The combined teaching method of case-based learning and W2 H2 thinking-type learning was used in the comparative morphology experiment teaching.The teaching method can further strengthen the reform of the compar-ative morphology experiment teaching, and improve the quality of practice teaching.

Objective To observe whether bone marrow mesenchymal stem cells (MSCs) can promote the repair of IgA nephropathy and to explore its possible mechanism. Methods Sprague-Dawley rats were randomly divided into three groups which were MSCs injection group, normal saline(NS) infusion group and healthy control group. IgA nephropathy model was established by the improving method with BSA +SEB +CCl4 in former two groups. MSCs of SD rats were continuously cultured in vitro and identified with specific surface antigens by flow cytometry and osteogenic and adipogenic differentiation. MSCs were labeled with bromodeoxyuridine (BrdU) in vitro before transplanted. At 1st and 4th week after MSCs injection, the changes of body weight, urine protein, renal function, histopathology and IgA immunofluorescence were observed. MCP-1, TGF-β1 in urine were detected by ELISA. The expression of MCP-1, TGF-β1 in kidney were examined by RT-PCR. The cytokines and BrdU labeled MSCs were detected by immunohistochemistry to observe the disposition in kidney. Results At the end of the first week of MSCs transplantation, MSCs group urine protein (36.86±4.78) mg/24 h, serum creatinine (53.50±6.28) μmol/L, and the NS group urine protein (66.98±5.86) mg/24 h, serum creatinine (82.50±8.36) μmol/L, the differences between two groups were significant (P<0.05). At the same time, the content of MCP-1, TGF-β1 in urine and expression in renal tissue of MSCs group were obviously less than those of NS group (P <0.05). At the end of the 4th week, the body weight, histopatholngy, IgA immunofluorescence of MSCs group were remarkably improved as compared with those of NS group. The content of MCP-1, TGF-β1 in urine and expression in renal tissue, and renal pathological change in MSCs group had no significant differences as compared with those of healthy control group. As the time passed, the disposition of BrdU-labeled MSCs in kidney was taper. Conclusions MSCs injection contributes to renal repair in rat IgA nephropathy. The mechanism may partly depend on adjusting the excretion of cytokines in renal microenvironment and/or other functions rather than completely depend on their differentiation to renal cells.

OBJECTIVE: To observe the effect of perioperative administration of rhubarb on the acute inflammatory response in patients with gastric cancer. METHODS: In this prospective, single-blinded, controlled clinical trial, thirty-one patients with gastric cancer operatively treated were randomly divided into two groups, with 14 patients in control group and 17 in study group. Patients in both groups were given an isocaloric and isonitrogenous enteral diet. The enteral diet was started 36 hours after operation, and continued for 6 days. Patients in the study group were fed with rhubarb before operation, and at 1 day and 2 days after operation. Indexes of acute inflammatory response such as serum C-reactive protein (CRP), interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-alpha), and indexes of nutritional status such as serum albumin (ALB), prealbumin (PA) and transferrin (TRF) were measured before operation, and at 1 day, 3 and 7 days after operation. RESULTS: Patients in both groups had acute inflammatory response, and the indexes of nutritional status decreased after operation.IL-6, CRP and TNF-alpha tested at 3 and 7 days after operation were lower in the study group as compared with those in the control group, and the recovery time of gastrointestinal motility such as borborygmus, gas elimination and defecation was shorter in the study group as compared with that in the control group. The indexes of nutritional status showed no significant differences between two groups after operation. CONCLUSION: Rhubarb can positively modulate the acute inflammatory response, promote the recovery of postoperative gastrointestinal motility, and benefit enteral nutrition support in patients who have undergone major operations for gastric cancer.

Objective To investigate the effect of preoperative acute hypervolemic hemodilution with 6% hydroxyethyl starch 130/0.4(HES130/0.4)and polygeline on hemodynamic response and variance regularity of hemodynamic response in open-and close-thoracic cavity in undergoing thoracotomy patients. Methods Sixty patients undergoing thoracotomy,ASA physical status ⅠorⅡ,aged 20~65 yeansold,weighing 45~70kg,were randomly divided three group:HES130/0.4 group ( group A,n=20) ,Polygeline group ( group B,n=20) and Ringer's solution group (group C,n=20).They were respectively infused 20ml/ (kg?h) with HES130/0.4,polygeline and Ringer's solution in one hour before infuseing followed Ringer's 10ml/ (kg?h). The Blood Pressure (BP) and heart rate (HR) were recorded.RPP was calculated before induction(baseline),5min before and 10 min after open thoracic cavity,5min before and 10min after close thoracic cavity. And central venous pressure (CVP) was measured at immediately after deep venous puncture ,5min before and 10min after open thoracic cavity,5min before and 10min after close thoracic cavity. Results The changes of hemodynamics in Ringer's solution group in operation were obvious as compared with baseline before operation.HES130/0.4 and polygeline were relatively stable.Two groups had no significant difference.The CVP of HES130/0.4 and polygeline groups increased obviously before and after open thoracic cavity,but the blood pressure was relatively stable.Only systolic blood pressure increased obviously as compared with Ringer's solution group at 5min before open thoracic cavity. At 10min after open thoracic cavity,HR and CVP in three groups increased obviously as compared with 5 min before open thoracic cavity.At 5 min before close thoracic cavity,blood pressure and CVP in three groups decreased obviously as compared with 10 min after open thoracic cavity. Conclusion The preoperative acute hypervolemic hemodilution with HES 130/ 0.4 and polygeline in undergoing thoracotomy patients can keep hemodynamics more stable and improve tolerance of patients to withstand hypovolemics.

Objective To study the epidemiological and clinical features of human parainfluenza virus (HPIV) infection in children in Suzhou,and to provide the evidence-based foundation for early warning,diagnosis and treatment of respiratory infection in children.Methods The sputum specimens and medical history were obtained from children with acute respiratory tract infection hospitalized at the Childen's Hospital Affiliated to Soochow University from January 2006 to December 2015.Seven kinds of common respiratory viruses including respiratory syncytial virus,influenza virus A,influenza virus B,HPIV Ⅰ,HPIV Ⅱ,HPⅣV Ⅲ and adenovirus were detected by using the direct im-munofluorescence.Mycoplasma pneumoniae(MP),chlamydia pneumoniae,human bocavirns (hBoV) were detected by using fluorescence quantitative PCR.Rhinovirus and human metapneumovirus were detected by using reverse transcription-PCR.Sputum was cultured for bacteria.Results In 21 769 cases,the detection rate of HPIV positive was 3.21％ (829 cases),among which,HPIV Ⅰ,HPIV Ⅱ,HPIV Ⅲ were respectively detected in 113 cases (0.52％),16 cases (0.07 ％) and 700 cases (3.21％),respectively.There were 378 cases of simple infection and 428 cases of mixed infection,and the mixed infection was very common in Streptococcus pneumoniae,Haemophilus influenza,MP and hBoV.There was a difference in HPIV infection among genders,and the detection rate of the boys was higher than that of girls[4.14％ (563/13 591 cases) vs.3.25％ (266/8 178 cases),x2 =11.036,P =0.001].In the 28 d-1 year old and ＞ 1-3 year old group,the detection rate of HPIV was higher[4.71％ (494/10 476 cases) and 4.21％ (244/5 793 cases),respectively].In spring and summer,there was a higher detection rate of HPIV infection.The clinical manifestations with simple infection of HPIV Ⅰ and HPIV Ⅲ were cough,fever and wheezing.The rate of fever and shortness of breath in those of HPIV Ⅰ was 71.74％ (33/46 cases),10.87％ (5/46 cases),and that in HPIV Ⅲ was 40.12％ (134/334 cases),2.10％ (7/334 cases),HPIV Ⅰ infection was more likely to cause fever and shortness of breath than those of HPIV Ⅲ,there were significant differences (x2 =16.410,P ＜ 0.001;x2 =10.177,P =0.001).Pneumonia had the highest detection rate of viral infection.Conclusions HPIV Ⅲ is the leading pathogen among the types of HPIV in the hospitalized children in Suzhou area.Among the subtypes of HPIV,the peak of HPIV infection occurs in spring and summer.The children less than 3 years old are the most susceptible to parainfluenza virus,and the HPIV detection rate is gradually declines with age.

Objective To explore the significance of MYCN gene amplification in children with neuroblastic tumors(NT).Methods The clinicopathological data of 154 cases with NT were reviewed,including general data, classification of pathology,clinical stage and prognosis.MYCN gene amplification was detected by fluorescence in situ hybridization(FISH) and its relationship between pathological characteristics and prognostic significance was analyzed.Results There was 154 cases of NT aged 1 day to 11 years,with a mean age of 26.1 months,and the median age of 20.5 months.Male and female ratio was 1.48 : 1.00.According to International Neuroblastoma Staging System (INSS) ,20 cases were of stage Ⅰ (13.0％) ,23 cases of stage Ⅱ (14.9％) ,43 cases of stage Ⅲ (27.9％) ,64 cases of stage Ⅳ(41.6％) and 4 cases of Ⅳs (2.6％).There were 72 cases(46.8％) with favorable histology,and 82 cases(53.2％) with unfavorable histology.MYCN amplification was found in 20 cases (13.0％) and the signal ratio of MYCN and chromosome 2 (CEP2) was 4.08-43.29.One hundred and thirty-four cases of MYCN non-amplification included MYCN gain in 91 cases(68.0％) ,MYCN negative in 43 cases(32.0％).MYCN expression showed the significant differences in ages, neuroblastoma type, international neuroblastoma pathology classification (INPC), mitosis karyorrhexis index (MKI), and clinical stages (all P ＜ 0.05).No significant difference was found in gender(P ＞ 0.05).Of 20 MYCN amplification cases,4 cases (20.0％) survived and 16 cases (80.0％) died,and the overall survival rate was 20.0％ (4/20 cases) ,with survival time was (17.10 ± 2.24) months;of 134 MYCN non-amplification cases,96 cases (71.6％) survived and 38 cases (28.4％) died, with survival time of (28.71 ± 1.28)months.Survival analysis showed the cases with MYCN amplification had worse prognosis (x2 =19.596, P ＜ 0.05).Conclusions Patients with MYCN amplification had poorer prognosis and lower incidence of MYCN amplification of pediatric NT was found in China.

Through the addition of discussion course associated with judicial expertise during the pre medical education, integration of true and typical forensic pathological cases into basic medical theory and experimental education, further addition of optional course of forensic medicine,and guiding the medical students applying the scientifically training projects about forensic pathology, students may improve their learning interesting and clinical thought, and are made early warning and increase the abilities of preventing and dealing with the suddenly medical tangles in the future, at the same time, the medical teachers also increase their professional levels and teaching qualities.These benefit the growing up of high quality medical doctors, decrease and even prevent the happening of medical tangles.

Objective To explore the relationship between the clinical features and the bacteria quantity confirmed by semi-quantitative culture of sputum in hospitalized infants with wheezing diseases.Methods Nine hundred and fifty-seven patients with wheezing diseases were enrolled from Jan.1,2010 to Dec.3 1,2011,and their clinical characteristics were collected.Respiratory seeretions were collected on admission by the pathogenic examination.They were grouped into 3 groups by the bacteria quantity,and the predictive analytics statistical saftware 20.0 was used to analyze the relationship between the clinical features and the bacteria quantity confirmed by semi-quantitative culture of sputum.Results 1.A total of 372(38.87％,372/957 cases)patients had positive sputum cuhures,and there were 585 patients in 0 + group,225 patients in 1 +-2 + group,147 patients in 3 +-4 + group;the main pathogens in 1 +-2 + group were haemophilus influenza (24.89％,56/225 cases) and streptococcus pneumonia (16.00％,36/225 cases) ;the main pathogens in 3 +-4 + group were streptococcus pneumonia(54.42％,80/147 cases) and haemophilus influenza(8.84％,13/147 cases).2.Presence of siblings,cyanosis,neutrophils and C-reactive protein were higher in 3 +-4 + group when compared with those of 0 + group,shortness of breath was common in 1 +-2 + group.3.Multinomial Logistic regression analysis identified the presence of siblings,residence,passive smoking,course of disease and cyanosis were identified as risk factors in 3 +-4 + group; gender,fever peak ＞ 38.5 ℃,breast-feeding,passive smoking,age,course of disease and cyanosis were as risk factors in 1 +-2 + group.4.Severe pneumonia was common in 3 +-4 + group.Conclusions Bacterial are often detected in infants hospitaled with wheezy episodes,and bacteria quantity is correlated with clinical presentation.Severe pneumonia is common in higher bacteria quantity group.

Objective To explore the the role of fraction exhaled nitric oxide(FeNO) in airway inflammation of Mycoplasma pneumoniae pneumonia(MPP).Methods Inpatients with low respiratory tract infection were enrolled from August to November in 2012,69 patients had MPP and 33 had no MPP(non-MPP).Patients with MPP were further grouped into a bronchopneumonia group and the lobar pneumonia group.Fifty-four inguinal hernia patients without respiratory tract infection during the last 2 weeks were enrolled as a control group.FeNO was measured by nitric oxide analyzer.Eosinophile level was detected by blood cells analysator.Results The level of FeNO in patients with MPP [(6.28 ±3.00) ppb] was lower than that of patients of non-MPP [(10.85 ± 2.86) ppb] and the control group [(9.74 ± 3.10) ppb] (t =7.30,6.26,respectively,all P ＜ 0.000 1) ; the level of FeNO between the bronchopneumonia group [(5.78 ± 3.06) ppb] and the lobar pneumonia group [(6.48 ± 2.98) ppb] with infection of Mycoplasma pneumoniae (MP) had no statistical significance(t =0.88,P ＞0.05).The proportion of blood eosinophile in patients with MPP [(0.60 ±0.51) ％] was lower than that of non-MPP group [(1.15 ± 0.76) ％] (t =4.14,P ＜ 0.000 1) ; the proportion of blood eosinophile between bronchopneumonia group [(0.61 ± 0.57) ％] and lobar pneumonia group [(0.60 ± 0.55) ％] with infection of MP had no discrepance (t =-0.05,P ＞0.05).Conclusions MP infection decreases production of FeNO.The possible mechanism for this phenomenon is that the cilia loss and hyperimmune response to MP may affect the production of FeNO.The airway inflammation of mycoplasma pneumonia is associated with cilia loss and hyperimmune response.

Objective To explore the correlation of meteorological parameters with the epidemic of acute Moraxella ca-tarrhalis respiratory infection in hospitalized children in Suzhou. Methods A total of 8143 children with acute respiratory infec-tion were participated in the trial during 2006 to 2010, and the secretions of nasopharynx were collected for bacterium culture. Moraxella catarrhalis was identified according to the routine technique of culture. Meteorological parameters including mean temperature, relative humidity, rainfall amount, duration of sunshine and mean wind velocity were collected monthly during the same period. The relationship between the epidemic of Moraxella catarrhalis and metrorological parameters were analyzed by seasonal decomposition method, the Spearman rank correlation and stepwise regression analysis. Results Moraxella catarrhalis was identified in 4.04% of 8 143 specimens. The prevalence of acute Moraxella catarrhalis respiratory infection was higher during winter and spring. The monthly infection rate of Moraxella catarrhalis was negatively correlated with mean temperature as well as duration of sunshine and wind velocity. Wind velocity was independent risk factor for Moraxella catarrhalis infection. Conclusions Moraxella catarrhalis is a primary pathogen in respiratory tract infection in children in Suzhou. The epidemic of Moraxella catarrhalis is closely related to meteorological parameters.