Objective To explore the practical method and teaching effect of problem-based learning (PBL) pattern in teaching of gastrointestinal disease for seven-year-program students during their internal medical probation.Methods The traditional pattern (gastrointestinal diseases) and PBL pattern (hepatobiliary diseases) were applied in these students to assess the teaching effects by exam scores and questionnaire.Results ① There was no significant difference between traditional training and PBL by exam scores (P＞0.05).② The PBL approach was widely accepted by students,which could contribute to the improvement of their learning motivation.It developed skills,including self-directed learning,summarizing,and clinical thinking capability and so on.Conclusion The PBL approach is a practical learning strategy that can improve the teaching effect; therefore it should be wildly practiced in future works.

Objective To compare the effect of water-infusion colonoscopy and conventional air-infusion colonoscopy on the bowel cleanliness during withdrawing.Methods A single blind randomized controlled trial was conducted. 222 patients were randomly divided into water-infusion group (group A, 112 cases) and air-infusion group (group B, 110 cases). The cleanliness scores, scores improvement, pain scores, time of reaching cecum, depth of colonoscopy, rate of whole colon examination, adenoma detection rate (ADR), operator’s dififculty and complications were compared between the two groups.Results The cleanliness score during withdrawing was higher in group A [M(8)/IQR(1) vs M(8)/IQR(2),P = 0.000], the improvement was higher in group A [(0.53 ± 0.74) vs (0.23 ± 0.55), P = 0.000], the abdominal pain score was signiifcantly lower in group A [M(2)/IQR(1) vs M(4)/IQR(2),P = 0.000] and the ADR was higher in group A (36.61 % vs 23.64 %,P = 0.041). The operator’s dififculty evaluation score was signiifcantly lower in group A [M(1)/IQR(1) vs M(2)/IQR(1),P = 0.005]. There were no signiifcant differences at the time of reaching cecum, the depth of colonoscopy and the whole colon examination rate between the two groups.Conclusion Water-infusion colonoscopy could signiifcantly improve the bowel cleanliness during withdrawing scope, improve the ADR and reduce abdominal pain of patients, without increasing the time to reach cecum.

Chromosomal integration enables stable phenotype and therefore has become an important strategy for breeding of industrial Saccharomyces cerevisiae strains. pAUR135 is a plasmid that enables recycling use of antibiotic selection marker, and once attached with designated homologous sequences, integration vector for stable expression can be constructed. Development of S. cerevisiae strains by metabolic engineering normally demands overexpression of multiple genes, and employing pAUR135 plasmid, it is possible to construct S. cerevisiae strains by combinational integration of multiple genes in multiple sites, which results in different ratios of expressions of these genes. Xylose utilization pathway was taken as an example, with three pAUR135-based plasmids carrying three xylose assimilation genes constructed in this study. The three genes were sequentially integrated on the chromosome of S. cerevisiae by combinational integration. Xylose utilization rate was improved 24.4%-35.5% in the combinational integration strain comparing with that of the control strain with all the three genes integrated in one location. Strain improvement achieved by combinational integration is a novel method to manipulate multiple genes for genetic engineering of S. cerevisiae, and the recombinant strains are free of foreign sequences and selection markers. In addition, stable phenotype can be maintained, which is important for breeding of industrial strains. Therefore, combinational integration employing pAUR135 is a novel method for metabolic engineering of industrial S. cerevisiae strains.
Genetic Engineering ; methods ; Genetic Vectors ; Metabolic Engineering ; Plasmids ; genetics ; Saccharomyces cerevisiae ; genetics ; Xylose ; metabolism

Objective To investigate the prevalence and the risk factors of gastroduodenal damages induced by nonsteroidal anti-inflammatory drugs (NSAIDs). Methods One hundred and eighty-four patients who were prescribed NSA1Ds for long time in rheumatology and cardiovascular clinics were enrolled. Clinical data such as age, sex, medication history and body mass index were recorded. The lesions were estimated by endoscopy and the specimens were tested for Helicobacter pylori (H. pylori) infection. Results Peptic ulcer was found in 63 (34. 24%) patients including gastric ulcer in 22, duodenal ulcer in 34 and compound ulcer in 7. The endoscopic examination showed that 57 out of 121 patients without peptic ulcer had ≥3 erosive lesions. Logistic regression analysis revealed that H. pylori infection was important risk factor that induced the peptic ulcer in those who were taking NSAIDs for long time (OR = 13. 86, 95% CI: 6. 53 ～ 29. 43). The incidence of gastroduodenal damage was similar in patients taking NSAIDs and low dose aspirin (OR =0.45,95CI:0.16～ 1.28). Conclusions NSAIDs may cause gastroduodenal damages in long-term users and H. pylori infection was an important risk factor. The effect of low dose aspirin on gastroduodenal damages is as same as NSAIDs.

Objective To detect the expression level of aquaporin 8 (AQP8) in patients with functional constipation(FC) or constipated irritable bowel syndrome (IBS-C),and the correlation between the expression of AQP8 and clinical features.Methods From March to December 2014,a total of 16 patients with IBS-C and 19 patients with FC met Rome Ⅲ criteria were collected,and nine healthy individuals were assigned to control group at the same period.The ascending and decending colonic tissues mucosa of FC,IBS-C and control group were taken under endoscope.The expression of AQP8 at mRNA and protein level was detected by real-time polymerase chain reaction (RT-PCR) and immunohistochemistry (IHC).The differences in AQP8 mRNA expression and AQP8 relative area were analyzed by Kruskal-Wallis test among groups,and Pearson correlation coefficient was performed for correlation analysis between the expression and clinical features.Results The relative expressions of AQP8 mRNA of ascending colon and descending colon of FC patients (1.38,0.61 to 4.09;2.65,0.82 to 7.52) and IBS-C patients (2.23,0.82 to 4.67;1.35,0.51 to 2.03) were higher than those of control group (0.56,0.19 to 0.97;0.38,0.21 to 1.19),and the differences were statistically significant (ZFc =-2.435,-3.149,ZIBS-C =-2.690,-2.152;all P＜0.05).AQP8 mRNA expression of descending colon in patients with FC was higher than that of patients with IBS-C,and the difference was statistically significant (Z =-2.003,P =0.045).The expression of AQP8 in patients with FC and IBS-C was positively correlated with disease course (ascending colon r=0.57 and 0.53;descending colon r=0.49 and 0.54,all P＜0.05),and was negatively correlated with frequency of defecation (ascending colon r=-0.82 and-0.61;descending colon r=-0.49 and-0.53,all P＜0.05).There was no correlation between the expression of AQP8 and age,gender,onset age,presence of abdominal symptoms of the patients (all P＞ 0.05).Most of AQP8 of FC group was expressed in cytoplasm of colonic mucosa epithelial cells,while that of IBS-C group and control group was mostly expressed at apical membrane and basal membrane of epithelial cells.The results of semi-quantification demonstrated that AQP8 relative area of descending colon of FC and IBS-C group increased compared with that of control group (3.42％ (1.24％ to 5.61％),2.45％(1.72％ to 4.27％) vs 1.18％ (0.35％ to 2.81％);Z=-2.534,-2.151,both P＜0.05).Meanwhile,AQP8 relative area of ascending colon of FC group increased compared with that of control group (2.46％(1.48％ to 4.18％) vs 1.14％(1.29％ to 2.15％) Z=-2.041,P＜0.05).Conclusion There are differences in AQP8 expression quantity and location in cells of descending colon between patients with FC and patients with IBS-C,which is a way for differentiation these two diseases.

Objective To explore the efficacy of triple therapy and sequential therapy in the eradication of Helicobacter pylori (Hp) in patients receiving long-term non-steroidal antiinflammatory drugs (NSAID) treatment.Methods Patients receiving long-term NSAID treatment were enrolled in this study.Patients diagnosed as Hp infection were divided into triple therapy and sequential therapy groups.The patients in triple therapy group received omeprazole,clarithromycin and amoxicillin theray for 10 days.The patients in sequential group received esomeprazole with amoxicillin for five days,and then esomeprazole with clarithromycin and metronidazole for another five days.All patients were given mucosal protective therapy as maintenance treatment after eradication therapy and followed up for 12 weeks.Patients underwent endoscopy examination and Hp testing before and after follow-up.Hp eradication rates were compared with the intention-to-treat (ITT) and per protocol (PP) analysis.Results According to ITT analysis,the eradication rates of Hp in triple therapy group and sequential therapy group were 78.4 ％ (40/51) and 80.0 ％ (40/50) respectively,there was no significant difference between these two groups (x2 =0.038,P=0.846).According to PP analysis,the eradication rates of Hp in triple therapy group and sequential therapy group were 84.4％ (38/45) and 87.0％ (40/46) respectively,there was no significant difference between these two groups either (x2=0.117,P=0.732).Conclusion There was no significant difference in Hp eradication between triple therapy and sequential therapy in patients receiving long-term NSAID treatment.

BACKGROUND: As one of the most common endocrinal disorders for women at childbearing age, the diagnostic criteria of polycystic ovary syndrome (PCOS) have been defined differently among different international health organizations. Phenotypic heterogeneity of PCOS also brings about difficulties for its diagnosis and management assessment. Therefore, more efficient biomarkers representing the progression of PCOS are expected to be integrated into the monitoring of management process using metabolomic approaches. METHODS: In this prospective randomized controlled trial, 117 PCOS patients were enrolled from December 2016 to September 2017. Classical diagnostic parameters, blood glucose, and metabolome were measured in these patients before and at 2 months and 3 months of different medical interventions. The receiver operating characteristic (ROC) curves were built based on multivariate statistical analysis using data at baseline and 3 months' management, and combinational biomarkers with appreciable sensitivity and specificity were selected, which then validated with data collected at 2 months. RESULTS: A set of metabolites including glutamic acid, aspartic acid, 1-methylnicotinamide, acetylcarnitine, glycerophosphocholine, and oleamide were filtered out with high performance in representing the improvement through 3-month management of PCOS with high sensitivity and specificity in ROC analysis and validation with other two groups showed an appreciable area under the curve over 0.96. CONCLUSIONS: The six metabolites were representative of the remission of PCOS through medical intervention, making them a set of potential biomarkers for assessing the outcome of PCOS management. TRIAL REGISTRATION ClinicalTrials.gov, NCT03264638.
Biomarkers ; Female ; Humans ; Metabolomics ; Polycystic Ovary Syndrome/diagnosis* ; Prospective Studies ; ROC Curve

To meet the needs of management of medical case information and biospecimen simultaneously, we developed a novel medical case information system integrating with biospecimen management. The database established by MS SQL Server 2000 covered, basic information, clinical diagnosis, imaging diagnosis, pathological diagnosis and clinical treatment of patient; physicochemical property, inventory management and laboratory analysis of biospecimen; users log and data maintenance. The client application developed by Visual C++ 6.0 was used to implement medical case and biospecimen management, which was based on Client/Server model. This system can perform input, browse, inquest, summary of case and related biospecimen information, and can automatically synthesize case-records based on the database. Management of not only a long-term follow-up on individual, but also of grouped cases organized according to the aim of research can be achieved by the system. This system can improve the efficiency and quality of clinical researches while biospecimens are used coordinately. It realizes synthesized and dynamic management of medical case and biospecimen, which may be considered as a new management platform.
Biological Specimen Banks ; Database Management Systems ; Humans ; Medical Records Systems, Computerized ; Medical Records, Problem-Oriented

Objective:To investigate the characteristics and causes of endplate injury in the oblique lateral interbody fusion for the treatment of lumbar diseases, and summarize the precaution of endplate injury.Methods:Thirty-five cases of endplate injury were observed, which were originally treated with oblique lateral interbody fusion with or without pedicle screw fixation from October 2014 to December 2017. There were 7 males and 28 females, and the age ranged from 51 to 78 years old (averagely 62.8±8.13 years). There were 2 cases of lumbar disc degeneration, 10 cases of lumbar canal stenosis, 17 cases of lumbar degenerative spondylolisthesis, 2 cases of lumbar spondylolysis with or without spondylolisthesis, and 4 cases of lumbar degenerative scoliosis. Lesion sites contained L 3,4 in 2 cases, L 4,5 in 21 cases, L 2-4 in 3 cases, L 3-5 in 4 cases, L 2-5 in 3 cases and L 1-5 in 2 cases. Preoperative bone mineral density examination revealed there were 7 cases of T>-1 SD, 24 cases of -2.5 SD

Objective To explore the effect of low-dose or standard-dose conjugated equine estrogen (CEE)combined with natural progesterone or dydrogesterone on bone density in menopause syndrome women.Methods Totally 123 patients with menopause syndrome were recruited and randomly assigned to 3 treatment groups: group A(low-dose CEE+progesterone), group B(standard-dose CEE+progesterone), group C(standard-dose CEE+dydrogesterone). Using continuous sequential regimen, the duration of intervention was 12 cycles.The bone mineral density of lumbar 2-4 and neck of femur,the bone metabolic markers, the level of FSH and estradiol were examined just before the drug administration and 12 months after the beginning of experiment. Results There were 107 cases completed the one year trial.(1)Bone density:after 12 cycles of treatment,there was no significant change in bone density in group A(P>0.05);lumbar vertebrae of group B and C increased significantly,at 3.0% and 2.1%respectively(all P<0.05).The bone density of left femoral neck of group C significantly increased by 2.9%(P=0.029). There was no significant difference among the treatment groups at the beginning of experiment(P>0.05).(2)Bone metabolic markers: after 12 cycles of treatment, the levels of calcium, phosphorus, alkaline phosphatase, Ca/Cr decreased significantly,the difference were statistically significant(all P<0.05).There was no significant difference among the treatment groups at the beginning of experiment(P>0.05).(3)Levels of FSH and estradiol:after 12 cycles of treatment,the levels of FSH in three groups were decreased significantly(all P<0.01). The levels of estradiol in three groups were increased significantly(all P<0.01). There was no significant difference among the treatment groups at the beginning of experiment(P>0.05). Conclusions Both low-dose and standard-dose menopause hormone therapy(MHT)could elevate the level of estradiol, reduce bone turnover, prevent bone loss of postmenopausal women effectively. The standard dose of MHT could also increase the density of vertebrae and femoral neck,and generate more clinical benefits.