With self-designed experiment as its basis,Basic Medical College of Shanghai Jiao Tong University has made teaching reform that is design-oriented and integrative with intent to cultivate students' innovation consciousness and practice ability.As a result,a teaching model of"research-based learning",which aims at bringing forth innovative talents,has been constructed and produced desired effects.

Carbapenems ; pharmacology ; Drug Resistance, Bacterial ; Humans ; Klebsiella Infections ; drug therapy ; microbiology ; Klebsiella pneumoniae ; drug effects

Objective:To observe the clinical effect of warm needling moxibustion at Zhongji (CV 3) and Zusanli (ST 36) in treatment of urinary retention after gynecological surgery. ＜br> Methods: Forty patients with urinary retention after gynecological surgery were randomly divided into two groups by the randomized method, 20 cases in each group. Patients in the treatment group were treated by warm needling moxibustion at Zhongji (CV 3) and Zusanli (ST 36). Patients in the control group were treated by inductive urination. The therapeutic effects of the two groups were observed after one course of treatment. ＜br> Results:The total effective rate was 95.0%in the treatment group and 70.0% in the control group. The difference in the total effective rate between the two groups was statistically significant (P＜0.05). ＜br> Conclusion: Warm needling moxibustion at Zhongji (CV 3) and Zusanli (ST 36) is more effective than inductive urination in treating urinary retention after gynecological surgery.

Objective:To explore the relationship between periodontitis and coronary heart disease (CHD)by meas-uring changes of serum inflammatory cytokine levels.Methods:A total of 197 patients from our hospital were en-rolled,including CHD + periodontitis group (123 cases),pure CHD group (CHD group,39 cases)and pure peri-odontitis group (periodontitis group,35 cases).Another 45 healthy subjects were enrolled as healthy control group. Concentrations of tumor necrosis factor-α(TNF-α),interleukin-6 (IL-6),serum amyloid-a (SAA),high sensitive C reactive protein (hsCRP)and plasma fibrinogen (Fg)were measured in all groups,and levels of above inflammatory cytokines were compared among four groups.Results:Compared with healthy control group,there were significant rise in levels of above inflammatory cytokines in CHD + periodontitis group (P<0.01 all),Com-pared with CHD group or periodontitis group,there were significant rise in levels of hsCRP [(6.52±2.03)mg/L, (4.34±1.76)mg/L vs.(9.21±2.65)mg/L],IL-6 [(65.32±21.01)ng/L,(65.12±12.34)ng/L vs.(85.76± 25.96)ng/L]and TNF-α[(9.75±3.74)ng/L,(9.34±4.55)ng/L vs.(13.46±8.12)ng/L],SAA [(2.25±1.2) pg/ml,(2.22 ±1.02)pg/ml vs. (2.85±1.45)pg/ml],P<0.05 all in CHD + periodontitis group;there were no significant difference in all serum inflammatory cytokine levels between CHD group and periodontitis group (P>0.05 all).Conclusion:Serum inflammatory cytokine levels significant rise in palients with periodontitis,it is related with coronary heart disease.

Objective To investigate the clinical pathological features and prognosis of gastric carcinoma with neu-roendocrine differentiation (NED) and mixed gonadal neuroendocrine carcinoma of the stomach (MANECs). Methods A retrospective analysis of 61 cases of gastric carcinoma with NED and 34 cases of MANECs and their histochemistry and im-munohistochemistry were also observed. Prognosis of the 2 groups were compared by the Kaplan-Meiers survival analysis. Prognostic factors associated with patients with gastric cancer were analyzed by COX proportional hazards model. Results Tumor location, distant metastasis and lymph node metastasis were statistically different between these 2 groups (P<0.05). Syn positive expression rate is higher than CgA and CD56 in the gastric carcinoma with NED group;Postoperative survive pe-riod of the gastric carcinoma with NED is shorter than that of MANECs (P<0.05). Lymph node metastasis and distant region-al transfer is obviously correlated with prognosis (P<0.05). Conclusion Immunohistochemistry is important for the diag-nosis of these two tumor. The number of neuroendocrine cells can help to assess prognosis and guide treatment.

Objective To explore the advantages and disadvantages of high quality care in clinical care. Methods 2000 cases of hospitalized patients from August 2010 to August 2011 in department of neurology were selected as research subject.The 2000 hospitalized patients were divided into the control group and the research group with 1000 cases in each group.The control group was given routine care,the research group selected high quality care.General activity of daily living (ADL) assessment and satisfaction degree of patients was surveyed at discharge for two groups and the results were compared. Results When patients were discharged,ADL scores and satisfaction degree of patients in the research group were higher than those of the control group. Conclusions Application of high quality care for patients can promote the improvement of activity of daily living and satisfaction degree of patients.

Objective To determine quantity of type Ⅰ collagen and mRNA expression of decorin and transforming growth factor (TGF)- β_1 in the upper portion of the anterior vagina in women with pelvic organ prolapse (POP). Methods Transvaginat biopsies were obtained from the anterior vaginal wall in 27 POP(POP group) and 21 non-poP(control group). The concentration of type Ⅰ collagen was determined by ELISA technique. RT-qPCR was used to verify the mRNA level of decorin and TGF- β_1. Results The mean concentration of type Ⅰ collagen in the premenopausal women in POP group [(47.94 ± 6.82) mg/g total protein (TP)]was significantly lower than that in control group [(62.33±6.57) mg/g TP],in the postmenopausal women in POP group, it was (41.82±5.96) mg/g TP, significantly lower than that in control group[(61.21 ± 4.84)mg/g TP](P< 0.01). The mRNA expression of decorin was 1.61 ± 0.10 in POP group, significantly lower than that in control group 2.77±0.60 ,while that of TGF-β_1 was higher in POP greup10.86 ± 0.23 than that in control group 9.87 ± 0.92 (P < 0.05). In the postmenopausal women in two groups, there were no significant difference in the mRNA expression of decorin and TGF-β_1 (P > 0.05). Conclusions A decrease in quantity of type Ⅰ coUagen in the connective tissue of anterior vagina may compromise the tensile strength and an increase susceptibihty to prolapse. Deeorin might be involved in the pathogenesis in premenopausal women with POP. The pathogenesis of POP is muhifactorial.

According to the goal of promoting all-round ability and the core idea of PRICE,the Medical School of Shanghai Jiao Tong University improves the curriculum,teaching method,experimental teaching,multidimensional examination to explore the new system of teaching reform for eight-year clinical medical education.

Efforts have been directed at the development of efficient protocols for the differentiation of pluripotent stem cells into pancreatic β-cells.This review focuses on the mechanism of RA,BMP,FGFs,IDE1,IDE2,ALK-i 1 and ALKI-2 during the process in which pluripotent stem cells differentiate to pancreatie β-cells and the relationship between the differentiation and the expression of the surface markers including CD14,CD49e,CD238,CD24,EpCAM,SSEA3 and SSEA1 in the different stage of this process.

Objective To explore the synchronous cosmetic surgical procedures for the beauty-seekers who have both single eyelid and commonly horizontal cockeye in order to acheive either time saving or beautifying. Methods Firstly, the distance of moving backwards and shortening length of the eye muscle were calculated and designed according to the degree of cockeye; secondly, the height of the double eyelids line and positioning were re-designed; then the moving backwards and shortening of the horizontal macula were put up to rectify the cockeye; finally, the incisal double eyelid operation was performed. Results All 25 patients with inner cockeyes were corrected at the right position; 4 of 11 patients with outer cockeyes were corrected 5～10 degrees over the right position, and others were at the right position. The single eyelid with thin-eyelid and middle-thick-eyelid restored within 3 months; but the patient with thick-eyelid restored slowly, about half a year in average. 2 patients with redundant skin at inner corner of eye were also corrected at the right position. Conclusions Although there is somewhat difficulty in the plastic surgery for patients with cockeye and single eyelids, synchronous operation can save time and outlay, and also acheive the aim of beautifying. Therefore, it is a good approach to deal with cockeye.