Objective To investigate the feasibility of student standardized patient (SSP) in practice. Methods Undergraduates majoring in TCM clinic in grade 2011 in Heilongjiang University of Chinese Medicine were set as subjects and were under the cultivation of new SSP teaching model and traditional teaching model respectively. Objective theory paper examination, clinical skill score and student subjective evaluation were used for the research on teaching efficacy. Results Students in the experimental group were better than their peers in the control group in the aspects of objective theory paper examination and clinical skill score (P<0.05), with good student feedback. Conclusion SSP combining simulated wards in teaching of TCM surgery can provide great help for the transformation of clinical students to clinical doctor, which should be a new teaching model in TCM surgery with further digging and promotion.

Objective To investigate the effect of mechanical ventilation on the pulmonary microvascular permeability in diabetic mice.Methods Sixty-four male C57/BL6 mice aged 10-12 months,weighing 20-25 g,were randomly assigned into 4 groups (n =16 each):control group (group C); mechanical ventilation group (group M); diabetes group (group D); diabetes mechanical ventilation group (group DM).Diabetes was induced by intraperitoneal streptozotocin 150 mg/kg (in citric acid buffer solution 0.1 mol/L) and confirmed by blood glucose level ＞ 16 mmol/L in groups D and DM,while the equal volume of citric acid buffer solution was given instead of streptozotocin in groups C and M.The animals were anesthetized with intraperitoneal pentobarbital 100 mg/kg and tracheostomized.The animals kept spontaneous breathing for 4 h in groups C and D,while the animals were mechanically ventilated for 4 h in groups M and DM.Eight mice from each group were randomly selected,arterial blood samples were obtained for blood gas analysis,and then the animals were sacrificed and the lung tissues were removed for determination of microscopic examination,W/D lung weight ratio and myeloperoxidase (MPO)activity.Four mice from each group were sacrificed and the pulmonary vascular permeability was determined.Four mice from each group were sacrificed and the primary pulmonary microvascular endothelial cells (PMVECs) were cultured in vitro and confirmed.The PMVEC permeability coefficient was measured using transendothelial [ 14 C ]BSA flux.Results Compared with group C,PaO2 was significantly decreased,and the MPO activity,pulmonary microvascular permeability and PMVECs permeability coefficient were significantly increased in groups M,D and DM,and W/D lung weight ratio was significantly increased in groups M and DM ( P ＜ 0.05).PaO2 was significantly lower,and W/D lung weight ratio,MPO activity,pulmonary microvascular permeability and PMVECs permeability coefficient were significantly higher in group DM than in group D ( P ＜ 0.05).Conclusion The mechanism by which mechanical ventilation induces lung injury may be related to the increase in the pulmonary microvascular permeability in diabetic mice.

Objective To evaluate the efficacy of oxycodone or hydromorphone combined with propofol for colonoscopy.Methods A total of 150 patients of both sexes,aged 18-64 yr,weighing 45-85 kg,of ASA physical status Ⅰ or Ⅱ,undergoing colonoscopy,were randomly divided into 3 groups (n=50) using a random number table:fentanyl combined with propofol group (group F),oxycodone combined with propofol group (group O) and hydromorphone combined with propofol (group H).In F,O and H groups,fentanyl 1 μg/kg,oxycodone 0.1 mg/kg and hydromorphone 0.02 mg/kg were injected over 60 s,respectively,and then propofol 1.5 mg/kg was injected intravenously.After eyelash reflex disappeared,a colonoscope was placed.When body movement occurred during examination,half of the initial dose of propofol was added.The time for induction of anesthesia,operation time,emergence time,recovery time,occurrence of adverse cardiovascular events,nausea and vomiting and respiratory depression,and amount of propofol consumed were recorded.Results There was no significant difference between the three groups in the time for induction of anesthesia,operation time,emergence time,recovery time,adverse cardiovascular events,respiratory depression,and amount of propofol consumed.Compared with group F,the incidence of nausea and vomiting and respiratory depression was significantly decreased,and the degree was reduced in H and O groups.No significant difference was found between group O and group H in the incidence of nausea and vomiting and respiratory depression and the degree.Conclusion Oxycodone or hydromorphone combined with propofol can be safely and effectively used for colonoscopy and the efficacy is better than that of fentanyl combined with propofol.

Objective To evaluate the role of endothelial nitric oxide synthase (eNOS) in inflammatory responses in mice with ventilator-induced lung injury using gene knockout.Methods Twenty-four male C578L/6J wild type mice and 24 male B6.129P2-Nos3tm1Unc/NJU (eNOS gene knockout) mice,aged 10-12 months,weighing 20-25 g,were randomly assigned into 2 groups (n=12 each) using a random number table:sham operation group (group S) and mechanical ventilation group (group MV).The animals were anesthetized with intraperitoneal 1％ pentobarbital sodium 70 mg/kg,and mechanically ventilated after tracheal intubation.The animals were mechanically ventilated for 4 h (oxygen flow rate 0.5 L/min,FiO2 50％,VT 15 ml/kg,RR 70 bpm,PEEP 2 cmH2O).After 4 h of ventilation,blood samples were obtained from the internal carotid artery for detection of PaO2.The animals were then sacrificed and the lungs were removed for determination of wet/dry lung weight (W/D) ratio,myeloperoxidase (MPO) activity,contents of malondialdehyde (MDA),interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α),and pulmonary microvascular permeability,and for microscopic examination of the pathological changes of lung (with electron microscope).Results Compared with group S of wild type mice,PaO2 was significantly decreased,while W/D ratio,MPO activity,contents of MDA,IL-6,TNF-oα and NO,and pulmonary microvascular permeability were increased in MV groups of wild type and gene knockout mice,and no significant change was found in the parameters mentioned above in group S of gene knockout mice.Compared with group MV of wild type mice,PaO2 was significantly increased,while W/D ratio,MPO activity,contents of MDA,IL-6,TNF-α and NO and pulmonary microvascular permeability were decreased in group MV of gene knockout mice.The pathological changes of lung were significantly attenuated in group MV of gene knockout mice as compared with group MV of wild type mice.Conclusion eNOS is involved in inflammatory responses in mice with ventilator-induced lung injury.

Objective To evaluate the effect of losartan on mechanical ventilation-induced lung injury in diabetic mice.Methods Forty-eight female SPF C57/BL6 nice,aged 10-12 months,weighing 20-25 g,were randomly assigned into 3 groups (n =16 each):control group (group C).,diabetes + mechanical ventilation (group DM) and losartan group (group L).Diabetes mellitus was induced by intraperitoneal streptozotocin 150 mg/kg and confirmed by blood glucose level ＞ 16 mmol/L in groups DM and L.Diabetic mice were mechanically ventilated (FiO250％,VT 15 ml/kg,RR 70 bpm,PEEP 2 cm H2O) for4 h.Losartan 30 mg/kg was injected intraperitoneally 30 min before ventilation in group L.Eight mice from each group were chosen at 4 of ventilation and arterial blood samples were obtained for detection of PaO2.The animals were then sacrificed and the lungs were removed for determination of W/D lung weight ratio,myeloperoxidase (MPO) activity,pulmonary microvascular permeability,angiotensin Ⅱ (Ang Ⅱ) receptor AT1 mRNA expression (by RT-PCR),Ang Ⅱ content and nuclear factor kappa B (NF-κB) p65 expression (by Western blot).Results Compared with group C,PaO2 was significantly decreased,while W/D lung weight ratio,MPO activity,pulmonary microvascular permeability and Ang Ⅱ content were significantly increased,and the expression of AT1 mRNA and NF-κB p65 was up-regulated in groups DM and L (P ＜ 0.05).PaO2 was significantly higher,and W/D lung weight ratio,MPO activity,pulmonary microvascular permeability,Ang Ⅱ content and the expression of AT1 mRNA and NF-κB p65 were significantly lower in group L than in group DM (P ＜ 0.05).Conclusion Losartan can reduce mechanical ventilation-induced lung injury in diabetic mice through inhibiting AT1 receptor and Ang Ⅱ levels and improving pulmonary microvascular permeability and inhibiting NF-κB activation.

Objective To evaluate the role of Toll-like receptor 4 (TLR4) in mechanical ventilationinduced increase in pulmonary capillary permeability in diabetic mice.Methods Two types of mice,aged 8-10 weeks,weighing 20-25 g,were used in this study:free wild type mice (C3H/HeN) and TLR4 gene mutation type (C3H/HeJ).Diabetes was induced by intraperitoneal streptozotocin 150 mg/kg (in citric acid buffer solution 0.1 mol/L) and confirmed by blood glucose level ＞ 16 mmol/L.Each type of diabetic mice was randomly divided into 2 groups (n =14 each):group diabetes + sham operation (group DS) and group diabetes + mechanical ventilation (group DM).The animals were anesthetized with intraperitoneal ketamine,midazolam and atropine.Tracheal intubation was performed and the animals kept spontaneous breathing in group DS.The animals were mechanically ventilated (FiO2 50％,RR 70 bpm,VT 15 ml/kg,PEEP 2 cmH2O) for 4 h in group DM.Arterial blood samples were obtained at 4 h of ventilation for blood gas analysis,PaO2 and PaCO2 were recorded,and NO concentration in the serum was measured.Then the animals were sacrificed and the lungs were removed for determination of W/D lung weight ratio (W/D ratio),content of evans blue (EB),and expression of caveolin-1,endothelial nitric oxide synthase (eNOS) and phosphor-eNOS (p-eNOS) (by Western blot).The ratio of p-eNOS/eNOS was calculated.Results Compared with group DS,PaO2,PaCO2 and p-eNOS/eNOS ratio were significantly decreased,and W/D ratio,EB content and caveolin-1 expression were increased in group DM (P ＜ 0.05).Compared with C3H/HeN mice,W/D ratio,caveolin-1 expression and EB content were significantly decreased,peNOS/eNOS ratio and serum NO concentrations were increased (P ＜ 0.05),and no significant changes in PaO2 and PaCO2 were found in C3H/HeJ mice in group DM (P ＞ 0.05).Conclusion TLR4 increases the pulmonary capillary permeability after mechanical ventilation in diabetic mice through effectively combining with caveolin-1 and reducing NO bioavailability.

Objective To estimate the dietary diversity,overweight and obesity of the rural adults aged 18-65 years in Jilin Province by diet diversity score(DDS),and to analyze the association between dietary diversity and overweight,obesity.Methods A representative sample of 674 rural residents was selected by a multistage sampling method from Jilin Province in 2012 June to July. A validated semi-quantitative food-frequency questionnaire was used to assess the usual food intake. The height and body weight were measured and the body mass index (BMI)was calculated. Logistic regression analysis was applied to calculate the risk of overweight and obesity for different DDS,after adjusted for mixed factors.Results 62.4% people in rural scored ≥6 while 1 1.8% people in rural scored ≤3.The detection rate of obesity of the rural adults in Jilin Province was higher than the mean level in China .For rural adults with moderate and adequate diversity score, the risk of overweight and obesity was 0.946 and 0.816 times the risk of overweight and obesity of the rural adults with pool diversity score. Conclusion Diet diversity of the rural adults in Jilin Province is low.The risk of overweight and obesity is high;the risk of obesity is decreased with the increasing of diet diversity level.

Objective To implement and evaluate evidence-based guidelines for enteral nutrition support in acute stroke patients with dysphagia.Methods This study is a prospective before and after comparison study.Collected 200 acute stroke patients with dysphagia and divided them into test group (trained medical staffs) and control group(untrained medical staffs) equally according to the time order.Two groups of 100 patients were surveyed using a checklist before and after implementation of 10 guidelines about nutrition support.Before the implementation of guidelines,the staffs were enforced training,and summarized regularly.Compliances with guidelines by doctors and nurses were compared,and outcomes of patients were assessed.Results Compared with the control group,the correct implementation of the project significantly improved in the experimental group on nutritional risk screening (92.0％,64.0％; x2 =22.840),nutritional supplements selection (80.0％,48.0％; x2 =22.220),nutrition infusion methods (90％,18％ ; x2 =1.040) and nutrition infusion adjustment (abdominal distension/adjusted:21/10,6/4;x2 =9.634,constipation/adjusted:41/40,57/53 ; x2 =5.122,all P ＜ 0.05).The mortality rate,poor prognosis and length of stay in department of neurology intensive care unit and in hospital were not significant different between the experimental group and the control group.The incidence of hospital-acquired pneumonia was significantly lower in the experimental group (44.3％) than that in the control group (67.5％,x2 =7.281,P =0.007),but other patient outcomes were unaffected significantly.Conclusion Implementation of evidence-based guidelines for enteral nutrition support in acute stroke patients with dysphagia is associated with improvements in clinical quality and selected patient outcomes.

OBJECTIVETo summarize the management of infant vascular tumors with Kasabach-Merritt phenomenon (KMP) and to evaluate the effect of drug combined with sclerotherapy.

METHODSFrom Feb. 2007 to Nov. 2014, 25 cases with KMP, who underwent drug therapy combined with sclerotherapy, were retrospectively studied. Oral corticosteroids (2 mg/kg per day) was used as the first-line therapy on all of the patients and intravenous vincristine (1.5 mg/m2 every week) was added when the platelet counts didn't recover obviously after 2-3 weeks. After the recovery of the platelet counts, the patients were admitted for sclerotherapy (average, 4.56 sessions per case) with 100% alcohol (1-3 ml per session), Lauromacrogol (1.25-5 ml per session) and betamethasone (0.25-1 ml per session). All the patients were followed up for 42 months ( range, 9 months to 6.5 years). Therapeutic outcomes were assessed by evaluating platelet counts, size of lesion, function of trunk and limb.

RESULTSAll the 25 cases got obvious recovery in the platelet counts [average, (94.3 ± 18.5) x 10(9)/L] after drug therapy, of which 16 were treated by single oral corticosteroids for 4-7 weeks and 9 were treated by corticosteroids plus intravenous vincristine for 2-5 weeks. Meantime, 11 cases received platelet transfusions, of which 3 were coupled with gamma globulin intramuscularly. During the first admission, each of the 25 cases received 1-4 sessions of sclerotherapy (average, 2.6 sessions each case). One week after the sclerotherapy, the platelet counts returned to (167-312) x 10(9)/L (average, (258.5 ± 34.4) x 10(9)/L). The hemoglobin and blood coagulation function returned to normal within 1-5 weeks. Meanwhile the mental condition, appetite, body weight, sleeping were greatly improved. The size of the lesions decreased gradually after the combined therapy including 13 cases within 3-12 months and 13 cases within 13-36 months. Long term follow-up indicated that only 1 case need treatment for recurrent decrease of platelet counts, and all of the 25 cases kept the normal weight, height, immunity as well as the growing development.

CONCLUSIONSOral corticosteroids plus intravenous vincristine combined with sclerotherapy is a reliable management with high cure rate, short course and minor side-effect.

Administration, Oral ; Betamethasone ; administration & dosage ; Combined Modality Therapy ; methods ; Ethanol ; administration & dosage ; Glucocorticoids ; administration & dosage ; Humans ; Infant ; Injections, Intravenous ; Kasabach-Merritt Syndrome ; blood ; therapy ; Platelet Count ; Polyethylene Glycols ; administration & dosage ; Retrospective Studies ; Sclerotherapy ; methods ; Vincristine ; administration & dosage

S-Nitros(yl)ation is a ubiquitous redox-based post-translational modification of protein cysteine thiols by nitric oxide or its derivatives, which transduces the bioactivity of nitric oxide (NO) by regulation of protein conformation, activity, stability, localization and protein-protein interactions. These years, more and more S-nitrosated proteins were identified in physiological and pathological processes and the number is still growing. Here we developed a database named SNObase ( http://www.nitrosation.org ), which collected S-nitrosation targets extracted from literatures up to June 1st, 2012. SNObase contained 2561 instances, and provided information about S-nitrosation targets, sites, biological model, related diseases, trends of S-nitrosation level and effects of S-nitrosation on protein function. With SNObase, we did functional analysis for all the SNO targets: In the gene ontology (GO) biological process category, some processes were discovered to be related to S-nitrosation ("response to drug", "regulation of cell motion") besides the previously reported related processes. In the GO cellular component category, cytosol and mitochondrion were both enriched. From the KEGG pathway enrichment results, we found SNO targets were enriched in different diseases, which suggests possible significant roles of S-nitrosation in the progress of these diseases. This SNObase means to be a database with precise, comprehensive and easily accessible information, an environment to help researchers integrate data with comparison and relevancy analysis between different groups or works, and also an SNO knowledgebase offering feasibility for systemic and global analysis of S-nitrosation in interdisciplinary studies.
Animals ; Binding Sites ; Databases, Protein ; Disease ; Humans ; Internet ; Mice ; Models, Molecular ; Nitrosation ; Protein Processing, Post-Translational ; Proteins ; chemistry ; metabolism ; Rats ; Software ; Sulfur ; metabolism