Combined with safe mothcrhood project,in order to completely promote teaching quality,we should explore establishing a uniform,standardized,scientific and perfect teaching model of obstetric residents' standard training by analyzing the status and the difficulties in standard training of obstetric residents,and by adopting scientific and reasonable evaluation measures.

AIM: To investigate the protective effect of microRNA-218 (miR-218) silencing on kidney tissue of streptozotocin (STZ)-induced diabetic nephropathy rats and the potential mechanism.METHODS: The diabetic rat model was established by a single intraperitoneal injection of STZ (50 mg/kg).Meanwhile, the miR-218 short hairpin RNA (shRNA) lentiviral vector was constructed.The Sprague-Dawley rats were randomly divided into 4 groups: healthy control group, diabetes group, empty vector group and miR-218-shRNA group.The blood glucose, 24 h urinary protein, serum creatinine (SCr) and blood urea nitrogen (BUN) in the rats at different time points (4, 8 and 12 weeks) were measured by an automated analyzer.The expression of miR-218 was detected by RT-qPCR, while the expression of heme oxygenase-1 (HO-1), nephrin and p38 mitogen-activated protein kinase (p38 MAPK) at mRNA and protein levels in the kidney tissues was determined by RT-qPCR and Western blot.The caspase-3 activity was detected by caspase-3 activity assay kit, and the cell apoptosis of the kidney tissues was analyzed by terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL).RESULTS: Compared with healthy control group, the expression of miR-218 was significantly increased in STZ-treated rats.Meanwhile, the concentrations of blood glucose, 24 h urinary protein, SCr and BUN were significantly increased in STZ-treated rats (P<0.05).The mRNA and protein expression of HO-1 and nephrin was significantly decreased, while the level of phosphorylated p38 MAPK was significantly increased in STZ-treated rats.In addition, the activity of caspase-3 was also significantly increased in STZ-treated rats.When the model rats were infected with miR-218-shRNA, the expression of miR-218 was significantly decreased and the above effects were markedly reversed.Furthermore, TUNEL results showed that compared with diabetic group and empty vector group, miR-218 silencing significantly attenuated the cell apoptosis in the kidney tissues in miR-218-shRNA group.CONCLUSION: miR-218 is involved in the kidney injury in diabetic rats, and silencing of miR-218 by lentiviral vector-mediated miR-218-shRNA transfection effectively inhibits kidney cell apoptosis, suggesting that miR-218 is a potential target for the treatment of diabetic nephropathy.

Objective To describe a case of female sexual abnormality with 46, XX caused by an androgen-producing adrenocortical tumor and to explore the mechanism of abnormal androgen secretion from the tumor. Methods The tumor tissues as the experimental group were compared with the normal adrenal tissue. The LH/human chorionic gonadotropin ( hCG) receptor was determined by immunohistochemisty, the activity of 3β-hydroxysteroid dehydrogenase ( 3β-HSD ) , 17α-hydroxylase ( CYP17 ) , and 17β-hydroxysteroid oxidoreductase ( 17β-HSD ) by enzyme linked immunosorbent assay(ELISA) and the expression of mRNA of 3β-HSD2, 17β-HSDB3, CYP17, and LH/hCG receptor by real-quantitative polymerase chain reaction ( RQ-PCR ) . Results The immunohistochemisty results showed that the LH/hCG receptor was negative in the experiment group, but positive in control. The activity of 3β-HSD and CYP17 of the experiment group was higher than that in the control (P<0. 01), while the activity of 17β-HSD was lower(2 638. 798±70. 551 vs 9 148. 174±382. 836, P<0. 01) according to ELISA results. The relative contentof3β-HSD2mRNAoftheexperimentgroupwashigherthanthatinthecontrol(P<0.05),andtherelative content CYP17 mRNA of the experiment group was much higher than that in the control (P<0. 01). However, the relative content of 17β-HSDB3 mRNA and LH/hCG receptor mRNA were much lower than those in the control ( P<0. 01) by RQ-PCR. Conclusion Sexual abnormality and virilization could be caused by the excessive androgen secreted by androgen-producing adrenocortical tumor, which is an extremely rare disease. The mechanism of the secretion of androgen from the tumor remains unknown so far. It may be related to the increased activity of 3β-HSD and CYP17, but has no relationship with the expression of LH/hCG receptor.

Objective:To investigate the diagnostic value of renal injury molecule-1 (KIM-1) and β2-microglobulin (β2-MG) concentration in hypertensive disorder of pregnancy (HDP) complicated with early renal injury.Methods:From July 2017 to October 2018, the clinical data of 56 pregnant women with HDP complicated with renal injury and 56 normal pregnant women in the same period in Xi′an Central Hospital were analyzed retrospectively.The pregnant women with HDP complicated with renal injury were the observation group and the 56 normal pregnant women were the control group.The difference of serum creatine (SCr), KIM-1, β2-MG concentration between the two groups at 30, 32, 34 and 36 weeks of gestation was compared, and the value of KIM-1, β2-MG combined diagnosis of early renal injury in HDP was analyzed.Results:At 30, 32, 34 and 36 weeks of gestation, Kim-1, β2-MG and SCr in the observation group increased significantly (Kim-1: Fintra-group=11.234, β2-MG: Fintra-group=12.852, SCr: Fintra-group=8.308; all P<0.001). In the observation group, SCr(30 weeks, 32 weeks, 34 weeks, 36 weeks: (75.35±10.32), (75.41±10.35), (77.02±10.50), (87.78±10.64) &mu;mol/L), Kim-1 (30 weeks, 32 weeks, 34 weeks, 36 weeks: (5.68±1.50), (7.56±1.52), (8.25±1.62), (9.65±1.76) ng/L), β2-MG (30 weeks, 32 weeks, 34 weeks, 36 weeks: (0.26±0.07), (0.29±0.08), (0.75±0.29), (1.02±0.38) ng/L) were all higher than those of control group SCr(30 weeks, 32 weeks, 34 weeks, 36 weeks: (74.37±10.34), (74.43±10.40), (75.10±12.52), (76.80±11.66) &mu;mol/L), Kim-1 (30 weeksL, 32 weeks, 34 weeks, 36 weeks: (5.31±1.75), (5.36±1.77), (5.39±1.60), (5.41±1.70) ng/L), β2-MG (30 weeks, 32 weeks, 34 weeks, 36 weeks: (0.25±0.07), (0.26±0.09), (0.28±0.08), (0.27±0.08) mg/L), the difference was statistically significant (SCr: Fintergroup=10.254, Kim-1: Fintergroup=16.352, β2-MG: Fintergroup=18.221; all P<0.001). There were interaction between the two groups at different time(SCr: Finteraction=15.632, Kim-1: Finteraction=25.645, β2-MG: Finteraction=34.251; all P<0.001). The sensitivity, specificity and accuracy of Kim-1 combined with β2-MG were 96.43% (54/56), 94.64% (53/56) and 95.54% (107/112), respectively.It was significantly better than Kim-1 alone (88.24% (45/51), 92.86% (52/56), 86.61% (97/112)), β2-MG alone (81.13% (43/53), 78.57% (44/56), 77.68% (87/112)), the difference was statistically significant (all P<0.05). Conclusion:The serum levels of KIM-1 and β2-MG in pregnant women with early renal injury of HDP are significantly increased, which can be used as a reliable indicator for prenatal monitoring and screening of early renal injury, and the combined detection can improve the accuracy of diagnosis.

Objective Using middle cerebral artery occlusion (MCAO) model to observe protective effect of effective components of bezoar on brain damage.To discuss the anti-cerebral ischemia mechanism and compare the efficacy of effective components of bezoar from the endoplasmic reticulum stress intervention angle.Methods Rats were stratified randomly divided into sham group,model group,Qingkailing group (positive drug,3 mL/kg),taurine group,ursodeoxycholic acid (UDCA,78 mg/kg) group,taurine-conjugated ursodeoxycholic acid (TUDCA,100 mg/kg) group.Through establish MCAO model in rats,observed the scores of the neurologic impairment,measured infarct volume by TTC.Immunohistochemistry and Western blotting were Used to detect the content of P-PERK,P-EIF2α,and ATF4.Results Compared with sham group,neurologic impairment scores of model group significantly reduced (P ＜ 0.01).Compared with model group,Qingkailing group,UDCA group,and TUDCA group significantly improved neurological function in rats (P ＜ 0.05,0.01).Compared model group,all the treatment groups could significantly reduce the volume of cerebral infarction (P ＜ 0.01).Compared with sham group,expression of P-PERK,P-EIF2α,and ATF4 was significantly increased (P ＜ 0.01).Compared with model group,all the treatment groups reduced the expression of P-PERK,P-EIF2α,and ATF4 in varying degrees,effect of Qingkailing and TUDCA were more obvious.Conclusion The effective components ofbezoar alleviate cerebral ischemia reperfusion injury in rats by inhibiting endoplasmic reticulum stress,the effect of TUDCA is better than that of taurine and UDCA.

OBJECTIVE; To improve the PIVAS quality management, reduce dispensing error and promote the safety of drug use.METHODS: The quality control circle (QCC) was used for quality management in PIVAS of our hospital. The reasons for dispensing errors were analyzed to determine the key improvement points using "the reduction of dispensing error of admixture drugs" as theme. Improvement plan was formulated, and effective countermeasures were determined by PDCA (Plan, Do, Check, Action) cycle management. The tangible results (the rate of dispensing errors) and intangible results were compared before (Feb. 2016) and after QCC (Aug. 2016). RESULTS: Some effective measures were formulated and implemented, including unified arrangement, introducing PIVAS MATE process management software, personnel post training, refining drug withdrawal management, visual management, etc. The tangible results included the rate of dispensing error decreased from 1. 81‰ to 0. 53‰; the rate of goal achievement reached 108. 47％; the rate of target progress was 70. 72％. The intangible results included optimizing drug dispensing process, standardizing drug withdrawal systent and personal training system. Those achievement improved confidence, responsibility, sense of cooperation and cohesiveness of QCC members. Additional result was obtained, i. e. utility model patent for avoiding light storage box. CONCLUSIONS: QCC can effectively improve the management quality of PIVAS workflow and the safety of intravenous medication.