Basic & Clinical Medicine

Gastrointestinal tract involvement of COVID-19

SONG Kai, WU Dong, YANG Ai-ming

2020, 40(7): 881-886.

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Coronavirus disease 2019(COVID-19) has been a worldwide pandemic. Although the disease is mainly manifested by pulmonary involvement, still many COVID-19 patients present with other organ damage, including gastrointestinal involvement such as diarrhea, anorexia, nausea, and virus nucleic acid being found in fecal samples. Pathological examination demonstrates virus particles presence in epithelial cells of the digestive tract. These findings indicate that the digestive tract is also an important target organ of SARS-CoV-2. This paper reviews the relevant literatures on COVID-19 gastrointestinal involvement and summarizes the pathophysiological mechanism, clinical features, and implications for infection control and prevention.

Exploring the long-term complications of COVID-19 and its prevention through comparison with SARS and MERS

HU Jing-jing, TONG Jin

2020, 40(7): 887-892.

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The pandemic of COVID-19 in China has made the pathogen SARS-CoV-2 become a hot spot. SARS-CoV and MERS-CoV are classified into beta-coronavirus genus and mainly attack respiratory system. This article explores the long-term prognosis of patients with COVID-19 through comparison of patients with SARS and MERS in order to explore potential prevention strategy as well as method.

Diagnosis and treatment of COVID-19 by combination of Chinese and Western medicine

WANG Miao-lei, LIU Jun-hong, WANG Long-de, MAO Lan-fang, ZHANG Ping, FU Bo-ya

2020, 40(7): 893-896.

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For several months, the invasion of SARS-CoV-2 has brought great challenges to the human health. China has taken immediate act to prevent and control the pandemic. So far, the prevention and control of the pandemic situation in our country has achieved a great success in terms of controlling the spread of the virus. During this period, Traditional Chinese medicine has made great contributions to the treatment and prevention of COVID-19. This article summarizes the progress in the diagnosis and treatment of COVID-19 by using combination of Chinese and Western medicine.

Catecholamine stress hormones promote the cell cycle re-entry of G₀ phase in mouse hepatocarcinoma cell line H22

CAO Ming-yue, LI Gao-xiang, CHEN Yu-zhu, HUANG Wei, YANG Nan, LIU Yan-yong

2020, 40(7): 897-902.

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Objective To investigate the effect of stress hormones on cell cycle re-entry of G₀ phase in mouse H22 hepatocarcinoma cells. Methods Flow cytometry antibody staining with CD44 and CD133 was used to determine the presence of cancer stem cells in H22 cells. In vitro, after treatment of H22 cells with stress hormone corticosterone (CORT), epinephrine (EPI) and norepinephrine (NE) for 48 h, the proportion changes of cells in G₀ phase and cell cycle distribution were detected by Ki-67 and PI flow cytometry staining. The hormone receptor antagonists were used to verify the receptor subtypes that mediated the cell cycle re-entry of G₀ phase cells. Results The proportion of cancer stem cells (CD44⁺CD133⁺) in H22 cells was 0.80%±0.15%. Compared with control group, the portion of G₀ phase cells was unchanged after corticosterone treatment, but was decreased by 62.50% and 53.00% respectively after EPI and NE treatment. Meanwhile, the total cells, proportion of G₂/M and S phase cells were increased compared to control group. The protein expression of Skp2 was increased and p27^kip1 decreased significantly after EPI and NE treatment(P＜0.05). In addition, α1-adrenergic receptor antagonists terazosin and prazosin blocked the G₀ phase cells cycle re-entry effect of EPI and NE. The protein expression of Skp2 was decreased and p27^kip1 was increased significantly after prazosin treatment compared to EPI or NE group(P＜0.05). Conclusions Catecholamine stress hormones mediate the cell cycle re-entry of G₀ phase cells in mouse H22 hepatocarcinoma cells by activating α1-adrenergic receptor,the mechanism of which may be associated with the Skp2 over-expression and the degradation of p27^kip1 protein.

Efficient identification of point-mutant monoclonal cells through array tagged high-throughput sequencing

HAN Ling, YANG Ke, XUE Zheng, LYU Xiang

2020, 40(7): 903-911.

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Objective To establish an array tagged high-throughput sequencing and pre-polyclonal screening strategy for fast identification of genome-edited cell clones. Methods Introducing of G to T point mutation at rs826415 site of K562 cells by CRISPR/Cas9-mediated homologous recombination. The candidate cells were then seeded by 10~20 cells per well in a 96-well-plateand and so to be expanded into 96 polyclones. A two-step nested PCR with array barcoded primers was used to amplify the rs826415 surrounding region to differentially tag PCR product from each polyclone. The PCR products were mixed and subjected to next-generation sequencing to detect the recombination and indel rate for each polyclone. The polyclonal cells carrying the highest ‘homology-directed repair (HDR) without indel’ rate were sorted for monoclonal growth and rs826415 genotyping. Results Polyclonal cells obtained by CRISPR/Cas9-mediated homologous recombination and limiting dilution were screened with array tagged high-throughput sequencing. Ratio of the cells showed ‘HDR without indel’ was determined for each polyclone. Of the 96 polyclones screened, an average ‘HDR without indel’ rate was 0.21%, and the highest rate was 4.35%. Cells in the later were then subjected to monoclonal growth in a new 96-well-plate. In the 30 monoclones obtained, one showed the expected hybrid T/G genotype at the rs826415 site, instead of the G/G genotype in the unmodified K562 cells, indicated successful mono-allele targeting. Conclusions The array tagged high-throughput sequencing strategy, in combination with a pre-polyclonal screening, provides an efficient method for fast identification of genome-edited monoclonal cell. It saves both human and financial resources as compares to conventional screening methods.

HSP90 inhibitor inhibits glycolysis and promotes apoptosis of mouse hepatocarcinoma cell line H22

LIU Na-si, CAO Ming-yue, WU You-ming, HUANG Wei, YANG Nan, LIU Yan-yong

2020, 40(7): 912-916.

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Objective To investigate the effect of HSP90 inhibitor on glycolysis and apoptosis in mouse hepatocarcinoma cells, and to explore its underlying mechanism. Methods Examine the level of lactate and ATP in mouse hepatoma cell line H22 treated with CORT, GR antagonist RU486 and HSP90 inhibitor 17-AAG; Evaluate the apoptosis level of H22 cells after CORT or various concentrations of 17-AAG treatment; H22 cells were treated with CORT, RU486 and 17-AAG respectively, and then the expression of GR and PI3K/Akt-related proteins was determined by Western blot. Results Compared with the control group, CORT promoted GR nuclear translocation, while inhibited after RU486 treatment. Compared with CORT treatment alone, CORT and 17-AAG co-treatment could weaken the promotion of GR nuclear translocation by CORT(P＜0.05); The level of lactate and ATP was increased significantly after CORT treatment (P＜0.05). After co-treatment with 17-AAG, this effect was inhibited (P＜0.05).And the level of lactate and ATP was decreased by 24% and 17% respectively; Compared with the control group, 17-AAG could significantly increase the total apoptosis rate of H22 cells in a dose-dependent manner(P＜0.05); Compared with the control group, the protein expression of pAkt increased after CORT treatment, while decreased significantly after co-treatment with 17-AAG (P＜0.05). Conclusions HSP90 inhibitor 17-AAG can inhibit GR nuclear translocation, thereby inhibit glycolysis and promote apoptosis of hepatocarcinoma cells, which is potentially regulated by PI3K/Akt pathway.

miR-338-3p alleviates neuronal ischemic injury of mice through negatively regulating cPKCγ expression

WEI Hai-ping, GUO Jia, GE Zhao-ming, SHAO Kang-mei, WANG Hao-tai, LU Ni, WANG Huan

2020, 40(7): 917-922.

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Objective To investigate the effect of miR-338-3p on ischemic injury of neurons after oxgen glucose deprivation(OGD)/reoxgenation(R). Methods In vivo model of middle cerebral artery occlusion(MCAO) was developed in mice and in vitro model of oxygen glucose deprivation(OGD) was developed with in cortical neurons. Using Western blot to detect cPKCγ protein levels in peri-infarct cortex of mice(n=5) with 1 h MCAO/R 24,48 and 72 h and in neurons(n=5) with 1 h OGD/R 0,6,12 and 24 h; using quantitative RT-qPCR to detect miR-338-3p and cPKCγ mRNA; using bioinformatics to detect the binding sites of cPKCγ 3′UTR and miR-338-3P. Using MTT and LDH methods to detect the survival rate and apoptosis rate of nurons(n=6); using immunofluorescence and HCA to detect the expression of caspase-3 in neurons(n=5). Results cPKCγ protein and mRNA significantly increased in mice with 1 h MCAO/R 24,48 and 72h and in neurons with 1 h OGD/R 0,6,12 and 24 h(P＜0.001); cPKCγ 3′UTR had one miR-338-3p binding site; the miR-338-3p mRNA level showed an opposite trend to that of cPKCγ mRNA level; after over-expression miR-338-3p, the survival rate decreased(P＜0.001) and the apoptosis rate increased(P＜0.001) and the mean fluorescence intensity of caspase-3 increased(P＜0.001) in neurons after 1 h OGD/R 24 h. After inhibition miR-338-3p, the survival rate increased(P＜0.001), the apoptosis rate decreased(P＜0.001) and the mean fluorescence intensity of caspase-3 decreased(P＜0.001) in neurons after 1 h OGD/R 24 h. Conclusions miR-338-3p enhances the survival rate and reduces apoptosis rate of ischemic neurons by negatively regulation of cPKCγ and so to alleviate the injury of ischemic neurons.

Immune regulation of IL-17 through NF-κB signaling pathway involved in the development of gastric cancer

LI Chun-bo, SU Yun, GONG Hong-xia, XUE Xuan, LI Ting-ting, NIU Shi-wei, NIE Peng

2020, 40(7): 923-928.

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Objective To investigate the molecular mechanism of interleukin-17 in the development of gastric cancer through NF-κB signaling pathway. Methods Thirty patients with gastric cancer in Wuwei Cancer Hospital of Gansu province and 30 control individuals who had physical examination in the hospital at the same time were selected. The expression of IL-17,IL-6 and IL-8 in serum of patients with gastric cancer and control was detected by ELISA.The pathological changes of gastric cancer were observed by microscopy with HE staining; Immunohisto-chemistry method was used to detect the expression of IL-17, NF-κB p65, IKK-β and IL-6 in gastric cancer tissues, adjacent tissues and gastric tissues far from cancer tissues.The expressions of IL-17, NF-κB p65, pNF-κB p65, IKK-β and IL-6 in gastric cancer tissues, adjacent tissues and gastric tissues far from cancer tissues were detected by Western blot. Results IL-17, IL-6 and IL-8 were up-regulated in serum of gastric cancer patients compared with healthy controls group(P＜0.05). The expressions of IL-17, NF-κB p65, IKK-β and IL-6 in gastric cancer tissues were significantly higher than that in normal and adjacent groups (P＜0.05). The expressions of IL-17, NF-κB p65, pNF-κB p65, IKK-β and IL-6 were increased in gastric cancer tissues compared with normal gastric tissue (P＜0.05); the expressions of pNF-κB p65, IKK-β and IL-6 increased in peri-cancer tissues compared with normal gastric tissue (P＜0.05).The expressions of IL-17, NF-κB p65, pNF-κB p65, IKK-β and IL-6 were increased in gastric cancer tissues compared with adjacent tissues(P＜0.05). Conclusions IL-17 can stimulate IL-6 to function in regulation of gastric cancer and promote the development of gastric cancer through the NF-κB p65 signaling pathway.This result may provide new insights into the pathogenesis of gastric cancer and suggests that IL-17 may be a potential target of gastric cancer treatment.

Effect of synaptic adhesion molecule NECL4 on Ca²⁺-CaMKII -CDC42 signal pathway in cerebral cortex

HU Geng, LIU Xiao, SHU Peng-cheng, PENG Xiao-zhong

2020, 40(7): 929-933.

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Objective To investigate the effect of synaptic adhesion molecule nectin-like molecule 4 (NECL4) on Ca²⁺-CaMKII-CDC42 signal pathway and the number of dendritic spines. Methods Using Necl4 knockout mice as the research animal, the brain tissues of 8-week-old Necl4 wild type (WT) and knockout (KO) mice were stained with Golgi staining, then the density of dendritic spines on the secondary dendrites in layer Ⅱ/Ⅲ of cerebral cortex neuron was examined. Western blot and RT-qPCR were used to detect the protein and mRNA expression of Ca²⁺-CaMKII signal pathway and downstream signal molecules, including CDC42, Rac1, RhoA, H-Ras, ERK and other signal proteins. Results The Golgi staining showed that the number of dendritic spines on the secondary dendrites of the cerebral cortex Ⅱ/Ⅲ layer neuron in Necl4 knockout mice was less than that in wild type mice(P＜0.01). The results of Western blot showed that the expression of CaMKIIα (P＜0.05) and phospho-CaMKIIα (Thr286) (P＜0.05) decreased in Necl4 knockout mice. The mRNA (P＜0.05) and protein (P＜0.05) levels of CDC42 were decreased in Necl4 knockout mice. Conclusions NECL4 regulates the number of dendritic spines in mouse cerebral cortex through Ca²⁺-CaMKII-CDC42 signal pathway.

Rapamycin inhibits colorectal cancer progression through down-regulating mTOR-GP73 pathway

ZHANG Meng-di, WANG Ya-nan, LI Jie, PU Yang

2020, 40(7): 934-939.

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Objective To explore the mechanism and potential regulation of GP73 in human colorectal cancer cell proliferation. Methods GEPIA website was used to analyze GP73 gene expression in human colorectal cancer samples. shRNA targeting GP73 was constructed and then transfected into Caco2 and HT-29 cells to knock-down GP73 expression. Cell proliferation was measured by CCK8 assay. Colony formation experiment was used to detect cell proliferation. CCK8 method was used to detect control cells and GP73-knockdown HT-29 cell proliferation after rapamycin treatment. Wild type mice administered with AOM-DSS induced colitis-associated colorectal cancer (CAC) were treated with rapamycin. Western blot was used to detect protein levels of mTOR and GP73 pathway in treated mice. Results GP73 is highly expressed in human colorectal cancer tissues. Deficient-GP73 inhibited human colorectal cancer cell proliferation. Rapamycin suppressed AOM-DSS induced CAC development and down regulated mTOR-GP73 axis. Down-regulation of GP73 caused human colorectal cancer cells insensitive to rapamycin treatment. Conclusions GP73 is highly expressed in human colorectal cancer tissues. Deficient-GP73 inhibits proliferation of human colorectal cancer cells. Rapamycin inhibits the progression of colorectal cancer through down-regulation of mTOR-GP73 pathway.

Establishment of cetp^-/- model and liver transcriptomics study in zebrafish

FENG Dong-ping, SHANG Han-qiao, YANG Hang, ZHANG Hu-jun, ZHANG Ting, YANG Meng-xi, TU Qiang, REN Jing-yi

2020, 40(7): 940-947.

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Objective To investigate the transcriptomic changes in atherosclerosis after cetp knockout of zebrafish. Methods The gene editing technology CRISPR/Cas9 was used to knock out cetp of zebrafish to construct a homozygous mutant model. Total RNA of livers from wild type and cetp^-/- model was extracted by the Trizol method, and gene expression profiles of cetp knockout were observed by transcriptomics. KEGG enrichment analysis was performed on significantly different expressed genes to explore the signal pathways it may affect. Results Homozygous mutant zebrafish that has a frameshift mutation of adding 5 base pairs was created through CRISPR/Cas9 technology. Transcriptomics analysis showed that the gene expression profile of zebrafish liver changed significantly after cetp knockout. A total of 3 808 different expressed genes were screened (P＜0.05), of which 1 918 genes were up-regulated and 1 890 genes were down-regulated. Genes related to lipid metabolism such as abca1 and abcg2a were significantly up-regulated and lipg were significantly down-regulated. Genes related to autophagy signaling pathways such as atg13 were significantly up-regulated, and down-regulated genes were enriched in related pathways such as DNA and RNA synthesis and the tricarboxylic acid cycle. Conclusions A zebrafish model with cetp knockout is established to study the mechanism of cholesteryl ester transfer protein (CETP) in atherosclerotic diseases. Although increased high-density lipoprotein cholesterol due to the inhibition of CETP prevents atherosclero-sis, inflammation is activated after cetp knockout in zebrafish and causes atherosclerosis. It suggests that CETP has a dual regulation mechanism in the development of atherosclerosis.

Role of ZBED3 in cortex cerebral development through conventional Zbed3 knockout mouse

SUN Chang-jie, SHU Peng-cheng, PENG Xiao-zhong

2020, 40(7): 948-954.

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Objective To explore the role of zinc finger BED domain-containing protein 3, a member of zinc finger domain protein superfamily, in cortex cerebral development through conventional Zbed3 knockout mouse. Methods In situ hybridization and immunofluorescence were used to detect the mRNA and protein of Zbed3. Immunofluorescence was recruited to analyze the proliferation of neural progenitor cells in Zbed3 conventional knockout mouse. EdU labeling and immunofluorescence were used to analyze the neural position and layer fates in Zbed3 conven-tional knockout mouse. RT-qPCR and Western blot were used to detect the gene expression difference caused by Zbed3 knockout. Results Zbed3 mRNA and protein were not found in Zbed3 conventional knockout mouse; Knockout of Zbed3 failed to affect the proliferation of neural progenitor cells and the formation of neocortex layers. The expression of β-catenin was up-regulated in Zbed3 conventional knockout mouse. Conclusions Knockout of Zbed3 is not able to cause the apparent phenotype in cortex cerebral development.

DihydrotanshinoneⅠ promotes apoptosis of human esophageal squamous cell carcinoma cell line EC9706

WANG Xiu-mei, WANG Kang-kang, CHEN Xiao-yan, LUO Jin-jian

2020, 40(7): 955-959.

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Objective To investigate whether dihydrotanshinone Ⅰ could regulate the biological activities of proliferation, migration and apoptosis of esophageal squamous cell carcinoma cell line EC9706 through Wnt/β-catenin signaling pathway. Methods EC9706 cells were cultured in medium containing 0, 10, and 30 μmol/L dihydrotanshinoneⅠ solution, and cell proliferation was examined with a cell counting kit-8, cell migration was checked with scratch test. Western blot was used to detect β-catenin, cyclin D1 and c-myc protein expression in cells. Apoptosis was detected by flow cytometry. Results DihydrotanshinoneⅠ effectively inhibited the proliferation and migration of EC9706 cells. DihydrotanshinoneⅠ down-regulated β-catenin, cyclin D1 and c-myc protein expression in cells (P＜0.05). DihydrotanshinoneⅠ promoted apoptosis in a dose-dependent manner. Conclusions DihydrotanshinoneⅠ can inhibit proliferation and migration of EC9706 cells and promote the cells apoptosis.

High density lipoprotein improves the symptoms of collagen-induced arthritis in mice

WANG Xin, DONG Qing-zhe, ZHANG Juan, LI Dong, AI Di, WANG Yun-long

2020, 40(7): 960-964.

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Objective To investigate the effects of high-density lipoprotein (HDL) on collagen-induced arthritis (CIA) animal model. Methods DBA/1 mice were divided into three groups: control group, CIA group and CIA+HDL group. Mice in the CIA and CIA+HDL groups were immunized with an emulsion of Freund's complete adjuvant and bovine type Ⅱ collagen on day 0. The control group was injected with saline. On day 21, the CIA group and CIA+HDL group were injected with an emulsion of Freund's incomplete adjuvant and bovine type Ⅱ collagen to streng then the immune response. The control group was injected with saline only. The CIA+HDL group was injected with HDL(10 mg/kg) on day 40 followed by HDL injection five times every 3 days. The control group and the CIA group were injected with the same volume of saline. Changes in mouse body weight and clinical scores ofarthritis were recor- ded.The mice were sacrificed on day 75, and the serum levels of tumor necrosis factor-α, anti-collagen-Ⅱ antibody IgG2a of the mice were measured using ELISA kit. Then the tissue sections of ankle joints were stained with hematoxylin-eosin to analyze the severity of rheumatoid arthritis in mice to evaluate the efficacy of high-density lipoprotein in the treatment of rheumatoid arthritis. Results Compared with the CIA group, intravenous injection of HDL at a dose of 10 mg/kg significantly alleviated the symptoms of rheumatoid arthritis in mice. The results showed that HDL alleviated the clinical symptom of arthritis and decreased the level of serum pro-inflammatory factor TNF-α and specific antibody of IgG2α (P＜0.05). Histopathological examination showed that HDL can smoothen the ankle articular surface, significantly decrease synovial hyperplasia, inflammatory cell and bone erosion and other pathological changes. Conclusions HDL can significantly alleviated the symptoms of collagen-induced rheumatoid arthritis of mice.

Effect of compound betamethasone combined with semiconductor laser on erosive oral lichen planus and Candida

WANG Sai-nan, REN Hao, LI Xin, JU Yun-meng, KONG Fan-zhi, LU Shu-lai

2020, 40(7): 965-970.

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Objective To investigate the clinical efficacy of compound betamethasone combined with semiconductor laser in the treatment of erosive oral lichen planus (EOLP). Methods Ninety cases with erosive lesions and pathologically confirmed EOLP diagnosed in the Department of Oral Mucosa of Qingdao Municipal Hospital were selected and randomly divided into three groups A, B, and C, with 30 cases in each and treated respectivel for 28 days. Group A patients were treated with compound betamethasone under local anesthesia (2 weeks/time); group B patients were treated with semiconductor laser local irradiation (3 times/week); group C patients were treated with betamethasone combined with semiconductor laser treatment.The lesion area and local focus were observed and recorded after 2 weeks and 4 weeks, Saliva were collected before and after treatment to detect the levels of IL-17 and IL-38, C.albicans were isolated with routine technology. Results After treatment, the lesion area of group C was significantly smaller than that of group A and group B(P＜0.05); the pain degree scores of group C were significantly lower than those of groups A and B(P＜0.05); the local focus scores of group C were significantly lower than those of groups A and B(P＜0.05). After treatment, the detection rate of C.albicans in group A, B and C patients was statistically significant(P＜0.05). After treatment, IL-17 and IL-38 in group C were significantly different from those in groups A and B(P＜0.05). Conclusions The overall effect of therapy with betamethasone plus semiconductor laser in the treatment of EOLP is better than that either mono-thearpy.

Clinical characteristics and endoscopic diagnosis and treatment of colorectal foreign body cases

ZHANG Sheng-yu, SHI Wen, RUAN Ge-chong, LI Ji, WANG Qiang, JIANG Qing-wei, WU Dong-sheng, ZHENG Wei-yang, WU Xi, YANG Ai-ming

2020, 40(7): 971-974.

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Objective To investigate the clinical features, endoscope diagnosis, and treatment of cases of colorectal foreign bodies. Methods A retrospective analysis of colorectal foreign body cases admitted to the Digestive Endoscope Center from June 2005 to September 2018 were completed. The information of gender, age, source and location of foreign bodies, complications, and methods of removal was collected so that characteristics and management experience were summarized. Results A total of 14 cases of colorectal foreign bodies were included, among which there were 10 males (71%) with an average age of 49 years old (21-80 years old). The origin of foreign body included iatrogenic (5 cases), oral (3 cases), anal (5 cases) and one case of unknown reason. As to the position of foreign bodies, iatrogenic and oral foreign bodies might distribute in the whole colon, while anal foreign bodies located in sigmoid-rectum mainly. In total 6 cases suffered from foreign body-related complications, including mucosal injury (1 case), intestinal wall injury (2 cases), intestinal obstruction (2 cases) and liver abscess (1 case). We attempted to remove foreign bodies under endoscopy in 12 cases, with success in 11 cases; the instruments used were foreign body forceps (7 cases) and snares (5 cases). The main reason of failure was big size of foreign bodies. Conclusions The distribution of colorectal foreign bodies is related to its origin; colorectal foreign bodies may cause colonic mucosal injury, intestinal obstruction or intestinal perforation, and even severe peritoneal infection; when attempting to remove colorectal foreign body under endoscope, foreign body forceps and snares can be used. After the foreign body's removal, it is necessary to be alert of the colon perforation.

Clinical characteristics and therapeutic strategy of urogenital solitary fibrous tumors

ZHAO Zhao, LIU Fan, JI Zhi-gang, ZHANG Zhen-yu, HUANG Zhong-ming, SHI Bing-bing

2020, 40(7): 975-979.

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Objective To analyze, summarize and explore the diagnostic methods and treatment strategies of urogenital solitary fibrous tumor (SFT). Methods The study was carried out by reporting a male patient with urogenital SFT, and by reviewing the demographic, clinical and pathological features, treatment and follow-up of 35 patients reported from 2008 to 2018. Results Of the 35 patients, 24 (68.6%) had urinary symptoms, while 11 (31.4%) had no obvious complaints of discomfort at the time of diagnosis. In terms of pathological results, the surgical and pathological specimens of 34 patients (97.1%) were CD34⁺, and 27 cases (77.1%) were Bcl-2⁺. Conclusions The MRI and CT are efficient technology for detection of the SFTs. The immunohistochemical test of surgical specimens is the key to establish diagnosis, especially the characteristic staining of CD34, Bcl-2,STAT6 and ALDH2 is of great value in the diagnosis. In addition, the detection of NAB2-STAT6 fusion protein by molecular pathology also facilitate the diagnosis of SFTs. Surgical resection is the best therapy for SFTs.

Comparison of MALDI-TOF-MS and RT-qPCR for detection of SLCO1B1 and ApoE gene polymorphisms

YE A-li, ZOU Yu-tong, ZHANG Hai-yan, WU Jie, ZHANG Rui, ZHANG Xiao-feng, MA Qing-wei

2020, 40(7): 980-985.

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Objective To compare the consistence between matrix-assisted laser desorption ionization time of flight mass spectrometry(MALDI-TOF-MS) with real-time fluorescence quantitative polymerase chain reaction (RT-qPCR) on genetic polymorphisms associated with the metabolism of lipids or drugs, and assess whether the MALDI-TOF-MS method can be used for clinical SLCO1B1 and ApoE gene polymorphism detection. Methods A total of 71 individuals diagnosed with hyperlipidemia, hypertension or atherosclerosis in Peking Union Medical College Hospital were included. The whole blood samples with EDTA were collected and genomic DNA was extracted. MALDI-TOF-MS and RT-qPCR were applied for analyzing rs2306283(388A＞G) and rs4149056(521T＞C)of SLCO1B1 as well as rs429358(388T＞C) and rs7412(526C＞T) of ApoE. The results of genetic polymorphisms were compared by Kappa coefficient. Results There were no statistically significant differences for genotype distribution of SLCO1B1 and ApoE between two methods. Only one sample had a typing difference in the rs4149056(521T＞C) locus between two methods. However, the results consistent with RT-qPCR were obtained after the sample was retested by MALDI-TOF-MS. Conclusions MALDI-TOF-MS can be applied to the detection of lipid and drug metabolism-related genes SLCO1B1 and ApoE polymorphisms, thereby guiding statins treatment.

Research of relation between glial cell line-derived neurotrophic factor and digestive system tumor

WANG Xiao-juan, LI Xiao-li, JIN Zheng-xu, ZHANG De-kui

2020, 40(7): 986-989.

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Abnormal expression of GDNF (glial cell line-derived neurotrophic factor) and its receptor(RET) are associated with the emergence and development of tumors in the digestive system. GDNF and RET are associated with peripheral nerve invasion with a dose-dependent manner in pancreatic cancer, while RET(-) cancer cells lose the ability to invade and destroy nerves. RET mutations promote the proliferation, migration and survival of colon cancer cells, and are associated with poor prognosis of colon cancer patients. GDNF can promote the angiogenesis of liver cancer tissues independently of vasogenic growth factor, providing sufficient nutrition for the growth and invasion of tumor cells. Methylation of the GFR 3 promoter was found in gastric cancer, and the degree of methylation was negatively related to postoperative survival of patients.

Progress of research on diabetes with hypertension aggravating vascular disease

LIU Ning, ZHANG Wei-hua

2020, 40(7): 990-994.

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The major cause of morbidity and mortality of diabetes is cardiovascular disease, which is exacerbated by hypertension. Diabetes and hypertension are closely interlinked because of similar risk factors, and there is also substantial overlap in the cardiovascular complications of diabetes and hypertension. Controlling comorbidities, especially hypertension, is important in reducing the vascular complications of diabetes.

New progress of goal-directed fluid therapy in enhanced recovery after surgery

HE Xiao-yi, ZOU Xue-jun, XING Hao-ran

2020, 40(7): 995-998.

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Goal-directed fluid therapy(GDFT) is an important method to accelerate patients rehabilitation after surgical operation. It can maintain the stability of hemodynamic indexes, balance of oxygen supply and demand, reduce the perioperative inflammatory response, minimize postoperative complications and improve the prognosis of patients.

A questionnaire on the current situation of patient safety and quality improvement in a tertiary hospital

WANG Yu, ZHANG Yun, ZHAO Dan-qing, CHU Xiao-tian, ZHANG Qi, ZENG Xue-jun

2020, 40(7): 999-1003.

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Objective To investigate the current situation of improving patient safety and healthcare quality in a tertiary hospital and the understanding of healthcare providers and medical students. Methods A total of 526 valid questionnaires were collected from clinicians, nurses, residents from Peking Union Medical College Hospital(PUMCH) and medical students of Peking Union Medical College(PUMC). Results In the past year, there were 8.2% and 58.8% of the respondents who had experienced medical errors and found potential risks in the clinical process. More than half of respondent's team had reported adverse events, and most of them (75.3%) followed the right way to report. Most people believed hospital authority encouraged reporting medical adverse events, while some of them still worried about potential blame and punishment stemmed from reporting. The results also showed that 88.0% supported development of special curriculum in this field. Some of them had experiences that may have impacts on patient safety in transfer-ring(42.6%)and handover (15.4%), and the majority of people agreed that occupational burnouthas negative impact to patient safety. Almost all the investigation participnts-complained that their emotions and work would be negatively affected if there was a medical error, while 44.5% said that the error also had a positive impact. Conclusions Most of the respondents are relatively satisfied with the current measures of patient safety and quality improvement in PUMCH, but they are still worried about the negative impact on the individuals after the adverse events are reported.

Impact of simulation-based training in learning of endobronchial ultrasound-guided transbronchial needle aspiration and specimen acquisition for genotyping of lung cancer

CHEN Min-jiang, XU Yan, ZHAO Jing, SUN Xue-feng, ZHONG Wei, WANG Meng-zhao

2020, 40(7): 1004-1010.

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Objective The efficacy of the two teaching methods for EBUS-TBNA was evaluated by comparing the learning curve, diagnostic accuracy, and specimen acquisition for genotyping by operators and so to find a better one for training pulmonologists. Methods The first fifty patients of each operator learning EBUS-TBNA between January 2015 and June 2019 in a single center were retrospective collected and grouped by the operators training methods. The diagnosis, genotyping and clinical characters were reviewed. Results A total of 442 patients were collected and reviewed. There were two training groups: a conventional training group (232 cases) and a simulator assistant training group (210 cases). There was no statistical difference in the diagnostic yield between the groups of trainees. However, specimen from lung cancer patients in simulator training group were more adequate for gene testing than in conventional training group (86.8% vs 71.2%, P＜0.05). By comparing the learning curve among the groups, it was found that the trainees in stimulator assistant training group needed less minimum number of operations to achieved proficiency than in conventional training group. Conclusions Simulation-based training is demonstrated to be more efficient in improving the bronchoscopists'skill in terms of getting sufficient specimen for gene testing. Simulation-based training may also shorten the time needed for bronchoscopists'training and can be applied in the EBUS-TBNA training course.

Investigation of SRTP improving the scientific research ability of undergraduate-master consecutive medical candidates

ZHAO Yu-xin, XU Peng, ZHAO Jia-le, LI Qin, WANG Rui-ping, Wular ADELI, FENG Shu-mei

2020, 40(7): 1011-1014.

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Objective To explore the role of student research training program(SRTP) in improving the scientific research interest, basic knowledge and basic ability of undergraduate-master's consecutive medical students. Methods A questionnaire survey was conducted among 69 medical students who were in the 2015 and 2016 clinical programs. They participated in and completed SRTP. And some situations was statistic analysis including students' SRTP team formation, project implementation, satisfaction, and academic results(published papers). Results 85% of the project direction was to be completed independently by the project team members under the guidance of the mentor.The comprehensive scientific research ability of students at the later stage of the project was obviously higher than the beginning of the project.More than 85% of students were satisfied with the completion of the SRTP course. SRTP had a significant improvement in students' scientific research thinking, communication and collaboration ability, experimental habits, and learning ability. There were shortcomings such as low student publications and low quality. Conclusions SRTP can be used as a pre-cultivation link for the improvement of scientific research ability of undergraduate-master's consecutive medical students. It plays a bridge role of scientific research ability in continuous cultivation of undergraduate-master degree, and which has important reference value for talent training in medical universities.

Application of SPOC flip classroom based on WeChat platform in clinical pharmacology teaching

YU Yan, SHEN Bing-zheng

2020, 40(7): 1015-1019.

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Objective To explore the application of SPOC flipped classroom based on WeChat platform in clinical pharmacology teaching. Methods The undergraduates, who took the course in the same grade majored in clinical medicine from the first clinical college of Wuhan University, were divided into the control group using traditional teaching methods and the experimental group adopting the SPOC flip classroom teaching method based on the WeChat platform. Results The theoretical test score(83.39±9.17) of the experimental group, which was significantly higher than the control group (76.91±9.70) (P＜0.05). For the examination of abbreviated question and case analysis with a score of 40 points, the score of experimental group (31.61±3.69) was higher than the control group (26.68±5.15) (P＜0.001). Conclusions The application of the SPOC flip classroom based on WeChat platform in teaching clinical pharmacology for the undergraduate students can improve their performance, especially the capacity to use the theoretical knowledge to solve clinical problems.

Investigation of the new ultrasonographic teaching pattern conducted in 4+4 medical educational pilot class at Peking Union Medical College

WANG Ming, YANG Meng, ZHANG Rui, TANG Lin, GUI Hang, YAN Li, LI Jian-chu

2020, 40(7): 1020-1024.

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Objective To investigate the value of new ultrasonographic teaching pattern in the urological integrated teaching course for 4+4 medical education pilot class of Peking Union Medical College (PUMC), and optimize future improvements based on teaching feedbacks. Methods Four themes were set up in the new ultrasonographic teaching pattern, including theory combined with ultrasonographic images and videos teaching, human ultrasonographic practice teaching, ultrasonographic simulation teaching and ultrasonographic case discussion. After the class, feedbacks from students were collected through questionnaire survey and the data was analyzed. Results The survey results showed that the multiple-model methods were well accepted by students. However, current teaching content and class hours were not enough to meet students' needs. Conclusions Increasing the input of ultrasonographic education is suggested for future improvement of imaging teaching at PUMC. Furthermore, establishing a more reasonable and hierarchical ultrasonographic teaching schedule based on the clinical teaching needs and students' learning capacity improve the learning outcomes of an integrated teaching.

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