Objective To observe the effect of Shenxiong injection on the changes of brain X-box binding protein 1 (XBP1) gene expression following cerebral ischemia-reperfusion in rats and to investigate its neuroprotective effect and mechanisms. Methods One hundred forty-four male SD rats were randomly assigned to sham-operation, saline control and Shenxiong groups. A rat model of middle cerebral artery occlusion was induced using the suture method. Shenxiong injection 33.3 ml/kg was injected intraperitoneally during the reperfusion in the Shenxiong group. The same volume of saline was injected intraperitoneally in the saline control group. The animals were sacrificed at 6, 12, 24, and 72 hours after the reperfusion.Meanwhile, immunohistochemical staining and reverse transcription-polymerase chain reaction (RT-PCR) were used respectively to detect the expressions of XBP1 protein and mRNA in the cerebral ischemic areas. TUNEL was used to detect neuronal apoptosis. Results The levels of XBP1 protein and mRNA increased after the reperfusion, and it reached the peak at 12 hours; both the numbers of apoptotic cells and neurological scores in the Shenxiong group were lower than those in the saline control group at 6, 12, 24, and 72 hours after the reperfusion (all P ＜0.01); the levels of XBP1 and mRNA at 6, 12, and 24 hours after the reperfusion were alsosignificantly lower than those in the saline control group (all P ＜ 0.01). Conclusions Shenxiong injection may have certain inhibition on the endoplasmic reticulum stress activated XBP1 pathway induced by cerebral ischemia-reperfusion.

Objective To investigate clinical effects of cutaneous branch flaps of the low medial leg for the repair of soft tissue defects on the foot and ankle.Methods A flap with pedical of cutaneous branches of the low medial leg was used for the repair of 7 cases of skin and soft tissue defects on the feet and ankle from March 2003 to October 2005.The cutaneous branches of the posterior tibial artery were identified along the medial border of the tibia and between the soleus muscle and the flexor digitorum longus muscle.The flap was mobilized according to the site and length of the cutaneous branches,and was transferred to soft tissue defects for skin grafting. Results The operating time was 3~5 hours(mean,4.2 hours).The flaps survived completely in all the 7 cases.Follow-up checkups were carried out for 5~18 months(mean,10 months).The appearance and functions of the foot were satisfactory and met the requirements for daily activities.Conclusions The procedure can effectively repair soft tissue defects on the foot and ankle and does not sacrifice the major arteries.This flap is easy to be prepared.

Objective To investigate chemokine receptor CX3CR1 gene T280M polymorphism in patients with ischemic cerebrovascular disease(ICVD) and its frequency.Methods 165 patients with ICVD(cerebral infarction 85 cases,lacunar infarction 40 cases,transient ischemic attack 40 cases) and 150 age- and sex-matched healthy controls(normal control group) were involved in this study.The polymorphism of T280M was analyzed by multiplex polymerase chain reaction-restriction fragment length based(PCR-RFLB),the gene frequency was compared between two groups and each ICVD subgroups.Results There were TT and TM genotypes in normal control group,and TT,TM and MM genotypes in ICVD group.The genotype were significant differences between the two groups(P0.05).Conclusions There is MM genotype in the chemokine receptor CX3CR1 gene T280M in the patients with ICVD,and their M allele frequency obviously increase.It suggests that CX3CR1 gene T280M polymorphism may be associated with ICVD.

Objective To investigate the expression of C/EBP homology protein(CHOP) in rat brain tissue after focal cerebral ischemia-reperfusion,as well as to observe the influence of the shenxiong injection on the expression of CHOP.Methods One hundred forty four male rats were randomly divided into three groups:the sham-operation group,operation group,shenxiong group.Focal cerebral ischemia and reperfusion rat models were established by using suture.Zea Longa method was introduced to evaluate neurologic behavioral changes.The levels of mRNA and protein of CHOP were measured with methods of immunohistochemistry and reverse transcription polymerase chain reaction.The neuronal apoptosis was detected by the method of terminal deoxynucleotidy1 transferase-mediated dUTP-biotin nick end labeling.Results The expression of CHOP was up-regulated in per-infarction after cerebral ischemia-reperfusion in rats.CHOP mRNA and protein levels peaked at the 12th h and 24th h after reperfusion,respectively.The apoptosis cell counting increased gradually after cerebral ischemia-reperfusion and peaked at the 24th h after reperfusion.Compared with the saline control group,treatment with shenxiong injection could reduce the neuronal apoptosis at the 6th,12th,24th,and 72nd h after reperfusion (P ＜0.01).Compared with the saline control group,treatment with shenxiong injection could decrease CHOP mRNA and protein expression at the 6th,12th,24th,and 72nd h after reperfusion (P ＜0.01).Conclusions Shenxiong Injection may prevent neurocyte from apoptosis by inhibition of the expression of CHOP induced by endoplasmic reticulum stress.

ObjectiveTo assess the clinical value of procalcitonin (PCT) in the diagnosis of sepsis in adults.Methods An extensive search for related literature from the Wanfang data, CNKI, VIP, Medline/PubMed, Embase/OvidSP and the Cochrane Library up to December 2014 was performed. The articles, including prospective observational studies or randomized controlled trials, regarding PCT for the diagnosing of sepsis were enrolled. Only patients older than 18 years were included. Patients with sepsis, severe sepsis, or septic shock served as the experimental group, and those with a systemic inflammatory response syndrome (SIRS) of non-infectious origin as control group. The language of literature included was English or Chinese. The quality of the studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Heterogeneity, pooled diagnostic odds ratio (DOR), pooled sensitivity, pooled specificity, pooled positive likelihood ratio, pooled negative likelihood ratio, the area under the summary receiver operating characteristic curve (SROC) and subgroup analysis were analyzed with the software of Metadisc 1.4.Results A total of 6 385 published reports were collected, and among them 24 met the inclusion criteria, including a total of 3 107 patients. The studies showed substantial heterogeneity (I2 = 69.4%), and random effect model was used for Meta analysis, showing that the pooledDOR was 10.37 [95% confidence interval (95%CI) = 7.10-15.17]. No evidence of a threshold effect was found (Spearman correlation coefficient = 0.27, calculated by logarithm of sensitivity and logarithm of 1-specificity,P = 0.20). TheDOR values of pooled and each study were not distributed along the same line in forest plots, and Cochran-Q = 78.33,P = 0.000 0, showing that there was heterogeneity in result from non threshold effect. Except for partial heterogeneity caused by non threshold effect, the result of Meta regression analysis including PCT detection method, categories of disease, research location and so on showedP values were all higher than 0.05. Thus, the heterogeneity could not be explained by Meta regression analysis. The pooled sensitivity was 74% (95%CI = 72%-76%), the pooled specificity was 70% (95%CI = 67%-72%), the pooled positive likelihood ratio was 2.79 (95%CI = 2.31-3.38), the pooled negative likelihood ratio was 0.34 (95%CI = 0.28-0.41), and the pooled AUC was 0.83 (95%CI = 0.79-0.87). AUC in medical patients was 0.80 (95%CI = 0.75-0.85), which was higher than that in surgical patients [0.71 (95%CI = 0.65-0.81)].Conclusions Our results indicate a moderate degree of value of PCT for diagnosis of sepsis in adult patients. The diagnostic accuracy in medical patients is higher than that in surgical patients. PCT is a good auxiliary biomarker for diagnosis of sepsis.

Objective:To imestigate the effect of Shenxiong injection on neuronal aooptosis and Fasassociated death dormin protein(FADD)and its mRNA expression after ischernia-reperfusion in rats.Methods:Atotal of 100 SD rats wgre randomly allocated into normal(n=10),sham-operation(n=10),cerebral ischemia-reperfusion(n=40),and Shenxiong injection(n=40)groups.A model of middle cerebral wtery occlusion was induced by suture method.The neuronal apoptosis was detected by the TUNEL assay.The expressions of FADD protein and mRNA were detected by inmmnohistochemical staining and reverse tramcription-polymerase chain reaction(RT-PCR),respectively.Results:As compared with the normal and sham-operation groups.the numbers of apoptotic cell in the cerebral ischemia-reperfusion group were increased significantly(P＜0.01),and the expressions of FADD protein and mRNA were enhanced significantly(all P＜0.01).As compared with the ceretral ischemia-reperfusion group,the numbers of apoptotic cell were decreased significantly (P＜0.05,P＜0.001),and the expressiom of FADD protein and mRNA were reduced significantly in the Shenxiong group(P＜0.05,P＜o.001).Convlusions:Shertxiong injection may inhibit the neuronal apoptosis after ischemia-reprfusion in r-cas by down-regulaftng the expression of FADD.

Identifying the goals of outstanding doctor tralning and orienting medical students' competency, we conducted rational integration and construction of curriculum system for graduate students of clinical medicine and implemented 5 modes of module teaching including professional course, foreign language course, practical skill course, scientific research course and comprehensive ability course . According to the different characters of courses and professional development , we adopted multi-dimensional teaching methods and input the quality education throughout the whole teaching process. These efforts promoted the reform of graduate course evaluation system and provided effective security for improving teaching contents, teaching methods, teaching means and evaluating methods.

Objective To investigate the treatment values of precise target delineation of chest MRI for lung cancer Methods From August 2011 to February 2015 , 45 non-small cell lung cancer patients were given chest CT scans and MRI scans before radiotherapy , and then active target tumor delineation , then related influencing factors were analyzed. Results All patients completed CT scans and MRI positioning. For patients that it was difficult to identify lung tissue lesions caused by lung cancer through CT , their MRI imaging showed high signal and the boundaries between the tumor and surrounding normal tissue became relatively clear. Meanwhile , 20 patients of borders were diagnosed by CT , while 25 by MRI; 36 patients with lymph node metastasis were diagnosed by CT while 40 by MRI. The difference was statistically significant (P<0.05). Univariate logistic regression analysis showed that pathological type and atelectasis were the influence factors for CT and MRI tumor target delineation differences (P<0.05), and multivariate logistic regression analysis showed the atelectasis was the main factor (P<0.05). Conclusion Compared with CT, breast MRI can precisely delineate target to improve the accuracy of target localization before radiotherapy. It can help determine lymph node metastasis and avoid the impact of atelectasis then ensure the accuracy of radiotherapy.

By co-culturing humm mesenchymal stem cells (hMSCs) and human umbilical rein endothelial cells (HUVECs) under hypoxia and creating a microenvironment similar to that of transplanted hMSCs for the treatment of avascular ni ANFH, the effect of hMSCs on survival, apoptosis, migration and angiogenesis of human umbilical vein endothelial cells (HUVECs) under the hypoxic condition were investigated in vitro. hMSCs and HUVECs were cultured and identified in vitro. Three kinds of conditioned media, CdM-CdM(NOR), CdM-CdM(HYP) and HUVEC-CdM(HYP) were prepared. HUVECs were cultured with these conditioned media under hypoxia. The survival rate, apoptosis rate, migration and angiogenesis of HUVECs were respectively detected by CCK-8, flow cytometry, Transwell and tube formation assay. The content of SDF-1α, VEGF and IL-6 in CdM was determined by ELISA. Our results showed that hMSCs and HUVECs were cultured and identified successfully. Compared with MSC-CdM(NOR) and HUVEC-CdM(HYP) groups, the survival rate, migration and angiogenesis of HUVECs in MSC-CdM(HYP) group were significantly increased while the apoptosis rate was declined (P<0.05). Moreover, the expression of SDF-1α, VEGF and IL-6 in MSC-CdM(HYP) group was up-regulated. Under hypoxia, the apoptosis of HUVECs was inhibited while survival, migration and angiogenesis were improved by co-culture of hMSCs and HUVECs. The underlying mechanism may be that hMSCs could secrete a number of cytokines and improve niche, which might be helpful in the treatment of femoral head necrosis.

Objective To evaluate the occupational competency of clinical post-graduate students by the 360-degree feedback system.Methods The occupational competencies of the 102 clinical post-graduate students were evaluated by department directors, teachers, the superior band taught physicians, peers, post-graduate themselves using a self-designed questionnaire.The evaluation content of professional competence included 12 core elements, such as medical knowledge, clinical skills, and professional ethics and so on.EpiData 3.02 was used to establish the database, SPSS 19.0 software was used to carry on the statistical analysis, and the statistical analysis method was mainly for the descriptive statistics analysis, the single factor analysis of variance.Results 5 kinds of evaluation subjects were statistically significant (P＜0.05) in medical knowledge, clinical skills, clinical thinking ability, lifelong learning ability, professional ethics, team cooperation ability, self cognition and management ability and total score.Students themselves and their peers scored high in various aspects, teaching superior doctors rated middle and the director and mentor gave low grade in all aspects and the scores rated by the department directors and teachers were lower than students themselves(P=0.003, P=0.047).Conclusion The 360-degree evaluation system can comprehensively and objectively evaluate the clinical post-graduate students' occupational competency and offer beneficial assistant to clinic and practice.