Humans ; Nephritis ; etiology ; therapy ; Prognosis ; Purpura, Schoenlein-Henoch ; complications ; therapy ; Sjogren's Syndrome ; etiology ; therapy

Current reform of higher medical education focuses on curriculum integration and corresponding reconstruction of teaching system. Chongqing Medical University has carried out the reform of medical personnel training mode from basic to clinical, which has achieved certain results. Three aspects including teaching content, teaching methods and appraisal system of the urogenital system curriculum integration are introduced in the paper. In the teaching content, the parts related to urogenital system in basic subjects and clinical subjects are extracted and integrated. In the process of teaching implementation, a teaching team is set up across departments and multidisciplinary joint teaching is carried out. In order to arouse the enthusiasm of students, inspire and cultivate students' scientific research thinking by improving teaching methods, several teaching methods such as case introduction teaching method, question discussion and debate meeting are used. Scientific evaluation system is used to observe and record the whole process of students' learning. Meanwhile, some existing problems and solutions of curriculum integration are discussed in the paper to provide references for peers in relevant colleges and universities.

Objective To investigate the risk factors of gallbladder carcinoma,so as to provide theoretical base for the prevention of gallbladder carcinoma.Methods The clinical data of 153 patients with gallbladder carcinoma (gallbladder carcinoma group) who were admitted to the Peking Union Medical College Hospital from January 2000 to December 2010 were retrospectively analyzed. A total of 300 patients with cholecystolithiasis (cholecystolithiasis group) and 300 patients without gallbladder carcinoma or cholecystolithiasis (control group)were collected and matched at the ratio of 1∶2 to conduct the controlled study.Data were statistically analyzed by the Chi-square test and conditional Logistric regression.Results Univariate analysis showed significant difference in age,history of cholecystolithiasis,postmenopausal age,accumulated menstrual period,giving birth or not and number of birth between gallbladder carcinoma group and control group ( x2 =58.22,180.14,9.59,24.30,18.66,15.17,P ＜0.05).Age,history of cholecystolithiasis,accumulated menstrual period and number of birth were the independent risk factors of gallbladder carcinoma (x2 =55.76,180.95,24.30,8.54,P ＜ 0.05).The risk of having gallbladder carcinoma in patients who had a history of cholecystolithiasis was 34 times higher than those who did not have the history of cholecystolithiasis (OR =34.22).Late postmenopausal age (51 -55 years old),longer accumulated menstrual period ( ≥30 years),and the number of birth ( 3 times) were associated with higher risk of gallbladder carcinoma (OR =3.96,9.68,3.51 ). Age,course of cholecystolithiasis and accumulated menstrual period and number of birth were the risk factors of gallbladder carcinoma when comparing patients who have history of cholecystolithiasis in the gallbladder carcinoma group with those in the cholecystolithiasis group (x2 =70.66,16.66,11.59,4.69,P ＜ 0.05 ).Age,course of cholecystolithiasis and accumulated menstrual period were the independent risk factors of gallbladder carcinoma ( x2 =64.29,8.82,5.58,P ＜ 0.05).The risk of gallbladder carcinoma increased as the increase of age and course of cholecystolithiasis. The accumulated menstrual period ≥ 30 years was also a risk factor of gallbladder carcinoma. Conclusions Age,history of cholecystolithiasis,course of cholecystolithiasis,accumulated menstrual period and number of birth may be the risk factors of gallbladder carcinoma.For patients with age above 60 years and course of cholecystolithiasis above 3 years,cholecystectomy should be conducted to reduce the incidence of gallbladder carcinoma,and great importance should be attached to female patients with indications mentioned above.

Objective To analyze the clinicopathological features of gallbladder adenosquamous carcinoma.Methods The clinical data of 8 patients with gallbladder adenosquamous carcinoma who were admitted to the Peking Union Medical College Hospital from January 2000 to December 2010 were retrospectively analyzed.The clinicopathological features,diagnosis and treatment strategies were summarized.The survival curve was drawn by Kaplan-Meier method,and the survival of the patients was analyzed by Log-rank test. Results The clinical manifestation of the 8 patients was non-specific,and all the patients were misdiagnosed as with primary gallbladder cancer complicated with cholecystolithiasis or chronic cholecystitis.The levels of carcinoembryonic antigen and γ-glutamyl transferase of 3 patients were higher than the normal,the level of alkaline phosphatase of 2 patients was higher than the normal,the level of aspartate transaminase of 1 patient was higher than the normal,the level of CA242 of 3 patients was higher than the normal and the level of CA19-9 of 4 patients was higher than the normal.The levels of aspartate transaminase,total bilirubin and direct bilirubin were in the normal range. Different surgical approaches were selected according to different tumor positions.The mean diameter of the tumor was (5 ±3)cm. Lymph node metastasis was detected at the hepatic hilar,hepatoduodenal ligament and area behind pancreatic head. Postoperative pathological examination confirmed that all the patients were with gallbladder adenosquamous carcinoma. All patients were followed up till April 2011. Two patients survived with no discomfort,and the survival time was 2-3 months.Six patients died of tumor recurrence or metastasis,and their median survival time was 8 months (range,4-13 months). Conclusions The clinical manifestation of gallbladder adenosquamous carcinoma is non-specific, and definite diagnosis depends on the results of postoperative pathological examination.Surgical treatment is the only effective method in improving the prognosis of patients with gallbladder adenosquamous carcinoma,and the prognosis of patients is poor.

Objective To investigate the change of HepG2 liver tumor perfusion after microbubble enhanced ultrasound cavitation treatment and observe the related pathological injury.Methods Twenty eight Balb/c(nu/nu) nude mice transplanted subcutaneous HepG2 tumor were divided into three groups randomly,including the microbubble enhanced ultrasound cavitation group,the ultrasound group and the sham group.Microbubble enhanced ultrasound cavitation treatment was performed by 0.1 ml microbubbles intravenous injection combined with pulse ultrasound emission in experimental group,while in control groups only ultrasound exposure or microbubble injection were applied.The perfusion of tumors was imaged using contrast-enhanced ultrasonography before and after treatments.Time-intensity curve and peak intensity were analyzed.The tumors were then harvested for histological examination.Results The perfusion of HepG2 tumors almost vanished immediately after treatment in experimental group,with the peak intensity reduced from (26.9 ± 10.9)％ to(8.2 ± 5.8)％ (P ＜0.05).There was no significant changes before and after treatments (P ＞ 0.05) in the two control groups.Histological findings were disruption of the endothelia,significant hemorrhage and increased intercellular fluid.Conclusions Microbubble-enhanced ultrasound cavitation can significantly reduce tumor blood perfusion and disrupt tumor vascularture.This new ultrasound therapy can potentially become a new physical anti-angiogenetic therapy for liver tumor.

Objective To compare the various surgical procedures commonly used to treat ampullary neoplasms.Methods The clinical data of 238 patients with ampullary tumor who were admitted to the Peking Union Hospital from January 1995 to June 2012 were retrospectively analyzed.There were 51 patients with benign ampullary adenomas (34 patients treated with local tumor resection,17 patients treated with pancreaticoduodenectomy) and 187 patients with ampullary cancer (25 patients treated with ampulla local excision,162 patients treated with pancreaticoduodenectomy).Results For both ampullary cancer and benign tumor,the group of patients who received local excision was superior to the group of patients who received pancreaticoduodenectomy in operative time,blood loss,hospital stay,and incidence of postoperative complications (all P＜0.05).For benign ampullary adenomas,there were no significant differences in postoperative median survival time between local resection and pancreaticoduodenectomy (P=0.071,x2 =2.003).For stage T1 or T2 ampullary cancer,there was also no significant difference in the postoperative median survival time (P=0.054,x2=3.163).However,the postoperative median survival time of the pancreaticoduodenectomy group was significantly longer than that of the local resection group for patients with stage T3 or T4 ampullary cancer (P=0.041,x2 =6.309).Conclusions Ampullary tumors are characterized by relatively good response to treatment.The results suggested that for patients with benign ampullary adenomas and stage T1 or T2 of ampullary cancer,local resection is a good surgical procedure.For patients with ampullary cancer at more advanced stages (T3 or T4),pancreaticoduodenectomy is the first choice of therapy.

Objective To summarize the clinical and pathological characteristics of primary gallbladder carcinoma, analyze factors such as surgical procedures, tumor stages that associated with prognosis, and standardize the diagnosis and treatment strategy for primary gallbladder carcinoma.Methods From January 1986 to October 2009, 197 patients of primary gallbladder carcinoma were treated in Peking Union Medical College Hospital (PUMCH). A retrospective study was performed basing on clinical data of these patients, statistical analysis carried out using SPSS version 13.0, Kaplan-Meier estimate employed for the survival analysis and Log-rank test for the group comparisons. Results One hundred and ninety-seven patients were enrolled (73 male and 124 female) with the mean age of 64.4±1.1years. Abdominal pain (77.3%) , obstructive jaundice (33.6%) and fever (19.5%) were the main symptoms of primary gallbladder carcinoma, with accompanying cholecystolithiasis in 99 cases. B-mode ultrasonic examination and CT scan were important for preoperative diagnosis. Nevin stages and surgical modalities were independent prognosis factors. For stage Ⅰ and Ⅱ patients the survival terms were not different between those receiving radical cholecystectomy and simple cholecystectomy. However, for stage Ⅲ, Ⅳ and Ⅴ patients the survival terms were of statistically different between those in radical cholecystectomy group and simple cholecystectomy group. Conclusions For stage Ⅰ and Ⅱ patients, simple cholecystectomy is a good surgical procedure. For those at more advanced stages, radical cholecystectomy is the choice of therapy, while simple cholecystectomy also improves the prognosis compared with laparotomy only.

Objective To explore risk factors for type 2 diabetes mellitus complicated with gallstone disease. Methods The clinical data of 429 type 2 diabetes mellitus patients complicated with gallstone disease (case group) and 2145 type 2 diabetes mellitus patients without gallstone disease (control group) were collected from the Health Center of Peking Union Medical College Hospital from January 2007 to May 2010. According to sure (SBP), diastolic blood pressnre (DBP), fasting blood glucose (FBG), total cholesterol (TC), Triglyceride (TG), high-density lipoprotein cholesterol (HDL-CH), low-density lipoprotein cholesterol (LDL-CH) and body mass index (BMI) were statistically analyzed by fourfold table chi-square test or conditional Logistic regression.Results Univariate analysis showed that there was a significant difference in the levels of SBP, FBG, TC, HDL-CH and BMI between the case group and the control group (x2 =20.323, 4.365, 4.028, 7.049, 7.319, P＜0.05). Multivariate analysis confirmed that SBP, TC, HDL-CH and BMI were risk factors for gallstone disease in patients with type 2 diabetes mellitus (x2 = 18. 047, 6. 905, 12. 884, 7. 557, P ＜ 0. 05). Conclusion Increased SBP, TC and BMI and decreased HDL-CH may be the risk factors for type 2 diabetes mellitus complicated with gallstone disease.

Objective To determine the risk factors of gallstones. Methods A case-control study was conducted on 4087 patients with gallstones (the study group) and 20435 individuals without gallstones (the control group) at the Health Center of Peking Union Medical College Hospital (PUMCH) between January 2007 to May 2010. Using age and sex, the study and the control groups were matched in 1 : 5 ratio. Data were statistically analyzed using Chi-square test and conditional logistic regression.Results Univariate analysis showed significant differences in diabetic mellitus (DM), systolic blood pressure (SBP), diastalic blood pressure (DBP), triglyceride (TG), high density lipoprotein cholesterol (HDL-CH) and body mass index (BMI) between the study and the control groups (P＜0.05). Multivariate analysis confirmed that DM, SBP, HDL-CH and BMI were associated with gallstones, and their adjusted odds ratio (95％ confidence interval) were 0. 825 (0. 736 ～0. 925), 0. 908 (0. 828～0. 996), 1. 211 (1. 056～1. 389) and 0. 746 (0. 691～0. 805), respectively.The incidences of total cholesterol (TCH) and low deasity dipoprotein cholesterol (LDL-CH) were not significantly different between the two groups (P＞0.05). ConclusionsDM、SBP、HDL-CH and BMI were found to be the risk factors for gallstones. To prevent gallstones, weight reduction, blood pressure control and normalization of blood lipid are important measures.

Objective To study the clinical and pathological characteristics of hepatocellularcholangiocarcinoma,and standardize the diagnosis and treatment strategy.Methods Between January 1990 to October 2010,12 patients with hepatocellular-cholangiocarcinoma were treated at Peking Union Medical College Hospital (PUMCH).A retrospective study was performed based on the clinical data of these patients to evaluate the diagnosis,curative treatment and prognosis.Kaplan-Meier estimate was employed for survival analysis and log-rank test for group comparisons.Results There were ten male and 2 female patients,with a mean age of 51±6.3 (range,40 to 59).Abdominal pain,fatigue and weight loss were the main symptoms.Eleven of 12 (91.7％) patients had chronic hepatitis B,and 10 (83.3％) had cirrhosis.None of the 12 patients was accurately diagnosed preoperatively.The 1,3,and 5-year overall survivals for 11 patients who were regularly followed up were 63.6％,27.2 ％ and 9.1 ％,respectively.Conclusions The clinical manifestations of hepatocellular-cholangiocarcinoma were diverse,which led to preoperatively misdiagnosis.The diagnosis was made on pathological examination.Surgical resection was the main treatment.The prognosis of hepatocellularcholangiocarcinoma was bad.