Department of rheumatology and immunology is a compulsory training department for the standardization training of the residents. However, it has been noted that the residents often ignore the importance of rheumatology. They are usually short of communication skill with the patients and theoretical knowledge. They often have high error rate in the clinical work and training their clini-cal skills and thinking ability is very difficult in the actual work. All of these problems may decrease the training quality and make the training a mere formality. Therefore, in order to carefully implement resident standardization training, a set of specific training programs has been developed, involving in theory of knowledge, practice standardization and comprehensive quality training. With these training programs, the quality and efficiency of the residents' training has greatly improved.

Background Many methods are widely studied to improve the therapeutic effect of trabeculectomy for glaucoma,and the clinical effectiveness of the amniotic membrane application during trabeculectomy is one of the research hotspots.Objective This study was to evaluate the efficacy and safety between trabeculectomy with (TE-AMT) and without amniotic membrane transplantation (TE-noAMT) for treating glaucoma.Methods Articles published from 1965 to December 2010 were searched from The Cochrane Library,PubMed,EMBASE,CNKI,Chinese Biomedicine Database,internet by computer,and manual search then was performed according to the predetermined strategy.Randomized controlled trials (RCT) on TE-AMT and TE-noAMT were included.The quality of included articles were scored based on Jadad table,and the relative parameters and information were extracted,including author,design of the trials,country,number of eyes and patients,gender,follow-up duration,age,classification of glaucoma,baseline IOP and loss rate.The main analysis indicators were the percentage of IOP reduction,completely operative successful rate,qualified success rate and adverse events.The pooled estimates were carried out with RevMan version 5.0 software.Results Nineteen RCTs documents were reviewed by meta-analysis with the Jaded scores ≥3 in 2 papers and ＜3 in 17 papers.Total 977 eyes of 818 patients were included.The weighted mean differences (WMD) of the percentage of IOP from baseline were (WMD =8.47％,95％ CI:5.20-11.75) at 6 months and (WMD=9.37％,95％ CI:4.97-13.77) at 12 months postoperatively.Relative risk (RR) of complete success rate and qualified success rate at postoperative 6 months were (1.40,95％ CI:1.19-1.65) and (0.47,95％ CI:0.22-1.00),respectively.RR values of adverse event such as shallow anterior chamber,hyphema,hypotony and choroidal detachment,failed filtering blebs at 6,12 months were 0.51 (95 ％ CI:0.30-0.85),0.43 (95％ CI:0.20-0.92),0.51(95％CI:0.26-1.00) and 0.57(95％CI:0.14-2.31),0.31(95％CI:0.20-0.47),0.31 (95％ CI:0.17-0.55),respectively.Conclusions TE-AMT appears to have better efficacy in lowering IOP,increasing complete success rate and reducing adverse event I in comparison with TE-noAMT.

Objective To investigate the relationship between cognitive function and emotional status in functional constipation patients.Methods Thirty-five functional constipation patients (the functional constipation group) and 24 healthy controls (the HCs) were enrolled in an event-related potential (ERP),behavior and electroeneephalogram study while performing an oddball auditory task.Response time,accuracy,latency and P300 amplitude were compared between the two groups.The Hamilton depression rating scale (HAMD-17),Hamilton anxiety scale (HAMA),symptom check list-90 (SCL-90) and Eysenck personality questionnaire (EPQ) were administered prior to the oddball task.Results The average HAMD-17,HAM A and SCL-90 (the somatization,obsessive-compulsive disorder,depression,anxiety and psychosis dimensions) scores of the functional constipation group differed significantly from those of the HCs.The intro-extraversion and neurosis dimensions of the EPQ were also significantly different.There was no significant difference in response time or latency between the two groups.The ERP results showed that the P300 amplitudes at the F3 and F7 sites were significantly different between the functional constipation group and the HCs.But there was no significant difference in P300 latencies at F3 or F7 between the two groups.Conclusions The findings suggest that patients with functional constipation are more susceptible to depression and anxiety,as well as somatization,obsessive-compulsive tendencies and other neurotic personality characteristics.Patients may employ psychological defense mechanisms to avoid the depression and anxiety.The ERP results imply there may be the implicit cognitive dysfunction with emotion in patients with functional constipation.

Objective To investigate the therapeutic effect of frozen-thawed murine islets which were transplanted into diabetic rats after cultured with hyperbaric oxygenated rotary cell culture system (HORCCS). Methods The purified rat islets were divided into two groups: A. In vitro experiment groups (IvEG) : The rat islets in each subgroup were cultured in HORCCS or common medium for 30 days, then evaluated for the intracellular DNA and insulin contents of islets, and the viability and insulin secreting level of islets. B. Islet transplantation experimental groups (TxEG) : The frozen-thawed islets were cultured in HORCCS or common medium for 7 days, and then transplanted into the recipients. We observed the blood glucose level (BGL) and insulin secreting level in the recipients as well as the uhrastructure change of islets in TxEG. Results The viability and insulin secreting level of islets cultured with HORCCS at 14th day were much higher than those cultured with common medium (P <0.05). The blood glucose level in recipients transplanted with islets cultured with HORCCS recovered to normal value at the 2nd week and lasted for 8 weeks. All these recipients maintained the normal glucose tolerance curve. Electronic microscopy found microchannel outlets on the surface of the frozen-thawed islets cultured with HORCCS. Conclusions Frozen-thawed islets cultured with HORCCS could establish nutrient transmission microchannels, which were not only capable of oxygen and nutrients transmission, but also improving cryopreservation solution to diffuse inside the islet cells evenly and uniformly. So this method not only lessens islet damage from cryopreservation, but also improves the effect of transplantation.

This study reported the analysis of plasma phospholipid metabolism of the rats and the pathological biomarkers between the type 2 diabetes model control group (MC) and the normal control group (NC). SD rats were randomly divided into 2 groups: NC and MC. To investigate state of plasma metabolite profiling in normal body, type 2 diabetes mellitus (T2DM) model group using UPLC-Q-TOF/MS which was used as analysis tool in this research. The compounds were identified by UPLC-Q-TOF/MS based on MS/MS fragment ions information, element composition in MassLynx 4.1 and the Lipid Maps database. The sign of two groups of samples in specific markers for screening was through a software package in R software (BioMark software). The results show that the pathological markers were mainly phosphatidylcholine (PC) and triglycerides (TG); the 2-acyl PC in the MC group was less more obviously than that in the NC group; high carbon number and high degree of unsaturation of the TG was reduced under the condition of type 2 diabetes. In the state of type 2 diabetes, metabolic changes occurred in rat plasma phospholipids obviously, which had a close relationship with the occurrence and development of T2DM.
Animals ; Biomarkers ; blood ; Chromatography, High Pressure Liquid ; Diabetes Mellitus, Experimental ; blood ; Diabetes Mellitus, Type 2 ; blood ; Metabolome ; Phospholipids ; blood ; Rats ; Rats, Sprague-Dawley ; Tandem Mass Spectrometry

Objective To study on the expression and clinical significance of programmed death ligant 1 (PD-1) in the development of colorectal cancer.Methods Flow cytometry (FCM) was used to detect and analyse the positive expression rate of PD-1 on CD3+ T cells in peripheral blood samples of 88 colorectal cancer patients and 74 healthy volunteers,and in sixpairs of tissue specimens (colorectal cancer tumor and adjacent normal tissues).Colon cancer tumor-bearing mice models were constructed by subcutaneous implantation of murine colon cancer cell line CT26,and the changes of positive expression rate of PD-1 on CD3+ T cells in spleens and transplanted tumor tissues were also detected by FCM in different time points during five,eight,11,14,17,20 days after the model was constructed.Finally,the experimental results were analyzed by t test or variance analysis.Results The positive expression rate of PD-1 on CD3+ T cells in peripheral blood of colorectal cancer patients was significantly higher than that in healthy volunteers ((29.25 ± 9.37) ％ vs (19.35 ± 7.37) ％,t =7.375,P＜ 0.01),and the positive expression rates were significantly increased in colorectal cancer patients with lower degree of differentiation,lymph node metastasis and higher Duke's stage.The positive expression rate of PD-1 on CD3+T cells was significantly higher in colorectal cancer tissues compared to adjacent normal tissues ((52.38±12.28)％ vs (24.72±4.78)％,t=5.143,P＜0.01).In the colon cancer tumor-bearing mice models,along with the growth of transplanted tumors,PD-1 positive expression rates on the CD3+T cells of tumor-bearing mice spleens and transplanted tumors showed a gradually rising tendency.From the eighth day to the 20th day after subcutaneous transplanted colon cancer cells,the average positive expression rate of PD-1 on the CD3+T cells of tumor-bearing mice spleens rose from (52.83±6.17)％ to (77.30± 6.84) ％,and the average positive expression rate of transplanted tumors rose from (60.43 ± 2.77)％ to (90.47±4.31) ％.Conclusion There is a correlation between the expression of PD-1 on mature T cell surface and the development of colorectal cancer,and the high specific expression of PD-1 may promote the invasion and metastasis of colorectal cancer.

Objective To clarify the role of the virtual reality (VR)in the training of trans-femoral cerebral angiography for novices without any experience of intravascular manipulation. Methods Twenty-four novices without experiences of intravascular manipulation were divided into 2 groups (VR group or control group)with random pair method concerning the age,gender and subjects. The par-ticipants in control group were trained in routine manners while those in VR group practiced on a simulator and subsequently participated in real angiography once as assistants. Real angiography tests were performed for all participants after the training session and additional angiography tests were per-formed for VR group just after the stimulation session on the simulator. Real angiography tests were supervised and scored according to a modified rating scale by neuroradiological experts who were blinded to the novices' training procedures. Difference between the real test performance of the two groups were compared by pared-samples t test,while the correlation between the performance of the real tests and simulator tests of VR group was proved by Pearson correlation analysis. P<0.05 was con-sidered statistically significant. Results The mean scores of VR group were (27.6±3.6)and (26.4± 3.8)in the tests on simulator and real angiography tests respectively,while score of control group was (21.2±3.4)in the real angiography tests. A positive correlation was revealed in VR group between performance on the simulator and that on real patients (r=0.825,P=0.001). Real performance of the VR group was significantly better than that of control group (P=0.010). Conclusions Virtual reality could ensure transfer of acquired endovascular skills from simulators to patients so as to become a valid tool for novices to improve the interventional techniques in tranfemoral cerebral angiography.

Objective To explore the most accurate T staging and optimal surgical method of lung adenocarcinoma of trans-lobe type, and to provide supportive diagnosis as well as therapeutic evidences for this disease. Methods A total of 192 postoperative patients, hospitalized in Tianjin Medical University General Hospital from January 2008 to June 2013, who were diagnosed with lung adenocarcinoma were recruited. Patients were divided into three groups according to the 7th edition of TNM staging criteria issued by the IASLC in 2009. A total of 163 patients with T2 stage were selected as Group T2, and 12 patients with T3 stage were selected as Group T3, both of which were considered as control groups. Other 17 pa?tients who were diagnosed as trans-lobe type of lung adenocarcinoma, were Group trans-lobe. The clinical data and progno?sis were compared between three groups. The trans-lobe type of lung adenocarcinoma was diagnosed based on imaging and pathological examination. Subtypes of trans-lobe lung adenocarcinoma were identified by referring to 2011 international mul?tidisciplinary classification standard of lung adenocarcinoma. Kaplan-Meier method was used to analyze the prognosis of dif?ferent subtypes and surgical modus in patients with lung adenocarcinoma of trans-lobe type. Results By comparison, the postoperative survival rate was significantly lower in patients diagnosed with trans-lobe type of lung adenocarcinoma than that of Group T2 (P<0.05), and no significant difference in survival rate compared with Group T3 (P>0.05). There were no significant differences in survival rates between different surgical modus (P<0.05). Seventeen patients with trans-lobe type of lung adenocarcinoma consisted of four subtypes, including 8 solid predominant, 5 acinar predominant, 3 papillary predomi?nant and 1 invasive mucinous adenocarcinoma. There were no statistical significances in postoperative survival time and sur?vival rates between four subtypes. Conclusion The clinical stage of trans-lobe type of lung adenocarcinoma should be clas?sified as stage T3. Both pulmonary bilobectomy and lobectomy combined with resection of proximal invaded lobe can be used as effective surgical therapies for trans-lobe type of lung adenocarcinoma.

Objective To investigate the incidence of newly-onset type 1 diabetes mellitus ( T1DM ) complicated with ketoacidosis(DKA) and its relevant factors in pediatrics. Methods Hospital records of 317 T1DM children below 18 years of age, diagnosed from 2010 to 2012 were reviewed. By using retrospectively analyzed data of inpatients with newly-diagnosed T1DM, the incidence of DKA was calculated. In this study, the influential factors of DKA included gender, age, residence, family history of diabetes mellitus, duration of symptoms, misdiagnosis or missed diagnosis, and delayed treatment. Patients were divided into two groups:group 1, aged<5 year and group 2, aged>5 year. Results Of all patients diagnosed with T1DM, 175 ( 55. 2%) presented with DKA, and mild, moderate, and severe DKA accounted for 26. 5%, 23. 9%, 49. 6%, respectively. The incidences of DKA in group 1 andgroup2were67.5% and48.0% (P=0.001),withthehighestfrequency(70.3%)inpatientsaged<2 years. The proportion of severe DKA in group 1 was significantly higher than that of group 2 (60. 0% vs 41. 3%, P=0. 048). The rates of misdiagnosis and missed diagnosis in the two groups were respectively 27. 4% and 12. 0%(P=0. 001), being 37. 8% in children<2 years. The HbA1C level of group 1 was lower than group 2 (11. 50% vs 12.54%,P=0.001). Intheacutemetabolicandhoneymoonperiod,Cpeptidelevelsofgroup1werebothlowerthan those of group 2 [(0. 36 vs 0. 55) ng/ml, P=0. 001;(0. 40 vs 0. 61) ng/ml, P=0. 02]. The DKA incidence of patients with misdiagnosis or missed diagnosis was significantly increased(83. 9% vs 49. 0%, P=0. 000). Compared with those without DKA, C peptide level of patients with DKA was lower in the acute metabolic period[(0. 56 vs 0.40)ng/ml,P<0. 01], but no difference in honeymoon period[(0. 67 vs 0. 59)ng/ml,P=0. 22]. Logistic regression showed that age, misdiagnosis or missed diagnosis were associated with the presence of DKA. The possibility of the occurrence of DKA in patients aged>5 years was half of patients aged<5 years ( OR=0. 448, P=0. 003), and the risk of DKA in patients with misdiagnosis or missed diagnosis was higher (OR=5. 640, P=0. 005). Conclusion DKA in patients with newly-onset T1DM is frequent and often severe. Multivariate analysis revealed that patients aged <5 years and those with misdiagnosis or missed diagnosis are encountered high risk of DKA.

Objective To evaluate the effect of 15-deoxy-△12,14-prostaglandin J2 (15d-PGJ2) on endotoxin-induced acute lung injury (ALI) in rats.Methods Forty healthy male Sprague-Dawley rats, aged 3-5 months, weighing 220-250 g, were randomly divided into 4 groups (n =10 each) using a random number table: control group (group C), 15d-PGJ2 group, lipopolysaccharide (LPS) group, and LPS +15d-PGJ2 group.In group 15d-PGJ2, 15d-PGJ20.3 mg/kg was injected via the tail vein, while the equal volume of normal saline was given in group C.In LPS and LPS+15d-PGJ2 groups, ALI was produced with LPS 6 mg/kg injected through the tail vein, and then the equal volume of normal saline and 15d-PGJ2 0.3 mg/kg were injected, respectively.At 4 h after LPS injection, blood samples were drawn from the abdominal aorta for blood gas analysis, and arterial oxygen partial pressure (PaO2) was recorded.The rats were then sacrificed, lungs were removed for microscopic examination, and for determination of wet/dry lung weight ratio (W/D ratio), TNF-α, IL-8 and cytokine-induced neutrophil chemoattractant-1 (CINC-1) contents (by enzyme-linked immunosorbent assay) , and nuclear factor kappa B (NF-κB) p65 and IκB-α expression (by Western blot).Results Compared with group C, no significant change was found in PaO2, W/D ratio, contents of TNF-α, IL-8 and CINC-1, and expression of NF-κB p65 and IκB-α in group 15d-PGJ2 (P＞0.05), and PaO2 was significantly decreased, W/D ratio and contents of TNF-α,IL-8 and CINC-1 were increased, the expression of NF-κB p65 was up-regulated, and the expression of IκB-α was down-regulated in LPS and LPS+ 15d-PGJ2 groups (P＜0.05).Compared with group LPS,PaO2 was significantly increased, W/D ratio and contents of TNF-α, IL-8 and CINC-1 were decreased, the expression of NF-κB p65 was down-regulated, and the expression of IκB-α was up-regulated (P＜0.05),and the pathological changes were attenuated in group LPS+ 15d-PGJ2.Conclusion 15d-PGJ2 can mitigate endotoxin-induced ALI in rats.