To meet the need of cultivating the high-quality medical personnel,we have ad-justed and reformed the content of the "Clerkship" teaching in obstetrics and gynecology and conducted the survey and research among teaching philosophy,training mode and management mechanism,and have obtained more satisfactory teaching result.

Objective To examine the effect of fibronectin connecting segment-1 (CS1) peptidefacilitated blockade of inflammatory cells-fibronectin adhesion on a rat liver transplantation model of prolonged ex vivo cold ischemia.Methods A model of liver transplantation in Wistar→Wistar rat was established.The donors of the CS1 treatment group received CS1 peptides through the tail vein for 3 days before operation.Another two doses of CS1 peptides were administered into the liver intraportally during procurement and before transplantion.Recipients received an additional 3-day course of CS1 peptides after transplantation.Rats in control group received scrambled peptides.Rats were sacrificed at 6,24 and 72 h after transplantion,and plasma transaminase activity and hepatic pathological changes were studied.The inflammatory cells and liver sinusoidal endothelial cells were visualized histochemically.Real-time PCR was used to detect tumor necrosis factor-α (TNF-α),interleukin-1β (IL-1β) and vascular endothelial growth factor (VEGF) mRNA expression in the liver.Results The plasma transaminase activity and hepatic necrosis areas in CS1 treatment group were significantly lower than in control group (P＜0.05).CS1 peptides treatment significantly decreased the number of Kupffer cells after transplantation and greatly inhibited the recruitment of neutrophils to the graft liver as compared with control group (P＜0.05).After prolonged cold ischemia,only a few hepatic endothelial cells exhibited positive staining of hepatic sinusoidal endothelial cell biomarker SE-1.Lots of hepatic sinusoidal endothelial cells positive for SE-1 staining could be detected in CS1 group at 72 h after transplantation,while much less SE-1 positive cells presented in the control goup.Prolonged cold ischemia caused a significant increase of TNF-α,IL-1β and VEGF mRNA expression in the graft liver of control group after transplantation.The expression of TNF-α mRNA at 6 and 24 h and VEGF mRNA expression at 24 h were significantly lower in CS1 group than in control group (P＜0.05).Conclusion Peptide-mediated blockade of inflammatory cells-fibronectin interaction decreased the mRNA expression of inflammatory cytokines,prevented hepatic sinusoidal endothelial cells from injury and subsequently protected against severe ischemia/reperfusion injury of the graft liver after transplantation.

Objective To study the application of coronary endarterectomy (CE) in coronary artery bypass graft (CABG), and to evaluate the effect of CE plus CABG on patients with chronic total occlusion (CTO) combined with diffuse distal atherosclerosis. Methods Thirty one patients, who underwent coronary endarterectomy in our institution between Oc-tober 2009 and October 2012, were reviewed retrospectively and compared the control group with 31 patients of their age, sex, LV function, and angina class. Results Among the 31 patients, 27 patients underwent one, 4 patient underwent two coronary arteries endarterectomized. Of all these 35 total endarterectomies, 13 (37%) were at left anterior descending artery, 3(9%) were at branches of the circumflex artery, and 19 (54%) involved the right coronary artery. There was no statistical dif-ference between two groups in clinical parameters including aorta cross time, cardiopulmonary bypass time, graft runoff, pul-sation index and mechanism ventilate time (P>0.05). There was no perioperative myocardial infarctions in CE group nor in control group. All patients were followed up and no recurrent angina were present in CE group. In CE group, one patient died of fungal pneumonia and heart failure half a year after operation. Conclusion In current cardiac surgical practice, coronary endarterectomy is an indispensable adjunct to CABG. The operative mortality and major morbidity were comparable or simi-lar to coronary artery bypass grafting, but its short-term and medium-term results were more favorable than to CABG.

Objective To observe clinical application value of percutaneous interventional techniques for the treatment of complications of AIDS.Methods Twenty-one AIDS patients with complications were enrolled.CT guided percutaneous needle biopsy and drainage were conducted,and the correct rate of diagnosis,clinical curative effect and complications post-interventional therapy were observed.Results The operations of all patients executed successfully.Fourteen patients underwent 16 times biopsy,11 were correctly diagnosed,the diagnostic accordance rate was 81.25%.Drainage was performed in 6 patients with abscess or cystis,then the lesions completely disappeared in 3,deflated in 2,while the rest one needed continously draining.Partial splenic embolization (50%) was performed in 1 patient,and after operation platelet content increased,while hepatic function decreased temporality.No complicated infection and other severe complications occurred.Conclusion Percutaneous interventional techniques for the treatment of complications of AIDS are safe and feasible.Medical staffs should be careful to exposition of HIV infection.

Mycobacterium abscessus complex (MABC), a rapidly growing nontuberculous mycobacterium, has received increasing attention worldwide due to its rising isolation rate. The similarity of symptoms between MABC pulmonary disease and tuberculosis, different treatment methods required by different subtypes, as well as high levels of innate, adaptive and acquired antibiotic resistance, make MABC treatment more difficult and lead to unfavorable clinical outcomes of patients. This article reviews the basic characteristics, common antibiotic resistance mechanisms, as well as diagnosis and treatment of MABC, to provide reference for future research and clinical treatment of MABC lung disease.

Objective To study the clinical characteristics of neonatal Serratia marcescens sepsis.Method A retrospective review of perinatal factors,clinical manifestations,laboratory findings,treatment and prognosis of Serratia marcescens sepsis in our unit from January 2012 to November 2017.Result A total of 21 cases of serratia marcescens sepsis were identified (diagnosed),all except one were prematurely born.Infection occurred on different days after birth,2 within 3 days,1 within 3 ～ 7 days and 9 in the second week,and the remainder,after 14 days.The clinical manifestations of neonatal Serratia marcescens sepsis were uncharacteristic,mainly manifested as gray pallor,lethargy,and recurrent apnea.Some infants had complications such as pulmonary hemorrhage,septic shock,necrotizing enterocolitis and scleroderma.Most infants had low white blood cell count,thrombocytopenia and high C-reactive protein at the onset of illness.All Serratia marcescens cases were sensitive to piperacillin/tazobactam,ceftazidime and meropenen.In total,17 cases had lumbar puncture,5 of them diagnosed with meningitis,with elevation of cerebrospinal fluid white blood cell count and protein,and 3 infants complicated with brain abscess.The duration of antibiotic therapy were 14 days or more depending on the clinical conditions.The overall mortality was 14.3％.Conclusion Serratia marcescens is an important opportunistic pathogen.It might cause serious infections in the premature infants including sepsis,brain abscess and meningitis.Regular neuro-imagings might be necessary for all sepsis infants.The infected and colonized neonates might be the hidden source of Serratia marcescens.The surveillance protocols,eradication of colonization,and strict adherence to hand disinfection/washing might help to prevent dissemination of invasive bacteria among premature infants.

Objective:After the propensity score matching method was used to balance the covariates between groups, the effects of pancreaticoduodenectomy (PD) and total pancreatectomy (TP) on the survival of patients with pancreatic head cancer and related prognostic factors were compared.Methods:The National Cancer Institute Surveillance, Epidemiology and Results (SEER) database were searched and 3 676 patients with pancreatic head cancer from 2010 to 2016 were selected, of whom 3 559 patients underwent PD (PD group) and 117 patients underwent TP (TP group) . Using propensity score matching to balance confounding factors, 117 pairs of cases from PD group and TP group were matched successfully. The Kaplan-Meier curve was used to observe the overall survival rate and cancer-specific survival rate of patients before and after matching. Log-rank test and Cox proportional hazard model were used to analyze and evaluate the impact of different clinicopathological characteristics on the prognosis of patients with pancreatic head cancer.Results:Before matching, the 1, 3, and 5-year cancer-specific survival rates of 3 559 patients in the PD group were 72.8%, 35.1% and 24.9%, and the median survival time was 23.89 months; the 1, 3, and 5-year cancer-specific survival rates of 117 patients in the TP group were 67.9%, 29.4% and 26.1%, and the median survival time was 21.51 months, and all the differences were not statistically significant (all P>0.05). After matching, the 1, 3, and 5-year cancer-specific survival rates of 117 patients in the PD group were 77.8%, 44.5% and 31.8%, and the median survival time was 31.50 months, which was significantly better than that of the TP group, and the differences were statistically significant (all P values <0.05). Cox regression analysis showed that surgical methods, tumor differentiation degree, N staging and pathological types were independent risk factors for overall survival and cancer-specific survival. Conclusions:Surgical methods, tumor differentiation degree, N stage and pathological type were independent risk factors affecting the overall survival rate and cancer-related survival rate. The survival benefit of PD was significantly better than that of TP, and the clinical choice of TP treatment for patients with pancreatic head cancer should be cautious.

OBJECTIVE: To investigate the relationship between the level of Foxp3 mRNA in the peripheral blood monocytes (PBMCs) with acute rejection or chronic allograft nephropathy after kidney allotransplantation. METHODS: Real-time quantitative polymerase chain reaction was used to examine Foxp3 mRNA expression in the PBMCs from 16 patients with acute rejection, 8 patients with chronic allograft nephropathy, 8 patients at stable stage after kidney transplantation, 8 patients of end-stage renal disease, and 8 normal controls. RESULTS: The level of Foxp3 mRNA in the PBMCs was significantly lower in patients with acute rejection than that in patients with chronic allograft nephropathy (P<0.01). Foxp3 mRNA expression was significantly lower in patients with chronic allograft nephropathy than that in the normal controls, the end-stage renal disease group, and stable stage group (P<0.01). The level of Foxp3 mRNA was not significantly different in the PBMCs among the normal controls, the end-stage renal disease group, and the stable stage group (P>0.05). CONCLUSION The level of Foxp3 mRNA expressed in PBMCs can reflect the status of renal allograft, and may be a noninvasive biomarker for diagnosing acute rejection and chronic allograft nephropathy.
Adult ; Biomarkers ; metabolism ; Case-Control Studies ; Female ; Forkhead Transcription Factors ; genetics ; metabolism ; Graft Rejection ; metabolism ; Humans ; Kidney Transplantation ; Male ; Middle Aged ; Monocytes ; metabolism ; RNA, Messenger ; genetics ; metabolism ; Uremia ; blood ; surgery

OBJECTIVE: To design short hairpin RNA (shRNA) interference sequence to silence glutathione S-transferase P1 (GSTP1) gene of androgen independent prostate cancer cell line DU145, and to explore its effect on proliferation and sensitivity to chemotherapeutics. METHODS: The target sequence was picked up to form the shRNA, and the 3 shRNA expression vectors were shRNA255, shRNA554 and shRNA593. The DNA template was cloned to plasmid pGPU6/GFP/Neo. The shRNA was identified by enzyme digesting and gene sequencing. The screening experiment was done to pick up the shRNA expression vector with the highest transfection ratio and best gene silencing results. DU145 cells were divided into a blank plasmid group and a shRNA transfected group. According to the chemotherapeutics the DU145 cells were divided into a fluorouracil (FU) group and a paclitaxel (PA) group, and the 2 groups were subdivided into 4 subsets according to the chemotherapeutic concentrations (FU: 30, 60, 120, and 240 μg/mL; PA: 0.2, 2, 10, and 20 μg/mL), meanwhile a blank control group was included respectively. 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) assay was used to evaluate the proliferation after the transfection. MTT and terminal de-oxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) assay were used to detect the inhibition effect of different concentrations of 5-FU or PA on the proliferation and induction of apoptosis of DU145. RESULTS: The transfection ratio of the 3 shRNA expression vectors (shRNA255, shRNA554, and shRNA593) was (63.30±1.04)%, (76.20±0.68)%, and (72.70±0.33)%, and the transfection ratio of shRNA554 was the highest. there was significant difference among the above 3 shRNA expression vectors (P<0.01). After the transfection, the mRNA was 128.31±2.50, 43.24±4.30 and 85.62±6.30, the GSTP1 protein was 163.92±12.40, 65.38±9.30 and 114.25±16.70. After the transfection of shRNA554, the mRNA and protein of GSTP1 were the lowest level. there was significant difference among the above 3 shRNA expression vector (P<0.01). MTT analysis showed that before the transfection, the survival ratio of cells under different concentrations of FU (30, 60, 120, and 240 μg/mL) was (95.60±2.11)%, (90.20±0.86)%, (83.10±3.12)% and (74.60±1.32)%; however after the transfection, the survival ratio of cells was (91.30±1.43)%, (84.60±2.13)%, (73.20±1.52)%, and (65.5±0.942)%. TUNEL assay showed that before the transfection, the apoptosis ratio of cells under different concentrations of FU (30, 60, 120, and 240 μg/mL) was (5.50±0.88)%, (10.20±1.64)%, (15.20±2.39)%, and (25.10±2.59)%; however after the transfection, the apoptosis ratio of cells was (10.8±0.62)%, (15.7±1.32)%, (20.4±1.89)%, and (34.9±2.54)%. After the transfection, the cell survival ratio decreased under the same concentration of FU, and the apoptosis ratio increased, with statistical significance (both P<0.01). MTT analysis showed that before the transfection, the survival ratio of cells under different concentrations of PA (0.2, 2, 10, and 20 μg/mL) was (98.50±2.34)%, (95.20±1.32)%, (89.40±0.68)%, and (82.70±1.73)%; after the transfection the survival ratio of cells was (94.20±0.78)%, (86.50±2.13)%, (78.70±1.34)%, and (70.10±0.76)%. TUNEL assay showed that before the transfection, the apoptosis ratio of cells under different concentrations of PA (0.2, 2, 10, and 20 μg/mL) were (2.40±1.07)%, (5.20±1.33)%, (10.50±2.41)%, (20.70±1.92)%; after the transfection the apoptosis ratio of cells was (5.46±2.13)%, (13.80±1.24)%, (21.20±2.39)%, and (29.20±2.21)%. After the transfection, the cell survival ratio decreased under the same PA concentration, and the apoptosis ratio increased, with statistical significance (both P<0.01). CONCLUSION gene GSTP1 silence via shRNA transfection to androgen independent prostate cancer cell line DU145 can inhibit its proliferation in time dependent manner, and induce apoptosis and raise its sensitivity to chemotherapeutics.
Androgens ; metabolism ; Antineoplastic Agents ; pharmacology ; Apoptosis ; genetics ; Cell Line, Tumor ; Cell Proliferation ; Gene Silencing ; Glutathione S-Transferase pi ; genetics ; Humans ; Male ; Prostatic Neoplasms ; genetics ; pathology ; RNA Interference ; RNA, Small Interfering ; genetics ; Transfection

OBJECTIVE: To determine the effect of transient withdrawal of immunosuppressive agents during the treatment of pulmonary infection on long-term survival of patients and graft s. METHODS: A total of 104 patients with post-transplant pulmonary infection were enrolled in this study. These patients received renal transplantation in Center for Organ Transplantation, Xiangya Hospital, Central South University, during December 2005 and August 2014. Among them, 50 patients stopped immunosuppressive agents during the treatment of infection. These patients served as stopping drug (SD) group, whereas the remaining patients who served as a control group did not stop immunosuppressive drugs. The five-year cumulative patient survival, graft survival, and laboratory results were compared between the 2 groups. RESULTS: The five-year cumulative patient survival rates in the SD group were significantly lower than those in the control group [(69.8 ± 7.0)% vs (94.2 ± 3.2)%, P=0.001]. There was no significant difference in the allograft survival rates between the 2 groups [(81.7 ± 6.6)% vs (90.9 ± 4.3)%, P=0.113]. In patients who survived from pulmonary infection, there was no significant difference in long-term survival rates between the 2 groups (P=0.979). CONCLUSION Pulmonary infection impacts allograft survival after patients underwent renal transplantation. Transient stopping immunosuppressive agents during the treatment of infection is a safe and necessary treatment strategy for patients with serious post-transplant pulmonary infection.
Graft Rejection ; Graft Survival ; Humans ; Immunosuppressive Agents ; administration & dosage ; Kidney Transplantation ; Lung Diseases ; therapy ; Postoperative Complications ; Survival Rate ; Transplantation, Homologous