Based on the current situation of pediatric surgery practice teaching in Qilu Hospital of Shandong University, 10 mind maps of common clinical diseases made by Imindmap 11 were applied to the practice teaching and teaching assessment through WeChat public platform. Mind map not only revealed the relationship between related disciplines and reappeared the clinical thinking process, but also greatly improved the enthusiasm and efficiency of interns' learning, and trained their innovative spirit and practical ability. At the same time, as a formative evaluation method, mind map facilitates teachers to evaluate and improves teaching activities. What’s more, it effectively improves the quality of teaching, and is worth promoting in clinical teaching.

Objective To observe the effect of long-term intake of low iodine diet on thyroid morphological structure and sodium iodine transporter (NIS) in parental and second filial generation rats, and to explore the changes of NIS protein expression in iodine deficiency disease (IDD), so as to further verify and explore the mechanism of IDD. Methods Referring to "Nutritional Composition of Experimental Animals With Feed" (GB 14924.3-2010), the crops widely planted and with high edible rate in the traditional cretinism epidemic area of Xinjiang were used as the main feed components to prepare different levels of iodine (low iodine groups 1 and 2 feed the iodine contents were about 50 and 20 μg/kg). The IDD rat model was established by the three-generation two-nest method, that is, 132 SPF Wistar rats were selected after weaning, half males and half females, randomly divided into 3 groups according to body mass by random number table method: control group (N, 52 rats, 22 females, 30 males, the iodine content was about 300 μg/kg), low iodine groups 1 and 2 (LⅠ, LⅡ, 40 rats, 22 females, 18 males in each group). Twelve rats in each group were sacrificed at the end of 3, 6, 9 months, respectively, half males and half females. The relative weight of thyroid was calculated and the gross structure and microscopic pathology were observed. The expression of NIS protein was determined by Western blotting. At the end of 3 months after feeding, four female rats in each group were selected to mate with male rats in group N in 1 : 1, and the newborn mice were fed the same way for three months and then subcultured again. The rat generation continued to be fed according to the mother group, and 10-12 rats were sacrificed at the end of 3, 6, 9 months, respectively, and the specimens and observation indexes results were collected same as the parental rats. Results The relative weight of the thyroid in parental LⅠand LⅡ groups were higher than those in the N group at 6 and 9 months [female:(19.67 ± 5.60), (23.81 ± 4.08) vs (10.14 ± 1.20);(22.24 ± 2.06), (33.51 ± 3.24) vs (9.80 ± 1.96);male:(13.0 ± 3.70), (13.84 ± 4.08) vs (5.90 ± 1.20);(14.20 ± 2.67), (19.98 ± 2.84) vs (6.06 ± 0.76), P < 0.05], the females were higher than the males at 3, 6, 9 months (P<0.05). The relative weight of the thyroid in second filial generation LⅠand LⅡgroups were higher than that in the N group at 3, 6 and 9 months (P < 0.05). Except the 6 month LⅠ group, the relative weight of thyroid in the other groups was higher than that in the male (P<0.05). In prolonged iodine-deficiency process, LⅠ and LⅡ groups, the color of the thyroid gland for parental and second filial generation rats appeared darkening, hyperemia and swelling. At the same time, microscopic pathology showed that the thyroid gland of different generations showed increased follicles and smaller follicular cavities. Epithelial cell hyperplasia and interstitial fibrosis and interstitial inflammatory cell infiltration at the end of 9 months were observed. At 3, 6, and 9 months after low iodine, the expression of NIS protein in the LⅠ and LⅡ parental and second filial generation rats was higher than that in the N group (P<0.05). Conclusions Long-term low iodine in different levels of feed can cause compensatory thyroid enlargement and hyperplasia in both parental and offspring rats, the expression of NIS protein has continued to rise.

Objective To investigate the security and efficacy of one stage and bilateral resection of thymic tissue and clearance of mediastinal fat by uniportal-video-assisted thoracic surgery(VATS) to cure patients with myasthenia gravis(MG).Methods A number of 131 patients with MG who underwent resection of thymic tissue and clearance of mediastinal fat by VATS in one single center from February 2009 to December 2013 were selected in this retrospective study.76 patients underwent unilateral resection of thymic tissue and clearance of mediastinal fat by three portal VATS from February 2009 to March 2012 and 55 patients underwent one stage and bilateral resection of thymic tissue and clearance of mediastinal fat by small uniportal-VATS from April 2012 to December 2013.The time for operation,the bleeding volume during operation,the volume of postoperative drainage and drainage time,the improvement of symptoms,the postoperative pain,hospital stays and the occurrence of myasthenia gravis crisis were compared between the two groups.Results The general condition and pathological type did not have significant statistical differences between the two groups.The operating time in the uniportal-VATS group was significantly longer than that in three portal VATS group,but the pain was lighter,and the hospital stay was shorter.There were no significant differences between groups in terms of blood loss,postoperative drainage time,and volume of drainage.The follow-up was from 32 to 90 months,and 118 (90.08％)patients completed the follow up.94.5 ％ of the patients in uniportalVATS group acquired complete stable remission(CSR),while it was 84.2％ in three portal VATS group(P ＜ 0.05),and the uniportal-VATS group had lower rate of myasthenic crisis (P ＜0.05).Conclusion One stage and bilateral resection of thymic tissue and clearance of mediastinal fat by small uniportal-VATS is safe and effective with shorter hospital stay and less pain,and it can get higher CSR and less myasthenic crisis,its efficacy is superior to traditional three portal VATS.

Objective To investigate the correlation of endothelial inflammation in patients with acute myocardial infarction (AMI)with no-reflow and severity of coronary lesion.Methods A total of 120 patients with AMI were all treated with percutaneous coronary intervention (PCI).The patients who had intraoperative no-reflow were in case group (n=40).The patients who were also treated by PCI but did not have no-reflow in the same period in our hospital served as the control group (n=80).According to the results of coronary angiography, no-reflow group patients were divided into three subgroups:single lesion group (n=14),two-lesion group (n=10), and three-lesion group (n=1 6 ).We monitored these patients’immediate postoperative endothelial microparticles (EMPs)and soluble intercellular adhesion molecule-1 (sICAM-1 )levels in both groups with flow cytometry and ELISA methods.Results In the case group,immediate postoperative EMPs and sICAM-1 levels in the blood circulation were significantly higher than those in the control group.EMPs area and sICAM-1 area under the curve in the case group were 0.755 and 0.701,which showed that EMPs and sICAM-1 levels had a good correlation with the occurrence of non-reflow in AMI patients after PCI.Gensini score and EMPs level rose with the increase of the lesion counts,and the level of EMPs was positively correlated with Gensini score.Conclusion In patients with AMI,the EMPs and sICAM-1 levels can well predict the occurrence of no-reflow and are of some value in predicting the severity of coronary lesion.

Objective To explore the relationship between self-management behaviors and family function among elderly pa-tients with diabetes in community in order to provide evidence for community nursing of diabetes.Methods A total of 670 elderly patients with diabetes were selected with convenience sampling household survey method and investigated with the family Adapta-tion,Partnership,Growth,Affection,and Resolve(APGAR)and the Summary of Diabetes Self-Care Activities(SDSCA).Results The family functions total score of the elderly patients with diabetes in community was (6.95±2.91),the self-management behav-iors total score was (20.06±5.80),among the self-management behaviors the score for exercise was the highest and blood glucose monitoring was the lowest;family function had remarkable positive relation with the total score of self-management behaviors a-mong elderly patients with diabetes in community(r=0.156,P <0.05).Conclusion There is a correlation between the self-man-agement behaviors and family function,good family function is conducive to the improvement of self-management behaviors for the elderly patients with diabetes.

Objective In order to improve the diagnosis accuracy , 18F-FDG PET/CT results of 169 cases of lung lesions were analyzed. Methods The data of 169 pathological diagnosed patients were collected. SPSS 18.0 was used for the data analysis. Results In 169 cases, 122 cases were proved malignant by patholog-ical diagnosis, in which 110 cases were correctly diagnosed by PET/CT. 47 cases were proved benign by patho-logical diagnosis, in which 15 cases were correctly diagnosed by PET/CT. The sensitivity was 90.2%, specificity was 31.9%, and the accuracy was 74.0%. Conclusion In order to improve the accuracy rate of PET/CT exam-ination and reduce the existence of false positive cases and false positive cases , we should estimate SUV (max) objectively and diagnose according to the size of the lesion , clinical history and laboratory results.

Objective The difficulty of full thoracoscopic Ivor-Lewis is the lack of a safe and low cost anastomosis.By improving the surgical process,to explore the application of circular stapler in the intrathoracic esophagogastric anastomosis.The thoracoscopic operation mode of esophageal cancer changes from simply following the McKoewn procedure to Ivor-Lewis and McKoewn procedure.Methods Retrospective analysis 123 cases of implementation thoracoscopic esophageal cancer from July 2009 to February 2013,which including the cases of intrathoracic anastomosis and cervical anastomosis.Divided it into two groups:intrathoracic anastomosis groups,which including thoracoscopic esophagectomy resection,gastroesophageal anastomosis and anastomotic pedicled omentum embedding,the cervical anastomosis groups,which including thoracoscopic esophageal free and gastroesophageal neck anastomosis.To comparing the incidence of ARDS,postoperative hoarseness,anastomotic complications (Anastomotic leakage and anastomotic strictures within two months after surgery),guardianship time of ICU and postoperative hospital stay between the two groups.Results All the patients were no deaths.The cervical anastomosis group operative time was significantly lower than the intrathoracic anastomosis group.The incidence of anastomotic fistula and anastomotic stricture of intrathoracic anastomosis group was significantly lower than that of the cervical anastomosis group,total hospitalization time of the intrathoracic anastomosis group were significantly lower than that of the cervical anastomosis group,there is no significant differences in postoperative hoarseness and ARDS incidence between the two groups.Conclusion For the lower esophageal carcinoma,it is technically mature and safe to apply the circular stapler for Ivor-Lewis surgery and sleeve omentumembedding anastomotic technique in full thoracoscopic,and the technology should be widely applied; for the upper esophagealcarcinoma,McKoewn procedure should be applied.

Thrombin-like enzymes (TLEs) are studied widely because of their therapeutic potential in myocardial infarction and thrombotic diseases. We synthesized the DNA fragment encoding thrombin-like enzyme calobin from Agkistrodon caliginosus (Korean Viper) venom by fusion PCR and expressed it in Pichia pastoris. After induction by 0.5% methanol for 48 h, the expression level of recombinant calobin reached 3.5 g/L in medium. The recombinant calobin was purified by Q-Sepharose Fast Flow ion-exchange chromatography and Sephacryl-S-100 gel filtration chromatography. Purified sample had a molecular weight of 32 kD shown in SDS-PAGE. It hydrolyzed fibrinogen and formed a light white hydrolysis circle in fibrinogen plate. SDS-PAGE analysis showed that recombinant calobin cleaved Aalpha-chain of fibrinogen specifically, and produced an appropriately 40 kD new band. However, we failed to find its fibrin-clot formation activity.
Agkistrodon ; Animals ; Pichia ; genetics ; metabolism ; Recombinant Proteins ; biosynthesis ; genetics ; Serine Endopeptidases ; biosynthesis ; genetics ; Thrombin ; biosynthesis ; genetics ; Viper Venoms ; enzymology

Objective To study the effect of thalidomide and arsenic trioxide on the proliferation and apoptosis effect in human myelodysplastic syndrome cell line MUTZ-1 and explore its possible mechanism.Methods MUTZ-1 cells were cultured with different concentration of thalidomide alone, arsenic trioxide alone, and thalidomide plus arsenic trioxide for 48 h. The cell proliferation was analyzed by CCK-8 test, and cell apoptosis was analyzed by flow cytometry. The expression of Bmi-1 was analyzed by semi-quantitative RT-PCR. Results Thalidomide alone had no significant inhibition on growth of MUTZ-1 cells (P >0.05).Arsenic trioxide alone had obviously inhibited the cell proliferation (P <0.05). While thalidomide plus arsenic trioxide group had the great inhibition effect(CDI <0.7), and reveal was that two drugs had synergism effect on inhibiting the MUTZ-1 cells. Arsenic trioxide group of apoptosis rate was increased with higher concentrations of drug, a dose-dependent (r = 0.627, P <0.05), thalidomide in the rate of apoptosis with no increase in drug concentration significantly (r= 0.313, P> 0.05), and the combined group with the drug also increased the concentration of expression (P <0.05). In arsenic trioxide group the expression of Bmi-1 / β-actin declined with the increased concentration, a dose-dependent (r =-0.912, P<0.05), thalidomide group Bmi-1 / β-actin with the increased concentration of no significant decline (r =-0.594, P >0.05), the combined group Bmi-1 inhibition was significantly higher than arsenic trioxide, thalidomide in a separate drug group (CDI <0.7).Conclusion Thalidomide group had no significant growth inhibition. Arsenic trioxide on MUTZ-1 cells significantly inhibited the growth and increased in the combined group significantly.

Objective To assess the efficacy and tolerability of continuous low-dose cyclophosphamide and prednisone regimen(CP)as salvage therapy for multiple myeloma patients with severe complications.Methods The CP regimen consisted of oral cyclophosphamide at 50 mg and oral prednisone at 15 mg daily.The patients were withdrawn if the response was invalid or not improved after 6 months,and follow-up was carried on if CR maintained for 6 weeks.A total of 23 consecutive patients received the CP regimen,with 18 patients having severe complications,and 5 patients unwilling to accept conventional chemotherapy because of severe infection.All patients had received one to four regimens before.Results Among 23 patients with CP regimen,the overall response rate(CR+VGPR+PR)was 61%,with 1 CR,4 VGPR,9 PR,3 MR and 6 PD.The quality of life and physical conditions were improved significandy.Conclusion Our data showed that CP was an effective,well-tolerated,and convenient regimen as salvage therapy for MM with severe complications.