Teaching of clinical skills is an important bridging phase from preclinical medicine to clinical practice.It is also an important element of medical students'clinical skills training.According to the character of internal medical cardiology,we should enhance the training of their clinical thinking ability,medical communication competence,and clinical operating ability to get satisfactory teaching effect.

Objective To synthesize a multiple antigenic peptide(MAP),observe its humoral immune response and evaluate its antifertility potential.Methods Based on fusogenic epitope mimic peptide and synthetic nonnatural Pan DR T Helper Epitope(PADRE),MAP antigenic peptides were designed and synthesized.After suspending with the equivalent Freund's adjuvant,the antigens were used to immunize the female C57BL/6 mice to evalutate their humoral immune response in animals and efficiency of specific antisera on inhibiting syncytial trophoblast fusion.Results The MAP peptide was successfully synthesized.After purified with HPLC,its purity reached 95%.After immunization,the highest level of specific IgG in mice serum was 1:1 024,and the corresponding antigen of human trophoblastic cell could be identified in the antisera.In presence of mice antiserum by 1:10 dilution,forskolin-induced intercellular fusion of BeWo choriocarcinoma cells decreased remarkably(P

We reported a clinical caseof gas gangrene in the lower back and buttocks due to local intramuscular injection. A 43-year-old male was treated by local private clinic for low back pain. He underwent local intramuscular injection in his lower back and buttocks. 5 or 6 hours after the treatment,he felt worsen of low back pain (VAS 5 points)with a fever. After one day of treatment, the lower back pain was even worse(VAS 8 points). And he had soy-sauce urine and a high fever. The results of laboratory examination and clinical manifestation suggested multiple organ failure within a short period of time. Imaging (CT) suggested large area of gas and muscle necrosis in the lower back and buttocks. Considering the progress of the disease, emergency surgery on lumbar back and right buttocks was performed after hospitalization. Rapid bacterial smear reported gram-positive coarse bacteria. Anaerobic culture suggested clostridium perfringens. Aerobic culture result did not show any bacterial growth. According to the clinical manifestation, imaging (CT), intraoperative judgment and postoperative anaerobic culture results, the clinical diagnosis was gas gangrene. Gas gangrene is a special infectious disease in clinic, which can be characterized by low morbidity, difficult early diagnosis,rapid disease progression and high mortality. Sinceintramuscular injection leaded to this disease in our case, the importance of standardized aseptic procedures should be emphasized.

Total 406 community residents entered in fitness improvement program with “management by objectives model of health promotion” from 2009 to 2011.The fitness status was monitored by Xuhui Physical Constitution Center before and after entering the program.The results showed that the level of fitness assessment,the composite score,lung capacity and reaction time were improved with the years (P ＜ 0.01) ; the step index and sitting-and-reach test in 2010 was better than those in 2009(P ＜ 0.01) ; the grip strength in 2010 and 2011 was better than that in 2009 (P ＜ 0.01); the test of single leg-standing with closing eyes in 2011 was better than that in 2009(P ＜ 0.05).There was no difference in body mass index before and after program (P ＞ 0.05).The results indicate that physical fitness and overall health can be improved by management by objectives model for health promotion.

OBJECTIVE: To observe the effects of Huatan Xiezhuo Recipe (HTXZR) on fatty liver of rats. METHODS: Forty-eight SD rats were randomly divided into five groups: normal control group, untreated group, Dongbao Gantai Tablet (DBGTT)-treated group, low-dose HTXZR-treated group and high-dose HTXZR-treated group. Fatty liver was induced in the rats by hyperlipid diet and intraperitoneal injection of tetracycline. The pathological changes of liver tissues in rats were observed, and the liver function, serum leptin, insulin resistance index, triglyceride (TG) and free fatty acid (FFA) in the liver were detected. RESULTS: The levels of serum leptin, insulin resistance index, FFA and TG in rats of the three treated groups were lower than those of the untreated group (P<0.01), and such effects in the HTXZR-treated groups were more significant than those in the DBGTT-treated group (P<0.05). CONCLUSION: The main action mechanisms of HTXZR in treating fatty liver are probably to promote the lipid metabolism, decrease the leptin and insulin resistance.

Objective To evaluate the complications and long-term efficacy of inside-out transobturator transvaginal tape ( TVT-O) for the treatment of stress urinary incontinence ( SUI) .Methods From January 2008 to December 2013,236 consecutive female patients (mean age 56 ±9 years,range 44-88 years)with the symptom of incontinence when abdominal pressure increasing (such as walking), underwent TVT-O operation.All these patients needed pads and were diagnosed with SUI by cough test and Marshall -bonny test before surgery , with the mean international consultation committee on incontinence questionnaire short form ( ICI-Q-SF) score of 15.6 ±3.9.Two grouping methods were used:the mid-term group including patients whose follow-up time was between 6 months and 3 years, the long-term group including patients whose follow-up time >3 years,the group of patients who underwent TVT-O only and the group of patients who underwent TVT-O plus pelvic floor repair at the same time . Their clinical and follow-up data , intraoperative and postoperative complications , subjective and objective effects were recorded and analyzed.Results Of these 236 patients,there were 1 case of bladder perforation (0.4%) and 1 case of intraoperative sling exposure to vagina ( 0.4%) .Postoperative complications included 36 ( 19.1%) groin/puncture point pain ,18 (9.5%) de novo frequency of micturition ,8 (4.2%) urinary retention /difficulty of urination.All the complications were relieved after symptomatic treatment or surgery except 2 cases of urinary retention/difficulty of urination.Their symptom kept existing after urethral dilatation and sling dissection and long-term intermittent self-catheterization was needed .One hundred and eighty-nine patients completed more than six months of follow-up, with mean follow-up time of ( 35.0 ±12.5 ) months.One hundred and sixteen (61.4%) cases was arranged to mid-term group and 73(38.6%) was arranged to long-term group.88.9%patients ( 168/189 ) were cured objectively and 9.5% patients ( 18/189 ) improved. There was also a significant subjective improvement ( ICI-Q-SF scores:15.6 ±3.9 preoperative versus 6.7 ± 2.3 postoperative,P<0.01).There was no significant difference of both objective and subjective efficacy between mid-term group and long-term group ( cured +improved rate 97.4% versus 95.9%;ICI-Q-SF scores 14.3 ±2.8 versus 16.7 ±3.4 preoperative ,5.8 ±1.2 versus 7.9 ±2.0 postoperative , P>0.05 ) . Patients who underwent TVT-O and those who underwent TVT-O +pelvic floor repair had no significant difference in efficacy (cured +improved rate 97.8%versus 100.0%,P>0.05).Conclusion TVT-O is a safe,effective and durable treatment for SUI , whether or not with concomitant procedure of pelvic floor repairment.

Objective To investigate the expression of survivin and B7-1 mRNA in acute leukemia and the prognostic significance in AL.Methods The expression of survivin and B7-1 mRNA was measuredin 64 AL patients with semi-quantity reverse transcription(RT)-PCR.14 adults were tested as normal controls(NC)and K562,NB4 cell lines were also tested as positive controls.Results The positive rates of survivin was higher than that of normal controis(NC).The expression of survivin in de novo AL Was higher than that in NC,while it decreased in complete remission(CR)patients.In relapsed patients the expression of survivin increased again.Meanwhile the expression of B7-1 has no signifieient change,but the expression Was lower than that in NC.In AL patients,the CR rate of positive survivin cases was lower than that of negative survivin cases.Conclusion Abnormal expression of survivin and B7-1 genes Was related to pathogenesis and progression of AL and it can serve as a marker of relapse and poor prognosis in AL.

Objective To construct an eukaryotic vector with expression of human survivin gene with green fluorescent protein which is named pIRES2-EGFP/survivin and transfected into K562 cell line.Methods Using pDNR/Survivin plasmid as a template, the full length of survivin cDNA was amplified by PCR and subsequently cloned into T-A vector and then subcloned into pIRES2-EGFP vector. After identified by digestion of restrictive endonucleases, pIRES2-EGFP/survivin was further confirmed by sequencing. Then it was transfected into K562 cells with superfect reagents. The mRNA was isolated and survivin gene was detected by Western blotting. Results The exact sequences of pIRES2-EGFP/survivin vector were confirmed by digestion of restrictive endonucleases and sequencing. After transfection, the expressions of green fluorescent protein were present. The mRNA expression of survivin has been detected in transfected cells by RT-PCR. Conclusion The vector pIRES2-EGFP/survivin has been constructed and could express survivin gone in K562 cells successfully.

OBJECTIVE: To establish HPLC method for the determination of thioguanosine in human red blood cells. METHODS: The determination was performed on Hypersil ODS colum. The mobile phase consisted of methanol-water (10∶90) with detection wavelength at 342nm. 6-Thioguanine(6-TG)was generated from thioguanosine through heating and hydrolyzing. 6-TG was extracted into 0.1mol/L hydrochloric acid for sample injection assay with external reference method for the quantification. RESULTS: The linear range of 6-TG was 30～1 200pmol/8?108RBCs. Its optimum hydrolyzing time was 1 hour and optimal extraction pH value ranged from 11 to 12. The content of phenyl mercury acetate in the extraction solution was 1.3mmol/L. CONCLUSION: Under optimized conditions, HPLC method for the determination of thioguanosine is fast, accurate and sensitive.

ObjectiveTo evaluate the therapeutic effect and toxicities of gemcitabine combined with cisplatin in the treatment of advanced or metastatic transitional cell carcinoma (TCC) of urinary tract. Methods Eighteen patients with advanced or metastatic TCC of urinary tract (15 cases of bladder TCC,2 of renal pelvic TCC,and 1 of ureteral TCC),who were pathologically confirmed,were treated with GC regimen (gemcitabine 1000 mg/m 2,iv infusion on day 1 and day 8;cisplatin 30 mg/m 2,iv infusion on day 2,day 8 and day 9).Before treatment, Karnofsy score for each patient was evaluated with a result of ≥60;liver and renal functions and blood routine test were normal.GC regimen was repeated for 2-3 cycles every 3-4 weeks and the response rate was evaluated.ResultsThree patients (16.7%) had complete response; 7(38.9%), partial response;5(27.8%),no response;and 3(16.7%) had progression.The overall response rate was 55.6%. The main toxic effects included decrease in white cell count (10 cases),anemia (7),nausea and vomiting (10) and constipation (8),which were mild or moderate and disappeared after stopping treatment.No chemotherapy-associated death occurred.ConclusionsGemcitabine combined with cisplatin in the treatment of advanced or metastatic transitional cell carcinoma of urinary tract is effective,and the toxicity is mild and tolerated. It is suggested that GC regimen can be used as the first line chemotherapy.