With the burgeoning of continuing medical education, grass-roots hospitals are confronted with quite a number of problems in the implementation of the task, such as a general rush into action with each department going its own way, incontrollable educational expenses that are beyond the hospitals, difficulties in developing programs at the hospital level because of the limitation of academic disciplines, and the buying and selling of credits. In view of the above problems, the authors put forward some suggestions for formulating a series of continuing medical education management strategies that both conform to the situation in our country and suit the needs of health professionals at grass-roots institutions.

China ; epidemiology ; Heat Stroke ; epidemiology ; Humans

Objective To clone and express recombinant outer membrane protein P6, determine its optimal expression conditions and to investigate the immunoprotective effects of the P6 protein on mice. Methods The P6 gene of nontypeable Haemophilus influertzae(NTHi) was amplified by PCR from the NTHi genome and cloned into expression vector pET-32a (+) to generate the pET-32a-P6 recombinants. They were confirmed by nuclease digestion and sequence analysis. The verified recombinant was transformed into E. coli BL21 (DE3). Its optimal expression conditions were determined such as engineering strains, the concentration of IPTG, inducing temperature, inducing time, different medium etc. The recombinant protein was purified by Q Sepharose~(TM) XL ion exchange and gel filtration chromatography. The protein was analyzed by SDS-PAGE, Western blot and sequencing. BALB/c mice were immunized with recombinant protein be-fore challenged by NTHi through intraperitoneal injection. Then the mortality rate of different group was com-pared. Results The recombinant P6 of NTHi was successfully constructed and expressed in E. coli at a rel-atively high level. The purity was up to 95% after purification. The relative molecular mass of the protein is 14 145. 848. The recombinant protein was confirmed to show specific reaction on the antiserum through Western blot. The animal experiments showed the mortality rates of immunization groups were significantly lower than that of the control group (P < 0.05). Conclusion The successful expression of the recombinant P6 will be very helpful for the further study on development of vaccine, its purified, immunological activity and antibody preparation.

Objective To investigate the clinical efficacy and safety of six-hole moxibustion box therapy for stable chronic obstructive pulmonary diseases(COPD).Methods Sixty patients with thoracic facet joint disorder were randomly allocated to treatment and control groups, 30 cases each. The control group inhaled tiotropium bromide inhalation powder spray and the treatment group received six-hole moxibustion box therapy in addition. The COPD Assessment Test (CAT) score and the dyspnea score were recorded and peripheral blood oxygen saturation was measured in the two groups before and after treatment. The adverse reactions were monitored in the two groups. Results There were statistically significant pre-/post-treatment differences in the CAT score and the dyspnea score in the two groups (P<0.05). There were statistically significant post-treatment differences in the CAT score and the dyspnea score between the treatment and control groups (P<0.05). There were statistically significant differences in pre-/post- treatment CAT score difference value and dyspnea score difference value between the two groups (P<0.05). There was a statistically significant pre-/post-treatment difference in peripheral blood oxygen saturation in the treatment group (P<0.05). There was a statistically significant post-treatment difference in peripheral blood oxygen saturation between the two groups (P<0.05).Conclusion Six-hole moxibustion box therapy plus tiotropium bromide inhalation powder spray is safe and effective in treating stable COPD.

BACKGROUND: It is discovered by administrating different emetics to vomiting animals, like cats, that there are a large amount of Fos positive neuronal expressions in the arc region from nucleus of solitary tract, lateral tegmentum to ventrolateral area. And it has been viewed that the arc region from area postrema, nucleus of solitary tract to ventrolateral reticular structure is the main emetic region. Whether do the non-vomiting animals reflect in response or not after emetic injection?OBJECTIVE: To observe the distribution of Fos positive neurons in relevant emetic regions of brain and spinal cord in rats after abdominal injection of emetic, cisplatin.DESIGN: Randomized controlled experiment based on animals.SETTING: Neural Physiological Research Room of Life Science College in Hebei Normal University and Physiological Room of Basic Medicine Institute in Hebei Medical University.MATERIALS: The experiment was performed in Neural Physiological Research Room of Life Science College in Hebei Normal University and Physiological Room of Basic Medicine Institute in Hebei Medical University from March to August 2003. Twelve SD male rats were employed, body weighted varied from 220 to 250 g, of clean-grade. They were randomized into experimental group of 6 rats and the control of 6 rats.INTERVENTIONS: In experimental group, the emetic, cisplatin, was injected abdominally 10 mg/kg. In the control, the physiological saline of same dose was injected. Afterwards, the activity changes in rats were observed at room temperature, quiet and light-avoided environment. Six hours later, the brain tissue was collected for frozen continuous sectioning. Immunohistochemical staining method was used to observe the distribution of Fos positive neurons in brainstem and forebrain nuclei and to count positive cell.MAIN OUTCOME MEASURES: ① Behavior observation in rats after emetic injection. ② Counts of Fos positive cell in relevant regions of brain in rats.RESULTS: Twelve rats all entered result analysis. ① In 20 minutes after injection, the rats in both groups were in tranquilizing state, lying prone with body curled, almost without any movement. In 60 minutes after injection, the rats in the control were recovered to normal, free of eating or drinking. The rats in experimental group were in prone-lying state with body curled. They rose up or shook the heads occasionally, and they breathed fast and uneven.In 2 hours after injection, in experimental group, the rats were still in abdominal prone tightly in the cage, with heads lowed and irregular shaking of noses. In 5 hours, the rats in experimental group began standing up and moving, with normal breathing, but they still did not eat or drink. ② Fos positive neurons in solitary tract, area postrema and lateral parabrachial nucleus and paraventricular nucleus, supraoptic nucleus and arc nucleus in hypothalamus (64.3 ±9.6, 83.4 ±15.0, 148.8 ±19.9, 80. 2 ± 11.8, 20.7 ±3.8, 86. 6 ± 10.8) were remarkably higher than those in the control(56. 2 ±6.3,73.5±9.9,136.9±17.8,66. 1±10.3,17.3±3.4,78.8±10.5).CONCLUSION: Emetics induce discomforts in internal organs of rats, due to which, there probably exist emetic regions similar to vomiting animals in central neural system. But it is probably lack of vomiting-related adjusting mechanism. Emetics irritate the increase of Fos positive neurons in relevant regions in the brain of rat, which suggests that there exist relevant neural chemical pathways similar to nausea in the brain of non-vomiting rats.

Objective To prospectively study the clinical significance of the MELD scoring system in surgical treatment of obstructive jaundice.Methods 112 patients with obstructive jaundice who were admitted into our hospital from January 2009 to December 2013 were divided into two groups:group A (Stage Ⅰ PTCD and stage Ⅱ open operation,n =53) and group B (1 stage open surgery,n =59).The amount of intraoperative bleeding blood loss,operation time,postoperative complications,duration of hospitalization,mortality rate,and the changes in liver function after surgery were compared between the two groups.Results The differences in the liver function index of the two groups on the same postoperative date were significantly different (P ＜ 0.05).The liver function of group A recovered faster than group B.Patients in group A with a MELD ＜ 10 points stayed in hospital significantly longer when compared with patients in group B.For patients in group A with MELD ＞ 10 points,the operation time,bleeding volume,postoperative complications and hospitalization were significantly less than the patients in group B (P ＜ 0.05).There were 3 patients (group B) who died with MELD ≥ 20 points after operation.Conclusions In patients with obstructive jaundice with a MELD score greater than 10 points,especially those with a score equal to or greater than 20,PTCD should be performed first to relieve biliary tract obstruction,followed by a stage Ⅱ open surgical operation after the liver function had improved.MELD had important clinical significance in the evaluation of operation risk in patients with obstructive jaundice.

ObjectiveTo detect the difference of cytokines and antibodies productions by immunologic system from mice and rabbits vaccinated with the M.RCAg-1 chimeric protein,expressed in E.coli,formulation with different adjuvants,including Freund's adjuvant and three clinically acceptable adjuvants,namely,Al(OH)3,Montanide ISA720 and Montanide ISA51.MethodsSix weeks female BALB/c mice were vaccinated with recombinant protein formulated with different adjuvants through intranasal.Serum were collected to detect specific antibodies of M.RCAg-1 and individual Epitope by ELISA ; natural parasite antigen was recognized by indirect immunofluorescence assay; mouse specific T lymphocyte activation was detected by enzyme-linked immunosorbent spot test (ELISPOT) ; Affinity assay between protein and immune IgG of rabbits with the biosensor,and the growth of Plasmodiumfalciparum in vitro to evaluate by growth inhibition assay(GIA).ResultsDifferent formulation can induce different levels of antibody titers,the effection of ISA51 adjuvant was most closely with Freund's adjuvant,and can induce a higher specific antibody of 11 epitopes within proteins,can effectively stimulate cellular immune response based on the IFN-γ,to avidity Montanide ISA51 adjuvant immune antibodies and M.RCAg-1 protein affinity than the other two adjuvants;and Montanide ISA720 adjuvants and Al (OH)3 adjuvant group in mice can't induce a significant IFN-γresponse(P＞0.05).On avidity assay,the Montanide ISA51 formulation group was better than the other two adjuvants; and Montanide ISA720 and Al (OH)3 adjuvant formulation group can't induce a significant IFN-γresponse in mice(P＞0.05) ; the inhibition rates were 60% and 100% in 3D7 and Dd2 Plasmodium falciparum at a concentration of 2 mg/ml IgG by Montanide ISA51 formulated protein,and IgG of Al( OH)3 formulation could not effectively inhibit the in vitro growth of Plasmodium falciparum( 10% ),while IgG of Montanide ISA720 formulation could not inhibit growth of parasite in vitro.ConclusionBy comparing three clinically acceptable adjuvants and Freund's adjuvant in BALB/c mice and New Zealand rabbit,Montanide ISA51 adjuvants can be acceptable formulated M.RCAg-1 protein induced humoral and cellular immune responses,can be used as one of the candidate adjuvants.

ObjectiveTo explore the effects of vector fusion peptides on the conformation and immune reactivity of recombinant polyepitope antigens,M.RCAg-1.MethodsWe subcloned polyepitope artificial antigen gene,M.RCAg-1,into prokaryotic expression vectors,pDS-ex,that contain different fusion tags at the N-terminus or no any tag by different restriction enzyme cutting site.Three recombinant proteins expressed by these vectors,named P312-1,P312-2,and P312-3,were purified and purity is greater than 95％.Then BALB/c mice were vaccinated with the three proteins formulated with Freund's adjuvant through intranasal.Serum were collected to detect specific antibodies of M.RCAg-1 and individual epitope by ELISA ; natural parasite antigen was recognized by indirect immunofluorescence assay; mouse specific T lymphocyte activation was detected by enzyme-linked immunosorbent spot test (ELISPOT) ; and the growth of Plasmodium falciparum in vitro to evaluate by growth inhibition assay(GIA),and analyze secondary and tertiary structures of recombinant proteins from different expression vectors by bioinformatics and circular dichroism technique.ResultsThe P312-1,P312-2 have almost the same amino acid sequence,and the three proteins have the same immunogenicity in animal models(P＞0.05),however,the different proteins elicited various T-cell responses,the rabbit antibody induced by these proteins showed diverse efficacy in malaria parasite growth inhibition assaysin vitro ( respectively,93.9％,14.7％,54.3％ ).The significant differences of secondary and tertiary structures were shown in recombinant proteins from different expression vectors,analyzed by bioinformatics and circular dichroism technique,which demonstrated the change of protein molecule spaces conformation,and the obviously change of some epitope locations.ConclusionThese results suggest that the expressed polyepitope artificial antigens originating from the different vector fusion peptides indeed affect the protein folding and,subsequently,the epitope exposure.Thus,these proteins are able to induce both distinct humoral and cellular immune responses in animal models,and they affect the efficacy of immune inhibition against the parasite,the enhancement or suppresses.

Objective: To investigate the effects of the interaction between occupational noise exposure and arterial stiffness on blood glucose, so as to provide insights into for early prevention of diabetes among workers exposed to occupational noise. Methods: A total of 518 noise workers were selected from a tobacco plant in Wuhan City. Participants' gender, age and work duration were collected using questionnaire surveys, and participants' height and weight were measured. Blood glucose and arterial stiffness were detected, and the noise intensity was measured in working environments with a personal noise dosimeter. The effects of occupational noise exposure, arterial stiffness and their interactions on blood glucose were examined using a multiple linear regression model. Results: A total of 518 workers were included, with 398 males (76.83%), a mean age of (40.85±10.68) years, a mean working age of (19.50±12.69) years, a mean body mass index of (23.66±3.31) kg/m2, and a mean blood glucose level of (5.15±0.99) mmol/L. There were 247 workers with occupational noise exposure (47.68%) and 175 workers with arterial stiffness (33.78%). Multiple linear regression analysis showed significant associations of noise (β'=0.112) and arterial stiffness (β'=0.168) with blood glucose, and there was an additive interaction between noise and arterial stiffness on blood glucose (β'=0.314). Conclusion The interaction between occupational noise and arterial stiffness affects blood glucose.