Objective To study the effect of case-based learning(CBL) combined with virtual reality simulator in peripheral vascular intervention training for refresher doctors.Methods Total 30 peripheral vascular refresher doctors were selected in department of vascular surgery,Xuanwu Hospital of Capital Medical University and were randomly divided into the observation group(n=15) and control group(n=15).Doctors in observation group were trained by CBL combined with virtual reality simulator while those in control group were taught by traditional teaching method.Theory examination,skill examination in real environment were performed after the training and achievement differences were compared between 2 groups.Questionnaires were given to the simulator CBL group,to learn refresher doctors' recognition of the teaching method and groups were compared using independent samples t test.Results Theory examination average score was (84.5 ± 7.7) in observation group,higher than the score(72.6 ± 8.7) in control group(P=0.024).Skill examination average score was(85.3 ± 9.3) in observation group,higher than the score(70.2 ± 10.2) in control group(P=0.013).Compared with control group,the mean performance errors in training group,the contrast volume,the mean angiography procedure time,the time of X-ray exposure,the total volume of X-ray exposure and the total volume of X-ray exposure every square meter all decreased significantly and the difference was statistically significant.P value＜0.05.100％ (15/15) simulator CBL group refresher doctors recognized CBL combined with vascular interventional simulator teaching method.Conclusions Teaching method of CBL combined with virtual reality simulator can stimulate the refresher doctors' interest in learning and help them master peripheral vascular interventional techniques.

BACKGROUND:Some studies have focused on bone marrow mesenchymalstem cells (BMSCs) combined with allograft bone or artificial bone substitute materials for bonedefect repair. But there is no report on BMSCs combined with Bio-oss for repair of rabbit skull defects as yet.OBJECTIVE:To observe the effect ofBMSCs combined with Bio-oss in repairing skull defects in rabbits.METHODS:BMSCs from male rabbits were isolated, cultured, and used as seed cells. In the skull of the female rabbits,three full-thickness bone defects with the same external diameter of 6 mm were made by a ring bone drill. Ninety-six female rabbits were randomly divided into four groups, and given Bio-oss/BMSCs in combination group, Bio-oss alone in Bio-oss group, BMSCs implantation in BMSCs group, and no intervention in blank group. All the implant surfaces were covered with guided tissue regeneration membrane.RESULTS AND CONCLUSION:The osteogenic effect in the combination group was better than that in the other three groups, and the Bio-oss group showed better osteogenesis in comparison with BMSCs and blank groups. But there was no significant difference between the BMSCs and blank groups. These findings indicate that the combined use of BMSCs as seed cells and Bio-oss as a scaffold material exerts overt osteogenic effects in rabbit skull defect area, which provides a new idea for the clinical treatment of bone defects.

Objective To establish a diabetic rat model of hindlimb ischemia, and provide a test method for dia-betic limb ischemia and diabetic foot study.Methods Twenty-five Wistar rats were divided into three groups:the model group and control group ( n=10) , and sham operated group ( n=5) .The rats of model group were induced by intraperito-neal injection of streptozotocin ( STZ, 60 mg/kg) , with the blood glucose level over 16.8 mmol/L, while the rats of control group were injected with normal saline.All the rats had the left femoral artery and its branches ligated, and then Doppler scan blood flow analysis was performed for the two hind limbs after operation at different time points.In the meantime, the changes of body weight and blood glucose were observed.The animals were sacrificed at 21days after operation.HE stai-ning was used to observe the pathological changes of gastrocnemius and femoral arteries.Capillary density and intima hyper-plasia were examined using immunostaining for CD31 and a-SMA.Results Blood glucose of the model group rats was sig-nificantly increased as well as the quantity of urine and feces,and associated with weight loss, which were maintained for more than 21 days.The blood flow of control rats was markedly decreased immediatly after operation, reached to the lowest point after surgery, and recovered from 7 -14 days after operation.In contrast to the control group, the model group showed a marked reduction in blood flow in the ischemic hind limb.Pathological examination revealed remarkable vascular atrophy and a significantly reduced number of vessels per high power field in the gastrocnemius muscle of model group rats with respect to the control group, and the femoral arteries of model rats were more narrowed than that of the control rats. Conclusions In this study, an effective, convenient diabetic rat model of hindlimb ischemia is successfully established which will facilitate the studies of drug intervention for diabetic limb ischemia and diabetic foot in the future.

Objective To assess the variations in different thyroid stimulating hormone(TSH) and free thyroxine (FT4) detection kits for evaluating thyroid function during pregnancy and to establish the corresponding normal reference ranges.Methods This study was based at the International Peace Maternity and Child Health Hospital affiliated to Shanghai Jiaotong University School of Medicine.A total of 200 pregnant women who visited the hospital between June,2011 and September,2012 were recruited in this study according to the National Academy of Clinical Biochemistry (NACB) criteria.Blood samples were sequentially collected from the women at the first (T1,9-12 weeks),second (T2,16-24 weeks) and third (T3,32-36 weeks) trimesters to determine the serum TSH and FT4 levels using four different detection kits (Siemens-C,Siemens-Ⅰ,Abott and Roche).A linear trend test was used to analyze serum TSH and FT4 levels with four different kits.A percentile range of P2.5 to P97.5 was used to establish the normal trimester-dependent reference ranges of TSH and FT4 levels for different detection kits.The Bootstrap method was used to compare the differences in the four reference ranges.Results Similar dynamic changes in TSH and FT4 levels during pregnancy were detected among the different kits (F=0.950,P=0.595; F=11.640,P=0.081,respectively).Among the four reference ranges of TSH,the Roche kit showed the most remarkable fluctuation during pregnancy,while Roche kit in the first trimester and Siemens C kit in the second and third trimesters showed larger fluctuations in reference ranges of FT4.More importantly,the reference ranges of TSH and FT4 showed significant variations among the four different kits in each trimester (TSH:T1:F=2 945.390,P ＜ 0.01; T2:F=2 826.260,P ＜ 0.01; T3:F=1 698.360,P ＜ 0.01.FT4:Tl:F=1 145.440,P ＜ 0.01; T2:F=2 260.240,P ＜ 0.01; T3:F=1 439.920,P ＜ 0.01).Conclusions TSH and FT4 measurement using four different commercial kits showed similar trimester-dependent dynamic changes.However,it is necessary to establish trimester-dependent and detection kit dependent normal reference ranges of TSH and FT4 for thyroid function evaluation for pregnant women.

This study was aimed to observe the effect of Compound Shi-Chang-Pu (CSCP) granula on behavior, structure changes of hippocampus with epileptic seizure of mice induced by pentyenetetrazole (PTZ). Sixty Kunming mice, which were half male and half female, were randomly divided into 6 groups, which were the blank control group, animal model, phenytoin (PHT) group, high-dose CSCP (4 000 mg·kg-1) group, middle-dose CSCP (2 000 mg·kg-1) group and low-dose CSCP (1 000 mg·kg-1) groups. The blank group and model group were given intragas-tric administration the same volume of saline, the others animals treated with continuous oral administration of drugs for 7 days. Intraperitoneal injection of PTZ (80 mg·kg-1) was given 1 h after the last medication to establish the a-cute epilepsy model (expect the blank control group). Observation was made on the influence of CSCP on incubation period, behavior degree and times of epileptic seizure among PTZ induced epilepsy mice, the structure changes of mice were detected by the brain tissue HE staining. The results showed that CSCP can improve the degree of seizure attack, prolong the incubation period of mild attack, and decrease Ⅳ and Ⅴ degree epileptic seizure, the PTZ in-duced epilepsy mice could damage the structure of hippocampus, reduce the number of cells, PHT and CSCP could ameliorate these changes. It was concluded that CSCP had certain inhibition on epileptic seizure mice induce by PTZ and ameliorate the damage of hippocampus. The antiepileptic mechanism still requires futher study.

Objective: To understand the situation of blood pressure control and its influencing factors in elderly patients with hypertension in Hangzhou, and to provide basis for the management of elderly patients with hypertension in community. Methods: The subjects of this study were hypertension patients aged 60 years and over in Hangzhou community health management of basic public health services. Demographic data and life behaviors were collected by a questionnaire survey, physical examination and laboratory tests were carried out. The multivariate logistic regression model was used to analyze the influencing factors for blood pressure control in elderly patients with hypertension. Results: A total of 109 583 people were investigated, with 50 500（46.08%） males and 59 083（53.92%） females. The control rate was 47.70% ( 52 273/109 583 ). After adjusted for age and gender, regular medication ( OR=0.874, 95%CI: 0.838-0.912 ) was the protective factor, obesity ( OR=1.291, 95%CI: 1.260-1.324 ), abnormal fasting plasma glucose ( OR=1.218-1.344, 95%CI: 1.178-1.410 ), the number of unhealthy lifestyles ( OR=1.271-1.292, 95%CI: 1.231-1.344 ), the items of dyslipidemia ( OR=1.047-1.253, 95%CI: 1.017-1.311 ), and the number of cardiovascular risk factors above ( OR=1.254-2.109, 95%CI：1.175-2.281 ) were the risk factors for blood pressure control in elderly patients with hypertension. Conclusions The control rate of elderly patients with hypertension in Hangzhou is 47.70%, which is associated with irregular medication, unhealthy lifestyle, obesity, dyslipidemia, abnormal fasting plasma glucose and clustering of these factors.

Objective To evaluate the efficiency and safety of infrainguinal arterial bypass in diabetic ischemia of the lower extremities. Method Eighty-two consecutive patients undergoing lower extremity arterial reconstruction from 2002 to 2005 were divided into diabetes group (DM) and nondiabetes group ( NDM ) . Graft patency, limb salvage, and perioperative complications were compared between the two groups. Results There were 82 patients receiving 86 grafts, 44 grafts (51. 2% ) in patients with diabetes (DM group) and 42 (48. 8% ) in nondiabetic patients (NDM group). Average age of the DM group was (68?10) years, vs. (63?12) years of NDM group (P=0.025). In-hospital perioperative mortality was 3. 7% ( DM group 4. 8% vs. NDM 2. 5% ,P = 1. 000). Cumulative primary and secondary graft patency in 4 year was 44% in DM group and 64% in NDM group, P =0. 112 and 69% in DM group, 66% in NDM group, P = 0. 083) , respectively. The 4 year overall limb salvage rate was not statistically defferent ( DM group, 68%; NDM group, 66%; P =0.114). Conclusions Diabetes mellitus does not influence perioperative mortality, graft patency, or limb salvage rates after lower extremity arterial bypass.

In order to study the pathogenesis of Listeria monocytogenes (LM), we cloned listeriolysin gene into prokaryotic expression vector PET21a. The expression vector was transformed into Escherichia coli BL21 for expression of listeriolysin O (LLO). LLO-His tag fusion protein was purified with a Ni-NTA affinity column and was used as an immunogen to vaccinate BALB/C mice. Hybridomas were developed by fusing mouse myeloma cells Sp2/0 and splenocytes from the immunized mice and screened with purified LLO. Three hybridomas secreting antibodies against listeriolysin O were obtained and named anti-LLO1, anti-LLO2 and anti-LLO3, respectively. Western blotting analysis showed that all of them could specifically bind to the LLO secreted by the LM. The titers of anti-LLO monoclonal antibodies in the supernatants of three hybridomas cultures were 1:3.6 x 10(4), 1:6.4 x 10(4) and 1:1.6 x 10(4), respectively, and the titers of ascites from the hybridoma-injected mice were 1:2 x 10(7), 1:2 x 10(7) and 1:1 x 10(7), respectively, based on ELISA test. The isotypes of the monoclonal antibodies were determined to be IgG1. The dissociation constants (Kd) of these three monoclonal antibodies were determined to be 6.18 x 10(-11), 7.50 x 10(-11) and 6.27 x 10(-11) respectively. These data and reagents will be of great assistance to elucidate the pathogenesis of Listeriosis.
Animals ; Antibodies, Monoclonal ; biosynthesis ; immunology ; Bacterial Toxins ; biosynthesis ; genetics ; immunology ; Cloning, Molecular ; Escherichia coli ; genetics ; metabolism ; Genetic Vectors ; genetics ; Heat-Shock Proteins ; biosynthesis ; genetics ; immunology ; Hemolysin Proteins ; biosynthesis ; genetics ; immunology ; Listeria monocytogenes ; genetics ; pathogenicity ; Mice ; Mice, Inbred BALB C ; Recombinant Fusion Proteins ; biosynthesis ; genetics ; immunology

Objective To investigate the effect and safety of autologous transplantation of peripheral blood mononuclear cells (PBMCs) for the treatment of lower limb ischemia. Methods Eighty-three limbs in 53 patients with lower limb ischemia were treated by autologous transplantation of peripheral blood mononuclear cells from June 2004 to October 2005. Of the patients, there were 71 diabetic ischemic limbs in 44 cases, 6 arteriosclerotic occlusion limbs in 5 cases and 6 thromboangiitis obliterans in 4 cases. Symptoms included a feeling of pain in 80. 7% (67/83) limbs, cold in 72.3% (60/83) limbs and numb in 67.5% (56/83) limbs. Results There was no mortality. The outcome was evaluated after 2 months of transplantation. The pain-relieve rate, improvement rate of cold feeling and numbness was 83. 6% , 91. 7% and 75. 0% , respectively. Ankle / brachial index ( ABI) increased in 39. 8% (33/83) limbs. TcPO2 of the ischemic legs was obviously elevated in 89. 2% (74/83 ) limbs. Ulceration area reduced in 29. 2% limbs. Digital subtraction angiography ( DSA) was performed in 44. 6% (37 limbs of 23 patients) with collateral circulation increased in 72. 9% limbs. 15 limbs (18. 1% ) were amputated including 5 limbs with lowered level of amputation. Conclusion Autologous transplantation of peripheral blood mononuclear cells is a simple, safe, and effective method to treat patients with lower limb ischemia in which arterial reconstruction is impossible.

Objective To compare the clinical curative effects of PTA and simple pharmacotherapy for intrapopliteal artery ischemic disease.Methods Seventy-three patients with intrapopliteal artery ischemic disease were divided into PTA group (n=37) and pharmacotherapy group (n=36).Their ABI,claudication distance,vascular patency,rest pain and amputation rate were recorded and analyzed with SPSS 22.0 at months 1,3,6,12,18 and 24 respectively before and after treat ment.The vascular patency and amputation rate were analyzed according to the Kaplan-Meier curve.Results The ABI was higher in PTA group than in pharmacotherapy group during the 1-24 months following up period after treatment,and was still higher in PTA group than in pharmacotherapy group at month 24 after treatment (0.640±0.238 vs 0.500±0.152,P=0.038).The claudication distance was shorter and the rest pain was milder in PTA group than in pharmacotherapy group at months 1 and 3,and at months 1-18 respectively (P＜0.05,P＜0.01).No significant difference was found in amputation-free survival curves between the two groups (Plogrank =0.618).Conclusion The symptom improvement of PTA is better than that of pharmacotherapy for patients with severe rest pain or severe intermittent claudication.