Objective:To establish a podocyte cell injury model induced by puromycin aminonucleoside(PAN),an in vitro model for studying the role of podocytes,especial the slit diaphragm molecules in proteinuria at the cellular and molecular levels.Methods:MPC5 were treated for 24 and 48 hours by 15,45 and 75 mg/L PAN,respectively.The podocyte molecular behavior during podocyte injury was evaluated:the apoptotic podocyte cells were revealed with FITC-Annexin V and Propidium Iodide(PI) assay and the proliferative podocyte cells detected with MTT assay after PAN treatment.The distribution of Nephrin and Podocin was revealed with indirect-immnofluorescent staining under confocal microscope.The distribution of F-actin was revealed with direct-immnofluorescent staining under microscope.Results:The percentage of apoptotic podocyte cells was increased in a dose-and time-dependent manner after PAN treatment.In PAN-treated group,the apoptosis was obviously increased at hour 48,the PAN-45 treated group was 33.48%?14.55% and PAN-75 treated group 38.01%?12.13% vs the control group 6.38%?0.50%(P

Considering the modern features and requirement of our medical education, we tried some exploration and reforms of the clinical practice training on students of clinical medicine major(7-year program). By strengthening the training of clinical practice while learning subjects, we came to the conclusion that students got their study’s aim much more positively and actively in their study, and the teaching goals are more direct and the teaching effects are better.

Objective To investigate the effective ways of improving medical students' clinical competence during the process of internship. Methods Totally 398 students of clinical medicine from 2006 and 2007 grade in Soochow University were enrolled as research objects. Forty objects distribut-ed to the First Affiliated Hospital were taken as experiment group while 358 objects distributed to other hospital as control group. In experiment group, objective structured clinical examination (OSCE) was introduced during regular internship, innovation was made on test on completion of a course and autonomous learning and clinical practice was advocated and enhanced. Traditional practice and ex-amination method was used in control group. SPSS 19.0 was used to do statistical analysis on the test scores of students. Paired sample t test and independent sample t test were employed. Measurement data is expressed as x±s and P<0.05 signifies statistically significant differences. Results Clinical practice ability of students in experiment group was enhanced to various degrees after internship com-pared with that before internship. ECG interpretation, heart and lung auscultation, interrogation tech-nique, medical and surgical operation performances of students in experiment group were promoted significantly (P<0.05). Students' overall competence in the final graduation skill test was better in ex-periment group than in control group (P<0.05). Conclusions OSCE-test on completion of a course not only make intern management more effective, but also make students' aim more definite, therefore it is conducive to enhancing clinical competence.

Objective:To explore the impact of compound nutrients supplementation on nutritional and immune status in middle-aged and elderly people.Method:The volunteers aged 50-65 years old were randomized into two groups.The supplement was given to the test group,the control group took placebo.Results:In comparison with the control group,the test group had a higher level of serum vitamin A and zinc,blood selenium.The humoral immune indices as IgA、IgG、IgM、C3 of the test group were higher than those of the control group,but no significant difference of cellular immunity indices between two groups.Conclusion:Supplementation of compound nutrients could improve the nutritional status of vitamin A,zinc and selenium,and may promote humoral immunity.

Objective To compare the clinical efficacy of luteal phase support with oral dydrogesterone tablets and vaginal progester-one gel combined with oral dydrogesterone tablets during hormone replacement therapy-frozen embryo transfer(HRT-FET).Methods A retrospective analysis was conducted on a total of 489 cycles which underwent HRT-FET at the Center of Reproductive Medicine,the University of Hong Kong-Shenzhen Hospital from November 2018 to June 2022.There were 226 cycles underwent with oral dydrogester-one tablets as luteal support,and 263 cycles underwent with vaginal progesterone gel combined with oral dydrogesterone tablets as luteal support.The primary observation index was the delivery rate.The pregnancy outcomes of HRT-FET in the two groups were compared and analyzed,and the related factors were analyzed.Results There were no significant differences in the age,body mass index,number of antral follicles,total number of eggs,serum levels of estradiol and progesterone on the second day of the menstrual cycle and the day before endometrial transformation between the two pregnant women(P＞0.05).There were also no significant differences in the abortion rate,ectopic pregnancy rate,biochemical pregnancy rate,clinical pregnancy rate,delivery rate,and neonatal weight between the two groups(P＞0.05).In the second day of cleavage stage embryo transfer subgroup,there were no significant differences in the abortion rate,ectopic pregnancy rate,biochemical pregnancy rate,clinical pregnancy rate,delivery rate,and neonatal weight between the two groups(P＞0.05),and in the fifth day of blastocyst transfer subgroup,there were also no significant differences in abortion rate,ectopic pregnancy rate,biochemical pregnancy rate,clinical pregnancy rate,delivery rate between the two groups(P＞0.05),and in the oral dydrogesterone tablets group,the neonatal weight was significantly higher than that of the vaginal progesterone gel combined with oral dydrogesterone tablets,and the difference was statistically significant(P＜0.05).The multivariate Logistic regression analysis showed that different luteal support protocols had no significant impact on the delivery rate(OR=0.703,95％CI:0.461-1.062,P=0.09).Conclusion There were no significant differences between oral dydrogesterone tablets and vaginal progesterone gel combined with oral dydrogesterone tablets in clinical pregnancy rate and delivery rate during HRT-FET.Therefore,the use of oral dydrogesterone tablets a-lone can be a new option for luteal support in HRT-FET.

Objective:To analyze the correlation among social support, positive coping and job burnout among nurses in Department of Infectious Diseases.Methods:From March 2020 to June 2021, convenience sampling was used to select 110 nurses from Department of Infectious Diseases of 8 ClassⅢ hospitals in Hangzhou, Zhejiang Province as the research object. The General Information Questionnaire, Maslach Burnout Inventory, Social Support Rating Scale (SSRS) , and Simple Coping Style Questionnaire (SCSQ) were used to investigate the nurses. Pearson correlation analysis was used analyze the correlation among job burnout, social support and positive coping. A total of 110 questionnaires were distributed, and 102 effective questionnaires were recovered, with an effective recovery rate of 92.73%.Results:Among the 102 nurses in Department of Infectious Diseases, 17.65% (18/102) were in mild burnout, 57.84% (59/102) were in moderate burnout, and 20.59% (21/102) were in severe burnout. The SSRS total score and each dimension score of nurses in Department of Infectious Diseases were positively correlated with the positive coping subscale score of SCSQ ( P<0.05) , and negatively correlated with the emotional exhaustion subscale and depersonalization subscale score of the Maslach Burnout Inventory ( P<0.05) , but it was positively correlated with the personal achievement subscale score ( P<0.05) . Conclusions:The overall job burnout of nurses in Department of Infectious Diseases was moderate to severe level, and social support and positive coping were correlated with job burnout. Nursing managers should develop measures to reduce the job burnout of nurses in Department of Infectious Diseases.

Objective:To examine the clinical experience and efficacy of unrelated cord blood transplantation (UCBT) in the treatment of recurrent refractory Epstein-Barr virus-associated hemophagocytic lymphohistiocytosis (EBV-HLH) in children.Methods:The clinical data of a patient with recurrent refractory EBV-HLH and intestinal perforation who was treated by UCBT in Department of Pediatrics, the First Affiliated Hospital of Zhengzhou University in September 2015 and finally cured were retrospectively analyzed.Meanwhile, literature was reviewed.Results:The patient, male, 1 year and 6 months, was admitted to the hospital with " fever for 15 days, rash for 9 days" as the main complaint, mainly manifested as high fever, large liver, spleen, lymph nodes, rapidly progressing pancytopenia, liver function damage, phagocytic blood cells on bone marrow smear, diagnosed as EBV-HLH in September 2015.The patient received chemotherapy according to the HLH-2004 protocol developed by the International Association of Cell Societies.During the treatment, he suffered two recurrence during the maintenance period, and a second-line rescue treatment was adopted, namely, " Pegaspargase, Doxorubicin liposome, Etoposide and Methylprednisolone" (L-DEP regimen) chemotherapy.The complete relief of diagnostic indexes for hemophagocytic lymphohistiocytosis was evaluated after chemotherapy.The patient developed sudden intestinal perforation and underwent emergency surgical surgery, enteroenterostomy.After the condition was stabilized, the patient was pretreated with the " Fludarabine+ Busulfan+ Cyclophosphamide" (Flu+ BU+ CY) therapy and then treated with UCBT, with intravenous nutritional support provided during the entire process.Neutrophil and platelet implantation was implemented on day 13 and day 35 after transplantation, respectively.The chimeric rate was 100%, and the implantation was a success.Hepatic veno-occlusive disease, fungal pneumonia and skin graft-versus-host disease (GVHD) Ⅱ occurred on the 15 th day, 22 nd day and 26 th day after transplantation, respectively.The corresponding symptoms improved after treatment.On day 49 after transplantation, phase Ⅱ " enterostomy fistula" was performed.The patient was followed up to 70 months after transplantation, and generally in good condition.His symptoms relieved, and no chronic GVHD and other comorbidities occurred. Conclusions:Allogeneic hematopoietic stem cell transplantation is the only possible effective means of treating relapsed refractory EBV-HLH in children.In the absence of a suitable sibling or unrelated donor, unrelated cord blood stem cells can be used as a graft source.Enterostomy after intestinal perforation is not contraindicated for transplantation.

Objective:To summarize the clinical features, treatment and prognosis of asparaginase (ASP) related cerebral venous sinus thrombosis (CVST).Methods:Clinical profiles including age, sex, first symptoms, coagulation function, imaging findings, ASP type, treatment and prognosis of eight acute lymphoblastic leukemia (ALL) or lymphoblastic lymphoma (LBL) children with ASP related CVST at the Department of Pediatrics, First Affiliated Hospital of Zhengzhou University from November 2016 to October 2021 were analyzed retrospectively.Results:Eight CVST children were all male, including 6 ALL and 2 LBL, with the onset age ranged from 5 to 15 years, 6 cases occurred in the stage of first induction remission, and the initial symptom were mainly epileptic seizures (7 cases). Magnetic resonance imaging combined magnetic resonance venography (MRV) showed the most common site of venous sinus enlargement was superior sagittal sinus (8 cases). Secondary cerebral hemorrhage was found in 5 cases. D-dimer elevated on the day of onset in all cases. Three patients were treated with intravascular mechanical thrombectomy and thrombolysis combined with anticoagulant therapy, 3 patients were treated with continuous anticoagulant therapy only, 2 patients were not treated with anticoagulant therapy. MRV follow-up for 3 months showed that the thrombi in patients were almost completely absorbed except in 2 patients who were not treated with anticoagulant therapy. Thrombolysis combined with anticoagulant therapy was the fastest way for thrombosis absorption. Among 8 patients, 1 died of early recurrence of ALL, and 7 patients accepted further asparaginase and no CVST recurrence or progression was found. There were no sequelae of nervous system except 1 patient with left upper limb muscle strength impairment.Conclusions:ASP related CVST is more common in older male children and the prognosis is good. ASP related CVST occurred mostly in the stage of first induction remission, and most initial manifestation is epileptic seizure. The superior sagittal region is a common site of thrombus, magnetic resonance imaging combined with MRV is helpful for accurately diagnosis. Timely anticoagulant treatment can improve the prognosis, and mechanical thrombectomy and thrombolysis can quickly recanalize the vessel.

Objective:To investigate the risk factors of birth weight discordance in dichorionic diamniotic (DCDA) twins.Methods:This study retrospectively analyzed 1 757 cases of DCDA twin pregnancies from 11 Chinese hospitals from January 1, 2014, to December 31, 2017. Birth weight discordance was defined as ≥ 20% difference between the twins. All cases were divided into two groups: the concordant group ( n=1 520) and discordant group ( n=237). General information was compared and the high-risk factors of birth weight discordance were analyzed. Mann-Whitney U test, Chi-square test or Fisher's exact test, and logistic regression analysis were used as statistical methods. Results:Compared with the concordant group, the discordant group showed a higher incidence of hypertensive disorders of pregnancy [24.5% (58/237) vs 12.8% (194/1 520), χ2=22.882, P<0.05], fetal structural malformations [4.2% (10/237) vs 1.0% (15/1 520), χ2=15.160, P<0.05], fetal distress [6.3% (15/237) vs 1.4% (21/1 520), χ2=22.602, P<0.05], umbilical cord abnormalities [3.8% (9/237) vs 1.2% (18/1 520), χ2=7.607, P<0.05] and abnormal placental cord insertion [3.8% (9/237) vs 1.4% (21/1 520), χ2=34.904, P<0.05], but lower incidence of premature rupture of membranes [11.0% (26/237) vs 16.5% (250/1 520), χ2=4.645, P=0.034]. Logistic regression analysis showed that the independent risk factors of birth weight discordance in DCDA twins were hypertensive disorders of pregnancy ( OR=2.258, 95% CI: 1.620-3.184, P<0.001), fetal structural malformations ( OR=4.268, 95% CI: 1.892-9.631, P<0.001), umbilical cord abnormalities ( OR=2.889, 95% CI: 1.245-6.705, P=0.014) and abnormal placental cord insertion ( OR=2.318, 95% CI: 1.012-5.311, P=0.047). Conclusions:Hypertensive disorders of pregnancy, fetal structural malformations, umbilical cord abnormalities and abnormal placental cord insertion may be the risk factors of birth weight discordance in DCDA twins.

Epilepsy is a common disease in central nervous system;most patients with epilepsy after regular anti-epilepsy drug treatment can be controlled,but drug treatment in about 20％-30％ of patients is invalid,known as refractory epilepsy.With the development of imaging techniques,PET/MRI emerge and they combine anatomical and functional imaging,which makes the imaging more clear,enjoying more accurate anatomical structure.Thus,PET/MRIplay important roles in the process of pathogenesis,diagnosis and preoperative assessment of epilepsy.We mainly introduce the concepts of PET/MRIand the comparison with other imaging technology,and describe the application of PET/MRI in preoperative assessment ofrefractory epilepsy.