Standardized residency training is the main form of postgraduate medical education.In this article, we analyzed a delayed diagnosed case with Cushing syndrome.The patient saw the doctors in provincial level hospitals for many times within a year, while specialists missed diagnosis by only concerning the symptoms related to their own specialties, instead of integrating all the manifestations.We believe that standardized residency training provides residents a broader horizon of related specialties, which is irreplaceable by fellowship training program, and is the essential of comprehensive analysis of complex clinical situations.Standardized residency training will also be helpful for diminishment of the educational gap between different medical colleges and improvement the medical level of the whole nation.

Objective To observe the influence of bone marrow mesenchymal stem cells (BMSCs) transplantation on the expression of alpha-amino hydroxymethyl-oxazole propionic acid (AMPA) receptors GluR1 and GluR2 in rats with spinal cord injury (SCI) so as to investigate the potential anti- chronic stress mechanism of BMSCs transplantation in treatment of rats with spinal cord injury.Methods A total of 48 adult male SD rats were equally divided into three groups:control group,treatment group and model group.The rats in the model and treatment group underwent lower thoracic SCI with the modified Allen' s method,and the rats in control group received only laminectomy.At day 7 after thoracic SCI,100 μl of Hank's buffered saline solution containing 1.0 × 106 BMSCs was injected into the subarachnoid space from L4-L5 intervertebral space in the treatment group and control group,and the same amount of Hank' s buffered saline solution was injected in the model group.The motor function of the rat posterior limbs was assessed by Basso-Beattie-Bresnahan (BBB) scale before and after operation.Half of the rats were anesthetized at days 14 and 28 postoperatively to harvest brains which were frozen and cut in a cryostat to detect the expressions of GluR1 and GluR2 proteins by immunohistochemistry.Results After BMSCs transplantation,the motor function of the posterior limbs in the treatment group was improved progressively.At day 14 after transplantation,the number of GluR1-positive cells of the model and treatment group was higher than that of the control group in the hippocampus CA1 region (P ＜0.05,P ＜0.01 respectively) ; GluR2-positive cells had the similar tendency,without significant difference(P ＞ 0.05 ).At the 28th day after transplantation,GluR1 positive cells of the model group were higher than those of the control group in CA1,CA3,DG regions and those of the treatment group in CA1,CA3 regions (P ＜0.05,P ＜0.01,respectively) ; GluR1 positive cells of the model and treatment group were higher than their counterpart at day 14 after grafting procedure,with significant difference (P ＜0.05,P ＜0.01,respectively).GluR2 positive cells of the treatment group were higher than those of the control group in the basolateral amygdale (BLA) (P ＜0.05 ) and had similar tendency with GluR1 expression in other regions ( P ＞ 0.05 ).Conclusion BMSCs transplantation implies a potential antichronic stress mechanism of SCI rats,since it can improve the motor function of posterior limbs in rats with lower thoracic SCI and regulate the expressions of AMPA receptor GluR1 and GluR2.

Objective To investigate the effect of low dose radiation on the expression of p16 gene in chronic myelogenous leukemia.Methods Leukemic stem cells(LSCs)which expressed CD34+,CD38- and CD123+ were isolated from bone marrow cells obtained from twenty patients newly-diagnosedas chronic myeloid leukemia with EasySepTM magnet beads.Hematopoietie stem cells(HSCs) which expressed CD34+ and CD38- were isolated from human cord blood cells obtained from twenty full-term deliveries with EasySepTM magnet beads as control.HSCs vs LSCs samples were further divided into three dose groups,including 0,12.5 and 50 cGy,respectively.RT-PCR and real-time quantitative reverse transcription-polymerase chain reaction methods were used to detect mRNA expression of p16 gene in HSCs and LSCs after irradiation.Cells were harvested at different time for detection of cell cycle and apoptosis by flow cytometer.Results p16 mRNA level in CML-LSCs was increased slightly at 12.5 cGy,and significantly increased at 50 cGy(Z=-3.39,P<0.01),but ho significant change was found in HSCs.The percentage of CML-LSCs cell in G0/G1 stagewas increased 48 h after 12.5 cGy irradiation,and 72 h post-irradiation with 50 cGy.The apoptosis rate of CML-LSCs was gradually raised after LDR,especially at 72 h post-irradiation of 50 cGy[(17.75±11.76)%vs(6.13±4.71)%,Z=-2.37,P<0.01 ].Conclusions p16 gene transcription could be up-regulated by low dose radiation,which might provide a theoretical evidence for CML therapy and LDR in leukemic clinical application.

Objective To develop allele specific oligonucleotide(ASO) -PCR assay based on TCR βgene rearrangements and provide a screening method for minimal residual disease (MRD) in adult patients with T-lineage acute lymphoblastic leukemia (T-ALL).Methods DNA samples from newly diagnosed 20 adult T-ALL patients were obtained.The TCR β gene rearrangements were detected by multiplex PCR,which included 38 paired of primers in 3 reaction tubes.Gel electrophoresis and two-color Gene Scanning was also applied for clonality analysis of TCR β followed by sequencing and subsequent blasting for monoclonal PCR products in four patients.ASO primers were designed based on the sequence of junction regions.MRD were detected in the bone marrow by RQ-PCR with ASO upstream primers, consensus Jβprobes and downstream primers.Results The detection rate of the clonal TCR β rearrangements was 85.0% (17/20).At least one complete Vβ-Jβ rearrangement could be detected at the time of diagnosis in 16 out of 17 patients(94.1%, 16/17).Incomplete Dβ-Jβ rearrangement could be detected in 7 patients (41.2% ,7/17).The positivitity rate of Vβ-Jβ to Dβ-Jβ was 2∶1 (94.1% versus 41.2% ).Two-color Gene Scanning analysis showed the Jβ2 family was used more frequently than the Jβ1 family (73% versus 27% ).The slopes of the standard curves ranged from - 3.60 to - 3.27.The correlation coefficients of all four standard curves were more than 0.99.The detection sensitivity of ASO-PCR was 4 × 10 -5 μg/μl.The fluorescence background were detected at a low level.Quantitative MRD values of TCR β rearrangement in sequential BM specimens of 4 adult T-ALL patients were monitored during the treatment, including complete remission after induction and after consolidation therapy. RQ-PCR showed the MRD values of TCR β rearrangement were gradually decreased in response to the treatment.Conclusions The quantification of TCR β rearrangement by ASO-PCR approach is sensitive, specific and reliable for the accurate evaluation of malignant clones.It is suitable for the monitoring of minimal residual disease of adult T-ALL patients.

Objective:To explore the expression of insulin-like growth factor-binding protein related protein 1(IGFBP-rP1) gene in children with acute leukemia and its potential significance. Methods:Real-time fluorescence quantitative PCR (RFQ-PCR) method was used for detecting IGFBP-rP1 mRNA expression in bone marrow (BM) cells of 168 children with acute leukemia. The results were compared with those of 30 non-leukemia children in control group. Meanwhile the relationship between IGFBP-rP1 expression level and clinical prognosis was analyzed according to clinical prognostic factors of children acute leukemia. Results:Expression level of IGFBP-rP1 in initial acute leukemia children was significantly higher than that of non leukemia children (P<0.01). It was higher in acute myeloid leukemia (AML) than in acute lymphoblastic leukemia (ALL)(P =0.013). The transcription level of IGFBP-rP1 mRNA in patients who had complete remission (CR) were lowest, which was nearly the same as non-leukemia childish patients. It increased again when leukemia relapsed, which was significantly higher than that in CR. However, as far as ALL was concerned, IGFBP-rP1 expression levels had no significant difference between newly-diagnosed, complete remission, and recurrent groups.Conclusion:IGFBP-rP1 may be involved in the initiation and development of childish leukemia. It has the potential to become a new target for AML treatment.

OBJECTIVE:To study the improvement effect of lanthanum hydroxide on chronic renal failure (CRF) hyperphos-phatemia in rats. METHODS:CRF hyperphosphatemia rat model were induced and then randomly divided into model group,lan-thanum carbonate group [0.3 g/(kg·d)],calcium carbonate group [4.2 g/(kg·d)] and lanthanum hydroxide high-dose,medium-dose and low-dose groups [1.5,1,0.5 g/(kg·d)] with 10 rats in each group. They were given adenine 0.2 g/(kg·d)intragastrically in the morning,and then given relevant medicine intragastrically in the afternoon;a week later,they stopped taking adenine but con-tinued to take relevant medicine for 22 d. 10 normal rats were selected as normal control group. General examination was conduct-ed,and renal coefficient,serum contents of calcium,phosphorus,PTH,creatinine(Scr)and usea nitrogen(BUN)were detected after last medication as well as renal pathological change. RESULTS:Compared with normal control group,model group showed CRF sign,renal coefficient,the contents of phosphorus,PTH,Scr and BUN were increased,while the content of calcium was de-creased(P<0.01);renal section showed obvious pathological characteristics. Compared with model group,CRF sign of rats were improved in lanthanum carbonate group,calcium carbonate group and lanthanum hydroxide groups. The renal coefficient (except for lanthanum hydroxide high-dose group),serum contents of phosphorus(except for calcium carbonate group),PTH(except for lanthanum hydroxide low-dose group and calcium carbonate group),Scr(except for lanthanum hydroxide low-dose group and calci-um carbonate group)and BUN were all decreased,while serum content of calcium and calcium-phosphorucs product(only in calci-um carbonate group)was increased(P<0.05 or P<0.01). There was no statistical significance in other difference. The renal sec-tion pathological characteristics were improved. CONCLUSIONS:Lanthanum hydroxide can improve renal function and reduce the level of serum phosphorus in CRF hyperphosphatemia model rats.

Objective To observe the effect of cistanche deserticola polysaccharides on learning and memory ability of different types of spatial learning and memory abilities in micey.Methods The 120 mice were randomly divided into blank group, model group, Cistanche deserticola polysaccharide, low and medium dose group, and Lacita group, 20 rats in each group. The low, medium and large dosage groups were given 25, 50 and 100 mg/kg Cistanche deserticola polysaccharides, piracetam group was given 10 mg/kg Laci Staw, blank group and model group were given 10 mg/kg volume distilled water. Continuous administration for 6 weeks. Cicloheximide mice were used to consolidate memory impairment model, using ethanol to establish a model with reappearance of memory disorders. The ability of learning and memory in water maze test in mice, the mice were detected in the brain of total protein, MDA, SOD.Results Compared with model group, the escape latency (9.45 ± 2.86 s, 12.73 ± 10.89 svs. 48.15 ± 30.33 s), and the first time arrived at the station (19.33 ± 3.27 s, 13.81 ± 9.79 svs. 40.71 ± 16.76 s) was the median, large dose group were significantly shortened (P<0.05); the first time to reach the site (11.58 ± 7.04 svs. 40.71 ± 16.76 s) in the low dose group was significantly shortened (P<0.05), the number of crossing the platform (5.46 ± 2.09vs. 3.03 ± 1.47) in the low dose group significantly increased (P<0.05); the total protein content in brain tissue (0.76 ± 0.25 g/Lvs. 0.55 ± 0.12 g/L) in the high dose group significantly increased (P<0.05). Compared with the ethanol model group, the escape latency (22.67 ± 18.35 s, 22.15 ± 16.22 s, 18.00 ± 13.44 svs. 51.33 ± 22.19 s), the first time arrived at the station (16.70 ± 11.25 s, 19.75 ± 14.62 s, 9.47 ± 5.46 svs. 30.09 ± 13.63 s) in the low, medium and high dose group were significantly shortened (P<0.05), crossing the target (5.15 ± 1.28, 4.83 ± 0.75vs. 1.34 ± 0.83) in the low, medium and high dose group were significantly increased (P<0.05).Conclusions Cistanche polysaccharide could significantly improve the reproducibility of memory impairment in mice.

The dried root of Ranunculaceae Aconitum perennial herb of North Aconitum, is commonly used. It has the function of cardiac stimulation, anti-inflammatory and analgesic, anti-tumor and immune regulation. However, its toxicity lower the safety and applicaiton. The pharmacological and toxicological effects were discussed in this paper, in order to provide reference for the intoxication diagnosis and clinical safety.

In recent years, recombinant human urokinase (rhPro-UK) has been widely used in the treatment of a variety of thromboembolic diseases, with significant efficacy and no obvious adverse reactions. In addition, it has a wide range of applications in many new technology fields. This article focuses on the application of rhPro-UK in the treatment of acute myocardial infarction, cerebrovascular disease, lower extremity deep vein thrombosis, arterial thrombosis and other diseases. rhPro-UK has demonstrated good thrombolytic efficacy and safety in these diseases, especially in patients with acute myocardial infarction, and adjuvant PCI therapy can significantly increase myocardial reperfusion, improve cardiac function, and do not increase the risk of bleeding. For cerebrovascular disease, rhPro-UK can significantly improve the degree of neurological deficit and has a high safety profile. In the treatment of lower extremity deep vein thrombosis, rhPro-UK has shown superior thrombolytic efficacy and safety compared with urokinase. For arterial thrombosis and biological stents, the use of rhPro-UK has also achieved some efficacy, but more research is needed to confirm its efficacy and safety. In addition, ultrasound-mediated drug-loaded thrombolysis systems also have potential applications in rhPro-UK therapy. Future research on rhPro-UK will focus more on the development of new technologies.

Objective:To explore the clinical value of peripheral remnant lipoproteins (RLP), low density lipoprotein cholesterol particle (LDL-P) and sdLDL particle (sdLDL-P) measurement in the diagnosis of carotid plaque, so as to provide practical basis for the accurate diagnosis of carotid plaque and the control of carotid plaque related cardiovascular and cerebrovascular diseases.Methods:People who underwent carotid plaque ultrasound examination in Xingtai Third Hospital , from January 2020 to June 2021 were selected as the research object. According to the ultrasound results, they were divided into carotid plaque group ( n=146) and control group without carotid plaque ( n=149). The fasting RLP, LDL-P and sdLDL-P of the two groups were measured by vertical auto profile (VAP) centrifugal separation phase, and the fasting TG and LDL-C were detected by routine mixed phase method. The indexes were compared between the two groups and the true positive rate, true negative rate, false positive rate and false negative rate of the diagnosis of carotid plaque were analyzed. The receiver operating characteristic curve of each test index was drawn, and AUC was used to evaluate the clinical diagnostic value of each test index for carotid plaque. Results:The levels of RLP, LDL-P and sdLDL-P in carotid plaque group were significantly higher than those in non-carotid plaque group ([1.07±0.36] mmol/L vs [0.59±0.17] mmol/L,[1 300±370] nmol/L vs [781±215] nmol/L,[435±139] nmol/L vs [156±59] nmol/L, all P<0.01). The true positive rate (78.08% [114/146],81.51% [119/146]) and true negative rate (84.56% [126/149], 86.58%[129/149]) of serum RLP and LDL-P for the diagnosis of carotid plaque were significantly higher than TG (58.90%[86/146], 43.62%[65/149]) and LDL-C (59.59% [87/146], 46.98% [70/149]), and the false positive rate (15.44% [23/149], 13.42% [20/149]) and false negative rate (21.92% [32/146], 18.49% [27/146]) were significantly lower than TG (56.38% [84/149], 41.10% [60/146]) and LDL-C (53.02% [79/149], 40.41% [59/146], all P<0.01). The AUC of the ROC curve of RLP (0.890), LDL-P (0.902) and sdLDL-P (0.973) for the diagnosis of carotid plaque was higher than TG (0.682) and LDL-C (0.712). The AUC of ROC curve of the RLP combined with sdLDL-P (0.977) for the diagnosis of carotid plaque was higher than the RLP and sdLDL-P (all P<0.01). Conclusion:The serum RLP, LDL-P and sdLDL-P can be used as indicators of carotid plaque, and their clinical diagnostic value are superior to TG and LDL-C; the combined diagnostic effect of lipoprotein subclass is better than that of single index alone.