Objective To evaluate the prophylactic effect of pancreatic duct stent (PPDS),NonSteroid Anti-Inflammtory Drugs (NSAIDs),and joint PPDS and NSAIDs on post endoscopic rectrograde cholangiopancreatography(ERCP) Pancreatitis(PEP) in choledocholithiasis patients.Methods A total of 200 choledocholithiasis patients were randomly divided into 4 groups,prophylactic pancreatic duct stent(PPDS) group (A),NSAIDs group (B),joint PPDS-NSAIDs group (C) and routine ERCP without prevention for PEP(group D).VAS score,levels of amylase in serum and CRP were measured before and 4 h,24 h,48 h after ERCP.Incidences of hyperamylasemia and PEP were observed.Results (1) Incidences of hyperamylasemia 48 h after ERCP were 6％ (3/50),6％ (3/50) and 4％ (2/50) in group A,group B and group C respectively,which were significantly lower than that of group D (11/55) (P ＜ 0.05).(2) Incidences of PEP 48 h after ERCP were both 2％ (1/50) in group A and group C,which were lower than that in group D (10％,5/50,P ＜ 0.05).Group B (4％,2/50) was lower than that of group D but there was no statistical significance(P ＞0.05).(3) VAS scores of all groups at 4 h,24 h and 48 h after the operation were significantly higher than before (P ＜ 0.05).Group B score was significantly lower than that of group D (P ＜ 0.05).Scores of group A and C at 4 h were lower than those of group D (P ＜ 0.05),and those at 24 h and 48 h were also lower but with no statistical significance (P ＞ 0.05).(4) Serum CRP levels at 4 h,24 h and 48 h were significantly higher than those before in each group.Serum CRP levels of group B and C were significantly lower than that of group D at 4 h,24 h and 48 h.Serum CRP level of group A was significantly lower than group D at 4 h,24 h.CRP level at 48 h of group A was lower than that of group D,but there was no statistical significance (P ＞ 0.05).Conclusion Both prophylactic pancreatic duct stent and NSAIDs (Parecoxib Sodium) can reduce incidence of hyperamylasemia after ERCP common bile duct lithotomy.Single or joint use of prophylactic pancreatic duct stent can prevent PEP.Furthermore,prophylactic pancreatic duct stent and NSAIDs (Parecoxib Sodium) can reduce pain and inflammation after ERCP common bile duct lithotomy.NSAIDs only (Parecoxib Sodium) is more effective than prophylactic pancreatic duct stent only and joint use of both.

Objective To study the ultrastructural changes in three different zones of benign prostatic hyperplasia(BPH). Methods The ultrastructural changes in peripheral,transitional and central zones(PZ,TZ and CZ)of prostates from 10 patients with BPH were observed with transmission electron microscopy. Results Glandular epithelia layers in TZ of BPH were increased.The stroma in TZ was mainly composed of smooth muscle cells (SMC) of vigorous proliferation and fibroblasts.Mast cell and lymphocyte with cytoplasma membrane merge were observed in this zone.In PZ and CZ of BPH, SMC showing degenerative changes,such as,nuclear pyknosis,dilatation of perinuclear space and vacuolation of cytoplasma were frequently seen. Conclusions There are significant differences in the ultrastructure of three zones in BPH.

Objective To investigate the adjustment effect of microRNA-155 on CD4+CD25+ regulative T cell (Treg) in peripheral blood of sepsis patients,and to elucidate the role of miR-155 in the pathogenesis of sepsis.Methods A retrospective study was corducted.60 sepsis patients (mild n =20,moderate n=20,and severe n =20)from emergency room or intensive care unit (ICU) of the Fourth Hospital of Jiangsu University were enrolled.20 healthy volunteers were enrolled as controls.Real-time fluorescent quantitation polymerase chain reaction (qRT-PCR) was used to detect the levels of miR-155 and Foxp3 mRNA expressions in peripheral blood.CD4+CD25+ Treg cells in peripheral blood were identified by flow cytometry.Peripheral interleukin-10 (IL-10) was measured by enzyme-linked immunosorbent assay (ELISA).Results The expressions of miR-155,Treg,Foxp3 mRNA and the level of IL-10were higher in the patients with sepsis than those in healthy control group [Treg:(2.89 ± 1.13)％ vs.(2.32 ± 0.91)％,t=10.540,P=0.002; miR-155:1.19 ±0.48 vs.0.80 ±0.33,t=8.605,P=0.006; Foxp3 mRNA:0.18 ±0.08 vs.0.13 ±0.03,t=6.862,P=0.008; IL-10 (ng/L):56.89 ± 17.28 vs.33.24 ± 11.93,t=12.742,P=0.001].These variables were elevated gradually with the elevation of acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ)score.The expressions of Treg,miR-155,Foxp3 mRNA and the level of IL-10 were (3.05 ± 1.21)％,1.36 ± 0.79,0.21 ±0.10,(62.82 ±21.38) ng/L in severe sepsis group; they were (2.86 ±0.88)％,1.25 ±0.56,0.17 ±0.08,(56.38 ± 19.65) ng/L in moderate group; they were (2.61 ± 0.87)％,0.94 ± 0.52,0.15 ± 0.05,(45.43 ± 14.40) ng/L in mild group.The values showed significant statistical difference among the mild,moderate and severe sepsis groups (all P＜0.01).Above values were significandy higher in non-survival group than those in survival group [Treg:(3.46 ±1.53)％ vs.(2.85 ± 1.03)％,t=14.250,P=0.005; miR-155:1.41 ±0.85 vs.1.16 ±0.76,t=11.875,P=0.006;Foxp3 mRNA:0.24 ± 0.11 vs.0.17 ± 0.09,t=8.795,P=0.001 ; IL-10 (ng/L):65.47 ± 23.58 vs.51.70 ± 16.86,t=16.313,P=0.001].The expression of miR-155 was positively correlated with the expression of CD4+CD25+ Treg and Foxp3 mRNA (r1=0.635,P1=0.007; r2=0.671,P2=0.005).Conclusion The result of this study suggest that miR-155 is involved in the cell proliferation regulation of CD4 +CD25 + Treg cells,and play some role in the immunological dissonance in sepsis.

Objective To explore the influence of type 2 diabetes mellitus combined with subclinical hypothyroidism on diabetic vascular complications.Methods One hundred and two patients with type 2 diabetes mellitus were selected.The serum free triiodothyronine (FT3),free thyroxine (FT4),thyroid stimulating hormone (TSH),anti-thyroid peroxidase antibody (TPO-Ab),thyroglobulin antibody (TG-Ab) levels were measured by chemiluminescence method.The patients were divided into type 2 diabctes mellitus combined with subclinical hypothyroidism group (47 cases) and type 2 diabetes mellitus with normal thyroid function group (55 cases) according to the thyroid function.The glycated hemoglobin (HbA1c),total cholesterol (TC),low-density lipoprotein cholesterol (LDL-C),triacylglycerol (TG),high-density lipoprotein cholesterol (HDL-C),urea nitrogen,creatinine and albumin levels were measured.The estimated glomerular filtration rate (eGFR) was calculated according to the formula of modification of diet in renal disease (MDRD).The presence of diabetic retinopathy was examined by fundus examination,and the presence of lower limb artery lesions was measured by vascular ultrasound.All indicators were compared between 2 groups.Results There were no statistical differences in age,disease course,HbA1c,body mass index (BMI),TC,TG,HDL-C,LDL-C,incidence of lower limb artery lesions and incidence of diabetic retinopathy between 2 groups (P＞ 0.05).TheeGRF in type 2 diabetes mellitus combined with subclinical hypothyroidism group was significantly lower than that in type 2 diabetes mellitus with normal thyroid function group:(83.74 ± 21.55) ml/(min· 1.73 m2) vs.(115.02 ± 12.29) ml/(min· 1.73 m2),and there was statistical difference (t =4.274,P ＜ 0.01).The incidence of diabetic nephropathy in type 2 diabetes mellitus combined with subclinical hypothyroidism group was significanlty higher than that in type 2 diabetes mellitus with normal thyroid function group:48.9％ (23/47) vs.23.6％(13/55),and there was statistical difference (x2 =7.103,P＜ 0.01).Logistic regression analysis showed that subclinical hypothyroidism was a risk factor for diabetic nephropathy (OR =0.524,95％ CI 0.12-0.93,P ＜ 0.05),but it was not the risk factor for diabetic retinopathy (OR =0.618,95％ CI0.19-2.16,P =0.475) and lower limb artery lesions (OR =0.485,95％ CI 0.32-2.13,P =0.689).Conclusion Subclinical hypothyroidism in patients with type 2 diabetes mellitus has no obvious effect on lower limb arterial complications and diabetic retinopathy,but may increase the risk of diabetic nephropathy.

The neurotoxin β-amyloid (Aβ) is the main hallmark of Alzheimer′s disease (AD). Recent evidence suggests that, in common sporadic or late-onset forms of AD, elevated brain Aβ levels are caused by impaired clearance rather than overproduction. The cell surface receptor′s low-density lipoprotein receptor-related protein-1 (LRP1) has been reported to not only play a role in Aβ endocytosis, but also exist in the blood-brain barrier system, peripheral blood, liver, kidney and other tissues and organs, and transport Aβ to the cerebrospinal fluid or blood system by passing through the blood-brain barrier or the blood-cerebrospinal fluid barrier effectively, and finally clear it out of the body through peripheral tissues and organs. In this review, the role of LRP1 in the peripheral transport and clearance of Aβ is described, and it may be a safe and effective way to reduce Aβ in the brain and even improve cognitive dysfunction.

Objective To establish mixed-sandwich ELISA detection system by screening aptam-ers of MPT64 antibodies with SELEX to detect clinical serum samples, and explore the potential laboratory diagnosis value of this method. Methods To detect the affinity of the final round ssDNA library to MPT64 antibodies inhibited by MPT64 antigen with the competitive ELISA method, optimize the mixed-sandwich ELISA detection method that was aptamer-serum-horseradish peroxidase labeled goat anti-human IgG anti-body detection system to detect 230 cases of clinical serum samples as well as the lowest concentration of MPT64 antibodies and the linear range. Results In competitive ELISA test results, the percentage of inhi-bition effect of MPT64 antigen to final round ssDNA library is from 0.25% to 80% when the MPT64 antigen concentration rised from 2 μg/ml to 256 μg/ml. The Optimized detection system of mixed-sandwich ELISA was constitute of the concentration of ssDNA coated with 0.1μg/hole, serum dilution of 1/200, horseradish peroxidase labeled goat anti-human IgG antibody concentration of 1/40 000. The lowest concentration of MPT64 antibody is 3 mg/L and the linear range is between 10 mg/L and 1000 mg/L. The serum samples of 100 cases of tuberculosis patients, 100 healthy individuals and 30 cases of non-tuberculesis were tested in this system and the test result was analyzed with Graphpad Prism, the difference of tuberculosis group and healthy group was statistically significant (P<0.001 ), the difference of TB group and non-TB control group was also statistically significant (P<0.001). The specificity and the sensitivity was 96.1% and 31.0% re-spectively. Conclusion The aptamer mixed-sandwich ELISA method will play an important role in the sero-logical diagnosis of tuberculosis.

Teaching competency is one of the basic skills for teachers to accomplish daily teaching routine.This article focused on issues like imbalanced development in teaching competency,young teachers' lack of solid basic teaching ability,teachers' weak research ability and their lack of research ability to support teaching process in local medical colleges.In theory it systematically explained the teachers' teaching competency structure.Through the implementation of three linkage training of university-faculty-teaching and research department,normalized and institutionalized training for teachers from teaching-hospital,cooperation between clinical and basic medicine teachers,teachers' basic teaching ability was improved.And by transforming teaching evaluation philosophy,setting teaching quality standards at different levels,strengthening teachers' teaching introspection,teachers' ability in teaching evaluation was increased.Besides,by delivering encouragement policy and project driven teachers were guided to upgrade research ability in order to reflect on teaching.

Objective To observe the effect of serum containing Baihe Zhimu Decoction(BZD) on ovarian granular cells(GC) injury induced by cadmium chloride(CdCl2) in rats.Methods Totally fifteen female SD rats aged 23 days,3 months and 12 months(5 rats in each age group) were enrolled into the study.The number of ovary GC was counted.The growth of GC within 10 days was observed continuously for the selection of the well-growth ovarian GC.On the third day of the culturing,the screened ovary GC was cultured for another 48 hours in 10,20,40,60 and 80?mol/L CdCl2 solution respectively at 37℃ with 5% CO2 added.The optical density(OD) at 490nm was determined by methyl thiazolyl tetrazolium(MTT) assay for the screen of the optimal concentration of CdCl2 solution.Then the ovary GC were cultured in 96-well plate for 72 hours with serum containing BZD(at the final concentration of 1.25%,2.5%,5%,10% and 20% respectively) added.Meanwhile,the blank control group(cultured with 10% DMEM culture medium),model group(cultured with 10% DMEM culture medium and optimal concentration of CdCl2 solution),and blank serum group(cultured with blank serum and optimal concentration of CdCl2 solution)were set up.After the culturing for 48 hours,the OD value of all the groups was detected to evaluate the effect of BZD-containing serum on CdCl2-induced ovarian GC injury in rats.Results The number of GC in 23-day rats was the biggest and their growth was the best in the manner of exponential growth,indicating that GC in 23-day rats was suitable for the modeling.Ovarian injury was increased with the concentration of CdCl2,and 40?mol/L was the optimal concentration for CdCl2,which induced the shrinkage of GC edge.Serum containing BZD promoted the growth of GC,and counteracted the CdCl2-induced GC injury.Conclusion The protective mechanism of BZD-containing serum on CdCl2-induced GC injury is probably related with the counteraction of CdCl2-induced injury and with the increase of ovarian GC activity and quantity.

Objective To assess the clinical outcome of massive hiatal hernia repair by mesh via laparoscopic approach. Methods A total of 31 patients with massive hiatal hernia who underwent laparoscopic repair from March 2005 to January 2009 were enrolled in the study, among which mesh was used in 20 patients. The clinical outcomes of these patients were compared with other 11 patients without mesh repair procedures. Results Surgical repair, combined with Dor fundoplication, was successful in all 31 cases.Five patients in the mesh group developed post-operative recurrent symptoms, 2 ( 10% ) of whom were confirmed by imaging study. Six patients in non-mesh group had recurrent symptoms after operation and 4 (36. 4% ) were confirmed. Conclusion Laparoscopic repair of massive hiatal hernia is technially demanding with a high post-operative recurrent rate. Administration of intro-operative mesh can reduce the difficulty of the procedure and recurrence as well.

Objective To identify how clinical nurses evaluate the fandamental nursing skills for inpatients based on difficulty level,which will provide the basis for a better arrangement of nursing staff.Methods The questionnaire designed by the researcher was used to investigate 230 clinical nurses' evaluation of the fandamental nursing skills for inpatients based on difficulty level.Results The difficulty of the fandamental nursing skills for inpatients was average scored from ( 1.90 ± 0.89) to (3.40 ± 1.05 ).For ulcer prevention and care (t =- 2.359,P ＜ 0.05 ),help patient turn over and effective coughing ( t =- 2.328,P ＜ 0.05 ),head nurses and general nurses have different evaluation on difficulty level [ ( 3.35 ± 1.08 ) and (2.57 ± 0.99 ) for general nurses respectively; (3.72 ± 0.86) and (2.97 ± 1.06) for head nurses,respectively ].The capability of basic nursing care giver was significantly not match with the expectation of clinical nurses (P ＜ 0.01).Conclusions The difficulty of basic nursing care techniques for inpatients was at a low level.For ulcer prevention & care,helping patient turn over and effective coughing,general nurses need to take them seriously.Also,the present arrangement of nursing staff needed to be improved properly according to the difficulty level of the fandamental nursing skills.