With the implement of inverted burden of proof,the work of clinical practice and teaching faces challenge. At present, more aspects of clinical medicine and practice teaching are not suitable for the new rule, and they have affected and restricted the improvement of quality of clinical practice teaching. It is necessary for interns and clinical tutors to study the new rule and suit its demands. Only in this way can the quality of clinical medicine, teaching and practice be improved.

Objective To investigate the protective effect of heme oxygenase-1 for xeno-heart transplantation and the possible mechanism.Methods Cobalt protoporphyrin (CoPP), HO-1 inducer, and zinc protoporphyrin (ZnPP), HO-1 inhibitor, were used to intervene donors and recipients on the model of NIH-Wistar cardiac transplants respectively and simultaneously some of recipients were treated with immunesuppressor cyclosporine A (CsA), and control group and CsA treated group were set up respectively. The expression of HO-1 protein, HO-1 mRNA, caspase-3 and STAT-3 in transplanted heart tissue was detected by immunohistochemistry, RT-PCR and Western Blot. At the same time, HO-1 enzymatic activity was examined in heart tissue, and the cardiac cell apoptosis was examined by means of TUNEL. The differences among various factors were compared.Results The survival time of cardiac transplants in CoPP group was longer than that in control and ZnPP groups (P

Objective To explore the mechanism of delayed xenograft rejection(DXR) by dynamic observation of histological and immunohistologic changes in mouse-to-rat cardiac xenografts.Methods A model of mouse-to-rat cardiac heterotopic xenotransplantation in neck was established by cuff technique.NIH mouse hearts not transplanted served as controls(n=4).Some xenograft recipients were killed and cardiac xenografts harvested at end of 3,8,16,24 h(n=4 for each time point) after transplantation.The cardiac hearts(n=16) of some xenograft recipients were not harvested until rejection time to determine their survival time.All heart samples were examined by HE and immunohistochemistry for semi-quantitative determination of antibodies including C3,IgM,IgG,E-selectin and macrophage marker——CD68.Results During the period after transplantation,the degree of rejection of xenografts became more and more serious till ultimate rejection.The mean survival time of the xenografts was(49.3?16.2) h.Immunohistochemical examination showed C3 were not detected in the xenografts at any time during the course of rejection;From 3 h after transplantation,obvious deposition of IgM was found in the grafts and IgG deposition got abundant;E-selectin expression was found as early as 3 h after transplantation and increased gradually;There was progressive infiltration by macrophages in the grafts.Conclusion Mouse-to-rat cardiac xenotransplantation can serve as an animal model of DXR.Endothelial cells activation,IgM and IgG,macrophage infiltration involve in DXR development except C3.

Objective To investigate the clinical effect of IFNα combined with mannan peptide in treatment of patients with HBeAg-positive chronic hepatitis B ( CHB ). Methods Eighty HBeAg-positive CHB patients with HBV DNA quantity ranging from 10 to 10 eopies/mL were enrolled and randomized into the treatment group and the control group ( n = 40 for each ). Patients in treatment group were given daily subcutaneous injection of IFNα-2b 5,000,000 U for 52 weeks, and received mannan peptide 10 mg per intravenous injection or 2. 5 mg per intramuscular injection for a total of 2 to 3 treatment courses (12 weeks for each). The control group received only IFNα-2b treatment. Liver function, serum markers of hepatitis B, HBV DNA quantity and blood tests were performed before the treatment and at 2, 4, 8, 16, 26 and 52-week during the treatment; and the adverse effects were recorded. Results The rates for ALT normalization, negative HBsAg, negative HBeAg, HBeAg seroconversion and negative HBV DNA were 91. 8% , 17. 5% , 52. 5% , 27. 5 % and 47. 5% at 52nd week in the treatment group, while those in the control group were 80. 0% , 12. 5% , 30. 0% , 10. 0 % and 25. 0% , respectively. There were significant differences in HBeAg-negative, HBeAg-seroeonversion and HBV DNA-negative rates between two groups (χ2 = 4. 178, 4.021 and 4.381, P < 0. 05 ) , and these indexes in the treatment group were increased to 57. 5% , 30. 0% and 50. 0 respectively at 52nd week after drug withdraw. White blood cells began to be elevated at 4th week and were restored to the normal levels at 8th week in the treatment group, while the count in the control was lower than the normal value even at 52nd week of the treatment with the average of (3.45±1. 18)×109/L. Conclusion Alpha-interferon combined with mannan peptide therapy is effective for patients with HBeAg-positive CHB, which may restore the declined peripheral WBC counts induced by interferon and improve the compliance.

AIM:To investigate NO-donor sodium nitroprusside(SNP)-induced apoptosis of human airway smooth muscle cells(HASMCs) of passive sensitization by serum from allergic asthmatic patients.METHODS: The technique of human airway smooth muscle(HASMCs) passively sensitized with serum from allergic asthmatic patients was adopted.The effect of SNP on the survival rate of passively sensitized HASMCs was detected by MTT method.Apoptosis of cells was detected by TUNEL and flow cytometry.RESULTS:(1) Compared to sensitized group,the survival rate of passively sensitized HASMCs decreased in SNP+sensitized group(n=5,P

OBJECTIVE：To study the mechanism of improvement effects of Fupi rougan granule （FRG）on hepatic fibrosis model rats. METHODS ：The rats were randomly divided into blank group ，model group ，Colchicine tablet group （chemical positive control ，0.2 mg/kg），Fuzheng huayu capsule group （TCM positive control ，0.415 g/kg），FRG low-dose ，medium-dose and high-dose groups （20，40，80 g/kg），with 10 rats in each group ，except for 11 rats in blank group and model group （one rat was used to judge whether the modeling was successful ）. Except for blank group ，other groups were given intraperitoneal injection of 50％ CCl4 olive oil solution and intragastric administration of 30％ ethanol to induce hepatic fibrosis model. After modeling ， administration groups were given relevant medicine intragastrically ；blank group and model group were given constant volume of normal saline intragastrically ，once a day ，for consecutive 4 weeks. After last administration ，morphology changes of liver tissue in rats were observed. The serum levels of HA ，LN，PCⅢ and Col Ⅳ in rats were detected ，and protein expression of Beclin- 1 and LC3-Ⅱin liver tissue were also determined. mRNA and protein expression of Akt ，AMPK，mTOR，p70S6K were detected in liver tissues of rats. RESULTS ：Compared with blank group ，the structure of hepatic lobules in the model group was disordered ，the proliferation of fibrous tissue was obvious ，and some pseudolobules were formed ；the serum levels of HA ，LN，PCⅢ and Col Ⅳ， the protein expression of Beclin- 1 and LC 3-Ⅱ in liver tissue as well as mRNA and protein expression of Akt ，AMPK，mTOR and p70S6K were increased significantly （P＜0.01）. Compared with model group ，the liver injury of rats in FRG groups was significantly relieved ，and the levels of the above indexes in serum and liver tissue （except for LN and PC Ⅲ in FRG low-dose group） were significantly reduced （P＜0.05 or P＜0.01）. CONCLUSIONS ：FRG can improve hepatic fibrosis in rats ，the mechanism of which may be associated with down-regulating the expression of autophagy associated protein and Akt/AMPK/mTOR/ p70S6K signaling pathway related protein.

Objective: To investigate the situation and influencing factors of bowel cleansing in patients before colonoscopy, and to provide reference for guiding patients′ bowel preparation. Methods: The clinical data of 421 patients undergoing electronic colonoscopy in the endoscopy center of the second people′s hospital of Lu′an city in Anhui Province from April to September 2018, Prospective collection by systematic sampling, including general data of patients, clinical data of bowel preparation and score of Boston bowel preparation scale. Univariate analysis and logistic regression analysis were performed on the relevant factors of bowel preparation. Results: Among the 421 patients, 52 cases were not eligible for intestinal cleaning, and the unqualified rate was 12.35%(52/421). Logistic regression analysis showed that: Total amount of drinking water prepared for intestinal tract before colonoscopy (OR=1.674, P=0.018),The total times of defecations after taking the drug (OR=1.270, P=0.014), the characteristics of last stool before colonoscopy (OR=2.211, P=0.042), the diet the day before colonoscopy (OR=0.553, P=0.006) , body mass index (OR=1.111, P=0.042), and intestinal diseases (P=0.022), were all intestinal clearance independent influencing factors of cleaning effect; While took laxative type (mannitol/PEG), drunk water speed (within 3 hours), first defecation time, the site of drinking bowel-clearing drugs, daily activity, none of the above factors affected the bowel preparation effect (P>0.05) . Conclusion Before colonoscopy, there were many factors affecting the cleaning effect of the intestine. The total water intake of intestinal preparation was less than 2 000 ml, the total number of defecation after taking medicine was less than 5 times, the last defecation contained residue, the day before the examination was strictly fasting, the body mass index was less than 18.5 kg/m², and colitis, enterelcosis and occupying lesion are independent risk factors for intestinal cleaning. Attention should be paid to the comfort care and guidance of intestinal preparation, and prospective intervention can effectively improve the cleaning effect of intestinal tract.