The G protein-coupled receptor, GPR40, is a specific receptor for free fatty acids. Singnaling pathways are activated in islet ?-cells by fatty acids as binding to GPR40. Fatty acids regulate insulin secretion and cause ?-cell hyperplasia through GPR40. GPR40 also mediates responses to antidiabetic drugs like thiazolidinediones. GPR40 agonists and/or antagonists show potential effect in the development of new anti-diabetic drugs.

Objective To compare the case-based learning with network with the traditional case-based learning in its effects on clinical practice of internal medicine. Methods Seventy-five in-terns of clinical medicine(5-years programme) and stomatology (7-year programme) of grade 2010 were enrolled, among which forty interns were assigned to the experimental group with the case-based learning with network, feedbacking summary in class after the case of self-study teaching through the network platform and discussion in groups; while the remaining thirty-five interns were provided with the traditional case-based learning as control group. Both groups were assessed with tests of the the-oretical knowledge and clinical skills at the end of their internship in internal medicine. A questionnaire, given to the interns in experimental group, was used to evaluate the teaching effect. The assessment result of both groups was done by t test with the SPSS 16.0 software. Results The total score of the network case teaching group is higher than the ordinary case teaching group. A significant difference of scores in theoretical knowledge and case analysis was witnessed between the two groups (85.2 ±8.7 vs. 80.5 ±9.8, P=0.031 and 87.3 ±6.2 vs. 84.4 ±5.6, P=0.038, respectively). More than 75%interns in the network case teaching group were satisfied with the case-based learning with network. Conclusion The teaching effect the network case teaching is obviously better than the ordinary case teaching . The introduction of the case-based learning with network in clinical practice of inter-nal medicine is beneficial to the implementation of syllabus and students' application of knowledge to clinical analysis. It also helps to improve students' interest and ability of autonomous learning, as well as improve the efficiency of clinical teaching.

Now there are many difficulties in pediatric clinical teaching. As one important part of medical education, how to improve the teaching quality is worth discussion. Based on the current situation of pediatric clinical teaching in our Soochow University, the suggestions of how to improve the quality of pediatric clinical teaching are given.

Internal medicine(IntMed) is one of the major subjects in medical undergraduate courses.With the transformation of medical mode from experience medicine to EBM,EBM shall be melted into IntMed teaching to change traditionary teaching mode and improve the teaching quality of IntMed,which helps to culture more new medical talented persons.

Objective To compare the characteristic of high permeability dialysis(HPD) and conventional hemodialysis(CHD) and to study whether HPD was more effectively in elimination of the macromolecular, medium and small molecule urinary endotoxin in uremia than CHD.Method 48 cases of hemodialysis patients were randomly divided into two groups: HPD group(26 cases)given by high permeability dialysis, and CHD group(22 cases)given by conventional hemodialysis dialyzer. Two groups were observed prospectively for 2 years and renal function , electrolytes, ? 2 microglubulin, amino acid, protein concentration, endotoxin in blood serum were detected before and after hemodialysis respectively.Results The clearance rates of blood creatinine, blood urea nitrogen, uric acid , ? 2 microglubulin in HPD group were better than that of CHD group. Serum amino acid, endotoxin, serum phosphorum changes were no statistical significance after hemodialysis in two groups. Protein concentration after hemodialysis was higher than that before hemodialysis in two groups. Conclusions High permeability dialysis has all virtues of conventional hemodialysis dialysis and can clear macromolecular and medium molecule endotoxin, but conventional hemodialysis can not do.

Objective To study the risk factors influencing the prognosis in the children patients with acute gastrointestinal dysfunction and to seek their therapeutic measures. Methods The clinical data of 125 cases patients with acute gastrointestinal dysfunction were retrospectively analyzed. The risk factors possibly influencing the prognosis were analyzed by multivariate statistical Logistic analysis. Results Among 125 children patients, 61 cases died, and the mortality rate was 48.8%. Logistic regression analysis indicated that poor circulation, cardiovascular system failure, hepatic failure, brain failure were significant risk factors of death associated with acute gastrointestinal dysfunction. (OR = 4.156, 3.330, 6.903, P<0.05 or<0.01). Conclusions Poor circulation, cardiovascular system failure, hepatic failure and brain failure are significant risk factors of death associated with acute gastrointestinal dysfunction.

Objective: To learn the health literacy status, trend and associated factors of Ningbo residents from 2015 to 2019, so as to provide basis for developing health policies and interventions. Methods: The monitoring data of health literacy of Ningbo residents from 2015 to 2019 was collected. The health literacy level was calculated and standardized by the population data of the sixth national census of Ningbo in 2010; five-year absolute growth and growth rate were used to reflect the changing trend. Multivariate logistic regression model was employed to analyze the influencing factors for the health literacy level. Results: The health literacy levels from 2015 to 2019 were 15.44%, 21.73%, 22.41%, 27.60% and 30.03%, with an annual increase trend ( P<0.05 ). The five-year absolute growth and growth rate were 14.59% and 94.49%. The Results of multivariate logistic regression analysis indicated that the year ( OR=1.158, 95%CI: 1.132-1.184 ), age ( 25-<35岁 years, OR=1.235, 95%CI: 1.039-1.468; 35-<45岁 years, OR=1.416, 95%CI: 1.193-1.681; 45-<55岁 years, OR=1.221, 95%CI: 1.024-1.455 ) , education level ( primary school, OR=1.790, 95%CI: 1.461-2.195; junior high school, OR=2.574, 95%CI: 2.102-3.154; high school/vocational high school/technical secondary school, OR=4.863, 95%CI: 3.943-5.998; college or above, OR=8.829, 95%CI: 7.109-10.965 ) , urban areas ( OR=0.934, 95%CI: 0.874-0.998 ) and occupation ( farmers, OR=0.692, 95%CI: 0.608-0.787; workers, OR=0.746, 95%CI: 0.664-0.837; enterprise staff, OR=0.822, 95%CI: 0.745-0.906; others, OR=1.106, 95%CI: 1.009-1.211 ) were the influencing factors for health literacy level. Conclusion The health literacy level of Ningbo residents shows an upward trend from 2015 to 2019, which are associated with age, education level, area and occupation.

OBJECTIVETo compare the changes of nucleus pulposus after in vitro culture of rabbit whole intervertebral disc and spinal motion segment.

METHODSTwenty-one New Zealand white rabbits which were randomly divided into organ group with 8 rabbits and segment group with 13 rabbits. Fifty intervertebral discs and 50 spinal motion segments were harvested respectively under aseptic conditions from two groups. These specimens were maintained in organ culture with hyperosmotic media (410 mOsm/kg), then 10 discs of the two groups were observed respectively by HE staining, immunohistochemistry of collagen type III, proteoglycan content and cells viability of nucleus pulposus before culture and at 3, 7, 14, 21 days after culture.

RESULTSHE staining showed the intervertebral disc tissue structure remained intact after culture of 21 days organ group and 14 days segment group,but there was severely degenerated of 21 days segment group. The intensity value of type II collagen immunohistochemical staining in the nucleus pulposus were not changed significantly between 21 days organ group and 14 days segment group (P > 0.05), but the staining of segment group at 21 days became shallower, there was significant difference compared with before each time points and organ group at 21 days (P < 0.05). PAS/AB staining of proteoglycan of nucleus pulposus showed that there were not decrease of tinting strength of two groups within 7 days, but the strength weakened slightly of two groups at 14 days, and the tinting strength became weaker at 21 days segment group, the change is more obvious than the organ group. The intensity value of fluorescence staining of nucleus pulposus cells was not changed significantly within 7 days of two groups (P > 0.05), the intensity value decreased slightly at 21 days organ group and 14 days segment group, but there were no significant difference compared with before time points (P > 0.05) however at 21 days segment group the intensity decreased as cells viability of nucleus pulposus decreased,and there was a significant difference compared with before each time points and organ group at 21 days (P < 0.05).

CONCLUSIONIt is not obviously degenerated of the discs of organ group cultured within 21 days and segment group cultured within 14 days, but there was significant degeneration of the intervertebral disc of segment group after cultured 21 days, so the rabbit spinal motion segment can be used on research about the biomechanics of intervertebral disc as a vitro experimental model within 14 days.

Animals ; Collagen Type II ; analysis ; Female ; Immunohistochemistry ; Intervertebral Disc ; chemistry ; pathology ; Male ; Organ Culture Techniques ; Rabbits

Objective To observe the characteristic features of musculoskeletal ultrasound (MSUS) in gouty arthritis (GA) and to assess its value in GA diagnosis.Methods Patients with GA and non-GA who underwent MSUS examination in Chinese PLA General Hospital were enrolled in this study. The synovitis,tenosynovitis,soft tissue swelling,bone erosion,bursitis and ossification were measured by greyscale ultrasound,and the synovial vascularity was measured by power Doppler ultrasound to evaluate the degree of inflammation.Results The ultrasound images of GA were intended to have specific features like tophus,hyperechoic deposition on the surface of the articular hyaline cartilage ( double contour sign ),hyperechoic deposition in the synovium appearing as bright stippled foci,and bright strap in tendons with a significant difference when compared with non-GA group (P ＜ 0.05).The percentage of tenosynovitis and bone erosion in non-GA group was higher than that in the GA group with a significant difference (P ＜0.05 ). Tophus,double contour sign,bright stippled foci or bright stippled foci in tendons together suggested gout with a specificity of 92.4％ and a sensitivity of 60.3％,the AUC of ROC was 0.764 ( P ＜0.05).Conclusion Tophus,double contour sign,bright foci and bright strap detected by MSUS are of diagnostic value on GA and MSUS may be a promising tool in diagnosing GA.