To strengthen the medical ethics education in the clinical practice stage in the department ot obstetrics and gynecology meets the requirements of the modern medical education under new situation.Aiming at the status quo of medical ethics education in China and abroad,this paper put forward specific recommendations in terms of the setting of teaching contents,the design of teaching approaches,the construction of teaching staff,as well as the evaluation of teaching achievements,and thus to enhance the understanding of medical students and interns to medical ethics and cultivate their practical capacity of analyzing and solving problems in clinical ethical dilemmas.

Objective To explore the effects of rosiglitazone (ROSI),a PPAR-γ ligand,on hyperlipidemia with severe acute pancreatitis (SAP) in the rat model induced by sodium taurocholate injected into intra-bile-pancreatic duct and explore their underlying mechanism.Methods A total of 120 male SD rats were randomly divided into two groups,and eighty rats were fed with high fat diet for two weeks to induce experimental hyperlipemia and the rest received normal diet.The rats fed with normal diet were divided into two groups:sham operation group (SO group,n =20) and SAP group (n =20).The hyperlipidemic rats were randomly divided into four groups:sham operation hyperlipidemia rats group (HL group,n =20),hyperlipidemia with acute pancreatitis group (HAP group,n =20),ROSI prevention group (HR group,n =20) and antagonist group (HRI group,n =20).Rats of SAP group and HAP group were induced by a retrograde infusion of 5％ sodium tauroholate into bile-pancreatic duct,whereas the rats in SO group and HL group were induced by saline instead; rats in HR group were administered ROSI (10 mg/kg) intra-peritoneally 1 hour prior to sodium taurocholate; rats in HRI group were administered GW9662 (0.3 mg/kg) intraperitoneally 30 min prior to ROSI.Rats from each group were sacrificed by exsanguination 12 h after the induction of pancreatitis.Blood samples were taken from all animals to measure serum amylase (AMY),total cholesterol (TC),triglycerides (TG).The severity of pancreatitis was evaluated by histological score of pancreatic injury.The level of nuclear factor (NF)-KB p65 protein in pancreas was measured by immunohistochemistry.The levels of intercellular adhesion molecule (ICAM-1) protein and tumor necrosisfactor-α (TNF-α) protein were detected by using Western blot analysis.Results The serum levels of TC and TG in HL group and HAP group were significantly higher than those in SO group and SAP group (10.86 ± 1.47,10.42±0.95vs.1.72±0.13; 1.24±0.28,1.36±0.13 vs.0.61 ±0.12,0.54±0.08; all P＜ O.05).Compared with SAP group,the levels of serum AMY,the pancreas pathological score,the levels of NF-KB p65,ICAM-1 and TNF-α in pancreas in the HAP group were significantly higher in HAP group (P ＜ 0.05).Compared with the HAP group and HRI group,HR group significantly decreased the levels of serum AMY,TC and TG; pancreas pathological score; the levels of NF-KB p65,ICAM-1 and TNF-α in pancreas significantly decreased in HR group (2006.9 ± 331.9 vs.6501.9 ± 3771.0,5892.2 ± 474.3 ; 4.36 ± 0.99 vs.10.42 ±0.95,11.08 ± 1.05; 0.58 ±0.12 vs.1.36 ±0.13,1.58 ±0.12; all P ＜0.05),but there were no statistically significant differences in those biomarkers between HAP group and HRI (P ＞ 0.05).Conclusions Our study demonstrated that hyperlipidemia aggravated the severity of sodium taurocholateinduced severe acute pancreatitis and ROSI exerted anti-hyperlipidemic effect and anti-inflanmatory effect against hyperlipidemia rats with sodium taurocholate-induced severe acute pancreatitis.

Objective To investigate the protective effects and mechanisms of intraperitoneal administration of thymosin β4 on severe acute pancreatitis in rats.Methods Fifty-four male Sprague-Dawley rats were randomly (random number) divided into sham operation (SO) group,severe acute pancreatitis (SAP) group and thymosin β4 (Tβ4) pretreatment group (n =18 in each group).SAP rat model was prepared by retrograde injection of 5％ sodium taurocholate into the biliopancreatic duct.Rats in Tβ4 group were treated with thymosin β4 (6 mg/kg) by intraperitoneal administration prior to SAP modeling.Six rats in each group were sacrificed at 3,6,12 hours,respectively after modeling.The serum levels of amylase,tumor necrosis factor-α (TNF-α),interleukin-1 β (IL-1 β),and interleukin-6 (IL-6)were detected,and pathological scores of the tissue of pancreas head were evaluated under light microscope.Pancreatic nuclear factor-kappa 1B (NF-κB) p65 and IκB α levels were detected by the Western blot.All data were analyzed by using the analysis of variauce or t test.Results The levels of serum amylase of SAP 3,6 and 12 hours groups were (3221 ±394) U/L,(4509 ±474) U/L and (6280 ±728) U/L,which were significantly higher than (2598±416) U/L,(3639 ±373) U/L and (4782 ±466) U/L of the Tβ4 groups (t =-2.666,-3.530,-4.245,P ＜ 0.05).The levels of serum TNF-α of the SAP 3,6 and 12 hours groups were (247.7 ± 18.5) pg/mL,(313.5 ± 17.7) pg/mL and (359.3 ±22.6) pg/mL,which were higher than (182.3 ± 13.6) pg/mL,(258.9 ± 14.9) pg/mL and (278.1 ± 16.3) pg/mL of the Tβ4 groups (t =-6.964,-5.769,-7.152,P ＜ 0.05).The levels of serum IL-1 β of the SAP 3,6 and 12 hours groups were (258.2±10.5) pg/mL,(345.1 ±22.0) pg/mL and (430.9 ±25.4) pg/mL,which were higher than (170.3 ± 12.4) pg/mL,(263.5 ± 13.3) pg/mL and (303.7 ± 16.1) pg/mL of the Tβ4 groups (t =-13.258,-7.762,-10.355,P ＜ 0.05).The levels of serum IL-6 of SAP 3,6 and 12 hours groups were (266.3 ±11.5) pg/mL,(355.0 ±24.4) pg/mL and (429.2 ±33.7) pg/ mL,which were higher than (171.1 ± 13.0) pg/mL,(234.9 ± 19.2) pg/mL and (277.2 ± 19.2) pg/ mL of the Tβ4 groups (t =-13.401,-9.474,-9.582,P ＜ 0.05).The pancreatic pathological scores of the SAP3,6 and 12 hours groups were (6.25 ±0.94),(8.83 ±0.82) and (12.08 ±1.16),which were higher than (4.17 ± 0.93),(6.33 ± 0.82) and (7.33 ± 1.25) of the Tβ4 groups (t =-3.867,-5.303,-6.823,P ＜ 0.05).The relative expression of pancreatic NF-κB p65 in SO group was (0.95 ±0.11),which was significantly lower than (2.40 ±0.17) of the SAP 12 hours group (t =-17.368,P＜ 0.05).The relative expression of pancreatic NF-κB p65 in Tβ4 group was 1.50 ± 0.10,which was significantly lower than SAP 12 hours group (t =10.917,P ＜0.05).The relative expression of pancreatic IκB α in SO group was (1.93 ±0.11),which was significantly higher than (0.78 ±0.18) of the SAP 12 hours group (t =13.260,P ＜ 0.05).The relative expression of pancreatic IκB α in Tβ4 group was (1.12±0.10),which was significantly higher than SAP 12 hours group (t =-4.112,P ＜ 0.05).Conclusions Thymosin β4 has the protective effect on SAP rat model,and the mechanism may be associated with inhibition of NF-κB signaling pathway and decreased proinflammatory cytokines.

Background and purpose:Remarkable advances have been made in cancer chemotherapy by developing new anticancer drugs and therapy strategies.However,multidrug resistance in human cancers remains a major clinical challenge for cancer treatment.Attempts in several clinical studies to reverse multidrug resistance protein (MDR) by using MDR modulators have not yet generated promising results.Our aim was to explored the mechanism of reversal of multidrug resistance in human leukemia K562 cells by PI3-K inhibitor.Methods:Trypanblue dye exclusion method was used to observe the drug sensitivity and the effect of LY294002 on the drug resistance.Western blot to analyze P-gp and p-Akt phenotypes,and flow cytometer was used to measure the intracellular drug accumulation. Results:K562/D induced by DNR was cross resistant to DNR,ADR,VCR and VP16 (Resistance Index:65,52,134 and 50 respectively).DNR induced over-expressions of P-gp and p-Akt in K562/D cells;LY294002 increased the intracellular drug accumulation,and then reversed the drug resistance to DNR,ADR,VCR and VPI6 in K562/D cells(Resistance Index:23,21,63 and 29 respectively),but not in the sensitive cells (K562/S).Conclusion:The multidrug resistance of K562/D cells can be induced by DNR which is related to the P-gp and p-Akt over-expressions, and LY294002 can reverse multidrug resistance in human leukemia cells in vitro via inhibits PI3-K/Akt pathway.

Objective To study effect of bufalin on invasion and metastasis of gastric cancer cells and related mechanism.Methods AGS human gastric cancer cell line was used for in vitro experiments.Cultured cells were treated by negative control group,bufalin group and oxaliplatin group.Cell proliferation was determined by MTT.Invasion and metastasis were observed by Wound-Healing Assay and Transwell Assay.Expression levels of E-cadherin,matrix metalloproteinases (MMP)-2,MMP-9 were detected by Western blotting.Results Bufalin was found to significantly inhibit the proliferation of AGS cells in a dose and time dependent manner.Wound-Healing Assay and Transwell Assay showed that as compared with the blank control group,bufalin inhibited invasion and metastasis of AGS cells (P＜ 0.05),but there was no statistically significant difference between bufalin group and oxaliplatin group (P＞0.05).Western blotting showed the expression of E-cadherin was increased in bufalin group as compared with the blank control group while the expression levels of MMP-9 and MMP-2 were down-regulated (P＜0.05),but there was no statistically significant difference between bufalin group and oxaliplatin group (P＞ 0.05).Conclusion Bufalin has anti-cancer activity on gastric cancer cells,and it has the ability of inhibiting cancer cell invasion and metastasis,and regulating the expression of some related gene.

OBJECTIVETo study the influence of tumor-associated macrophages (TAMs) on the biological function of SW620 cell.

METHODSMacrophage was induced into M2-type macrophage form with interleukin (IL)-4. CD68, macrophage mannose receptor (MMR), and inducible nitric oxide synthase (iNOS) were analyzed with Western blot. SW620 was co-cultured with TAMs in the Transwell. Cytokines including IL-10, IL-12, IL-23, and tramsforming growth factor-β (TGF-β) were detected with enzyme-linked immunosorbent assay (ELISA). The activity of nuclear factor-κB (NF-κB) in SW620 was analyzed with electrophoretic mobility shift assay (EMSA). The proliferation and apoptosis of SW620 cells after co-cultured with TAM were determined with tetrazolium four nitrogen (XTT) assay and fluorescence activated cell sorting (FACS), respectively. RESULTS IL-4 induced M2 type macrophage expressed CD68 and MMR instead of iNOS. After co-cultured with SW620 for 24 hours and 48 hours, M2 type macrophage secreted higher levels of IL-10 and TGF-β than the pre-culture level (P 0.05). The activity of NF-κB in SW620 decreased by 72% and 75% after 24 hours and 48 hours compared with the pre-culture level, respectively (both P<0.01). The activity of proliferation decreased by 48% and 59% and the apoptotic rates increased by 6.37% and 7.68% and 0.37% after 24 hours and 48 hours (all P<0.01) compared with the pre-culture levels.

CONCLUSIONTAM may inhibit the proliferation and promote the apoptosis of SW620 by suppressing the activity of NF-κB.

Apoptosis ; Cell Line, Tumor ; Cell Proliferation ; Coculture Techniques ; Colonic Neoplasms ; metabolism ; pathology ; Humans ; Interleukins ; metabolism ; Macrophages ; metabolism ; physiology ; NF-kappa B ; metabolism ; Nitric Oxide Synthase Type II ; metabolism ; Transforming Growth Factor beta ; metabolism

Objective To investigate the effects of mercury on T lymphocytes and serum immune indexes of workers with Methods occupational mercury exposure. A total of 45 workers with occupational mercury exposure were selected as the ， mercury exposure group and 47 workers without occupational mercury exposure were selected as the control group using the judgment sampling method. Cold atomic absorption spectrometry was used to detect the urinary mercury level of the two groups. （ ） +， + +， + + - + Flow cytometry was used to detect the proportion of cluster of differentiation CD 3 CD3CD4 CD3CD8 and CD3CD19 ， - （ - ） - （ - ） cells in peripheral blood and the levels of tumor necrosis factor α TNF α and interleukin 8 IL 8 in serum. The levels of （ ） ， Results immunoglobulin Ig A IgG and IgM in serum were measured by immune nephelometry. The urinary mercury level of （ ： vs ，P ） individuals in the mercury exposed group was higher than that of the control group median 92.7 13.2 μg/g Cr <0.01 . The +， + +， - + proportion of CD3 CD3CD4 CD3CD19 cells in peripheral blood and serum IgG level in the mercury exposed group （ P ）， - - （ P ） decreased all <0.05 and the serum TNF α and IL 8 levels increased all <0.01 compared with the control group. Urinary - + mercury level was negatively correlated with the proportion of CD3CD19 cells in peripheral blood and serum IgG level in the ［ （r） ， ， P ］， study subjects Spearman correlation coefficient S were −0.21 and −0.31 respectively all <0.05 and positively - - （r ， ， P ） ， correlated with serum TNF α and IL 8 levels S were 0.36 and 0.39 respectively all <0.05 . However the urinary mercury （ P ）， +， + +， level was neither correlated with IgA and IgM levels in serum all >0.05 nor with the proportion of CD3 CD3CD4 + + （ P ） Conclusion CD3CD8 cells in peripheral blood all >0.05 . Occupational exposure to mercury can lead to abnormal ， changes in peripheral blood T lymphocyte subsets B lymphocytes and serum immune factors in workers. The mercury load of occupational mercury exposure workers may impact their immune function.

The study was aimed to explore the mechanism of SYK and CBL family of ubiquitin ligases in Bufalin-induced HL-60 cells apoptosis. Cell viability was tested by trypan blue staining and apoptosis was detected by using flow cytometry. The expressions of CBL and CBL-b and the phosphorylation of SYK were detected by using immunoprecipitation and Western blot. The results showed that Bufalin inhibited HL-60 cell proliferation in time- and dose-dependent manners. IC(50) of suppressing cell viability at 24, 48 and 72 hours were about 26.3, 7.8 and 2.0 nmol/L respectively. The high dose of bufalin already induced apoptosis of HL-60 cells at 8 hours. SYK was quickly phosphorylated, and the expressions of CBL and CBL-b were down-regulated after treatment with Bufalin. It is concluded that SYK activation and CBL protein down-regulation may be involved in Bufalin-induced HL-60 cell apoptosis.
Apoptosis ; drug effects ; Bufanolides ; pharmacology ; Cell Proliferation ; drug effects ; Down-Regulation ; Gene Expression Regulation, Leukemic ; HL-60 Cells ; Humans ; Intracellular Signaling Peptides and Proteins ; metabolism ; Protein-Tyrosine Kinases ; metabolism ; Proto-Oncogene Proteins c-cbl ; metabolism ; Signal Transduction ; Syk Kinase

Objective:To compare the cuff pressure and leakage volume and the related complications of filling the tracheal tube cuff by minimum air leakage method and cuff pressure manometer method after endotracheal intubation, so as to provide theoretical basis for patients who was intubated to obtain appropriate cuff pressure.Methods:A prospective randomized controlled study was conducted. 100 patients admitted to the department of critical care medicine of the Fifth Center Hospital in Tianjin from December 2015 to June 2019 were enrolled. According to the random number table method, the patients were divided into the experimental group and control group, with 50 patients in each group. After successful endotracheal intubation, all patients were placed in a supine position with the head of the bed raised by 30°. The experimental group used the minimum air leakage method, and used the cuff pressure manometer to obtain the cuff pressure. In the control group, cuff pressure was maintained at 25-30 cmH 2O (1 cmH 2O = 0.098 kPa). Parameters such as cuff pressure and ventilator leakage volume at the beginning and 4 hours, 8 hours after the inflation were compared between the two groups, as well as the incidence of ventilation-associated pneumonia (VAP) and airway complications after extubation. Results:Among the 100 cases, 53 were males and 47 were females. The age ranged from 23 to 87 years old, with an average of (68.53±8.46) years old. The intubation time ranged from 1 to 16 days.① At 4 hours and 8 hours after inflation, the cuff pressures of the two groups were lower than that of the first time of inflation, and the air leakage of the ventilator increased gradually with the extension of time. Compared with the control group, cuff pressures at each time point in the experimental group were significantly higher than those in the control group [mmHg (1 mmHg = 0.133 kPa): 33.72±9.14 vs. 25.68±5.26 at 0 hour, 30.54±7.81 vs. 24.35±4.93 at 4 hours, 26.57±5.64 vs. 22.42±4.14 at 8 hours, all P < 0.05], and ventilator leakage volumes were smaller than those in the control group (mL: 25.57±8.51 vs. 34.65±9.47 at 0 hour, 40.54±8.51 vs. 60.34±7.85 at 4 hours, both P < 0.05). ② The incidence of VAP in the experimental group was significantly lower than that in the control group (4% vs. 10%, P < 0.05). There was no statistically significant difference in the incidence of other airway complications between the experimental group and control group (airway mucosal edema: 14% vs. 12%, ulcer: 8% vs. 6%, tracheal esophageal fistula: 0% vs. 0%, hoarseness: 4% vs. 6%, cough: 30% vs. 34%, sore throat: 28% vs. 32%, tracheal softening: 0% vs. 0%, cuff rupture: 10% vs. 8%, all P > 0.05). Conclusions:The optimal cuff pressure is very important for preventing VAP and reducing airway complications. The minimum air leakage method makes the clinical obtained endotracheal intubation cuff pressure more accurately, with less air leakage, safe and effective, and it is worthy of clinical promotion.

Health service is an important part of the integrated development of the Yangtze River Delta. Taking the cooperation practice between Shanghai Tenth People′s Hospital and Suzhou Yinshanhu Hospital as an example, this article introduced the multi-agent cooperation mode of the loose medical alliance including the government, urban hospitals and cross provincial grassroots medical institutions. Among them, the local government provided policy, fund guarantee and guidance, the urban hospital exported management ideas, medicine talents and technologies, and the primary hospital conducted dual training by inviting in and going out to achieve double growth. Through the high gap cooperation between tertiary hospital and primary hospital, Yinshanhu hospital had been comprehensively developed. The loose medical alliance with multi subject coordination and cross region could give full play to the advantages of the loose healthcare alliance mode, achieve multi-win, and have reference significance for promoting the regional integration of medical and health services in the Yangtze River Delta.