Objective:To study the expression of DcR3 of myocardial tissue in diabetic mouse and normal rats and the impact of DcR3 recombinant protein to the expression of related molecules and myocardial cell apoptosis to discuss the action of DcR3 to myocardial cell apoptosis in Diabetic rats.Methods:Intraperitoneally injected streptozotocin one time to establish the model of Diabetic rats.Injected different doses of DcR3 recombinant protein to tail vein[1.2 mg/(rat? d),0.8 mg/(rat? d),0.4 mg/(rat? d)] 40 d. The expression of DcR3 mRNA, Fas mRNA and FasL mRNA of myocardial tissue was detected with RT-PCR;the expression of apoptosis related molecules Bcl-2 and Caspase-8 was analyzed with Western blot;the IL-1β, TNF-αand LFN-γof the blood was detected with double antibody sandwich ELISA;the percentage of myocardial cell apoptosis was observed with HE dyeing.Results:To compare the DcR3 treatment group with diabetic group,the expression DcR3 of myocardial tissue was high,the expression of Fas mRNA and FasL mRNA was descended.The Caspase-8 protein was ascended and the Bcl-2 protein was descended.The middle dose group was the most obvious.the IL-1β,TNF-αand IFN-γin the blood was descended differently in each DcR3 treatment group(P<0.05,P<0.01).The percentage of myocardial cell apoptosis was declined(P<0.05).Conclusion:DcR3 recombinant protein have the action of inhibiting the rats′myocardial cell apoptosis,the mechanism is related to competing with Fas,blocking-up FasL of inducing apoptosis, expressing DcR3 of myocardial cell,the descending of apoptosis related factors Caspase-8,the ascending of Bcl-2 and the reduction of cytokine levels.

ObjectiveTo study the correlation with Genes Coding forESBLs and ClassⅠIntegron in ESBLs-producing Escherichia coli from children.MethodsPCR was used for gene typing detection of 100 strains of ESBLs-producingEsche-richia colistrains. While detection of class I integrase gene in the 100 strains ESBLs-producingEscherichia coli and 100 strains of non-ESBLs producingEscherichia coli were separately performed by PCR. It provides the solid base not only to reveal the relationship between class I integron and drug resistance, but also the relationship between class I integron and ESBLs-producing. ResultsThe most frequently genotyping from ESBLs-producingEscherichia coli in children isCTX-M (84%), followed by TEM-1(63%). The predominant distribution of genotype in ESBL- producing strains isTEM-1 +CTX-M (45%), followed by CTX-M (34%). Class I integrase gene detected in ESBLs- producing and non- ESBLs producing strain were 100 cases (100%) and 25 cases (25%) separately, the difference was statistically signiifcant (P<0.05); drug resistance in class I integron positive strains were signiifcantly higher than in class I integron negative strains, especially in Ciprolfoxacin, Levolfoxacin, and Amino-glycoside (86.4%, 88%, and 80%).ConclusionsThe distribution of Class I integron in ESBLs-producingEscherichia coli is signiifcantly higher than that in non-ESBLs-producing strains, It is rational that Class I integron highly correlate with strong drug resistance in ESBLs-producing strains.

[Adstract] Micro-lecture, as the main teaching form of MOOC and SPOC network teaching platform, is deeply welcomed by the majority of students. Pathology is the bridge connecting basic medicine and clin-ical medicine in medical education, which has such characteristics as many knowledge points, dispersion and obscurity, etc. Therefore, the production of micro courses is based on the knowledge points, and according to the characteristics of the knowledge points, it should also be applied reasonably according to the charac-teristics of each chapter. Adopting the teaching of self-study after class and teachers and students' discussion in class for micro courses can not only greatly improve the quality of teaching, but also develop the students' ability of independent thinking and the ability to analyze and solve problems, which transforms the teaching of pathology from pure knowledge to ability.

Objective:To systematically review the teaching effect of problem-based learning (PBL) combined with evidence-based medicine (EBM) teaching mode on the standardized residency training.Methods:CNKI, Wanfang database, VIP database, SinoMed, Embase, PubMed and Web of SCI databases were searched, and the randomized controlled trial (RCT) studies of the application of EBM combined with PBL teaching in standardized residency training were collected. The retrieval time was from the establishment to 1st July, 2018. Two investigators independently extracted data and assessed the quality of the studies. After assessing the risk of bias of included studies, Meta-analysis was performed on RevMan 5.3.Results:In total, 4 studies were included in the review. Narrative assessment was adopted, because outcome indicators of these study were varied and the quality of the literatures could not meet the requirement of Meta-analysis. Our study suggested that the residents who were in PBL combined with EBM teaching mode group got higher scores in the standardized residency training, compared with those in the lecture-based learning (LBL) teaching mode group, especially in case analysis score, total score of examination, improvement of clinical thinking ability, communication and expression ability, organization and cooperation ability, etc.Conclusion:The current evidence suggests that the application of EBM combined with PBL teaching mode has a positive effect on the standardized residency training. Compared with the traditional LBL teaching, EBM can improve students' ability. However, limited by the quantity and quality of included studies, the above conclusions still need to be verified by more studies with larger samples and higher quality.

Objective:To investigate the influence of high frequency oscillatory ventilation combined with ulinastatin on serum inflammatory factors, blood gas indexes and endothelial function in patients with respiratory distress after smoke inhalation lung injury.Methods:Sixty-two patients with acute respiratory distress syndrome induced by smoke inhalation lung injury from January 2016 to January 2019 in the 910th Hospital of the PLA Joint Service Support Unit were enrolled.With a prospective cohort study, the patients were divided into control group (31 cases) and observation group (31 cases) according to the random number table.The control group were treated with high-frequency oscillatory ventilation.The observation group was given intravenous ulinastatin treatment on the basis of the control group, 3×105 U/time, dissolved in 50 ml of normal saline, once every 8 hours.Acute physiology and chronic health evaluation (APACHE) Ⅱ score was performed before intervention and 48 hours after intervention.Serum interleukin-6 (IL-6), interleukin-8 (IL-8), tumor necrosis factor-α(TNF-α), nitric oxide, endothelin-1 were detected by enzyme-linked immunosorbent assay. Arterial blood oxygen partial pressure (PaO 2), arterial partial pressure of carbon dioxide (PaCO 2), oxygenation index were measured by blood gas analyzer. The Extra-vascular lung water index (EVLWI), pulmonary vascular permeability index (PVPI) were recorded by pulse indicator continuous cardiac output monitoring.The occurrence of adverse reactions were recorded. Results:The IL-6 ((66.8±15.2) ng/L), IL-8 ((70.3±10.4) ng/L, TNF-α ((24.6±3.5) ng/L) of the observation group after treatment 48 hours were lower than before treatment ((89.3±21.0) ng/L, (288.4±33.5) ng/L, (101.3±9.0) ng/L), the difference was statistically significant(t value was 5.704, 21.215, 30.281, repectively, all P<0.05), and the observation group were significantly lower than the control group((90.4±22.4) ng/L, (162.4±16.6) ng/L, (62.3±4.4) ng/L), the difference was statistically significant(t value was 4.906, 12.324, 19.252, repectively, all P<0.05). After 48 h of intervention in the control group and the observation group after 48 h of intervention, the oxygenation index ((208.5±55.4) mmHg and (315.3±49.8) mmHg), PaO 2 ((101.6±12.4) mmHg and (118.8±10.3) mmHg) of the control group and the observation group after 48 hours of intervention were significantly higher than before intervention((114.8±24.6) mmHg and(112.3±20.5) mmHg, (70.6±10.5) mmHg and(70.3±10.2) mmHg)(t value was 15.663 and 22.387, 11.216 and 16.214, repectively, all P<0.05, the PaCO 2 ((44.7±7.4) mmHg and (39.3±4.8) mmHg), EVLWI ((12.42±3.66) ml/kg and (9.70±2.33) ml/kg), PVPI (2.34±0.48 and 1.82±0.35) significantly lower than before intervention((47.8±5.6) mmHg and(48.3±6.5) mmHg, (16.58±4.05) ml/kg and (16.60±4.10) ml/kg, 2.86±0.55 and 2.90±0.53), ( t value was 3.655 and 7.372, 3.516 and 6.521, 3.571 and 8.024, repectively, all P<0.05), the oxygenation index , PaO 2 in the observation group after intervention were significantly higher than those in the control group, P<0.05, while PaCO 2, EVLWI and PVPI in the observation group were significantly lower than the control group, t value was 7.106, 4.213, 4.037, 7.122, 3.976, repectively, all P<0.05.The nitric oxide((76.65±30.25) μmol/L and (54.15±20.36) μmol/L), endothelin ((58.32±20.26) ng/L and (42.23±21.15) ng/L), APACHE Ⅱ score ((10.05±2.84) points and (7.14±2.74) points) of the control group and the observation group after 48 h intervention were significantly lower than before intervention ((90.30±33.33) μmol/L and(89.62±34.64) μmol/L, (71.64±28.35)ng/L and (70.36±26.56)ng/L, (23.46±4.13)points and(23.60±4.20)points), ( t value was 3.761 and 8.063, 4.031 and 7.376, 6.193 and 11.531, repectively, all P<0.05). The nitric oxide, The endothelin and APACHE Ⅱ scores in observation group after 48 h intervention were significantly lower than those of the control group ( t value was 3.759, 3.515, 3.715, repectively, all P<0.05). There were no adverse drug reactions occurred during the treatment in both groups. Conclusion:High frequency oscillatory ventilation combined with ulinastatin in the treatment of respiratory distress after smoke inhalation lung injury can inhibit the excessive release of inflammatory mediators and improve vascular endothelial function, thereby reducing capillary leakage, reducing EVLWI and increasing oxygenation index.

【Objective】 To achieve supervision and management of the whole business process of blood center, raise productivity and ensure blood quality by enabling blood center managers comprehensively grasp the key business operation situation of the whole process at anytime and anywhere. 【Methods】 A whole business process supervision and management system was established covering background of preparation, business scope, content of position supervision and management, overall framework design, interface design of management and supervision management, physical database design, program development and online debugging, and was integrated with the blood bank management information system. The display and management were through a mobile APP to record key indicators of business process from blood collection to blood supply timely and comprehensively. Statistical analysis was conducted on total collection volume, total preparation volume and total supply volume, as well as discarding rate of test unqualified and of non-test unqualified (lipemic blood excluded) in 2023 and 2022. 【Results】 We established a mobile APP based on a blood bank management information system for business supervision and management of whole process, and achieved management by phones. After its implementation in 2023, the total collection volume, total preparation volume and total supply volume in 2023 were all higher than those in 2022, with growth rates of 5.88% (13 247/225 454 U), 4.73% (24 156/510 698 U), and 6.70% (34 814/519 914 U), respectively. The discarding rate in 2023 was lower than that in 2022 (0.54%, 2 868/534 854 U) vs (0.60%, 3 047/510 698 U) (P<0.01), and the non-test unqualified discarding rate (lipemic blood excluded) in 2023 was significantly lower than that in 2022(0.12%, 649/534 854 U) vs (0.19%, 991/510 698 U)(P<0.01). 【Conclusion】 The construction of supervision and management system of a whole business process based on blood bank management information system can meet the standardized service needs of managers at anytime and anywhere, continuously raise productivity and the standardization and scientific level of blood bank management, thus ensuring blood supply.