Objective To observe the changes of CD_(28) and soluble CD_(27)(sCD_(27)) among HIV-1-infected Chinese patients receiving highly active antiretroviral therapy(HAART) and to explore their clinical significance.Methods The HIV-RNA viral load(VL) and cell counts of CD_3~+CD_4~+,CD_3~+CD_8~+,CD_4~+CD_(45)RA~+CD_(62)L~+,CD_4~+CD_(28)~+,CD_8~+CD_(28)~+ and the content of sCD_(27) were determined in 28 cases of HIV-1-infected patients at the baseline and 12,24 and 48 weeks respectively after the treatment with three drug regimens based on two nucleoside reverse transcriptase inhibitors(NRTIs) and an Non-NRTI(NNRTI) for 1 year.Results The average of HIV-RNA VL before the treatment was 5.25 logs,and decreased to 3.30,1.92 and 1.74 logs after the treatment for 12,24 and 48 weeks respectively.The cell counts of CD_3~+CD_4~+,CD_3~+CD_8~+,CD_4~+CD_(45)RA~+62L~+,CD_4~+CD_(28)~+,CD_8~+CD_(28)~+ before the treatment were(236?85),(917?345),(58?15),(175?63) and(285?87) cells/?l,and changed into(327?112),(803?343),(114?25),(286?132) and(387?201) cells/?l after the treatment for 48 weeks respectively.The content of sCD_(27) decreased from(475?123) U/ml to(174?77) U/ml after the treatment for 48 weeks.The HIV RNA VL had significantly negative correlation with cell counts of CD_4~+T,CD_4~+CD_(28)~+ and CD_8~+CD_(28)~+,and there was positive correlation between HIV RNA VL and the level of sCD_(27).Conclusion The immune reconstitution and activation depend on the efficacy of antiretroviral therapy.The HIV RNA VL and cell counts of CD_4~+T are the representative parameters of immunologic and viral responses of HAART.The cell counts of CD_4~+CD_(28)~+ and CD_8~+CD_(28)~+ and their percentages show concomitant changes with viral load,and play an effective role in the progression and prognosis of AIDS.The level of sCD_(27) is positively correlated with HIV RNA VL and negatively with counts of CD_4~+T cell.The detection of sCD_(27) by enzyme linked immunosorbent assay(ELISA),which is much more convenient and cheaper than RT-PCR and flow cytometry,may serve as an important parameter to judge the pathogenetic condition of HIV-1-infected patients and to examine the therapeutic effects of HAART in the medical resource-limited area.

Objective To investigate the adjustment effect of microRNA-155 on CD4+CD25+ regulative T cell (Treg) in peripheral blood of sepsis patients,and to elucidate the role of miR-155 in the pathogenesis of sepsis.Methods A retrospective study was corducted.60 sepsis patients (mild n =20,moderate n=20,and severe n =20)from emergency room or intensive care unit (ICU) of the Fourth Hospital of Jiangsu University were enrolled.20 healthy volunteers were enrolled as controls.Real-time fluorescent quantitation polymerase chain reaction (qRT-PCR) was used to detect the levels of miR-155 and Foxp3 mRNA expressions in peripheral blood.CD4+CD25+ Treg cells in peripheral blood were identified by flow cytometry.Peripheral interleukin-10 (IL-10) was measured by enzyme-linked immunosorbent assay (ELISA).Results The expressions of miR-155,Treg,Foxp3 mRNA and the level of IL-10were higher in the patients with sepsis than those in healthy control group [Treg:(2.89 ± 1.13)％ vs.(2.32 ± 0.91)％,t=10.540,P=0.002; miR-155:1.19 ±0.48 vs.0.80 ±0.33,t=8.605,P=0.006; Foxp3 mRNA:0.18 ±0.08 vs.0.13 ±0.03,t=6.862,P=0.008; IL-10 (ng/L):56.89 ± 17.28 vs.33.24 ± 11.93,t=12.742,P=0.001].These variables were elevated gradually with the elevation of acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ)score.The expressions of Treg,miR-155,Foxp3 mRNA and the level of IL-10 were (3.05 ± 1.21)％,1.36 ± 0.79,0.21 ±0.10,(62.82 ±21.38) ng/L in severe sepsis group; they were (2.86 ±0.88)％,1.25 ±0.56,0.17 ±0.08,(56.38 ± 19.65) ng/L in moderate group; they were (2.61 ± 0.87)％,0.94 ± 0.52,0.15 ± 0.05,(45.43 ± 14.40) ng/L in mild group.The values showed significant statistical difference among the mild,moderate and severe sepsis groups (all P＜0.01).Above values were significandy higher in non-survival group than those in survival group [Treg:(3.46 ±1.53)％ vs.(2.85 ± 1.03)％,t=14.250,P=0.005; miR-155:1.41 ±0.85 vs.1.16 ±0.76,t=11.875,P=0.006;Foxp3 mRNA:0.24 ± 0.11 vs.0.17 ± 0.09,t=8.795,P=0.001 ; IL-10 (ng/L):65.47 ± 23.58 vs.51.70 ± 16.86,t=16.313,P=0.001].The expression of miR-155 was positively correlated with the expression of CD4+CD25+ Treg and Foxp3 mRNA (r1=0.635,P1=0.007; r2=0.671,P2=0.005).Conclusion The result of this study suggest that miR-155 is involved in the cell proliferation regulation of CD4 +CD25 + Treg cells,and play some role in the immunological dissonance in sepsis.

Objective To evaluate the effectiveness of TR Band hemostat in trans-radial coronary intervention patients.Methods The randomized controlled trials (RCTs) on the application of TR Band hemostat in trans-radial coronary intervention patients were collected through the databases such as the Cochrane Library,OVID,PubMed,CBM,VIP and Wanfang Data.The quality of studies was critically appraised and data were extracted by two reviewers independently,and Meta-analysis was conducted for the included studies.Results Five RCTs involving 5 028 patients were included.Meta-analysis showed that the application of TR Band hemostat in trans-radial coronary intervention patients could shorten the time of hemostasis by compression,reduce the incidence rate of skin lesions,improve the postoperative patients with comfort,but the efficacy was not significant in puncture site bleeding,hematoma and incidence of radial artery occlusion (RAO).Conclusions The application of TR Band hemostat in trans-radial coronary intervention patients can significantly decrease the incidence of oppression hemostasis time and reduce the incidence rate of skin lesions,improve the postoperative patients with comfort.It is worth being popularized.

Three weeks’ training, visiting and demonstrating classes in Michigan State University gave us an opportunity to understand the education system, the teaching characteristics and the “students centered”teaching principle of USA. Some reasonable teaching methods were applied in the class which may embody the student-oriented teaching aim and develop the students’ subjective initiative. The teaching effect showed that most students were fond of the teaching strategies and they also did good job in final tests.

The purpose of education is to cultivate talents who can master the ability of self-learning lifelong. With the rapid development of multimedia technology, the knowledge carrier represented by micro curriculum plays a very important role in improving students' self-learning ability. In traditional Chinese medicine college, due to the short of time, weak learning foundation, the ability of self-learning is hard to improve in the modern medical courses such as biochemistry. This is not conducive to the cultivation of modern talents of Chinese medicine. In this paper, we chose the biochemistry teaching in TCM college as an example, and discuss how we can make the application of micro courses reasonably in the teaching process. This study was regarded as a starting to improve the students' self-learning ability effectively.

Objective To investigate the clinicopathological characteristics and treatment of C1q nephropathy in children.Methods Data of 23 C1q nephropathy cases in Nanjing Children's Hospital during recent eight years were retrospectively reviewed. Results The incidence of C1q nephropathy was 4.78％ in primary glomerulonephritis proven by biopsy.Among 23 patients,15 were boys and 8 were girls.The mean age at onset was (5.0±3.4) years old with a range of 0.9-12.4 years.The clinical manifestations included nephrotic syndrome(NS) in 18 cases (78.3％),nephrotic-range proteinuria in 4 cases(17.4％) and microhematuria in 1 case.Two patients with NS and one patient with nephrotic-range proteinuria also presented microhematuria.One patient with NS who received oral herbal medicine for two weeks developed acute renal insufficiency at the same time of diagnosis.Three cases had a family history of kidney disease,among them two patients(presented nephrotic range proteinuria) were siblings,their father had proteinuria as well,and routine genetic examination confirmed familial Denys-Drash syndrome in association with C1q nephropathy.One NS patient's sister had nephrotic-range proteinuria too,but renal biopsy was not performed.No patient had hypertension.None of the patients had low C3 or C4 levels,and serological markers of systemic lupus erythematosus were absent.Light microscopy showedminimalchangedisease (MCD)in13cases (56.5％), mesangialproliferative glomerulonephritis(MsPGN) in 6(26.1％) and focal segmental glomerulosclerosis(FSGS) in 4(17.4％).Immunofluorescence displayed C1q co-deposits of IgG(78.3％),IgM(78.3％),IgA (34.8％) and C3 (47.8％),and a full-house pattern was found in 6 patients (26.1％).Electron microscopy revealed 4 out of 19 had mesangial deposits,except for 4 patients whose glomerulus could not be found.Children with either NS(18 cases) or nephrotic-range proteinuria(2 cases)received prednisone,among them,15 were steroid-resistant,4 were steroid-dependent,only 1 was steroid-sensitive.Those with steroid-resistant(15 cases) or steroid-dependent(3 cases) received further immunosuppression with cyclophosphamide(CTX) or cyclosporine A (CsA).One NS case of steroid-dependent received prednisone re-induction therapy.The siblings associated with DenysDrash syndrome and one case presented microhematuria were commenced on angiotensin-converting enzyme inhibitor(ACEI).Of the 19 patients with sufficient follow-up date,15 cases (78.9％)achieved complete remission,2 cases(10.5％) achieved partial remission,and 2 cases (10.5％) were ineffective.Median follow-up was 15 months.Remission of the NS occurred in 94.4％ (17/18)while nephrotic-range proteinuria was 50.0％(2/4).Remission of MCD was 100.0％,MsPGN was 83.4％(5/6),but FSGS was only 50.0％(2/4).Conclusions C1q nephropathy is rare,and often manifests as steroid-resistant or steroid-dependent NS and nephrotic-range proteinuria.The most common histological feature is MCD,and some as MsPGN or FSGS.A combination of prednisone and immunosuppressive agent is always effective for MCD and MsPGN,but FSGS always has a poor response.

Objective: To construct an index system for evaluating the effectiveness of dynamic pricing adjustment of medical services, for the purpose of providing a set of evaluation tools for price regulatory authorities to evaluate the effectiveness of pricing adjustment of medical services, to keep track of pricing trends, to implement dynamic monitoring and to guide decision-making. Methods: Oriented to public hospitals in Guangdong province, literature analysis and Delphi method were used to construct the index system for evaluating the effectiveness of dynamic adjustment of medical service price. Descriptive analysis, consistency test and index importance evaluation were applied to statistical analysis. Results: Thirty-two experts evaluated the importance of 41 alternative indicators. The index system for evaluating the effectiveness of dynamic adjustment of medical service price was finally constructed, including six structural indicators, six process indicators and six result indicators. Conclusions Experts are representative, authoritative and well-coordinated. The consultation results are reliable. The evaluation index system has high reliability and validity, and can be used to objectively evaluate the dynamic adjustment effect of medical service price.

Objective:To develop an evaluation index system for dynamic adjustment effect of medical service prices in public hospitals, as a set of quantitative evaluation tools for management departments to keep track of the trend in time, implement dynamic monitoring and guide decision-making.Methods:Based on the evaluation system of price adjustment effect, through the importance assessment of expert consultation and multiple index percentile method, the scoring criteria were formulated and the empirical analysis was carried out.Results:The total scores of hospital A and hospital B were 71.31 and 77.94 respectively, classified as " average" . The evaluation could basically reflect the effect of dynamic adjustment of medical service price in public hospitals.Conclusions:The evaluation has the functions of displaying differences, witnessing achievements and tracing causes. It can be used to evaluate the effect of dynamic adjustment of regional prices, to assist the regulators to keep track of trends, monitor dynamically and guide decision-making in time, and be used by hospitals in self-evaluation to find problems, improve their own operation and promote the healthy development of hospitals.

Objective To investigate the correlations of serum Apelin-13 and fatty acid binding protein 4(FABP4)levels with metabolic and bone metabolic indicators in postmenopausal women with different bone mass.Methods A total of 145 postmenopausal women were selected as subjects and divided into three groups based on bone mineral density(BMD)test results:normal bone mass group(49 cases),osteopenia(ON)group(51 cases),and osteoporosis(OP)group(45 cases).Se-rum Apelin-13,FABP4 levels,bone metabolic indicators,and biochemical indicators were measured and compared among the three groups.Spearman correlation analysis was used to analyze the correla-tions of Apelin-13,FABP4,and other indicators with BMD.Multivariate Logistic regression analysis was performed to analyze the risk factors for OP,and the receiver operating characteristic(ROC)curve was plotted to analyze the predictive value of serum Apelin-13 for postmenopausal osteoporosis(PMOP).Results The serum Apelin-13 level in the OP group was lower than that in the ON group and the normal bone mass group(P＜0.05).No significant difference in serum FABP4 levels was found among the three groups(P＞0.05).The levels of serum parathyroid hormone(PTH),alkaline phosphatase(ALP),type Ⅰ procollagen amino-terminal propeptide(PⅠNP),type Ⅰ collagen cross-linked C-terminal peptide(CTX Ⅰ),and bone-specific alkaline phosphatase(BALP)in the OP group were higher than those in the ON group and the normal bone mass group(P＜0.05).Lumbar post-menopause BMD was positively correlated with serum Apelin-13 levels(P＜0.05),but had no cor-relation with serum FABP4 levels(P＞0.05).Lumbar BMD was negatively correlated with serum PTH,ALP,P Ⅰ NP,CTX Ⅰ,BALP,and age(P＜0.05),but positively correlated with body weight,body mass index,T-score,fasting insulin,and insulin resistance index(P＜0.05).Multi-variate Logistic regression analysis showed that serum Apelin-13,PTH,ALP,P Ⅰ NP,CTX Ⅰ,and BALP levels were independent factors influencing the occurrence of OP in postmenopausal women(P＜0.05).ROC curve results showed that the optimal cut-off value of serum Apelin-13 for predic-ting PMOP was 18.51 pg/mL,with an area under the curve of 0.716,a sensitivity of 70.0％,and a specificity of 64.4％.Conclusion Apelin-13 is lowly expressed in the serum of PMOP patients,and its expression level is closely related to lumbar BMD,which may serve as an early screening in-dicator and potential therapeutic target for PMOP.

Objective To investigate the correlations of serum Apelin-13 and fatty acid binding protein 4(FABP4)levels with metabolic and bone metabolic indicators in postmenopausal women with different bone mass.Methods A total of 145 postmenopausal women were selected as subjects and divided into three groups based on bone mineral density(BMD)test results:normal bone mass group(49 cases),osteopenia(ON)group(51 cases),and osteoporosis(OP)group(45 cases).Se-rum Apelin-13,FABP4 levels,bone metabolic indicators,and biochemical indicators were measured and compared among the three groups.Spearman correlation analysis was used to analyze the correla-tions of Apelin-13,FABP4,and other indicators with BMD.Multivariate Logistic regression analysis was performed to analyze the risk factors for OP,and the receiver operating characteristic(ROC)curve was plotted to analyze the predictive value of serum Apelin-13 for postmenopausal osteoporosis(PMOP).Results The serum Apelin-13 level in the OP group was lower than that in the ON group and the normal bone mass group(P＜0.05).No significant difference in serum FABP4 levels was found among the three groups(P＞0.05).The levels of serum parathyroid hormone(PTH),alkaline phosphatase(ALP),type Ⅰ procollagen amino-terminal propeptide(PⅠNP),type Ⅰ collagen cross-linked C-terminal peptide(CTX Ⅰ),and bone-specific alkaline phosphatase(BALP)in the OP group were higher than those in the ON group and the normal bone mass group(P＜0.05).Lumbar post-menopause BMD was positively correlated with serum Apelin-13 levels(P＜0.05),but had no cor-relation with serum FABP4 levels(P＞0.05).Lumbar BMD was negatively correlated with serum PTH,ALP,P Ⅰ NP,CTX Ⅰ,BALP,and age(P＜0.05),but positively correlated with body weight,body mass index,T-score,fasting insulin,and insulin resistance index(P＜0.05).Multi-variate Logistic regression analysis showed that serum Apelin-13,PTH,ALP,P Ⅰ NP,CTX Ⅰ,and BALP levels were independent factors influencing the occurrence of OP in postmenopausal women(P＜0.05).ROC curve results showed that the optimal cut-off value of serum Apelin-13 for predic-ting PMOP was 18.51 pg/mL,with an area under the curve of 0.716,a sensitivity of 70.0％,and a specificity of 64.4％.Conclusion Apelin-13 is lowly expressed in the serum of PMOP patients,and its expression level is closely related to lumbar BMD,which may serve as an early screening in-dicator and potential therapeutic target for PMOP.