The application of Standardized patient(SP) in Chinese clinical teaching is still in its infancy.The experience of SP in respiratory medicine teaching is also very limited.This article discusses the experience in applying SP in respiratory medicine teaching and several issues of SP training that should he paid attention to,and hrings forward our expectation in SP training in China.

Objective To detect the initial results of total hip arthroplasty (THA) after failure of internal fixation of femoral neck fractures and investigate the key points in surgical procedures and prosthesis selection.Methods A retrospective analysis was performed on 36 cases who had THA for femoral neck fractures due to the initially failed internal fixation between January 2007 and December 2012.There were 21 males and 15 females,with age ranging from 46 to 72 years (mean,58.6 years).After internal fixation,13 cases were complicated by femoral head necrosis,eight fracture nonunion,and 15 fracture nonunion combined with femoral head necrosis.All the 36 cases had cementless THA,including proximally fixed stem in 25 cases and distally fixed stem in 11 cases.Harris hip score was assessed before operation and at follow-up.Results All the cases received a follow-up of 26-52 months (mean,32.5 months).Mean Harris hip score improved from 26.3 to 83.6,including excellent results in 12 cases,good in 22,and fair in two,with excellence-good rate of 94％.Conclusion With respect to the failed internal fixation of femoral neck fractures,THA is an effective remedial method to improve hip function and quality of life of the patients.

ObjectiveTo observe the changes of expression of aquaporin-1(AQP-1)and AQP-4 in drowned and postmortem immersed rats’lungs.MethodsThirty healthy male Wistar rats were randomly divided into drowning group, postmortem immersion group and cervical dislocation group. The morpho-logical changes of rats’lungs were observed using HE staining. The mRNA and protein expressions of AQP-1 and AQP-4 in rats’lungs were detected by real-time PCR, immunohistochemistry and Western blotting, respectively.ResultsThe results of immunohistochemistry and the Western blotting showed that the protein expression of AQP-1 of the drowning group was higher than the postmortem immersion group and the cervical dislocation group(P<0.05). The result of immunohistochemistry showed that the protein expression of AQP-4 of the drowning group was higher than the postmortem immersion group and the cervical dislocation group(P<0.05)while no difference were detected among the three of them by Western blotting(P>0.05). The mRNA expressions of AQP-1 and AQP-4 in rats’lungs of the drown-ing group was significantly higher than the postmortem immersion group(P<0.05).ConclusionThe in-crease of mRNA and protein expressions of AQP-1 and AQP-4 in lungs of rats with cute lung injury of the drowning group would be useful for differentiating vital drowning from postmortem immersion.

[Objective] To evaluate the results of open reduction with bone autografting and calcaneus reconstruction with internal fixation in treatment of intra-articular calcaneus fracture. [Methods]From January 2005 to May 2007, 17 cases/19 feet of intra-articular calcaneus fractures received treatment of reconstruction plate and bone autografting, with 15 male/18 feet, 2 female/ 2 feet. Patients’ age ranged from 19 to 67 years (mean, 37.5 years). Fracture occurred in left side in 9 cases, right in 6 cases, both sides in 2 cases. All patients received treatment of open reduction with bone autografting and calcaneus reconstruction with internal fixation.[Results]All the patients achieved bone union. One stage union was achieved in 15 feet. Poor blood-supply was found in 3 feet and bone union was achieved after systematic treatment. Wound exudation was found in 1 feet, and bone union was achieved after dressing change treatment. All patients were followed up for an average of 19.7 months (10-38 months). The average union time was 2.5 months, without infection found.X-ray and CT were used to measure Bhler angle, width and axial length, all the indexed showed significant difference (P

Objective:To establish a human monocyte cell line U937 stably expressing CD200.Methods:The eukaryotic expression vector pcDNA3-CD200 containing human CD200 cDNA and vector pcDNA3 were transferred into human monocyte U937 cell line by electrotransfer.These two cell lines were selected by G418, and the selected cell lines were subcultured. U937 cell line was enclosed as control group.The expression of CD200 mRNA and protein was detected by RT-PCR and flow cytometry.Results:After G418 selection,U937 cell line in control group was died, and the cell lines transferring pcDNA3 and recombined pcDNA3-CD200 were subcultured over 30 generations.The CD200 mRNA expression in pcDNA3-CD200 group was confirmed with RT-PCR.The CD200 expression in U937-pcDNA3-CD200,U937-pcDNA3 and U937 were 77.20%,3.20% and 2.10%,compared with other two groups (F=133 996.40,P0.05).Conclusion:Our study provides foundation for mechanism of action for CD200 in future.The human monocyte series U937 cell line that expresses CD200 protein stably is established successfully by gene transfection method.

Objective To study the inhibitory effects of Probucol on the expressions of serum promatrix metalloproteinase-2(pro-MMP-2) and matrix metalloproteinase-2(MMP-2) in patients with coronary heart disease(CHD).Methods The levels of serum Pro-MMP-2 and MMP-2 were detected by zymograph and total cholesterol(TC),triglyceride(TG),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C)were measured by enzyme method in 30 CHD patients before and after treatment with Probucol.Results After treatment of Probucol,the expression levels of pro-MMP-2,MMP-2,TC and LDL-C in serum were decreased than those before treatment,respectively;there were obvious differences of various indexes mentioned above between before and after treatment(P0.05).Conclusion Probucol can inhibit the expressions of pro-MMP-2 and MMP-2 in serum as same as TC and LDL-C.Probucol,as one of TIMPs,may be applied to stabilize plaque..

Objective:To evaluate the relationship between breast reconstruction and postoperative complications by meta-analysis.Methods:Through a defined search strategy, related literature was collected in databases from PubMed, MEDLINE, EMBASE, Cochrane, CNKI, Wanfang Database and VIP Database, from January 1990 to November 2017. Data were extracted and each merged data was analyzed using RevMan 5.3 software. The postoperative complications between transverse rectus abdominis musculocutaneous-flap (TRAM) and deep inferior epigastric perforatorflap (DIEP), TRAM and latissimus dorsiflap (LDF), LDF and LDF+ prosthesis, LDF+ prosthesis and simple prosthesis implantation were compared.Results:Twenty-nine papers met inclusion criteria of our study. The Meta-analysis results showed that the risk of local flap necrosis, seroma, infection, fat liquefaction, abdominal wall hernia and abdominal bulging in TRAM group were higher than those in DIEP group, and the differences were significant. There was no significant difference in total flap necrosis, wound dehiscence, venous congestion between the two groups; the risk of total flap necrosis, wound dehiscence and infection in TRAM group were higher than those in LDF group, and the differences were significant. The risk of seroma in TRAM group was lower than that in LDF group, and the differences were significant. There was no significant difference in fat liquefaction between the two groups; there was no significant difference in the postoperative complications between LDF group and LDF+ prosthesis group; the risk of seroma in LDF+ prosthetic group was higher than that in prosthetic group, and the differences was significant. The risk of prosthetic capsular contracture and prosthesis displacement in LDF+ prosthetic group were lower than those in prosthetic group, and the differences were significant. There was no significant difference in prosthesis exposure and infection between the two groups.Conclusions:DIEP has most of the advantages of TRAM and fewer complications. It plays an important role in breast reconstruction in the future. We should make a choice of breast reconstruction methods according to the patient＇s conditions as far as possible in clinical practice.

Objective To explore the effect and mechanism of the bone morphologenetic protein 4 (BMP4)/Smad signaling pathway on the apoptosis of mouse primordial follicle oocytes .Methods Three-day-old Kunming mouse ovarine tissues were digested by the two-step enzymatic method to extract and purify oocytes .The cultured oocytes were divided into three groups: the normal culture medium (Con group), the medium with BMP4 (BMP4 group), and the medium with BMP4 and BMP4 inhibitor ( BMP4+inhibitor group ) .TUNEL was used to examine the effects of BMP 4 on the survival of the primordial follicle oocyte;Immunohistochemical staining and Real-time quantitative PCR were performed to investigate the expressions of p-Smad1/5/8, sohlh2, c-kit and foxo3a;siRNA interference, sohlh2 plasmid transfection and LY294002 treatments were performed to explore the mechanism of the BMP 4/Smad signaling pathway on the apoptosis of oocytes . Results TUNEL results demonstrated that the ratio of apoptotic oocytes in BMP 4 group was significantly lower than that in the Con group ( P <0.05 ) and the BMP4 +inhibitor group ( P <0.05 ); BMP4 significantly promoted the nuclear translocation of Smad and inhibited the nuclear translocation of foxo 3a, the mRNA and protein levels of sohlh2 and c-kit remarkably increased in BMP4 group.The effect of BMP4 on the oocyte survival was significantly repressed after sohlh 2 siRNA transfection.Sohlh2 overexpression up-regulated the expression of p-foxo3a, and this activity was abolished by LY 294002.Conclusion BMP4/Smad signaling pathway may inhibit primordial follicle oocyte apoptosis , via up-regulation of the expression of sohlh2 and c-kit, and then down-regulation of the nuclear translocation of foxo 3a.

ObjectiveUsing large sample clinical study to reevaluate the safety and efficacy of recombinant human growth hormone(ANSOMONE) in treating pediatric growth hormone deficiency(GHD).Methods1012 cases were administered with ANSOMONE at a dose of 0.1 IU · kg-1 · d -1 in bedtime for 6 months.The alteration of mean height,growth rate,height standard deviation scores,bone age,and anti-GH antibody and occurrence of adverse effects were observed.ResultsThe growth rate was promoted from ( 2.50 ± 0.85 ) cm/year to ( 13.44 ± 4.27 ) cm/year,the net growth rate was( 10.94 ±3.69)cm/year.There was significant difference between the pre-treatment and post-treatment patients ( P ＜ 0.01 ).The post-treatment anti-GH antibody positive rate was 13.34％,which had no obvious effect on the efficacy.Few patients exert transient inflammation reactions,which disappeared with any treatment.ConclusionANSOMONE had significant efficacy,and could promote the height increase obviously.It had good safety without any obvious side effect and early-maturing effect.

Objective To observe the effect of daidzein on extracellular matrix of uremic rats and to discuss its mechanism.Methods Uremic rat model were established by 5/6 nephrectomized. Model rats were devided into daidzein group, control group. Rats with sham-operation were regarded as the normal control. At time of baseline, 4th and 8th week after operation, urinary protein and biochemical detection were measured. The pathologic changes, fibronectin (FN) and typeⅣcollagen (ColⅣ) were investigated at 8th week. The Western-Blot and RT-PCR were used to measure protein expression and mRNA transcription of TGF-β1. Results At 8th week after operation, the urinary protein (12.35 ± 2.13 mg/24 hvs. 19.93 ± 3.19 mg/24 h), serum urea (10.11 ± 0.65 mmol/Lvs.12.09 ± 0.78 mmol/L) and creatinine (68.10 ± 2.51μmol/Lvs.77.63 ± 3.20μmol/L) in the daidzein group decreased significantly than those in the control group (P<0.01). The deposition of ColⅣ (16.33% ± 2.14%vs. 24.68% ± 3.97%) and FN (19.17 ± 2.68 vs. 29.35 ± 4.15) in the daidzein group decreased significantly than those in the control group (P<0.01). Compared with control group, the pathological lesion in the daidzein group was less serious. The mRNA transcription (0.37 ± 0.06vs. 0.64 ± 0.08) and protein expression of TGF-β1 (0.28 ± 0.09vs. 1.40 ± 0.13) in the daidzein group were attenuated significantly than those in the control group (P<0.05). ConclusionsDaidzein had a beneficial effect on uremic rats. It may be associated with a decrease of extracellular matrix accumulation.