There were a lot of differences between the American and Chinese medical education.Students in American should obtain bachelor's degree of humanities or science before reciveing medical doctor's degree at graduation.High altitude militray medicine is a characteristic discipline of the third military medical university,aming at training general doctors for the plateau.During the designing of high altitude militray medicine curriculum and its teaching process,we actively learned from the advanced experiences of American based on the reality,optimizd currulum,improved teaching methods,greatly cultivated the students' protential in order to increase the qualify of high altitude militray medicine personnel.

Objective To observe the pituitary tumor transforming gene (PTTG), estradiol-stimulated protein 1 (ESP1) expressions in S, G 2/M phases in A549, SPC-A-1 cell lines. Methods The mammalian cells for cell cycle was synchronizated by thymidine, the total RNA in the S, G 2/M phases was collected, and the total RNA was observed by Real-time PCR. Results PTTG expression in A549 and SPC-A-1 cell lines was higher in S phase than that in G 2/M phase while no PTTG expression in MRC-5 cells in S, G 2/M phases. ESP1 expression in A549, SPC-A-1, MRC-5 cell lines was lower in S phase than that in G 2/M phase. Conclusion That no PTTG in S and G 2/M phases in the normal cell line and PTTG expression in the lung cancer cell line higher in S phase than that in G 2/M phase suggested that the aneuploidy may be caused by the overexpression of PTTG. ESP1 expression was lower in S phase than G 2/M phase in all of the three cell lines, suggesting that sister chromatids separation depend on the active ESP1.

AIM: To study the protective effects of HIF-1α gene transfection on hypoxic injury in human HepG2 cells. METHODS: After gene transfection, HepG2 cells were randomly divided into 4 groups: normoxia with Ad-GFP transfected group, normoxia with Ad-HIF-1 transfected group, hypoxia with Ad-GFP transfected group and hypoxia with Ad-HIF-1 transfected group. LDH leaking rate, cell viability, contents of NO and ROS, the iNOS activity were measured. RESULTS: High levels of HIF-1α mRNA and protein were detected in Ad-HIF transfected HepG2 cells. Cell viability was significantly lower in Ad-GFP transfected-hypoxia group than that in Ad-GFP transfected-normoxia group (P<0.05). No marked difference of cell viability was found between Ad-HIF transfected-hypoxia group and Ad-HIF transfected-normoxia group. ROS was significantly higher in Ad-GFP transfected-hypoxia group than that in Ad-GFP transfected-normoxia group (P<0.05), while no marked difference was found either between Ad-HIF transfected-hypoxia group and Ad-HIF transfected-normoxia group or between Ad-HIF transfected-hypoxia group and Ad-GFP transfected-hypoxia group. The content of NO and iNOS activity were significantly higher in Ad-HIF transfected-normoxia group and Ad-GFP transfected-hypoxia group than those in Ad-GFP transfected-normoxia group (P<0.05), no marked difference was found either between Ad-HIF transfected-hypoxia group and Ad-GFP transfected-hypoxia group or between Ad-HIF transfected-hypoxia group and Ad-HIF transfected-normoxia group. CONCLUSION: Higher HIF-1α expression is contributed to protective effects against hypoxic injury in HepG2 cells, the mechanisms of which may be correlated with promoting expression of gene regulated by HIF-1 and restraining over-expression of injure factors.

OBJECTIVE:To improve the synthesis technology of sorafenib tosylate (Ⅰ). METHODS:The intermediate N-methyl-(4-chlorpyridin-2-yl)carboxamide(Ⅳ)was obtained by chlorination and amidation with 2-picolinic acid as the starting com-pound. Meanwhile,N-[4-chloro-3-(triflouromethyl)phenyl]-N′-(4-hydroxyphenyl)urea (Ⅶ) was prepared from aminophenol and 4-chloro-3-trifluoromethyl phenyl isocyanate,which was obtained from 4-chloro-3-(trifluoromethyl)aniline(Ⅴ)by reaction with initiator triethylamine. Sorafenib tosylate was synthesized from Ⅳ and Ⅶ with potassium tert-butoxide by condensation and salt for-mation. The target compound was characterized by 1H-NMR. RESULTS:The target compound was confirmed as Ⅰ,with the over-all yield of 74% [based on 4-chloro-3-(trifluoromethylanilin)]. The purification of chromatogram was 94%. Optimized technology improves yield and simplifies multi-step intermediate decompression,distillation and purification process;the application of initia-tor shortens the duration of reaction. CONCLUSIONS:Ⅰ is prepared successfully,and raw material can be obtained easily and is easy to operate with high yield.

ObjectiveTo explore the clinical effects of forearm cutaneous neurovascular flaps to be used on repairing remote wound.Methods17 cases of soft tissue defect of head and facial region and upper extremity were repaired with forearm cutaneous neurovascular flaps.Results The flaps of 16 cases were entirely survived, partial necrosis appeared in 1 case and healed after changing dressing.Following up for 3 to 6 months, the quality and shape of all the flaps and function recovery of all patients were satisfied.ConclusionsWith adequate blood supply, the survival rate of forearm cutaneous neurovascular flaps is high and the procedure to repair remote wound is easy, and it is one of best ways to repair the soft tissue defect in head and facial region and upper extremity with forearm cutaneous neurovascular flaps.

Objective To investigate the different effects of internal and external biliary drainage on the levels of TNF-α,NO in blood serum and NO,inducible nitric oxide synthase(iNOS) in gastric mucosa with obstructive jaundice and explore the mechanism of gastric mucosa damage and compare the quality of internal and external drainage.Methods To establish the animal model:one hundred male adult Sprague-Dawley rats were randomly assigned to five groups:obstructive jaundice for 7 days group (OJ-7 d group),obstructive jaundice for 14 days (OJ-14 d group),internal biliary drainage group(ID group),external drainage group(ED group)and sham operation group(SH group).The OJ-7 group rats were executed 7 days after the first operation,the rest four groups were executed 7 days after the secondary surgery,leaving serum and gastric mucosa.Tested the levels of INF-α,NO in blood serum and NO,iNOS in gastric mucosa and did pathological biopsy of gastric mucosa.Results The levels of TNF-α,NO in blood serum and NO,iNOS in gastric mucosa significantly increased in OJ-7 group.The levels of TNF-α,NO in blood serum and NO,iNOS in gastric mucosa continued to rise in OJ-14 group,and was significantly higher than OJ-7 group,the gastric mucosa was obviously impaired.The levels of TNF-α,Internal drainage can significantly NO in blood serum and NO,iNOS in gastric mucosa were significantly lower in ID group,gastric mucosal damage significantly reduced.Conclusions After internal drainage,iNOS expression was inhited in gastric mucosal,NO production was significantly reduced,led to protect the gastric mucosa,which provide experimental basis for choice in OJ clinical treatment.

Aim To explore the effect of nNOS specific inhibitor 7-nitrioindazole(7-NI) on the neurogenesis after focal cerebral ischemia in the adult mice dentate gyrus.Methods Focal cerebral ischemia was induced by middle cerebral artery occlusion(MCAO).A bromodeoxyuridine(BrdU) method was used to identify the proliferated cells in hippocampal dentate gyrus.Step-down test was performed to assay the learning and memory function.Results The number of BrdU~+ cells was increased in the ipsilateral but not contralateral dentate gyrus after focal cerebral ischemia.7-NI promoted the increment in the ipsilateral dentate gyrus significantly.7-NI also improved the survival of the new-born cells,as well as the learning and memory function of ischemic mice.Conclusion Our results indicate that nNOS down-regulates the neurogenesis after focal cerebral ischemia.

Objective To analyze the risk factors for the failure of noninvasive mechanical ventilation (NIV) in the treatment of acute exacerbation of chronic obstructive pulmonary disease (AECOPD),and to help the clinical risk assessment and decision making.Methods A retrospective case control study was conducted.The patients with AECOPD undergoing NIV admitted to Kaifeng Emergency Center from June 2011 to March 2016 were enrolled,and they were divided into two groups according to whether NIV was successful or not within 12 hours.The nutritional status,blood gas analysis,serum electrolytes,D-dimer,renal function,serum pre-albumin,as well as kinetic vital signs,Glasgow coma scale (GCS) score,expression of respiratory distress,and spontaneous expectoration were recorded.Logistic forward stepwise regression analysis was used to analyze the factors for failure of NIV.Results 122 patients.with the initial NIV were enrolled,with NIV failure in 41 patients within 12 hours,accounted for 33.6％.Compared with NIV success group,the percents of respiratory rate ≥ 25 breaths/min (75.6％ vs.17.3％),expectoration disorders (78.0％ vs.19.8％),circulatory disorders (61.0％ vs.18.5％),malnutrition (61.0％ vs.11.1％),decreased serum pre-albumin (58.5％ vs.17.3％),and GCS score ＜ 12 (75.6％ vs.28.4％) in NIV failure group were significantly increased (all P ＜ 0.05).But there were no significant differences in gender,age,body temperature,blood gas analysis,D-dimer,serum creatinine between two groups.It was shown by the results of binary logistic regression analysis that respiratory rate,expectoration disorders,circulatory disorders,malnutrition,serum pre-albumin,and GCS score were the factors of NIV failure [odds ratio (OR) values were 10.879,6.338,9.860,23.273,8.862,6.774,and P values were 0.011,0.038,0.024,0.003,0.015,0.041,respectively].It was shown by the results of logistic stepwise regression analysis that respiratory rate ≥ 25 breaths/min,expectoration disorders,circulatory disorders,malnutrition,decreased serum pre-albumin,and GCS score ＜ 12 were independent risk factors of NIV failure (OR values were 6.610,5.403,5.138,8.153,4.979,5.100,and P values were 0.007,0.013,0.023,0.007,0.027,0.023,respectively).Conclusions The multiple independent risk factors can induce NIV failure within 12 hours in emergency patients with AECOPD,i.e.increased respiratory rate,expectoration dysfunction,circulatory disorders,malnutrition,decreased serum pre-albumin,and decreased GCS score.Emergency physicians should pay attention to these early risk factors in AECOPD patients,which can be taken as correct judgment and guide.

This study aimed at exploring the application of microtox technology to the evaluation of comprehensive toxicity of Sheng Mai injections.Characteristic parameters of vibrio fischeri (CS234) were measured by methodology inspection under different conditions to optimize the reaction condition with reliable technology.It was the first experiment to accomplish the comprehensive toxicity of Sheng Mai injections from various manufacturers using vibrio fischeri under the target condition.It was found that parameters of the optimum condition contained 0.9 mL recovery liquid volume in each freeze-dried vial and 50 μ L bacteria suspension of each sample,being included in 2 mL solution in aggregate under 10 mins' detection time after adding bacteria suspension with the favorable pH value ranging from 5 to 10 and luminous intensity from 0.8 to 1.2 million within 10 mins.The relative standard deviation values of replication experiment and precision test were all below 15％.Under this optimum detection condition,it was found that the EC50 values were 22.10％,34.10％ and 46.04％,respectively,presenting significant statistical differences (P＜0.05).These results demonstrated that the growth of biological detection standards of Sheng Mai injection was highlighted a long way to go.Besides,the microtox-based fast test for the evaluation of the comprehensive toxicity of Sheng Mai injection showed a prospective application to controlling the quality of different products from manufacturers.

This study aimed at exploring a new method--microtox technology to evaluate the comprehensive toxicity of safflower injections from different drug manufacturers.In the experiment,we investigated the characteristic parameters of vibrio fischeri (CS234) under different conditions,and then locked the optimum parameters for safflower injection assay:recovery liquid volume 0.9 mL in freeze-dried vial,50 μL bacteria suspension in each sample,and the detection time of 10 mins after adding the bacteria suspension.Under this optimum detection condition,we found that the EC50 values were 3.36％,5.58％ and 4.33％,being significantly different between 3 representative drug manufacturers (P ＜ 0.05).In conclusion,it was implied that the biological detection standards of safflower injections need improving,while the microtox-based fast test of the comprehensive toxicity of safflower injection showed a favorable and prospective application to controlling the product qualities of different manufacturers.