Objective ThrouGh the detection of heat shock protein 90(HSP90)Gene expression in the peripheral blood in in patients with hypertensive disorders complicatinG preGnancy( HDCP ),to understand its role in the pathophysioloGy of HDCP. Methods The expression of HSP90 was observed in Groups of normal preGnant women,Gestational hypertension patients,mild preeclampsia patients,severe preeclampsia patients by ELISA. Results The expression of HSP90 in peripheral blood of Gestational hypertension Group,mild preeclampsia Group,severe preeclampsia Group were siGnificantly hiGher than normal preGnant Group( P<0. 0l ) . Conclusion HSP90 may have close relationship with the onset and development of HDCP. It can predict HDCP by detectinG the level of HSP90 in peripheral blood.

Objective To detect heat shock protein 90 (HSP90) expression in the placenta in pregnancy induced hypertension in order to understand its role in the pathophysiology of hypertensive disorders comphcating pregnancy (HDCP).Methods The gene and protein expression of HSP90 in the placenta of normal pregnant women,gestational hypertension patients,mild preeclampsia patients,severe preeclampsia patients,by RT-PCR and Western blotting.Results The gene and protein expression of HSP90 in placenta of gestational hypertension group,mild preeclampsia group,severe preeclampsia group were significantly higher than that of normal pregnant group (P ＜ 0.01),and it showed the increased progressively with the increasing of disease stage.Conclusion HSP90 may be involved in the onset and development of HDCP.Monitoring HSP90 concentration in the placenta which is the initial theoretical basis for the target as HSP90 for the treatment of HDCP.

Objective To explore the different apoptotic gene expressions and apoptotic signaling transduction of human rhabdomyosarcoma (RD) cells infected by enterovirus 71 (EV71) in different stage.Methods The survival of EV71-infected RD cells was observed by trypan blue staining.The apoptotic morphology and rates of RD cells were surveyed and detected by Annexin V-FITC/PI staining and flow cytometry,respectively.PCR array was employed to analyze 88 apoptotic gene expressions from EV71-infected RD cells at 8 h and 20 h postinfection (p.i),respectively.Results After RD cells were infected with EV71 (MOI =5) at 8 h p.i,the viability was significantly decreased.Flow cytometry data demonstrated that the apoptotic rates of EV71-infected RD cells had increased to 18.0％ and 19.1％ at 20 h p.i in early and later stage respectively.RT-PCR array studies revealed significant variations in the expression of apoptotic genes.Among 88 genes,only the expression of IFN-β1 was upregulated 5.22 folds,whereas 47 genes including ACIN1,Akt,Apaf1,caspase and CIDEB were found to be downregulated that were lower than 2 folds at 8 h p.i.However,28 genes including FasL,CD40L,TNF,caspase-10 and caspase-3 were induced more than 2 folds after EV71 infection at 20 h.Conclusion The downregulation of apoptosis-related genes is associated with viral apoptosis-suppressing effect in RD cells in the early stage of EV71 infection.The death receptor signaling pathways including Fas/FasL and TNF/TNFR are activated to induce cell apoptosis in the late stage of EV71 infection.Moreover,host cell can also inhibit apoptosis by regulating signal pathway of CD40/CD40L,NF-κB/RelA and PI3K/Akt activation.

Objective:To construct the online teaching model of clinical clerkship teaching and improve the online teaching system of clinical medicine in China.Methods:Based on "3P" teaching model, a complete online clinical clerkship teaching model was constructed from three links: pre-class preparation, classroom teaching and after class evaluation. It was applied to practical teaching in 101 students in 2017 batch of clinical medicine "5+3" class, 2017 batch of five-year pediatrics class and 2017 batch of basic medicine class. After practice, all students were surveyed and the results were analyzed.Results:Through the analysis of questionnaire, 89.5% of the students were satisfied with the online course design, 81.61% of the students thought that the online design was scientific and reasonable, 86.6% of the students thought that the clerkship teaching process was attractive and could stimulate students' interest in learning, and 90.72% of the students thought that the goal of clerkship teaching was clear and the key problems and difficulties were clear.Conclusion:The online teaching mode of clinical clerkship has high student satisfaction and good teaching effect, which provides a new way for online clerkship model.

Objective To explore the correlation between EBV DNA load and peripheral immune cells (including lymphocyte supsets and natural killer cells) before treatment in patients with NPC, and analyze the influence of circulating immune cell supsets related to EBV on the prognosis of NPC patients. Methods We retrospectively analyzed the general data of 203 NPC patients without distant metastasis at the first treatment, as well as the data of peripheral blood EBV DNA and circulating immune cell supset. The ROC curve analysis was used to determine the cutoff value of each circulating immune cell supset. Kaplan-Meier method was used for survival analysis, and Cox regression model was used for multi-factor prognostic correlation analysis. Results The 3-year OS, PFS, DMFS and LRFS of EBV DNA < 400 copies/ml group and EBV DNA≥400 copies/ml group were 99.2% vs. 90.1% (P=0.001), 96.7% vs. 90.1% (P=0.028), 98.4% vs. 90.1% (P=0.005) and 98.4% vs. 100% (P > 0.05), respectively. EBV DNA is negatively correlated with the ratio of CD19⁺ B cells before treatment (r=-0.138, P=0.040), and there was no significant correlation between EBV DNA and other circulating immune supgroups (P > 0.05). ROC analysis showed that the cut-off value of CD19⁺B cell ratio before treatment related to the 3-year OS was 8.33% (P=0.02). The 3-year OS, PFS, DMFS and LRFS of patients with CD19⁺B cells ratio ≤8.33% and CD19⁺B cells ratio > 8.33% were respectively 90.4% vs. 99.2% (P=0.003), 89.2% vs. 97.5% (P=0.008), 90.4% vs. 98.3% (P=0.008) and 98.8% vs. 99.2% (P > 0.05). However, ROC analysis showed that there was no significant correlation between OS and other peripheral immune cells (including the proportion of CD3⁺T, CD3⁺CD4⁺T, CD3⁺CD8⁺T and CD56⁺NK cells and CD4⁺/CD8⁺ ratio). Multivariate analysis showed that EBV DNA load was an independent prognostic factor of 3-year PFS of NPC patients, and the ratio of CD19⁺B cells was an independent prognostic factor of 3-year PFS, MFS and OS of NPC patients. Conclusion Before treatment, there is a negative correlation between plasma EBV DNA and the proportion of CD19⁺B cells in peripheral blood. Both can be used as the predictors of 3-year OS, PFS and DMFS of NPC patients.

In order to construct the online teaching mode of clinical clerkship course and improve the online clerkship teaching system of clinical medicine in China, based on the "3P" model, a complete set of online clinical clerkship mode has been constructed from three links of teaching, pre-class preparation, classroom teaching and after-class evaluation, and applied to clinical teaching practice of Internal Medicine. The practice suggests that students are highly satisfied and the teaching effect is good, which provides a new idea for the reform of online clerkship teaching of clinical medicine.

Objective To summarize the long-term outcomes and safety of childhood Hodgkin lymphoma (HL) with protocol ABVD. Methods The clinical data of 20 children with HL admitted to the Union Hospital of Fujian Medical University from July 2010 to June 2017 were retrospectively analyzed. Among the 20 children with HL, 15 were male and 5 were female. The median age of initial diagnosis was 6.5 years old (3-12 years old). The pathological types were as follow: 1 case was nodular lymphocyte-predominant HL (NLPHL) and 19 cases were classical HL (cHL), including 9 cases of mixed cell type, 9 cases of nodular sclerosis type and 1 case of lymphocyte rich type. Basing on Ann Arbor staging system, 1 patient was evaluated as stage Ⅰ, 4 patients were stage Ⅱ, 10 patients were stage Ⅲ, and 5 patients were stage Ⅳ. There were 3 patients in the low-risk group, 7 patients in the intermediate-risk group, and 10 patients in the high-risk group. There were 9 patients with B symptoms. All patients were treated with the ABVD regimen. Results All the 20 patients completed all chemotherapy courses. After 2 courses, the effective rate was 100％(20/20), including 12 cases of complete remission (CR) and 8 cases of partial remission (PR). After the treatment, 19 cases achieved CR, and at the end of the 6 courses, the evaluation showed that 1 case had residual lesions. Follow-up to February 2018, clinical symptoms of 18 cases achieved CR, 2 cases relapsed (all high-risk group); the median follow-up time was 42 months (10.1-87.9 months), the overall survival rate was 100 ％ (20/20), the estimated 5-year rate of freedom from treatment failure (FFTF) was (89.1 ±7.3) ％.Conclusions According to the risk stratification, ABVD regimen has good safety and long-term efficacy for children with cHL. Even the patients in low-risk or intermediate-risk group do not achieve CR after 2 courses and do not receive radiotherapy, the prognosis of them is still good.

Objective:To explore the risk factors and preventive strategies of pancreatitis after percutaneous transhepatic biliary drainage (PTBD) in patients with pancreatic cancer and obstructive jaundice.Methods:A total of 241 patients were retrospectively analyzed from May 2001 to October 2014 in Tianjin Medical University Cancer Institute and Hospital. The possibly correlated 9 factors were analyzed, including gender, age, hemoglobin level, total bilirubin level, degree of pancreatic duct dilatation, degree of pancreatic atrophy, degree of biliary stenosis, the pancreatic duct visualization, and drainage mode.Results:Univariate analysis suggested that pancreatic duct dilatation, pancreatic atrophy, visualized pancreatic duct and drainage mode were associated with the incidence of pancreatitis after PTBD ( P<0.05). Logistic regression analysis showed that visualization of pancreatic duct ( OR=6.33) was a risk factor for pancreatitis, while pancreatic duct dilatation ( OR=0.14), pancreatic atrophy ( OR=0.12) and external drainage ( OR=0.11) were protective factors for pancreatitis. Conclusion:In pateints with pancreatic cancer and obstructive jaundice, pancreatic duct dilatation and pancreatic atrophy predict low risk of pancreatitis after PTBD,while intraoperative pancreatic duct visualization and internal or external drainage may increase the incidence of postoperative pancreatitis.