In order to improve the effectiveness of private class inquiry with the development of information teaching, the smart teaching platform has been established, with instructional management, curriculum setting, teacher preparation, classroom application, supervision and monitoring modules. Taking the platform as the medium, the small class inquiry learning community of entity curriculum is constructed between students and the teachers. In the eight-year medical teaching, the content of learning cycle is designed according to the entity curriculum, which is issued on cloud platform before class, in class and after class. Students learn basic concepts by themselves in the learning community, explore the application of knowledge under the guidance of teachers, and expand knowledge in class or after class. After having test in teaching procedure, the small class learning community based on smart teaching cloud platform has a submission rate, interaction rate and score rate of more than 90%. It can not only make full use of the advantages of information-based teaching resources, but also build face-to-face learning community in the course teaching, reflecting the emotional interaction of personalized teaching. It's suggested that new approaches to teaching should be student-centered and activity-based, engaging students actively in the learning process, which can promote students' autonomous learning ability and innovative thinking ability.

Robotics ; Robotic Surgical Procedures ; Kidney Transplantation

OBJECTIVE：To investigate the effects of integrated su pervision mode by doctors ，pharmacists and nurses on the whole-process implementation of therapeutic drug monitoring （TDM）. METHODS ：The patients monitored with TDM in our hospital admitted from Jan. to Dec. 2018 were selected as control group ，treated with the traditional drug supervision mode （i.e. the work of doctors ，nurses and pharmacists was relatively independent ）. Treatment group was composed of inpatients monitored with TDM from Jan. to Dec. 2019，treated with the integrated supervision mode of doctors ，nurses and pharmacists （i.e. doctors ，nurses and pharmacists cooperated with each other ，taking the patients and sample as the center ，pharmacists as the key link formulated the implementation standards of each link ，and clarified their respective responsibilities ）. The concentration compliance rate ，the incidence of incorrect samples ，critical value notification rate ，clinical satisfaction ，drug recommendation feedback and adoption ， compliance rates of 6 kinds of monitored drugs （sodium valproate ，digoxin，tacrolimus，cyclosporin，methotrexate，vancomycin） were compared between two groups. RESULTS ：The overall compliance rate ，critical value notification rate and clinical satisfaction rate of the observation group were respectively 64.57％，99.39％ and 97.22％，which were significantly higher than 57.86％， 96.80％ and 92.22％ of control group （P＜0.05）. The incidence of incorrect samples in observation group was 0.72％，which was significantly lower than 3.09％ of control group （P＜0.001）. The feedback rate of individual pharmacists （89.19％），the feedback rate of doctors （80.50％）and the adoption rate of medication suggestions （69.98％）in the observation group were significantly higher than control group （50.34％ ，71.46％ and 55.36％ ，P＜0.001）. The compliance rate of tacrolimus concentration in observation group was slightly lower than control group （73.40％ vs 75.77％，P＞0.05）. The concentration compliance rate of other 5 varieties was higher than control group ，and the differences of valproate sodium ，digoxin and vancomycin concentrations between two groups were statistically significant （P＜0.05）. CONCLUSIONS ：The implementation of integrated doctors ，nurses and pharmacists supervision mode in TDM can effectively improve the drug concentration compliance rate ，realize the . dynamic supervision and feedback of individualized drug use ， which is conducive to ensure the safety of clinical medication.

Objective To evaluate the efficacy of in-situ split liver transplantation (ISSLT) in children.Methods From June 2015 to August 2018,10 liver grafts from DBD were split in-situ.All the donors were male,and the median age of the donors was 28.5 year old (18-48 year).One left half graft and 9 left lateral lobe grafts (including 2 reduced size grafts) were transplanted to 10 pediatric recipients.Four grafts were transplanted in our center,and the rest 6 grafts were shared to other two transplant center.The primary diseases of the recipients included biliary atresia (8/10),hepatic sinus obstruction syndrome (1/10) and Alagille syndrome (1/10).The median age of the recipients was 10 month (7 month-11 year),and the mean body weight was 9.8 ± 6.6 kg (5-28 kg).Results All liver grafts were split in-situ.The mean split time of liver grafts was 88.5 ± 18.9 min.The mean weight of split grafts was 336.7-± 85.4 g.All recipients were subjected to piggyback liver transplantation.Operation time was 542.5 ± 112.1 min.Anhepatic time was 52.0 ±-13.5 min.GRWR was (3.98 ±0.96)％.GRWR of two cases was more than 5％,so segment Ⅲ was partially reduced.During the follow-up period,9 cases were alive and 1 case died due to multiple organ failure 1 day after liver transplantation.Conclusions ISSLT can enlarge the graft pool for children and achieve good results.

BACKGROUND: In clinical Ia (cT1N0M0) patients, some may have poor prognosis, for it might occur pathologic N1 (pN1) or N2 (pN2) postoperatively. The aim of this study is to determine the radiologicaland pathological factors related to clinical Ia adenocarcinoma. METHODS: The retrospective study was conducted on 297 clinical Ia adenocarcinoma patients resected at our hospital between May 2012 to December 2016. The clinical profiles, radiological and pathological features were analyzed between nodal upstaging group and non-upstaging group. RESULTS: Of 297 patients treated for cN0 tumors, 250 cases (84.2%) were confirmed postoperatively as having pN0 tumors, and 47 (15.8%) were confirmed as having pN1 or pN2 tumors. Female, low smoking index, micropapillary predominant and solid predominant adenocarcinoma, puresolid tumor and large tumor size were all more frequently seen in the nodal upstaging group than in the pN0 group (P<0.05). Logistic regression indicate that radiological solid tumor, micropapillary predominant and solid predominant adenocarcinoma and vessel invasionare the risk factors of nodal upstaging in clinical Ia adenocarcinoma. CONCLUSIONS Radiological solid tumors, micropapillary predominant and solid predominant adenocarcinoma andvessel invasion are risk factors for nodal upstaging for early stage lung cancer. Radiological solid tumors should perform SLND in Ia adenocarcinomas.
Adenocarcinoma ; diagnosis ; pathology ; Adenocarcinoma of Lung ; Female ; Humans ; Lung Neoplasms ; diagnosis ; pathology ; Male ; Middle Aged ; Neoplasm Staging ; Prognosis ; Retrospective Studies ; Risk Factors

Objective:To study the anti-inflammatory activity of total alkaloids from Solanum lyratum.Methods:Human umbili-cal vein endothelial cells ( HUVECs) were cultured and induced by H 2 O2 (200 μmol· L-1 ) , and RAW 264.7 cells were cultured and induced by lipopolysaccharide ( LPS ) .The two inflammatory cell models were randomly divided into the normal group , model group, positive control group, and total alkaloids group respectively at low , medium and high dose.After the treatment, the cells were continued to be cultured , and CCK-8 method was applied to observe the cell survival rate .SD rats were randomly divided into the nor-mal group, model group, positive control group, total alkaloid group respectively at low, medium and high dose,and then the rats re-ceived subplantar injection of carrageenan in the paw .After the treatment , inflammation was analyzed by the swelling degree of acute ankle joint injury, and the contents of prostaglandin E2 (PGE2) and cyclooxygenase-2 (cox2-) were detected.Results:The effect of total alkaloids from Solanum lyratum at medium dose on H 2O 2-induced HUVECs and that of total alkaloids from Sola num lyratum at high dose on LPS-stimulated macrophages were similar to that of the positive control group without statistical significance (P>0.05), and the total alkaloids from Solanum lyratum at medium and high dose could significantly reduce the swelling degree of the acute ankle model in rats (P<0.01), and decrease the content of PGE2 in the toe exudate of rats and that of COX-2 in serum (P<0.01) with statistical significance when compared with that in the model group (P<0.01).Conclusion:The total alkaloids from Solanum lyra-tum have significant anti-inflammatory activity , and it is necessary to further study the efficacy and action mechanisms .

Objective:To optimize the water extraction process of traditional Chinese medicine ( TMC) Qubai granule. Methods:The orthogonal test was used to study four influencing factors including water amount, soaking time, extraction time and extraction times with dry extract yielding rate and the content of ferulic acid as the evaluation indices. Results:The optimum extraction process was as follows:A2 B1 C2 D2 , namely adding 10-fold amount of water, without soaking in advance, extracting twice with 2 h for each time. Con-clusion:The process is simple, stable and reproducible, which provides basis for the industrial production.

OBJECTIVETo compare the protein profiles between decapeptide-treated and untreated planktonic cells of Streptococcus mutans (S. mutans) by differential proteomic analysis to determine and identify the key proteins.

METHODSIn our previous study, we investigated decapeptide (KKVVFKVKFK-NH2), which was a novel adenosine monophosphate. Compared with other oral pathogens tested, decapeptide had a preferential antibacterial activity against S. mutans. It also inhibited S. mutans biofilm formation and reduced the one-day developed biofilm. In the present study, we first synthesized decapeptide, and then compared the protein profiles between decapeptide-treated and untreated planktonic cells of S. mutans by two-dimensional gel electrophoresis and matrix-assisted laser desorption ionization time-of-flight mass spectrometry. We also verified different expressions of key protein enolase in the protein level.

RESULTSThe results showed that decapeptide altered the protein expression of planktonic S. mutans. These proteins were functionally involved in carbohydrate degradation by glycolysis, protein folding, conjunction, transport, translation, adenosine triphosphate binding, protein binding, sequence-specific DNA binding, transcription factor activity, and two-component response regulator activity. Western blot results showed that enolase protein expression decreased obviously in decapeptide-treated cells of S. mutans.

CONCLUSIONThe protein expression of S. mutans significantly changed after synthetic antimicrobial decapeptide treatment, suggesting that decapeptide may present a preferential effect on oral caries by changing the expression of certain key proteins, such as enolase protein.

Anti-Bacterial Agents ; Anti-Infective Agents ; Biofilms ; Dental Caries ; Depsipeptides ; genetics ; Electrophoresis, Gel, Two-Dimensional ; Oligopeptides ; genetics ; Proteomics ; Streptococcus mutans ; metabolism

Objective??To?compare?the?protein?profiles?between?decapeptide-treated?and?untreated?planktonic?cells?of?Streptococcus mutans?(S.mutans)?by?differential?proteomic?analysis?to?determine?and?identify?the?key?proteins.Methods??In?our?previous?study,?we?investigated?decapeptide?(KKVVFKVKFK–NH2),?which?was?a?novel?adenosine?monophosphate.?Com-pared?with?other?oral?pathogens?tested,?decapeptide?had?a?preferential?antibacterial?activity?against?S. mutans.?It?also?inhibited?S. mutans?biofilm?formation?and?reduced?the?one-day?developed?biofilm.?In?the?present?study,?we?first?synthesized?decapep-tide,?and?then?compared?the?protein?profiles?between?decapeptide-treated?and?untreated?planktonic?cells?of?S. mutans?by?two-dimensional?gel?electrophoresis?and?matrix-assisted?laser?desorption?ionization?time-of-flight?mass?spectrometry.?We?also?verified?different?expressions?of?key?protein?enolase?in?the?protein?level.?Results??The?results?showed?that?decapeptide?altered?the?protein?expression?of?planktonic?S. mutans.?These?proteins?were?functionally?involved?in?carbohydrate?degradation?by?gly-colysis,?protein?folding,?conjunction,?transport,?translation,?adenosine?triphosphate?binding,?protein?binding,?sequence-specific?DNA?binding,?transcription?factor?activity,?and?two-component?response?regulator?activity.?Western?blot?results?showed?that?enolase?protein?expression?decreased?obviously?in?decapeptide-treated?cells?of?S. mutans.?Conclusion??The?protein?expression?of?S. mutans?significantly?changed?after?synthetic?antimicrobial?decapeptide?treatment,?suggesting?that?decapeptide?may?pre-sent?a?preferential?effect?on?oral?caries?by?changing?the?expression?of?certain?key?proteins,?such?as?enolase?protein.

Objective To investigate the cachexia morbidity among hospitalized patients with digestive system cancer and evaluate its impact on clinical outcomes.Method By analyzing the clinical data of 5 118 hospitalized patients with digestive system cancer in Zhongshan Hospital,Fudan University from January 2012 to December 2013,we investigated the cachexia morbidity and compared the clinical outcome between cachectic patients and noncachectic patients.Results The overall cachexia morbidity of hospitalized patients with digestive system cancer was 15.7％ (803/5 118).The highest cachexia morbidity was 34.0％ (89/173),found in patients with pancreatic cancer.In cachectic group and non-cachectic group,the overall completion rate of radical resection was 67.1％ (539/803) and 74.5％ (3 214/4 315),respectively (P =0.000).Compared to the non-cachectic group,the cachetic group had significantly longer postoperative hospital days [(11.5 ±6.2) d vs (9.4 ±4.9) d,P =0.003],slower postoperative recovery of bowel function [(3.4 ±0.9) d vs (3.2 ±0.8) d,P =0.013],longer postoperative time to intake semifluid [(4.4 ± 1.5) d vs (3.9 ± 1.3) d,P =0.002],and more postoperative complications in 28 days after surgery [8.9％ (48/539) vs 5.8％ (186/3 214),P=0.006].After surgery,131 patients in the cachectic group were transferred to the ICU,and 646 patients in non-cachectic group transferred to the ICU (24.3％ vs 20.0％,P=0.026).Compared to the non-cachecic group,the reoperation rate [3.2％ (17/539) vs 1.5％ (48/3214)],ventilator support rate [8.0％ (43/539) vs 5.7％ (184/3 214)],and mortality [2.4％ (13/539) vs 1.1％ (35/3 214)] of the cachectic group were all significantly higher (P =0.006,0.042,0.011).Conclusions Cachexia is common in hospitalized patients with digestive system cancer,especially in patients with pancreatic cancer.Cachexia has negative impact on the clinical outcomes.