Multimedia teaching and SimMan,which is a portable and advanced patient simulator for team training,were used to develop a new course for the medical students of grade four. This course was named "SimMan clinical techniques training". The course of Sim-Man clinical techniques training can help students comprehend truly all kinds of cases in clinical practices,improve their capabilities of clinical thoughts and clinical techniques,and it makes fine basis for their clinical practices in the hospitals.

Objective To observe the influence of Buyang Huanwu Decoction ( BYHWD) on the inhibition of rat myocardial H9C2 cell activity and SH2-containing tyrosine phosphatase-1 ( SHP-1) activity induced by trastuzumab, and to explore the possible regulatory mechanism after observing the intervention of BYHWD on rat myocardial H9C2 cell transfected with SHP-1 or SHPC/S-1 gene. Methods The eukaryotic expression vectors pcDNA3.1 (+)- SHP-1 and pcDNA3.1 (+) -SHPC/S–1 were constructed and then were transfected to rat myocardial H9C2 cells using the method of liposome transfection. The cells with positive clones were screened out with G418, and then were cultured with trastuzumab for maintaining growth. Using quantitative RT-PCR, we detected the expression of SHP-1 gene and SHPC/S - 1 gene in rat myocardial H9C2 cells. The phosphatase activity analysis was used for observing the regulatory effect of BYHWD on SHP-1 in myocardial cells. Furthermore, we observed the apoptosis of rat myocardial H9C2 cells by methyl thiazolyl tetrazolium (MTT) assay after treatment with BYHWD. Results Sequencing results indicated the successful construction of eukaryotic expression vectors, which had stable expression in myocardial H9C2 cells even under the intervention of trastuzumab. The results of phosphatase analysis showed that H9C2-SHP-1 had the highest activities of phosphatase, but the activities were decreased after the intervention with BYHWD ( P<0.05) . The results of MTT assay also showed the apoptotic rate of H9C2-SHP-1 cells was decreased after treatment with BYHWD ( P <0.05) . Conclusion BYHWD can promote the proliferation of myocardial H9C2 cells inhibited by trastuzumab, and can regulate the expression of SHP-1 in myocardial cells, which will supply reference to the further study of treatment of trastuzumab-induced cardiac toxicity.

Objective:To observe the clinical effect of electroacupuncture (EA) at four sacral points on overactive bladder syndrome.Methods:A total of 120 female patients with overactive bladder syndrome were allocated to a treatment group of 80 cases and a control group of 40 cases on a voluntary basis.The patients in the treatment group received EA at four sacral points,and the treatment was given three times a week for 6 consecutive weeks,while the patients in the control group received oral administration of M-receptor antagonist tolterodine tartrate,which was given 4 mg each time,once a day for 6 consecutive weeks.Then the symptom scores were compared between the two groups before and after treatment.Results:At the end of treatment,the symptom scores showed statistical significant differences in comparing with those before treatment in both groups (both P＜0.01);the symptom score in the treatment group was lower than that in the control group,showing a statistically significant difference (P＜0.05).Conclusion:EA at four sacral points is an effective method for overactive bladder syndrome.

Objective:To observe the relationship between lymphocyte phenotype and clinical presentation in cancer patient receiving immunotherapy combined with chemoradiotherapy.Methods:42 patients were enrolled into the study.Among these patients,22 received stimulated normal peripheral blood lymphocytes(PBLs) as well as chemoradiotherapy,and 20 patients received chemoradiotherapy only as control group.Immunotherapy was administrated biweekly,totally 8 times.Results:22 patients receiving immunotherapy had lymphocyte phenotype change which was also in accordance with symptom improvement,but didn't reach statistical significance.Among 22 patients receiving immunotherapy had 15(68.18%) had lymphocyte phenotype change which was in accordance with symptom improvement,including elevation of CD3 + 3,CD + 4(P

Objective To investigate the role of gamma secretase inhibitor-I (GSI-I) in cell proliferation and apoptosis of human glioma cell lines U87 and U251.Methods RT-PCR and fluorescent quantitative RT-PCR (qRT-PCR) were employed to evaluate the expressions of Notch receptors and their target gene Hes-I in both U87 and U251 cells treated by GSI-I,respectively.Then,MTT assay was used to examine the effects of GSI-I on cell proliferation of the 2 glioma cells.Meanwhile,flow cytometry technique was also employed to detect the cell cycle changes and apoptosis induced by GSI-I treatment.Results The activity of Notch pathway was inhibited by GSI-I treatment through down-regulating the expression of Notch receptors target gene Hes-I in both U87 and U251 cells.Treatment with 2.5μmol/L GSI-I or above concentrations could significantly induce the cell cycle arrest of U87 and U251 cells and these effects were positively concentration-dependent.Flow cytometry technique showed that GSI-I inhibited the cell proliferation by inducing the cell cycle arrest of U87 cells at GI phase and inducing the apoptosis of U251 cells.Conclusion GSI-I can dramatically inhibit the cell proliferation and induce the apoptosis of U87 and U251 cells,providing a reliable evidence for clinical glioma treatment.

Objective To explore the clinical phenotype, treatment and prognosis of immune dysregulation, polyendocrinopathy, enteropathy, X-linked (IPEX) syndrome, and to improve pediatricians' knowledge of this disease. Methods Clinical data of a case of IPEX with congenital ichthyosiform skin lesions were retrospectively analyzed, and related literatures China were reviewed. Results The 2-month-11-day old boy came to our hospital due to ichthyosiform skin lesions accompanied by blood oozing in the head and feet exudatation, with severe sepsis and gastrointestinal perforation. He was died of multiple organ failure. DNA sequencing of whole-genome exon group showed a hemizygous mutation of c.1150G> A, p.A384> T in FOXP3 gene. His mother was a heterozygous mutation carrier, while his father was normal. Conclusions In addition to typical symptoms including early-onset refractory diarrhea, multiple endocrine disease and growth retardation, IPEX should be considered also in infants with ichthyosiform rash and severe infection. Gene sequencing will help diagnose the disease.

Objective To elucidate whether and how injection site diversity influences on the sodium hyaluronate (HA) distribution on cartilage surface of the knee joint.Methods From September 2014 to December 2014, 32 human cadaveric knees were sorted from small to large based on femoral condyle width (FCW) and divided into group Ⅰ (n=16, odd number, the patella medial approach) and group Ⅱ (n=16, even number, injected through the medial joint line approach).Knees of both groups were interfused with a 5％ (mg: ml) methylene blue tracer.Each specimen was then simulated a 5°-45° alternating walking for 2 h in the Electro Force platform.Afterwards, all the knee cavities were cut open to examine the range of HA distribution.Based on the eight-zoning classification law for the knee cartilage surface, the coverage area of HA in each zone was scored and the characteristics of HA distribution was depicted, as well as HA zonal distribution diversity between groups were statistically analyzed.Results HA of both patella medial and medial joint line subgroups showed analogical distribution in all zones except the lateral tibial plateau at the time of FCW ≤ 7.0 cm.However, HA coverage through the patella medial approach showed significantly higher distribution scores in the patella zone and the femoral trochlear zone, but significant lower distribution scores in the antero-lateral/postero-lateral femoral condyle, the medial posterior femoral condyle zone and the lateral tibial plateau zone compared with medial joint line approach at the time of FCW ＞ 7.0 cm.Conclusion When delivered through different injection approaches, HA showed analogical distribution characteristics in most zones of the knee cavity in population with a small bodily shape (FCW ≤ 7.0cm), but significant diverse distribution characteristics in population with a big bodily shape (FCW ＞7.0 cm).When FCW ＞ 7.0cm, HA injected through the medial-patellar approach tended to be distributed mainly over the patella-femoral articulation and the anterior knee cavity, while HA injected through the joint line approach tended to be distributed mainly over the tibio-femoral articulation and the posterior knee cavity.

Objective To investigate the xenotransplantation model of fetal pig skin precursor tissue and its development after transplantaion. Methods Porcine skin precursor tissue was obtained from the embryo of gestation day 56 (E56), and made into microskin or stamp skin graft. The microskin was transplanted to the dorsal wound in BALB/c nude mice, then covered with human corpse skin. The stamp skin graft was imbedded subcutaneously into the back of nude mice, and microskin was injected subcutaneously into the auricles of nude mice. Their growth and development were observed and they were examined by HE staining at 6th and 12th week after transplantation respectively. Two-sample t test was used to analyze the size of newly grown skin tissue. Results Porcine skin precursor tissue graft in three models above survived and continued growth after transplantation, and growth ability of the dorsal wound transplantation model was significantly stronger than that of the auricle model. Epidermis and hypodermis were detected in newly grown skin tissues. Hair follicles, a few of sebaceous glands, but no sweat glands were observed in auricle model, while many sebaceous glands and sweat glands were observed in the dorsal wound model. Conclusion Transplantation of microskin to dorsal wound is the optimal model of investigating the xenotransplantation of fetal pig skin precursor tissue and its development after transplantion.

Objective To assess the clustering of cardiovascular risk factors and their effects on target organ damage in elderly patients with hypertension .Methods 421 treated elderly hypertension patients were divided into 5 groups based on the number of risk factors :hypertension without additional risk factor (group A ,25 cases) ,and the other 4 groups were complicated with 1 (group B ,76 cases) ,2(group C ,127 cases) ,3(group D ,128 cases)and ≥ 4 (group E ,65 cases) risk factors .The structure and function of heart and carotid artery were examined by ultrasonography in order to evaluate the damage of target organ and the morbidity .Re-sults The patient groups with three or more risk factors showed significantly higher levels of BMI ,plasma glucose ,triglyceride , LDL-C cholesterol ,serum creatinine and serum uric acid ,and needed greater number of antihypertensive drugs ,compared with other groups(P<0 .05) .The patient groups with two or more risk factors showed significantly higher levels of LVMI ,IMT and MAU/Cr compared with group A(P<0 .05) ,and significantly lower levels of the creatinine clearance (P<0 .05) .In addition ,they showed significantly higher incidences of coronary heart disease and cerebrovascular disease and chronic kidney disease compared with group A (P<0 .05) .Conclusion These results suggest that the hypertensive patients with clustering risk factors required greater number of antihypertensive drugs .The more additional risk factors exit ,the more target organ damages and higher morbidity occur ,and more intensive intervension are required to control not only blood pressure but also other complicated risk factors .

Objective To evaluate the efficacy of tibial bone-skin flap grafts in the management of se- vere traumatic osteomyelitis complicated with bone and skin defect in leg to avoid amputation.Methods From March 1998 to Aug.2004,12 cases of the traumatic osteomyelitis complicated with bone and skin defect in leg were treated with vascularized tibial bone-skin flap graft.The longest flap was 17cm,widethest 10cm, The longest bone flap was 12cm.They were followed up for 0.6 to 5 years.Results All the tibial bone-skin flaps survived completely,2 cases of osteomyelitis recurred.The followed-up,from 0.5 to five years,showed good bone union in all cases,averageing 15 weeks.The infection was under control.The leg function and con- tour were satisfactory.Conclusion The tibial bone-skin flap has the advantages of having distinguished sign of anatomy,highly vascularized,easy to obtain,simply and flexible procedure,improving circulation,short- ens hospitalization and suitable for treatment of traumatic osteomyelitis complicated with bone and skin defect in leg.