In surgery, clinical probation is important to integrate medical science theory with practice. This paper proposed the meaning and features of cased-based cognitive apprenticeship, and explored the application of the strategy in general surgery for clinical probation, with an attempt to provide beneficial reference to improve teaching quality in surgery for clinical probation.

Objective To analyze MRI features of different cervical flexion positions in Hirayama disease (HD) and discuss the effects on these features by different cervical flexion angles.Methods The cervical MR images of neutral and different flexion positions (20°, 25°, 30°, 35° ,40°) of 20 patients, who were clinically diagnosed as HD,were studied.At flexion positions, the appearance of anterior shifting of the posterior wall of the cervical dural canal and widening of epidural space was recorded.The maximum sagittal diameters (d) of widened cervical epidural space and the cervical canal sagittal diameters (D) on the same level were measured to calculate d/D value for quantitative evaluation of the two signs.Comparisons of appearance of the signs among different flexion positions were made using F/sher's exact test.Repeated measures analysis of variance (rmANOVA) was used to compare mean d/D values among groups with different positions, and paired comparisons were also performed.Results The appearance of anterior shifting of the posterior wall of the cervical dural canal were different between 20° group (70%, 14/20) and other 4 larger angles groups (100%) (χ2 =5.76, P=0.020).The d/D values were 0.51±0.06,0.54±0.08,0.57±0.09,0.61±0.09,0.59±0.07 respectively at abovementioned 5 flexion positions, which were different among groups( F = 3.450 ,P = 0.013 ).The value was greater at 35° than that at 20° and 25°( P <0.05 ), and it was also greater at 40° than that at 20° ( P < 0.05 ).Conclusion Cervical flexion angle has an effect on anterior shifting of the posterior wall of the cervical dural canal and widening of epidural space.

Objective To investigate the regulation of swimming motility by H-NS in Vibrio parahaemolyticus(VP). Methods VP was inoculated into the semi-solid swimming agar plate containing 1% Oxoid tryptone, 2% NaCl, 0.5%Difco Noble Agar, and 0.1% arabinose followed by incubation at 37℃ for 4.5 h before the diameters of bacterial lawns were measured.Total RNAs were extracted from the wild-type (WT) strains and the hns null mutant (Δhns), and the quantitative real-time( RT)-PCR( qRT-PCR) was carried out to calculate the transcriptional variation of flaA between WT andΔhns strains.The entire promoter DNA region of flaA was amplified and cloned into the lacZ fusion vector pHRP309 containing a promoterless lacZ gene. The recombinant lacZ reporter plasmid was transformed into WT and Δhns, respectively, to measure the β-galactosidase activities in cellular extracts using the β-galactosidase enzyme assay system. Results and Conclusion The phenotype results showed that swimming motility of VP was enhanced by H-NS.The qRT-PCR and LacZ fusion results indicated that the transcription of flaA was positively regulated by H-NS.Collectively, H-NS promotes the swimming motility of VP, at least partly, by activating the transcription of flaA.

Objective To explore the dose-dependent and time-dependent effect of docetaxel on the expression of mammalian eukaryotic initiation factor 3 subunit A (eIF3a) in lung cancer cell line. Methods The human lung cancer cell line A549 was treated with gradient concentrations of docetaxel for different time. Real-time PCR and Western blot were used to detect mRNA and protein expression levels of eIF3a and α-tubulin, respectively. Results Docetaxel did not affect α-tubulin expression at either mRNA level or protein level. When A549 cells were treated with high concentration of docetaxel (30 μg/L), the expression level of eIF3a mRNA tended to increase in a time-dependent manner. Protein expression level of α-tubulin was not associated with eIF3a expression significantly in cells treated by docetaxel.Conclusion Docetaxel could slightly increase the expression of eIF3a mRNA, and eIF3a does not regulate the expression of α-tubulin in A549 cells treated by docetaxel.

Objective: To evaluate the feasibility and effect of transcatheter closure of ventricular septal defects(VSD) using the VSD occluder.Methods: From December 2003 to March 2005,13 VSD patients,8 males and 5 females,ranging in age from 4 to 35(15.2?10.7)years,underwent catheter closure using the VSD occluder.Tthe mean diameter of the VSD obtained by transthoracic echocardiography was 4-12(5.4?1.2) mm.Transcatheter closure was performed under transthoracic echocardiographic guidance after left ventriculography.All patients were followed up 1,3 and 6 months after the procedures. Results: The devices were successfully placed in 12 of the patients and complete closure achieved in 11.Trace residual shunt was observed in 1 patient but disappeared within 10 minutes.No severe complications were noted except 1 case of complete right bundle branch block revealed by electrocardiography. Conclusion: Transcatheter closure of VSD by the VSD occluder is a safe and effective procedure,with good immediate results.Further clinical trials are under way to assess its long-term effect.

OBJECTIVETo correlate sperm nucleoprotein transition (SNT) with sperm morphology, DNA damage and embryo development, and assess its value for assisted reproductive technology (ART).

METHODSThe SNT of 437 infertile men underwent ART were assayed, and its correlation with sperm morphology, DNA damage, fertilization rate, normal fertilization rate, cleavage rate, available embryo rate, D3 high quality embryo rate, blastocyst formation rate and high quality blastocyst rate were analyzed.

RESULTSThe normal morphology rate of sperms, DNA damage, fertilization rate, normal fertilization rate, cleavage rate, embryo transfer rate (ETR), D3 high quality embryo rate, blastocyst formation rate (BFR) and high quality blastocyst in normal males (Group A, abnormal rate≤30%, 135 subjects) did not significantly differ from those with an abnormal rate between 30% and 60% (Group B, 170 subjects) (P>0.05). For those with an abnormal rate of above 60% (Group C, 132 subjects), the sperm normal morphology rate, DNA damage, normal fertilization rate, ETR, D3 high quality embryo rate, high quality blastocyst rate were significantly lower compared with Group A (P<0.01), while no significant difference was found in fertilization rate, cleavage rate and BFR between groups A and C (P>0.05).

CONCLUSIONSNT is related with sperm morphology rate, DNA damage and embryo development, and should be assessed before ART.

Adult ; Blastocyst ; metabolism ; DNA Damage ; Embryo Transfer ; Embryonic Development ; Female ; Fertilization in Vitro ; Humans ; Infertility, Male ; genetics ; metabolism ; Male ; Nucleoproteins ; genetics ; metabolism ; Spermatozoa ; metabolism

Objective:To investigate the expressions of leptin receptor (OBR) and phosphorylated protein kinase B (p-AKT) in patients with diffuse large B-cell lymphoma (DLBCL) and its significance.Methods:Immunohistochemistry was applied to detect the expressions of OBR and p-AKT in tissues from 90 patients with DLBCL and 20 patients with reactive lymphoid hyperplasia (RLH) between 2010 and 2015 in Shandong Provincial Hospital Affiliated to Shandong First Medical University. Cell proliferation assay was used to detect the effect of leptin on the proliferation of SUDHL4 and SUDHL5 in DLBCL cell lines, and the expression of p-AKT in SUDHL4 and SUDHL5 after the cultured leptin was detected by using Western blot.Results:The high expression rate of OBR and p-AKT of DLBCL was 47.7% (43/90) and 27.7% (25/90), respectively, and low expression was found in 20 cases of RLH. There were statistically differences in the expressions of OBR and p-AKT in DLBCL and RLH ( P < 0.01, P = 0.027). The expressions of OBR and p-AKT were not correlated with age, gender, extranodal infiltrations, clinical staging, lactic dehydrogenase (LDH) level, B-symptom and international prognostic index (IPI) score (all P > 0.05). The expression of OBR was positively related with that of p-AKT in DLBCL patients ( r = 0.532, P < 0.05). Leptin could increase the proliferation of SUDHL4 and SUDHL5 cells and promote the expression of p-AKT. Conclusion:Leptin and OBR can promote the proliferation of DLBCL cells and may be involved in the occurrence and development of DLBCL by activating PI3K-AKT pathway.

Objective:To evaluate the protective efficacy and safety of Brucella 104M against aerosol challenge in BALB/c mice and characterize its immunological effects. Methods:Female mice of 6-8 weeks old were immunized with Brucella abortus strain 104M by intratracheal aerosol delivery or intranasal instillation or subcutaneous injection route. Six mice of each group were sacrificed at 4, 8, 16, 24 weeks after immunization. At each time point, the clinical manifestations of mice were investigated, the serum, spleen and lung samples of mice were collected, body weight, spleen weight, bacteria loads in spleens, the anti- Brucella antibodies titers in serum and the cytokines concentrations of IFN-γ, IL-18 in serum or lung homogenate of the mice were detected. Twenty two weeks after immunization, all the mice were challenged with Brucella A19 through intratracheal aerosol delivery. Results:Compared with the control group, neither abnormal clinical symptoms nor significant changes in body weight were found in 104M immunization groups, at each time point when immunized through either nose dropping route, subcutaneous injection or aerosol routes; and the spleen weight of immunization groups were lower than control group after challenge ( P<0.05): *M1 (0.26±0.16)g

The Effect of arsenic trioxide (As(2)O(3)) on myelomonocytic progenitor cells of patients with myelodysplastic syndrome was studied. Bone marrow CFU-GM was assayed in the agar semi-solid culture, and the bone marrow cells were incubated in liquid culture and the expressions of CD33, CD15 and bcl-2 on the marrow cells were detected by APAAP method in 24 patients. The suppressive effects of As(2)O(3) to CFU-GM were increased with the rise of As(2)O(3) concentrations. The suppression of As(2)O(3) (0.388 micro mol/L) to cluster formation was stronger than to colony formation, the suppressive rates were 70.78% vs 34.05% in low-risk group, and 86.76% vs 65.86% in high-risk group (P < 0.01), respectively. 0.194 micro mol/L of As(2)O(3) decreased clusters and increased colonies in low-risk group, but decreased clusters and did not change colonies in high-risk group. High concentration (1.94 micro mol/L) of As(2)O(3) downregulated the expression rate of CD33 and CD15 in both groups, and low concentration (0.194 micro mol/L) downregulated the expression rate of CD33 and upregulated the expression rate of CD15 in low-risk group, but decreased expression of CD33 and did not alter CD15 in high-risk group. At the same time, the high concentration of As(2)O(3) downregulated expression of bcl-2 and resulted in karyopyknosis and cytoplasm condensation; low concentration generated similar effect on expression of bcl-2 and cell morphology in high-risk group, but did not affect in low-risk. It is concluded that As(2)O(3) suppressed myelopoiesis and impelled myelomonocytic cells to apoptosis, low concentration of As(2)O(3) induced the proliferation and differentiation of myelomonocytic cells in low-risk group, however, suppressed the growth of myelomonocytic cells and accelerated the cells apoptosis in high-risk group.

Objective:Peripheral nerve invasion (PNI) is associated with local recurrence and poor prognosis in patients with advanced gastric cancer. A risk-assessment model based on preoperative indicators for predicting PNI of gastric cancer may help to formulate a more reasonable and accurate individualized diagnosis and treatment plan.Methods:Inclusion criteria: (1) electronic gastroscopy and enhanced CT examination of the upper abdomen were performed before surgery; (2) radical gastric cancer surgery (D2 lymph node dissection, R0 resection) was performed; (3) no distant metastasis was confirmed before and during operation; (4) postoperative pathology showed an advanced gastric cancer (T2-4aN0-3M0), and the clinical data was complete. Those who had other malignant tumors at the same time or in the past, and received neoadjuvant radiochemotherapy or immunotherapy before surgery were excluded. In this retrospective case-control study, 550 patients with advanced gastric cancer who underwent curative gastrectomy between September 2017 and June 2019 were selected from the Affiliated Hospital of Qingdao University for modeling and internal verification, including 262 (47.6%) PNI positive and 288 (52.4%) PNI negative patients. According to the same standard, clinical data of 50 patients with advanced gastric cancer who underwent radical surgery from July to November 2019 in Qingdao Municipal Hospital were selected for external verification of the model. There were no statistically significant differences between the clinical data of internal verification and external verification (all P>0.05). Univariate analysis and multivariate logistic regression analysis were used to determine the independent risk factors for PNI in advanced gastric cancer, and the clinical indicators with statistically significant difference were used to establish a preoperative nomogram model through R software. The Bootstrap method was applied as internal verification to show the robustness of the model. The discrimination of the nomogram was determined by calculating the average consistency index (C-index). The calibration curve was used to evaluate the consistency of the predicted results with the actual results. The Hosmer-Lemeshow test was used to examine the goodness of fit of the discriminant model. During external verification, the corresponding C-index index was also calculated. The area under ROC curve (AUC) was used to evaluate the predictive ability of the nomogram in the internal verification and external verification groups. Results:A total of 550 patients were identified in this study, 262 (47.6%) of which had PNI. Multivariate logistic regression analysis revealed that carcinoembryonic antigen level ≥ 5 μg/L (OR=5.870, 95% CI: 3.281-10.502, P<0.001), tumor length ≥5 cm (OR=5.539,95% CI: 3.165-9.694, P<0.001), mixed Lauren classification (OR=2.611, 95%CI: 1.272-5.360, P=0.009), cT3 stage (OR=13.053, 95% CI: 5.612-30.361, P<0.001) and the presence of lymph node metastasis (OR=4.826, 95% CI: 2.729-8.533, P<0.001) were significant independent risk factors of PNI in advanced gastric cancer (all P<0.05). Based on these results, diffused Lauren classification and cT4 stage were included to establish a predictive nomogram model. CEA ≥ 5 μg/L was for 68 points, tumor length ≥ 5 cm was for 67 points, mixed Lauren classification was for 21 points, diffused Lauren classification was for 38 points, cT3 stage was for 75 points, cT4 stage was for 100 points, and lymph node metastasis was for 62 points. Adding the scores of all risk factors was total score, and the probability corresponding to the total score was the probability that the model predicted PNI in advanced gastric cancer before surgery. The internal verification result revealed that the AUC of nomogram was 0.935, which was superior than that of any single variable, such as CEA, Lauren classification, cT stage, tumor length and lymph node metastasis (AUC: 0.731, 0.595, 0.838, 0.757 and 0.802, respectively). The external verification result revealed the AUC of nomogram was 0.828. The C-ndex was 0.931 after internal verification. External verification showed a C-index of 0.828 from the model. The calibration curve showed that the predictive results were good in accordance with the actual results ( P=0.415). Conclusion:A nomogram model constructed by CEA, tumor length, Lauren classification (mixed, diffuse), cT stage, and lymph node metastasis can predict the PNI of advanced gastric cancer before surgery.