This paper analyzed the current status of clinical research at Peking University, which was compared with that of a number of international and domestic universities. Suggestions were put forward in accordance with the current domestic problems in clinical research.

Objective To investigate the risk of heart failure to the mother and the neonate.Methods The clinical data of 30 pregnant womem with heart failure from January 1993 to December 2010 from Capital Medical University Tongren Hospital was retrospectively analyzed.Results Of the 30 patients,there were 12 affected with congenital heart disease (40％) ; 9 with rheumatic heart disease 30％,7 with heart failure in pregnancy-induced hypertension 23％.Heart failure appeared at the average of (34.20 ± 4.25) weeks in pregnancy.The average terminal time of pregnancy was (34.84 ± 2.17) weeks.The rate of early birth was 73.33％.The average birth weight was (2011 ±568) g,with 7 babies less than 2000 g.No death occurred in both new the mother and the neonate.Condusion The main causes of heart failure in pregnancy are congenital and rheumatic heart disease and pregnancy-induced hypertension.For those heart failure occurs before 30 weeks,it is the first selection that pregnancy shoud be terminated; For those occur after 30 weeks,active treatment should be performed to improve maternal heart function and promote fetal maturity.Apropriate threatment during per-cesarean section may decrease the case fatality of the mother and neonate.

Objective To investigate the incidence of healthcare-associated infection(HAI)in hospitalized patients≥65 years at a hospital in Hunan Province.Methods Data of patients with HAI in this hospital in 201 1—2013 were classified and analyzed statistically.Results A total of 47 626 patients were investigated,1 068 cases of HAI oc-curred,all cases were single site infection,incidence and case rate of HAI were both 2.24% ,incidence in patients aged <65 years (2-65 years old)was 0.98% (234/23 998),and ≥65 years was 3.53% (834/23 628),difference was significant between two groups (χ2= 354.44,P<0.001). HAI rate in patients aged <65,65~,70~,75~, 80~,85~,and ≥90 years was 0.98% ,1.59% ,1.28% ,2.77% ,5.20% ,6.93% ,and 9.43% respectively. The major infection site was lower respiratory tract (59.95% ,n= 500),the main detected pathogens were Pseudo-monasaeruginosa (19.43% )and Escherichia coil (18.72% ).Conclusion The incidence of HAI in the elderly patients increased with age increasing,the main infection site is lower respiratory tract.

Objective:To determine the effects of silencing glucose regulated protein ( GRP94 ) on the proliferation and apoptosis of breast carcinoma MCF7 cells. Methods:Chemically synthesized siRNA targeting GRP94 gene and transfected into MCF7 cells used by Liopfectamine RNAIMAX. The mRNA and protein expression levels of GRP94,cyclinD1,Bax and Bcl-2 were detected by Real-time PCR and Western blot. CCK8 assay was used to detect the effect of specific GRP94 siRNA on cell proliferation and the effect on cell cycle and apoptosis were analyzed by flow cytometry and Hoechst 33258 staining. Results:Compared with the siRNA-NC cells, the expression of GRP94 was significantly down-regulated in MCF7 cells. Knockdown of GRP94 in MCF7 cells decreased cell proliferation and promoted cell apoptosis. The expression of cyclinD1and Bcl-2levels were significantly reduced, and Bax level was increased in siRNA-GRP94 MCF7 cells. Conclusion: The siRNA-mediated GRP94 silence significantly inhibits MCF7 cell proliferation,promoted cell apoptosis by down-regulating cyclin D1,Bcl-2 expression and up-regulating the Bax expression in MCF7 cells.

BACKGROUND:Whether adipose-derived mesenchymal stem cells are able to exert immunomodulatory effects in the treatment of myocardial infarction, as wel as the best time, is less reported.
OBJECTIVE:To observe the effect of adipose-derived mesenchymal stem cells on inflammatory reaction and ventricular remodeling after myocardial infarction, and to explore the possible mechanisms of adipose-derived mesenchymal stem cells for the treatment of myocardial infarction.
METHODS:Enzyme digestion method was employed to isolate and culture rat adipose-derived mesenchymal stem cells. By ligation of the left anterior descending coronary artery, we established animal models of myocardial infarction in 40 rats. The rats were randomly divided into four groups:sham group, control group (injected high-glucose Dulbecco’s modified Eagle’s medium), 3-hour transplantation group (transplanted adipose-derived mesenchymal stem cells after 3 hours of myocardial infarction), 7-day transplantation group (transplanted adipose-derived mesenchymal stem cells after 7 days of myocardial infarction). After 14 days of operation, the levels of tumor necrosis factor-αand interleukin-10 in the plasma were detected by enzyme linked immunosorbent assay. After 28 days of operation, the left ventricular end diastolic diameter, left ventricular end systolic diameter, left ventricular ejection fraction and left ventricular fractional shortening were measured by echocardiography.
RESULTS AND CONCLUSION:Compared with the control group, in the 3-hour transplantation group and 7-day transplantation group, the levels of tumor necrosis factor-αwere significantly lower (P<0.01), and the levels of interleukin-10 were significantly higher (P<0.01) at postoperative 14 days;the left ventricular end diastolic diameter and left ventricular end systolic diameter in the two transplantation groups were also significantly smal er (P<0.05), but left ventricular ejection fraction and left ventricular fractional shortening were significantly elevated (P<0.05), which was more apparent in the 3-hour transplantation group than the 7-day transplantation group. Adipose-derived mesenchymal stem cells transplantation in acute phase of myocardial infarction can suppress the inflammatory response, regulate the cytokine network equilibrium, and thus delay ventricular remodeling and improve cardiac function.

Objective To evaluate the value of evoked potentials (EP) in diagnoses of minimal hepatic encephalopathy (MHE) for liver cirrhotic patients without overt hepatic encephalopathy (OHE). Methods A blind and self control study was conducted in 114 liver cirrhotic patients without OHE. All patients were tested for MHE by the number connection test-A(NCT-A), digit symbol test (DST), visual evoked potentials (VEP), brain-stem auditoru evoked potentials (BAEP), short latency somatosensory evoked potentials (SSEP), P300 auditory event-related potentials (P300ERP). MHE was identified when the NCT-A or/and DST was abnormal. The positive rate was compared among VEP, BAEP, SSEP and P300ERP for their reliability and validity in diagnosis of MHE. Results Of 114 patients, 60 patients were found with MHE (52. 6%), which was positively correlated with Child-Pugh classifications (r=0. 278, P = 0. 003). The positive rate was found 17.5% in VEP, 29.8% in BAEP, 38. 6% in SSEP and 57. 0% in P300ERP. There was no significant difference in diagnosis of MHE between P300ERP and NCT-A+DST (X2 =0. 432,P = 0. 511). The sensitivity of VEP, BAEP, SSEP or P300ERP for diagnosis of MHE was 13. 3%, 41. 7%, 46. 7% or 73. 3%, respectively, whereas the specificity was 77. 8%, 83. 3%, 70. 4% or 61. 1 %, respectively. The receiver operating characteristic curve revealed that the best sensitivity and specificity for the diagnosis of MHE was P300EERP (area under the curve was 0. 672, 95%CI 0. 572 * 0. 773). The agreement of NCT-A+DST with VEP, BAEP, SSEP or P300ERP was 43. 9%, 61. 4%, 57. 9% or 67. 5%. Conclusions P300ERP is a sensitive and specific method for the diagnosis of MHE. which can serve as a supplement but not instead of NCT-A+DST.

Medical students face higher levels of stress compared to the general population. Statistical analyses of questionnaire surveys were made to compare the teaching effect between traditional teaching and PBL.The results indicate that the PBL teaching is more conducive to students to relief from the course-related stress in medical colleges.

Objective To explore the causes and the consequences of iatrogenic bile duct injury as well as experiences in its diagnosis and treatment. Method The clinical data of 28 in-patients who suffered from bile duct injury followed by cholecystectomy during January 1995 to September 2011 were collected and retrospectively analyzed. Result Bile duct injuries were found and diagnosed in al 28 in-patients during the processes of reoperation. Different treatments were carried out. 8 cases with mild injury were treated by placing the abdominal cavity drainage. 6 cases with bile duct split were repaired and set up with T tube drainage. 4 cases were initially treated by bile-intestinal Roux-y anastomosis. 1 case received repair operation of bile-intestinal Roux-y anastomosis after the external drainage of bile. 9 cases were initially treated with end-end bile duct anastomosis and 7 of 9 cases with concurrent anastomotic stenosis were performed repairing re-operations twice or more than twice. Among 7 cases, 1 case was performed with the operation of umbilical vein flap repair while 6 cases were treated with bile-intestinal Roux-y anastomosis repair. All cases in this observation were followed up to two years after repairing surgery:2 patients died and the rest 26 patients recovered after treatment. Conclusions The initial repairing operation is critical for iatrogenic bile duct injury and bile-intestinal Roux-y anastomosis should be the first choice of therapy,and it should be operated by experienced surgeons.

Objective To evaluate the clinical effect of the simple syringomyelia patients with syringopleural shunt (SPS) and syringosubarachnoid shunt (SSS).Methods Twenty-eight patients with syringomyelia were selected as our subjects.Of which,18 patients were operated with SPS and 10 cases were with SSS.The therapy effect was compared between groups.Results All patients were checked with MRI 3 months after the operations and showed that syrinx cavity was significantly narrow of all patients.At early stage (48 h) after surgery 9 cases in SPS and 4 cases in SSS were showed the decrease syrinx cavity.Among patients with SPS,15 cases (83.3％) had the symptoms and signs improved,1 case (5.5％) withno changes,1 case (5.5％) with worse effect,and 1 cases(5.5％) occurred the tethered spinal cord.Meanwhile,among,patients with SSS,8 cases(80.0％) had the symptoms and signs improved,1 case(10.0％) with no changes,and 1 case (10.0％) with worse effect.There were 4 patients with pneumothorax in SPS group after operations,and the lung compression ratios were less than 5％.These cases were not taken any special treatment for the pneumothorax.All patients in two groups had not been infected and pleural effusions.No cases had taken the tube plugging.Conclusion The simple syringomyelia patients with the spine injury should take the cavity shunt.The SPS has some advantages because it can provide the partly negative pressure.But it should be certified by more cases and a long-time follow up.

[Abstrct] Objective The deformity of severe varus knee (varus angulation > 15°) can be treated by many ways in primary total knee arthroplasty , but the efficacy and cost are different. The topic of this study provides a new surgery: autograft (wedge grafts) implant and substitute medial tibial bone defects. Methods From Jan. 2006 to Jan. 2014 , a retrospective study was conducted in the First Affiliated Hospital of BaoTou Mendical College. Out of 687 patients, 721 primary knees were operated. Bone defects in proximal tibia (varus angulation >15° ) were encounted in 16 patients in 21 knees in the pattern of non-inclusive slope bone defects in the mean varus degree of 27°. Their IBM was 31 kg/m2. The average age of patients was (63 ± 5) years. The score of clinical knee society score (KSS) before operation was 18 on average. Among of them, the pain score were 12 points, the average range of motion (ROM) were 12 points. the average funtional score were 20 points. During operation,the slope bone defect of the medial tibial plateau was tailored into wedge-shaped ladder bone defect by osteotomy,and then the defect was filled with the resected tibial plateau autograft in which the thickness and shape were matched completely. The high-intensity cortical part of the autograft was placed in the rim to sustain the tibial prosthesis. Three months after operation ,patients started to walk without the help of crutch. Results The average followup period was 5.3 y , We observed that an average postoperative scores of clinical KSS from 42 points to 88 points with the score of functional KSS from 57 points to 92 points. Fusion was observed by trabeculae crossing from the graft to the tibial metaphysis on plain films at least 6 mouths without collapse, stress fracture, untight and bone ununion. Confirmation of vascularization of the graft was observed in bone scans of nuclide. showing increased uptake in the operated area. Inflammatory makers were normal. Conclusion Autograft (wedge grafts) reconstruction of medial tibial bone defects, is of high rate of healing in implant bones, good restoration of the function and low cost.