Teaching in out-patient clinic is a new and unique teaching mode,which is characteristic of one-to-one tutoring experiences.Students are put in the key positions while mentors serve as assistants in the whole process.By means of repeated practicing,summing-ups and perceiving,students improve their ability to combine theory with practice,enhance capabilities of communication,enrich their social experience and increase their talent of independent working.Meanwhile,further trainings may endow our medical students with better abilities of summarization.Through practice,teaching clinic has been proved to be a reasonable teaching mode which deserves promotion.

Vascular endothelial growth factor (VEGF)-specific effects on vascular endothelial cells,by promoting endothelial cell proliferation,increased vascular permeability,to induce tumor angiogenesis and lymphangiogenesis in tumor development has played key role.Studies have shown,VEGF and its receptor expression and the incidence of thyroid cancer,lymph node metastasis,prognosis,inhibition of VEGF and its receptor expression in anaplastic thyroid cancer and medullary cancer treatment in a certain application.

MicroRNA(miRNA) is a kind of small non-coding RNA which contents 18-25 nucleotide (nt). MiRNA plays an important role in human tumor of digestive system. Recently lots of research demonstrates that miRNA can act either as oncogenes or as tumor suppressor genes or sometimes as both. And many families of miRNAs'targets have been found. So the study of miRNA will supply a new way to the diagnosis and therapy of digestive diseases.

Objective To observe the effect of combined treatment with rhTRAIL(recombinant human TNF-related apoptosis inducing ligand) and selective Cox-2 inhibitor Celecoxib on gallbladder carcinoma in vitro and to explore the possible mechanism of the effect. Methods Western blot analysis was used to detect the expression of c-FLIP and death receptors after treatment by Celecoxib. Apoptosis of gallbladder cell line SGC-996 after the combined treatment with Celecoxib and rhTRAIL was detected in three ways: (1) phase microscopy of the cells, (2) detection of effector caspase-3 and caspase-7 activity, and (3) determination of the proportion of apoptotic cells labeled by Annexin V-PI flow cytometric analysis using CELLQUEST software. Results Celecoxib down-regulated the expression of c-FLIPs and up-regulated the expression of DR5 in a dose- and time-dependent mode on cell line SGC-996. Apoptotic levels in the combined treatment group in cell line SGC-996 were significantly higher than those in the single drug treatment group and control group. Conclusion Celecoxib markedly sensitized rhTRAIL-induced apoptosis through the down-regulation of c-FLIPs and up-regulation of DR5 in gallbladder carcinoma cell line SGC-996.

OBJECTIVE: To establish a rapid and precise detective method of 33.5 kd vesicular protein and to screen an effective treatment of cholelithiasis. METHODS: Specific antibody of the biliary vesicular protein was obtained by immunizing rabbits and enzyme-linked immunosorbent assay (ELISA) kit was developed. The concentrations of 33.5 kd vesicular protein in serum and bile of gallstone patients and control were examined respectively. The effects of Cholagogue Dry Syrup and Eulektrol Capsule on decreasing 33.5 kd vesicular protein were also studied by ELISA kit. RESULTS: One-step ELISA equation was Y=0.035 X (r=0.99). The vesicular protein concentrations in serum and bile of cholesterol gallstone group [(179.8+/-97.9) mg/L and (213.4+/-70.1) mg/L respectively] were significantly (P<0.05) higher than in the pigment stone group and control. Data showed that, with 2-week administration, Cholagogue Dry Syrup significantly decreased both biliary and serum 33.5 kd vesicular protein of cholesterol gallstone patients, while Eulekrol Capsule and control groups didn't have the same results. CONCLUSION: The concentrations of 33.5 kd protein are different in cholesterol gallstone patients and healthy groups which might be related to cholesterol nucleation process. Cholagogue Dry Syrup is of cholagogic and litholytic effect by decreasing biliary lithogenesis.

Objective To observe the effects of laparoscopy combined with choledochoscopy in the treatment of polypoid lesions of gallbladder and the effects on postoperative rehabilitation of patients. Methods 78 cases of patients with polypoid lesions of gallbladder treated in our hospital from August 2011 to November 2014 were selected as the study object. According to the order of medical treatment and hospital admission , the patients were numbered and randomly divided into laparoscopy group and combined group , with 39 cases in each group. The laparoscopy group were treated by laparoscopic cholecystectomy while the combined group were treated by laparoscopy combined with choledochoscopy gallbladder-protection surgery. The operation indicators , recovery of gastrointestinal function and incidence of postoperative complications in the two groups were observed. After discharge , the 2 groups of patients were followed up for 1 year. The improvement of postoperative digestive tract symptoms and rehabilitation of patients was observed. Results The intraoperative bleeding volume, postoperative fasting time, defecation time and hospitalization time of the combined group [(20.13 ± 7.48) mL, (0.51 ± 0.98) d, (1.20 ± 0.84) d, (1.98 ± 1.54)d] were less than those of the laparoscopy group (P <0.05); The incidence rate of complications in the combined group (10.26%) was lower than that in the laparoscopy group (33.33%) (P < 0.05); Immediately at the end of operation and 1 week after operation, VAS scores of the combined group [(4.23 ± 0.41), (2.46 ± 0.17) ] were lower than those in the laparoscopy group (P < 0.05); At the last follow-up, KPS score of the combined group increased to (89.98 ± 1.24), which was higher than that in the laparoscopy group (P < 0.05); GradeⅠpostoperative recovery in the combined group accounted for 87.18% which was higher than that in the laparoscopy group (64.10%). There was no case of grade III and the proportion was lower than that in the laparoscopy group (15.38%). The differences in proportions of grade I and III between the two groups were statistically significant (P < 0.05). Conclusion To adopt laparoscopy combined with choledochoscopy in the treatment of polypoid lesions of gallbladder , the curative effect is certain and the minimally invasive advantage is obvious. The long-term recovery effect is good and the safety is high.

Objective To explore the protective effect of treatment of somatostatin combined with growth hormone on brain injury in early severe acute pancreatitis(SAP)rats, and to investigate the relationship between brain injury and ratio of endothelin 1(ET 1) /nitric oxide(NO). Methods SAP model was established by retrograde pancreatic bile duct injection of 3.5% sodium taurocholate at a dose of 2.5 ml/kg in rats. Eighty SAP rats were equally divided into SAP group, somatostatin (S) group (introvenous injection of somatostatin at a dose of 42 ?g/kg once a day for 2 days), somatotropin (G) group (subcutaneous injection of somatotropin at a dose of 0.5 ?g/kg once a day for 2 days) and S+G group. Twenty normal rats were used as controls. The changes of encephaledema and blood brain barrier permeability were measured by dry wet method and Evan′s blue staining, respectively. Apoptosis of brain cells was detected by TUNEL method, and the ratio of serum ET 1/NO was also determined. Results The ratio of serum ET 1/NO was remarkably increased in SAP rats, which was correlated with the intensity of brain edema, permeability of blood brain barrier and apoptosis of brain cells. The treatment of somatostatin combined with growth hormone reduced the ratio of ET 1/NO and thus decreased the intensity of encephaledema, the permeability of blood brain barrier and apoptosis of brain cells. The changes of the brain slow wave were found simultaneously by electroencephalography in SAP rats after the therapy. Conclusions The treatment of somatostatin combined with growth hormone in SAP rats can inhibit serum ET 1/NO, prevent the development of brain edema, decrease the permeability of blood brain barrier, and alleviate the brain cells apoptosis. All these result in the relief of the brain injury.

Objective To evaluate the diagnostic accuracy of ELISA kit for cholesterol gallstone. Methods The ELISA kit of 33?500 vesicular protein was established by sandwich method, and the concentrations of the protein in gallbladder bile were examined among cholesterol, pigmental gallstone patients and control groups. Results The gallbladder 33?500 vesicular protein (213?70) ?g/ml is much higher in cholesterol gallstone patients than in pigmental gallstone patients (72?55) ?g/ml and control groups (65?52) ?g/ml (F=60.9, P

Objective To investigate the relationship between thyroid nodules with calcification and thyroid carcinoma and its significance in the screening of thyroid carcinoma in high risk group.Methods The clinical data of 1771 patient undergoing surgery for thyroid nodules from March, 2006 to March, 2009 in Huashan Hospital, Fudan University were retrospectively analyzed. Results Among 1771 patients, 500 were finally identified as having malignant tumors. Incidence of calcification in thyroid carcinoma was 68. 4%, and that in benign thyroid nodules was 27.0% ( χ2 = 259. 5, P ＜ 0. 05 ). The specificity of microcalcification for the diagnosis of carcinoma was 89. 4%, and its positive predictive value was 66. 3% ( χ2 = 368.6, P ＜ 0. 01 ). The incidence of thyroid carcinoma in patients ＜ 45 years was 39.2%, while that in patients ≥ 45 years was 22.9% ( χ2 = 51.12, P ＜ 0. 05 ). The incidence of carcinoma in patients of single thyroid nodule was 31.7% and that in those with multiple nodules was 26. 4% (χ2 =4. 766,P ＜ 0. 05). Metastasis was pathologically diagnosed in 26. 8% of lymph nodes found by preoperative ultrasonography. Conclusions The specificity of thyroid nodule calcification, especially microcalcification is high for the diagnosis of thyroid carcinoma. High-risk index for carcinoma includes thyroid nodules with microcalcification, ＜ 45 years old and single thyroid nodule.

During the central nervous system (CNS) development, the interactions between intrinsic genes and extrinsic environment ensure that each neuronal developmental stage (eg. neuronal proliferation, differentiation, migration, axon extension, dendritogenesis and formation of functional synapses) occurs in the proper timing and sequence. The successful coordination requires that numerous groups of genes are exquisitely regulated in a spatiotemporal manner by various regulatory mechanisms, including sequence-specific DNA-binding proteins, histone modifications, DNA methylation, chromatin remodeling, and microRNAs (miRNAs). By targeting chromatin structure, transcription and translation processes, these mechanisms form a regulatory network to accomplish the fine regulation of gene expression in response to environmental stimuli at different developmental stages. Dysregulation of the gene expression during neuronal development has been shown to be implicated in a number of neurodevelopmental disorders, such as autism spectrum disorders (ASD), Rett syndrome (RTT), Fragile-X syndrome (FXS) and other genetic diseases. The further understanding of the regulation of gene expression during neuronal development may provide new approaches for the diagnosis and treatment of these disorders.
Cell Differentiation ; Child Development Disorders, Pervasive ; genetics ; DNA Methylation ; DNA-Binding Proteins ; Gene Expression Regulation, Developmental ; Heredodegenerative Disorders, Nervous System ; genetics ; Humans ; MicroRNAs ; Neurons ; pathology ; Synapses