ADSCs) in vitro to differentiate into neuronal-like cells,and to analyze the features of their cell morphology and ultrastructure. Methods Adipose stromal cells were obtained and amplified in vitro. Then make use of chemical induction to induce them. Observed ADSC and differentiation of cells in morphology and ultrastructure under inverted microscope and transmission electron microscopy. Immunocytochemistry to detection of Nestin, Neuron Specific Endolase( NSE) ,and glial fibrillary acidic protein(GFAP) expression in cells. Used Real-time PCR to detection of Nestin,GFAP gene mRNA expression before and after induction in ADSC. To observe the morphology and ultrastructure of the cells prior to and after induction under microscope and electron microscope. Results The morphology of ADSC was similar to fibroblasts ,and could be amplified stability within 10 passages in vitro. Some of the cells induced display a typical astrocyte-like cells in ultrastructure. Followed neuronal induction,astrocyte-like cells began to stain brightly for CFAP, Nestin. GFAP stained in both the cytoplasm and nuclei of astrocyte-like cells, but Nestin only stained in the cytoplasm. The peak positive expression rate within 14d following neuronal induction. The rate of positive expression cells was( 14.4 ± 3. 6) % for Nestin, (87. 3 ± 5. 3 ) % for GFAP. Then two kinds of protein expression remained the similar rate. The average relative concentration of GFAP and Nestin gene mRNA have significant statistical difference between ADSC and differented cells analyzed by Real-time PCR (P<0.05).The peak concentration of GFAP was within 20 d after induction,and GFAP was within 14 d after induction. Conclusion In the cytoplasm of adult adipose-derived cells possess Nestin genetic material,which is the marker of neural stem cell. The differential astrocyte-like cells have the typical morphology, ultrastructure and GFAP phenotype of mature astrocytes.

Objective To evaluate the effect of radiochemotherapy for unresectable extra-hepatic bile duct cancinoma. Methods Form June 1993 to August 2003, 28 unresectable extra-hepatic bile duct carcinoma treated by radiochemotherapy were analyzed. There were 13 gallbladder carcinoma and 15 bile duct carcinoma. The radiotherapy regimen consisted of conventional radiation therapy group(15 patients,with a median dose of 45Gy, range 30-60Gy) and three-dimensional conformal radiation therapy group(13 patients, with a median dose of 55Gy , range 50-70Gy). Among these patients, 12 patients were treated by radiotherapy alone( RT), 16 patients treated by radiochemotherapy(CRT), with a chemotherapy regimen consisting of 5-Fu 500mg twice weekly or 5-Fu 500mg + DDP 30mg once weekly for 3-6 cycles. Results The CR+PR, SD and PD rate was 14%, 64%, and 21%, respectively. The overall 1-,2-year survival rate was 38% and 15%, with a median survival time of 9.4 months. The 1-year survival of gallbladder cancer and extra-hepatic bile duct cancer was 46% and 27%;of 3DCRT and conventional radiotherapy was 42% and 33%;of those radiation dose less than 50Gy and more than 50Gy was 29% and 45%;of RT alone and radiochemotherapy was 37% and 31%, respectively. There was significance difference in overall survival between those RT dose less than 50Gy and more than 50Gy,(P=0.023). Grade 1-2 and Grade 3 acute gastrointestinal toxicity was 57% and 18%, respectively. Only 25% patients suffered grade 1-2 hematology toxicity. Conclusion Radiochemotherapy shows moderate effect for unresectable extra-hepatic bile duct cancer with acceptable side effects.

AIM:To investigate the influence and mechanisms of human pancreatic cancer tumor microenvironments on T-cell immunoglobulin mucin-3 (TIM-3) expression and function of dendritic cells (DCs).METHODS:Tumor-infiltrating dendritic cells (TIDC) and para-carcinoma tissue DCs were isolated by Ficoll-Hypaque density centrifugation from trypsinized pancreatic carcinoma tissues, and the peripheral blood mononuclear cells were isolated from pancre-atic cancer patients or healthy people.The expression of TIM-3 on DCs was detected by flow cytometry.DCs isolated from healthy people peripheral blood mononuclear cells were induced by rhGM-CSF and IL-4.The expression of TIM-3 in the DCs treated with the culture supernatants of Capan-2, SW1990 and Panc-1 pancreatic cancer cells or human skin fibroblast (Hs27) cells for 48 h, and in the DCs treated with supernatants of Capan-2 cells, anti-VEGF-R2, anti-IL-10 and EP2 re-ceptor blocking peptide were evaluated by flow cytometry.The releases of IFN-βand IL-12 in the culture supernatants of DCs pretreated with monoclonal antibody ( mAb) to TIM-3 or DNase+RNase, followed by stimulation with apoptotic Ca-pan-2 cells, were detected by ELISA.RESULTS:DCs in tumor microenvironments had higher expression of TIM-3 than the DCs from para-carcinoma tissues and pancreatic cancer patient or healthy people peripheral blood ( P<0.01 ) .TIM-3 expression in the DCs treated with the culture supernatants of Capan-2, SW1990 and Panc-1 pancreatic cancer cells for 48 h was much higher than that in Hs27 cells (P<0.05).Treatment with a combination of anti-VEGF-R2, anti-IL-10 and EP2 receptor blocking peptide largely diminished the upregulation of TIM-3 on the DCs mediated by Capan-2 cell superna-tants (P<0.05).The concentrations of IFN-βand IL-12 in the DCs with high expression level of TIM-3 were lower than those in the DCs with low TIM-3 expression level.Treatment with mAb to TIM-3 resulted in much more IFN-βand IL-12 releases (P<0.01), but DNase+RNase made this effect disappear.CONCLUSION:TIM-3 serves as a negative regula-tor of DCs innate immune responses in the pancreatic cancer microenvironments.The secretion of soluble factors to tumor microenvironment by pancreatic cancer cells, including IL-10, VEGF and PGE2 , may contribute to the regulation of TIM-3 expression.

Objective To strengthen the ability of clinical thinking and the ability to solve practical clinical problems for medical students.Methods Medical undergraduates studying in affiliated hospitals of Tongji university from 2005 to 2010 were enrolled The clinical thinking training and assessment in clinical teaching were enhanced by introducing problem-based learning,case-based learning and by strengthening the role of interns in clinical work and emphasizing clinical thinking ability assessment during various kinds of clinical skills examinations.Meanwhile,the teaching management and supervision were improved.The awareness and ability of clinical teachers to train students′ clinical thinking were aroused and cultivated through teaching staff training so as to ensure that clinical thinking training and assessment were involved in the whole process of clinical teaching.Results The students' abilities of self-study,scientific thinking and oral expression were improved.The passing rates of our graduates in national general medical practitioner test were increasing yearly from 2006 to 2008.Conclusion Strengthening clinical thinking ability training during clinical teaching plays an active role in improving clinical skills in medical students.

BACKGROUND:Pulmonary infection is the main complication after kidney transplantation, and its onset and morbidity may be related to conventional oral drugs after kidney transplantation.
OBJECTIVE:To analyze the effect of methylprednisolone instead of prednisone on severe pulmonary infection after kidney transplantation.
METHODS:Clinical data of 58 patients with severe pulmonary infection after kidney transplantation were retrospectively analyzed. First, according to the characteristics of post-onset patients and lung CT findings, broad-spectrum antibiotics and anti-fungal treatment were adopted, and subsequently targeted therapy, that is, withdrawal or adjustment of dosage and combination regimen of immunosuppressive agents, was employed depending on etiology, fungi and virus detection results. Among the 58 patients, 28 patients were injected methylprednisolone, and 30 patients took oral prednisone. Hyoxemia correction, support therapy and immune replacement therapy were applied.
RESULTS AND CONCLUSION:Thirty-nine of 58 patients (67.2%) were positive for pathogens, including 7 cases of simple bacterial pneumonia, 4 cases of fungal pneumonia, 3 cases of simple cytomegalovirus infection, and 25 cases of mixed infections (5 cases of multiple bacterial infections, 17 cases of fungal and bacterial co-infections, and 3 cases of fungi, bacteria and cytomegalovirus co-infections). Patients subjected to methylprednisolone treatment spent shorter time to recover their temperature than those undergoing oral prednisone (P<0.05). In addition, creatinine fluctuation range in the methylprednisolone group was less than that in the prednisone group (P<0.05). The results showed that intravenous injection of methylprednisolone may accelerate absorption of inflammatory exudate in the lung and shorten treatment time.

BACKGROUND:Exogenous basic fibroblast growth factor (bFGF) plays an important role in the ligament tissue healing process, and the use of transgenic methods to transfect exogenous genes into cells can promote the secretion of bFGF. OBJECTIVE:To observe phenotypic changes and the bFGF protein expression after bFGF recombinant adenovirus was used to transfect rabbit bone marrow mesenchymal stem cells (BMSCs). METHODS:Passage 2 BMSCs were divided into three groups:Ad.bFGF-eGFP group, Ad.eGFP group and control group. Under a phase contrast microscope we observed the changes in cellmorphology. The expression of bFGF protein in BMSCs was determined by enzyme-linked immunosorbent assay (ELISA). The proliferative curve was detected by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT). RESULTS AND CONCLUSION:The transfected cells showed a uniform phenotype of fibroblasts. MTT colorimetric assay revealed that more proliferative activity of transfected BMSCs was shown in the Ad.bFGF-eGFP group than in the Ad.eGFP group and control group. ELISA results showed that expression of bFGF protein was higher in the Ad.bFGF-eGFP group than in the Ad.eGFP group and control group (P<0.05). BFGF recombinant adenovirus can induce the differentiation of BMSCs into fibroblasts, increase proliferative ability and promote the expression of bFGF protein.

AIM:To investigate the relationship between the expression of adducin 3 (ADD3) and its splicing isoforms and colorectal cancer (CRC).METHODS:The expression of ADD3, ADD3-Ia and ADD3-Ib in 50 pair of CRC tissues , 20 pairs of colorectal polyp tissues , and 2 CRC cell lines SW480 and SW620 before and after oxaliplatin or fluoroura-cil intervention were detected by real-time PCR.The cell activity was determined by MTT assay , the cell migration ability was evaluated by wound-healing assay , and the cell invasion ability was measured by Transwell assay .RESULTS:The expres-sion levels of ADD3 and ADD3-Ib were decreased in the CRC tissues as compared with the normal mucous (P<0.01), and ADD3-Ia/Ib ratio was increased in the CRC tissues (P<0.01).The expression level of ADD3-Ia was higher in T3-4 group than that in T1-2 group (P<0.05).Reduced expression of ADD3, ADD3-Ia and ADD3-Ib in colorectal polyps was observed compared with the normal tissues (P<0.01).Compared with the SW480 cells, the expression levels of ADD3-Ia and ADD3-Ib were lower (P<0.05) and the ADD3-Ia/Ib ratio was higher (P <0.01) in the SW620 cells.After treated with oxalipla-tin or fluorouracil, the cell activity, migration and invasion in the SW620 and SW480 cells were weakened accompanied by the increases in the expression levels of ADD 3, ADD3-Ia and ADD3-Ib to various certain extents .CONCLUSION:In CRC there is a tendency that ADD3-Ib reduction leads to ADD3 decrease, accompanied by an increased ADD3-Ia/Ib ratio.The expression changes of ADD 3 and its splicing isoforms in the CRC may be relevant to its invasion ability .