Clinical medicine is a comprehensive discipline integrating natural science and hu-manities and social science. Lemology is closely related with basic medicine and medical microbiology and medical immunology are the basis of lemology. Therefore, in the process of cultivating postgradu-ates of lemology, we should not only should attach importance to the cultivation of basic medical knowl-edge and clinical professional quality, but also pay more attention to the development of the intelligence factors and non-intelligence factors. Meanwhile education on humanity, social sciences and relevant laws and regulations should be enhanced to cultivate doctors' professional quality. Reverse thinking and lateral thinking in the clinical diagnosis should be strengthened to achieve the training objectives of cultivating international medical talents.

Using brain microdialysis and LC-MS/MS to detect acetylcholine in rat brain to investigate the effects of ligustrazine. A liquid chromatography-tandem mass spectrometry method has been developed and validated for the determination of acetylcholine in rat brain dialysate sampling by microdialysis. The results indicated that ligustrazine administration by subcutaneous injection significantly increased Ach release in rat medial prefrontal cortex and nucleus accumbens in a dose-related manner. The drug' s effect on Ach release in rat brain could be directly detected by microdialysis combined with HPLC-MS/MS and this method is selective and sensitive.
Acetylcholine ; metabolism ; Animals ; Chromatography, High Pressure Liquid ; Dose-Response Relationship, Drug ; Ligusticum ; chemistry ; Male ; Microdialysis ; Nucleus Accumbens ; metabolism ; Plants, Medicinal ; chemistry ; Prefrontal Cortex ; metabolism ; Pyrazines ; administration & dosage ; isolation & purification ; pharmacology ; Rats ; Rats, Sprague-Dawley ; Spectrometry, Mass, Electrospray Ionization ; Tandem Mass Spectrometry

Objective To review the CT findings in patients with pulmonary infection after kidney transplantation and to determine the characteristic features in different infections.Methods The medical records were reviewed in 446 patients with pulmonary infection after kidney transplantation and 121 patients who had pulmonary thin-section CT were included in this study.The pattern and distribution of the pulmonary abnormalities were interpreted independently by two thoracic radiologists.Statistical analysis was performed using the X2 test and the Fisher's exact teat.Results (1)Time course:65(14.6/) patients initially had pulmonary infection in the first 30 days,147(32.9/)between 1 and 3 months,91(20.4/)between 3 and 6 months,23(5.2/)between 6 and 12 months,120(26.9/)afler 12 months of transplantation.In the first month after procedure,bacterial infection(4/5,80.0/)was the most common infection,bacterial(34/41,82.9/)、mixed(19/41,46.3/)and virus infections(11/41.26.8/)were seen commonly 1 to 6 months following transplant,the incidence of fungal(14/38,36.8/)and myeobaeterial(5/38,1 3.2/)infections was increased after 1 2 months of transplantation.(2)Pathogens:Baeterial(34,28/)and mixed infections(34,28/)were the most common,followed by fungus infeetion(9.7/),TB(7,6/)and eytomegalovirus(5,4/).(3)CT findings:Ground-galss attenuations(69,57.0/)was the most common findings of pneumonia,followed by reticular or linear opacities(68,56.2/),nodules (66,54.5/),pleural thickening(41,33.9/),consolidations(31,25.6/),tree-in-bud patterns(24,19.8/),pleural effusion(22,18.2/),and bronchovascular bundle thickening(16,13.2/).Ground-glass attenuation was commonly seen in cytomegalovirus pneumonia (4,80.0/),and nodule was commonly observed in bacterial infection(23.67.6/),tree-in-bud pattern was the most common finding in pulmonary tuberculosis (4.P=0.049).There were no statistically significant difierences in the prevalence of other CT paRerns (P＞0.05).Conclusions The peak incidence of pulmonary infection is in the 3 month after renal transplantation and bacterial infection is the most common.The CT diagnosis of infeetion can be made by combining the time course of infection,clinical laboratory data and lesion distribution.

Objective To summarize the clinical characteristics of primary pigmented nodular adrenocortical disease (PPNAD).Methods Eight patients with PPNAD from 2001 to 2009 in PUMC Hospital were reviewed,their clinical data were collected.Results PPNAD often occurred in adolescents.62.5% of patients with PPNAD were complicated with Carney complex(CNC).In addition to general features of Cushing's syndrome,amenorrhea and growth retardation in stature were very frequent in clinical manifestations of PPNAD.Plasma ACTH was undetectable,circadian rhythm of plasma cortisol was disappeared,glucocorticoid excretion was increased paradoxically during the dexamethasone suppression test in 50% patients with PPNAD.Adrenal imaging from 75% patients revealed normal-sized adrenal glands or suspectable micronodular changes.Adrenal pathologic analysis revealed numerous brown cortical nodules containing lipofuscin pigmentation.Unilateral adrenalectomy may relieve symptoms of Cushing's syndrome,but plasma ACTH and circadian rhythm of plasma cortisol were difficult to recovere.Hypercorticoidism might re-occure after unilateral adrenalectomy.Conclusion PPNAD should be bewared in ACTH independent Cushing's syndrome patients without apparent adrenal mass,and CNC should be screened and followed up.

OBJECTIVETo study the effect of insulin, cyclic adenosine monophosphate (cAMP), and dexamethasone (DEX) on 550 bp (-600 -/+ 69) fragment of phosphoenolpyruvate carboxykinase (PEPCK) gene promoter by reporter gene.

METHODSThe recombinant pGL2-PEPCK-Luc and the control plasmid pSV-beta-Galactosidase were co-transfected to rat hepatoma cell line (CBRH7919) by lipofectin. By measuring luciferase activity, we evaluated in vitro regulation of PEPCK gene promoter on reporter gene transcription.

RESULTScAMP and DEX stimulated PEPCK promoter obviously; meanwhile, they also had accumulative effects. At different physiological concentrations, insulin had a suppressive effect on PEPCK promoter, which was dose-independent.

CONCLUSIONThere is a perfect feedback mechanism for PEPCK promoter in hepatoma cell. 550 bp (-600 -/+ 69) fragment of PEPCK may be a candidate gene in the gene therapy of diabetes.

Animals ; Cell Line, Tumor ; Cyclic AMP ; pharmacology ; Dexamethasone ; pharmacology ; Dose-Response Relationship, Drug ; Gene Expression Regulation, Enzymologic ; drug effects ; Insulin ; administration & dosage ; pharmacology ; Liver Neoplasms, Experimental ; pathology ; Luciferases ; genetics ; metabolism ; Phosphoenolpyruvate Carboxykinase (GTP) ; genetics ; metabolism ; Promoter Regions, Genetic ; drug effects ; genetics ; Rats ; Recombinant Proteins ; genetics ; metabolism ; Transfection

OBJECTIVETo evaluate in vitro regulation of phosphoenolpyruvate carboxykinase (PEPCK) gene promoter on gene transcription, and construct luciferase reporter plasmid pGL2-PEPCK-Luc.

METHODSA 550 bp fragment of PEPCK promoter cut from plasmid pPEPCK-int was inserted into transitional vector PBS-SK to construct a transition plasmid PBS-PEPCK. Then the recombinant luciferase reporter plasmid pGL2-PEPCK-Luc was cloned.

RESULTSRestriction enzymes and nucleotide sequence conformed that the coupling site of recombinant plasmid was correct without base mutation and deletion, and the sequence inserted was the same as data of GeneBank. The luciferase could be expressed in hepatoma cell transfected by pGL2-PEPCK-Luc.

CONCLUSIONEstablished a new means to study transcriptional regulation of PEPCK promoter.

Animals ; Base Sequence ; Gene Expression Regulation, Enzymologic ; drug effects ; Humans ; Liver Neoplasms ; genetics ; Luciferases ; genetics ; Molecular Sequence Data ; Phosphoenolpyruvate Carboxykinase (GTP) ; genetics ; metabolism ; Plasmids ; genetics ; Promoter Regions, Genetic ; genetics ; Protein Binding ; Rats ; Recombinant Fusion Proteins ; genetics ; metabolism ; Transcription, Genetic ; Transfection ; Tumor Cells, Cultured

Objective To investigate the incidences, risk factors, genotypes and epidemiology of community-acquired blood stream infection caused by extended spectrum β-lactamases (ESBLs)-producing Escherichia coli and Klebsiella pneumonia strains and to analyze the sensitivity of those ESBLs producing strains to commonly used antibiotics. Methods Forty-two patients who were diagnosed with community-ac-quired blood stream infection caused by Escherichia coli or Klebsiella pneumonia strains in Sichuan Provincial People′s Hospital were recruited in this study. Disc diffusion method was used for the phenotypic confirmato-ry test of ESBLs. Agar dilution method was performed to measure the antimicrobial susceptibility of the ESBLs-producing strains to 13 clinically commonly used antibiotics. Genotypes of the ESBLs-producing strains were identified by polymerase chain reaction (PCR). Multilocus sequence typing (MLST) was used to analyze the epidemiology of ESBLs-producing strains. Logistic regression analysis was performed to analyze the risk factors for community-acquired blood stream infection. Results The ESBLs-producing Escherichia coli strains accounted for 56. 3% (18 / 32) and the ESBLs-producing Klebsiella pneumoniae strains accounted for 20% (2 / 10). All of the 20 ESBLs-producing strains were sensitive to imipenem, meropenem, ertapen-em, nitrofurantoin and moxalactam. The ESBLs-producing strains sensitive to amikacin, piperacillin-tazobactam and fosfomycin accounted for 95% , 90% and 85% , respectively. Drug resistance rates of the 20 strains to cefotaxime, levofloxacin, ciprofloxacin and cefepime were relatively high accounting for 100% , 80% , 80% and 75% , respectively. Among the 20 ESBLs-producing strains, 7 strains only carried the CTM gene, while the other 13 strains were all positive for two genotypes of ESBLs, mainly identified as TEM+CTM-M-14 and TEM+CTM-15 genotypes. The 18 Escherichia coli strains were classified into 10 ST types, most of which were ST131 type, followed by ST10 and ST38 types. This study indicated that malignant tumor might be a possible risk factor. Conclusion The prevalence of community-acquired blood stream infection caused by ESBLs-producing Escherichia coli strains was becoming increasingly serious. Malignant tumor might be the risk factor associated with the producing of ESBLs in Escherichia coli and Klebsiella pneumonia strains. TEM+CTX-M-14 was the predominant genotype of ESBLs-producing strains and the prevalent clone was ST131 type. Carbapenems and enzyme inhibitor compounds were ideal drugs for the treatment of commu-nity-acquired blood stream infection caused by ESBLs-producing Escherichia coli and Klebsiella pneumonia strains. This study was limited by the small sample size. Therefore, it is necessary to conduct further resear-ches based on a large number of samples.

Objective To evaluate the value of T-cell spot of tuberculosis test (T-spot.TB) in differential diagnosis of Crohn's disease and intestinal tuberculosis.Methods From May 2010 to October 2010,in Xijing hospital,Fourth Military Medical University,the peripheral blood samples of 126 patients were collected and peripheral blood mononuclear cells were isolated with density gradient centrifugation.T-spot.TB was conducted according to the kit instructions.The clinical diagnosis of Crohn's disease and intestinal tuberculosis was according to clinical manifestations, imaging,endoscopy,pathology,laboratory tests and on empirical anti-TB treatment response.The sensitivity and specificity of T-spot.TB in diagnosis of Crohn's disease and intestinal tuberculosis was analyzed.Results Fifteen patients were diagnosed as Crohn's disease (11.9％,15/126),14 patients were intestinal tuberculosis (11.1％,14/126) and 40 patients were extraintestinal tuberculosis (31.7％,40/126).The positive rate of T- spot.TB in Crohn's disease,intestinal tuberculosis,extra-intestinal tuberculosis and other diseases was 1/15,12/14,70％ (28/40) and 0％ (0/57),respectively.Thedifference between the groups was statistically significant (P =0.00).There was statistically significant difference of T-spot.TB positive rate between Crohn's disease and intestinal tuberculosis (x2 =70.58,P=0.00).The sensitivity and specificity of T- spot.TB in Crohn's disease detection was 93.3％(14/15) and 87.5％(14/16),in intestinal tuberculosis was 85.7％(12/14) and 93.3％ (14/15).The negatively predictive value of Crohn's disease was higher [87.5％ (14/16)] than that of intestinal tuberculosis [12.5％ (2/16)].Conclusion T-spot.TB is helpful for differential diagnosis of Crohn's disease and intestinal tuberculosis.

OBJECTIVETo discuss the clinical effects of open reduction and internal fixation (ORIF) for treatment of patients with Lisfranc injury combined the second metatarsal base comminuted fracture.

METHODSFrom March 2007 to June 2012, 7 patients with Lisfranc injury combined the second metatarsal base comminuted fracture were treated including 5 males and 2 female aged from 22 to 51 years old (means 42 years), 4 of sprain and 3 of traffic injury. According Myerson classification, there was 1 case of type A, 3 of type B and 3 of type C. Kirschner wire was used to fix Lisfranc ligament placing from the medial cuneiform bone to the second metatarsal base during the operation. After the operation American Orthopaedic Foot and Ankle Society (AOFAS) criteria system were applied to evaluate the foot and ankle function. Preoperative and postoperative AP, lateral and oblique X-ray and CT scan were collected for radiographic evaluation.

RESULTSAll patients were followed up from 12 to 20 months (16.8 months in average). According to AOFAS criteria system, 3 cases were excellent result,3 good, 1 fair. All the wounds were primary healing without skin necrosis, infection, Kirschner loose,broken, or other complications.

CONCLUSIONKirschner wire had good clinical efficacy for fixing Lisfranc ligament injury with the second metatarsal base comminuted fracture, and could avoid arthrodesis.

Adult ; Bone Wires ; Female ; Humans ; Male ; Metatarsal Bones ; injuries ; surgery ; Middle Aged ; Tarsal Joints ; injuries ; surgery ; Wound Healing

This study investigated the accuracy of MRI features in differentiating the pathological grades of pancreatic neuroendocrine neoplasms (PNENs).A total of 31 PNENs patients were retrospectively evaluated,including 19 cases in grade 1,5 in grade 2,and 7 in grade 3.Plain and contrastenhanced MRI was performed on all patients.MRI features including tumor size,margin,signal intensity,enhancement patterns,degenerative changes,duct dilatation and metastasis were analyzed.Chi square tests,Fisher's exact tests,one-way ANOVA and ROC analysis were conducted to assess the associations between MRI features and different tumor grades.It was found that patients with older age,tumors with higher TNM stage and without hormonal syndrome had higher grade of PNETs (all P＜0.05).Tumor size,shape,margin and growth pattern,tumor pattern,pancreatic and bile duct dilatation and presence of lymphatic and distant metastasis as well as MR enhancement pattern and tumor-topancreas contrast during arterial phase were the key features differentiating tumors of all grades (all P＜0.05).ROC analysis revealed that the tumor size with threshold of 2.8 cm,irregular shape,pancreatic duct dilatation and lymphadenopathy showed satisfactory sensitivity and specificity in distinguishing grade 3 from grade 1 and grade 2 tumors.Features ofperipancreatic tissue or vascular invasion,and distant metastasis showed high specificity but relatively low sensitivity.In conclusion,larger size,poorlydefined margin,heterogeneous enhanced pattern during arterial phase,duct dilatation and the presence of metastases are common features of higher grade PNENs.Plain and contrast-enhanced MRI provides the ability to differentiate tumors with different pathological grades.