To improve the quality of health care by improving the quality of residency training,the Accreditation Council for Graduate Medical Education of USA has renewed the standards and methods of residency training to improve health care,and issued the compe- tence-based training standards. The residents have to achieve six key competences when they finish the training. The University of Washington,School of Medicine,responds to the new re- quirements and standards by reforming its residency training pathway,enriching formal teach- ing/training activities,and improving its supervision and the evaluation. We should use for refer- ence reforming the residency training in China.

Neonatal diabetes mellitus ( NDM ),which was often misdiagnosed as type 1 diabetes in the past,is a heterogenous single-gene genetic disease.Permanent neonatal diabetes( PNDM )is mainly associated with mutation in KCNJ11,ABCC8,and insulin associated gene instead of immunity.The most common manifestation includes diabetic ketoacidosis,intrauterine growth retardation and dehydration.Gene examination contributes to the classification of NDM and corresponding targeted therapy.Oral sulfonylurea may be used in treating patients with gene mutation of ATP-sensitive K+ channel.

This review focuses on the current literatures on the therapeutic potential of non-renal derived adult stem cell transplantation for kidney disease.Although the therapeutic mechanism remains debatable,some reports suggest that hematopoietic stem cell transplantation holds potential for treatment of renal diseases such as renal ischemia reperfusion injury,IgA nephropathy and lupus nephritis.Mesenchymal stem cell(MSC) are capable of homing to injured kidney and contribute to activate intrinsic kidney cells,promote angiogenesis,inhibit oxidative stress and reduce apoptosis,inflammation and renal fibrosis.These renoprotective effects are likely mediated by paracrine/autocrine mechanism via cytokine and microvesicles from MSC.Pluripotent stem cells may be induced from fibroblast,mesangial cells,renal tubular epithelial cell and urine epithelial cell.Induced pluripotent stem cell(iPSC) can differentiate into renal lineage cells.The derivation of kidney disease-specific iPSC opens new avenues for the resolution to limited donor availability in kidney transplantation and for treating kidney diseases such as diabetic nephropathy and autosomal dominant polycystic kidney disease.

Objective To analyze the clinical and pathological features of Wegener granulomatosis (WG) in children in order to improve the understanding of this disease. Methods Nine cases of WG,including two cases from our hospital and seven cases throughout the country,were analyzed in aspects of their clinical characteristics,laboratory examinations,X-ray and treatments. Results Of the nine cases,six cases were male and three cases were female with average age of twelve years old. The average time from the initiation of clinical symptom to diagnosis was 8.3 months. Patients had multiple systems and organs involvements. Lung and kidney involvement were the most common. Six out of seven were positive in c-ANCA and anti-PR3 antibody. Biopsy was conducted in eight patients,and pathological manifestations involved parenchymal necrosis,granulomatosis,vasculitis and so on. Most patients improved significantly after being treated with glucocorticoids and cyclophosphamide. Conclusion WG is a syndrome which involves many organs without distinctive clinical manifestation. An ANCA test should be performed to make an early diagnosis.

Not only does autophagy play a vital role in maintaining kidney cell survival and homeostasis,but al-so it is involved in the pathophysiology of several kidney diseases. Recent studies have indicated that autophagy was ac-tivated in kidney cells during acute kidney injury and its regulatory mechanism was unclear. Autophagy activation in kidney may be associated with oxidative stress, endoplasmic reticulum stress, hypoxia inducible factor-1α, p53 and Bcl-2 family. The role of autophagy in acute kidney injury is still controversial. Most believe that it plays a protective role during acute kidney injury. Therefore autophagy will become a novel and potential target for the prevention and treatment of acute kidney injury.

Objective To explore the experiences in the treatment of prostatic hyperplasia in patients with severe cardiac disease by transurethral electrovaporization of the prostate(TVP). Methods Transurethral resection of the prostate(TURP) combined with transurethral electroresection was performed on 31 cases of patients with severe cardiac disease following the placement of temporary pacemakers. Results Electroresection was performed just once following the placement of temporary pacemakers in patients with prostatic hyperplasia. The average postoperative follow up was 1 year. Easy and smooth miction was found. Conclusion Age accompanied with cardiac disease is not an absolute contraindiction for TURP.

Object To develop a new process for the extraction of camptothecin from leaves of Camptotheca acuminata Decne Methods By uniform experimental design after proper choice of solvent Results The optimal conditions were extraction with 16 times of 0 3% NaOH for three hours each time Conclusion This is the first attempt to use dilute NaOH solution for the extraction of camptothecin from the previously seldom utilized leaves of C acuminata, which resulted in a yield well over 0 1% The process resulted in a lower production cost and require less fire protection measures as compaired with the conventional use of alcohol

This study was aimed to compare the function of dendritic cells (DCs) in patients of Y in-Huang syn-drome and Y ang-Huang syndrome from the peripheral blood of HBV related hepatic failure. Jaundice patients of HBV related hepatic failure were divided into two groups, which were the Y ang-Huang syndrome group and Y in-Huang syndrome group. And a healthy control group was also established. The DCs were separated and cultured in vitro from PBMCs in the peripheral blood. Surface molecules such as HLA-DR, CD80, CD86, CD83 and CD1αwere detected by the flow cytometry. And the level of IFN- α and IL-4 in the supernatant of DCs were also de-tected. The expression difference of inflammatory cytokines and immune cells between Y in-Huang and Y ang-Huang syndrome in patients of HBV related hepatic failure were compared. The results showed that compared with healthy people, the expression rate of DCs phenotype such as HLA-DR, CD1α, CD83, CD80, CD86 in patients of HBV related hepatic failure was significantly decreased (P < 0.01); the excreted factor IFN-α had a significant rising (P < 0.01). Compared to Y ang-Huang syndrome group, the expression rate of CD83 and CD86 in the Y in-Huang syndrome group of HBV related hepatic failure patients was significantly reduced (P < 0.01). And the ex-creted factor of IL-4 had a significant rising in Y in-Huang syndrome group (P < 0.01). Compared to the Y in-Huang syndrome group, the excreted factor IFN-α in the Yang-Huang syndrome group had a significant rising (P< 0.01). It was concluded that DCs function of patients with HBV related hepatic failure in both Y in-Huang syn-drome and Y ang-Huang syndrome group showed low immune function. And the immune function of the Y in-Huang syndrome group was lower. There was excessive releasing of inflammatory factors in the Y ang-Huang syn-drome group. And there was enhanced anti-inflammatory cytokine expression in the Y in-Huang group.

Arthritis, Juvenile ; therapy ; Child ; Humans ; Macrophage Activation Syndrome ; therapy ; Plasmapheresis

Objective To investigate the cerebral regularity of dynamic charge and the correlation with intracranial pressure(ICP),clinical seriousness and prognosis on acute stage of intracerebral hemorrhage(ICH) patients by transcranial Doppler(TCD).Methods 54 patients with first acute supratentorial ICH 24h after onset were studied.All patients were dynamic evaluated by beside TCD on 1st,7th,21st day.The correlation of TCD with ICP,MESSS were studied.Results On the 1st day the TCD abnormity of the acute phase of the ICH occurred mainly in the anterior circulation of cerebrum,in which the cardinal manifestation was high-resistance,low-flow velocity blood waveforms,especially on the bleeding side.Continuous TCD monitoring revealed the low velocity of the cerebral blood flow increased;meanwhile the high value of PI decreased gradually and the TCD monitoring was within the normal range three weeks after the attack.The ICP had negative correlation with the VmMCA,positive correlation with the PI value.MESSS scale had negative correlation with the VmMCA,positive correlation with the PI value.Conclusions The TCD examination can be used to monitor the cerebral hemodynamics of the patients suffering from intracerebral hemorrhage.The combination of fVEP and TCD facilitate the evaluation of the dynamic changes of ICP so as to instruct lowering the ICP.