Objective To investigate patients'cognition of social status of physicians and nurses,and find out the influence factors of it. Methods 286 patients were asked to finish serf-designed scale of social status of physicians and nurses. Results Most patients thought social status of nurses was above the middle level in our country.The majority of patients considered doctors " social status was higher than nurses'(approval rate 75.5% ).The nurses'economic treatment was lower than doctors' (approval rate 62.2% );About 14 items among 15 items on the occupational reputation,doctors" occupation cognition rate was higher than the nurses,the nurses' occupation cognition rate was higher than the doctors' occupation only on the item of labor intensity.The influence factors of the social status differences between physicians and nurses were economic treatment,the important degree of occupation,the professional authority,the requirement of specialized skills for workers. Conclusions To study the influence factors of the social status difference of physicians and nurses is beneficial for us to study the strategy of improving the nurses' social status in order to fulfil the viewpoint of science development,keep nurse troops developing continuously and set up the harmonious physician-nurse relationship.

By comparing with the molecule weights, retention times and product ion spectra of the standards, the cholic acid, deoxycholic acid and chenodeoxycholic acid were identified in the traditional Chinese compound medicine——“Qingkailing” injection by high performance liquid chromatography/mass spectrometry/mass spectrometry. Two other isomers of cholic acid and deoxycholic acid were also found, but tieir detail structure was still unknown due to the absence of standards. A quantitative method to determine cholic acid in the medicine was established and studied. An internal standard was used in quantitative analysis. When the concentration of cholic acid is from 875 ng/L to 140 μg/L, the chromatographic peak area and concentration are of good linear relation. The linear correlation coefficient was determined to be 0.9999 and the RSD is 2.04%. This method is simple, selective and highly sensitive, which is helpful for the quality control of traditional Chinese medicine.

This paper reports a simple method using the mesentery as a naturai mountingsubstrate for the study of mesenteric free cells under the scanning electron micros-cope.Mouse mesentery was cut into pieces about Ⅰ square centimeter in size andadhered on to neutral filter paper.The specimen were fixed in 5% glutaraldehyde and1% osmium tetroxide for 20 minutes,each step washed lightly with pH 7.4 PBS,dehydrated with ascending series of alcohol,put into amyl acetate,critical pointdried with CO_2,coated with gold and examined in scanning electron microscope.The morphologic features of free cells in the peritoneal lumen,such as polymorpho-nuclear leucocytes,macrophages and lymphocytes could be observed satisfactorily.We studied in particular the relationship between immunoreactive cells and targetcells(fetal liver cell)injected into the peritoneal cavity,Polymorphonuclear leuco-cytes could be seen invading into and eroding the target cells and macrophage cau-sing their swelling and lysis.Cooperative action of immunoreactive cells and anincrease in number of milk spots were also observed.

Objective To investigate the changes of A20 expression stimulated by free fatty acids (FFA) and its pathway.Methods HepG2 cells and U937 cells were stimulated by 0.5 mmol/L mixed FFA.The expression of A20,phosphor-p65 and phosphor-IκBα of neclear factor (NF)-κB pathway and phosphor-c-Jun N-terminal kinase (JNK),JNK,phosphor-extracellular signal-regulated kinase (ERK),ERK,phosphor-p38 and p38 of mitogen-activated protein kinase (MAPK) pathway were detected by Western blotting.The level of interleukin (IL)-12p,IL-1β,tumor necrosis factor (TNF)-α,IL-6,IL-10 and IL-8 cytokines in the supernatant of cell culture were detected by flow cytometry.T-test was performed for statistical analysis.Results The level of A20 changed along with the stimulated time of FFA.NF-κB and MAPK pathways were activated after FFA stimulation.The secretion of IL-6 and IL-8 increased after HepG2 cells stimulated by FFA and both reached peak at 24 hour.Compared with control group,the difference in IL-8 was statistically significant ((423.8 ± 8.9) pg/mL vs (12.4 ± 4.5) pg/mL,t=41.28,P＜0.01).The difference in IL-6 was also statistically significant ((4 082±423.6) pg/mL vs (52.9±29.5) pg/mL,t=9.49,P＜0.01).After U937 cells were stimulated by FFA,the secretion of IL-8 increased compared with control group.And in a certain period of time the secretion was time dependence.The maximum secretion of 24 hours was (200.6±5.7) pg/mL vs (5.0±3.9) pg/mL,and the difference was statistically significant (t=28.16,P＜0.01).IL-10,IL-12p,IL-1β and TNF-α were detected.Both NF-κB pathway and MAPK pathway were detected.Conclusions The in vitro FFA mediated steatotic cell model could induce the expression change of A20 and secretion of inflammatory cytokines.NF-κB and MAPK pathways involved in the response to FFA in HepG2 cells and U937 cells.

Objective To discuss the clinical presentations and imaging features of a novel avianorigin influenza (H7N9).Methods Anteroposterior chest radiographs and serial thin-section CT images in 5 patients with H7N9 were reviewed retrospectively by two radiologists,the predominant inaging patterns of lung abnormalities and clinical data were recorded and analyzed.Results The large consolidation of the right lung with air bronchograms was the most common radiographic appearance in all patients with H7N9 at admission,and the abnormalities were more severe in the bilateral lower lobes.Both lungs developed large,scattered consolidations and ground-glass opacities with the progression of disease.The lesions in the left lung were more rapidly absorbed than those in the right lung.Conclusion Influenza H7N9 has certain chest imaging characteristics in the onset,progression and recovery of disease.

Objective To establish a standardized management system and process for teaching ward rounds of clinical practice,so as to improve the quality of clinical practice. Methods (1) We established the system and process for teaching ward rounds. (2) The students of 2008 grade were divided into two groups. The new system and process for teaching ward rounds was used in 71 students in the experimental group,and the primary teaching ward rounds system was used in 72 students in control group. (3) A survey concerned about students' abilities of grasping theoretical knowledge, clinical thinking, self-study, clinical operation and doctor-patient communication were investigated in both students and their tutors. Result The result showed that the abilities of grasping theoretical knowledge,clinical thinking,self-study,clinical operation and doctor-patient communication in the experimental group were enhanced much more than the control group ( <0.01) . Conclusion The standardized management system and process for teaching ward rounds of clinical practice can improve the students, comprehensive abilities and the quality of clinical practice.

Objective: To understand the relationships between video time, exercise time and the mental sub-health of Chinese adolescents, and to assist the development of Chinese adolescents’ mental health. Methods: In this study, 16 545 adolescents aged 13-22 years in six administrative regions of China were surveyed using an adolescent sub-health multi-dimensional assessment questionnaire (MSQA), and daily physical exercise time, video screen time and other indicators were recorded. Binary Logistic regression analysis was used to understand adolescents’ mental sub-health and the correlation between video time and exercise time. Results: Detection rate of mental sub-health status in adolescents with video time ≤2 h/d was lower than that of adolescents with video time >2 h/d(19.1%，22.1%), and the detection rate of adolescents with exercise time ≤60 min/d(22.1%，17.7%) was higher than that of adolescents with exercise time >60 min/d. These differences were statistically significant (χ2=14.47, 6.97, P<0.05). Binary Logistic regression analysis showed that the risk of mental sub-health status for Chinese adolescents whose screen time was more than 2 h/d was 1.20 times that of those with screen time ≤2 h/d, and the difference was statistically significant (P<0.01). The risk of mental sub-health for students whose exercise time was > 60 min/d was 0.86 times that of students who exercised ≤ 60 min/d, and the difference was statistically significant (P<0.05). Conclusion Screen time >2 h/d and exercise time <60 min/d were negative factors leading to mental sub-health symptoms in Chinese adolescents.It is proposed to jointly promote the healthy adolescent development through health education,as well as positive family and social environment.

Almost all patients with multiple myeloma (MM) have chromosomal translocation which can result in genetic variation. There are mainly five types of chromosomal translocations, involving the IGH gene translocation to 11q13 (CCND1), 4p16 (FGFR/MMSET), 16q23 (MAF), 6p21 (CCND3) and 20q11 (MAFB). It is possible that all IGH translocations converge on a common cell cycle signal pathway. Some MM develops through a multistep transformation from monoclonal gammopathy of undetermined significance (MGUS) to smoldering MM (SMM) and eventually to MM and plasma cell leukemia (PCL). Similarly to what Darwin proposed in the mid-19th century-random genetic variation and natural selection in the context of limited resources, MM clonal evolution follow branching and nonlinear mode. The failure of MM treatment is usually related with the minimal subclone which is hardly found at newlydiagnosed.
Clonal Evolution ; Cyclin D1 ; Genes, Immunoglobulin Heavy Chain ; Humans ; Multiple Myeloma ; genetics ; Translocation, Genetic

BACKGROUNDPrimary systemic light chain amyloidosis (AL) is a rare plasma cell disease, our purpose was to analyze the immunophenotypic characteristics of the plasma cells in bone marrow in AL patients, and explore whether the detection of abnormal plasma cell clones in bone marrow by flow cytometry (FCM) could be used as an important indicator of AL diagnosis.

METHODSFresh bone marrow samples were collected from 51 AL, 21 multiple myeloma (MM), and 5 Waldenström's macroglobulinemia (WM) patients. The immunophenotype of bone marrow cells were analyzed and compared by FCM using a panel of antibodies including CD45, CD38, CD138, CD117, CD56, and CD19.

RESULTSIn AL, light chain restriction could be identified in 31 cases (60.9%), in which the λ light chain restriction was found in 24 cases (77.4%). In MM, κ light chain restriction was found in 13 cases (61.9%), and λ light chain restriction in eight cases. CD45 on abnormal plasma cells was negative to weakly positive in both AL and MM, but was positive to strongly positive in WM. In the bone marrow plasma cells of the 51 AL, 78.4% were CD56+, 68.6% were CD117+, and 88.2% were CD19-. While in the 21 MM cases, 66.7% were CD56+, 38.1% were CD117+, and 90.4% were CD19-. The plasmacytoid lymphocytes in the five WM patients were CD19+ and CD56-, CD117-.

CONCLUSIONDetection of abnormal plasma cell clones in bone marrow by FCM is valuable for the diagnosis of AL.

Adult ; Aged ; Aged, 80 and over ; Amyloidosis ; immunology ; metabolism ; CD56 Antigen ; metabolism ; Female ; Flow Cytometry ; Humans ; Immunoglobulin Light-chain Amyloidosis ; Immunoglobulin lambda-Chains ; metabolism ; Immunophenotyping ; Leukocyte Common Antigens ; metabolism ; Male ; Middle Aged ; Multiple Myeloma ; immunology ; metabolism ; Proto-Oncogene Proteins c-kit ; metabolism ; Waldenstrom Macroglobulinemia ; immunology ; metabolism

Objective : To study the protective effect and mechanism of iPSC⁃MSCs on cartilage matrix in knee oste⁃ oarthritis (KOA) patients in vitro. Methods : Cartilage tissues removed from KOA patients with joint replacement surgery were collected and subjected to tissue and cellular experiments , respectively. Cartilage tissue was cut into small pieces and randomly divided into a control group , an IL⁃1β ( 10 ng/ml) induction group , and iPSC⁃MSCs 96 h and then co⁃cultured with different amounts of iPSC⁃MSCs ( 1 × 104 , 1 × 105 , 1 × 106 ) cells for 72 h. For in tissues , the pathological changes of isolated cartilage tissues were examined by HE staining. The levels of ADAMTS⁃4 , ADAMTS⁃5 , and type II collagen expression were analyzed by immunohistochemistry , while the levels of MMP13 , IL⁃6 , and IL⁃10 in culture supernatants were detected by ELISA kits. The 2 to 5 generations of chondrocytes , which were extracted from cartilage tissue of KOA patients , were stimulated with IL⁃1β ( 10 ng/ml) for 48 h and then co⁃cultured with different concentrations of iPSC⁃MSCs ( 1 × 104 , 1 × 105 , 1 × 106 ) cells for 72 h. Immunofluorescence and Western blot detected the expression of RUNX2 , ADAMTS⁃4 , and ADAMTS⁃5 in chondrocytes. Results : Comparison with the control group , in the IL⁃1β⁃induced group , the levels of RUNX2 , ADAMTS⁃4 , and ADAMTS⁃5 increased , the level of type II collagen decreased , the levels of MMP⁃13 and IL⁃6 in the culture supernatant increased ( P < 0. 05) , and the level of IL⁃10 decreased ( P < 0. 05) ; Compared with the IL⁃1β⁃induced decreased the expression of RUNX2 , ADAMTS⁃4 , and ADAMTS⁃5 , promoted type II collagen expression and elevated IL⁃10 levels. Conclusion iPSC⁃MSCs inhibited ADAMTS⁃4 and ADAMTS⁃5 expression in vitro , reduced cartilage extracellular matrix degradation , and played a role in articular cartilage protection.