Phased national medical licensing examination requires clinical students to have the ability to apply basic medical knowledge to solve comprehensive clinical problems. But the traditional teaching patterns of Medical Microbiology experiments can no longer meet requirements of actual education effect. In order to accommodate new situation, we have integrated medical licensing examination with microbiology experimental teaching syllabus and contents. We have also comprehensively applied a variety of teaching methods and curriculum formative assessment in class. These reforming methods have efficiently improved classroom teaching effect and greatly inspired the enthusiasm of students, and effectively improved early clinical thinking ability and innovation ability of students.

Objective To study the intra-and extra-hepatic collateral pathways in various types of Budd-Chiari syndrome (BCS) using liver acceleration volume acquisition (LAVA) enhanced MRI.Methods The clinical data and imaging findings of 240 patients with BCS were collected and analyzed.The types of BCS confirmed by DSA.Intra-and extra-hepatic collateral pathways were studied using LAVA enhanced MRI with a 3.0T scanner.Correlations of the intra-/extra-hepatic collateral pathways with the types of BCS were analyzed using the Chi-square test.Then,the degrees of correlation were calculated by the Cramet correction coefficient of contingency.Results Among the 240 patients,DSA confirmed 60 patients to have hepatic vein occlusion,39 patients to have inferior vena cava occlusion and 141 patients to have both hepatic vein and inferior vena cava occlusion.MRI demonstrated dilated accessory hepatic veins in 157 patients,intra-hepatic communicating branches in 69 patients,inferior phrenic veins in 43 patients,superficial epigastric veins in 135 patients,umbilical veins in 94 patients and hemiazygos/azygos veins in 195 patients.Accessory hepatic veins and hemiazygos/azygos veins as collateral pathways were associated with the types of BCS (x2 =30.239,P ＜ 0.05;x2 =51.295,P ＜ 0.05,respectively).The degrees of correction were 0.355 and 0.462,respectively.Accessory hepatic veins as collateral pathways were most common in the mix type,accounting for 79.4％.Hemiazygos/azygos veins were most common in the inferior vena cava occlusion type and the mix type,accounting for 92.3％ and 91.5 ％,respectively.Conclusions Accessory hepatic veins and hemiazygos/azygos veins as collateral pathways were associated with the types of BCS,while the intra-hepatic communicating branches,inferior phrenic veins,superficial epigastric veins and umbilical veins were not correlated with the types of BCS.LAVA may help to diagnose and determine the best choice of treatment for the various types of BCS.

Objective To study the clinical presentations,radiologic features,prognosis,and possible causes of liver injury associated umbilical venous catheter (UVC ).Methods We reviewed database of our NICU from December 2012 to November 2015 and identified preterm infants with liver injury while UVC in place.The gestational age,birth weight,gender,days of UVC in place prior to liver injury, the depth of UVC (cm),UVC tip position,ultrasound findings of liver injury,laboratory tests,treatment and outcomes were collected.Results During study period,322 infants received UVC insertion.Ten cases (3.1 %)of liver injury associated with UVC were diagnosed.Of the ten infants,nine were diagnosed as extravasation of fluid to liver parenchyma,and one was diagnosed as liver hematoma.The mean birth weight was (1184 ±207)g,mean gestational age was (28.5 ±1.7)weeks.The UVC tip was at thoracic (T) vertebrae T 9 to T 11 level,nine UVC tips were below the right diaphragm level.All UVCs were used for total parenteral nutrition before liver injury was diagnosed.Six infants had clinical manifestations,and four infants were free of clinical manifestations.The most prominent clinical signs were abdominal distension (n =5),weak bowel sounds (n =5)and hepatomegaly (n =4).One infant who was diagnosed with liver hematoma also had progressive hemoglobin decline (minimum 34 g/L)and shock.Abdominal ultrasound showed well-limited,irregular,hyperechoic rimmed lesions with heterogeneously hypoechoic centers or anechoic liquid dark space.Extravasation of fluid to liver parenchyma will restorate within one week after the UVC was remove.One baby who was diagnosed as liver hematoma passed away at 9 days of life.Liver ultrasound of eight returned to normal in 52 days to 3.5 months,and one had calcified lesions at 9 months of age.Conclusions Liver injury is an unusual complication of UVC insertion and usage.Proper positioning of the UVC tip may help to avoid this complication.Early recognition,prompt diagnosis with liver ultrasound examination and timely treatment can lead to better outcome in newborns with extravasation of fluid to liver parenchyma.

OBJECTIVETo explore material bases and neurobiological mechanisms of "Shen storing will" by observing learning and memory capacities and N-methyl-D-aspartic acid (NMDA) receptor expressions in Shen deficiency constitution (SDC) rats.

METHODSTotally 40 SD rats were randomly divided into the model group, the Zuogui Pill (ZP) group, the Yougui Pill (YP) group, the blank control group (consisting of normal pregnant rats), 10 in each group. SDC young rat model (inherent deficiency and postnatal malnutrition) was prepared by the classic way of "cat scaring rat". Medication started when they were scared by cat. Rats in the ZP group and the YP group were administered by gastrogavage with ZP suspension 0.1875 g/mL and YP suspension 0.0938 g/mL respectively. Equal volume of normal saline was administered to rats in the blank control group and the model group by gastrogavage. All medication was given once per day, 5 days in a week for 2 consecutive months. Learning and memory capacities were detected by Morris water maze test. Expressions of NMDA receptor subunits NR2A and NR2B in hippocamus were detected by immunohistochemical method.

RESULTSCompared with the blank control group, the latency period, total distance in Morris water maze test were longer in the model group (P < 0.05). All the aforesaid indices all decreased in the ZP group and the YP group, with statistical difference when compared with the model group (P < 0.05). The protein expressions of NR2A and NR2B in hippocamus were lower in the model group than in the blank control group (P < 0.05). But when compared with the model group, they were obviously higher in the ZP group and the YP group (P < 0.05).

CONCLUSIONSSDC rats had degenerated learning and memory capacities and lowered NMDA receptor expressions. ZP and YP could up-regulate learning and memory capacities and NMDA receptor expressions, thereby improving deterioration of brain functions in SDC rats.

Animals ; Drugs, Chinese Herbal ; pharmacology ; Female ; Learning ; drug effects ; Memory ; drug effects ; Pregnancy ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Receptors, N-Methyl-D-Aspartate ; metabolism ; Up-Regulation

Objective To evaluate the effectiveness of maternal prenatal education on promoting breastfeeding rate for preterm infants in neonatal intensive care unit (NICU).Methods Gravidas who were admitted to Peking University First Hospital for any risk of preterm delivery from November 2013 to December 2014 and preterm infants admitted to the NICU (length of stay ≥ 5 d) of the same hospital during the same period were involved.All the gravidas received prenatal education and completed questionnaires.Two hundred and ninety-five preterm infants who met the inclusion criteria were divided into two groups including education group (n=125) and non-education group (n=170) according to whether their mothers received prenatal education or not.Conditions of the preterm infants during hospitalization and after discharge and breastfeeding rates were comparatively analyzed between the two groups.T test,Chi-test and Wilcoxon rank-sum test were used for statistical analysis.Results (1) There were 380 gravidas received questionnaires.Among them,346 (91.1％)completed the questionnaires and were recruited in this study.Only 31.8％ (110/346) of these gravidas were active in learning more about breastfeeding and 46.2％ (160/346) of them lacked confidence in breastfeeding after the appearance of preterm delivery signs.There were significant improvements in their attitudes towards considering breastfeeding seriously and discussing with their family,confidence in breastfeeding,the importance of colostrum and how to breastfeed a preterm infant in hospital after maternal prenatal education (all P＜0.001).Prenatal education was thought to be helpful in 77.5％ (268/346) of the gravidas.(2) The two groups of preterm infants showed good homogeneities in gestational age,gender,birth weight and other basal conditions as well as in incidences of in-hospital complications and conditions after discharge (all P＞0.05).Proportions of breast milk intake (breast milk intake over total dairy intake) in preterm infants were higher in education group than those in non-education group within 5 d after birth [0.0 (0.0-16.5)％ vs 0.0 (0.0-2.5)％,Z=-3.422],＞5-≤ 7 d [33.7 (0.0-82.8)％ vs 0.0 (0.0-50.3)％,Z=-3.070],＞7-≤ 14 d [75.2(23.5-96.4)％ vs 47.6(0.0-92.2)％,Z=-2.345] and during hospitalization [58.4 (21.0-78.8)％ vs 31.9 (0.0-71.7)％,Z=-3.902] (all P＜0.05).Breastfeeding rates were higher in education group than those in non-education group at the age of 5 d [47.2％(59/125) vs 27.1％ (46/170),x2=12.747],7 d [70.4％ (88/125) vs 51.2％ (87/170),x2=11.031],three months [83.3％(65/78) vs 56.1％ (60/107),x2=15.297] and six months [64.5％ (49/76) vs 49.1％ (53/108),x2=4.282] (all P＜0.05).Exclusive breastfeeding rates in the first,third and sixth months after birth were higher in education group [45.7％(53/116),42.3％ (33/78) and 36.9％ (28/76)] than those in non-education group [21.3％ (32/150),28.0％ (30/107)and 22.2％ (24/108)] (22=17.847,4.091 and 4.703,all P＜0.05),respectively.Conclusions Most gravidas with risk factors of preterm delivery have no confidence on breastfeeding.Prenatal maternal education is an effective and feasible intervention to improve breastfeeding rate for preterm infants in NICU from early hospitalization till six months after birth.

Objective To observe the pathological changes of bone hydatid cyst of meriones meridianus after radiation therapy,and to investigate the clinical effect of radiotherapy on bone hydatid disease.Methods Ascus was dissected sterilely from sheep liver that naturally infected with Echinococcus granulomas,sheared and sac skin removed.Then it was washed and precipitated with 0.9％ sterile saline for 3 times,and scolex was HE stained and counted,from which a 20 ml suspension was made containing 12 × 106/L of scolex.Health meriones meridianus (referred to as gerbil) 140,male and female were in each half,aged 2 to 3 months,body weight(38 ± 6)g,were involved in the study.Gerbil was injected a 0.2 ml suspension containing Echinococcus granulomas scolex into hind tibial periosteum,and X-ray was taken 12 months after the injection.According to the bone destruction in the vaccination site,gerbil hindleg tibia with clear jagged bone destruction was treated as inclusion criteria,and 72 animal were selected as gerbil bone hydatid disease animal models,male and female were in each half.A tatal of 72 gerbils were randomly divided into 4 groups:control group,40 beequerel(Gy) group,50 Gy group and 60 Gy group,18 rats in each group,male and female in each half.The model animals were treated with radiotherapy for 5 times,with 2 d interval,and radiation dose was 300 cGy/min.Each group of gerbils was sacrificed after radiotherapy,bone Echinococcus granulomas cysts was taken out sterilely,and observed by light and electron microscope.Intracapsular cyst fluid was extracted,washed and precipitated with 0.9％ sterile saline repeatedly,and and the pellet was HE stained for observation of scolex morphology and activity by light microscope.Results The morphology and activity ofEchinococcus granulomas in cystic fluid in control group were normal; the morphology and activity of Echinococcus granulomas were still normal in the 40 Gy group,and Echinococcus granulomas was not stained red; but those were abnormal,deformation and atrophy and stained red in the 50 Gy group; and were stained red,deformed,fractured and were wrapped by unknown in the 60 Gy group.By light microscope,the germinal layer,cuticle layer,brood capsule and histological structure of protoscolex were basically normal in irradiated region in the control group.The pathological changes of hydatid cyst in the 40 Gy group were mainly degeneration,structure of hydatid cyst was abnormal,stratum corneum was extensive edema,germinal layer became thinner and the fertile cyst was rare.The main pathological change of hydatid cyst in the 50 Gy group was that corneous layer was widely fractured,and the germinal layer was edema,buckling folds,cells decreased,rare seen brood capsule and scolex; the main pathological changes of hydatid cyst were mainly necrosis in the 60 Gy group,cuticle was extensive fault,stratum corneum and germinal layer was separated,germinal layer was atrophy and disorder,no brood capsule and scolex.By electron microscope,cuticle structure of Echinococcus granulomas cyst was clear,microvillus arranged neatly,morphology and structure of the cell and organelle in cytoplasm were normal in the control group.There were many inflammatory cells infiltrating germinal layer of Echinococcus granulomas cyst,microfilament and contents in microfilament were reduced in the 40 Gy group.Microvillus of Echinococcus granulomas disappeared,nuclear membrane was unclear,endoplasmic and mitochon eclasis,lymphocyte nuclear chromatin was clumping and edge set and in circular permutation in the 50 Gy group.Microvillus disappeared,perinuclear membrane indistinct and ruptured,parts of nucleoli were fragmented and marinated,endoplasmic reticulum was extensive expansion,mitochondria was pyknosis and obvious vacuolization,lymphocyte nuclear chromatin clumping and edge set,lysosomes and macrophage emerge in the 60 Gy group.Conclusions Radiotherapy can destroy the morphology and structure of bone hydatid cyst,radioactivity at 50 Gy has a lethal effect on hydatid cyst.Radiation treatment of bone hydatid disease has a good clinical effect.

The role of methyl-CpG binding domain protein 2 (MBD2) in an ApoE-deficient mouse model of age-related macular degeneration (AMD) was investigated. Eight-week-old Mbd2/ApoE double deficient (Mbd2(-/-) ApoE(-/-)) mice (n=12, 24 eyes, experimental group) and MBD2 (wt) ApoE(-/-) mice (n=12, 24 eyes, control group) were fed on Western-type diet for 4 months. The mice were sacrificed, and total serum cholesterol levels were analyzed and Bruch's membrane (BM) of the eyes was removed for ultrastructural observation by transmission electron microscopy. Moreover, intercellular adhesion molecule 1 (ICAM-1) immunoreactivities were evaluated by fluorescence microscopy in sections of the eyes in both groups for further understanding the function mechanism of MBD2. There was no significant difference in the total serum cholesterol levels between control group and experimental group (P>0.05). Transmission electron microscopy revealed that AMD-like lesions, various vacuoles accumulated on BM, notable outer collagenous layer deposits and dilated basal infoldings of retinal pigment epithelium (RPE) were seen in both groups, and the BM in control group was significantly thickened as compared with experimental group (P<0.05). Fluorescence micrographs exhibited the expression of ICAM-1 in choroid was higher in control group than in experimental group. We are led to conclude that MBD2 gene knockout may lead to accumulation of more deposits on the BM and influence the pathogenesis of AMD via triggering endothelial activation and inflammatory response in choroid, improving microcirculation, and reducing lipid deposition so as to inhibit the development of AMD-like lesions. Our study helps to provide a new therapeutic approach for the clinical treatment of AMD.

Objective To discuss the clinical value of 99Tcm-sestamibi(99Tcm-MIBI) myocardial perfusion imaging on detecting myocardial ischemia in children with Kawasaki disease(KD) at convalescence period.Methods Twenty-one children wih KD at convalescence period were divided into 2 groups according to results of echocardiography.Four cases with coronary artery dilation,17 cases without coronary artery dilation.All cases accepted dipyridamole stress myocardial perfusion imaging.These patients who had positive results were given rest myocardial perfusion imaging again next day.Results Among 21 cases,9 cases(42.8%) were positive in perfusion imaging.Four cases with coronary artery dilation showed myocardial ischemia in different degree detected by myocardial perfusion imaging.Among 17 cases without coronary artery dilation,5 cases(29.4%) were positive.Conclusions Compared to echocardiography,99Tcm-MIBI myocardial perfusion imaging can objectively evaluate the location,extent and degree of myocardial ischemia of children with KD.It will be a routine test in observing its phase development.

Parkinson's disease (PD) is the second major neurodegenerative disease.The pathogenesis of PI) is still unclear.It is generally believed that neural damage, mitochondrial dysfunction, inflammation, oxidative stress and autophagy dysfunction caused by the transmission and aggregation of a- synuclein play an important role in the occurrence and development of PD.More and more research show- that metabolic disorder is one of the pathogenesis of PD.We examined whether overexpression of a- synuclein could induce metabolic disorder in mice and the possible mechanisms.Mice were divided into two groups: Thyl-aSYN transgenic mice (TG) and the control wild-type (WT) group.The rotarod test was used to analyze motor function in mice.We detected the body weight, plasma insulin content, glucose tolerance and insulin tolerance in the two group mice.The morphology of islets in the two groups were observed by hematoxylin eosin (HE) staining, and the islets were isolated to detect the glucose- stimulated insulin secretion (GSIS).The results showed that compared with the WT group, exercise tolerance of 12-month-old TG group decreased by 23.1% (P < 0.05) , body weight increased by 7% (P < 0.01), glucose tolerance decreased (P < 0.05), insulin tolerance decreased (P < 0.05), and insulin contents in the peripheral blood decreased by 20% (P < 0.05).Compared with the WT group, the levels of ce -syn proteins in the pancreas of the TG group increased by 1.32 times (P < 0.05) , the area of islets in the TG group decreased (P < 0.05 ) , the number of islets decreased (P < 0.01) , and the insulin secretion function decreased (P< 0.01).This study showed that the role of a-synuclein in PD is not limited to the damage of dopaminergic neurons, it also can affect metabolism and the morphology and function of peripheral organs, which provides a new theoretical basis for the pathogenesis of PD.

In traditional oral practice, the presystemic interactions with gut microbiota is an important mechanism underlying the holistic health benefits of Chinese herbal medicines (CHMs), making the study of CHMs distinct from the research of Western medicines of which the systemic exposure (level in blood) is the starting point and the core. Gut microbial metabolism complements host metabolism in maintaining metabolic homeostasis of many biologically important endogenous molecules and the disposition of numerous exogenous compounds. Among them, the widely distributed gut bacterial β-glucuronidases (BGUSs) coordinate with host UDP-glucuronosyltransferases (UGTs) to play a role in the occurrence and intervention of diseases by affecting the glucuronidation homeostasis and altering the intestinal local and/or systemic exposure of endogenous compounds and xenobiotics. On one hand, many ingredients of CHMs undergo enterohepatic circulation; On the other hand, CHMs can act on BGUSs directly or indirectly change the distribution and function of BGUSs through reprogramming gut microbiome. The multiple interactions between BGUSs and CHMs may play an important role in the overall therapeutic benefits of CHMs. This work firstly summarizes the latest research progress on BGUSs; then the physiological, pathological and pharmacological significance of BGUSs are exemplified with representative endogenous and exogenous compounds from the aspects of nutrient utilization, metabolic homeostasis, and therapeutic response based on the varied substrate spectra of BGUSs; finally, the scattered data in literature were integrated to summarize the multiple interactions between BGUSs and CHMs, highlighting the important role of BGUSs in the holistic actions of CHMs.