Crohn’s disease( CD)is a gastrointestinal progressive granulomatous disease with unknown etiology. It is characterized as active stage alternating with remission stage,long-term course with many complications,sometimes needing surgery and having the tendency of relapse in patient ’s whole life. Therefore,it is important to define an effective therapeutic endpoint to ameliorate the natural course of CD. This article reviewed the progress in defining treatment endpoint of CD.

Inflammatory bowel disease( IBD)includes ulcerative colitis( UC)and Crohn’s disease( CD),its incidence is increasing yearly in our country. With the progress of molecular biology,genetics,the understanding of IBD is deepen,however,the exact pathogenesis of IBD is still not fully clear,and it may be related to gene,environment, immunity,microorganism. Studies have shown that smoking,vitamin D,sex hormones,emotions,diet may be related with the occurrence of IBD. This article reviewed the role of environmental factors in IBD.

Objective To investigate the advantages, indications and efficiency of video-assited thoraco-scopic sugery in spontaneous pneumothorax. Methods 31 patients with spontaneous pneumothorax underwent video-assited thoracoscopic sugery, performed with endoscopic manual suture without use of endoscopic cutters. Results All patients were cured without recurrence. Conclusions Video-assited thoracoscopic sugery is the first choice in treating spontaneous pneumothorax,with minimal trauma,less bleeding. Endoscopic manual suture can obviously re-duce the treatment cost.

BACKGROUND: Pathological changes of pulmonary emphysema are not reversible according to the existent pathogenesis of pulmonary emphysema. Research over many years report that injury of pulmonary blood capillary may take part in new pathogenesis of pulmonary emphysema based on lung volume reduction operation and bronchial lumen occlusion. Mesenchymal stem cells (MSCs) have multi-directional differentiation potencies, such as the differentiation into vascular endothelial cells. Therefore, MSCs may promote pulmonary vascularization and repair pulmonary tissue.OBJECTIVE: To observe the effect of MSCs transplantation on pathological changes of arterial blood gas and pulmonary tissue in model rats with pulmonary emphysema, and investigate the therapeutic effects on MSCs on pulmonary emphysema and the pathogenesis of pulmonary emphysema.DESIGN: Randomized controlled animal study.SETTING: The Second Hospital of Shanxi Medical University.MATERIALS: Thirty healthy Wistar rats, 6 weeks old, of either gender, weighing 180-200 g. They were provided by Physiological Experiment Animal Center, Shanxi Medical University. All rats were randomly divided into MSCs treatment group, model group and control group with 10 rats each.METHODS: The experiment was carried out in the Physiological Laboratory of Shanxi Medical University from April 2005 to April 2006. Rats in the MSCs treatment group and in the model group were anesthetized and intratracheally perfused with 250 U/kg Porcine pancreatic elastase (PPE) to establish pulmonary emphysema models; while, rats in the control group were perfused with saline. The models were successfully established 4 weeks later. All rats were anesthetized and then femur and tibia were obtained to separate and culture MSCs in vitro. Immunocytochemistry was used to detect the expression of CD71 in order to evaluate MSCs. Bromium azacytidine-labeled MSCs were inserted along caudal vein into rats in the MSCs treatment group; while, rats in the model group and control group were inserted with the same volume of PBS solution.MAIN OUTCOME MEASURES: ① Changes of arterial blood gas in the three groups; ② Pulmonary tissue was used for pathological sections in order to calculate mean alveolar number, mean alveolar area and mean linear intercept; ③Immunocytochemical staining was used to measure numbers of CD34+ cells so as to determine proliferation of alveolar blood capillary.RESULTS: Three rats in all died during the model establishment, while another 3 rats were supplied. Therefore, an overall number of 30 rats were involved in the final analysis. ① Culture and evaluation of MSCs: At 3 days after inoculation, MSCs were generally adherent to walls and fusiformly shaped. In the third generation, the expression of CD71 was observed on the surface of MSCs.② Comparisons of arterial blood gas in the three groups: There were no significant differences in pH value, PO2, PCO2 and SaO2 in the three groups (P ＞ 0.05). ③ Pathological changes of pulmonary tissue: Pathological changes in the MSCs treatment group were milder than those in the model group;meanwhile, mean alveolar number in the MSCs treatment group was more than that in the model group, and there was significant difference between them (F=80.201, P＜ 0.05). While mean alveolar area and mean linear intercept in the MSCs treatment group were smaller than those in the model group, and there were significant differences (F =26.755,26.875, P ＜ 0.05). ④ Comparisons of CD34+ expression in pulmonary tissue: Relative positive area of CD34+ in the MSCs treatment group and model group was smaller than that in the control group (F =20.411, P ＜ 0.05), but that in the MSCs treatment group was larger than that in the model group, and there was significant difference between them (F=20.411, P＜ 0.05).CONCLUSION: MSCs can reverse the pathological changes of pulmonary emphysema; on the other hand, the decrease of the number of pulmonary capillary maybe one of the important pathogeneses of pulmonary emphysema.

BACKGROUND:The human telomerase reverse transcriptase gene (hTERT) transfected into target cel s can play an important role in target cel proliferation and differentiation by increasing telomerase activity and maintaining telomere length. OBJECTIVE:To explore the effect of hTERT transfection on telomerase activity and biological characteristics of precartilage stem cel s culured in vitro. METHODS:Precartilage stem cel s cultured in vitro were subjected to hTERT gene transfection via a retrovirus vector pLXSN. Meanwhile, control and negative control groups were set up. After transfection, TRAP-ELISA assay was used to detect telomerase activity;RT-PCR and western blot employed to detect hTERT mRNA and protein expressions;cel counting kit-8 used to detect cel proliferaiton based on cel growth curve;and flow cytometry adopted to detect cel cycle and distribution. RESULTS AND CONCLUSION:The telomerase activity was significantly increased at 48 hours after hTERT gene was transfected into the precartilage stem cel s. After transfection of hTERT, hTERT mRNA and protein levels were significantly increased, the cel growth rate was significantly increased, the proportion of cel s at G 0/G 1 phase was decreased, and the number of S-phased cel s increased compared with the control group and negative control group. There were significant differences among the groups (P<0.05). In conclusion, hTERT transfection via retrovirus vector pLXSN can promote the proliferation of precartilage stem cel s in rats by increasing the telomerase activity.

Objective To investigate the clinical value of the combined detection of manganese superoxide dismutase (Mn-SOD)genetic polymorphism and lipoprotein phospholipase A2 (Lp-PLA2)in the early diagnosis of coronary heart disease (CHD).Methods 92 cases of coronary heart disease patients and 78 cases of healthy control group were selected.The activ-ity of Lp-PLA2,the activity of Mn-SOD and genotype of Mn-SOD 9 Ala/Val genetic polymorphism were detected in the ser-um of each group via the use of colorimetry,continuous monitoring technique and gene-sequencing method respectively and then the correlation of serum Mn-SOD,Lp-PLA2 and Mn-SOD genetic polymorphism with CHD were analyzed.Results The Lp-PLA2 activity in serum of CHD groups with Mn-SOD 9 VV genotype was statistically significantly higher than that of patients with the AV+AA genotype (P<0.01).The serum Mn-SOD activity in patients with VV genotype was signifi-cantly lower than that of those with AV+AA genotype (P<0.01).Conclusion Combined detection of Mn-SOD 9 Ala/Val genetic polymorphism and Lp-PLA2 activityin the serum can provide an important foundation for the diagnosis and predic-tion of coronary heart disease.

Objective To investigate the relationship between serum homocysteine (HCY)levels and oxidative stress in pa-tients with coronary heart disease (CHD).Methods According to the diagnostic criteria of CHD in 2010 (WS 319-2010)is-sued by the Ministry of Health,79 patients with CHD in Xi’an Central Hospital from June 2014 to December 2014 were se-lected as the experimental group,and 5 5 cases of healthy physical examination for the same period were selected as the nor-mal control group.The levels of oxidative stress marker malondialdehyde (MDA)and the activity of antioxidant enzyme su-peroxide dismutase (SOD)in serum were detected to analyze the state of oxidative stress.The levels of serum HCY were de-tected,and the correlation between HCY levels and MDA levels and SOD activity was analyzed.Results The levels of MDA in the CHD group were significantly higher than that in the control group,while SOD activity was significantly lower than that in the control group,the differences were statistically significant (t=3.112,2.684,all P<0.05).The levels of HCY in the CHD group were significantly higher than that in the control group,the difference was statistically significant (t=3.268,P<0.05).In the CHD group,the levels of HCY were positively correlated with the levels of MDA (r=0.236,P<0.05),and negatively correlated with SOD activity (r=-0.221,P<0.05).Conclusion Serum HCY levels were increased and oxidative stress reaction was enhanced in patients with CHD.Oxidative stress was associated with elevated serum HCY levels.Serum HCY levels and oxidative stress played an important role in the occurrence and development of CHD.

Objective To establish the training objective systems for undergraduates in mili-tary clinical medicine in order to promote the educational reform of military medicine, and to improve the quality of talents training in military medical universities. Methods Literature analysis was made to determine the initial military clinical medical undergraduate training objectives, and a questionnaire was given to experts, on-the-job military doctors, medical graduates to know the real requirements of military doctors' position. A total of 455 valid questionnaires were collected. Then the questionnaire results were discussed and summarized by the method of expert discussion. Finally,. Delphi method was used to determine the ultimate training objective system. Results The ultimate training objective system of military undergraduate clinical medicine contains two aspects, eight fields and sixty-one standards objective systems. Conclusion Organically fusing military medical knowledge, ability and professional quality requirement into two levels and eight modules and clearly understanding the standards and requirements of each module are significantly systematic, advanced and operable, which has important reference value and guiding significance to both the military medical colleges and uni-versities and the local universities.

Objective To investigate the effects of transcutaneous electro acupuncture stimulation (TEA) on esophageal motility of patients with refractory gastroesophageal reflux disease (RGERD) by high resolution manometry (HRM),and to provide a new treatment option for RGERD.Methods From February 2014 to June 2015,a total of 45 patients with RGERD were enrolled.TEA instrument was used for electro acupuncture stimulation at the points of Zusanli and Neiguan.HRM was carried out before and after treatment.The changes of HRM parameters such as lower esophageal sphincter pressure (LESP),distal contractile integral (DCI),and amplitude of 3 cm,7 cm above lower esophageal sphincter (LES),esophageal body velocity and contractile front velocity (CFV) were also compared.The paired-samples t test was performed for statistical analysis.Results According to LESP value,45 patients were divided into low LESP group (10 patients) and normal LESP group (35 patients).According to parameter of esophageal motility function,patients were divided into esophageal dysmotility group (25 patients) and normal esophageal motility group (20 patients).After TEA treatment,the LESP of lower LESP group was (14.83± 4.17) mmHg (1 mmHg =0.133 kPa),which was higher than that before treatment ((9.54 ±2.42) mmHg),and the difference was statistically significant (t=4.92,P=0.001).LESP of esophageal dysmotility group was (19.04±5.91) mmHg,which was higher than that before treatment ((16.20±6.09) mmHg),and the difference was statistically significant (t=4.92,P=0.001).There was no statistically significant difference in LESP of normal LESP group and normal esophageal motility group before and after treatment (both P＞0.05).After treatment,DCI of esophageal dysmotility group was (530.76±215.53) mmHg· cm· s,which was higher than that before treatment ((363.92 ± 279.17) mmHg · cm · s),and the difference was statistically significant (t=2.86,P＜0.05).There was no statistically significant difference in esophageal body velocity,amplitude of 3 cm,7 cm above LES andCFV before and after treatment (all P＞0.05).There was no statistically significant difference in all of the esophageal motility parameters in normal esophageal motility group before and after treatment (all P＞0.05).Conclusion TEA can increase LESP and DCI in RGERD patients with esophageal motility dysfunction,improve contraction of entire esophagus and raise esophageal clearance capacity.

Objective 　To explore the operating approaches through cavity for large tumors in sellar area. Methods　The one side orbit-below frontal approach was used for 13 cases with large tumor on axial line from inside suprasellar and the orbit pterional approach was selected for 11 cases with larger tumor in suprasellar area or outside the area. Results　Total removal was achieved in 9 cases, subtotal in 9 cases and partial in 6 cases. 1 patient died after operation. The rest recovered well recoveered without serious complication. Conclusions　The two approaches have the merits of simple technique, exposing well, gentle brain pulling and few complication, which are suitable for operation on the large tumor in sellar area.