In order to adapt to teaching reform of Medical Immunology and create a"golden course",through teaching prac-tice,our research group proposes a"three-dimensional curriculum teaching system",which organically combines teaching concepts with teaching design and process,with construction of various resources(material libraries),and finally,multi-level teaching evalua-tion is completed to achieve overall unity of teaching.

In order to adapt to teaching reform of Medical Immunology and create a"golden course",through teaching prac-tice,our research group proposes a"three-dimensional curriculum teaching system",which organically combines teaching concepts with teaching design and process,with construction of various resources(material libraries),and finally,multi-level teaching evalua-tion is completed to achieve overall unity of teaching.

Objective:To explore the regulatory role and mechanism of tribbles pseudokinase 3 (TRB3) on hepatocarcinoma (HCC) cells proliferation, apoptosis and migration.Methods:Immunohistochemistry and Western blot were used to detect TRB3 expression in cancerous and adjacent cancerous liver tissues of HCC patients. TRB3 expression was detected in vitro in HepG2 and Huh7 hepatocarcinoma cell lines. Simultaneously, CCK8 and EdU were used to detect cell proliferation after TRB3 targeted inhibition with small interfering RNA. CCK8 and EdU were used to detect cell proliferation. Flow cytometry assay was used to detect apoptosis. Transwell assay was used to evaluate migration ability. Simultaneously, Western blot was used to detect changes in apoptosis, migration-related proteins and AKT phosphorylation activity. The mean comparison between the two groups was performed by t-test, and the comparison between multiple groups was performed by one-way analysis of variance.Results:Western blot showed that the expression of TRB3 was significantly up-regulated in HCC tissues. Compared with normal liver tissues adjacent to cancer, the relative expression levels were 0.78 ± 0.12 and 0.29 ± 0.09, respectively, P < 0.01, and the difference was statistically significant. After interfering siRNA inhibited TRB3, CCK8 and EdU tests showed that the proliferation activity of HepG2 and Huh7 cells were significantly weakened ( P < 0.05). Flow cytometry results showed that the apoptotic proportions of HepG2 and Huh7 cells was significantly increased ( P < 0.01). Western blot also showed that the expression of apoptosis regulatory proteins BAX and BIM were significantly increased ( P < 0.01). Transwell assay results showed that the migration ability of HepG2 and Huh7 cells was decreased ( P < 0.05), and the expression of migration regulatory proteins MMP4 and MMP9 was also significantly down-regulated. Western blot results showed that the AKT phosphorylation level was significantly increased. Conclusion:TRB3 regulates hepatocarcinoma cells proliferation, apoptosis and migration by inhibiting the AKT phosphorylation activity. Therefore, TRB3 may be a potential target site for the liver cancer treatment.

Objective Baseline investigation was conducted on the current situation of intravenous infusion treatment in a Class Ⅲ Grade A children's hospital in Hu'nan Province, and the quality improvement was carried out according to the investigation results, and explored the quality improvement effect. Methods The baseline investigation on intravenous infusion treatment was conducted in a Class Ⅲ Grade A children's hospital in Hu'nan Province in September 2016. A total of 558 children from 18 clinical departments were selected as research subjects by random number table method. Quality improvement was carried out according to the survey results. A total of 1 088 cases of children undergoing intravenous treatment were investigated for the second round in September 2017. The infusion site, puncture tool, catheter fixation, catheter related complications, catheter maintenance and connection mode were compared before and after quality improvement. Results The selection of infusion sites before and after quality improvement meets the requirements. The usage rate of indwelling needle increased from 88.5% to 94.4%, and the usage rate of spiral joint increased from 56.6% to 73.8%. Both the differences were statistically significant (χ2=78.38, 50.0;P＜0.05). After quality improvement, the incidence of catheter missing was decreased from 92.5% to 82.5% when nurses performed catheter maintenance, with statistical significance (χ2=30.1,P＜0.05). Conclusions By practicing standards for clinical venous treatment, strengthening training, and carrying out process quality control, the quality of work for nursing staff in the selection of infusion tools and the control of complications of indwelling catheters has been significantly improved.

Objective To investigate the stapled trans-anal rectal resection (STARR) and Altemeir's resection for rectum prolapse in spinalcord injury (SCI) patients. Methods Anus bowel disease of 260 SCI patients were investigated, 21 cases with rectum prolapse who wereinvalid for nonoperative treatment chose Altemeir's resection or STARR depending on the degree of rectum prolapse. They were recorded ac- cording to International Spinal Cord Injury Bowel Function Based and Extension Set before and 12 months after operation. Results 85 SCIpatients were with rectum prolapse (32.7%), 21 patients complicated with constipation and mixed hemorrhoid, 19 with rectal mucous membraneprolapse (<7 cm), 4 with rectal internal mucous intussusception, 2 were completely rectum prolapse (≥7 cm). Rectum prolapse of Ⅰdegree was found in 13 cases, Ⅱ in 5 cases, and Ⅲ in 3 cases. Patients with Ⅰ or Ⅱ degrees rectum prolapse accepted STARR, those withⅢ degrees accepted Altemeir's resection. No serious complication was found. Self-report of intestinal dysfunction affecting the quality oflife during the 12 months after operation significantly decreased (P<0.01), so as the need of drawing out defecate with hands (P<0.01), theusage of liner, plug, or antidiarrheal (P<0.001). The symptom such as endless defecate feeling, abdominal distension, abdominal pain, abdominaldiscomfort were significantly alleviated (P<0.05). Conclusion STARR and Altemeir's resection are both safe and effective operationfor rectum prolapse in SCI patients.

Objective To study the value of serum tartrate-resistant acid phosphatase 5b (TRACP5b) in bone metastasis in early breast cancer patients with negative axillary lymph nodes.Methods The serum level of TRACP5b was determined by enzyme-linked immumosorbent assay (ELISA) in 26 breast cancer patients and 18 healthy female adults.Results The serum level of TRACP5b was (3.85 ± 0.85) U/L in the group of breast cancer patients and (2.08 ± 0.84) U/L in the control group.The difference had statistical significance (P ＜0.05 ).The sensitivity was 42.31％ and the specificity was 94.44％ for TRACP5 b in predicting bone metastasis of breast cancer with negtive axillary lymph nodes.Conclusions TRACP5b has higher sensitivity and specificity in breast cancer patients than in healthy female adults.TRACP5b is a useful serum marker to predict bone metastasis in breast cancer patients.

The American Clinical Practice Guiding -Neurogenic Bowel Management in Adults with Spinal Cord Injury (SCI) had been prepared based on scientific and professional information known about neurogenic bowel management, its causes, and its treatment, in 1998. It will provide reference to China's neurogenic bowel management after SCI in rehabilitation and treatment.

OBJECTIVE:To screen and analyze the ?-lactamases-resistant genes in imipenem-resistant pseudomonas aeruginosa (IMPRPa). METHODS: ?-lactamases-resistant genes including IMP,VIM and OprD2 in 60 clinically isolated IMPRPa strains were detected by polymerase chain reaction (PCR),and sequence analysis was performed on the PCR amplified products of some of IMP and VIM genes. RESULTS: Of the 60 IMPRPa strains,?-lactamases-resistant positive genes were as follows: IMP gene was positive in 7 strains,VIM gene was positive in 18 strains,and both IMP and VIM genes were positive in 3 strains. Sequencing of the PCR products of IMP and VIM genes were IMP-1 and VIM-2 types,and OprD2 gene deletion was noted in 29 strains. CONCLUSION: OprD2 protein channel deletion and metal-producing ?-lactamases are the chief mechanisms for the resistance of IMPRPa to imipenem.

Objective To investigate the trend of omtibacterial resistance rate of Acinetobater baumannii in our hospital from Jan.2000 to Jun.2005,and for the guidance of rational use of antibacterials.Methods A.baumannii strain was isolated and tested by K-B method from clinical samples and antibiotic resistance was analyzed and studied retrospectively.Results There was an elevated tendency of the resistance rates to common antibacterial in A baumanii for past six years. The resistance rate to imipenem was the lowest (3.6%) and to amikacin, cefoperazone/sulbactam was 29.5%-77.4%.Conclusion The resistance rates to common the antibacterial in A.baumanii are high and the resistance pattern is wide. It is important to select antibiotics according to the antibiotics sensitivity in vitro.