Clinical teaching plays an important role in the education of medical graduate students.In the clinical teaching of the graduate students of burn and plastic surgery,we based it on clinical practice and guided the students in changing their modes of learning and thinking from examination-orientedness to problem solving,from simple vertical to clinical lateral thinking.We made sure that they all acquired innovative ideas and correct methods of clinical research by various academic activities,and cultivated their practical abilities and medical virtues by strict training and moral education.

Objective To investigate the status of Chlamydia trachomatis(CT) infection in pregnant women in Wuxi ,and to ex‐plore the relationship between CT and abortion .Methods A total of 3 199 cases of pregnant women visiting this hospital from Jan‐uary 2013 to December 2014 were enrolled in this study and divided into the missed abortion group(2 633 cases) ,incomplete abor‐tion group(265 cases) ,the inevitable abortion group(137 cases) ,threatened abortion group(104 cases) and control group(60 cases , all women undergoing induced abortion) .The CT infection was detected by using the fluorescent quantitative polymerase chain reac‐tion(FQ‐PCR) .Results The positive rate of CT in missed abortion group ,incomplete abortion group ,the inevitable abortion group and threatened abortion group were 5 .62% ,4 .53% ,5 .11% and 4 .81% ,respectively ,all were higher than that in the control group (3 .33% ) ,without statistically significant differences (P>0 .05) .The positive rate of CT in women in 16- <21 years old age group and 21- <26 years old age group was higher than that in other age groups ,which was 7 .06% and 6 .20% respectively .However , there were no statistically significant differences in positive rate of CT between these age groups (P>0 .05) .Conclusion The posi‐tive rate in women undergoing spontaneous abortion is higher than that in women undergoing induced abortion ,and young women has a higher infection rate of CT .

Objective:To study the biotransformation rule of the chemical components of total ginsenosides from ginseng stems and leaves tranformed by submerged fermentation of ganoderma lucidum,and to lay the foundation for further development and research of the medicinal fungus of ginseng stems and leaves.Methods:The total ginsenosides from ginseng stems and leaves were fermented by ganoderma lucidum,the changes of chemical components before and after fermentation were measured by thin-layer chromatography;the levels of total ginsenosides from ginseng stems and leaves before and after fermentation were detected by ultraviolet spectrophotometry;the levels of ginsenoside Rb1,Rg3,Rd,CK,Re,Rg,and Rh1 before and after fermentation were measured by high performance liquid chromatography.The human hepatocellular carcinoma SMMC-7721 cells were divided into blank control group,low,medium and high doses of total ginsenosides from ginseng stems and leaves groups and medicinal fungus of ginseng stems and leaves groups.The dosages of total ginsenosides from ginseng stems and leaves and medicinal fungus of ginseng stems and leaves were 5,10 and 20 mg·L-1,respectively.The inhibitory rate(IR) of the cells was determined by MTT assay.Results:The results of thin-layer chromatography showed that the saponins before and after fermentation occured mutual transformation;the levels of total ginsenosides from ginseng stems and leaves before and after fermentation were 749.98 and 602.26 mg·g-1,respectively;the levels of panaxadiol saponins Rb1,Rg3,Rd and CK before fermentation were 24.54,2.21,87.22 and 0 mg·g-1,and the levels of panaxatriol saponins Re,Rg and Rh1 were 151.34,77.02,and 3.06 mg·g-1.After fermentation,the level of Rb1 was decreased by 61.45%,the levels of Rg3,Rd and CK were increased by 238.91%,34.43% and 268.00%.The levels of Re and Rg1 were decreased by 63.75% and 64.41%,and the level of Rh1 was increased by 408.88%;the IR of the SMMC-7721 cells in medium dose of medicinal fungus of ginseng stems and leaves group was higher than that in medium dose of total ginsenosides from ginseng stems and leaves group(P<0.05);the IR of the SMMC-7721 cells in high dose of medicinal fungus of ginseng stems and leaves group was higher than that in high dose of total ginsenosides from ginseng stems and leaves group(P<0.01).Conclusion:The total ginsenosides from ginseng stems and leaves transformed by the submerged fermentation of ganoderma lucidum can significantly change its chemical components,which have stronger anti-proliferation activity in the SMMC-7721 cells.

Objective To investigate the protective effect and possible mechanism of Gossypol on isolated myocardial ischemia/reperfusion injury in rats.Methods 40 male Sprague-Dawley rats were randomly divided into 4 groups:Blank group,heart ischemia reperfusion group (MI/R group),high and low-dose Gossypol group (40,20 mg/L).The model of the myocardial ischemia/reperfusion injury were established using the Langendorff method.The hemodynamicsindexes,cardiac enzymes AST and LDH,inflammatory cytokines (NF-κB,ICAM-1,TNF-α and IL-6) were measured.The effect and mechanism of Gossypol on early-stage MI/R of the oxidative stress response and the JNK/p38 MAPK signal pathway were investigated.Results Experimental results showed that Gossypol could significantly improve the functional capacity of the heart,reduce the contents of AST,LDH and inflammatory cytokines in reperfused heart tissue,and increase superoxide dismutase levels to protect the heart.The mechanism of this substance may involve anti-lipid peroxidation and inhibition of p38 kinase phosphorylation and JNK,and reduction of oxidative stress injury and apoptosis damage induced by MI/R.Conclusion This study confirm that Gossypol exerts extensive anti-MI/R effects.Its mechanism may be related to the interfering with the oxidative stress response and suppressing the JNK/p38 MAPK signal pathway.

Objective:To evaluate the safety and efficacy of belimumab(BLM) in patients with SLE.Methods:Clinical data were collected for SLE patients who were diagnosed and treated with BLM in the Department of Rheumatology and Immunology (inpatient and outpatient department) of Guilin Medical College Affiliated Hospital from 1 December, 2019 to 12 May, 2023. BLM + standard of care (SOC) for the BLM group and SOC only for the SOC group. The primary clinical endpoint was adverse events (AE) occurring in groups, and the secondary clinical endpoint was disease activity index including SLEDAI-2000, clinical indicators, glucocortoid dosage reduction, and disease flare in the two groups. Propensity score matching method, independent sample t-test, non-parametric rank-sum test, variance analysis were used for statistical analysis. Results:Among the 79 BLM patients included, 48 had hematological impairment (61%), 53 had renal impairment (67%), 11 had skin and mucosal impairment (14%), 20 had joint impairment (25%), and 2 had neurological impairment(3%). There were no serious adverse events during the treatment in both groups. In the BLM group, with 14 cases experienced respiratory system infection, 1 with urinary system infection, 3 with skin infection, 4 with herpes virus infection, and 16 with liver function impairment. In the SOC group, there were 26 cases experienced respiratory system infection, 1 with urinary system infection, 6 with digestive system symptoms, 6 with skin infection, 4 with herpes virus infection, 10 with liver function impairment, 2 with thrombosis, and 1 with sepsis. Patients tolerated BLM generally well, with fewer adverse events occurring [in patients with the long course treatment, the number of AE cases in the BLM group vs SOC group 11 [(33%) vs 22 (68%), ( χ2=3.74, P=0.053)]. From all study groups and high-dose glucocorticoid (≥20 mg) groups, it was observed that the BLM group had a more significant reduction in glucocortoid dose [baseline glocucorticoid reduction in the BLM group decreased from 20 (12, 40)mg/d to 6 (4, 10)mg/d ( Z=0.12, P=0.01). In the renal injury group, after treatment, serum creatinine level decreased in the BLM group glomerular filtration rate increased from 72.37 (41.97, 95.74) to 97.03 (71.18, 114.34) ( Z=-4.62, P<0.001). There was less flares in the BLM group [7 cases (28%) vs 18 cases (72%), χ2=5.58, P=0.018] when compared with the soc group. Conclusion:BLM is safe and effective for the treatment of SLE, which can reduce disease activity, improve clinical parameters, reduce glocucorticoid dosage, and have a low flare rate.

Objective: To observe the clinical effect of Jiawei-Xiaoxianxiong decoction combined with conventional western medicine for the refractory angina pectoris with Qi stagnation and blood stasis syndrome and to explore its mechanism. Methods: A total of 98 patients who met the inclusion criteria were divided into two groups according to the random number table method, 49 in each group. The control group was treated with conventional therapy. The study group was treated with Jiawei-Xiaoxianxiong decoction on the basis of the control group. Both groups were treated for 4 weeks. The symptom of angina pectoris was scored before and after treatment. The Serum level of cardiotrophin-1 (CT-1), cytochrome C (Cyt C), soluble intercellular adhesion molecule-1 (sICAM-1), von Willebrand Factor (vWF), MDA and SOD were measured by ELISA, and the clinical effect was evaluated. Results: The total effective rate was 75.5% (37/49) in the study group and 63.3% (31/49) in the control group. There was significant difference between two groups (χ²=5.235, P=0.022). After treatment, the level of CT-1 (105.19 ± 12.04 ng/L vs. 158.25 ± 14.18 ng/L, t=19.967), Cyt C (0.53 ± 0.11 ng/L vs. 0.81 ± 0.15 ng/L, t=10.537) in the study group were significantly lower than those in the control group (P<0.01); the serum level of sICAM-1 (261.13 ± 38.40 μg/L vs. 415.55 ± 42.26 μg/L, t=18.930), vWF (105.22 ± 18.63 μg/L vs. 145.57 ± 21.18 μg/L, t=10.013), MDA (4.80 ± 0.59 mol/L vs. 6.21 ± 0.87 mol/L, t=9.389) in the study group were significantly lower than those of the control group (P<0.01); the SOD (12.07 ± 1.84 mol/L vs. 10.89 ± 1.65 mol/L, t=3.342) level in the study group was significantly higher than that of the control group (P<0.01). The number of attacks, duration, degree of pain, nature of pain and nitroglycerin dosage in the study group were significantly lower than those in the control group (t=9.711, 11.521, 8.818, 13.922, 17.791, respectively, all Ps<0.01). Conclusions The Jiawei-Xiaoxianxiong decoction combined with routine western medicine therapy can improve the symptoms of angina and clinical efficacy in patients with refractory angina pectoris of Qi stagnation and blood stasis syndrome. It is speculated that its mechanism may be related to anti-myocardial cell apoptosis, alleviating vascular endothelial injury and antioxidation.

OBJECTIVE： To establish the method for simultaneous determination of saikosaponin a and saikosaponin d in Bupleurum chinense water extract， and to optimize its water extraction technology for electromagnetic cracking. METHODS： HPLC method was used. The determination was performed on SB-C18 column with mobile phase consisted of acetonitrile-water （gradient elution） at the flow rate of 1.0 mL/min. The column temperature was 40 ℃. The detection wavelength was set at 210 nm， and  the sample size was 10 μL. Based on single factor experiment， using extraction time， particle size， solide-liquid ratio as factors， total extraction rate of saikosaponin a to saikosaponin d as indexes， the extraction technology was optimized by using Box-Behnken response surface methdology， and compared with the results of ultrasound method and decoction method. RESULTS： The linear range of saikosaponin a and saikosaponin d were 50.70-202.80 μg/mL （r＝0.999 9） and 50.50-202.00 μg/mL （r＝0.999 9）， respectively. The quantitation limits were 0.16 and 0.13 μg/mL， respectively. The detection limits were 0.05 and 0.04 μg/mL，respectively. RSDs of precision， stability and reproducibility tests were all lower than 2％. The average recoveries were 98.23-102.47％ （RSD＝1.80％， n＝6） and 98.84％-102.06％ （RSD＝1.60％， n＝6）. The optimal extraction technology was as follows： the extraction time of 2.50 min； the particle size of 80 mesh， solid-liquid ratio of 1 ∶ 28 （g/mL）. Results of 3 times of validation tests showed that the optimal technology included the average total extraction rates of saikosaponin a and saikosaponin d were 8.42 mg/g， which was higher than that of ultrasonic method （8.34 mg/g） and decoction method （8.06 mg/g）， and the extration time was shorter. CONCLUSIONS： Established method is simple and accurate， and can be used for simultaneous determination of saikosaponin a and saikosaponin d in B. chinense water extract. The optimized water extraction technology for electromagnetic cracking is stable and feasible.

OBJECTIVE To prepare hyperoside mixed nanomicelles （Hyp-F127/TPGS） and optimize its preparation technology，and to investigate its intestinal absorption characteristics. METHODS Hyp-F127/TPGS was prepared by thin film dispersion method. Based on single factor test and Plackett-Burman design ，combined with Box-Behnken response surface method ， the preparation process was optimized and validated using entrapped efficiency （EE）and drug loading （DL）as evaluation indexes ， F127-TPGS mass ratio ，hydration time and the amount of Hyp as factors. The appearance and microscopic morphology of Hyp-F127/TPGS obtained by the optimal technology were observed ，and the particle size ，polydispersity index （PDI）and Zeta potential were also determined. The critical micelle concentration （CMC）of blank micelle （F127/TPGS），in vitro release behavior and preliminary stability of Hyp-F 127/TPGS were investigated ，and absorption characteristics of Hyp-F 127/TPGS were investigated by in situ unidirectional intestinal perfusion model. RESULTS The optimal preparation technology of Hyp-F 127/TPGS included F127-TPGS mass ratio of 2∶1，hydration time of 2 h，and Hyp amount of 9 mg. Results of three validation tests showed that the EE of Hyp-F 127/TPGS was （87.20±0.99）％，and the DL was （5.02±1.20）％，deviations from predicted values were 0.92％ and 2.39％. The micelles prepared by optimal technology were yellow ，clear and transparent solution ，with good Tyndall effect ；under transmission electron microscope ，they were spherical ，complete and evenly distributed ；the particle size was （15.02±0.16）nm， the PDI was 0.092±0.031，and the Zeta potential was （－6.67±1.47）mV. The CMC of F 127/TPGS was 21 μg/mL，Hyp-F127/ TPGS was stable after 4 weeks of storage at 4 ℃，and the cumulative release rates of Hyp-F 127/TPGS and Hyp control were （66.30±2.93）％（96 h）and（99.24±0.27）％（60 h），respectively. Hyp-F 127/TPGS and Hyp reference were absorbed in each intestinal segment ，and the main absorption sites were jejunum and duodenum respectively ；drug absorption rate constant andapparent absorption coefficient of the former were significantly higher than those of the latter （P＜0.05 or P＜0.01）. E-mail：zhangyuhangxz@163.com CONCLUSIONS The optimized preparation technology of Hyp-F127/TPGS is stable and feasible ；prepared Hyp-F 127/ TPGS shows a sustained -release effect ，which promotes the intestinal absorption of H yp to a certain extent.

Objective To translate the Water Orientation Test of Alyn 2 (WOTA2) into Chinese, and to study its reliability and validity for patients with spinal cord injury. Methods After authorizing, the English version WOTA2 scale and its training package were translated into Chinese. From January to September, 2018, 137 patients with spinal cord injury were evaluated with the Chinese version WOTA2 by two evaluators independently, and evaluated again three days later by one of the evaluators. The Cronbach's α, Spearman-Brown coefficient, intra-group correlation coefficient (ICC) and Kappa coefficient were calculated to evaluate the reliability. Content Validity Index (CVI) of items (I-CVI) and scale (S-CVI) were used to evaluate the content validity, and factors analysis was used to evaluate the structure validity. Results The Cronbach's α was 0.947 in all items of the scale, 0.890 in mental adjustment items and 0.954 in aquatic skills items. Pearson correlation coefficient of the half scales separated by odd and even items was 0.948, and the Spearman-Brown coefficient was 0.973. The ICC of test-retest was 0.965 in total score, 0.965 in centesimal system total score, 0.847 in mental adjustment score and 0.970 in aquatic skills score. The ICC of inter-testers was 0.964 in total score, 0.965 in centesimal system total score, 0.847 in mental adjustment score and 0.970 in aquatic skills score. The Kappa coefficient was 0.528 to 0.927 in test-retest and 0.528 to 0.927 in inter-testers. The I-CVI was 0.8 to 1.0 and S-CVI was 0.63. Factors analysis extracted four factors, which met the theory, and contributed 67% of cumulative variance. Conclusion The Chinese version WOTA2 is good in reliability and validity for patients with spinal cord injury, and can be used in the clinical practice of aquatic therapeutic exercise in China.