BACKGROUND: Within the bone marrow stroma there exists a subset of non-hematopoietic stem cells referred to as marrow stromal cells or mesenchymal stem cells. Mesenchymal stem cells (MSCs) are a group of cells with highly capability of self-renew and potential of multilineage differentiation, these properties make them present a promising prospect for clinical practice. Of particular concern is hepatogenic potential that can be used for liver-directed stem cell therapy and transplantation. However, the culture system has not been developed.OBJECTIVE: To explore whether human MSCs are able to differentiate into functional hepatocyte-like cells with hepatocyte growth factor (HGF) and basic fibroblast growth factor (bFGF) in vitro.DESIGN : Open study.SETTING: Department of Infectious Disease and Institute of Urology Surgery, First Affiliated Hospital, Nanchang University.MATERIALS: The study was performed in the Institute of Urolgoy Surgery, the First Affiliated Hospital of Nanchang University from July 2004 to March 2005. Bone marrow was donated by healthy adult with informed consent. DMEM/F12 medium (Gibco); insulin, transferrin, human epidermal growth factor (EGF); human HGF; monoclonal antibodies against human AFP; FITC-conjugated rabbit anti-mouse IgG (Sigma); human bFGF (Invitrogen); monoclonal antibodies against human CK18 and CK19 (Chemicon); fetal bovine serum (Si jiqin, Hangzhou).METHODS: Bone marrow (10 mL) in this study was aspirated from the iliac crest of healthy donors. MSCs were isolated by density gradient centrifugation in combination with plastic adherence. For hepatic differentiation, the 4th- to 8th-passage human MSCs seeded on 24-well tissue culture plates coated with 0.1% gelatin, at 1×104 MSCs/mL, were serum deprived for 2 days, in DMEM/F12 supplemented with 10 μg/L EGF, 10 μg/L bFGF, 5 mg/L insulin and 5 mg/L transferrin. Differentiation was induced by treating MSCs with differentiation medium, consisting of DMEWF12 supplemented with 10 μg/L bFGF, 20 μg/L HGF, 5 mg/L insulin, 5 mg/L transferrin. Medium changes were performed every three days. MSCs without HGF and bFGF in medium served as the control. In the differentiating period, the concentration of AFP in the suernatant was determined dynamically by radioimmunoassay (RIA). The hepatic surface phenotype including AFP, CK18 and CK19 were identified by immunofluorescent staining at day 0, 7, 14, 21 and 28. Glycogen storage was detected by Periodic Acid-Schiff (PAS) staining.MAIN OUTCOME MEASURES: ① the morphological changes of induced MSCs; ② the concentration of AFP in the supernatant; ③ the hepatic surface phenotype; ④ glycogen storage.RESULTS: ① After 14 days ofinduction, the fibroblast-like morphology of human MSCs was lost and cells became broadened and fiattened. After prolonged culture, polygonal cells were seen and further matured hepatocyte-like colonies were seen by day 28. ② The concentration of AFP in the supernatant was first detected on day 14, at a concentration of 0.1 μg/mL, and increased to 0.4 μg/mL by day 17, then decreased to 0.3 μg/mL by day 21. ③ Immunofiuorescent staining showed the expression of AFP and CK18 until day 14. The expression of CK19 was detected by day 28. ④ Glycogen storage could be detected by day 21.CONCLUSION: Human bone marrow MSCs are able to differentiate into functional hepatocyte-like cells and may sere as a new source of cells for cell therapy of hepatic diseases.

Objective To investigate the effects of different doses of dexmedetomidine on the anesthetic efficacy of propofol and remifentanil in patients undergoing plastic surgery.Methods Sixty ASA Ⅰ or Ⅱ patients of both sexes,aged 18-64 yr,weighing 45-75 kg,scheduled for elective plastic surgery,were randomly assigned into 3 groups (n =20 each):control group (C group),low loading dose dexmedetomidine group (D1 group) and high loading dose dexmedetomidine group (D2 group).Dexmedetomidine was infused at a rate of 0.4 μg· kg-1 · h-1 until 30 min before the end of surgery after a loading dose of dexmedetomidine 0.6 (group D1) or 1.0 μg/kg (group D2) was infused at 10 min before induction of anesthesia in groups D1 and D2.Anesthesia was induced with target-controlled infusion of propofol (target plasma concentraiton 4.0 μg/ml) and remifentanil (target effect-site concentraiton 2.0 ng/ml).After the patients lost consciousness,rocuronium 0.6 mg/kg was injected intravenously.The patients were mechanically ventilated after tracheal intubation.Anesthesia was maintained with target-controlled infusion of propofol (target plasma concentraiton 2.0-3.5 μg/ml) and remifentanil (target effectsite concentraiton 1.5-2.5 ng/ml).Narcotrend index was maintained at Class D.Narcotrend index,systolic pressure (SP),diastolic pressure (DP) and HR were recorded before anesthesia (baseline),at 10 min of dexmedetomidine infusion,at 0,1 and 5 min after tracheal intubation,at the end of dexmedetomidine infusion,and at 0,1and 5 min after removal of the endotracheal tube.The induction time,consumption of propofol and remifentanil,time for recovery of spontaneous breathing and orientation,extubation time,and Richmond Agitation Sedation Scale score at 10 min after removal of the endotracheal tube were recorded.The development of sinus bradycardia during operation and complications during recovery from anesthesia were also recorded.Results Compared with group C,the total consumption of propofol and remifentanil,Richmond Agitation Sedation Scale score at 10 min after removal of the endotracheal tube,and incidences of nausea,bucking and agitation during recovery from anesthesia,and Narcotrend index and HR at 10 min of dexmedetomidine infusion were significantly decreased in groups D1 and D2,and induction time was shortened in D2 group (P ＜ 0.05 or 0.01).The incidence of sinus bradycardia during operation was significantly higher in group D2 than in groups C and D1 (P ＜ 0.05).There was no significant difference in the time for recovery of spontaneous breathing and orientation,and extubation time between the three groups (P ＞ 0.05).There was no significant difference in SP,DP and HR before and after tracheal intubation and before and after removal of the endotracheal tube between groups D1 and D2 (P ＞ 0.05).Conclusion Infusion of dexmedetomidine at a rate of 0.4μg·kg-1 · h-1 after a loading dose of 0.6 μg/kg infused before induction of anesthesia can shorten the induction time,reduce the consumption of propofol and remifentanil,effectively inhibit the stress responses to tracheal intubation or removal of the endotracheal tube,and decrease the occurrence of side effects in patients undergoing plastic surgery.

Objective:To research the curative effect of moxifloxacin solution atomization inhalation in the treatment of chronic obstructive pulmonary disease (COPD) combined with respiratory failure.Methods:94 cases of COPD patients combined with respiratory failure from May 2014 to May 2016 were selected and divided into the control group(n=47) and the research group (n=47) acording to the lottery method,the control group received routine treatment,while the research group was treated based on the control group with moxifloxacin solution inhalation treatment.The curative effect,serum tumor necrosis factor-α(TNF-α),c-reactive protein (CRP) and interleukin 10 (IL-10),creatine phosphokinase (CK),aspertate aminotransferase (AST) levels,the blood oxygen partial pressure (PaO2),CO2 partial pressure (PaCO2),APACHE Ⅱ score and occurrence of adverse reactions were compared between two groups.Results:After treatment,the total effective rate of research group was higher than that of the control group (P＜0.05).The serum levels of TNF alpha,CRP,PaCO2,CK,AST,APACHE Ⅱ score of research group were evidently lower than those of the control group (P＜0.05).The serum levels ofIL-10,PaO2 of research group were evident higher than those of the control group (P＜0.05).The occurrence of adverse reactions showed no differences between the two groups (P＞0.05).Conclusion:Moxifloxacin solution atomization inhalation was effective in the treatment of COPD combined with respiratory failure,which might be related to the inhibition of inflammatory response,and improvment of breath.

The curriculum construction of medical students' occupational career planning has its own character. Principles of curriculum construction siuh as practical object, professional content and target-oriented organization should be sticked to and four aspects of curriculum construction such as target,content, organization and evaluation. are discussed in detail.

AIM:To investigate the effect of liraglutide ( LG) on the expression of fibronectin type Ⅲdomain-containing protein 5 (FNDC5) in the C2C12 myotubes.METHODS:The C2C12 mouse myoblast cell line was induced to differentiation.Differentiated cells were stimulated with gradient concentrations (1 ~1000 nmol/L) of LG for different time (0 ~24 h).The effects of LG on the expression of FNDC5 and the activation of adenosine 5'-monophosphate ( AMP)-activated protein kinase ( AMPK) signaling pathway were determined .After pretreated with glucagon-like peptide-1 ( GLP-1 ) receptor antagonist exendin 9-39 , the inhibitor of Ca 2+/calmodulin-dependent protein kinase kinase 2 (CAMKK2), STO609, or the inhibitor of AMPK, Compound C, the LG-induced FNDC5 expression in C2C12 myotubes was examined.The expression of FNDC5 and the activation of AMPK were determined by Western blot .RESULTS: In C2C12 myotubes, LG promoted the expression of FNDC5 in a dose-and time-dependent manner .LG also activated AMPK signaling pathway .These effects of LG were partly abolished by exendin 9-39 , STO609 and Compound C .CONCLUSION:LG promotes the expression of FNDC5 via GLP-1 receptor in the C2C12 myotubes possibly through activation of the CAMKK2/AMPK signaling pathways .

Objective To explore the effects of lead acetate on free radicals and lipid peroxidation in the cerebral cor?tex, cerebellum, and hippocampus in rat brains. Methods SD rats (n=48), who were just weaned, were randomly divided in?to 4 groups base on their weight. Then the rats were fed with lead acetate in drinking water at the final concentrations of 0 mg/L (deionized water), 200 mg/L, 400 mg/L, 800 mg/L respectively. Blood lead level as well as the hydroxyl free radical inhibiting activity, the levels of hydrogen peroxide (H2O2) and malondialdehyde (MDA) in cerebral cortex, cerebellum, and hippocam?pus were measured 60 days after lead contamination in water. Results Upon lead exposure, blood lead levels increased sig?nificantly as compared with the control. The hydroxyl free radical inhibiting activity in cerebral cortex, cerebellum, and hip?pocampus decreased significantly in a dose dependent manner of lead(P < 0.05). And they all correlated negatively with blood lead level (r=-0.505,-0.414,-0.448, P<0.05). By contrast, blood lead level was positively correlated with H2O2 and MDA in these brain tissues (r=0.301, 0.411, 0.378, and 0.404, 0.324, 0.510,P < 0.05). Conclusion Lead exposure can lead to lipid peroxidation of rat brain tissues through inducing free radicals.

Objectives Aiming at the current health management mode of chronic disease preven-tion and control as the focus of work, this paper was to evaluate the effect of chronic disease management-based education on clinical teaching and training in cardiovascular medicine. Methods Totally 54 students participating in internship training in Department of Cardiology, the Shanghai Ninth People’s Hospital be-tween July 2013 and Aug 2014 were enrolled. Twenty-eight students were taught by chronic disease man-agement-based method while twenty-six students were taught by traditional method. After the internship training in cardiology, final examination (theoretical exam, skill appraisal and case analysis) were compared between the two groups to assess the teaching efficacy. Questionnaire survey was employed to investigate student satisfaction with chronic disease management-based teaching method. Data were analyzed by SPSS 13.0 software. Quantitative data or enumeration data between two groups were compared by t-test or chi-square test respectively. Results There was no significant difference in the theoretical exam score between two groups (P=0.422). However, the scores of skill appraisal and case analysis in students taught by chronic disease management-based method were significantly higher than those in students taught by traditional method (P<0.05). Most students taught by chronic disease management-based method were satisfied with the novel teaching method. Conclusion In the course of clinical medicine education, the emphasis on the management of chronic diseases can not only significantly improve the quality of clinical teaching in car-diovascular medicine, but also lay the foundation for the implementation of the concept of chronic disease management.

Objective To explore the association between C-reactive protein/albumin ratio(CAR)and the risk of cardiovascular events in maintenance hemodialysis(MHD)patients.Methods This study enrolled MHD patients who were treated in the blood purification center of the Second Affiliated Hospital of Guangzhou Medical University between August 2016 to December 2019,and the follow-up deadline was March 31,2021.Collected the clinical data of patients who conform to the inclusion criteria,including demographic,complications,primary basic disease,biochemical indicators of the patients who underwent 3 months regular dialysis treatment and the occurrence of cardiovascular events during the follow-up period.The Kaplan-Meier method was used to estimate the probability of cardiovascular incidents in MHD patients.The Cox proportional hazards model based on generalized propensity score weighting(GPSW)was used to estimate the relationship between CAR and cardiovas-cular events in MHD patients.Results A total of 170 eligible objects were included in this study,64 patients with cardiovascular events(37.6%).The Cox proportional hazards model which based on GPSW(HRCAR = 2.087,95%CI:1.085～4.015,P = 0.028),indicated that the hazard ratio of cardiovascular events was 2.087 when the CAR each additional a unit in MHD patients.Conclusion CAR and the risk of cardiovascular events in MHD patients have a significant positive correlation,which can help clinical workers recognize the MHD patients who have high risk of cardiovascular events and intervene in time.

Objective To explore the effects of diagnostic delay on early disease course of Crohn's disease (CD ), and to analyze the risk factors related with the progress of early disease course. Methods From December 2014 to July 2017,a total of 56 patients in Renmin Hospital of Wuhan University initially diagnosed as CD were selected.The clinical manifestation,previous history,imaging examination, endoscopic examination and pathological results of the patients were collected after initial diagnosis of CD. CD-related surgery,CD-related rehospitalization and use of immunomodulators were followed.According to time interval between initial symptom onset and initial diagnosis,the patients were divided into diagnostic delay group (diagnostic delay time＞two years,14 cases)and non-diagnostic delay group (diagnostic delay time≤two years,42 cases).The clinical characteristics at initial diagnosis and early prognosis were compared between the two groups.The risk factors affecting early prognosis of CD patients were analyzed. Kaplan-Meier was used for prognosis analysis.Log-rank test and Cox proportional hazards model were performed to analyze factors affecting early prognosis.Results The results of imaging examination indicated that the proportion of intestinal injury of diagnostic delay group was significantly higher than that of non- diagnostic delay group (χ2＝ 4.49,P ＝ 0.03 ).During follow-up,the proportion of CD-related rehospitalization of diagnostic delay group was higher than that of non-diagnostic delay group,and the difference was statistically significant (χ2＝7.34,P＝0.01).During follow-up,the nine patients received surgery.The one-year and three-year cumulative incidence of surgery was 10.7% and 22.7%,respectively;one-year cumulative incidence of surgery in diagnostic delay group and non-diagnostic delay group was 38 .6%and 9 .6%,respectively.The results of Cox univariable and multivariable analyses both indicated that intestinal injury in imaging examination at diagnosis was the risk factor of surgery (both hazard ratio (HR)＝2.313,both P＜0.01).A total of 21 patients had CD-related rehospitalization during follow-up.And one-year and 31-month cumulative incidence of hospitalization was 27 .8% and 5 6 .3%,respectively;one-year cumulative incidence of CD-related rehospitalization in diagnostic delay group and non-diagnostic delay group was 43 .7% and 2 1 .6%,respectively;and the difference was statistically significant (χ2＝5 .88 ,P＝0.02).The results of Cox univariable analysis indicated that having systematic manifestation,intestinal inj ury in imaging examination and diagnostic delay were the risk factors of CD-related rehospitalization (HR＝2.972,2.313 and 1.403,all P＜0.05).The results of multivariable analysis indicated that having systematic manifestation and intestinal injury in imaging examination were independent risk factors of CD-related rehospitalization (HR＝3.891 and 2.541, P ＜ 0.01,respectively).Conclusions The proportion of intestinal injury of patients with diagnostic delay is high and the early prognosis is poor. Intestinal injury in imaging examination at initial diagnosis is independently risk factor of CD-related surgery and rehospitalization during follow-up.

Capillary leak syndrome is a disease characterized by high permeability of vascular endo-thelium leading to anasarca,hypotension,hypoalbuminemia and hemoconcentration,It can cause multiple or-gan failure and high mortality in acute stage. Vascular endothelial hyperpermeability is the core of pathogene-sis of capillary leak syndrome. This article reviewed the latest research progress on the pathogenesis of capil-lary leak syndrome from the aspects of serological mechanism,histological changes and genetic factors.