The randomized controlled trials (RCTs) of treating diabetic nephropathy (DN) with alprostadil and valsartan were collected from CNKI,Wan fang date,VIP,PubMed,Embase,and Cochrane Library.The selected data was analyzed with RevMan 5.1 software.The effect of combination of valsartan and alprostadil in treating DN was evaluated.In 19 RCTs,675 cases were co-treated with alprostadil and valsartan and 670 were treated with valsartan.The results indicated that 24 h urine microalbumin excretion [WMD =-53.23,95％ CI (-67.55,-38.91),P＜0.01] and24 h urine protein[WMD=-0.38,95％ CI(-0.69,-0.07),P=0.02] in patients treated with combination of valsartan and alprostadil were reduced more markedly than in those treated with valsartan alone.There was no significant difference in blood urea nitrogen [WMD =-0.791,95 ％ CI (-20.62,4.79),P =0.22] and serum creatinine[WMD=-5.82,95％ CI(-19.22,7.58),P=0.39] between two kinds of treatment.These results suggest that combined treatment with valsartan and alprostadil shows advantageous effect on reducing urinary protein in DN.

Objective To investigate the influence of Jianpi Bufei Huatan Recipe (JBHR), a Chinese herbal compound with the actions of strengthening spleen, tonifying lung and resolving phlegm, on the pulmonary function of childhood bronchial asthma at remission stage, and to explore the possible therapeutic mechanism. Methods Sixty bronchial asthma children at remission stage were divided into treatment group and control group, 30 cases in each group. Both groups were treated with inhalation of fluticasone propionate, and additionally, the treatment group was given oral use of JBHR(mainly composed of Radix Astragali, Radix Pseudostellariae, fried Rhizoma Atrctylodis Macrocephalae, Radix Saposhnikoviae, Poria, Pericarpium Citri Reticulatae, Rhizoma Pinelliae, prepared Radix Glycyrrhizae, calcined Os Draconis, calcined Concha Ostreae, and Semen Lepidii seu Descurainiae). The therapeutic effect of the two groups was evaluated after treatment, and the changes of peak expiratory flow(PEF), peak expiratory flow variation(PEFv) were also observed after treatment for 1, 2, 3, 6, 9, a nd 12 month(s). Results (1)The total effective rate of the treatment group was 93.33%, and that of the control group was 83.33%, the difference being significant(P<0.05). (2) During the treatment, PEF was higher and PEFv was lower in the treatment group than those in the control group(P<0.05). Conclusion JBHR could relieve the clinical symptoms, improve the pulmonary function and decrease the hyperactivity of airway of pediatric bronchial asthma at remission stage with lung-spleen qi deficiency.

Ginseng root saponins ( GRS ) was extracted from native ginseng.The dosage used was calculated according to the content of saponins.Immunosuppression in mice was induced in 15 days after implar- ting Ehrlich ascites carcinoma (EAC) subcutaneously in armpit, and in 5-11 days after implanting EAC into peritoneal cavity. GRS administered orally 50mg/kg- for 8 days did not prevent the atrophy of the thymus in tumor-bearing mice but rather aggravated it. GRS administered orally 50mg/kg for 14 days partially restored the suppressed phagocytosis of peritoneal macrophages in tumor-bearing mice. GRS administered orally 50mg/kg for 6 days somewhat restored the suppression of hemolysin formation in tumor-bearing mice 5 days after implanting EAC, But GRS given in the same route and dosage for 9 days, showed no effect on the suppression of hemolysin formation. GRS administered orally 50mg/kg for 10 days partially restored the suppression of delayed hypersensitive reaction in tumor-bearing mice.

To investigate the clinical significance of serum soluble programmed cell death ligand-1 (PD-L1) in adult patients with community-acquired pneumonia (CAP). A total of 44 CAP patients, 54 severe CAP patients and 30 healthy volunteers were recruited in this study. Serum soluble PD-L1 were detected. Univariate and multivariate regression analyses were used to assess the influence of multiple clinical variables on prognosis. Serum soluble PD-L1 level in severe CAP group was 98.20(57.94, 128.90) ng/L, which was significantly higher than that in the CAP group [59.32(33.55, 92.58) ng/L] and healthy controls [20.44(12.15, 36.20) ng/L] (all P<0.001). PD-L1 level was positively correlated with CRUB-65( r=0.481, P<0.001) and the pneumonia severity index (PSI) score ( r=0.442, P<0.001). Univariate regression analysis showed that CURB-65 ( HR=2.544, 95% CI 1.324-4.889, P=0.005), PSI score ( HR=1.036, 95% CI 1.012-1.061, P=0.004), soluble PD-L1( HR=1.013, 95% CI 1.001-1.026, P=0.041) were risk factors of mortality during hospitalization. Multivariate regression analysis suggested that PSI score ( HR=1.042, 95% CI 1.012-1.073, P=0.005), soluble PD-L1 ( HR=1.011, 95% CI 1.002-1.071, P=0.020) were independent predictors for mortality risk in CAP patients. CAP patients with soluble PD-L1≥98.20 ng/L had a significantly lower survival rate than those with soluble PD-L1<98.20 ng/L ( P=0.033). In conclusion, this study indicates that serum soluble PD-L1 level in CAP patients is correlated with the survival prognosis.

Objective To observe the clinical efficacy of acupuncture in treating severe pneumonia complicated with gastrointestinal dysfunction (GIDF).Method Sixty patients with severe pneumonia complicated with GIDF were randomized into a treatment group and a control group, 30 cases in each group. The two groups were both given conventional Western medications. In addition, the treatment group was intervened by acupuncture, and the control group by oral administration of Mosapride citrate capsules and enteral nutrition via nasogastric tube. After 7-day treatment, the changes of GIDF score, intraabdominal pressure, bowel sound and gastric retention were observed in the two groups, and the clinical efficacies were compared.Result The total effective rate was 93.1% in the treatment group versus 78.6% in the control group, and the between-group difference was statistically significant (P<0.05). The scores of GIDF and the indexes (intraabdominal pressure, bowel sound, and gastric retention) were significantly changed after the treatment in both groups (P<0.05). The scores of GIDF and the indexes in the treatment group were significantly different from those in the control group after the intervention (P<0.05).Conclusion Acupuncture can promote the recovery of gastrointestinal function in severe pneumonia patients, since it can significantly improve the intraabdominal pressure, bowel sound and gastric retention.

Foreign Language Department of Kunming Medical University has developed medical English self-access learning platform based on campus network, created medical English online courses and network resource library , established major oriented learning evaluation mechanism . It provides an online teaching, learning, practice, testing and evaluation environment for college teachers and students. The architecture of the platform takes medical specialty into consideration, which focuses on the training of students' English skills. The detailed design of the platform is presented. The platform was launched in September 2014. Performance testing is used to measure the ability of the system. Three methods including students' interview, the interaction between the teaching management staff and quantitative analysis are adopted to evaluate the application results . Finally this paper has preliminarily explored self-access learning modes available for students. According to the related information, the platform runs smoothly after it was put into use and improves students' learning ability of medical English to a certain extent.

Objective:To explore the expression of peptidyl prolyl cis-trans isomerase (Pin1) activity in peripheral blood of patients with rheumatoid arthritis (RA) and the value and correlation of T helper cell 17/regulatory cells (Th17/Treg) cells, and to analyze the effect and influence of all-transretinoic acid (ATRA) on it.Methods:① Comparing the difference of Pin1 expression and absolute counts of Th17 and Treg between RA patients before and after treatment and healthy control group, Kruskal-Wallis rank sum test was used for analysis. ② To analyze the correlation between the expression of Pin1 and its general data, activity indicators [such as erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and disease activity score 28 joints (DAS28) scores], Th17, Treg and some cytokines in RA patients, and to use Pearson and Spearman correlation tests. ③ To analyze the difference of Pin1 expression and Th17/Treg in peripheral blood of RA patients treated with low-dose all-trans retinoic acid (10 mg twice a week) and traditional immunosuppressants such as hydroxychloroquine for 3 months respectively. Mann-Whitney U test was used for comparison between the two groups, and the difference was statistically significant with ( P<0.05). Results:① The activity of Pin1 in peripheral blood of the newly treated group of RA was [13.62(9.16, 19.42)] higher than that of the healthy control group [8.97(7.62, 11.45)]( Z=42.82 , P<0.05), and Th17 was [18.28(12.76, 24.08)] higher than that of the healthy control group [6.04(4.96, 4.96)]( Z=48.83 , P<0.05). Treg [11.06(5.31, 21.87). It was lower than that of healthy control group [40.41(24.33, 48.52)]( Z=42.21 , P<0.05). ② the activity of Pin1 in peripheral blood of RA patients was positively correlated with CRP, the number of involved joints, DAS28 score, interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) ( r=0.396, P<0.05; r=0.683, P<0.05; r=0.466, P<0.05; r=0.315, P<0.05; r=0.416, P<0.05). ③ Compared with the newly treated RA group, the activity of Pin1 [6.94(5.96, 8.77), Z=42.82 , P<0.05] and Th17 7.38 decreased [7.38(3.85, 11.21), Z=48.83 , P<0.05], while Treg [40.41 (17.77, 33.47)] increased ( Z=42.21 , P<0.05). ④ Compared with the traditional medicine group, Treg [28.9(21.73, 37.36)] was higher in the retinoic acid group, and the difference was statistically significant ( Z=-2.683 , P<0.05). The activity of Pin1 was [6.23(5.58, 8.75)], but there was no statistical significance ( Z=-1.622 , P=0.104). Conclusion:Pin1 in peripheral blood of RA patients is over-expressed. Th17 is increased and Treg is decreased. ATRA combined with other traditional drugs can reduce Pin1 activity, promote Treg growth and improve disease activity of RApatients to a certain extent.

In terms of the relatively backward English teaching concept of medical colleges, a latest international teaching concept CDIO is combined into medical college English teaching, reflected and reformed theoretically and practically. Theoretically, the integration of CDIO, medical education and English teaching and its positive effects are analyzed. Practically, course system, teaching contents and teaching methods are reformed in a linear sequence of C, D, I and O to form a new teaching structure of bilateral promotion between basic English learning and medical English learning. Applying the concept of CDIO into medical college English teaching will be of great benefit to promote the English practice ability of medical college students.

Objective To analyze the misdiagnosed cases of the nodular goiter (NG)in real-time contrast-enhanced ultrasound(CEUS),in order to improve the diagnostic accuracy of NG.Methods Two-hundred and sixty-five cases of NG CEUS images,especially the 48 nodules in 44 misdiagnosis cases,were retrospectively analyzed to find out the main reasons of the misdiagnosis.In addition,the factors which effected the results of CEUS such as size,number and calcification of NG nodules were summarized.Results There were 42 nodules misdiagnosed as thyroid cancer,5 nodules misdiagnosed as thyroid adenoma and 1 nodular goiter misdiagnosed as subacute thyroiditis in 874 nodular goiter cases.The misdiagnosis rate of nodular goiter was 5.49% (48/874)by the diagnostic criterion of homogeneous enhancement in CEUS.The differences size and calcification of nodules had a significant impact on CEUS.The misdiagnosis rate of the NG nodules with major diameter less than 10 mm was much higher than that of more than 10 mm,the misdiagnosis rate of NG nodules with coarse calcification was much higher than the situation of microcalcification(P <0.05).Conclusions Major diameter less than 10mm and coarse calcifications of NG nodular are the main factors which influence the results of CEUS.

Objective: To analyze the distribution feature of occupational pneumoconiosis in Sichuan Province. Methods: The cases of newly diagnosed occupational pneumoconiosis from 2012 to 2021 in Sichuan Province were collected from the Occupational Diseases and Hazards Monitoring Information System under China Disease Prevention and Control Information System, and were analyzed retrospectively. Results: From 2012 to 2021, there were 30 136 newly diagnosed occupational pneumoconiosis cases in Sichuan Province. The average age of patients was 55.2 years and the median work age was 12.1 years. There were 6 471 cases (accounting for 21.5%) exposed to dust for less than 5.0 years. The number of the cases declined in newly diagnosed occupational pneumoconiosis and occupational pneumoconiosis with less than 5.0 years of dust exposure. The numbers of coal workers' pneumoconiosis and silicosis were 16 210 and 13 577, respectively (accounting for 98.9% of the total cases). The majority of pneumoconiosis cases were classified as stage Ⅰ(accounting for 67.1%). The cases from Leshan City, Bazhong City, Dazhou City, Yibin City, Guangyuan City and Luzhou City accounted for 68.8% of the total cases. The main types of work were coal miner and excavation worker, which accounted for 31.7% and 18.8%, respectively. The scale of enterprises was mostly small and micro, accounting for 35.1% of the cases, and the industry distribution was mostly coal mining and washing, accounting for 53.4% of the cases. Conclusion: In Sichuan Province, the number of cases shows an overall decline in both newly diagnosed occupational pneumoconiosis and occupational pneumoconiosis with less than 5.0 years of dust exposure, with a relatively short duration of occupational exposure. The key cities for pneumoconiosis prevention and control are Leshan City, Bazhong City, and Dazhou City, while the key industry is coal mining and washing.