Objective To investigate doctor-patient communication skills status and the influencing factors so as to pu forward to develop the proposal.Methods We selected undergraduate students in fourth grade which participated in the 2012 Shanghai Jiaotong University School of Medicine OSCE examinations before practice of clinical medicine by cluster sampling 1 and we selected four western and chinese medicine hospitals randomly sample 2,which are three level of first-class hospitals in Shanghai.We design the questionnaire and observe sampling with the SEGUE framework.Application of SPSS 13.0 data for statistical analysis,descriptive statistics analysis,u test,t test,ANOVA,rank sum test and correlation analysis method.Results The test with SEGUE framework shows that the scores of samplingl were 12.54 points(out of 24),the score rate is low which was 52.25％,and in the score rate of the dimensions,the end of inquiry dimension is 4％ which is the lowest.There are significant statistical differences between different groups of influencing factors such as Medical occupation interest score and so on.There is no statistically significant difference between the SEGUE score of traditional Chinese medicine and western medicine clinical Intern.The communication skills of western medical students are higher.Doctor-patient communication skills related factors such as recognition of the importance of doctor-patient communication skills and other groups are statistically significant,the correlation coefficients are very small which is between 0.1 and 0.3.Conclusion The overall level of doctor-patient communication skills on clinical internship are not high,through the guidance and training on the occupation interest of medical students,we can strengthen the recognition of the importance of doctor-patient communication skills,so that we will improve the doctor-patient communication skills for the medical students.SEGUE framework should be used to routine medical students communication skills evaluation.

Objective To establish Ad-LIF-OSM transgenic feeder cells for the expansion of CD34+ hematopoietic stem/progenitor cell and tentatively study its effect in expansion and differentiation of cord blood hematopoietic stem cell(HSC) in vitro.Methods In the foundation of pAdTrack-CMV-LIF-polyA+promoterΔ,the OSM gene was inserted to the vector plasmid.Then we structure the transfer plasmid pAdTrack-CMV-LIF-polyA+promoterΔ-OSM.The transfer vector and backbone vector were further cotransfected for homologous recombination. The result pAdEasy-1-pAdTrack-CMV-LIF-polyA + promoterΔ-OSM homologous recombination plasmid were transfected into the human embryonic kidney 293 (QBI-293A) cells,leading to formation of the recombinant adenviruses Ad-LIF-OSM which co-expressing LIF and OSM.Infect the feeder layer cells with groups of Adenovirus,detection the expressing of LIF and OSM in WI-38 cells by RT-PCR and ELISA.Compares the stem cells differentiation and proliferation of the different experimental groups in vitro by transwell and cell counting.Results The sequencing results show that the OSM genes were anastomotic in Ad-LIF-OSM.LIF and OSM gene could be detected in feeder layer cells which infected by Ad-LIF-OSM.Exogenetic LIF and OSM have special effect in culturing HSC in vitro.Conclusion The adenoviral vector co-expressing LIF and OSM (Ad-LIF-OSM) were successfully constructed.Ad-LIF-OSM transgenic feeder cells can effectively proliferate umbilical cord blood CD34+ HSPC in vitro and delay it differentiate.

Problem-based learning (PBL) teaching method combined with formative evalua-tion was used in the teaching practice of pediatrics education. This method was implemented by four phases: courses designing, group-preparing, problems-organizing and teaching practice. The method was evaluated by students' feedback and survey results of patients, teachers and teaching councilors. It was showed that the teaching effects of PBL combined with formative evaluation was better than tra-ditional teaching method in pediatrics teaching.

Objective To study the effect of Shenfukang Ⅱ on kidney function and TGF-β1/Smads signal pathway with 5/6 nephrectomy model in rats. Methods Thirty SD rats were randomly divided into the sham operation group, model group and Shenfukang group according to a random number table. We used 5/6 nephrectomy to prepare animal models. The rats were given Shenfukang Ⅱ particles 450 mg/(kg?d) gavage, the others group were given equal volume of saline gavage, once a day, continuous 21 days. The rats were given gavage at the 9 th week after operation. The changes of renal function index BUN, SCR and UA of rats in each group were detected 21 days after administration. The expression of TGF-β1, TGFβR1, Smad7, pSmad2, pSmad3 in renal tissues were detected by immunohistochemistry. The Smad7, pSmad2 and pSmad3 detected the expression of in renal tissues by Western Blot. Results Compared with the model group, the content of BUN (15.03 ± 2.19 mmol/L vs. 24.30 ± 2.82 mmol/L), SCR (74.22 ± 7.36 μmol/L vs. 93.61 ± 14.73 μmol/L) in Shenfukang group significantly decreased (P<0.05). The expression of TGF-β1, TGFβR1, pSmad2 and pSmad3 significantly decreased in kidney tissue, while the expression of Smad7 significantly increased in kidney tissue. The expression of p-smad2 (0.47 ± 0.03 vs. 0.64 ± 0.04) and p-smad3 (0.43 ± 0.04 vs. 0.55 ± 0.02) significantly decreased (P<0.05), and the expression of Smad7 (0.54 ± 0.03 vs. 0.39 ± 0.02) significantly increased (P<0.05). Conclusions Shenfukang Ⅱ have improved on kidney function with 5/6 nephrectomy model rats. The study revealed that Shenfukang II may play an anti-fibrotic effect on regulating TGF-β1/Smads signaling pathway with 5/6 nephrectomies model.

Objective: By use of Meta analysis to compare efficacy, safety and compliance of subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) on allergic rhinitis (AR). Methods: Cochrane Library, Pubmed, Embase, CNKI Database, Wan Fang and Chinese Sci-tech Journal Database (from established time to May of 2018) were searched for trials about the AR treated by SCIT and SLIT. The relevant literatures were screened, and the randomized controlled studies were chosen. Nasal symptom scores, visual analogue scale (VAS) scores, adverse reactions and compliance were used as the outcome indicators, and the methodological quality of the literatures was evaluated strictly. The extracted data were analyzed by RevMan 5.3 and Stata 14 software. Results: A total of 20 randomized controlled studies were included, the overall quality of which was relatively high. No publication bias was found. There was no significant difference in nasal symptom scores, VAS scores and compliance between SCIT and SLIT (SMD value was 0.03, 0.14, respectively, RR=1.12; 95%CI value was -0.17-0.23, -0.03-0.31, 0.92-1.35, respectively, all P>0.05); SLIT group resulted in lower overall incidence of adverse reactions than that of SCIT group (RR=1.79, 95%CI: 1.42-2.26, P<0.05). Conclusion Both SCIT and SLIT have similar eppecacy and compliance for treatment of AR, while adverse reactions are more frequently observed in SCIT.

Objective To compare and analyze the effect of minimally invasive percutaneous nephrolithotomy compare with traditional open surgical in treatment of kidney stones outcome. Methods Selected 120 patients with kidney stones from January 2009 to January 2014 in our hospital, all patients had complete clinical data, included 60 cases of renal sinus traditional lines pelvis lithotomy, established as the control group, and the remaining 60 routine minimally inva-sive percutaneous nephrolithotomy surgery, set up minimally invasive group, the operative time, blood loss, postoperative fistula time and hospital stay and complications were compared between two groups. Results 60 patients with invasive group homogeneity of puncture success and smooth gravel, stone successful in 58 cases, the success rate was 96.7%(58/60). Intraoperative complications pneumothorax, colon injury does not appear, one-time stone clearance rate was 80.0%(48/60). Stable vital signs after surgery, no nephrectomy, severe complications wound fistula, pneumothorax oc-curred. 4 cases of postoperative urinary tract infection sustained high fever, anti-infection cure. 1 case duodenal injury control group intraoperative peritoneal injury in 2 cases, 2 cases of postoperative fever, intestinal fistula, urinary tract infection in 8 cases. Operative time, blood loss, postoperative fistula compare the time and duration of hospitalization, of observation group improved significant than the control group, the difference was statistically significant (P<0.05 or P<0.01). Conclusion Minimally invasive percutaneous nephrolithotomy in the treatment of kidney stones with less trau-ma, less bleeding, fewer complications, shorter hospital stays and can be worthy of promotion and application.

Objective To detect the serum level of 3-carboxy-4-methyl-5-propyl-2-furanpropanoic acid (CMPF),a significant metabolite offish oil,in subjects with normal glucose tolerance (NGT) in local communities,and to investigate the association of CMPF with fatty acid metabolism.Methods A total of 272 NGT participants from screening for diabetes in Shanghai in 2013 were enrolled.Anthropometric measurements,biochemical evaluation,and questionnaire interview were performed for all the participants.The participants were divided into normal weight group [body mass index (BMI) ≤23.9 kg/m2,n =143] and overweight/obesity group (BMI ≥ 24 kg/m2,n =129).The serum CMPF concentrations were determined using an enzyme-linked immunosorbent assay.Results Serum CMPF level in overweight/obesity group was lower than that in normal weight group [96.50 (46.11,169.56) μmol/L vs 153.20 (83.16,282.97) μmol/L,P＜0.05].The serum CMPF level was negatively correlated with BMI (r =-0.256,P＜0.01),triglycerides (r =-0.175,P =0.004),and free fatty acid (r =-0.126,P =0.041) according to bivariate correlation analyses.A multivariate stepwise linear regression analysis showed that the serum CMPF level was independently associated with BMI,triglycerides,free fatty acid,and HbA1C.A logistic regression analysis showed that the CMPF was a protective factor against obesity (OR =0.324,95％ CI 0.158,0.664).Conclusion Serum CMPF level is reduced in overweight/obese subjects.CMPF is beneficial to lipid metabolism.

Objective To evaluate the effectiveness and associated factors of prevention of motherto-child human immunodeficiency virus (HIV) transmission in Hubei Province,and to provide a reference for prevention of mother-to-child transmission of HIV.Methods In this prospective cohort study,HIV-positive pregnant women who were in some counties and cities of Hubei Province from January 2004 to December 2016 were enrolled.Prevention of mother-to-child transmission of HIV was conducted for these HIV-positive pregnant women and their infants,and their clinical data were collected.Descriptive analysis and x2 test were used to analyze the general characteristics of HIV-positive pregnant women and their infants.Logistic regression analysis was adopted to explore the associated factors of mother-to-child HIV transmission.Results In total,536 HIV-positive pregnant women (628 pregnancies) were found,among which,334 pregnant women and 345 infants were enrolled in this study.Twenty-four infants were HIV-positive,which was 6.96％ in all infants (95％CI:4.27％-9.64％).The rates of mother-to-child HIV transmission without prevention,formula feeding only,infant medication plus formula feeding,mother and infant medication plus formula feeding were 35.71％ (95％CI:21.61％-51.93％),8.82％ (95％CI:2.08％-15.57％),7.41％ (95％CI:0.92％-24.22％),and0.48％ (95％CI:0.01％-2.64％),respectively.No antiretroviral medications during delivery (OR =14.484,95 ％CI:1.740-120.577,P=0.013),breastfeeding (OR=6.542,95％CI:2.416-17.713,P=0.000),and CD4-T lymphocyte count＜200 cells/μL during delivery (OR=3.060,95％CI:1.076-8.703,P=0.036) were independent risk factors of mother-to-child HIV transmission.Conclusions The rate of mother-to-child HIV transmission without prevention is high in Hubei Province,which can be significantly reduced by comprehensive interventions (mother and infant medication plus formula feeding).Thus,we should diagnose HIV-positive pregnant women as early as possible,and should give pregnant woman antiretroviral therapy plus infant medication and formula feeding to further reduce the rate of mother-to-child HIV transmission.

Eucommiae Folium(EF),a traditional Chinese medicine,has been used to treat secondary hypertension,including renal hypertension and salt-sensitive hypertension,as well as hypertension caused by thoracic aortic endothelial dysfunction,a high-fat diet,and oxidized low-density lipoprotein.The antihyperten-sive components of EF are divided into four categories:flavonoids,iridoids,lignans,and phenyl-propanoids,such as chlorogenic acid,geniposide acid and pinoresinol diglucoside.EF regulates the occurrence and development of hypertension by regulating biological processes,such as inhibiting inflammation,regulating the nitric oxide synthase pathway,reducing oxidative stress levels,regulating endothelial vasoactive factors,and lowering blood pressure.However,its molecular antihypertensive mechanisms are still unclear and require further investigation.In this review,by consulting the relevant literature on the antihypertensive effects of EF and using network pharmacology,we summarized the active ingredients and pharmacological mechanisms of EF in the treatment of hypertension to clarify how EF is associated with secondary hypertension,the related components,and underlying mechanisms.The results of the network pharmacology analysis indicated that EF treats hypertension through a multi-component,multi-target and multi-pathway mechanism.In particular,we discussed the role of EF tar-gets in the treatment of hypertension,including epithelial sodium channel,heat shock protein70,rho-associated protein kinase 1,catalase,and superoxide dismutase.The relevant signal transduction path-ways,the ras homolog family member A(RhoA)/Rho-associated protein kinase(ROCK)and nicotinamide adenine dinucleotide phosphate(NADPH)oxidase/eNOS/NO/Ca2+pathways,are also discussed.

ObjectiveTo analyze the migrating components absorbed into blood of the aqueous extract of Euphorbia helioscopia， and to explore the pharmacodynamic material basis of the aqueous extract of E. helioscopia against chronic obstructive pulmonary disease（COPD）. MethodUltra-performance liquid chromatography-quadrupole-time-of-flight mass spectrometry（UPLC-Q-TOF-MS/MS） was used to detecte the migrating components absorbed into blood of rats after intragastric administration of aqueous extract of E. helioscopia. An Agilent RRHD SB-C₁₈ column（3 mm×100 mm， 1.8 μm） was used with 0.1% formic acid aqueous solution（A）-acetonitrile（B） as the mobile phase for gradient elution（0-15 min， 5%-30%B； 15-20 min， 30%-50%B； 20-30 min， 50%-95%B； 30-35 min， 95%-5%B）， and the detection wavelength of 190-800 nm， column temperature of 40 ℃， flow rate of 0.3 mL∙min^-1 and injection volume of 4 μL. The electrospray ionization（ESI） was used in positive and negative ion modes， and the detection range was m/z 50-1 250. Network pharmacology was used to screen out the key components and the key targets of COPD through the interaction analysis. Metascape database was used to predict the molecular function， biological process， cellular composition and signal pathways mainly involved in the anti-COPD effect of E. helioscopia. Molecular docking technique was used to determine the affinity of key targets with key components. ResultA total of 29 migrating components absorbed into blood of rats were identified after intragastric administration of aqueous extract of E. helioscopia， 9 of which were prototype components and 20 were metabolites. Network pharmacological analysis showed that luteolin， quercetin， apigenin， naringenin and helioscopinolide C were the key components of E. helioscopia against COPD， and vascular endothelial growth factor A（VEGFA）， albumin（ALB）， protein kinase B1（Akt1）， tumor necrosis factor（TNF） and interleukin-6（IL-6） were the key targets. Molecular docking results showed that one diterpene lactone（helioscopinolide C） and three flavonoids（naringenin， luteolin， apigenin） in the migrating components absorbed into blood all had strong binding activity to the key targets of E. helioscopia against COPD. ConclusionNaringenin， helioscopinolide C， luteolin and apigenin may be the main anti-COPD active substances of E. helioscopia.