The 491st case: thrombocytosis, gastrointestinal hemorrhage, intestinal perforation / 中华内科杂志

Essential thrombocythemia (ET) is a chronic myeloproliferative neoplasm (MPN) featured by clonal proliferation of platelets, thrombosis and hemorrhage. Portal hypertension is a serious complication of ET associated with poor prognosis. We report a patient with ET complicated with acute upper gastrointestinal hemorrhage and intestinal perforation due to portal hypertension. She had an uneventful recovery after surgical and endoscopic treatment.

Clinical characteristics of aortoesophageal fistula complicated with massive upper gastrointestinal hemorrhage / 中华全科医师杂志

Objective:To analyze clinical features of aortoesphageal fistula (AEF) patients with massive upper gastrointestinal hemorrhage.Methods:Five AEF patients with massive upper gastrointestinal hemorrhage admitted in Peking Union Medical College Hospital from 2016 January 1st to 2019 December 31st. The clinical data, endoscopic findings, radiological manifestations, treatment and clinical outcomes were retrospectively analyzed.Results:Among 5 patients, 4 were males, 1 was female with an average age of (58±8) years old. The underlying conditions were atherosclerosis ( n=4), hypertension ( n=3), hyperlipidemia ( n=1); 2 cases had aortic aneurysm stent implantation and 1 case of rheumatic heart disease had valve replacement. All 5 patients were complicated with hematemesis and hypovolemic shock, and 4 cases had sentinel hemorrhage. Contrast-enhanced CT or CT angiography of the aorta showed thicken esophageal wall, local esophageal discontinuity, aortic aneurysm, gas around the aortic stent and contrast agent spilling over. The gastroscopy showed esophageal depression lesions, deep ulcers, mucosal erosion with bleeding. Conservative therapy and endoscopic hemostasis failed, 2 patients died without surgical intervention; 3 patients underwent emergency surgeries, 2 survived and 1 died perioperatively. Conclusions:Aortoesophageal fistula is in lack of specific clinical manifestations but is highly in mortality. Therefore CT and gastrocopic examination should be performed for suspected patients, early diagnosis and surgical treatment are the key to save patients′ lives.

Online PBL teaching design and application based on curriculum integration / 中华医学教育探索杂志

Due to the impact of COVID-19, the online problem-based learning (PBL) teaching mode was first implemented based on the curriculum integration of basic medicine and clinical medicine in our university in 2020. A total of 357 eight-year program clinical medicine students from three grades participated in the online PBL courses. The students have had related skills and knowledge of integration curriculum, and the teachers have carried out sufficient analysis of learning situation, preparation of software and hardware, as well as teaching design. Teachers and students has communicated with each other smoothly and cooperated closely through the Tencent Conference software platform, therefore this teaching mode has gained better feedback among students, with higher satisfaction of courses and significantly improved students' learning enthusiasm. The curriculum integration has laid the foundation for the case design and application of online PBL teaching, while the success of online PBL teaching has also reflected the original intention of curriculum integration reform.

Initial study of stratifying management with objective structured clinical examination in resident standardized training / 基础医学与临床

Using objective structuned clinical exammation ,OSCE to access a new resident standardized training , analyze the result and perform stratifying management and teaching based on the result , which may improve the effi-ciency and effectiveness of resident standardized training .

Short-term curative effect of ribavirin combination therapy with pegylated interferon alfa-2a vs. interferon alfa-2a in patients with chronic hepatitis C / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To perform a retrospective cohort study in order to determine the differences in short-term curative effect of ribavirin in combination with interferon alfa (IFNa)-2a vs. pegylated (Peg)-IFNa-2a in patients with chronic hepatitis C (CHC).</p><p><b>METHODS</b>One-hundred-and-eighty-eight treatment of the CHC patients who were administered combination therapy of ribavirin with IFNa from 2010 to 2012. One-hundred-and-thirty-three of the patients received the therapy with IFNa-2a and the remaining 55 received Peg-IFNa-2a. Hepatitis C virus (HCV) load and levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were measured at treatment weeks 4, 12, 24, and 48. Adverse reactions were recorded. Differences between the groups were assessed by statistical analysis.</p><p><b>RESULTS</b>The patients in the Peg-IFNa-2a group and the IFNa-2a group showed no significant difference in sex distribution, age, smoking habits, or drinking habits at baseline (all P more than 0.05). Both antiviral therapies significantly reduced the HCV load and levels of ALT and AST (baseline levels vs. all treatment weeks examined, P less than 0.05); however, the reduction in the HCV load at week 4 was significantly more robust with the Peg-IFNa-2a therapy (2.96 ± 0.66) log10 IU/ ml vs. (3.47 ± 1.42)1og10 IU/ml; F =4.14, P=0.04). The Peg-IFNa-2a group also showed a significant higher rate of rapid virological response (RVR) than the IFNa-2a group (72.72% vs .57.14%; x²=4.37, P=0.04), but there were no statistically significant differences found between the two groups for early virological response rate (EVR), endpoint antiviral treatment virologic response rate (ETR), biochemical response rate, or rate of adverse reactions (all P more than 0.05).</p><p><b>CONCLUSION</b>Ribavirin in combination with Peg-IFNa-2a produces a better RVR than in combination with IFNa-2a .Yet, the EVR, ETR, biochemical response rate, and rate of adverse reactions is similar for the two forms of IFNa-2a. Further studies are required to determine the potential superiority of Peg-IFNa-2a for a long-term curative effect.</p>

Toxic megacolon complicated by ulcerative colitis in six patients:a case report and literature review / 中华内科杂志

ObjectiveTo summarize the clinical features of ulcerative eolitis (UC) complicated by toxic megacolon for early diagnosis and proper treatment. MethodsSix cases of toxic megacolon in the patients suffered from UC in Peking Union Medical College Hospital from 1983 to 2010 were analyzed,and related literature was searched and reviewed.ResultsThe incidence of the toxic megacolon in the patients with UC in our center was 0.7％ (6/824),which was lower than those reported in the literature.There were always risk factors triggering the disease.The prognosis of the patients was poor,even after medical care and surgery intervention.Evaluation of the patients and making right timing to perform the surgery would improve the prognosis of the patients in foreign literature. ConclusionIt's crucial to make early diagnosis of the toxic megacolon in the patients suffered from UC. The right choice and timing to perform urgent surgery or selective surgery may improve their prognosis.

Application of the pithy formula and hook memory method in medical English study / 中华医学教育探索杂志

Remembering medical English terms is the difficult point in learning medical English.Only through learning the rules and characteristics of medical terms can one remember and get command of thousands of medical terms rapidly and effectively.When studying medical English terms,we explored and summarized a series of pithy formula hook memorial method - a pithy formula linked to the affix and etyma was turned into rhyming verse and formed a memory chain after memorizing by hook memory method many times so as to keep the medical terms firmly in the mind rapidly.

Clinical characters of ulcerative colitis associated colorectal cancer and carcinogenesis related protein expression / 中华消化杂志

Objective To explore the clinical features and possible carcinogenesis mechanism of the ulcerative colitis (UC)-associated colorectal cancer. Methods From 1984 to 2008, 6 clinical cases of UC-associated colorectal cancer were collected at Peking Union Medical College Hospital. The characters of morbidity, clinical features, pathology type, treatment and prognosis were analyzed.Immunohistochemistry(IHC) was performed to study the protein expression of adenomatous polyposis coli protein(APC), β-catenin, P53 and Wnt-1 in the specimens. Results The canceration of UC was 1.1 %, higher in female cases (5/6), the average duration was 14.3 years. All cases presented typical UC manifestation, most involved total colon (5/6) and none of them complicated with primary sclerosing cholangitis (PSC). There were 4 rectal cancers and 2 descending colon caners the UC cases collected. The major pathology type was adenocarcinoma with poor prognosis. The positive protein expression ratio of APC, β-catenin, P53 and Wnt-1 were 6/6, 6/6, 5/6 and 6/6 respectively.Conclusion The rectal cancer should be monitored and prevented in UC patients with total colon involved and long disease duration. Multi-pathway may possibly be involved in the carcinogenesis.

Taking the opportunity of clinical skill center construction to promote the reforms on the teaching of clinical practice / 中华医学教育探索杂志

As an important part of medical education,clinical practice teaching is an im-portant period for medical students to become doctors,in which they integrate theory with practice.So,in clinical practice teaching process,it is important to cultivate students’ innovative ability and practical ability,and emphasize quality-oriented education.For clinical skills training center,it is of great significance to reform management of clinical skills teaching,establish scientific and effective teaching methods,develope the correct clinical thinking and innovative aware-ness.

Bone marrow mesenchymal stem cell gene modified by recombinant adeno-associated virus-2 in vitro / 中国组织工程研究

BACKGROUND: Recombinant adeno-associated virus 2(rAAV-2) has attracted considerable attention due to its nonpathogenic nature in contrast to other viral vectors such as adenoviral and retroviral vectors in gene therapy attempts.OBJECTIVE: To explore rAAV-2 transduction to bone marrow mesenchymalstem cell(BMSC) in vitro and evaluate the possibility of using rAAV-2 as a vector for gene therapy of acute myelogenous leukemia(AML).DESIGN: An open experiment with cells as the observational subjects.SETTING: Department of Hematology, Nanfang Hospital, Southern Medical University.MATERIALS: The experiment was conducted in the Department of Hematology, Nanfang Hospital, Southern Medical University from February to July 2004. We used passages 3 to 5 BMSCs derived from six de novo AML patients and four healthy volunteers in this study.METHODS: BMSC was isolated from 6 to 10 mL of bone marrow aspirates obtained from the iliac crests of the patients who had been diagnosed as having de novo AML and from those of healthy volunteers. The acquired BMSC was infected by rAAV-2 which contained enhanced green fluorescent protein (rAAV-2-eGFP) at different multiplicity of infection(MOI) (MOI = 1 × 102,1 × 103, 1 × 104, 1 × 105, 1 × 106, 1 × 107) . Then we observed through phase contrast fluorescent microscope and flow cytometer to evaluate green fluorescent protein(GFP) expression 10 to 14 days after transduction. GFP expression was observed as the rAAV-2-eGFP transduced BMSC cultured in vitro. We also observed the in vitro gene expression profile of GFP in rAAV-2-eGFP transduced BMSC which was selected by neomycin ( G418). First, we confirmed GFP expression in BMSC through phase contrast fluorescent microscope, then on flow cytometer to detect the percentage of GFP expression.MAIN OUTCOME MEASURES: The efficiency of rAAV-2-eGFP transduction to BMSC. GFP expression was observed through phase contrast fluorescent microscope and flow cytometer at different time points after transduction.rAAV-2-eGFP to BMSC derived from normal volunteers and AML patients had no significant differences. GFP began to express 10 to 14 days after transduction, and the transduction efficiency ranged from 0. 3% to 1.4%. By changing infection condition, we could not make a higher transduction efficiency( P ＞ 0.05) . One round infection of BMSC by rAAV-2-eGFP at a MOI of 1 × 105 was ( 1. 030 ± 0. 034) %, 3 rounds of infection of BMSC by rAAV-2-eGFP at a MOI of 1 × 105 was (1. 140 ±0. 036)%, and coinfected by LipofectAMINE was (1. 380 ± 0. 054)%. However, 293 cell line which was the package cell of rAAV-2 could be efficiently transduced by AML patients transduced by rAAV-2-eGFP at MOI = 1 × 105: The percentage of GFP expression cell gradually decreased from 1.14% at day 12 after transduction to 0. 6% as cell passaged from 2 to 3, and maintained at a level of 0. 5% to 0. 6% later on till 61 days after transduction. After selected by neomycin(G418) 1 month later, rAAV-2-eGFP transduced BMSCs could maintain a long-term GFP expression at a level of 6.0% in vitro without significant decay within 100 days of observation period after transduction.CONCLUSION: The advantages of rAAV-2 mediated gene transduction lie in safety, no immune response to the host, and long-term expression maintained by the target gene. rAAV-2 and BMSC can be used for in vitro gene therapy, and as a systemic gene delivery system, it might be an alternative for systemic gene therapy in the future.

Preliminary practice and exploration in teaching of Clinical Diagnostics for foreign students / 中华医学教育探索杂志

The enrollment of international medical students has been expanding.How to improve the quality of medical education is a key point.To explore a better way and method to improve the quality of the medical teaching for foreign students in China,the preliminary experi-ences of teaching of Clinical Diagnostics for foreign students are reviewed.

Synthesis, Cloning and Expression of a Multiple Epitope Antigen of BCR-ABL Fusion Gene / 中国实验血液学杂志

Chronic myeloid leukemia (CML) appears an ideal and exciting immunological target. Novel and rational immunotherapy may therefore play an important adjuvant role in the treatment of CML patients. Peptides derived from the BCR-ABL fusion region have been shown to be immunogenic and are able to stimulate the production of BCR-ABL-specific T cell lines and clones. In this study, A 280 bp multiple epitope region of BCR-ABL fusion antigen was designed and synthesized. This region contains three BCR-ABL antigen epitopes which can bind to HLA-A2, HLA-A3 and HLA-DR11 molecules, respectively, and epitopes of cholera toxin B (CTB) and tetanus toxoid (TT) which are able to elicit vigorous T cell responses. The fusion antigen gene has highly been expressed in E. coli and the purified fusion protein reserved satisfied activity and antigenicity. The results of this investigation provided a basis for further research on the developing specific T cell immunotherapy of CML.