Table of Content

05 November 2020, Volume 40 Issue 11

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Original Articles

Sex differences found in model mice of phenylhydrazine-induced anemia

SUN Shao-hua, ZHANG Xuan, YANG Yao-qi, LYU Tao

2020, 40(11):  1457-1461. 

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Objective To observe the effect of gender on animal model in phenylhydrazine(PHZ)-induced hemolytic anemia(HA). Methods Ten to 11 week old C57BL/6 mice were injected intra-peritoneal with PHZ solution (120 mg/kg). Peripheral blood was collected from submandibular vein before PHZ injection and on the 3rd, 5th, 7th, 9th and 14th days after PHZ injection. The indexes of red blood cells and white blood cells were detected by auto hematology analyzer. Results On the third day after PHZ injection, both female and male mice showed similar symptoms of acute HA: pale paw skin; hemoglobinuria; weight loss; decreased erythrocyte counting and hematocrit(P＜0.05). On the third day after PHZ injection, the compensatory increase of spleen size in female mice was significantly higher than that in male mice(P＜0.05). On the 9th day after PHZ injection, erythrocytes number, hematocrit and hemoglobin content of female mice were also significantly higher than that of male mice(P＜0.05). Conclusions There are sex differences in stress erythropoiesis induced by PHZ in mice. The recovery rate of erythropoiesis in female mice is higher than that in male mice.

Analysis of gene expression profile based on two types of pulmonary hypertension model

XING Shu-juan, DONG Ming-qing, YANG Li-xia, LUO Ying

2020, 40(11):  1462-1467. 

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Objective Microarray and bioinformatics analysis were performed to explore the pathogenesis and the key genes coding for the development of pulmonary artery hypertension(PAH). Methods The differential expression microarray data in PAH mice(data from both current research and NCBI database with accession number GSE 48936) were analyzed simultaneously. Results 1)Totally 112 differentially expressed genes were obtained by the combined analysis of the two sets of data. 2)These genes were mainly enriched in biological processes such as inflammatory process, defense response, and stress response. 3)These genes were chiefly involved in the cytokine-cytokine receptor interaction, chemokine signaling pathway and the effect of cytochrome p450 on the metabolism of exogenous substances. 4)The 112 genes were analyzed by string database, 10 central genes (CD68, CD86, CCL6, ms4a6d, CXCL10, C3ar1, CXCL9, C1qA, C1qB and Ctss)with high degree scores were screened out. Three significant modules were selected by using the MCODE of Cytoscape software and involving genes mainly enriched in inflammatory response, positive regulation of leukocyte migration, IL-17 signaling pathway and regulation of defense response. Conclusions These genes are potentially involved in the development of PAH and this conclusion may facilitate identification of pathogenesis of PAH.

Differentiation of human urine-derived iPSCs into hair follicle stem cells

ZHOU Hua-teng, LI Chang-ming, WANG Li-xiang, HU Jin-tao, DU Wei-bin, ZHANG He-lou, REN Wei-fan

2020, 40(11):  1468-1473. 

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Objective To differentiate urine derived pluripotent stem cells (iPSCs) into hair follicle stem cells (HFSCs) to construct a skin substitutes. Methods Human urinary cells isolated from a healthy donor were re-programmed into iPSCs. iPSCs were then induced into iPS-HFSCs. Immunocytochemistry and RT-qPCR were used to examine the characteristics of the induced iPS-HFSCs. Results The iPSCs induced from urine cells have characteristics as embryonic stem cells. iPSCs derived cells displayed the morphology, genes expression and phenotypes similar to iPS-HFSCs. Conclusions The urine cells are successfully reprogramed into iPSCs by four transcription factors, and iPSCs derived cells show characteristics similar to HFSCs.

Expression of BDNF is increased in activated astrocytes of ALS transgenic mice

DING Kang, ZHANG Feng-ping, WANG Shu-kun, LIU Mei-yi, JIANG Xin, CHEN Yan-chun, ZHOU Feng-hua

2020, 40(11):  1474-1478. 

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Objective To explore the expression and localization of brain derived neurotrophic factor(BDNF) in neurons and astrocytes(AS) of transgenic mice with amyotrophic lateral sclerosis(ALS), and to further clarify the pathogenesis of ALS. Methods Immunofluorescence assay was used to detect the expression of BDNF in spinal cord neurons and astrocytes of 95, 108 and 122 days old ALS transgenic mice. The wild type(WT) mice were used as controls group. Neuron cell line NSC34 was used as a cell model to establish wild type and SOD1-G93A mutant NSC34 cell strains, the transgenic mice from the same litter were selected to culture the primary astrocytes. The protein expression of BDNF in NSC34 cell model and primary astrocytes was detected by Western blot. Results Compared with WT mice, the expression of BDNF in neurons was decreased in spinal cord tissues of 95, 108 and 122 days old ALS transgenic mice(P＜0.05), while the expression of BDNF/GFAP double positive cells was significantly increased.In the cell model, BDNF expression decreased in SOD1-G93A mutant NSC34 cells(P＜0.05) and increased in activated astrocytes(P＜0.05). Conclusions The expression and localization of BDNF in neurons and activated astrocytes of transgenic mice with ALS suggest that the autonomic mechanism of neurons and the non-autonomic mechanism mediated by astrocytes play an important role in the pathogenesis of ALS.

Autophagy in CaSR-mediated migration of non-small-cell carcinoma cell line A549

LIU Jia-long, LI Chun-lin, LI Guang-wei

2020, 40(11):  1479-1483. 

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Objective To investigate the role of autophagy in hypoxia-activated CaSR(calcium-sensing receptor,CaSR) in mediating migration of A549 cells. Methods A549 cells in the logarithmic growth phase were randomly divided into control group(N), hypoxia group (H), hypoxia agonist group (H+Gd), hypoxia inhibitor group (H+NPS), and autophagy pathway inhibitor group (H+Gd+3-MA).Western blot was used to detect the expression of CaSR and autophagy protein (Beclin-1) in the cells; Cell scratch experiment was used to detect migration of A549 cells; Transwell assay was applied to evaluate the invasion of A549 cells. Results Hypoxia resulted in increased CaSR expression in A549 cells (P＜0.05), a decreased expression of autophagic effector protein Beclin-1(P＜0.05), increased the percentage of cell healing per unit time (P＜0.05), and the number of cell invasion-permeable membranes (P＜0.05).GdCl₃ strengthened the effect of hypoxia, while NPS2390 did weaken the effect of hypoxia. On the basis of hypoxia and GdCl₃ conditions, 3-MA further increased the expression of metastasis related indicators of A549 cells, but not the autophagy related indicators. Conclusions CaSR activation promotes migration and invasion of A549 cells by down-regulating autophagy.

TCF7L2 rs290481 polymorphisms are correlated to type 2 diabetes combined with coronary heart disease

LUO Shi-mu, OUYANG Hang, JIANG Yan-cheng, ZHANG Zhi-shan

2020, 40(11):  1484-1488. 

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Objective To investigate the correlation between single nucleotide polymorphisms (SNPs) on the rs290481 site of TCF7L2 gene and type 2 diabetes mellitus complicated with coronary heart disease(CHD). Methods Peripheral blood DNA was extracted and TCF7L2 gene was amplified by polymerase chain reaction (PCR) and then sequenced in 120 patients with simple type 2 diabetes (T2DM), 120 patients with coronary heart disease (CHD), 120 patients with type 2 diabetes combined with coronary (T2DM+CHD) and 120 healthy controls. Chi-square test was used to analyze the difference of genotype frequency in four groups and binary logistic regression was used to analyze the risk factors of diabetes with coronary heart disease. Results The distribution frequency of AA, AG and GG on TCF7L2 and rs290481 SNP sites from T2DM group were significantly different with the controls, CHD group and T2DM plus CHD group respectively (P＜0.01). The serum level of HbAlc and GLU, was significantly different between AA and AG/GG genotypes (P＜0.05). Logistic regression data demonstrated that history of hypertension, HbAlc, GLU and the rs290481 AG/GG genotype of TCF7L2 were independent risk factors of diabetes mellitus complicated with CHD. Conclusions The polymorphism of TCF7L2 rs290481 gene is associated with the risk of type 2 diabetes complicated with CHD. AG/GG genotype confer a significantly increased risk of type 2 diabetes mellitus with CHD.

Synonymous mutations in von-Hippel Lindau gene cause familial pheochromocytoma

MA Xiao-sen, ZHANG Xue-bin, ZHOU Ting, CUI Yun-ying, TONG An-li

2020, 40(11):  1489-1493. 

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Objective This is a case report of family with VHL disease caused by a rare synonymous mutation of VHL gene and then the frequency of the mutation in pheochromocytoma/paraganglioma (PPGL) was investigated. Methods Genomic DNA was extracted from the peripheral blood of proband and his families. The whole exome sequencing was performed to examine the potential pathogenic variations in proband and the Sanger sequencing was used to verify the mutations detected above. Results The proband was a 15-year-old male with episodic palpitations, profuse sweating and elevated blood pressure. Biochemical tests showed that 24 h urinary norepinephrine was significantly increased. CT scanning found masses in bilateral adrenal glands. The masses were removed by surgical operation and pathologically diagnosed as pheochromocytoma. In the proband's family, only the aunt of his mother suffered from pheochromocytoma, and the tumor had been surgically removed. A total of 4 family members were found to be carrier of VHL synonymous mutation c.414A＞G (p.Pro138Pro). No one else in the family had other clinical manifestations of VHL disease. In addition, one patient with the same germ line mutation was also found in another 107 cases of PPGL. Conclusions The VHL synonymous mutation is firstly reported in Chinese families. The frequency of the mutation in the PPGL cohort is about 1%.

Rev-erb agonist SR9009 inhibits the proliferation of human colon cancer cell line HCT116 through reducing autophagy

SHI Guang, NING Na, HOU Xiao-hong, SUN Cong, YUAN Yuan, WANG Li, WANG Xiao-hui

2020, 40(11):  1494-1499. 

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Objective To investigate the effect of hemeregulated nuclear receptor(Rev-erb) agonist SR9009 on the proliferation and potential mechanism of human colon cancer cell line HCT116. Methods HCT116 cells were cultured and treated with Rev-erb agonist SR9009 with proper dosagee and treatment time. The cell proliferation was observed with a phase contrast microscopve. The cell viability was tested using a CCK-8 kit. The mRNA transcription of Rev-erb α, Rev-erb β and autophagy genes Beclin1, LC3 and p62 were detected by real-time PCR. The protein expression of Rev-erb α, Rev-erb β, Beclin1, LC3 and p62 were detected by Western blot. Results 1)Rev-erb agonist SR9009 inhibited the HCT116 cell proliferation as compared with control group (P＜0.05), and the right dose of SR9009 was 20 μmol/L and the treatment time was 24 hours. 2)SR9009 significantly increased Rev-erb α and Rev-erb β mRNA transcription (P＜0.01) and protein expression (P＜0.05) in HCT116 cells. 3)R9009 significantly reduced the expression of autophagy genes Beclin1 and LC3 in HCT116 cells (P＜0.05), causing autophagy protein p62 accumulation. 4)HCT116 cell viability was further decreased with an autophagy inhibitor 3-methyladenine (3-MA) after SR9009 treatment (P＜0.05), the cell viability was restored by an autophagy activator rapamycin (P＜0.05). Conclusions Rev-erb agonist SR9009 inhibits proliferation and cell viability of colon cancer cell line HCT116 by reducing autophagy.

Inhibition of miR-621 expression promotes proliferation, migration and invasion of human gastric cancer cell lines

CHEN Guo-yan, FENG Xiao-bo

2020, 40(11):  1500-1505. 

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Objective To detect the expression of miR-621 in gastric cancer tissues and cell lines and to evaluate the prognostic significance of miR-621, and to analyze the effect of miR-621 on the biological function of gastric cancer cells. Methods Expression of miR-621 in cancer tissue and cell lines was detected by real-time polymorperase chain reaction(RT-qPCR). Chi-square test was used to analyze the relationship between miR-621 and clinical pathological features of gastric cancer patients. Prognostic significance of miR-621 for gastric cancer was analyzed by survival curve and Cox regression. Finally, human gastric cancer cells were transfected with miR-621 mimics and inhibitors to analyze the proliferation, migration and invasion ability of gastric cancer cells. Results The expression of miR-621 was significantly downregulated in gastric cancer tissues and cell lines as compared to the adjacent tissues and gastric mucosa cell lines(P＜0.01), and low expression was associated with lymph node metastasis, tumor differentiation, and TNM stage in gastric cancer(P＜0.05). The patients with low expression of miR-621 had a poor overall survival rates(log-rank test P＜0.001), and miR-621 was an independent prognostic indicator for gastric cancer patients(HR=3.09, 95% CI=1.31-7.27, P=0.01). In addition, low-expression of miR-621 significantly increased proliferation, migration, and invasion of gastric cancer cells(P＜0.05). Conclusions Low expression of miR-621 is associated with poor prognosis of gastric cancer, which promotes the proliferation, migration and invasion of gastric cancer cells.

Salidroside induces apoptosis and inhibits epithelial-mesenchymal transition of human osteosarcoma cell lines

TAN Xiong, CHEN Jie, BI Guo-shan, SHEN Xin, DAI Xian-peng, YAN Hong-xia

2020, 40(11):  1506-1511. 

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Objective To investigate the effects of salidroside(Sal) on proliferation, apoptosis and epithelial-mesenchymal transition(EMT) of osteosarcoma cell lines(HOS and U2OS). Methods Osteosarcoma HOS and U2OS cells were incubated with different concentrations of Sal for 24 h. Cell activity and apoptosis were detected by MTT assay and flow-cytometry, respectively. Western blot was used to detect the expression of Bcl-2/Bak and EMT-related molecules E-cadherin, N-cadherin, Slug and Snial. Subsequently, the effects of Sal on cell invasion and migration were detected by Transwell assay and cell scratch assay. Finally, the level of EMT-related molecules E-cadherin, N-cadherin, Slug and Snial was detected by Western blot after treatment with PI3K/Akt inhibitor. Results Different concentrations of Sal significantly inhibited cell activity of HOS and U2OS cells, increased the cellular apoptosis rate and expression of Bak, while reduced the expression of Bcl-2 in cells. The invasion rate and migration of HOS and U2OS cells were significantly reduced after incubation with Sal at 150 μmol/L.The expression of E-cadherin was up-regulated, while N-cadherin, Slug and Snial expression were down-regulated in HOS and U2OS cells after incubation with Sal at 150 μmol/L.After incubation with PI3K/Akt inhibitor, the expression of E-cadherin was further increased as compared with the cells treated with Sal alone, while the expression of N-cadherin, Slug and Snial was significantly decreased(P＜0.05). Conclusions Sal may inhibit the proliferation, invasion, migration of osteosarcoma cell lines,promote their apoptosis and decreases the EMT through inhiting PI3K/Akt signaling pathway of osteosarcoma cell lines.

Chitosan composite hydrogel loaded with TGF-β3 promotes the repair of meniscus defects in rabbits

WANG Yun, XU Hong-yu, PAN Zong-you, NI Li-cheng, WANG Gang-xiang, ZHAO Yong, ZHENG Qiang

2020, 40(11):  1512-1518. 

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Objective To study the effect of bone marrow mesenchymal stem cells(BM-MSCs) combined with chitosan composite hydrogel loaded with transforming growth factor beta 3 (TGF-β3) to repair meniscus defects. Methods A full-thickness defect model of the anterior horn of the meniscus was developed in 60 New Zealand white rabbits. They were randomly divided into: the control group which did not implant any materials. The repair group Ⅰ in which chitosan composite hydrogel and bone marrow mesenchymal stem cells composite were injected into the defect group, and in group Ⅱ,the chitosan composite hydrogel loaded with TGF-beta 3 and bone marrow mesenchymal stem cells complex were repaired. After 12 weeks of operation, the samples were taken for radiology, gross and histological observation. Western blot was used to detect type Ⅱ collagen and proteoglycan protein. Results In the control group, the full-thickness defect of the meniscus anterior horn was not obviously repaired; in the repair group Ⅰ,most of the defects were filled with repaired tissue; in the repair group Ⅱ, the defects were completely filled with repaired tissue. The expression level of type Ⅱ collagen and proteoglycan protein in repair group Ⅱ was higher than that in control group (P＜0.05). Conclusions Bone marrow mesenchymal stem cells combined with chitosan hydrogel loaded with TGF-beta 3 can promote the repair of meniscus defects in rabbits.

Clinical Sciences

Analysis of clinical characteristics of patients with fever caused by acute attack of gout

DONG Peng, LIU Wei, MAN Si-liang, LI Hong-chao, WANG Li-fang, SONG Hui

2020, 40(11):  1519-1522. 

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Objective To identify the clinical characteristics of patients with fever caused by acute attack of gout. Methods The clinical data of patients with fever caused by acute attacks of gout admitted to the Department of Rheumatology and Immunology of Beijing Jishuitan Hospital from January 2014 to December 2019 were analyzed and compared with that of non-fever gout patients during the same period. Results Among a total of 366 gout patients, 50 patients(13.7%) with fever were caused by acute gout attacks. Among patients in the fever group, the peak age distribution is 30-40 years old. In terms of fever, most patients had low fever. In comparison of clinical characteristics, patients in the fever group had a relatively longer course of disease, more case of total articular involvement, and more frequent gout episodes in the past year (P＜0.05). In terms of inflammatory response, patients in the fever group had higher white blood cell count (P＜0.05), higher proportion of neutrophils(P＜0.01), and higher level of C-reactive protein (CRP) (P＜0.001). However, there was no significant difference between the two groups in terms of gender, age of onset, body mass index (BMI), tophi, history of alcohol drinking, family history of gout, blood uric acid level, hypertension, diabetes, and hyperlipidemia. Conclusions The fever caused by acute gout attacks is mainly low fever. These patients have a relatively longer course of disease, more case of total articular involvement, and more gout frequent episodes in the past year, and stronger more inflammatory reactions.

Needs assessment and affecting factors of cancer outpatients treated with radiotherapy

LI Rui, LIU Xia, SUN Xian-song, LI Wen-bo, QIN Xue, LI Hong-ming, QIU Jie

2020, 40(11):  1523-1528. 

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Objective To assess and investigate the reliability and validity of Needs Evaluation Questionnaire (NEQ) in Chinese version, and to analyze how characteristics of demography affects unmet needs. Methods A single-center study in Peking Union Medical College Hospital was conducted and 142 cancer outpatients were included. The NEQ was divided into 4 different aspects: informative needs, needs related to assistance/care, relational needs and needs for psycho-emotional support by means of exploratory factor analysis and confirmatory factor analysis. Univariate analysis was used to explore the impact of characteristics of demography on the unmet needs of each aspect. Results The reliability and validity of NEQ were acceptable. The result of univariate analysis indicated that household income affected informative needs (H=23.768, P＜0.001), relational needs (H=16.877, P＜0.01) and the needs related to assistance/care (H=11.010, P＜0.05). The degree of informative needs,relational needs and needs related to assistance/care kept low when patients had high household income. The age of patients affected informative needs(H=11.022, P＜0.05). The degree of informative needs was high on condition that patients were teenagers or in middle age. The education level affected relational needs (H=9.144, P＜0.05). The degree of rela- tional needs was high on condition that patients had middle level educational background. Conclusions Outpatients with tumor have high-level unmet needs. More attention should be paid to informative needs, relational needs and needs related to assistance/care on condition that patients have low household income. Besides, it is necessary to focus on the informative needs of patients in adolescent age or middle age and relational needs of patients with middle level educational background.

Comparison of dosimetry between TOMO and VMAT after TURBT for bladder cancer

LI Hong-ming, YU Lang, LI Rui, SHEN Jie, ZHANG Fu-quan, WU Song

2020, 40(11):  1529-1533. 

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Objective To analyze and compare the dosimetric difference between helical tomotherapy (TOMO) and volumetric modulated arc therapy (VMAT) in postoperative patients with bladder cancer, so to provide a reference for optimal radiotherapy technique for this disease. Methods Ten bladder cancer patients with who were received radiotherapy after transurethral bladder tumor resection (TURBT) from January 2019 to December 2019 in Peking Union Medical College Hospital were included. Clinical target volume (CTV) and organ at risk (OAR) were delineated on the CT images, and then the TOMO plans and the VMAT plans were designed, respectively. The difference was evaluated by D95%, Dmean, Dmax, Dmin, and CI, HI of the target volume, and V20, V30, V40, D5, D10, Dmean and Dmax of the rectum, small intestine, pelvic bone marrow, femoral head and other OARs. Results Both TOMO and VAMT plans met the clinical dosimetry needs, and the Dmean, Dmax, Dmin and HI of the target volume of the TOMO plans were better than those of the VMAT plans (all P＜0.05). In terms of OARs, TOMO plans were better than VMAT plans, as comparing to the V20 and V30 of small intestine, Dmax of the right femoral head, Dmax of the rectum, Dmean and Dmax of the pelvic bone marrow(P＜0.05). Conclusions For bladder cancer patients who received radiotherapy after TURBT, both the TOMO plans and VMAT plans can achieve the clinical dosimetry needs, but the TOMO plans exhibit more dosimetry advantages, better target volume conformity and uniformity, and lower exposure of OARs. These results may function as a potential reference for the choice of radiotherapy plan for bladder cancer patients.

Perioperative management for neurosurgery patients complicated with hemophilia

LEI Cheng, MEI Hong-xun, HAN Ru-quan

2020, 40(11):  1534-1536. 

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Objective To explore the methods and experience of anesthesia related management in perioperative neurosurgery patients complicated with hemophilia. Methods The clinical data of patients with hemophilia undergoing neurosurgery were collected. Results Two patients underwent neurosurgery were diagnosed as hemophilia properatively. Multidisciplinary consultation was conducted. Coagulation factor Ⅷ was perioperatively infused. Conclusions Hemophilia is a serious hereditary hemorrhagic disease. Perioperative multidisciplinary intervention, monitoring of coagulation function, timely supplementation of coagulation factors and fine anesthesia management are important for perioperative safety of patients.

Technology and Methodology

Capture and ligation-based loop-mediated isothermal amplification technology

PIAN Hong-ru, YANG Ming-zhu, ZHENG Zhi

2020, 40(11):  1537-1541. 

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Objective To establish a capture and ligation-based loop-mediated isothermal amplification technology (CLIP-LAMP) based on probe capture and ligation reaction to provide a new method for laboratory diagnosis and pathogen detection. Methods Capture probes and detection probes were designed with step-loop structure which can hybridize with the target DNA/RNA sequence. Whole blood or dry blood smears were lysed directly in the 96-well capture plate and target nucleic acid was fixed in the tube with capture probes without nucleic acid extraction. Detection probes which hybridized to target sequence were ligated to form a dumb-bell form DNA structure, which can serve as a template in the loop-mediated isothermal amplification. The specificity and sensitivity of this technique were evaluated by application to quantitative detection of 18S rRNA in plasmodium. Moreover, the technique was used to test some clinical samples. Results This method was successfully applied in plasmodium detection with high sensitivity and specificity. The method detected as low as 0.01 parasites/μL, which was more sensitive than RDT and traditional microscopy. Moreover, it accurately detected the 18S rRNA of parasite in infected samples. The method was able to test 96 samples in 4 hours. Conclusions A nucleic acid extraction-free, capture and ligation-based loop-mediated isothermal amplification is developed, which provide a more efficient and sensitive method for molecular diagnosis and screening analysis.

Mini Reviews

Progress on the correlation between exosomal microRNAs and Alzheimer's disease

DIAO Hua-qiong, LI Xiao-li, LIN Liang-yin, LIU Hai-peng, CHEN Hong-jing, DING Hai-yue, WEI Dan

2020, 40(11):  1542-1545. 

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Alzheimer's disease is the most common dementia in the aged population and is characterizd by hidden attack and progressive development. Some studies showed that exosomal microRNAs(miRNAs) regulates the shearing of amyloid precusor protein,deposition of beta-amyloid peptides(Aβ) and phosphorylation of Tau protein, influencing the generation of neuritic plaques and neurofibrillary tangles. In addition, special miRNAs can be transpor-ted by exsome across blood-brain-barrier and inhibit Tau phosphorylation. Measuring the expression profile of exosomal miRNAs in the peripheral blood may be a non-invasive diagnosis and treatment method of AD.

Research progress on aging related factors and delaying measures for aging of female germ line stem cells

ZHONG Zhi-sheng, HONG Wen-li, CAO Xiu-ping, NIE Kun, TANG Zi-juan, XIE Qi, LI Jia

2020, 40(11):  1546-1550. 

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In recent years, female germ line stem cells (FGSCs) in mammals have attracted much attention because of their contribution to follicular renewal and fertility maintenance/restoration, but their aging mechanism and preventive measures are still unclear. Studies have shown that the microenvironment changes in FGSCs nests, such as immune disorder, chronic inflammation and oxidative stress, can lead to the aging and plummeting of FGSCs through the mediation of relevant signaling pathways and genes. Therefore, the regulation of immune dysfunction, anti-inflammation and oxidative stress, and potential intervention to related signaling pathways as well as genes expression are expected to have some effect on slowing down FGSCs aging process.

Research progress on the role of platelet-derived microparticles in the development of atherosclerosis

GUO Fang-jun, YANG Ren-qiang

2020, 40(11):  1551-1555. 

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Platelet-derived microparticles(PMPs) are extremely small vesicles with complex structure and composition released by platelets, which contain proteins, mRNAs, miRNAs and other bioactive substances and participate in various pathophysiological processes. PMPs promote the development of atherosclerosis(AS) by participating in the processes of vascular endothelial cell injury, inflammatory reaction, lipoprotein deposition, macrophage phagocytosis and plaque instability. Anti-platelet drugs can lower down the plasma level of PMPs. Therefore, PMPs provide a new perspective for the explanation of the pathogenesis and treatment of cardiovascular diseases.

Role of regulatory immune response to myocardial injury caused by SARS-CoV-2

HU Heng-jing, LIU Yao, JIANG Zhi-sheng

2020, 40(11):  1556-1560. 

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The 2019 novel coronavirus(SARS-CoV-2) belongs to β coronavirus and is the seventh one to be found as pathogen of humans in Wuhan by the end of 2019. Clinical statistics shows that the virus often leads to myocardial injury, and patients with underlying cardiovascular diseases have a higher risk of infection and worse prognosis. The mechanism of the virus on myocardial injury is still unknown. This paper discusses the role of SARS-CoV-2 in myocardial damage with regard to immune system.

Research progress of biological clock in regulation of tumor development

GAO Dong-xiao, LIU Dan, GUO Qiang, LUO Ying, LIU Jing

2020, 40(11):  1561-1564. 

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Biological clock is a physiological controlling system with self-regulating functions. There is a close relationship between biological clock disorders and the occurrence of tumors, but underlying mechanism has not yet been elucidated. The biological clocks affect the tumorigenesis through cell cycle, proliferation and gene mutations. Exploring the possible mechanism between biological clock and tumorigenesis can provide some potential strategies for tumor treatment and intervention.

Progress of autophagy on regulating adipocyte lipid metabolism and differentiation

ZHOU Ye, CHEN Shu-qin, JIN Yong, LI Li

2020, 40(11):  1565-1569. 

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Disorders of lipid metabolism are closely related to the metabolic diseases such as obesity. Autophagy is the main process of host cells to clear and degrade cellular contents. Different autophagy types play different roles in processing lipids and interact with traditional lipase-mediated lipolysis pathways. Autophagy also plays an important role in regulating adipocyte differentiation. Mitophagy is a form of selective autophagy that can regulate the differentiation of adipocytes and maintain the balance of beige adipocytes, which can provide new ideas of targeted therapy to the prevention of obesity and other metabolic diseases.

Application of artificial intelligence technology in whole course management of colorectal cancer

WANG Pei-pei, WU Bin

2020, 40(11):  1570-1573. 

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With the rapid development of science and technology, artificial intelligence(AI) is much often experimentally used in the diagnosis, treatment, and prognosis prediction of many diseases. The principle of colorectal cancer treatment has changed from simply treating tumors to prolonging the patient's survival and improving their life quality. The concept of tumor overall management has thus being developed. In this paper, the development of AI technology in the whole course management of colorectal cancer is reviewed and through which to provide an outlook of prospecting a more deeply and widely use of AI technology in the whole course management of colorectal cancer.

Medical Education

Application of augmented reality technology in operation planning and clinical training of joint surgery

LIU Shu-zhong, YAO Si-yuan, YANG Bo

2020, 40(11):  1574-1578. 

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Augmented reality (AR) technology has been used and is of great benefit to the formulation of operation planning, simulation of operation scheme, improvement of operation outcome and reduction of risk in joint surgery, and also creates favorable conditions for the understanding of common diseases in joint surgery and training of practical operation skills of young orthopedic surgeons.

Exploration the blended teaching model based on virtual simulation experiment by virus inoculation into chicken embryos

LUO Xu-guang, ZANG Hao-jing, YANG Jiao-jiao, FAN Wei-ping

2020, 40(11):  1579-1583. 

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Virtual simulation experiments have become an important part of the informatics-based high education. This paper described the training of virus inoculation into chichen embryos by virtual simulation to avoid potential biological risk in classic experiment. In order to support students learning of basic techniques in microbiology, a cooperative learning using the jigsaw approach had been explored. Under the guidance of student-centered strategy At the same time, the evaluation of learning outcome was developed. Our goal was to construct a hybrid online and offline training system. Student's learning initiative and the experimental training outcomes have been significantly improved. In addition, this new system also facilitates the integration of education on professionalism/competence and humanity spirit into laboratory technology training.

Investigation on the current status of English level among orthopaedic surgeons and analysis of influencing factors

JI Song-jie, ZHANG Jin-qing, ZHANG Jing, XU Jing, JIANG Xu, ZHOU Yi-xin

2020, 40(11):  1584-1587. 

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Objective To investigate the current status of English language skills among orthopedic surgeons and to explore the influencing factors of their English language level. Methods A total of 100 orthopedic surgeons, a third-grade hospital and a secondary-grade hospital were selected and evaluated using Cambridge University English Examination Papers. They were grouped according to the level of English, which was found to be related to age, education, training experience abroad, employer hospital and the quantity of SCI papers. Results The English scores ranged from 10 to 25 points. The univariate analysis showed that age, education, experience of training abroad, employer hospital, and published SCI papers were related to the English proficiency of orthopedic surgeons(P＜0.05); Multiple regression analysis showed that education, level of employer hospital, experience of going abroad and of SCI paper publication had significant impact on English proficiency. Conclusions Orthopedic surgeons' English level is individually different. Improving their education, providing overseas study opportunities, and strengthen their capacity building of publishing SCI papers can rise their English level.

Investigating the teaching demands and the effect of teaching improvement on training of critical care medicine by undergraduates of eight-year curriculum at Peking Union Medical College

ZHOU Yuan-kai, HE Huai-wu, DING Xin, ZHOU Xiang, LONG Yun

2020, 40(11):  1588-1591. 

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Objective To investigate the learning needs and learning outcome of rotation in critical care medicine by eight-year curriculum undergraduates at Peking Union Medical College(PUMC),and to evaluate the effect of the revised clinical training program. Methods From December 2015 to July 2018,the questionnaire survey through mobile phone was issued the students during the internship in critical care department and collected the survey paper after the internship was finished. The training program was modified based on the survey results.From September 2018 to August 2019, the same survey and examination were issued to the students and compare the learning outcomes before and after the change of training program. Results A total of 142 valid questionnaires and examination scores were collected. The medical students had a high enthusiasm for learning critical care medicine. Shock resuscitation and respiratory failure were more difficult to learn. The modified program did rise the degree of mastery and the scores of the examination(P＜0.01). Conclusions Some weaknesses and learning barriers during the training of intensive care medicine were found. Modification of training program based on the results from the survey has significantly improved learning outcomes of undergraduates during the training of intensive care medicine.

A multi-disciplinary team model based on CBL in clinical teaching of hypothalamus-pituitary diseases

DUAN Lian, ZHENG Guang-yao, LU Lin, ZHU Hui-juan, YAO Yong, PAN Hui

2020, 40(11):  1592-1595. 

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Objective To explore the effect of case-based learning (CBL) combined with hypothalamus-pituitary MDT clinic in clinical teaching of hypothalamus pituitary diseases. Methods The trainees who participated in the hypothalamus-pituitary MDT discussion and CBL teaching in Peking Union Medical College Hospital from January to December 2019 were requird to fill in the questionnaire about the learning outcomes before and after participating in hypothalamus-pituitary MDT discussion and teaching. Likert 5 grade score method was used to evaluate the teaching effect. Results Among the 89 trainees,the degree of understanding of pituitary nonfunctional tumors, functional pituitary tumors, diabetes insipidus, differential diagnosis of pituitary stalk thickening, differential diagnosis of pituitary inflammatory diseases, and imaging knowledge of pituitary diseases before participating in hypothalamus-pituitary MDT were 41.57%, 48.31%, 49.44%, 12.36%, 12.36% and 23.60%, respectively. The degree of understanding increased to 74.16%, 76.40%, 82.02%, 73.03%, 78.65% and 86.52% respectively, and there was statistical difference after quantitative score (P＜0.01). Conclusions The teaching mode of hypothalamus-pituitary MDT based on CBL can improve the resident and attending physicians'knowledge about pituitary diseases. This teaching manner is expected to be applied in the clinical teaching of pituitary diseases.

Analysis of self-efficacy and its correlated factors of nursing skill evaluation by nursing interns

ZHANG Qi, ZHANG Yun, FU Chen, ZHANG Wei, ZHAO Xia, ZENG Xue-jun

2020, 40(11):  1596-1599. 

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Objective To investigate nursing interns' self-efficacy of clinical nursing assessment skills and its influencing factors, both at the middle and the final stages of their internship, so to improve the quality of clinical teaching and students' assessment skills. Methods We used convenience sampling to enroll nursing students who completed their internship in Peking Union Medical College Hospital from January 2016 to December 2017. A self-designed questionnaire was introduced to evaluate their self-efficacy of clinical nursing assessment skills in the middle and the final stages of internship. Differences between the two stages were compared, and influencing factors were analyzed. Results Forty-five students (with junior college diploma or above) were included, with a mean age of (22.0±1.1) years. There were 9 males (18.0%), and the mean interning duration were (6.0±1.4) months in the middle stages of internship and (10.2±1.6) months in the final stage. Scores of self-efficacy at admission were similar between the middle and final stages of internship. However, students at the final stage of internship got significantly higher scores both in total and in therapeutic assessment skills than those in the middle internship stage (77.3±7.9 versus 73.5±11.0, P＜0.05; 38.9±5.9 versus 36.2±7.8,P＜0.05).Gender, age and diploma were related to scores of self-efficacy in the mid-final stage of internship (P＜0.05). Conclusions Clinical teaching played a critical role in the education of nursing students. Targeted teaching measures should be taken to promote their ability of training assessment according to the stages of their internship, their gender, age and diploma, so to further improve the quality of clinical training.

Application of mixed reality in surgical teaching

LI Zheng-yao, ZHOU Xi, ZHAI Xiao, PAN Hui, LIU Yong

2020, 40(11):  1600-1603. 

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This paper, as a reference for the researchers of mixed reality(MR) and surgical educators, introduced concept of MR and its characteristics as a surgical teaching tool. The paper also reviewed the current application of MR in surgical training, and analyzed its application approaches and an expected development in future.

Preliminary study of “co-tutors” mode combined with “closed loop” quality control for training postgraduates majoring in pathogen biology

WANG Hai-long, LIU Hong-li, FAN Wei-ping, MENG Xiao-li, LIU Juan-juan, LI Po, GUO Rui

2020, 40(11):  1604-1607. 

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To improve the capacity building of research and practical skills of postgraduates majoring in pathogen biology, a “co-tutors”training mode was developed. The first tutor was mainly responsible for the theoretical education and scientific research training, and the second tutor is mainly responsible for the training of students'practical skills.The mode was combined with a “closed-loop” quality control system to supervise the training of g postgraduates along with high-quality papers. This training program supported capacity building of research and practial skills.

Guideline Interpretation

Essential and interpretation of colonic diverticulitis section in the 2019 “Guidelines for Colonic Diverticular Bleeding and Colonic Diverticulitis: Japan Gastroenterological Association”

LEI Cheng, WU Bin

2020, 40(11):  1608-1612. 

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The Japan Gastroenterology Association and the other three societies jointly published the first edition of “Guidelines for Colonic Diverticular Bleeding and Colonic Diverticulitis” in 2019. This guideline presents and explains the epidemiological characteristics, clinical characteristics, diagnosis and treatment procedures, examination and treatment programs, and prevention of colonic diverticular bleeding and colonic diverticulitis in the form of clinical questions (CQs), and formulated the level of evidence and recommendation intensity. This guideline also provides reference to the Chinese doctors for clinical management of colorectal disease. This article intends to interpret the essentials of colonic diverticulitis section in this guideline.