In view of the predominance problems in present experimental teaching of medical microbiology, we reformed the experimental contents and experimental teaching methods,to establish an entire experimental curriculum teaching system to be suitable for seven-year system and long educational system students,which manifests the creative teaching idea.

Objective To investigate the different killing effect to human pulmonary adenocarcinoma cell line cells GLC-82 with coexpressed double suicide genes compared with single gene. Methods Recombinant expression vectors containing CD (cytosine deaminase) and/or TK(thymidine kinase) gene under CMV promoter were constructed successfully. The vectors were transfected to GLC-82 tumor cell lines by use of lipofectamine. The clones were picked out after G418 selection. Extraneous gene integration and expression were confirmed by PCR and semi-quantitative RT-PCR. The cytotoxicity to these transgenic cells under treatment with 5-Fc and GCV were measured by MT1 assays. Results Double and single suicide gene transfer were both stably expressed in GLC-82 cells . The cytotoxic effects of co-expressed TK-CD genes were superior than that of the single gene. Conclusion The CD + TK/5-Fc + GCV coexpression system is more effective for killing effect of tumor cells than CD/5-Fc or TK/GCV system alone.

OBJECTIVETo evaluate the effect of different silane couplers on bond strength and durability of two machinable glass ceramics to resin cement.

METHODSTwo machinable glass ceramics (A and B) were silanized by three silane couplers (A, B, C), and were bonded with a resin cement (G-CEM) to form micro-shear test specimens of six groups. The specimens of each group were subdivided into two subgroups, and their micro-shear bond strength was measured before and after 10000 thermal cycles. Bond strength data were analyzed by two-way ANOVA.

RESULTSBefore thermal cycles, the bond strength of ceramic A treated by silane coupler A was lower than that of ceramic B (P = 0.002). The bond strength of ceramic A treated by silane coupler C was significantly higher than that treated by silane coupler A and B (P = 0.014, P = 0.019). 10 000 thermal cycles obviously decreased the bond strength of all groups except the group of ceramic A treated by silane coupler B, and no significant difference was found between three silane coupler with either of two ceramic. However the bond strength of ceramic B treated by silane coupler B and C was significantly higher than that of ceramic A (P = 0.003, P = 0.027).

CONCLUSIONAs well as the types of silane coupler, the type of ceramic could affect their bond strength and durability to resin cement.

Ceramics ; Materials Testing ; Resin Cements ; Silanes

BACKGROUNDTamsulosin, an alpha-1 receptor antagonist, has been demonstrated effective in promoting distal ureteral stone passage and in reducing pain associated with stone expulsion. This study aimed to evaluate the effect of tamsulosin in comparison with nifedipine and extracorporeal shock wave lithotripsy (ESWL) on the expulsion rate of distal ureteral stones at different sizes.

METHODSWe assigned 314 patients to three categories: I, the stone with maximal diameter of 4.0 - 5.9 mm; II, 6.0 - 7.9 mm, and III, 8.0 - 9.9 mm. Patients in each category were randomly subdivided into three treatment subgroups: group A (nifedipine group), group B (tamsulosin group), and group C (ESWL group). Stone-free rate and the dose of analgesics were recorded weekly during the 4-week follow-up period.

RESULTSThree hundred and three patients completed the study. The results showed that nifedipine and tamsulosin treatments promoted a small (4 - 8 mm, categories I and II) stone expulsive rate that was comparable with ESWL treatment. Nonetheless, when the stone diameter was 8.0 - 9.9 mm, ESWL showed a greater stone free rate than nifedipine and tamsulosin treatments; no significant difference existed between the latter two therapies. Although the ESWL treatment group required the least analgesics, tamsulosin treatments required less pain medication than nifedipine (P < 0.05).

CONCLUSIONSTamsulosin treatment is recommended for patients with the stone diameter smaller than 8 mm because of its feasibility, effectiveness and safety. ESWL is more appropriate than tamsulosin therapy for the patients whose stones are larger than 8 mm.

Adrenergic alpha-Antagonists ; pharmacology ; Adult ; Calcium Channel Blockers ; pharmacology ; Female ; Humans ; Lithotripsy ; Male ; Middle Aged ; Nifedipine ; therapeutic use ; Sulfonamides ; therapeutic use ; Treatment Outcome ; Ureteral Calculi ; drug therapy ; therapy

OBJECTIVETo discuss the technical points, advantages, follow-up results and mechanism of endovenous holmium laser treatment for varicose veins.

METHODSEndovenous holmium laser procedures were performed for 96 patients (99 legs) with primary varicosity of lower extremities. Perioperative Duplex was used for preoperative diagnosis, intraoperative guide and postoperative follow-up. The time of procedure and clinical results were observed. The mean follow-up time was 7 months.

RESULTSSixty-seven in 99 legs with saphenous vein occluded immediately during operation. All saphenous veins were confirmed to be occluded 7 days after the procedure. There was no recanalization with Duplex finding during the follow-up period. No wound complications. Two cases were with minor skin burn. One case was with saphenous nerve injury. Three cases were with thigh ecchymosis.

CONCLUSIONPreliminary results show endovenous holmium laser treatment for varicose veins is safe and effective in treating varicose veins with cosmetic appearance and quicker recovery.

Adult ; Aged ; Aged, 80 and over ; Female ; Follow-Up Studies ; Holmium ; therapeutic use ; Humans ; Laser Coagulation ; methods ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; Saphenous Vein ; surgery ; Treatment Outcome ; Ultrasonography, Doppler, Duplex ; Varicose Veins ; diagnostic imaging ; surgery

Objective Norwood Stage Ⅰ is the standard procedure to cope with hypoplastic left heart syndrome (HLHS),which continues to be the most challenging congenital heart disease.The aim of this study is to retrospectively compare the classical perioperative management of Norwood Stage] with the modified strategy.Methods Between June 2010 and November 2017,totally 10 patients with HLHS underwent the standard Norwood Stage Ⅰ procedure.They are stratified to two tiers:Group A,from June 2010 to August 2014,there were 5 boys.Age at surgeries ranged from 29 to 75 days,and weight 2.57-3.50 kg with median of 3.13 kg.Group B,from August 2014 to November 2017,there were 4 boys and 1 girl.Age at surgeries ranged from 6 to 22 days,and weight from 2.0-3.1 kg.In Group A,all 5 cases underwent the standard Norwood Stage.procedure under deep hypothermic circulatory arrest,including 4 cases of modified Blalock-Taussig shunt (MBTS) and 1 case of RV-PA shunt.In Group B,all 5 cases adopted side graft technique and RV-PA shunt,aortic arch and ascending aorta were reconstructed with treated bovine pericardial patch.Group B used incubators to adjust systemic vascular resistance instead of vasodilators.Results Group A's early mortality is 40％;Group B's early mortality is 20％,1 case died of tamponade.Conclusion The standard Norwood Stage Ⅰ procedure is a complex procedure,which demands multidisplinary cooperation,to palliatively correct HLHS.To adjust and find a suitable perioperative managements can improve the results.Sharing experiences on perioperative managements of Norwood Stage Ⅰ between heart centers in China will be helpful to decrease the mortality and morbidity in relatively short period.

Objective To analysis the the strategy of repairing coarctation of aorta with hypoplastic aortic arch in neo-nate.Methods Collected consecutive 24 neonates suffered coarctation of aorta with hypoplastic aortic arch form January 2015 to March 2017,12 patients were underwent aortic arch reconstruction with extremely extended end-to-end anastomosis under cardiopulmonary bypass(CPB) through the media sternotomy approach(CPB group), while another 12 cases were under coarc-tation repair using end-to-end anastomosis or end-to-side anastomosis through left posterolateral thoracotomy approach ( control group).The postoperative blood pressure,echocardiography and cardiac CT scan were used to evaluate the result of the aortic arch rconstruction.The pressuregradientof the upper limb and lower limb,flow velocity of the anastomoses, aortic arch morphol-ogy,rate of the residual abstruction were compared between the two groups.Results Mechanical ventilation time[ CPB group (17 ±27)h vs.control group(44 ±52)h, P＜0.05], ength of stay in ICU[CPB group(3.75 ±1.36)days vs.control group (6.54 ±5.08)days, P＜0.05], all patients were followed up for 1－12 months,the aortic residual pressure[CPB group(14 ± 10)mmHg (1 mmHg＝0.133 kPa) vs.control group(26 ±17)mmHg,P ＜0.05) ], flow velocity of the anastomoses[CPB group(2.32 ±0.78)m/s, control group(1.55 ±0.99)m/s, P ＜0.05 ], pressuregradientof the upper limb and lower limb [CPB group (6.67 ±3.49)mmHg, control group(7.41 ±4.29)mmHg, P＞0.05].There was no died in two gruops.Con-clusion Anastomosis with end to end techinique under cardiopulmonary bypass may achieve better effect in neonates with co-arctation of aorta with hypoplastic aortic arch,it has better duplcity, operability and early curative effect,but the long-term effect need the multicenter and large sample-volume study to explore.

Objective To investigate the therapeutic value of caspofun-gin combined with clindamycin for pneumocystis pneumonia ( PCP ).Methods The clinical data of two severe PCP patients treated by caspo-fungin combined with clindamycin regimen in department of respiratory medicine of our hospital were analyzed.Because of definitely sulfame-thoxazole/trimethoprim (SMZ/TMP) allergy history, they were both ini-tially treated with caspofungin single drug , and received mechanical ven-tilation and methylprednisolone treatment.However , clindamycin was added to both patients after 3-4 days because of poor response to caspo-fungin monotherapy.Then they got better gradually , the arterial blood gas and chest CT scan showed that the respiratory failure and lung infil-tration were much improved.Results and Conclusion The courses of caspofungin combined with clindamycin were both 3 weeks, the patients were cured without adverse drug reactions.For PCP patients with limited usage of SMZ/TMP, caspofungin combined with clindamycin may be an effective and safe regimen.

OBJECTIVETo preliminarily investigate the relationship between serum apelin level and pulmonary artery pressure in children with congenital heart disease.

METHODSOne hundred and twenty-six children with congenital heart disease undergoing surgical treatment were enrolled as subjects. The serum level of apelin was determined before surgery and at 7 days after surgery. The ratio of pulmonary artery systolic pressure to aortic systolic pressure (Pp/Ps) was calculated before extracorporeal circulation. According to the Pp/Ps value, patients were classified into non-pulmonary arterial hypertension (PAH) group, mild PAH group, moderate PAH group, and severe PAH group. Pulmonary artery mean pressure was estimated by echocardiography at 7 days after surgery.

RESULTSThe non-PAH group had the highest serum level of apelin before and after surgery, followed by the mild PAH group, moderate PAH group, and severe PAH group (P<0.05). All groups had significantly increased serum levels of apelin at 7 days after surgery (P<0.05). The serum level of apelin was negatively correlated with pulmonary artery pressure before surgery (r=-0.51, P<0.05) and at 7 days after surgery (r=-0.54, P<0.05).

CONCLUSIONSThe decrease in serum apelin level is associated with the development of pulmonary hypertension in children with congenital heart disease. The significance of serum apelin in predicting the development and degree of pulmonary hypertension in children with congenital heart disease deserves further studies.

Apelin ; Blood Pressure ; Child, Preschool ; Female ; Heart Defects, Congenital ; blood ; physiopathology ; Humans ; Hypertension, Pulmonary ; blood ; Infant ; Intercellular Signaling Peptides and Proteins ; blood ; Male ; Pulmonary Artery ; physiopathology

OBJECTIVETo study the protective effect of cold autologous blood cardioplegic solution on the heart of infants with cyanotic congenital heart disease (CCHD).

METHODSNinety-six infants with CCHD who underwent cardiopulmonary bypass (CPB) were randomly and equally divided into three groups: histidine-tryptophan-ketoglutarate (HTK) solution, cold non-autologous blood cardioplegic solution, and cold autologous blood cardioplegic solution. The right auricular tissues were taken before aortic cross-clamping and at 30 minutes after aortic declamping, and ATP level and energy charge (EC) in the myocardium were measured. Venous blood was collected before and immediately after CPB, and the serum levels of creatine kinase (CK)-MB and cardiac troponin I (cTnI) were measured. The clinical parameters, such as the re-beat time and re-beat rate during CPB, cardiac index, dependence on positive inotropic agents, and left ventricular ejection fraction (LVEF) at 2 hours after CPB, the incidence rate of arrhythmia within 24 hours after CPB, and postoperative complications and mortality, were recorded.

RESULTSAt 30 minutes after aortic declamping, the three groups showed significantly decreased ATP and EC levels (P<0.05), and the cold autologous blood group had significantly higher ATP and EC levels than the other two groups (P<0.05). Immediately after CPB, the three groups showed significantly increased serum levels of CK-MB and cTnI (P<0.05), and the cold autologous blood group had significantly lower serum levels of CK-MB and cTnI than the other two groups (P<0.05). The cold autologous blood group had significantly better outcomes than the other two groups in terms of the re-beat time during CPB and the dependence on positive inotropic agents and LVEF at 2 hours after CPB (P<0.05).

CONCLUSIONSCold autologous blood cardioplegic solution is superior to HTK and cold non-autologous blood cardioplegic solutions in preserving myocardial energy and reducing myocardial injury in infants with CCHD who undergo CPB, thus providing a better protective effect on the heart.

Cardioplegic Solutions ; pharmacology ; Cardiopulmonary Bypass ; Energy Metabolism ; Female ; Glucose ; pharmacology ; Heart Defects, Congenital ; metabolism ; surgery ; Humans ; Infant ; Infant, Newborn ; Male ; Mannitol ; pharmacology ; Myocardium ; metabolism ; Potassium Chloride ; pharmacology ; Procaine ; pharmacology ; Ventricular Function, Left