The application of medical network education system has created favorable conditions for the network education in our hospital. This paper describes the system and resource database construction, educational application and some problems confronted. Construction improvement and widely application of the system are also thoroughly discussed.

Hepatitis C virus (HCV) accounts for the majority of cases of transfusion acquired hepatitis and may cause chronic hepatitis, cirrhosis and hepatocellular carcinoma. Currently, there is no vaccine against HCV and treatment is expensive and not always effective.The adaptive host immune response in viral clearance of HCV infection was described and the recent progress in vaccine development of HCV, focusing on the fields of DNA vaccine candidates, recombinant viral vectored vaccine candidates and combined (prime-boost) vaccine candidates were summarized. Some challenges and limitations of developing a HCV vaccine were also analysed. In summary, a promising approach of developing an experimental HCV vaccine to induce extremely potent and broad T-cell responses based on prime-boost strategy was presented.

Objective To study the expression and the role of interleukin (IL)-23/IL-17 axis in colonic tissue of trinitrobenzene sulphonic acid (TNBS) induced eolitic mice.Methods Mice were divided into four groups:control (n=24),TNBS (n= 24),TNBS 48 hours + mlL-17 antibodies (n=24),TNBS 48 hours + normal rat blood-serum (n= 24).TNBS-induced colitis model was constructed.The mice in control group and TNBS colitis group were sacrificed at 24 hours,48 hours,7th day,respectively.In TNBS 48 hours + mlL-17 antibodies group and TNBS 48 hours + normal rat blood-serum group,a single injection with the polyclonal mlL-17 antibodies or serum were given intraperitoneally at two hours before enema with TNBS,respectively,and the mice were killed at 48 hours after enema with TNBS.The histological score of colon and myeloperoxidase (MPO) activity of colonic tissue were evaluated in each group.IL-23p19 and IL-17 concentrations in colonic tissue were measured by enzyme-linked immunosorbent assay (ELISA).Expression of nuclear factor (NF)-κBp65in colonic tissue was detected by immunohistochemistry method.Expression of IL-23p19,IL-17 and IL-12p35 mRNA in colonic tissue were detected by real-time fluorescent quantitative reverse transcriptase polymerase chain reaction (RT-PCR) with SYBR Green I.Results The protein levels of IL-23p19 in colonic tissue in TNBS colitis groups at 24 hours,48 hours and 7 days were (15.53±3.32),(31.16±4.98) and (14.03±3.56) ng/mg,respectively,and their mRNA level were (4.09±0.34),(3.39±0.46) and (6.54±1.82),respectively.The protein levels of IL-17 were (0.35±0.06),(0.38±0.08),and (0.26±0.05) ng/mg,respectively,and their mRNA level were (4.21±2.61),(2.65±0.91) and (5.63±1.43),respectively.The expression levels of IL-23p19 and IL-17 in colitis model were significantly higher than those in control group and the peak was at 48 hours.Moreover,expression of IL-23p19 and IL-17 and their mRNA were positively correlated to their mRNA levels.In TNBS 48 hours + mIL-17 antibodies group,the expression levels of NF-κBp65,the microscopic scores and MPO (1.86 % ± 0.36 %,0.63 ± 0.52,0.40 ± 0.03 U/g,respectively) were significantly lower than those in TNBS 48 hours group (4.35% ±0.37%,5.13±0.64,2.29±0.40 U/g tissue,respectively).Neutralization of IL-17 was significantly protected against TNBS-induced colonic inflammation and MPO and expression of NF-κB p65.The results indicated that neutralization of IL-17 significantly reduced colonic inflammation and suppressed NF-κBp65 activation.This protection occurred in the presence of equivalent induction of local IL-23 p19 and high levels of IL-12p35 in the polyclonal raiL-17 antibodies-treated mice.Conclusions IL-23/IL-17 axis plays a critical role at the early acute phase of TNBS-induced inflammation.IL-17 may represent a new target for therapeutic intervention for inflammatory bowel disease.

Objective To study the feasibility of the treatment of tubule pregnancy by interventional technique. Methods By using Seldinger′s method, 40 cases of tubule pregnancy received superselective angiography of uterine artery,followed by perfusion of methotrexate (MTX) through the catheter and embolization of uterine artery with gelatin sponge. The concentration of serum ? HCG, the change of pelvic cavity, and the open condition of oviduct were regularly monitored postoperatively. Results Angiographic findings of tubule pregnancy were classified into 3 types. Type Ⅰ, no abnormal vascular appearance were found in 3 cases (7.5%). Type Ⅱ, patchy vascular staining of villi in parauterine area was observed in 4 cases (10.0%). Type Ⅲ, a round vascular staining of villi surrounded by small blood vessels in parauterine area occurred in 33 cases (82.5%). The cure rate in total 40 cases achieved 97.5% (39/40). After treatment, the mean time that the serum ? HCG concentration returned to normal was (7.66?2.01) d and the mean time that the menstruation returned to normal was (29.78?7.14) d. In 21 cases who hoped their fertility remaining intact, the oviduct were verified open by hysterosalpingography (HSG) in 20 cases, the open rate was 95.24%. Conclusion The treatment of tubule pregnancy by interventional technique was proved no harmful effect to reproductive organs and would expect to preserve fertility. This method could resolve the difficult problem of celiac hemorrhage which making conservative treatment impossible and internal hemorrhage happened in the course of traditional conservative therapy leading to treatment failure finally. This method might be a new conception and a choice to treat tubal pregnancy through artery.

Four qi theory is an important part of property theory of traditional Chinese medicine. Current researches mainly focus on two aspects of cold and heat properties, which are not only important elements of treating diseases, but also are factors of causing adverse reaction. In this article, through the study on the toxicity mechanism of cold and hot properties, authors put forward to the control measures of toxic and side effects of traditional Chinese medicine with cold and hot properties, and pointed out that the importance of controlling toxicity of traditional Chinese medicine with cold and hot properties lies in the modernization and internationalization of traditional Chinese medicine.

Objective To investigate the effect of dynamic regulation of negative pressure values in vacuum sealing drainage (VSD) on healing of soft tissue wounds.Methods From January 2013 to December 2015,115 patients were treated at our institute for open soft tissue defects of Gustilo-Anderson type ⅢaⅢc.They were 69 males and 46 females,aged from 17 to 76 years (average,44.7 years).They were divided into 4 groups to be subjected to different negative pressure values.Group A (n =29) was subjected to negative pressure values from-40 to-20 kPa,group B (n =29) to values from-80 to-60 kPa,group C (n =29) to values from-40 to-20 kPa for the first 72 hours followed by values from-80 to-60 kPa,and group D (n =28) to values from-60 to-80 kPa for the first 72 hours followed by values from-40 to -20 kPa.The 4 groups were compared in terms of drainage volume,wound shrinking,cleaning time,healing time and complications.Results The drainage volumes on the 7th day in groups B and D (4.89 ± 0.66 mL/cm2 and 4.33 ± 0.96 mL/cm2) were significantly higher than those in groups A and C (2.90 ± 0.67 mL/cm2 and 2.99 ±0.56 mL/cm2);the wound shrinking areas on the 14th day in groups B and D (14.16 ± 1.77 cm2 and 13.84 ± 1.65 cm2) were significantly larger than in groups A and C (12.57 ± 1.92 cm2 and 10.95 ± 1.37 cm2) (P ＜ 0.05).The cleaning time in group A was significantly longer than in the other 3 groups (P ＜ 0.05).The healing time in groups A and C was longer than in groups B and D (P ＜ 0.05).The incidences of pain in groups B and C were significantly higher than in groups A and D (P ＜ 0.05).The incidences of infection and blocking in group A were higher than in the other 3 groups (P ＜ 0.05).Conclusion Dynamic regulation of negative pressure values from-80 to-60 kPa for the first 72 hours followed by values from-40 to-20 kPa is an optimal choice for VSD management of soft tissue defects due to adequate drainage,obvious wound shrinking,quick cleaning and healing,and limited complications.

Objective To compare the dosimetric parameters between the use of Tandem and Ring (TR;Nucletron#090.617) or Tandem and Ovoid (TO;Nucletron#189.730) applicators during three-dimensional (3D) high-dose rate (HDR) brachytherapy (BT) for cervical cancer.Methods The records of 40 cervical cancer (ⅡB-ⅣA) patients treated with 3D-image-guided HDR-BT were reviewed.Of these 40 patients, 20 were treated with the TO applicator, and 20 with the TR applicator.The D100% and V150% of the clinical target volume (CTV) and the D2 cc of organs at risk (OAR)(the rectum, bladder, and small intestine) during 3D-HDR-BT using TO and TR were compared using the independent sample t-test.ResultsOverall metrics:CTV volume:66.04±13.86 cm3(TR) vs.65.67±15.08 cm3(TO)(P=0.052);CTV D100:3.71±0.34 Gy (TR) vs.3.37±0.49 Gy (TO)(P=0.016);CTV V150%:0.54±0.02(TR) vs.0.56±0.04(TO)(P=0.034);rectum D2 cc:3.38±0.30 Gy (TR) vs.2.95±0.80 Gy (TO)P=0.037);bladder D2 cc:4.33±0.39 Gy (TR) vs.2.93±1.27 Gy (TO)(P=0.00);and small ntestine D2 cc:3.04±1.02 Gy (TR) vs.3.41±0.57 Gy (TO)(P=0.171).Conclusions TR has better CTV coverage than TO during 3D HDR brachytherapy for cervical cancer.In addition, D2 cc of the rectum and bladder were both igher with TR than with TO, though there is no significant dosimetric difference in the small intestine between the two applicators.Therefore, tumor location, extent of invasion, and vaginal conditions should be considered when selecting the suitable pplicator for the treatment of cervical cancer.

Pancreatic neuroendocrine tumors (P-NETs) are a group of heterogeneous tumors,including functional and nonfunctional ones.With the enhancement of clinicians' awareness about this disease and the improvement of imaging diagnostic techniques,the incidence of P-NETs has obviously increased in the past years.Based on the mitotic counting and Ki-67 positive index,the grading classification is of great value for the diagnosis,treatment and even prognosis of P-NETs.P-NETs are a group of malignant tumors with inert biological behaviors,whose surgical resection rate and long-term survival is much better than those of pancreatic ductal adenocarcinoma.P-NETs have different malignant potentials.Clinicians need to develop a comprehensive treatment plan in combination with the patient's symptoms,tumor grading classification and TNM staging information.Surgery is the only curable way to cure P-NETs.Even if radical resection is not suitable,palliative surgery may alleviate the patients,symptoms,and even prolong their survival time.According to the tumor location,size,quantity,degree of grading,local invasion and distant metastasis,different surgical procedures should be selected.

Objective To identify whether the branches of cervical nerve roots joined into the accessory nerve trunk or not.Methods In 10 adult cadavers (7 males and 3 females, including 20 laterals of brachial plexus nerves), we observe source of cervical plexus branches to the accessory nerve anatomically.In 10 clinical cases of males with brachial plexus nerve injures, in the supraclavicular approach of brachial plexus exploration, the part of the supraclavicular cutaneous nerve for histological specimen were cut off;in the posterior approach, electrical stimulation of the trunk and branches of cervical plexus were performed to observed istaltrapezius muscle contraction.After accessory nerve transfer, the residual terminal accessory nerve and branch of cervical plexus were taked for histological specimens;and observed and judged of each nerve sample by acetylcholinesterase (AchE) immunohistochemical staining.Results In 10 of 20 lateral cases, cervical plexus communicating branches were derived from the fourth cervical nerve root.The intraoperative electrical stimulation of the accessory nerve trunk, 10 cases of distal trapezius muscle were significantly shrink;electrical stimulation of the cervical plexus branch, 2 cases after stimulation of the mild distal trapezius contraction, the remaining 8 cases without trapezius muscle contraction.10 cases of supraclavicular nerve staining for AchE were negative, 10 cases of accessory nerve terminal branches of AchE staining were mixed,10 cases of branch AchE cervical plexus to the accessory nerve staining were negative.Conclusion The branches of the fourth cervical nerve root constantly joins into the accessory nerve, participating in the trapezius muscle inner vation, the fibers of the branches are sensorial fibers.

Objective To explore the prognostic significance in monitoring minimal residual disease (MRD) in childhood acute lymphoblastic leukemia (ALL) by a simple method,and to detect cloned immunoglobulin H (IgH) and T cell receptor γ (TCRγ) gene rearrangements by using multiplex polymerase chain reaction (PCR) and automated fragment analysis.Methods Bone marrow samples were collected from 86 newly diagnosed cases of childhood ALL at the Department of Pediatrics,the First Affiliated Hospital of Sun Yat-Sen University,from May of 2009 to August of 2013.IgH and TCRγ gene rearrangements were amplified by qualitative multiplex PCR.The clonality of PCR production was analyzed by GENEMAPPERID software.Only those carried monoclonal IgH/TCRγ on diagnosis were arranged to monitor MRD.Detectable monoclonal IgH/TCRγby the end of induction was defined as MRD positive.All patients were treated with GD2008 ALL protocol.Clinical data of all newly-diagnosed ALL patients in the corresponding period were reviewed.The final follow-up on May 31,2014.Survival rates and event free survival (EFS) curves were estimated by the Kaplan-Meier,and compared by using the log-rank test.Results The percent age of 94.2 (81/86 cases) patients was at least 1 marker positive.Subsequent MRD was monitored in 79 cases.The median follow-up time was 20 months (9-61 months).By the end of induction,20 cases were MRD positive and 59 cases were M RD negative,and the 3-year EFS were 56.4％ ± 14.7％ and 94.0％ ± 3.4％ (x2 =8.563,P =0.003),respectively.According to the traditional prognostic stratification criteria,MRD was detected 65 cases in the non-high risk group:23 cases in standard risk group and 42 cases in intermediate risk group,and the difference of 3-year EFS had no statistical significance (95.3％ ±4.7％ vs 76.6％ ±9.0％,x2 =0.934,P =0.334).While using MRD by the end of induction as a risk stratification criterion,there was a statistical significant difference compared with the 3-year EFS for MRD-negative (n =52) group and MRD-positive (n =13) group (93.1％ ± 3.8％ and 59.5％ ± 16.2％,x2 =7.128,P =0.008).Conclusions It is a simple but feasible method to monitor MRD in childhood ALL by using this qualitative multiplex PCR with automated fragment analysis for monoclonal IgH/TCRγ gene rearrangements.MRD by the end of induction can be used as a more accurate risk stratification criterion than the traditional one.It is worth of further research.