Objective To evaluate the clinical efficacy of low molecular weight heparin in treatment of patients with severe community-acquired pneumonia (CAP).Methods PubMed, BMA, EMbase, ASP, Cochrane Library, EMCC, CBM, CNKI, CECDB, CQVIP, and VIP databases were searched to identify the relevant randomized clinical trials (RCTs) from the publications during the period from January 1994 to January 2014. The search terms were “low molecular heparin”, “severe community-acquired pneumonia”, “prognosis” in both Chinese and English. The quality of the included studies were strictly evaluated and data were extracted. Stata/SE version 12 software was used for systematic review and meta-analysis.Results Six RCTs were ifnally qualiifed in the analysis, including a total of 208 cases in treatment group and 196 cases in control group. The patients in control group received conventional therapy, while the patients in treatment group received low molecular weight heparin by subcutaneous injection as add-on to conventional therapy. Meta-analysis showed that after treatment with low molecular weight heparin for 7 days, the APACHE II score of severe CAP patients signiifcantly decreased (P = 0.43,I2 = 0%, SMD = -0.70, 95%CI: - 0.90, -0.49) with controllable publication bias (bias_p = 0.93, bias_95CI: -6.79, 6.37). The PaO2 of severe CAP patients signiifcantly increased (P = 0.858,I2 =0%, SMD = 0.51, 95%CI: 0.30, 0.72) with controllable publication bias (bias_p =0.770, bias_95CI: -4.82, 5.90). However, after low molecular weight heparin treatment for 7 days, the PaCO2 of severe CAP patients did not change significantly (SMD = -0.17, 95 %CI: -0.38, 0.04).Conclusion Low molecular
weight heparin is beneifcial in the treatment of severe CAP patients in terms of signiifcantly decreased APACHE II score, increased oxygenation, and improved clinical symptoms.

Objective To explore the effect of hesperidin on cardiac function and ventricular remodeling following myocardial infarction (MI) in mice.Methods Ligation of left anterior descending (LAD) was operated to establish MI model.Forty-two C57BL/6 mice were randomly (random number) divided into control and MI group;and 24 h after LAD ligation,mice in MI group were further divided into MI control and hesperetin group.Eight weeks later,cardiac function and structure changes were determined by the methods of hemodynamic measurement and echocardiography.HE staining was used to measure crosssectional area (CSA) of atrial myocytes,and PSR staining was applied for observe collagen deposition and calculation of collagen volume fraction (CVF).Real-time PCR was used to detect the mRNA expressions of cardiac hypertrophy markers (ANP,BNP and β-MHC) and cardiac fibrosis markers (Collagen Ⅰ,Collagen Ⅲ and CTGF).The contents of superoxide anion and hydroxy radical were detected by colorimetric method.Results Compared with control group,left ventricular posterior wall thickness (LVPWT) and interventricular septum thickness (IVST) were increased to be thicker,left ventricular fractional shortening (LVFS) and left ventricular ejection fraction (LVEF) were significantly lower,and ± dp/dtmax was remarkably reduced in MI control group (P ＜ 0.05).Compared with MI control group,hesperetin could increaseLVFS [(29.48±3.87)％ vs.(20.69±3.99) ％],LVEF [(46.40±1.68)％ vs.(30.51± 1.17) ％] and ±dp/dtmax [(3 344.33 ±269.57) mmHg/S vs.(2 205.19 ±224.17) mmHg/S;(2250.40±218.35) mmHg/S vs.(-1 566.91 ±217.37) mmHg/S];but could reduce LVPWT [(2.29±0.05) mm vs.(2.85±0.10)mm]andIVST[(1.44±0.09) mm vs.(1.89±0.06) mm].Compared with control group,CSA and CVF were significantly increased in MI control mice.However,hesperetin could reduce CSA and CVF.Compared with control group,the mRNA expressions of cardiac hypertrophy and cardiac fibrosis markers were significantly increased in MI control mice;but hesperetin could significantly inhibit the mRNA expressions of cardiac hypertrophy and cardiac fibrosis markers.Additionally,hesperetin could significantly reduce the contents of superoxide anion and hydroxy radical.Conclusion Hesperetin intervention can inhibit ventricular structure change,and improve hemodynamics and cardiac function after acute myocardial infarction via inhibiting the production of reactive oxygen species (ROS).

Objective:To evaluate the effects of comprehensive reform of clinical education on cultivating the clinical thinking ability of medical students in internal medicine.Methods:A total of 44 clinical interns on medicine rotation were included in this study and divided into experimental group and control group, and a series of measures for clinical teaching reform, which included undergraduate tutorial system, team-based learning (TBL) mode, combination of electronic medical record and handwritten medical record, as well as formative assessment, were applied to fully promote clinical thinking ability of medical students. SPSS 17.0 software was used to compare the scores of final academic tests of rotation and competition of medical record writing between the control and the experiment groups. Self-designed questionnaires on undergraduate tutors and clinical interns were applied to comprehensively evaluate the effects of this education reform.Results:Independent-sample t tests showed there were statistically significant difference ( P<0.01) in the scores of final academic tests of rotation and competition of medical record writing between the two groups, and the mean score of the experiment group was higher than that of the control group. Questionnaire survey showed that tutors and clinical interns both fully affirmed the positive effects of the education reform on cultivating clinical thinking ability of medical students in internal medicine. Conclusion:Application of comprehensive education reform in clinical teaching of internal medicine, which based on introduction of undergraduate tutorial system and TBL mode, could effectively promote the clinical thinking ability of medical students and the teaching quality.

Purpose To investigate the effect and molecu-lar mechanism underlying SOX9 during esophageal squamous cell carcinoma(ESCC)cells.Methods Immunohistochemistry(IHC)was used to detect the expression of SOX9 in ESCC tis-sues and adjacent normal tissues.The correlation of SOX9 ex-pression with clinicopathological features and prognosis of ESCC was analyzed.The differentially expressed genes in Eca109-Vec-tor and Eca109-SOX9 cells were detected by Affymetrix miRNA array.qRT-PCR was used to determine the differential gene in TE-1 and TE-1-siSOX9 cells.The relationship between SOX9 and active/unphosphorylated β-catenin levels was detected by Western blot.The effects of Wnt inhibitor LGK974 on the prolif-eration of ESCC cells were detected by CCK-8.Results SOX9 was highly expressed in ESCC(4.58±3.04)as compared with that in adjacent normal tissues(1.56±2.08,P＜0.001).SOX9 was related to histopathological grade and invasion depth(P＜0.05).Kaplan-Meier analysis indicated high SOX9 expres-sion in ESCC was significantly correlated with shorter overall sur-vival(P＜0.05).Transcriptome profiling and qRT-PCR analysis suggested that SOX9 contributed to the regulation of AXIN2,FZD7 and WNT5A.Overexpression of SOX9 in Eca109 cells in-creased active/unphosphorylated β-catenin levels,whereas silen-cing SOX9 caused a decrease.Significant attenuation of cell pro-liferation was observed at various concentrations of LGK974 with-out affecting SOX9 expression on SOX9-expressing cell lines.As expected,this inhibitory effect was not obvious in Eca109-Vector cells when compared with Eca109-SOX9 cells treated with the same concentration of LGK974.Conclusion SOX9 is highly ex-pressed in ESCC and SOX9-mediated Wnt/β-catenin signal path-way activation at least partially contributes to the SOX9-induced ESCC growth.These findings suggest that SOX9 is a promising prognostic marker and therapeutic target for ESCC.