Internal medicine(IntMed) is one of the major subjects in medical undergraduate courses.With the transformation of medical mode from experience medicine to EBM,EBM shall be melted into IntMed teaching to change traditionary teaching mode and improve the teaching quality of IntMed,which helps to culture more new medical talented persons.

Objective To explore the expression of calcium binding protein (S100A11) and its clinical significances in human hepatocellular carcinoma (HCC) tissue and blood plasma. Methods The expressions of S100A11 in 46 cases of HCC tissues and their paracancerous tissues were detected by immunohistochemistry. The relationship between S100A11 expression level in HCC tissues and clinical parameters was analyzed. The S100A11 expression levels in blood plasma of HCC patients (62 cases), liver cirrhosis patients (32 cases), chronic hepatitis patients (30 cases) and healthy subjects (30 cases) were detected. The sensitivity and specificity of S100A11, alpha fetoprotein (AFP) and γ-glutamyl transpeptidase Ⅱ (GGT-Ⅱ ) in HCC diagnosis were compared. Results The positive rate of S100A11 in HCC tissue (78. 3%) was significantly higher than that in paracancerous tissues (19. 6%) (P<0. 05). The expression level was correlated with the degree of differentiation, the lower differentiation degree with the higher expression level. According to ROC curve, if the cutoff points for diagnosis was set at 7. 3 μg/L, the positive rate of S100A11 in HCC patients blood plasma was 30. 6% , which was significantly higher than that in the blood plasma of patients with liver cirrhosis, patients with chronic hepatitis and healthy persons (P<0. 05). There was no correlation between S100A11 and AFP or GGT-Ⅱ in the blood plasma of HCC patients. These three indicators were complementary in HCC diagnosis, and the diagnostic sensitivity increased to 84.5% with combined detection. Conclusions S100All may be related to HCC genesis and development. The HCC diagnostic sensitivity may be increased with combined detection of S100All ,AFP and GOT- Ⅱ.

Objective To compare the efficacy and side effects between systemic chemotherapy and hepatic arterial infusion by combination of oxaliplatin and 5-fluorouracil (FOLFOX-6) with 5-fluorouracil in the patients who have developed hepatic metastasis after colorectal cancer operation. The factors that would affect the prognosis without operational treatment were also analyzed. Methods 46patients who had signed the informed consents were allocated into two groups: the group with general chemotherapy (Trial Group includes 26 cases) and the one with hepatic arterial infusion chemotherapy (Control Group includes 20 cases). The total effective rate, the prognosis, the cytoxicitic side effects,quality of life, the total survival rate and the responses were the main parameters determined. Kaplan-Meier was used to analyze Mono-factor to the prognostic responses and the Cox mode was used to analyze poly-factor to the prognostic responses. Results The overall survival rate was significantly higher by using systemic treatment versus HAI(median, 15. 0 v 11.2 months;P＜0.05). The difference in overall responsive rate (CR+PR) between the two groups was statistically significant (50% v 10%;P=0. 011). No significant difference was found in PS scale during the treatment. (P=0. 126). Except for myelosuppression and abdominal pain, no significant difference was found in the other side effects. Univariate analysis revealed that the invasive lesions to serosa, the distribution of liver metastases, the size and number of liver metastases, primary carcinoma involving lymph nodes and the treatment were correlated with prognoses. Cox regression analysis showed that the larger diameter of liver metastases, the number of liver lesions, primary carcinomas involved in serosal layer and the treatment modules were independent prognostic factors. Conclusions The oxaliplatin-based FOLFOX-6 chemotherapy regiment has a better responsive rate and survival rate than the traditional infusion with 5-fluorouracil to the main hepatic artery for interventional therapy. The diameter of the hepatic metastasis larger than 5em, multiple hepatic metastasis and the primary lesions penetrating serosal layer suggest the poor prognosis. The oxaliplatin-based systematic chemotherapy has a better prognosis. Therefore,it is worth carrying on further study on modification of traditional hepatic arterial infusion and on evaluation of therapy by combination of the hepatic arterial infusion with the systematic chemotherapy.

Objective:To explore the expression of C-terminal binding protein 2 (CtBP2) in human esophageal carcinoma and its relationship with clinicopathological parameters and survival. Methods:The expression levels of CtBP2 in eight cases of fresh frozen specimens of esophageal squamous cell carcinoma (ESCC) and the adjacent esophageal tissues were detected by Western blot. Immuno-histochemistry was used to detect CtBP2 expression in 90 samples of ESCC tissues and adjacent non-tumor tissues. Based on patient in-formation and follow-up data, the correlation of CtBP2 expression with patients' clinicopathological characteristics and overall survival was further evaluated using Fisher's exact test and Kaplan-Meier method, respectively. Results: Immunohistochemistry and Western blot analysis showed that CtBP2 expression in tumor tissues was higher than that in adjacent non-tumor tissues. CtBP2 expression was significantly correlated with histologic grade (P=0.002) and depth (P=0.032). Kaplan-Meier analysis demonstrated that high CtBP2 ex-pression was correlated with a short survival time. Conclusion:CtBP2 expression was upregulated in ESCC tissues, indicating that it may play a role in the oncogenesis and development of ESCC.

Objectives To investigate the associations of the plasma homocysteine levels with the alterations in arterial stiffness in a commu-nity-based cohort. The gender differences in these associations were examined. Methods We evaluated the relationship between plasma homocysteine levels to three measures of vascular function [carotid-femoral pulse wave velocity (CF-PWV), carotid-ankle PWV (CA-PWV) and heart rate corrected augmentation index (AI)] in 1680 participants (mean age:61.5 years;709 men, 971 women) from communities of Beijing, China. Results In univariate analysis, plasma homocysteine levels was positively related to the CF-PWV (r=0.211, P<0.0001) and CA-PWV (r=0.148, P<0.0001), whereas inversely associated with AI (r=?0.052, P=0.016). In multiple linear regression models adjusting for covariants, plasma homocysteine remained positively related to the CF-PWV (standardizedβ=0.065, P=0.007) in total cases. When the groups of men and women were examined separately, plasma homocysteine remained positively associated with the CF-PWV (standardizedβ=0.082, P=0.023) in men, whereas the relations between homocysteine and any of the arterial stiffness indices were not further present in women. Conclusions In Chinese population, plasma homocysteine levels are independently associated with alterations of large artery stiffness in men but not in women.

ObjectiveTo establish the time-resolved fluoroimmunoassay (TRFIA) method for the detection of serum galectin-3 and investigate the clinical value of serum galectin-3 for the diagnosis of pancreas cancer.MethodsMonoclonal anti-human galectin - 3 antibody and biotinylated polyclonal antibody were used to establish the sandwich TRFIA for detection of serum galectin-3.The optimal experimental condition was studied.Serum levels of galectin-3,CEA and CA19-9 in the patients with pancreatic cancer,benign pancreatic mass,pancreatitis,and healthy controls were measured.The diagnostic value of serum galectin-3,CEA and CA19-9 for pancreas cancer was studied.ResultsThe linearity of the TRFIA for detection of serum galectin3 tanged between 0 to 100 μg/L.The within-run CV and between-run CV were ≤6.45％ and ≤8.68％,respectively,and the average recovery was 106.6％.The level of serum galectin-3 was 4.93 ( 0.85 ～ 23.80) μg/L in pancreatic cancer group,which were significantly higher than those in benign pancreatic mass [2.83 ( 2.17 ～ 4.06) μg/L ],pancreatitis [ 2.62 (0.55 ～ 9.76 ) μg/L ],and healthy controls group [ 1.88 ( 0.59 ～ 3.94) μg/L] (P ＜0.05).By using 3.77 μg/L as the cut-off point,the smsitivity,specificity for the diagnosis of pancreatic cancer was 75.5％ and 90.9％.The levels of Gal 3 and CEA,CA19-9 was not correlated ( r =0.1321,P =0.3761 ; r =0.0920,P =0.5384).Combined determination of galactin-3 and CEA,CA19-9 levels could increase the diagnostic sensitivity to 92％.ConclusionsTRFIA method for the detection of galactin-3 is sensitive and stable.Galectin-3 could be a potentially novel serum tumor marker of pancreatic cancer.

Objective To study the value of serum galectin-3 detected by nanomagnetic beads sorting time resolved fluoroimmunoassay (TRFIA) tandem analysis in the diagnosis of pancreatic cancer.Methods The serum of 88 cases of pancreatic cancer,50 cases of acute pancreatitis,10 cases of pancreatic cysts,and 20 cases of healthy volunteers as control were collected.First,galectin-3 antibody coupled nanomagnetic-beads was used to sort the semm,then TRFIA was applied to detect the level of galectin 3,and the result was compared with that of routine TRFIA.ROC curve was constructed to determine the cutoff value and sensitivity for pancreatic cancer diagnosis.Results The method of nanomagnetic beads sorting TRFIA detected the level of galectin 3 between O.78 and 100 ng/ml in a linear manner,the intra-CV was ≤6.38％,and inter-CV was ≤7.22％,and average recovery rate was 105.3％.The serum level of galectin-3 in control group by nanomagnetic beads sorting TRFIA was 0.38 (0.02 ～ 3.06) ng/ml,which was significantly higher than that detected by routine TRFIA [0.18 (0.00 ～ 2.64) ng/ml,P =0.000).The serum levels of galectin-3 by nanomagnetic beads sorting TRFIA in pancreatic cancer,acute pancreatitis,pancreatic cysts and healthy volunteers were 4.85(0.00 ～42.67),0.69(0.00～ 13.62),0.70(0.00 ～ 14.54),0.38(0.02 ～ 3.06) ng/ml,and the level of galectin-3 in pancreatic cancer was significantly higher than that in acute pancreatitis,pancreatic cysts and healthy volunteers group (P ＜0.01),while the difference among the other three group was not significantly different.The AUC of galectin-3 for pancreatic cancer was 0.851 ± 0.040,95％ CI:0.772 ～ 0.929.While using 1.07 ng/ml as the cut-off value,the positive rates for the diagnosis of pancreatic cancer,acute pancreatitis,pancreatic cysts and healthy volunteers were 84.1％ (74/88),34.0％ (17/50),20.0％ (2/10),10.0％ (2/20),and the sensitivity for diagnosis of pancreatic cancer was significantly higher than those in other 3 groups (P ＜ 0.01).Conclusions Nanomagnetic beads sorting TRFIA tandem analysis method can enrich serum galectin-3,and increase the sensitivity of detection for pancreatic cancer and enhance the diagnostic value of galectin-3 for pancreatic cancer.

Objective To investigate the therapeutic effects and mechanism of anti-radiation pneumonia decoction(ARPD) on radiation induced lung fibrosis in rats.Methods One hundred and five male SD rats in a SPF grade were divided into Chinese medicine group,single radiation group and control group by random digits table method,with 35 in each group.After anesthetization,rats in Chinese medicine and single radiation groups were exposed to 6 MV X-rays at the dose of 15Gy.Rats in Chinese medicine group were treated with ARPD at the dosage of 10 ml·kg-1 ·d-1 once a day,but rats in single radiation group did not receive ARPD treatment.Rats in control group were treated with neither irradiation nor drugs.Five rats of each group were killed and the lung tissues and blood samples were collected at 15,30,60,75,90,105 and 140 d.The pathological changes of lung tissues were observed and the tissue protein and gene expressions of TGF-β1,PAI-1 and collagen type Ⅲ(C Ⅲ) were assayed by Western blot and RT-PCR.ELISA was used to detect serum TGF-β1 and plasma PAI-1.Tissue and serum HYP were determined by acid hydrolysis and alkaline hydrolysis methods respectively.Results Inflammation was found in the lung tissues of all the exposed rats.Obvious pathological lung fibrosis was found at 60 d,the inflammation and the fibrosis in treated group were slighter than those in single radiation group.In Chinese medicine group,the protein and gene expression levels of TGF-β1,PAI-1,C Ⅲ 30 d(Protein:t =2.49-3.74,t =2.63-4.57 and t =2.76-3.83;Gene:t =2.59-4.33,t =2.83-4.62 and t =2.83-3.96,P＜0.05),serum TGF-β1 and plasma PAI-1 15 dlater (t =2.85-6.27 and t =3.69-5.27,P＜0.05),and the levels of tissue and serum HYP60 dlater (t=3.65-4.40 and t =6.56-3.75,P＜0.05),all of them were lower than those in single radiation groups.There were significant positive correlations between tissue TGF-β1 and PAI-1 as well as C Ⅲ (Protein expression:r =0.604,0.759,P ＜0.05;Gene expression:r=0.519,0.816,P＜0.05).Conclusions ARPD may inhibit the pulmonary fibrosis by decreasing the levels of TGF-β1,PAI-1 and C Ⅲ.

Objective The aim of current study is to determine the effect and mechanism of thymic stromal lymphopoietin on apoptosis of mouse nucleus pulposus cells by investigating the apoptotic activity and variation of intracellular phosphorylated protein kinase B (p-Akt),X-linkedinhibitor of apoptosis protein (XIAP),cysteinyl aspartate specific proteinase-3 (caspase-3),with the treatment of thymic stromal lymphopoietin.Methods Mouse lumbar nucleus pulposus cells were cultured and identified under a fluorescence microscope.Second or third passage cells maintained in monolayers were used for the following experiments.The groups were divided randomly into normal group,TNF-α treated group,TSLP treated group,TSLP+LY94002 treated group and TSLP+Embelin treated group.As a control,normal group was treated with PBS.TNF-α treated group was treated with 500 ng/ml TNF-αt as a positive control.TSLP treated group was treated with 10 ng/ml rhTSLP.TSLP+LY94002 treated group and TSLP+ Embelin treated group were treated with 10 ng/ml TSLP with the pretreatment of different pathway inhibitors for 30 ain in different corresponding experiments,for which 10 μ mol LY294002 or 50 LY294002 responding experimentsreatment of different pathway inhibitors formouse nucleus pulposus cells was detected by FACS.The expression levels of the intracellular p-Akt,XIAP,caspase-3 were investigated by Western blot analysis.Results As the culture cell type Ⅱ collagen staining was positive observed by fluorescence microscopy,we confirmed that the cuhured cells were nucleus pulposus cells.In comparison with negative control,the levels of p-Akt,XIAP in TSLP treated group were elevated (t=9.510,P=0.001;t=8.851,P=0.001).Thecaspase-3 activity were slightly enhanced and the rate of cells apoptosis was no significance.Compared with TSLP treated group,downregulated level of pAkt and XIAPand upregulatedcaspase-3 activity in TSLP+LY294002 treated group were observed (t=8.798,P=0.001;t=7.032,P=0.002;t=5.908,P=0.004).Upregulated caspase-3 activity were also observed in TSLP+ Embelin treated group (t=7.990,P=0.001).Furthermore,significant increased apoptotic cell rate was observed in TSLP+LY294002 or TSLP+Embelin treated groups (t=21.268,P=0.001;t=21.279,P=0.001).Conclusion TSLP may have a potential anti-apoptotic effect on mouse NP cells via upregulating XIAP in PI3K/Akt signaling pathway to restrain the activation of caspase-3.

Objectives:To explore the relationship between insomnia symptoms and neuroticism in patients with COVID-19,and to explore the role of anxiety and psychological capital in the relationship.Methods:Totally 687 patients with COVID-19 were recruited from Shanghai Fangcang Hospital.The Athens Insomnia Scale(AIS),Eysenck Personality Questionnaire-Revised Short Scale for Chinese Neuroticism Subscale(EPQ-RSC-N),Self-Rat-ing Anxiety Scale(SAS)and Psychological Capital Questionnaire(PCQ)were used to measure insomnia symp-toms,neuroticism personality trait,anxiety symptoms and psychological capital levels.The deviation-corrected per-centile Bootstrap method was used to test the mediating effect,and the PROCESS program was used to test the moderated effect.Results:The detection rate of insomnia symptoms was 49.93％.The AIS scores were lower in male patients than in female patients(P＜0.01).The SAS scores partly mediated the relationship between neuroti-cism scores and AIS scores,with an effect size of 0.03,accounting for 18.29％of the total effect.With the im-provement of PCQ scores,the predictive effect of SAS scores on AIS scores gradually decreased(β=-0.01,t=-4.41,P＜0.001).Conclusions:Anxiety symptoms in patients with COVID-19 play a partial mediating role in the positive relationship between insomnia symptoms and neuroticism.The psychological capital moderates the relation-ship between insomnia and anxiety symptoms.