Objective: To investigate the impact of levosimendan on mortality in patients with severe heart failure (HF) by Meta-analysis. Methods: We search the PubMed, EMBASE and Cochrane Central Registry of cardiovascular disease to identify all randomized impact of levosimendan vs other medications. The document retrieval was from the establishment of each database until 2014-07. The literatures were taken based on Jadad scale standard and the qualified control study was used without dose and time restrictions by Rev Man 5.2 soft ware, and a total of 37 articles with 4470 patients were finally enrolled for Meta-analysis. Results: Compared with controlling medications, levosimendan could decrease the mortality in patients with cardiac disease caused severe HF (RR: 0.85; 95% CI 0.75-0.97;P=0.02), and cardiac surgery caused severe HF (RR: 0.49; 95% CI 0.28-0.85;P=0.01). Compared with dobutamine, levosimendan could reduce the mortality in patients with severe HF (RR: 0.84; 95% CI 0.73-0.99;P=0.02) and severe ischemic HF (RR: 0.85; 95% CI 0.73-0.99;P=0.04). Conclusion: Levosimendan may reduce the mortality in patients with severe HF caused by cardiac disease, cardiac surgery and ischemic cardiac injury.

Bioadhesive delivery systems with sustained release characteristics can promote the absorption and increase the bio-availability of drugs by prolonging the residence time on the applied site. The evaluation of adhesion property of bioadhesive drug deliv-ery systems is important because the sustained release effect and the absorption are closely related with the adhesion. The methods for the evaluation of the adhesive properties of bioadhesive drug delivery systems in vitro were summarized in the article, including determi-ning the minimum peel force, measuring the residues on mucosa surface, determining the retention time on mucosal surface, measuring the swelling and the viscosity of fluid and so on, and the operation of some methods were described simply as well.

a mygdalin ex isting the pro blem of exce ssive sulfurd ioxide evenw ithout sulfur smoked thro ugh “distill-io dometry”. M ethods Hea dspace gas ch romatograph y-flame phot ometric metho d was compa red with dist ill-iodometry method to d etect the con tent of sulfur dioxide in Se men Armeni acae Amarae, and silver ni trate titration and iodometr ic titration w ere used to determine th e pure amygd alin and sam ple through conventional sulfur dioxid e determinati on device. R esults In th e process ofd etermination of sulfur dio xide residues in Chineseh erbal medicin e and decoc tion pieces c ontaining am ygdalin, som e iodine cons umption was caused bya mygdalin dec omposing. C onclusion Co nventional i odometric m ethod and so dium hydrox ide titrationm ethod cann o longer be used for dete ction of sulf ur dioxide r esidue amoun t of Chinese herbal medici ne and decoc tion pieces co ntaining amy gdalin. Objective To explore th e causes ofs ome Chinese herbal medi cine and deco ction pieces containing.

Objective To evaluate the feasibility and clinical value of endoscopic decompression with metal stent and colorectal tube for acute malignant colorectal obstruction. Methods With the aid of fluoroscopy, 26 cases with acute malignant colorectal obstruction were treated. Their obstructive sites consisted of rectum(n=14), sigmoid colon(n=8), descending colon(n=2) and transverse colon(n=1). Results In 18 of 26 patients, metal stents were successfully inserted (18/20, 90%), in 6 cases colorectal tube were successfully inserted(6/6, 100%), the total technical success rate was 92. 3% (24/26). Thereafter, 1 patient has no effect, 23 patients showed relief of obstructive symptoms within 1-2 days, the clinical success rate was 88.5% (23/26). Permanent metal stent placements were performed in 13 cases for palliative treatment, 10 underwent subsequent elective surgical resection after 7 ~ 10 days, without complications, such as anastomotic leakage and intraperitoneal infection. One case was failed in recurrent rectal carcinoma after resection, one case with widespread metastatic sigmoid colon carcinoma occurred colon perforation and received immediate Hartmann operation. Recurrent obstruction was detected in one patient with distal stent migration within 6 weeks, and second stent were placed to solve the problems. Stent occlusion from stool impaction was found in one patient 1 month after stent insertion, and was solved by endoscpic interventions. Conclusion Endoscopic decompression with metal stent and colorectal tube can alleviate the acute malignant colorectal obstructive sympotoms with high success rate. It is a simple, safe, effective and well tolerated method, and can obviate colostomy, prominently reduce trauma and agony, and increase the living quality of patients.

Objective: To evaluate the risk factors for contrast-induced nephropathy (CIN) in patients of acute coronary syndrome (ACS) with normal or slightly impaired renal function after percutaneous coronary intervention (PCI).
Methods: A total of 254 consecutive ACS patients with normal or slightly impaired renal function received PCI in the Second Artillery General Hospital from 2013-06 to 2015-06 were retrospectively studied. All patients had eGRF≥60 ml (min?1.73 m2) and they were divided into 2 groups:CIN group, the patients with serum creatinine increased by 0.5mg/dl (44.2μmol/L) or elevated to 25%higher than the baseline, n=23;Non-CIN group, n=231. The basic condition with laboratory tests, operative indexes were recorded and eGRF value were calculated in all patients.
Results: There were 9%(23/254) patients suffered from CIN after PCI. Multivariate regression analysis indicated that emergent PCI (OR=0.370, 95%CI 0.060-2.297), increased plasma level of NT-proBNP (OR=4.209, 95%CI 1.202-14.742) and without pre-operative aspirin administration (OR=7.950, 95%CI 1.108-57.034) were the clinical risk factors for post-operative CIN occurrence.
Conclusion: Emergent PCI, higher plasma level of NT-proBNP and no pre-operative aspirin administration were the risk factors for CIN occurrence in ACS patients with normal or slightly impaired renal function after PCI.

OBJECTIVETo explore the feasibility of preparation of a mouse model of orthotopic colon cancer by injecting tumor cell suspension into mesenteric triangle of the cecum.

METHODSTwenty SPF 8-week old BALB/c mice (male:female = 1:1) were used in this study. The mouse caecum was exposed by laparostomy, and suspension of mouse colon adenocarcinoma CT26. WT cells was injected into the mesenteric triangle of cecum for preparation of a mouse model of orthotopic colon cancer.

RESULTSMouse orthotopic colon cancer was developed by injection of tumor cell suspension into mesenteric triangle of the cecum showing a successful rate of 100%, without intestinal obstruction, and the liver, spleen, diaphragm and mesenteric lymph nodes metastasis rates were high in all the 20 experimental mice.

CONCLUSIONSThe establishment of mouse models of orthotopic colon cancer by injection of tumor cell suspension into the mesenteric triangle is a simple, rapid, and easy to master procedure, causing less damage to the colon wall, safe and with less trauma to the mice. This method may provide an ideal mouse model of orthotopic colon cancer for the study of pathogenesis as well as liver metastasis mechanisms of colon cancer.

Adenocarcinoma ; pathology ; secondary ; Animals ; Cecal Neoplasms ; pathology ; Cecum ; Colonic Neoplasms ; pathology ; Disease Models, Animal ; Feasibility Studies ; Female ; Liver Neoplasms ; secondary ; Lymphatic Metastasis ; Male ; Mice ; Mice, Inbred BALB C ; Neoplasm Transplantation ; methods

Objective:To explore the core competency of doctors in tertiary public hospitals in regions of different income levels in China, and provide reference for promoting such competency and related policy formulation.Methods:Using multi-stage stratified cluster sampling method, 195 tertiary public hospitals in 16 provinces of China were selected from November 2021 to March 2022. 200 doctors were sampled from each hospital. A self-designed questionnaire was used to investigate the status of doctors′ core competencies, as well as the status of their postgraduate medical education and continuing medical education. According to the per capita gross regional product of each province in China Statistical Yearbook 2022, each province was divided into high, middle and low income regions, and the questionnaire data were descriptively analyzed, while χ2 test was used to compare the differences between groups. Results:A total of 32 673 valid questionnaires were collected. There were 12 135 doctors (37.14%) in China who had received comprehensive education and training of core competency in all dimensions. Among the dimensions of self-rated core competency of the surveyed doctors, there were 10 019 doctors (30.66%) with insufficient teaching ability and 438 (1.34%) with insufficient professional quality, and there was no significant difference between regions ( P>0.05). There were 2 385 (27.08%), 2 528 (27.55%) and 3 646 (24.82%) doctors in high-, middle- and low-income regions with insufficient lifelong learning ability, respectively. The proportion of doctors in middle- and high-income regions was higher than that in low-income ones ( P<0.05). There were 1 317 (15.57%), 1 290 (14.06%) and 2 719 (18.51%) doctors with insufficient knowledge and skills in high-, middle- and low-income areas, respectively. The proportion of doctors in low-income regions was higher than that in middle- and high-income regions ( P<0.05). The proportion of doctors who did not receive any kind of postgraduate medical education or continuing medical education in low-income regions was 7.33% (1 077 people), higher than that in high-income and middle- income ones ( P<0.05); 50.44% (4 442 people) of surveyed doctors in high-income regions believed that for standardized training of resident physicians (hereinafter referred to as residential training), the clinical teachers were " overworked to take this job", which was higher than that in middle- and low-income regions ( P<0.001); In middle-income regions, 46.16% (4 235 people) and 43.46% (3 987 people) believed that the salary residents and specialized physicians in standardized training (hereinafter referred to as specialized training) was too low, while 42.47% (3 897 people) and 30.44% (2 793 people) believed that the clinical practice opportunities of students were limited, both of which were higher than those in high-income and low-income regions ( P<0.001); 34.91% (5 128 people) of surveyed doctors in low-income regions believed that the investment was insufficient for training bases of residential training, 27.81% (4 085 people) of those held that training bases for specialized training were unevenly distributed, and 33.19% (4 876 people) of those held that continuing medical education was plagued by " insufficient promotion coverage, and insufficient opportunities for primary doctors", all of which being higher than those in high- and middle-income regions ( P<0.001). Conclusions:There is an obvious need to improve the core competence of doctors in the teaching ability dimension of tertiary public hospitals in China, especially in middle- and high-income regions for lifelong learning, and in low-income regions for knowledge and skills; There are differences between postgraduate medical education and continuing medical education systems in regions of different income levels in China. It is necessary to improve the competency oriented postgraduate medical education and continuing medical education systems.