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    Original article (Basic research)
    Analysis of mutation of 3′UTR region of TBX1C gene for children with conotruncal heart defects
    FANG Shao-hai, XU Yue-juan, CAO Rui-xue, et al
    2014, 34 (6):  767. 
    doi: 10.3969/j.issn.1674-8115.2014.06.001

    Abstract ( 902 )   PDF (476KB) ( 921 )  

    Objective To screen mutations in 3′UTR region of TBX1C gene of patients with conotruncal heart defects (CTHD) and explore the possible mechanism that how mutations in this region affect the expression and function of TBX1C gene. Methods Fifty-two CTHD patients without 22q11.2 microdeletion (the CTHD group) and eighty nine healthy children (the control group) were selected. Sequences of 3′UTR region of TBX1C gene were amplified by the PCR and all PCR products were sequenced by both forward and reverse sequencing. Sequencing results were compared to TBX1C 3′UTR sequences in GenBank (NM 080647.1) and possible mutations were screened. Online software PicTar and TargetScan were used to predict microRNA (miRNA) which could bind to 3′UTR region of TBX1C gene. The effect of mutations in 3′UTR region of TBX1C gene on the expression of miRNA-regulated TBX1C gene was analyzed. Results A mutation of c.*164_*165insC was found in patients of the CTHD group. A cytosine was inserted between the 164th and 165th nucleotide from the termination codon. This mutation is a new mutation since it did not exist in patients of the control group and was not reported by other studies. Results of prediction showed that there were ten miRNAs which could bind to 3′UTR region of TBX1C gene and this mutation did not locate in binding regions of ten miRNAs and 3′UTR region of TBX1C gene. Conclusion A new mutation, c.*164_*165insC, exists in 3′UTR region of TBX1C gene. This mutation may affect the spatial configuration of binding of 3′UTR region of TBX1C gene and miRNAs and further affect the regulatory effect of miRNAs on the expression of TBX1C gene.

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    Preparation of VEGFR2-targeted PLGA ultrasound contrast agent and in vitro targeting tests
    WANG Cui-wei, DU Jing, YANG Shi-ping, et al
    2014, 34 (6):  772. 
    doi: 10.3969/j.issn.1674-8115.2014.06.002

    Abstract ( 855 )   PDF (596KB) ( 1078 )  

    Objective To prepare the poly lactic-co-glycolic acid (PLGA) vascular endothelial growth factor receptor 2 (VEGFR2)-targeted ultrasound contrast agent and observe its targeting and imaging ability in vitro. Methods The PLGA nanoparticles (NPs) of macromolecule material were prepared by a modified double-emulsion solvent evaporation method. General properties of PLGA NPs were detected by the FE SEM. The contrast agent and anti-VEGFR2 antibody were conjugated to prepare the targeted ultrasound contrast agent by the carbodiimide method. The LSCM was used to evaluate the targeting ability in vitro and the high frequency ultrasonography was used to observe the imaging ability in vitro. Results NPs of PLGA ultrasound contrast agent were regularly round with uniform size and good dispersion. The PLGA VEGFR2-targeted ultrasound contrast agent firmly attached to the surface of SVEN1 ras (SVR) during the course of targeting tests in vitro. The in vitro ultrasound imaging of the PLGA VEGFR2-targeted ultrasound contrast agent showed fine punctuate hyper echo with no attenuation for the rear echo. Conclusion The PLGA VEGFR2-targeted ultrasound contrast agent is prepared successfully. It can specifically target and attach to SVR with high expression of VEGFR2 in vitro and its in vitro ultrasound imaging is good.

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    Effects of subchronic injection of dizocilpine during adolescence on prepulse inhibition and glucose tolerance of mice in adulthood
    DING Wen-hua, Dake Qi, JU Pei-jun, et al
    2014, 34 (6):  777. 
    doi: 10.3969/j.issn.1674-8115.2014.06.003

    Abstract ( 807 )   PDF (271KB) ( 837 )  

    Objective To investigate the effects of the subchronic injection of dizocilpine (MK-801) during adolescence on prepulse inhibition (PPI) and glucose tolerance of mice in adulthood. Methods Twenty mice in adolescence were randomly divided into the control group (n=10) and model group (n=10). After birth for 30-43 d, mice of two groups were injected with saline of 0.9% (4 mL/kg) and MK-801 (0.6 mg/kg) respectively once a day for two weeks. Food intake and body weight were measured each week. Open field test, PPI test, and glucose tolerance test (GTT) were performed in adulthood of mice (70-80 d after birth). Results The PPI of mice of the model group at prepulse of 79 dB intensity was significantly lower than that of the control group (P<0.05), suggesting that MK-801 successfully induced schizophrenia-like behavior of mice. Body weights of mice of the model group were significantly lower than those of the control group (P<0.05). Results of GTT showed that plasma glucose levels of mice of the model group were significantly higher than those of the control group at 90 min and 120 min after glucose injections (P<0.001,P<0.01), suggesting that abnormal glucose tolerance appeared in MK-801 induced schizophrenia-like mice. The differences of food intake and locomotor activities in open field tests of mice of the model group and control group were not statistically significant (P>0.05). Conclusion The subchronic injection of MK-801 during adolescence can induce the impairment of PPI and abnormal glucose tolerance of mice in adulthood.

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    Emodin promotes differentiation of preosteoblast via BMP-9 signaling pathway
    CHEN Xiao-jing, HU Yan, ZHANG Shuang, et al
    2014, 34 (6):  781. 
    doi: 10.3969/j.issn.1674-8115.2014.06.004

    Abstract ( 758 )   PDF (753KB) ( 1027 )  

    Objective To explore the effects of emodin on proliferation and differentiation of MC3T3-E1 preosteoblasts and the possible mechanism. Methods The treated group contained MC3T3-E1 cells treated by emodin of different concentrations (0.05, 0.1, 0.5, 2.0, and 5.0 μmol/L) and the control group contained MC3T3-E1 cells not treated by emodin. The cell proliferation rate was detected by the MTT assay. The activity of ALP was determined by the quantitative PNPP method. The alizarin red staining was used to observe the number of mineralized nodules. The expression of signaling molecules relevant to BMP pathway was detected by the RT-PCR. The activity of ALP was measured and the effects of BMP-9 on the differentiation of osteoblasts were observed after cells were treated by Noggin, which was a BMP-specific inhibitor. Results Emodin had no effect on the proliferation of MC3T3-E1 cells. Emodin increased the expression of ALP and formation of mineralized nodules at the concentrations from 0.5 μmol/L to 5 μmol/L, especially at the concentration of 5 μmol/L. Emodin enhanced the expression of BMP-9 and expressions of upstream and downstream signaling molecules relevant to BMP-9 pathway also changed accordingly. The emodin-induced differentiation of osteoblasts was inhibited after being pretreated by Noggin. Conclusion Emodin can promote the differentiation of preosteoblasts by activating the signaling pathway of BMP-9.

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    Expression change of Klotho in acute kidney injury induced by ischemia-reperfusion and its relationship with apoptosis
    QIAN Ying-ying, YAN Yu-cheng, SHEN Yue, et al
    2014, 34 (6):  788. 
    doi: 10.3969/j.issn.1674-8115.2014.06.005

    Abstract ( 808 )   PDF (851KB) ( 1013 )  

    Objective To observe the expression change of Klotho in acute kidney injury (AKI) induced by ischemia-reperfusion and to explore the effects on the apoptosis of renal tubular epithelial cells. Methods Ten BALB/c mice were randomly divided into the ischemia-reperfusion group (I/R group, n=5) and sham-operation group (Sham group, n=5). The AKI model was established by bilateral renal pedicles clamping. The serum and renal issues of mice were collected after the model was established for 24 h. Levels of blood urea nitrogen and serum creatinine were detected by the enzymatic assay. The level of serum Klotho was measured by the ELISA. TUNEL staining was performed to assess the renal apoptosis. Expressions of genes and proteins of Klotho, Bax, Bcl-2, and Caspase-3 of renal tissues were detected by the Real-Time PCR and Western blotting. The relationship between the general and local levels of Klotho and the renal apoptosis was analyzed for mice with AKI by the Pearson line correlation method. Results Compared to the Sham group, renal tubular cells of mice of the I/R group significantly degenerated and necrotized; apoptotic cells increased significantly; and the level of cleaved Caspase-3 protein, Bax to Bcl-2 mRNA, and the protein ratios of renal tissues were significantly increased after 24 h of operations. The levels of serum Klotho of the I/R group were significantly lower than those of the Sham group [(669.89±136.51) pg/mL vs. (2 107.92±549.22) pg/mL, P<0.01]. The mRNA and protein expressions of renal Klotho were downregulated by approximately 90% (P<0.001) and 20% (P<0.05), respectively. The correlation analysis showed that the mRNA ratio of renal bax to bcl-2 was negatively correlated to both serum Klotho protein (r=-0.833, P<0.01) and renal klotho mRNA (r=-0.916, P<0.001). The renal Bax/Bcl-2 protein ratio was also significantly and negatively correlated to the renal Klotho protein (r=-0.637, P<0.05). Conclusion The general and local expressions of Klotho of mice with AKI induced by the ischemia-reperfusion decrease significantly, which may be closely related to the kidney injury induced by the apoptosis.

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    Synthesis of N-stearyl tyrosine salts and measurement of its critical micelle concentration
    TANG Shuang-qi, YIN Sha, LU Yang
    2014, 34 (6):  794. 
    doi: 10.3969/j.issn.1674-8115.2014.06.006

    Abstract ( 664 )   PDF (331KB) ( 820 )  

    Objective To synthesize N-stearyl tyrosine disodium (NST-2Na) and dipotassium (NST-2K) and to determine their critical micelle concentration (CMC). Methods N-stearyl tyrosine (NST) was synthesized from stearic acid via two step reactions and then basified by NaOH or KOH to obtain the target compounds. The feasibility of UV spectrophotometry for measuring the CMC was determined by the CMC trial of sodium dodecyl sulfate (SDS) and N,N-diethyl aniline (DEA) was used as the probe. The CMC of two NST salts was measured by the UV spectrophotometry. Results The results of high performance liquid chromatography (HPLC) showed that the purity of NST-2Na and NST-2K was 98.35% and 92.65%, respectively. The CMC values of SDS determined by the UV spectrophotometry were consistent with those of literatures. The CMC was 27.5 mg/100 mL for NST-2Na and 25.0 mg/100 mL for NST-2K. Conclusion The UV spectrophotometry is a simple and reliable method for measuring the CMC of NST salts.

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    Effects of Uygur sand therapy on bone mechanical properties of femurs of rabbits with knee osteoarthritis
    HUANG Shao-jun, JULAITI Maitirouzi, HU Xiao-xin, et al
    2014, 34 (6):  799. 
    doi: 10.3969/j.issn.1674-8115.2014.06.007

    Abstract ( 765 )   PDF (488KB) ( 878 )  

    Objective To investigate the effects of Uygur sand therapy on bone mechanical properties of femurs of rabbits with knee osteoarthritis (OA). Methods The OA model was established by injecting papain in right posterior femoral articular cavity of 16 New Zealand rabbits. Rabbits were then divided into the sand therapy group (n=8) and control group (n=8). The sand therapy group underwent the sand therapy in a place that simulated the Turpan sand therapy field, 2 times per day, 30 min per time for 4 weeks. The control group did not receive the sand therapy. Femurs of rabbits were scanned by CT and data was collected. Interactive medical image control system (MIMICS) was used to analyze and compare the volume of each bone layer (soft bone, compact bone, and cortical bone) of two groups. The threepoint bending test was conducted in vitro for the left and right posterior femurs of rabbits of two groups to obtain the load-deflection curve. The cross sectional moment of inertia, maximum bending normal stress, and maximum shear stress were calculated by comparing the load and deflection. The data of CT scans and results of three-point bending tests were summarized and compared. Results The analytical results of the CT scan data of each bone layer showed that the cortical bone of the control group tended to transfer to the compact bone and soft bone, while the soft bone of the sand therapy group significantly transferred to the compact bone and cortical bone. The results of three-point bending test showed that morphological parameters of the femur section of the sand therapy group were significantly lower than those of the control group (P<0.05). The maximum load, maximum bending normal stress, and maximum shear stress of the femur section of the sand therapy group were significantly higher than those of the control group (P<0.05). The differences of the cross sectional moment of inertia and deflection of two groups were not statistically significant (P>0.05). Conclusion The sand therapy has positive effects on the volume distribution of bone layer and mechanical properties of femurs of adult OA rabbits.

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    Effects of myeloid-derived suppressor cells induced by dexamethasone on rejection of skin transplantation of mice
    LIAO Jiong-bo, SHAO Kun, WANG Xiao, et al
    2014, 34 (6):  804. 
    doi: 10.3969/j.issn.1674-8115.2014.06.008

    Abstract ( 823 )   PDF (1168KB) ( 909 )  

    Objective To investigate the expression and immunoregulation effect of myeloid-derived suppressor cells (MDSCs) induced by dexamethasone in the skin transplantation model of mice. Methods The male C57BL/6 mice were receptors and the female BALB/c mice were donors. The tailback skin transplantation model of mice was then established (n=40). Donor mice were randomly divided into the experiment group and control group (n=20). Mice of the experiment group received an intraperitoneal injection of dexamethasone 5 mg/kg per day while mice of the control group received an equal volume of saline. The rejection of skin allograft was observed and the rejection time was determined. The transplanted skin was excised for pathological examination on the seventh day after operations. Some mice were sacrificed on the ninth day after operations and their spleens and draining lymph nodes of transplanted skin were obtained and detected by the flow cytometry. Results The median survival time of allograft skin of the experiment group was (24±3.062) days, significantly longer than (9±0.816) days of the control group (P<0.05). HE stained paraffin sections showed that the rejection of skin graft of the experiment group was significantly less serious than that of the control group. The results of the flow cytometry indicated that in spleen tissues of the experiment group, the proportion of CD11b+GR1+ cells was significantly higher than that of the control group, the expression of TNF-α was down-regulated (P<0.05), the expression of IL-10 was up-regulated (P<0.05), and expressions of chemotactic factor receptor CXCR2 and adhesion molecules CD44 and CD62L were increased (P<0.05). In the draining lymph nodes of the experiment group, the proportion of CD11b+GR1+ cells was significantly higher than that of the control group (P<0.05), while the proportion of CD4+T cells and the expression of IFN-γ were significantly decreased (P<0.05). Conclusion Dexamethasone may induce the MDSCs and promote MDSCs migrate to the allograft region. By inhibiting the function of CD4+T cells, MDSCs can relieve the graft rejection and extend the survival time of grafts.

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    Anatomical study of recurrent artery of Heubner of Chinese people
    WANG Ren, XU Tao, YUAN Fang, et al
    2014, 34 (6):  811. 
    doi: 10.3969/j.issn.1674-8115.2014.06.009

    Abstract ( 1023 )   PDF (476KB) ( 875 )  

    Objective To explore the anatomical features of recurrent artery of Heubner (RAH) of Chinese people. Methods The number, routes, outer diameter, branches, and perfused areas of RAHs of 90 cerebral hemispheres from 45 brain samples fixed by formalin of 10% were observed and measured by the operation microscope. Results A total of 128 RAHs were found in 45 brain samples. There were 1-3 RAHs in each cerebral hemisphere. The average number was (1.42±0.62) mm. The RAH started from 8 mm of the horizontal proximal segment to 3 mm of the distal segment of anterior communicating artery (ACoA). The average distance was (0.46±1.29) mm from the distal end of ACoA. The outer diameter was 0.05-1.20 mm and the average outer diameter was (0.64±0.24) mm. The length was 12-56 mm and the average length was (30.41±10.24) mm. The RAH supplied the cortex as well as the cerebral parenchyma. Conclusion RAH has anatomical variations. It is clinically helpful to identify anatomical features of RAH and its relationships with A1 segment of ACoA, orbitofrontal artery, and frontalpolar artery.

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    Original article (Clinical research)
    Meta-analysis of annual progression rate of each subtype of impaired glucose tolerance during developing course towards diabetes
    JIANG Dong-dong, HAN Ting-ting, HU Yao-min
    2014, 34 (6):  815. 
    doi: 10.3969/j.issn.1674-8115.2014.06.010

    Abstract ( 743 )   PDF (371KB) ( 892 )  

    Objective To systematically evaluate the annual progression rate of each subtype of impaired glucose tolerance (IGR) during the course of developing towards diabetes and provide the objective proof for early screening and intervention of IGT. Methods Random and non-random control studies relevant to impaired fasting glucose (IFG), impaired glucose tolerance (IGT), isolated-impaired fasting glucose (I-IFG), isolated-impaired glucose tolerance (I-IGT), and combined glucose intolerance (CGI) were retrieved form the PubMed, EMbase, Science Citation Index databases, Cochrane Library, CBMdisc, and CNKI by computer and manual retrievals. Papers were screened according to the inclusion and exclusion criteria. Data was abstracted and the methodology quality was assessed. The RevMan 5.0 software was adopted to conduct the meta-analysis. Results Thirteen studies were included. The results of meta-analysis showed that the annual progression rate during the course of developing towards diabetes of the IGT group, IFG group, I-IFG group, I-IGT group, and CGI group was 7.18 (95%CI 3.70-13.94,P<0.000 01), 4.29 (95%CI 2.29-8.03, P<0.000 01), 5.94 (95%CI 3.87-9.14, P<0.00001), 9.55 (95%CI 6.55-13.94, P<0.000 01), and 12.96 (95%CI 7.09-22.69, P<0.000 01) times of that of the control group. Conclusion The annual progression rate of each subtypes of IGR during the course of developing towards diabetes is 5%-10% and the progression rates of IGT and I-IGT are slightly higher than those of IFG and I-IFG. With the extension of observation time, the annual progression rate of each subtype gradually decreases.

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    Characteristics of population pharmacokinetics and influence factors after short-term injection of etomidate to children
    WEI Rong, WANG Chun, ZHANG Sai-Ji, et al
    2014, 34 (6):  820. 
    doi: 10.3969/j.issn.1674-8115.2014.06.011

    Abstract ( 803 )   PDF (564KB) ( 1093 )  

    Objective To explore the characteristics of pharmacokinetics and influence factors after short-term injection of etomidate and to establish the population pharmacokinetics model. Methods Eleven pediatric patients with ASA Ⅰ-Ⅱ who scheduled to undergo elective surgeries under general anesthesia were selected. Etomidate of 60 μg·kg-1·min-1 was intravenously injected until the bispect ral index (BIS) value was below 50. The arterial blood samples were drawn at scheduled time points and the plasma concentration of etomidate was detected. Nonlinear mixed-effect model was adopted to establish the population pharmacokinetics model of etomidate. The effects of covariates (such as the age, height, and body mass, etc.) on pharmacokinetic parameters were analyzed. Results Initial analysis showed that the objective function values were 61, -63, and -77 for the one-compartment model, two-compartment model, and three-compartment model, respectively. The three-compartment model was most suitable for describing the pharmacokinetics of etomidate for children. The number of target functions further decreased after the body mass based allometric model was fitted. No other covariates that could significantly affect the pharmacokinetics were found. The typical values of population pharmacokinetic parameters were: V1=6.53×(WT/70)(L), V2=12.4×(WT/70)(L), V3=27.3×(WT/70)(L), Cl1=1.23×(WT/70)0.75(L/min), Cl2=1.42×(WT/70)0.75 (L/min), and Cl3=0.35×(WT/70)0.75. Conclusion Age does not affect the pharmacokinetics of etomidate, which suggests the metabolic pathway is mature at birth. The allometric effect of body weight on the pharmacokinetics of etomidate shows that for children with smaller body masses, their injection dose and rate of unit body mass should be higher.

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    Relationship between status of human papillomavirus infection and integration and cervical lesions
    QIN Guang-yi, TAO Min-fang
    2014, 34 (6):  825. 
    doi: 10.3969/j.issn.1674-8115.2014.06.012

    Abstract ( 675 )   PDF (335KB) ( 837 )  

    Objective To explore the gene types of HPV that infects the genital tract of women and the relationships of multiple infections, hr-HPV load, integrated state of HPV16, and the severity of cervical lesions. Methods A total of 1 082 patients who received treatment in the Department of Obstetrics and Gynecology of Sixth People's Hospital, Shanghai Jiao Tong University during the period of 2009.1.1-2011.12.31 were selected. PCR-reverse dot blot, HC-Ⅱ, and multiplicitas real time PCR were adopted to detect the gene types of HPV that infected the genital tract of patients, hr-HPV load, and integrated state of HPV16. Results Nineteen gene types of HPV were detected from the genital tract of patients. Among 379 patients who were infected by HPV (35.03%), 310 of them were infected by hr-HPV (28.65%). The most common HPV types were HPV16, HPV11, HPV6, HPV52, HPV58, and HPV18. Their infection rates were 12.57%, 8.32%, 7.95%, 6.56%, 5.54%, and 4.71%, respectively. The higher the hr-HPV load of the genital tract of patients and the multiple infection rate, the risk of suffering serious cervical diseases was higher (P<0.05,P<0.001). The proportion of HPV16 integration in cervical tissue cells was positively correlated to the severity of cervical lesions (r=0.812,P<0.001). Conclusion The most common hr-HPV types that threat the female reproductive health are HPV16, HPV18, HPV52, and HPV58. The multiple infection rate of HPV in the genital tract, loading dose of hr-HPV, and proportion of HPV16 integration are high risk factors of suffering cervical precancerosis and cancer.

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    Effects of day nursing care in community on social function of patients with chronic schizophrenia
    YAO Zhi-zhen, XU Qi, WU Liu-fa, et al
    2014, 34 (6):  830. 
    doi: 10.3969/j.issn.1674-8115.2014.06.013

    Abstract ( 748 )   PDF (421KB) ( 943 )  

    Objective To explore the effects of day nursing care in community on improving the social functions of patients with chronic schizophrenia. Methods The random, control, and open clinical trial design was adopted. Eighty patients with chronic schizophrenia were selected and randomly divided into the intervention group (n=40) and the control group (n=40). Patients of the intervention group received day nursing care in community for 12 months and patients of the control group received routine follow-up care. Patients of two groups were evaluated by the Brief Psychiatric Rating Scale (BPRS), Nursing Observation Rating Scale (NORS), and Social Disability Screening Schedule (SDSS) before intervention and 6 months and 12 months after intervention. Results After day care nursing was conducted for 6 and 12 months, the total score of NORS of the intervention group was significantly higher than that of the control group and the total score of BPRS of the intervention group was significantly lower than that of the control group (P<0.05). Compared to the control group, the total score of SDSS and scores of eight factors other than the marriage function and family activities of the intervention group were significantly decreased (P<0.05). The rehabilitation and social function improvement of the intervention group were much better than those of the control group. Conclusion Day nursing care in community for patients with chronic schizophrenia can efficiently improve the social adaptability and communication ability of patients and elevate their social function.

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    Meta-analysis of high flux hemodialysis for prognosis of maintenance hemodialysis patients
    ZHANG Ying-ying, LI Xiao-jun, LIU Feng, et al
    2014, 34 (6):  836. 
    doi: 10.3969/j.issn.1674-8115.2014.06.014

    Abstract ( 849 )   PDF (1261KB) ( 830 )  

    Objective To assess the effect of high flux hemodialysis (HFHD) on the clinical prognosis of maintenance hemodialysis (MHD) patients by the metaanalysis. Methods Published studies on the comparisons of HFHD and low-flux hemodialysis (LFHD) of randomized controlled trials (RCTs) and clinical controlled trials (CCTs) were retrieved, strictly evaluated by the methodological quality, and analyzed by the mata-synthesis. The effects of HFHD on the survival rate, cardiovascular mortality, and causes of mortality of MHD patients were systematically evaluated. Results A total of 8 studies (3 RCTs and 5 CCTs) were included and 5 015 patients were selected after being analyzed by the mata-synthesis. Results of meta-analysis showed that the difference of mortality of the HFHD group and LFHD group was not statistically significant (RR=0.85, 95%CI:0.71-1.01, P=0.06). Three RCTs showed that HFHD significantly reduced the cardiovascular mortality (RR=0.83, 95%CI:0.71-0.98, P=0.03). Two RCTs that used the same unit for describing the clearance of β2-microglobulin (β2-MG) indicated that HFHD had a better clearance rate of β2-MG (MD=-10.89, 95%CI: -14.89-6.97, P<0.000 1). Conclusion HFHD can improve the clearance rate of β2-MG and reduce the cardiovascular mortality but can not reduce the mortality of MHD patients. HFHD may have good long-term effect for MHD patients with low serum albumin or diabetic nephropathy.

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    Expression and clinical significance of Rictor in endometrial carcinoma tissue
    WEN Shan-yun, CAO Shu-jun, YUAN Wei, et al
    2014, 34 (6):  842. 
    doi: 10.3969/j.issn.1674-8115.2014.06.015

    Abstract ( 718 )   PDF (830KB) ( 878 )  

    Objective To explore the expression and the clinical significance of Rictor in the endometrial cancer (EC) tissue. Methods The expression levels of Rictor mRNA of 30 fresh EC tissue samples and 17 normal endometrium tissue samples were detected by the Real-Time PCR. The 249 EC paraffin tissue samples excised during operations were randomly divided into the experiment group (n=134) and confirmation group (n=115). The expression level of Rictor of EC tissue was detected by the immunohistochemistry. The relationship of expression levels of Rictor protein and clinical pathologic features of two groups was compared and the relationship of the expression of Rictor and the overall survival rate of EC patients was analyzed. Results The expression level of Rictor mRNA in EC tissues was significantly higher than that of normal endometrium (P<0.001). The rates of positive expression of Rictor for high FIGO stage (P<0.001 for the experiment group, P=0.011 for the confirmation group), high FIGO grade (P<0.001 for the experiment group, P<0.001 for the confirmation group), and vascular invasion (P=0.011 for the experiment group, P=0.043 for the confirmation group) were significantly higher than those of low FIGO stage, low FIGO grade, and non-vascular invasion. The univariate analysis showed that the overall survival rate of EC patients was relevant to the FIGO stage, pathological type, grade, vascular invasion, lymphatic metastasis, and the expression level of Rictor (P<0.05 or P<0.01). The multivariate analysis indicated that the rate of positive expression of Rictor was negatively and significantly correlated to the overall survival rate of EC patients (P<0.05). Conclusion The expression level of Rictor protein is closely related to the FIGO stage, grade, and vascular invasion. Rictor can be regarded as an independent indicator for judging the prognosis of EC.

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    Relationship between polymorphism of thymidylate synthase gene and side effects of FEC regimen for breast cancer patients of different races
    ZHANG Feng-chun, XU Hai-yan, XU Guang-ru, et al
    2014, 34 (6):  850. 
    doi: 10.3969/j.issn.1674-8115.2014.06.016

    Abstract ( 682 )   PDF (366KB) ( 792 )  

    Objective To explore the distribution of polymorphism of thymidylate synthase (TYMS) gene in breast cancer patients and the relationship between the genotypes and the side effects of chemotherapy. Methods The variable number of tandem repeats (VNTR) in 28 bp of 5′untranslated region (untranslated region, 5′UTR) of TYMS gene was selected as the genetic marker. PCR-nondenaturing polyacrylamide gel electrophoresis was employed to determine the genotype of 50 Caucasian patients and 23 Asian patients with breast cancer and analysis was conducted according to clinical pathological features, side effects of FEC chemotherapy, and survival data of patients. Results The frequencies of genotypes of 2R/2R, 2R/3R, and 3R/3R of TYMS 28 bp VNTR in Caucasian patients were 12.0%, 62.0%, and 26.0%, and in Asian patients were 4.4%, 30.4%, 65.2%, respectively. The differences were statistically significant (P<0.05). The allclomorphic genes and genotypes of loci of TYMS 28 bp VNTR were irrelevant to histological types, histological grades, lymph node metastasis, clinical stages, estrogen receptor, progenstogen receptor, and human epidermal growth factor receptor 2. The mean time of follow-up was 43.21 months. Five cases relapsed and five patients died. The univariate analysis and multivariate analysis indicated that the genotype of TYMS gene was not a factor that affected the prognosis. After being treated by the chemotherapy, the incidence of leucopenia (grade 3-4) of Asian patients was significantly higher than that of Caucasian patients (86.96% vs 60.00%, P=0.021). The incidence of leucopenia (grade 3-4) of 3R/3R of TYMS 28 bp VNTR was higher than that of 2R/3R and 3R/3R. But the differences were not statistically significant (75.00%, 65.79%, and 57.14%, respectively, P=0.578). Conclusion The tolerability to FEC chemotherapy of Caucasian and Asian breast cancer patients is different. This may be relevant to the polymorphism of 28bp VNTR of TYMS gene.

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    Intervention effects of active cycle of breathing techniques on patients with acute exacerbation of chronic obstructive pulmonary disease
    ZHANG Li, GAN Xiu-ni
    2014, 34 (6):  855. 
    doi: 10.3969/j.issn.1674-8115.2014.06.017

    Abstract ( 1474 )   PDF (256KB) ( 1138 )  

    Objective To evaluate the intervention effects of active cycle of breathing techniques (ACBT) on patients with acute exacerbation of chronic obstructive pulmonary disease (COPD). Methods Seventy patients with acute exacerbation of COPD were divided into the more sputum group (n=35) and less sputum group (n=35) according to the daily sputum weight. All patients underwent the active cycle of breathing techniques (ACBT) intervention (ACBT and postural drainage) and regular intervention (standardised physiotherapy, SP). The self-paired design was adopted and random intervention sequence of two methods was determined by the sealed envelope method. Changes of the expectorated sputum, SpO2, and heart rate were observed. Results Compared to SP, the sputum weight of patients of the more sputum group intervened by ACBT was significantly increased during the intervention and 1 h after the intervention. SpO2 had no significant changes and the heart rate decreased significantly during the intervention. Compared to SP, the sputum weight of patients of the less sputum group intervened by ACBT was significantly increased during 1d. The sputum weight had no significant changes during the intervention and 1h after the intervention. SpO2 and the heart rate improved significantly during the intervention. Patients of both groups had no serious side effects after being intervened by ACBT. Conclusion The ACBT intervention can help sputum excretion and respiratory exercise in short period of time for acute exacerbation of COPD and has no obvious side effects.

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    Relationship between serum anti-Müllerian hormone and insulin resistance of patients with polycystic ovarian syndrome
    XU Ling, NIU Zhi-hong, LI Yan, et al
    2014, 34 (6):  859. 
    doi: 10.3969/j.issn.1674-8115.2014.06.018

    Abstract ( 751 )   PDF (323KB) ( 896 )  

    Objective To investigate the correlation between the serum anti-Müllerian hormone (AMH) and the insulin resistance (IR) for patients with polycystic ovarian syndrome (PCOS). Methods Forty-nine patients who were diagnosed as PCOS were selected as the experimental group and 50 patients with tubal infertility and regular menstruation were selected as the control group. Patients with PCOS were divided into the high HOMA-IR group (n=25) and low HOMA-IR group (n=24) based on the median of homeostasis model assessment insulin resistance (HOMA-IR)index. Patients with PCOS were also divided into the overweight group (n=25, BMI≥23 kg/m2) and non-overweight group (n=24, BMI<23 kg/m2) based on the body mass index (BMI). Levels of serum AMH, reproductive hormones, and sugar metabolism indicators of patients were measured and comparisons among groups were conducted. The relationship between the level of AMH and HOMAIR was analyzed. Results The levels of serum AMH, luteinizing hormone (LH), LH/follicle-stimulating hormone (FSH), testosterone (T), INS, and HOMA-IR of the experimental group were significantly higher than those of the control group. The differences were statistically significant (P<0.05). The levels of serum AMH of the high HOMA-IR group were higher than those of the low HOMA-IR group. The differences were statistically significant (P<0.05). The HOMA-IR and the level of serum AMH of the experimental group were positively correlated (r=0.53, P<0.01). The HOMA-IR and the level of serum T of the overweight group were significantly higher than those of the non-overweight group. The differences were statistically significant (P<0.05). Conclusion The level of serum AMH of patients with PCOS significantly increases. The increase is irrelevant to BMI and is positively correlated to the level of IR.

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    Value of 18F-PET/CT imaging in staging for children with neuroblastoma
    LI Jia-ning, FU Hong-liang, FENG Fang, et al
    2014, 34 (6):  864. 
    doi: 10.3969/j.issn.1674-8115.2014.06.019

    Abstract ( 733 )   PDF (332KB) ( 863 )  
    Objective To evaluate the clinical value of 18F-FDG PET/CT in staging for children with neuroblastoma (NB). Methods The data of 45 patients who were diagnosed as NB were retrospectively analyzed. Patients were divided into the pre-treatment group (n=13) and post-treatment group (n=32). All patients underwent 18F-flourodeoxyglucose (FDG) PET/CT imaging and the maximum standardized uptake value (SUV) was used as the basis for PET quantitative analysis. Results All
    patients of the pre-treatment group showed increased FDG uptake at the primary site (13/13, 100%). Seven patients of the post-treatment group showed increased FDG uptake (7/32, 21.9%). Among 23 patients who were detected with lymph nodes metastasis (23/45, 51.1%), 17 with local lymph nodes metastasis, 13 with distant lymph node metastasis, 18 with bone (or bone marrow) metastasis (18/45, 40.0%), 2 with pleura metastasis, 1 with liver metastasis, 3 with meninges metastasis, 1 with brain metastasis (some patients with multi-organ metastasis). After PET/CT imaging, stages of 4 patients of the pre-treatment group changed (4/13, 30.8%). Among them, the stage of 1 patient upgraded from II to IV (1/2), stages of 3 patients upgraded from III to IV (3/5). Stages of 17 patients of the post-treatment group changed (17/32, 53.1%). Stages of 4 stage 0 patients were upgraded due to bone (or bone marrow) metastasis (4/14, 28.6%). Among suspected stage I patients, stages of 6 patients were degraded because abnormal tissues at primary sites had no FDG uptake (6/7, 85.7%). The stage of 1 stage II patient was upgraded because nodules with FDG uptake were found in abdomen (1/3). Stages of 2 stage III patients were upgraded due to bone metastasis and intraspinal metastasis (2/2). Conclusion 18F-FDG PET/CT can provide objective evidences for staging and improve the accuracy of initial staging and re-staging for NB. Re-staging can benefit more from the PET/CT. Stages of stage III patients change more significantly. Stages of stage I patients are degraded significantly after treatments. The main reason that PET/CT can change the stage is the high sensitivity for whole body lesion detection. PET/CT can also evaluate the activity of abnormal tissues in primary sites after operations.
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    Correlation between IVIM diffusion-weighted MR imaging and Gleason score of prostate cancer
    CHEN Xiao-xi, WU Lian-ming, ZHANG Xiao-fei, et al
    2014, 34 (6):  868. 
    doi: 10.3969/j.issn.1674-8115.2014.06.020

    Abstract ( 919 )   PDF (794KB) ( 1215 )  
    Objective To explore the value of intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI) for diagnosing prostate cancer and the correlation between IVIM DWI and the Gleason score. Methods The data of multi-b-value DWI of 38 patients with prostate cancer and 32 patients with benign prostate hyperplasia (BPH) were retrospectively analyzed. The D and f values of regions of prostate cancer and BPH were calculated by the IVIM bi-exponential model. The differences of D and f values of regions of prostate cancer and BPH were analyzed. The differences of D and f values of prostate cancer with different Gleason scores were compared and the correlation with the Gleason score was analyzed. Results D and f values of regions of prostate cancer were significantly lower than those of regions of BPH (P<0.05). The D and f values of prostate cancer with different Gleason scores were significantly different (P<0.05). The D value of prostate cancer was negatively correlated to the Gleason score (r=-0.772, P<0.01) and the f value of prostate cancer was negatively correlated to the Gleason score (r=-0.780,P<0.01). Conclusion D and f values can be used for the diagnosis and evaluation of prostate cancer. The IVIM model is expected to predict the aggressiveness and prognosis of prostate cancer from both diffusion and perfusion.
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    Clinical evaluation of sublingual allergen specific immunotherapy in treatment to children with bronchial asthma and allergic rhinitis
    MA Cai-xia, LU Mei-fang, GE Li-ping, et al
    2014, 34 (6):  873. 
    doi: 10.3969/j.issn.1674-8115.2014.06.021

    Abstract ( 690 )   PDF (299KB) ( 774 )  
    Objective To explore the therapeutic effect and safety of sublingual allergen specific immunotherapy (SLIT) for the treatment of bronchial asthma with allergic rhinitis. Methods One hundred and twenty children from 5 to 14 years old with asthma and allergic rhinitis were selected and randomly divided into the SLIT treatment group (sublingual administration of the dermatophagoides farinae drop) and conventional treatment group. Each group had 60 patients. Scores of asthma control questionnaire (ACQ), rhinitis symptoms, monthly medication and adverse reactions were recorded. The specific IgE (SIgE) value of serum dermatophagoides farinae was measured. Results After treatment for one year, the scores of ACQ, rhinitis symptom, and monthly asthmatic medicine and the SIgE value of serum dermatophagoides farinae of the SLIT treatment group and conventional treatment group were decreased. The decrease of the SLIT treatment group was significantly more than that of the conventional treatment group. The differences were statistically significant (P<0.01). The incidence of side effects (including skin rash, nasopharyngeal itch, and asthma attack) relevant to immunotherapy was 13.3% and no serious side effects happened. Conclusion SLIT can safely and effectively treat children with bronchial asthma and allergic rhinitis and is better than the conventional therapy.
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    Application of trans-esophageal echocardiography in trans-thoracic minimal invasive occlusion surgery of infantile multiple atrial septal defect
    WU Shu-bin, DING Fang-bao, TANG Min, et al
    2014, 34 (6):  877. 
    doi: 10.3969/j.issn.1674-8115.2014.06.022

    Abstract ( 663 )   PDF (484KB) ( 960 )  
    Objective To explore the application value of the trans-esophageal echocardiography (TEE) for the trans-thoracic minimal invasive occlusion
    surgery of infantile multiple atrial septal defect (ASD). Methods The right atrium of 18 patients with multiple ASD was exposed by minimal invasive incision
    besides the right sternum. The size and number of ASD and the distance between ASD were measured by the guidance of TEE. According to the measurements,
    proper ASD occluders were selected. The sleeve of occluder went through atrial septal defect, entered the left atrium, and occluded the multiple ASD by the
    guidance of TEE. The results of treating the multiple ASD by the occluder were evaluated immediately after the operation. Results Multiple ASD of 18 patients
    were all occluded by one occluder for each patient. Immediate TEE examination after operation showed that all occluders were in good positions without
    deformations, movements, and shedding. Multiple ASD had no residual shunt. Functions of cardiac valves were not affected. Conclusion The treatment of infantile
    multiple ASD by the trans-thoracic minimal invasive occlusion surgery is a safe and effective technology. TEE is clinically very important for selecting
    cases and occluders, intra-operative guidance and observations, and follow-up.
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    Relationship among individual lipid indicators, dyslipidemia risk stratification, and bone mineral density of old males
    WU Meng-meng, CHEN Zhi-guo, LU Jin-hua, et al
    2014, 34 (6):  880. 
    doi: 10.3969/j.issn.1674-8115.2014.06.023

    Abstract ( 645 )   PDF (332KB) ( 776 )  
    Objective To investigate the relationship among individual lipid indicators, dyslipidemia risk stratification, and bone mineral density (BMD) of old males. Methods A total of 247 old physical examinees were divided into the normal lipid group (n=84) and abnormal lipid group (n=163). The latter was further divided into the low risk group, medium risk group, and high risk group. The BMD T-score was measured by the quantitative ultrasound (QUS). Subjects were divided into the normal bone mass group and bone loss group according to the results of measurements. The relationship among individual lipid indicators, dyslipidemia risk stratification, and
    bone mineral density was analyzed. Results For individual lipid indicators, the incidences of osteopenia of subjects with high cholesterol and LDL-C were 73.8% and 73.5%, which were significantly higher than those of subjects with normal cholesterol and LDL-C (P<0.01). The differences of individual lipid indicators of three subgroups of the abnormal lipid group were not statistically significant. The incidences of osteopenia of the low risk group, medium risk group, and high risk group gradually rose, i.e. 41.7%, 67.2%, and 79.4%, respectively. The differences were statistically significant (P<0.01). The results of correlation analysis showed that the TC, LDL-C, and lipid risk stratification were positively correlated with the incidence of osteopenia (r=0.153,P=0.016; r=0.171,P=0.007). The lipid risk stratification was significantly and negatively correlated with BMD T-score (r=-0.301, P<0.01). After age, BMI, and exercise habits were corrected, the lipid risk stratification was still significantly and negatively correlated with BMD T-score (r=-0.259, P<0.01). Conclusion Individual lipid indicators of TC and LDL-C may relate to the incidence of osteopenia. Compared to individual lipid indicators, the lipid risk stratification relate to BMD T-score more closely and can better predict the risk of osteopenia.
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    Clinical observation of Artisan iris-fixated aphakic intraocular lens for treatment of aphakic eyes
    YE Bei, TONG Jian-ping, LI Hui-yan, et al
    2014, 34 (6):  885. 
    doi: 10.3969/j.issn.1674-8115.2014.06.024

    Abstract ( 723 )   PDF (476KB) ( 1075 )  
    Objective To observe the clinical effects and surgical complications of Artisan iris-fixated intraocular lens (IOL) implantation for the treatment of aphakic eyes. Methods Thirteen patients (thirteen eyes) with aphakic eyes who received Artisan IOL implantation were observed. The uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), and intraocular pressure (IOP) changes of patients before and after surgeries were compared. The corneal edema, anterior chamber flash, IOL position, and iris were observed by the slitlamp microscope. The number of corneal endothelium was counted. Results The average time of follow-up was two years. The UCVA of five eyes was 0.5 or better (38.5%) and the BSCVA of six eyes was 0.5 or better (46.2%). The IOP did not change significantly before and after surgeries. There were no significant cornea edema, decentration or tilting of IOL, and inflammation of anterior chamber. The mean loss rate of endothelial cells was 10.1%. There were two eyes with the iris injury and two eyes with the iris hemorrhage during the surgery, but were absorbed shortly after the surgery. There was one eye with IOL dislocation during the follow-up and the IOL was refixed. No macular edema was observed. Conclusion Artisan irisfixated IOL implantation is a safe and effective method for treating aphakic eyes. The surgery is simple with less damage to tissues and less complications. The postoperative visual acuity can be significantly improved.
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    Diagnosis, treatment and follow-up of 61 children with nephroblastoma
    HE Ke-jun, ZHANG Qin, YUAN Xiao-jun, et al
    2014, 34 (6):  890. 
    doi: 10.3969/j.issn.1674-8115.2014.06.025

    Abstract ( 801 )   PDF (673KB) ( 1045 )  
    Objective To evaluate the effects of different factors on the survival rate of children with nephroblastoma so as to choose treatment methods more reasonably and to improve the prognosis of patients. Methods Sixty-one nephroblastoma cases admitted by the Department of Pediatric Hematology/Oncology of Xinhua Hospital from Jan. 2007 to Dec. 2012 were retrospectively analyzed and the clinical data were statistically analyzed by the Kaplan-Meier process. Results Among 61 cases, 41 cases were male and 20 cases were female. The expected 4-year overall survival rate was 91.8%. The expected 4-year overall survival rates of stageⅠ+Ⅱ, stage Ⅲ, and stage Ⅳ+Ⅴ were 100%, 90.5%, and 78.6%, respectively. The survival rate of late stage of nephroblastoma was significantly lower than that of the early stage. The survival rate of patients who had residual or ulcerated tumors was significantly lower than that of tumor-free patients (4-year overall survival rates of 82.6% and 97.4%, P<0.05). Conclusion The overall prognosis of children with nephroblastoma is good. The normative multi-discipline combined treatment can improve the prognosis. Clinical staging and whether tumors are residual or ulcerated are important prognosis factors.
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    Relationship between jaw bone density at implant sites measured by cone beam computed tomography and torque of implants
    DONG Zheng-jie, CHENG Hong, WANG De-fang, et al
    2014, 34 (6):  894. 
    doi: 10.3969/j.issn.1674-8115.2014.06.026

    Abstract ( 627 )   PDF (540KB) ( 842 )  
    Objective To explore the relationship between the jaw bone density measured by the cone beam computed tomography and the torque of implants. Methods Sixty three patients with dentition defect who planned to receive implant prosthesis were randomly selected. Patients were scanned by the cone beam computed tomography and HU values of the jaw bone density at implant sites were measured by the Kavo eXam Vision software. Torque values of 83 implants were recorded according to requirements of the cylinder root form implant of Biomet 3i. The linear regression equation was then acquired based on the data of scatter diagram and the relationship between the jaw bone density and the torque of implants was analyzed. Results The measurement results of cone beam computed tomography showed that bone density values of the maxillary anterior, maxillary posterior, mandibular anterior, and mandibular posterior were (415.44±147.14) HU, (336.00±148.04) HU, (815.09±88.08) HU, and (537.08±167.28) HU, respectively. The torque values of implants of the maxillary anterior, maxillary posterior, mandibular anterior, and mandibular posterior were (43.08±10.52) Ncm, (36.90±11.68) Ncm, (50.00±0.00) Ncm, and (44.05±11.17) Ncm, respectively. The results of correlation analysis indicated that the jaw bone density measured by the cone beam computed tomography and the torque of implants were highly correlated (r=0.536, P<0.01). Conclusion According to the jaw bone density at implant sites measured by the cone beam computed tomography, the torque of implants can be preliminarily estimated and it is helpful for making the operation plan.
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    Original article (Public health administration)
    Study on financing mode and responsibility sharing mode of adverse drug reaction
    HUANG Deng-xiao, HUANG Qi-min, LI Xiao-bin, et al
    2014, 34 (6):  898. 
    doi: 10.3969/j.issn.1674-8115.2014.06.027

    Abstract ( 744 )   PDF (320KB) ( 737 )  
    Objective To explore the responsibility sharing of relevant parts for the adverse drug reaction (ADR), modes of compensation financing, and the role of government in financing. Methods Two hundred and sixty pharmaceutical producing enterprises, 115 management authorities, and 125 drugs sales and users (medical institutions) were selected. The questionnaire was designed for the survey, which covered the ranking of responsibility sharing modes of ADR, methods of compensation financing, and the role of government in financing. The distributions of chosen items of each party were represented by the frequency and composition ratio. The chi square test was used to analyze the differences of distribution trends. Results There were 467 valid questionnaires and the valid rate was 93.4%. For the responsibility of damage sharing, pharmaceutical producing enterprises and management authorities should take the major responsibility, sales and medical institutions should take the minor responsibility, and victims took no responsibility. For the compensation financing, three parts all agreed that the most important methods were taxes, cash, and donations. For the role of government in financing, 96.2% of respondents believed that the government should invest, but their opinions towards the investment methods were different. And 55.3% of respondents believed that the government should invest proportionally. Conclusion When compensating the victims of ADR, pharmaceutical producing enterprises and management authorities should take the major responsibility, the major financing method is taxes, and the government should invest.
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    Study on evaluation model for competency of clinical teachers
    CHEN Li-jin, XIE Xian-yu, JIN Yan, et al
    2014, 34 (6):  902. 
    doi: 10.3969/j.issn.1674-8115.2014.06.028

    Abstract ( 1012 )   PDF (398KB) ( 940 )  
    Objective To establish an evaluation model for the competency of clinical teachers based on the McClelland competency model. Methods Core elements of the competency of clinical teachers were investigated by literature reviews, expert interviews, behavioral event interview (BEI), and questionnaires. The questionnaire of the competency of clinical teachers was prepared and the data relevant to characteristic items of the competency were obtained. The investigation data were proceeded by the exploratory factor analysis and confirmatory factor analysis. Results A distribution and classification model for characteristic items of the competency of clinical teachers was established, which included 6 class I factors and 20 class II factors. The efficiency and stability were proved by the confirmatory factor analysis. The classification of class III evaluation was performed for each class II factor. Conclusion This paper establishes a proven evaluation model for the competency of clinical teachers. The model is based on the solid theory basis. It has a comprehensive indicator system for factors and clear description for classes. The model is helpful for improving the scientificity of evaluating clinical teachers, teaching ability, and teaching quality.
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    Survey of nurses' perception of hospital safety climate relevant to occupational exposure to blood-borne pathogens
    QIAN Ping, XI Hui-Qin, PAN Ling-ling, et al
    2014, 34 (6):  909. 
    doi: 10.3969/j.issn.1674-8115.2014.06.029

    Abstract ( 711 )   PDF (327KB) ( 810 )  
    Objective To investigate nurses' perception of hospital safety climate relevant to occupational exposure to blood-borne pathogens and to analyze major influent factors. Methods A total of 768 nurses were surveyed by the questionnaire prepared by authors and the Chinese version of Hospital Safety Climate Scale (C-HSCS). The hospital safety climate was investigated from five dimensions, i.e. management support, barriers to safe working, feedback and training, cleanness and neatness of work places, and conflict and communication of the safety management. Major influent factors were analyzed. Results The overall reliability of C-HSCS was 0.92 and the mean scores of nurses' perception of hospital safety climate were 4.00± 0.56. Two dimensions with the lowest scores were barriers to safe working (2.85±1.04) and cleanness and neatness of work places (3.55±1.08). The items with lowest scores were light workload (2.51±1.21) and plenty of nurses (2.64±1.25). The differences of nurses of different ages, work periods, departments, and professional titles were statistically significant (P<0.05, P<0.01). Conclusion The nurses' perception of hospital safety climate is good. The establishment of hospital safety climate should focus on reasonably allocating human resources and building a better occupational environment. During the establishment of hospital safety climate, active and optimistic young nurses should be encouraged and experienced nurses should be heartened to involve in evaluating the safety threats. The focus of management of occupational exposure to bloodborne pathogens is the emergency room.
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    Survey of relationship between work environment and subjective well-being of nurses
    WU Xiao-rong, YANG Yan
    2014, 34 (6):  913. 
    doi: 10.3969/j.issn.1674-8115.2014.06.030

    Abstract ( 869 )   PDF (363KB) ( 829 )  

    Objective To analyze the effects of the work environment on the subjective well-being of nurses by investigating the current status of work environment and subjective well-being of nurses. Methods The general well-being scale and perceive nursing environment scale were used to investigate 464 nurses. Results The overall scores of work environment were 79.83±9.70. For each item, the average scores were 2.76±0.23. Among all dimensions, the highest scores were the ability and leadership skills of nursing managers (2.92±0.14) and the lowest scores were sufficient manpower and material resources (2.36±0.27). The overall scores of subjective well-being were 74.18±12.787. The positions, departments, and whether work on shifts influenced the subjective well-being of nurses (P<0.05). The work environment was positively correlated to the subjective well-being of nurses (P<0.01). Conclusion The work environment of investigated nurses is at a middle level. Their subjective well-being is good. The work environment is closely related to the subjective well-being. Positive work environment is helpful for improving the subjective well-being of nurses.

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    Review
    Advances of epidemiology and resistance mechanism of Clostridium difficile infection
    LI Zhen, ZHANG Li-hua, DONG Dan-feng, et al
    2014, 34 (6):  919. 
    doi: 10.3969/j.issn.1674-8115.2014.06.031

    Abstract ( 699 )   PDF (336KB) ( 803 )  

    In recent years, with the dramatic changes in the epidemiology of Clostridium difficile infection (CDI) as well as increases in incidence and severity of the disease, CDI has become a global public health challenge. There have been several outbreaks of CDI in North America and Europe and Clostridium difficile has also become an important pathogenic cause of nosocomial infection in Asia. However, the awareness and surveillance of CDI still remain poor in China. A better knowledge of the epidemiology of CDI and antimicrobial resistance of Clostridium difficile can provide the basis for the prevention and treatment of CDI. This paper reviews the epidemiology and research progresses of resistance mechanism of CDI.

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    Correlation between 11β-hydroxysteroid dehydrogenase and metabolic syndrome
    RUAN Li-li, ZOU Chao-chun
    2014, 34 (6):  924. 
    doi: 10.3969/j.issn.1674-8115.2014.06.032

    Abstract ( 885 )   PDF (336KB) ( 809 )  

    Metabolic syndrome (MetS) is a pathological condition of disorders of several metabolic components and a risk factor of causing cardiovascular diseases and diabetes. Dysregulation of glucocorticoid is an important feature of MetS. 11β-hydroxysteroid dehydrogenase (11β-HSD) of the body mainly converts the active glucocorticoid to its inactive precursor and regulates the concentration of local glucocorticoid. 11β-HSD involves pathophysiologic processes of MetS such as insulin resistance, obesity, type 2 diabetes, and hypertension. The application of 11β-HSD1 inhibitors may provide new methods for treating MetS.

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    Advances of DAF-2/IGF-1 signaling pathway relevant to aging in Caenorhabditis elegans
    MAO Yu-qin, HAN San-feng, WANG Li-shun
    2014, 34 (6):  929. 
    doi: 10.3969/j.issn.1674-8115.2014.06.033

    Abstract ( 1181 )   PDF (367KB) ( 1037 )  

    Ageing is one of the key factors that cause many diseases. Up-to-date, most knowledge and information about the genetics of ageing in biology comes from the studies on Caenorhabditis elegans (C.elegans). The C.elegans plays an important role in the study of anti-ageing. The first aging regulation mechanism understood by the people is the DAF-2/IGF-1 signal pathway. This paper reviews the leading and promoting effects of C.elegans, which acts as a model organism, on the course of research of the DAF-2/IGF-1 signal pathways and provides helpful ideas and methods for anti-ageing studies.

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    Advances of preventive and therapeutic strategies for acquired heterotopic ossification
    GAO You-shui, SUN Yu-qiang, ZHANG Chang-qing
    2014, 34 (6):  934. 
    doi: 10.3969/j.issn.1674-8115.2014.06.034

    Abstract ( 767 )   PDF (367KB) ( 846 )  

    Acquired heterotopic ossification (AHO) is a common complication following severe trauma, burning, cerebrospinal injuries, and artificial joint replacements and often leads to unsatisfactory prognosis. Although non-steroidal anti-inflammatory drugs (NSAIDs) and radiotherapy have been the classical methods for prevention and treatment of AHO, their effectiveness is doubted in recent years and the systemic complications induced by radiation therapy (RT) cannot be ignored. Therefore, new methods for the effective prevention of AHO have to be developed. The incidence and severity of AHO can be effectively reduced through analyzing risk factors, revealing preventive mechanisms of new NSAIDs and RT, and combining with surgical interventions. The deep insight into the mechanism of AHO has resulted in targeted preventive and therapeutic methods, especially retinoic acid receptor target drugs that may bring revolutionary changes.

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    Brief original article
    Diagnostic value of ultrasonography and modified Alvarado score for elderly patients with acute appendicitis
    HU Feng, SHAO Chong-fei, HUANG Wei-qiang
    2014, 34 (6):  939. 
    doi: 10.3969/j.issn.1674-8115.2014.06.035

    Abstract ( 733 )   PDF (549KB) ( 1014 )  

    Objective To compare the diagnostic value of the ultrasonography and modified Alvarado score for elderly patients with acute appendicitis. Methods A retrospective analysis of 200 patients with complaints of acute right lower abdominal pain, clear surgical results, and age over 60 years was conducted. The diagnostic value of the ultrasonography and modified Alvarado score was compared by the receiver operating characteristic (ROC) curves. Results The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the ultrasonography were 85.31%, 82.46%, 92.42% and 69.12%, respectively. The area under the ROC curve (AUC) was 0.890. AUC of the modified Alvarado score was 0.782, slightly lower than that of the ultrasonography. The sensitivity, specificity, PPV, and NPV were 87.41%, 73.68%, 89.29% and 70.0%, respectively for the cut-off point of 6. Conclusion The diagnostic value of the ultrasonography is equivalent to that of the modified Alvarado score for elderly patients with acute appendicitis. Combination of them has certain reference value for early diagnosis and treatment.

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    Clinical value of urodynamic examination for evaluating old male patients with acute urinary retention
    CHEN Wei-guo, JIANG Yu-feng, HOU Jian-quan, et al
    2014, 34 (6):  943. 
    doi: 10.3969/j.issn.1674-8115.2014.06.036

    Abstract ( 738 )   PDF (218KB) ( 763 )  

    Objective To investigate the clinical value of the urodynamic examination for old male patients with acute urinary retention (AUR). Methods One hundred and three old male patients with AUR received the urodynamic examination after retention catheterization for 2-5 days. For patients failed to remove catheters, the urodynamic examination was repeated after 4 and 12 weeks of AUR occurrence and the analysis was conducted in combination with clinical data. Results According to results of the first urodynamic examination, 103 AUR patients were divided into the low detrusor activity group (DUA group, n=36) and non-low detrusor activity group (NDUA group, n=67). The age and incidence of complications of the DUA group were significantly higher than those of the NDUA group (P<0.05,P<0.01). The differences of the international prostate symptom scores (IPSS), prostate specific antigen (PSA) levels, and prostate volumes of two groups were not statistically significant (P>0.05). Urodynamic parameters of 103 patients after 4 weeks of AUR occurrence were significantly better than those within 1 week of AUR occurrence (P<0.01 or P<0.05). But compared to urodynamic parameters after 12 weeks of AUR occurrence, the differences were not statistically significant (P>0.05). Conclusion The urodynamic examination can effectively evaluate the bladder function of old male patients with AUR. The proper time for examination is after 4 weeks of AUR occurrence.

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    Technique and method
    The clone, expression, and purification of surface layer protein of Lactobacillus acidophilus ATCC4356
    SUN Qin, ZENG Nai-yan, ZHOU Ai-wu, et al
    2014, 34 (6):  946. 
    doi: 10.3969/j.issn.1674-8115.2014.06.037

    Abstract ( 721 )   PDF (836KB) ( 821 )  

    Objective To clone the encoding gene of surface layer (S-layer) protein of Lactobacillus acidophilus, realize the prokaryotic expression, and purify expression products. Methods The gene of S-layer protein of Lactobacillus acidophilus was extracted, amplified, ligated to the expression vector of pET-SUMO3, and transcribed and expressed in E.coli BL21 (DE3). The S-layer protein was extracted and purified by the nickel-affinity chromatography. The expression products were verified by the SDS polyacrylamide gel electrophoresis (SDS-PAGE) and Western blotting. Results The encoding gene of S-layer protein of Lactobacillus acidophilus ATCC4356 was cloned and had 98% homology with the relevant gene. Results of the SDS-PAGE and Western blotting showed that the fusion protein expressed efficiently in bacteria. The recombinant S-layer protein (43 000 Da) could be obtained by the affinity chromatography and removing the fusion tag by the enzymatic digestion. Conclusion The prokaryotic expression can be achieved and the S-layer protein with high purity can be acquired by obtaining the encoding gene of S-layer protein of Lactobacillus acidophilus. These are helpful for subsequent studies on biological functions.

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    Clinical experience
    Treatment of complex congenital heart diseases by total cavopulmonary connection without cardiopulmonary bypass
    BAO Chun-rong, MEI Ju, DING Fang-bao, et al
    2014, 34 (6):  951. 
    doi: 10.3969/j.issn.1674-8115.2014.06.038

    Abstract ( 697 )   PDF (222KB) ( 820 )  

    Objective To summarize the clinical experience of treating complex congenital heart diseases by the staged total cavopulmonary connection (CPC) without cardiopulmonary bypass (CPB). Methods Twenty nine patients with complex congenital heart diseases underwent staged TCPC without CPB. Among them, 11 cases had functional univentricle with pulmonary stenosis; 13 cases had tricuspid atresia with hypoplasia of right ventricle; 2 cases had Ebstein's anomaly with hypoplasia of right ventricle; and 3 cases had total atrioventricular septum defect with double outlet right ventricle and pulmonary stenosis. Six cases with left superior vena cava received the first stage operation of bilateral BDG and after twenty three months, they received the TCPC without CPB. Results There was no postoperative death. All patients were recovered and discharged. All patients except 7 cases were followed up for 5-10 years and there was no medium and long term death. The cyanosis of all patients was disappeared and their arterial oxygen saturation was 89%-97%. The cardiac function was class I for 18 patients and class II for 4 patients. Conclusion The staged TCPC without CPB has good outcomes with fewer complications.

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    Case report
    Primary extramedullary plasmacytoma of the breast: a case report
    PAN Xian-jun, ZHANG Qi-juan, SUN Rong-hua, et al
    2014, 34 (6):  954. 
    doi: 10.3969/j.issn.1674-8115.2014.06.039

    Abstract ( 656 )   PDF (369KB) ( 773 )  

    The extramedullary plasmacytoma (EMP) is a malignant tumor primarily formed by the monoclonal proliferation of plasma cells outside the marrow hematopoietic tissue. Extramedullary plasmacytoma of the breast is rare, especially primary extramedullary plasmacytoma of the breast. This paper reports a case of 22-year-old female whose wound of left-breast mass excision ulcerated repeatedly for 4 years and the patient was diagnosed as the primary extramedullary plasmacytoma of the breast. The PET/CT examination suspected the left axillary lymph node metastasis. The patient’s condition improved significantly after the radiotherapy and chemotherapy.

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