Objective To investigate the salty, efficacy and feasiblify on eholedochotomy with endobiliary drainage and prumary closure of the common bile duct. Methods There were 20 partients without introhepatic or re-tained stones and biliary stricture underwent common bile duet exploration. 20 of them with endobiliary tube drainage and primary CBD closure and the other 20 patients with T tube drainage. Results The average of the time to return routine home was (9. 2 ±1. 3)d, (15. 2 ± 3.6) d(P < 0. 01). The hospital expense of postoperation was (3 252± 312)Yuan,(4 116±388)Yuan(P<0.01). Conclusion Choledochotomy with endobiliary catheter and primary closure of CBD is a safe, effective and feasible procedure for the management of choledochohthiasis.

Objective To investigate the relationship between the infiltration of lymphocytes in renal tissues and podocytes injury in patients with lupus nephritis (LN),and provide the evidence of mechanism of podocytes injury in LN.Methods Thirty cases of biopsy proven LN patients were enrolled into the study,10 cases were selected as a the controls.The clinical and pathological data and renal tissues were collected.The infiltration of T lymphocytes (CD4+,CD8+ cells) and B lymphocytes (CD20+ cells) in renal tissues were detected by immunohistochemical method.The nephrin expression was detected by immunofluorescence.The relationship between CD4+,CD8+,CD20+ cells in renal tissues and 24 h UP,nephrin expression were analyzed by Pearson's correlation analysis,respectively.Results ① Compared with the control group,the 24 h UP was increased [2.86±1.37 vs 0.10±0.22 (g/24 h)];the infiltrations of inflammatory cells were increased significantly,the podocytes injury could be observed,combined with effacement of podocytes foot processes or disappeared in the LN group.Moreover,the increase of 24 h UP of active LN group was more evident than that in the inactive group [3.91 ±1.45 vs 1.77±0.69 (g/24 h),F=24.15,P＜0.05],and the infiltration of inflammatory cellsand effacement of podocytes foot processes were more severe in the active LN group.②Compared with the control group,the nephrin expression decreased and the infiltration of CD4+,CD8+ and CD20+ cells in the renal tissues increased significantly,which was mainly aggregated in renal interstitial tissue.And In addition,CD4+ [98±13 vs 40±12 (cells/glomerulus),F=240.18,P＜0.05],CD8+[109.0±16.4 vs 53.3±12.1(cells/glomerulus),F=210.40,P＜0.05] and CD20+ [149.4±1.4 vs 82.6±13.3 (cells/glomerulus),F=544.30,P＜0.05] cells of the active LN group were more remarkable than that in the inactive group.③ The Pearson correlation analysis showed that CD4+,CD8+ and CD20+ cells in renal tissues were positively correlated with 24 h UP (r=0.688,0.748,0.702;P＜0.01),and were negatively correlated with nephrin expression (r=-0.623,-0.793,-0.693;P＜0.01).Conclusion The infiltrations of CD4+,CD8+ and CD20+cells in renal tissues are very closely related with podocytes injury in patients with LN,and the infiltration of lymphocytes may be an important mechanism for podocytes injury in LN patients.

Objective To study the cholesterol nuclear-cytoplasmic interaction effect and position cholesterol traits QTL in mice.Methods Improving the nuclear-cytoplasmic interaction models and methods that have been constructed, and analyzing the public database of total cholesterol and lipoprotein data of F2 group that derived from DBA/2J ( D2) and CAST/EiJ ( CAST) mice.Results Six QTL that controlling total cholesterol, HDL and nonHDL were located in 4 linkage groups in the genome.In the models constructed in this study, we found a QTL has significant interaction with cytoplasmic background, which changes the previous results of data analysis, the genetic mouse cholesterol and lipoprotein components opened up new ideas.Conclusion Mouse cholesterol trait is the result of interaction of nuclear genes and cytoplasmic background.

In order to find out the social attitude towards euthanasia and related issues,we conduct a questionnaire investigation on medical staff,patients,medical school students,and community groups in Beijing.From the survey,we find out that there is a relatively high degree of awareness of euthanasia,and the different attitudes for euthanasia are relevant to the educational backgrounds and professional backgrounds.In addition,by analyzing the mentality of people talking about the death,we find out that people with a healthy outlook on life and death are more inclined to agree with active euthanasia.

Objective To assess the effects of tacrolimus (FKS06) on podocyte in type 2 diabetic model rats and to explore the potential mechanism.Methods The model rats were fed with high fat and high sugar food and combining with a low-dose of streptozotocin (STZ).They were then randomly divided into a diabetic mellitus group (DM group) and a FK506 group.A normal control group (NC group) was also set.The rats in FK506 group were given with 0.5 mg· kg-1· d-1 FK506 for 8 weeks.The biochemical parameters were measured.The changes of renal pathology and ultrastructure of podocyte were observed by the light and electron microscopy.The expression of nephrin and LC3-Ⅱ was determined by immunohistochemistry and Western blotting.Results (1) Compared with those in NC group,KW/BW,systolic blood pressure (SBP),fasting blood glucose (FBG),triglyceride (TG),total cholesterol (TC),urinary albumin excretion rate (UAE) and creatinine clearance rate (Ccr) in DM group were significantly increased (all P ＜ 0.05).And the KW/BW,UAE and Ccr were decreased in FK506 group compared to those in DM group (all P ＜ 0.05),while other parameters had no significant difference (all P ＞ 0.05).(2) Compared with those in NC group,the glomerular volume,mesangial cell proliferation and accumulation of mesangial matrix were increased,and the foot process became disorder and fusion in DM group,while these changes were significantly reduced in FK506 group.(3) Compared with that in NC group,the expression of nephrin and LC3-Ⅱ was decreased in DM group (all P ＜ 0.05),and both of parameters were higher in FK506 group than those in DM group (all P ＜ 0.05).Conclusion FK506 may enhance podocyte autophagy in type 2 diabetic model rats and attenuate podocyte injury.

Curriculum study is a major phase for medical postgraduate education,however,the patterns of the curriculum system are not uniform among domestic medical colleges,not to mention the uniformed patterns for scientific degree and professional degree.Hence,our school has reformed the curriculum system to set up different curriculum systems for both scientific degree and professional degree according to their different educational goals in an aim to improve the quality of education.

With the size of graduate education continues to expand,deepening the reform of graduate education to improve the quality of graduate education has become the core of graduate education.This paper introduces the common problems and solution of graduate education in cilinical medicine professional degree.

This article discussed on the continuing medical education for general practitioners within a nonprofit multihospital system.Literature review,statistical analysis and survey results were employed.Training situation for general practitioner at home and aboard was reviewed.Statistics on population,disease spectrum,present situation of community doctors in Luwan branch of Ruijin hospital was also analyzed.Results showed that current education system for general practitioners cannot catch up the increasing demand yet.Meanwhile patients expected well qualified and skillful physicians in the community healthcare centers.Reinforcement of continuing medical education for general practitioners was the stepping stone of a nonprofit multihospital system.Improving skills and qualifications of physician played an essential role in the urban network of medical services.

Background:Chronic inflammation is closely associated with occurrence and development of gastric cancer,and inflammatory cytokines,interleukin-18(IL-18)and IL-1β are involved via a variety of mechanisms. Aims:To determine the serum levels of IL-18 and IL-1β in patients with different gastric mucosal lesions and to explore the role of these two cytokines in gastric cancer and their clinical significance. Methods:Serum levels of IL-18 and IL-1β were detected by ELISA in patients with different gastric mucosal lesions,including 324 gastric cancer,40 chronic non-atrophic gastritis (CNAG),13 chronic atrophic gastritis with or without intestinal metaplasia(CAG/ IM)and 20 mild to moderate dysplasia. Helicobacter pylori(Hp)IgG antibody was detected in patients with gastric cancer. Correlations of serum levels of IL-18 and IL-1β with clinicopathological parameters and Hp infection were analyzed in patients with gastric cancer. RoC curve was used to assess the performance of serum IL-18 and IL-1β for diagnosis of gastric cancer. Results:Serum levels of IL-18 and IL-1β increased gradually from CNAG,CAG/ IM,dysplasia to gastric cancer;except for IL-1β between CNAG and CAG/ IM groups,significant differences were found between any two groups(P < 0. 05). In gastric cancer group,they were positively correlated with tumor size,lymph node and distant metastases,depth of invasion,TNM stage and Hp infection(P < 0. 05). Area under the RoC curve(AUC)of combined detection of serum IL-18 and IL-1β for diagnosis of gastric cancer was superior to that of IL-18 or IL-1β detection alone(0. 867 vs. 0. 837 and 0. 795). Conclusions:Serum levels of IL-18 and IL-1β increase dynamically with the tumorigenesis of gastric cancer,and are closely related to growth, invasiveness and metastasis of gastric cancer. Combined detection of serum IL-18 and IL-1β might be used as a biomarker for diagnosis and tumor progression and prognosis assessment of gastric cancer.

Objective To analyze the clinical profile and short-term postoperative prognosis of mixed hepatocellular carcinoma and cholangiocarcinoma (mHCC-CC). Methods Clinical data of 17 mHCC-CC cases undergoing hepatectomy were retrospectively analyzed. Results Patients average age was 53 years (27～76 years).There were 11 males (64.7％) and 6 females.Ten patients (58.8％) were asymptomatic,twelve patients(70.6％ ) had positive serology for hepatitis B infection,serum AFP levels ＞25 ng/ml in 12 cases. Serum CA199 levels ≥ 37 U/ml in 4 cases. All patients underwent radical hepatectomy,including ＞ 1.5 cm safe margin and lymphadenectomy.The 6-,12-,and 18-months overall survival rate was 93.8％,86.5％ and 57.7％,respectively.The 100- and 200-day disease-free survival was 65.3％ and 43.5％.The median disease-free survival was 161 days. Conclusions mHCC-CC is difficult to diagnose preoperatively.The diagnosis depends on pathological examination.The main treatment was surgical resection.The prognosis of mixed primary liver cancer is poor and tends to recur early after hepatectomy.