Objective To assess the effects of tacrolimus (FKS06) on podocyte in type 2 diabetic model rats and to explore the potential mechanism.Methods The model rats were fed with high fat and high sugar food and combining with a low-dose of streptozotocin (STZ).They were then randomly divided into a diabetic mellitus group (DM group) and a FK506 group.A normal control group (NC group) was also set.The rats in FK506 group were given with 0.5 mg· kg-1· d-1 FK506 for 8 weeks.The biochemical parameters were measured.The changes of renal pathology and ultrastructure of podocyte were observed by the light and electron microscopy.The expression of nephrin and LC3-Ⅱ was determined by immunohistochemistry and Western blotting.Results (1) Compared with those in NC group,KW/BW,systolic blood pressure (SBP),fasting blood glucose (FBG),triglyceride (TG),total cholesterol (TC),urinary albumin excretion rate (UAE) and creatinine clearance rate (Ccr) in DM group were significantly increased (all P ＜ 0.05).And the KW/BW,UAE and Ccr were decreased in FK506 group compared to those in DM group (all P ＜ 0.05),while other parameters had no significant difference (all P ＞ 0.05).(2) Compared with those in NC group,the glomerular volume,mesangial cell proliferation and accumulation of mesangial matrix were increased,and the foot process became disorder and fusion in DM group,while these changes were significantly reduced in FK506 group.(3) Compared with that in NC group,the expression of nephrin and LC3-Ⅱ was decreased in DM group (all P ＜ 0.05),and both of parameters were higher in FK506 group than those in DM group (all P ＜ 0.05).Conclusion FK506 may enhance podocyte autophagy in type 2 diabetic model rats and attenuate podocyte injury.

Aim To explore the effect of water extract of Radix Isatidis(WERI)on proliferation and differentiation of 3T3-L1 preadipocytes.Methods 3T3-L1 preadipocytes were cultured to explore the effect of WERI on their proliferation measured by MTT and flow cytometry.Oil red O staining was applied to investigate the effect of different concentrations of WERI on the differentiation of 3T3-L1 preadipocytes.

Objective To investigate the relationship between the infiltration of lymphocytes in renal tissues and podocytes injury in patients with lupus nephritis (LN),and provide the evidence of mechanism of podocytes injury in LN.Methods Thirty cases of biopsy proven LN patients were enrolled into the study,10 cases were selected as a the controls.The clinical and pathological data and renal tissues were collected.The infiltration of T lymphocytes (CD4+,CD8+ cells) and B lymphocytes (CD20+ cells) in renal tissues were detected by immunohistochemical method.The nephrin expression was detected by immunofluorescence.The relationship between CD4+,CD8+,CD20+ cells in renal tissues and 24 h UP,nephrin expression were analyzed by Pearson's correlation analysis,respectively.Results ① Compared with the control group,the 24 h UP was increased [2.86±1.37 vs 0.10±0.22 (g/24 h)];the infiltrations of inflammatory cells were increased significantly,the podocytes injury could be observed,combined with effacement of podocytes foot processes or disappeared in the LN group.Moreover,the increase of 24 h UP of active LN group was more evident than that in the inactive group [3.91 ±1.45 vs 1.77±0.69 (g/24 h),F=24.15,P＜0.05],and the infiltration of inflammatory cellsand effacement of podocytes foot processes were more severe in the active LN group.②Compared with the control group,the nephrin expression decreased and the infiltration of CD4+,CD8+ and CD20+ cells in the renal tissues increased significantly,which was mainly aggregated in renal interstitial tissue.And In addition,CD4+ [98±13 vs 40±12 (cells/glomerulus),F=240.18,P＜0.05],CD8+[109.0±16.4 vs 53.3±12.1(cells/glomerulus),F=210.40,P＜0.05] and CD20+ [149.4±1.4 vs 82.6±13.3 (cells/glomerulus),F=544.30,P＜0.05] cells of the active LN group were more remarkable than that in the inactive group.③ The Pearson correlation analysis showed that CD4+,CD8+ and CD20+ cells in renal tissues were positively correlated with 24 h UP (r=0.688,0.748,0.702;P＜0.01),and were negatively correlated with nephrin expression (r=-0.623,-0.793,-0.693;P＜0.01).Conclusion The infiltrations of CD4+,CD8+ and CD20+cells in renal tissues are very closely related with podocytes injury in patients with LN,and the infiltration of lymphocytes may be an important mechanism for podocytes injury in LN patients.

Objective To observe the feasibility and safety of self-made extended endobronchial tube applicated in one-lung ventilation for radical resection of esophageal cancer.Methods 80 patients were randomly divided into two groups:self-made extended endobronchial tube group (group A) and double-lumen endobronchial tube group (group B).The degree of lung collapse,systolic blood pressure,diastolic blood pressure,heart rate,airway pressure (Paw),arterial partial pressure of oxygen(PaO2),arterial partial pressure of carbon dioxide(PaCO2),arterial oxygen saturation (SaO2) were monitored.The time for insertion,rate of successfully intubation for single time,incidence of postoperative hoarseness and sore throat were recorded.Results There were no significant differences in degree of lung collapse,systolic blood pressure,diastolic blood pressure and heart rate,SaO2 in the two groups(all P＞0.05).The comparison of the time for insertion between the two groups:(1.5±0.4)min vs.(2.6±0.8)min(t=4.78,P＜0.05);rates of successfully intubation for single time:95.0％ vs.80.0％(χ2=5.19,P＜0.05).The comparison of Paw between the two groups:T1:(17.3±1.1)cmH2O vs.(22.5±0.9)cmH2O,t=4.613,P＜0.05;T2:(17.9±0.5)cmH2O vs.(23.6±1.4)cmH2O(t=5.438,P＜0.05);T3:(18.1±0.8)cmH2O vs.(24.6±1.2)cmH2O(t=3.741,P＜0.05).The comparison of blood gas during one-lung ventilation between the two groups:PaO2(281.5±53.4)mmHg vs.(187.6±48.8)mmHg(t=5.28,P＜0.05);SaO2(98.1±6.3)％ vs.(94.5±5.7)％(t=3.46,P＜0.05);PaCO2(31.2±3.6)mmHg vs.(37.6±4.1)mmHg(t=6.32,P＜0.05).The comparison of incidence of postoperative hoarseness:1case vs.6cases(χ2=5.91,P＜0.05);The comparison of incidence of sore throat:4cases vs.13cases(χ2=6.13,P＜0.05).Conclusion Single-lung ventilation has achieved via either the double lumen tube or the self-made extended endobronchial tube.However,the self-made extended endobronchial tube is recommended for single-lung ventilation because of the advantages of its easy intubation and position,full oxygenation,low Paw,less incidence of postoperative hoarseness and sore throat.Self-made extended endobronchial tube can be used as a one-lung ventilation method in its indications.

Objective:To understand the similarities and differences of medical ethics education between Chinese and American medical colleges and universities,grasp the advantages and disadvantages,and analyze the enlightenment of American medical ethics education to our country.Methods:We used individual interview method of qualitative research methods and conducted semi-open interview.Results:China can adjust the curriculum provision appropriately,enrich the content of medical ethics education,improve the medical ethics practice education,enrich teaching approaches and diversify examination form in medical students moral education cultivation.Conclusion:Both China and the United States attach great importance to medical professionalism education,medical ethics training and the doctor-patient relationship education.However,there are significant differences in their history,culture,religion and morality,as well as the medical systems,education on medical students and medical ethics education.Views formed in the interview provide certain reference and guidance for Chinese medical ethics education at a certain level.

Objective To study clinical efficacy of leuprorelin acetate in treatment of uterine adenomyosis with infertility.Methods From January 1,2011 to March 31,2012,166 cycles in 166 infertile patients combined with uterine adenomyosis undergoing in vitro fertilization embryo transplant (IVF-ET) with long protocol ovum induction by leuprorelin acetate in centre of medical reproduction,ningbo women and children's hospital were studied retrospectively.In the mean time,200 cycles in 200 infertile patients with tubal factors were enrolled as control group.The volume of uterus and outcome of IVF-ET were compared and studied between two groups.Results (1) Volume of uterus:in adenomyosis group,after 2-6 cycles of injecting leuprorelin acetate (3.75 mg/28 days),the mean uterine volume was shrinked from (180 ±73) cm3 to (86 ± 67) cm3 (P ＜ 0.05).(2) Outcome of IVF-ET:the rate of embryo implantation was 39.1％ in adenomyosis group and 35.8％ in control group.The rate of clinical pregnancy was 54.2％ in adenomyosis group and 53.7％ in control group.The rate of abortion was 4.7％ in adenomyosis group and 4.2％ in control group.They all did not show statistical differences (P ＞0.05).(3) In adenomyosis group,the rate of fertilization,two pronuclear (2PN) and superior embryo were 67.2％ (319/475),60.8％(289/475) and 52.9％ (162/306) in patients with failed pregnancy and 74.2％ (423/570),67.7％(386/570) and 62.1％ (256/412) in patients with successful pregnancy after IVF-ET,which reached significant difference (P ＜ 0.05).Conclusion Leuprorelin acetate could improve volume of uterine adenomyosis and outcome of pregnancy in patients undergoing IVF-ET.

Objective To investigate the effect of Notch signaling during bone marrow mesenchymal stem cells (BMSC) differentiating into islet in vitro.Methods The specific inhibitor of γ-secretase DAPT was used to inhibit the Notch signaling pathway.Mter induction,DTZ staining,indirect immunofluorescence staining,RT-PCR and Westenn blotting were used to detect the expression of insulin,glucagon,Pdx-1 and Ngn3.Results (1) Identification of BMSCs:Indirect immunofluorescence staining showed that BMSCs could express CD59 and CD90,which both were makrers of mesenchymal stem cells.Besides,BMSCs could express nerve culluar markers such as NSE,GFAP,suggesting multi-directional differentiation.(2) The result of MTT showed DAPT could inhibit the cell proliferation in a time-dependent manner and a dose-dependent mannar.Besides,DAPT could inhibit the expression of target gene of Notch signal pathway in a time-dependent manner and a dosedependent mannar.After treated by 1,5,20 μmol DAPT,the expression of Hes1 had reached to 92.06％,71.40％ and 46.89％ of controls respectively,suggesting efficiency of inhibition on Notch reached 7.94％,28.6％ and 53.11％ respectively (all P＜ 0.05).(3) Indirect immunofluorescence staining showed the expression of pancreas-specific markers such as insulin and glucagon were much higher in DAPT treated BMSCs than that in controls,which was confirmed by RT-PCR and Western blotting analyses.The proportion of insulin-producing cells differentiated from DAPT treated BMSCs was (74.03 ± 3.96)％,which was higher than that from controls[(36.49 ± 3.24)％,P＜ 0.05].(4)Furthermore,RT-PCR and Western blotting analysis showed that the expressions of Pdx-1 and Ngn3 were earlier than that of insulin and glucagon,and the expressions of Pdx-1 and Ngn3 were higher in DAPT treated BMSCs than that in controls.Conclusions Notch signaling pathway plays a role in the differentiation of BMSCs into islet in vitro.Pharmacological interference with Notch signaling pathway may provide a novel method to obtain islet for therapeutic use.

Objective To explore the reasonable dose of hydromorphone hydrochloride in the elderly patients after hip surgery. Methods 120 cases of elderly patients who underwent total hip arthroplasty in Affiliated Hospital of Jiangsu University from April 2016 to July 2016 were divided into six groups randomely,with 20 cases each group,they were 0.020,0.035,0.050,0.065,0.080 and 0.095mg/mL group,the corresponding concentrations of HYD were given to each group after surgery,blood rheology, inflammatory cytokine, VAS and Ramsay sedation scores were observed at different time points, Complications were recorded. Results One day and three days after operation,whole blood viscosity and whole blood reduced viscosity level of six groups were significantly increased (P<0.05),with the increase of the concentration of HYD,whole blood viscosity and whole blood reducing viscosity of each group decreased,compared with 0.020-0.050 mg/mL group,the 0.065-0.095 mg/mL group was lower (P<0.05).One day and three days after operation,the levels of inflammatory cytokines were increased in six groups (P<0.05),with the increase of the concentration of HYD,the level of inflammatory factors decreased,compared with 0.020-0.050 mg/mL group,the 0.065-0.095 mg/mL group was lower (P<0.05).The VAS scores of six groups were decreased in different degree with the prolongation of time, with the increase of the concentration of HYD,VAS at different time after operation decreased to some extent (P<0.05),compared with 0.020-0.035 mg/mL group,the 0.050-0.095 mg/mL group was lower (P<0.05). Ramsay sedation scores increased in 0.020-0.035mg/mL group and decreased in 0.065-0.095mg/mL group,but no significant change in 0.050mg/mL group. The incidence of adverse reactions was the lowest in the 0.050 mg/mL group. Conclusion HYD can be used for postoperative analgesia in elderly patients undergoing hip joint surgery,the concentration of HYD was correlated with the analgesic efficiency, and the recommended concentration was 0.050 mg/mL.

The provision of hospice care can improve the quality of life for terminal patients. Currently the measurement tools for knowledge, attitudes and practices(KAP)of hospice care providers have been developed and widely used internationally. This article reviews the measurement scales and relevant factors for KAP of hospice care to provide reference for further studies. The databases of CNKI, Wanfang data, PubMed, Web of Science databases, Google and Baidu search engines were systematically searched. According to the retrieval strategy, 42 literatures were finally included for analysis. The development of measurement scales and influencing factors about KAP of medical staff were reviewed from the included studies. It appeared some mature scales have been applied in different extent, or available for interpretation into different language versions. Most of researches adopted quantitative tools to measure medical staff's KAP on hospice care. The current researches conducted in China mainland showed a change on target population from nurses to specialized doctors and from a single group to multidisciplinary medical team. In the future, it would be more focusing on multidisciplinary team mainly comprised of general practitioners, nurses and social workers. Till recently, there is little literature evidence for study of the characteristics of localization.

Objective To explore the efficacy of debridement and primary suture for mesh-related infections after tension-free inguinal hernia repair.Methods From January 2007 to December 2013,208 cases with nesh infections following inguinal hernia repairs were treated with debridement in Department of Hernia and Abdominal Wall Surgery of Beijing Chaoyang Hospital,147 cases were treated with primary suture (suture group) and 61 cases were treated with dressing change (open group).Results The mean time of mesh infection was (8.37 ± 6.89) months.The results of bacterial culture in the two groups were similar.First grade healing rate of suture group was 80.95％ (119/147),compared to zero percent in open group.Length of stay [(20.86 ± 7.90) d vs.(31.82 ± 11.50) d,t =3.47,P =0.034] and hospital cost [(3 200 ± 5 800) yuan vs.(26 500 ± 6 600) yuan,t =4.51,P =0.02] in suture group were less than in open group.No patients developed recurrent hernia in suture group compared with one recurrence in open group.Conclusions Debridement and primary suture for mesh-related infections after tension-free inguinal hernia repair could increase the rate of first grade healing,shorten average length of hospital stay and reduce total costs.