Objective To explore the clinical value of high risk human papillomavirus(HR-HPV) test in shunting monitoring of atypical squamous cell of undetermined significance (ASCUS) and to seek the best treatment for patients with ASCUS.Methods 470 patients with ASCUS tested by TCT were given HR-HPV testing and biopsy under colposcopy.The clinical characteristics were analyzed.Results 470 cases of ASCUS contained a variety of cervical lesions:inflammation/acuminate accounted for 69.15％ (325/470),cervical intraepithelial neoplasia (CIN)accounted for 29.57％ (139/470),and invasive carcinoma accounted for 1.28％ (6/470).The positive rate of cervical pathological examination was 30.85％ (≥ CIN Ⅰ,145/470).The positive rate of HR-HPV was 50.43％(237/470).The detection rate of ≥CIN Ⅰ in HR-HPV positive group and negative group was 55.27％ (131/237)and 6.01％ (14/233),while the detection rate of ≥ CIN Ⅱ in HR-HPV positive group and negative group was 36.71％ (87/237) and 1.29％ (3/233).The differences were statistically significant(P ＜ 0.01).Incidence of ≥ CIN Ⅰ and invasive carcinoma in HR-HPV positive group was about 19.332 fold of that in HR-HPV negative group(95％ CI =10.632 ～ 35.152),while the incidence of ≥CIN Ⅱ and invasive carcinoma was about 44.467 fold of HR-HPV negative group (95％ CI =13.812 ～ 143.152).The detection sensitivity,specificity,positive predictive value,negative predictive value(NPV) of HR-HPV in the≥ CIN Ⅰ patients were 90.34％,67.38％,61.60％,93.99％.Those of ≥ CIN Ⅱ patients were 96.67％,60.53％,36.71％,98.71％.Conclusion ASCUS included partial CIN of high grades and cervical cancer,and the proportion of HPV infection is large,detection of high risk HPV-DNA is an effective shunting management method of ASCUS.

Objective To investigate the expression of IgG4 in liver tissues of patients with type Ⅰ autoimmune hepatitis (AIH) and to analyze the clinical manifestation,biochemical indexes,immunological genetic features,pathological characteristics and the effects of immunosuppressive therapy.Methods From March 2012 to July 2013,45 patients diagnosed as type Ⅰ AIH were enrolled.Immunostaining of CD38,IgG and IgG4 in liver tissue slices was performed,inflammation grade G and fibrosis stage S were determined.At the same time,serological indexes (alanine aminotransferase (ALT),aspartate transaminase (AST),alkaline phosphatase (ALP),IgG,antinuclear antibody (ANA) titer,antibodies to asialoglycoprotein receptor (ASGPRAb)) of the patients were collected,serum IgG4 was tested and the response to immunosuppressive therapy was observed.Wilcoxon rank sum test and t test were performed for quantitative data comparison.Spearman correlation coefficient was used for correlation analysis.Results Among 45 patients with type Ⅰ AIH,five patients (11.1％) were IgG4 associated AIH (IgG4-AIH group).There were no significant differences in age,gender,biochemical indexes (serum levels of ALT,AST,ALP),immunity indexes (serum levels of IgG,ANA titer,ASGPRAb) and degree of liver fibrosis between patients with IgG4-associated AIH and classical AIH (40 cases) (all P＞ 0.05).Compared with classical AIH group (18.3(6.7) mg/L).The serum level of IgG4 of IgG4 AIH group was 25.8(9.2) mg/L,which significantly increased (Z=-2.041,P＜0.05).However,there was no significant difference in serum level of IgG4 between the two groups (P＞0.05).There was no correlation between the number of infiltrated IgG4 positive plasma cells and the serum level of IgG4 (r=0.311,P=0.279).The inflammation in the liver tissues of IgG4-AIH group was more significant compared with that of classic AIH group (H=4.120,P＜0.05).The number of CD38' or IgG+ plasma cells was larger compared with that of classical AIH (CD38(39.3(13.5)/high power field (HPF) vs (21.3(8.8))/HPF,IgG(39.3 (14.0))/HPFvs (18.5(8.9))/HPF;Z ＝-3.561 and-3.584,both P＜0.01).The number of IgG4+ plasma cells in liver tissues was positively correlated with the number of CD38+ or IgG+ plasma cells (r=0.884 and 0.791,both P＜0.01).Conclusions Among patients with type Ⅰ AIH,the incidence of IgG4-associated AIH was not high.The serum level of IgG4 did not significantly increase in these patients.However,the histological inflammation activity was significant along with many CD38+ or IgG+ plasma cells infiltration.

BACKGROUND: A large number of preclinical experimental data have shown that stem cells can regulate the immune function, and serve the function of cell replacement. OBJECTIVE: To summarize the anti-inflammatory effects of stem cells in the treatment of ischemic stroke, based on which, we further discuss the specific mechanisms. METHODS: We conducted a systematic and comprehensive search in PubMed, Elsevier, Springer, Wiley, Ovid, EBSCO databases. The range of retrieval time was from 2012 to 2017. The keywords were stem cells, stroke, inflammation, immune. Totally 110 articles were retrieved initially, and 47 articles were included in result analysis. RESULTS AND CONCLUSION: By reading extensive literature, we analyzed and summarized the research status quo of the anti-inflammatory effects of neural stem cells, mesenchymal stem cells and endothelial cells in the treatment of ischemic stroke. The mechanisms mainly include reducing focal inflammation, immune regulation, promoting the secretion of various neurotrophic factors, reducing secondary cell death, protecting neurons and promoting cell function recovery and further promoting the recovery of nerve function. The mechanisms underlying local immune regulation and anti-inflammatory effects of stem cells are mainly described as the shift from M1 to M2 macrophages under the intervention of stem cell factors, to intervene secreted immune cytokine profiles and exert effects on inhibition and polarization of glial cells. Further investigation is required on the anti-inflammatory effects and immune regulation of stem cell therapy for stroke.

Objective:To study the preventive and therapeutic effects of silk fibroin peptides (SFP) on acute alcoholism in mice. Methods:In first experiment, the mice were randomly divided into four groups, and every group was treated by 56o alcohol (ethanol dosage 7.56 ml/kg bw) via i.g. Eighty mice were fed normal saline (NS) and different dosages of SFP (0.1, 0.5, 2.5 g/kg bw) 30 min later respectively, then the rate of ebriety and time of sobriety were determined. Another 72 mice were also divided into four groups and given NS and SFP similarly. The concentration of ethanol in serum was measured 1 h, 2 h and 4 h later respectively. In second experiment, the mice were also divided into four similar groups, but 56o alcohol was given at 6.16 ml/kg?bw via i.g. NS and SFP were given similarly, 0.5 h before alcohol. Two experiments were performed to observe the effect of SFP on prevention of temulence. Results:The time of sobriety and concentration of ethanol of SFP groups fed 0.5 and 2.5g/kg bw were lower significantly than those of NS group (P

Objective To investigate the effect of doxycycline on the Th1/Th2 cell balance in experimental allergic encepha-lomyelitis(EAE)rats.Methods Forty female Wistar rats were randomly divided into the EAE control group,low,medium and high does DOX treatment groups,10 cases in each group.The onset situation in rats was observed.The IL-4 and IFN-γlevels secreted by peripheral blood mononuclear cells (PBMC)at the peak stage were detected.The levels of IL-1β,IL-10,TNF-αin brain tissue,and the albumin content in cerebrospinal fluid and serum were detected.The QA value was calculated.Results In each DOX group,the clinical symptoms of rats were alleviated compared with the EAE control group.In each DOX group,the PBMC secreting IFN-γlev-el and IFN-γ/IL-4 ratio in the onset peak stage were lower than those in the EAE control group,while the IL-4 level was higher than that in the EAE control group(P <0.01).Compared with the medium-dose DOX group,the increase of IL-4 level in the high-dose DO group was unapparent(P >0.05),but the difference between other DOX groups had statistical significance(P <0.01).The IL-1βand TNF-αlevels of brain tissue and QA value during onset peak stage in various doses DOX groups were decreased compared with the EAE control group,while the IL-10 level was increased compared with the EAE control group(P <0.05).With the DOX dose increasing,the levels of IL-1β,TNF-αand QA value in various doses DOX groups became lower,the IL-10 level became high-er,there was statistically significant difference among various doses DOX groups (P <0.05 ).Conclusion DOX can obviously alle-viate the clinical symptoms of EAE rats,its mechanism may be related with that DOX could decrease the level of Th1 cytokine and increase the level of Th2 cytokine,correct the Th1/Th2 cell balance,thus protect the blood brain barrier(BBB).

AIM:To study the morphological changes of cardiac H9c2 cells during the developmental process of fetal rat.METHODS:Embryonic rat heart-derived H9c2 cells were maintained in DMEM supplemented with 10%fetal bovine serum.The H9c2 cells were plated at a density of 6 000 cells/cm and divided into 5 groups:H9c2 cells were trea-ted with 5 mmol/L glucose, 25 mmol/L glucose, 50 mmol/L glucose, Norvasc (25 nmol/L) +25 mmol/L glucose, or Norvasc (25 nmol/L)+50 mmol/L glucose for 48 h.The morphology of H9c2 cells was observed.The cell surface area was measured by Image-Pro Plus 6.1 software.Fluorescence spectrophotometry was used to detect the concentration of in-tracellular calcium ion ( [ Ca2+] i ) in the cardiomyocytes.The concentration of CaN in the cell was measured by ELISA. The mRNA expression of CaNAβ, NFAT3 and β-MHC in the cells was detected by real-time PCR.The protein levels of CaNAβ, NFAT3 and β-MHC in cultural H9c2 cells were detected by Western blot.RESULTS: The mean area of the cells, the mean fluorescence value of [ Ca2+] i and the concentration of CaN in 25 mmol/L glucose group were higher than those in 5 mmol/L glucose group, and those were lower than those in 50 mmol/L glucose group.After treated with Nor-vasc, those results decreased significantly.The expression of CaNAβ, NFAT3 andβ-MHC at mRNA and protein levels in 25 mmol/L glucose group was higher than those in 5 mmol/L glucose group, but was lower than those in 50 mmol/L glu-cose group .The expression of CaNAβ, NFAT3 andβ-MHC at mRNA and protein levels decreased significantly in Norvasc treatment group.CONCLUSION:Ca2+-CaN-NFAT3 signaling pathway is perhaps involved in high glucose-induced H9c2 cardiomyocyte hypertrophy.

Objective:To observe factors influencing the risk of urinary tract infection (UTI) after cerebral hemorrhage (ICH).Methods:A total of 77 ICH patients undergoing rehabilitation between August 2015 and August 2017 were studied. Among them, 24 were diagnosed with a UTI according to clinical manifestations and urine routine tests and urine culture. They formed the UTI group. The other 53 were the non-UTI group. Complete clinical evaluations were available for all 77, and those data were used to identify risk factors for UTI using univariate and multivariate logistic regression analysis.Results:The univariate analysis showed that age, side of paralysis, consciousness dysfunction, Brunnstrom staging of the lower extremity, tracheotomy, indwelling catheter, lung infection, white blood cell count, neutrophil percentage, serum natrium, uric acid, D-dimer level and fibrinogen were all significant predictors of UTI. The multivariate analysis identified age, right side hemiplegia and D-dimer level as useful predictors.Conclusions:Advanced age and a high D-dimer level are independent risk factors for UTI after ICH, while hemiplegia on the right side is a protective factor.

We aim to develop and implement a disaster medicine curriculum for medical student education,so the six-step approach to curriculum development for medical education has been used as a formal process instrument. Recognized experts in disaster health care have provided input using disaster-related physician training programs, scientific evidence if available, proposals for education by international disaster medicine organizations and their expertise as the basis for content development. The final course consists of 14 modules composed of 2-h units. The concepts of disaster medicine, including response, med-ical assistance, law, command, coordination, communication, and mass casualty management, are intro-duced. Hospital preparedness plans and experiences from worldwide disaster assistance are reviewed. Life-saving emergency and limited individual treatment under disaster conditions are discussed . Specifics of initial management of explosive, war-related, radiological/nuclear, chemical, and biological incidents empha-sizing infectious diseases and terrorist attacks are presented. An evacuation exercise is completed, and a mass casualty triage is simulated in collaboration with local disaster response agencies. Decontamination procedures are demonstrated at the local fire department, and personal decontamination practices are exer-cised. Mannequin resuscitation is practiced while personal protective equipment is utilized. An interactive review of professional ethics, stress disorders, psychosocial interventions, and quality improvement efforts complete the training. The curriculum offers medical disaster education in a reasonable time frame, interdis-ciplinary format, multi-experiential course and flexible structure. It can serve as a template for basic medi-cal student disaster education.

Objective:To explore the application effect of standardized patient combined with situational simulation teaching in the course of Intensive and Critical Diseases Care among higher vocational college students.Methods:A total of 66 nursing students in direction of intensive care from Batch 2015 and 60 ones from Batch 2016 were selected as the control group and the experiment group respectively. The control group adopted traditional teaching method, while the experiment group adopted the model of standardized patient combined with situational simulation teaching on the basis of traditional teaching methods. Before teaching, we designed the standard cases of the course, set up and trained the standardized patient team members. Then the standardized patient combined with situational simulation teaching was applied to the experimental teaching of the course. At the end of the course, the comparison of the theoretical examination score and the operational examination score of the two groups of students was made, and the self-designed questionnaire survey for the experimental group was used to evaluate the teaching effect.Results:The theoretical examination score [(82.80±4.17) points] and the operational examination score [(85.90±1.85) points] of students in the experiment group were higher than those of students in the control group [(80.74±3.15) points vs. (83.82±1.91) points], with significant differences ( P<0.01). The results of self-designed questionnaire survey showed that more than 90.0% of the students from the experiment group thought that this teaching mode could improve their interest in learning and subjective initiative; more than 76.7% thought that this teaching mode could improve their own abilities such as observation of disease changes, communication, teamwork and clinical thinking; more than 93.3% recognized the application of this teaching mode. Conclusion:The application of standardized patient combined with situational simulation teaching could improve the theoretical knowledge and operational skills of the students, and could also train the students' comprehensive quality such as clinical thinking, emergency handling ability, communication ability and so on, so as to improve the teaching effect.

Objective To compare the therapeutic effect of Pilates and conventional training after total hip arthroplasty (THA).Methods Fifty-eight patients who had undergone minimally invasive total hip replacement surgery were divided into an observation group (n =29) and a control group (n =29) using a random number table.The observation group was given Pilates rehabilitation training,including a series of exercises especially designed for this condition,for 6 months after the operation.The control group was provided with conventional postoperative rehabilitation training including passive range of motion exercise,balance training,etc.,lasting for 1 to 2 months in hospital,followed by self-training after discharge.At 1 month,3 months and 6 months after the operation hip joint function was evaluated in both groups using the Harris hip score and the modified Barthel index (MBI).The time for first out-of-bed activity after the operation,length of hospital stay and postoperative complications of the two groups were also recorded.Results At 1 month after the operation,the average Harris hip score and MBI score of the observation group were significantly better than those of the control group [(59.78 ± 6.22) vs (51.26 ± 3.42) and (52.56 ± 16.67) vs (45.63 ± 15.24),respectively].Two and 4 months later,in the observation group the average Harris hip score had improved significantly to (82.12 ± 3.32) and further to (91.42 ± 5.91),while the MBI score increased significantly to (58.39 ± 13.32) and (81.17 ± 13.87).The same tendency was observed in the control group and at those two time points no significant difference was observed between the observation group and the control group.The patients in the observation group had their first out-of-bed ambulation significantly earlier,a significantly shorter average hospital stay and significantly fewer postoperative complications.Conclusion Pilates training after minimally invasive THA can promote earlier and quicker functional recovery than conventional rehabilitation training.