From the view of medical professionals, this paper explored the standards of residents′ competency cultivation in Zhuhai using Delphi method. The research outcome that consisted of 53 factors and 6 dimensions was obtained after two rounds of expert consultation. There are 6 first-level indexes including professionnalism and body-mind quality, clinical practice skill, the competency of lifelong learning and self-improvement, humanistic medicine practice skill, medical knowledge, and the competency of promoting the medical system to develop. As well, there are 18 second-level indexes and 29 third-level indexes. The standards stated that the clinical prac-tice skill would not be the main part of residents′competency cultivation. Qualified residents should reach the na-tional standard of the clinical practice skill but also the other five indexes.

Objective To assess the disease severity and prognosis value by observing the kinetic change of serum procalcitonin(PCT)and PCT clearance rate(PCTc)in the patients with ventilator associated pneumonia (VAP). Methods A single-center prospective observational study was conducted. A total of 128 patients with VAP admitted into intensive care unit(ICU)of First Affiliated Hospital of Xinjiang Medical University from February 2012 to June 2014 were enrolled. The patients were divided into recovery group(n=88)and deterioration group(n=40) according to the therapeutic outcome. The acute physiology and chronic health evaluationⅡ(APACHEⅡ)scores were estimated within 24 hours when VAP was diagnosed. The serum PCT(PCT1,PCT5,PCT7,PCT9)and PCTc(PCTc5, PCTc7,PCTc9)were examined at 1,5,7 and 9 days after the VAP was diagnosed. The diagnostic and predictive performance of PCT,PCTc and APACHEⅡ scores were assessed by the receiver operating characteristic curve (ROC). Results APACHEⅡscores in recovery group were significantly lower than those in the deterioration group (14.49±5.30 vs. 18.90±5.30,t=-4.349,P=0.000). There was no significant difference in PCT level(μg/L)at 1 day after VAP was diagnosed between recovery group and deterioration group〔2.84(0.81,6.43)vs. 3.50(0.97,10.27), Z=-1.431,P=0.152〕. With prolonged treatment,PCT was gradually decreased in recovery group,while remained at higher level in deterioration group,which was significantly lowered at 5 days after VAP diagnosed in recovery group compared with that in the deterioration group〔1.28(0.65,3.13)vs. 2.39(0.78,9.35),Z=-2.012,P=0.044〕. PCTc maintained higher level in recovery group which was gradually increased with the improvement of the disease, and PCTc in deterioration group was lowered which was gradually decreased with the development of the disease. PCTc at 5,7,9 days in recovery group was significantly higher than that in deterioration group〔5 d:50.43(20.39,80.60)%vs. -56.68(-286.28,172.92)%, Z=-2.250, P=0.024;7 d:54.01(5.70,102.30)% vs. -76.91(-335.03, 181.21)%,Z=-2.561,P=0.010;9 d:63.88(25.93,101.80)%vs.-133.49(-547.20,280.16)%,Z=-3.133, P=0.002〕. The area under ROC curve(AUC)of PCT5,PCT7,PCT9 predicting the prognosis was 0.591,0.683, 0.746,respectively〔95% confidence interval(95%CI)was 0.456-0.726(P=0.161),0.557-0.808(P=0.005), 0.631-0.860(P=0.000)〕. When PCT9 was 5.65μg/L,the sensitivity of 95%and the specificity of 61%. The AUC of PCTc5,PCTc7 and PCTc9 was 0.648,0.685,0.729,respectively〔95%CI was 0.513-0.783(P=0.028),0.555-0.815(P=0.006),0.607-0.851(P=0.001)〕. When PCTc9 was 92%,the sensitivity was 98%and the specificity was 71%. The AUC of APACHEⅡscore was 0.693(95%CI 0.578-0.808,P=0.003). When APACHEⅡscore was 19.5,the sensitivity was 77%and the specificity was 58%. Conclusions The increased levels of PCT in patients with VAP were associated with the poor control of infection and may indicate the deterioration of VAP,it also can reflect the activity of lung infection in time. Keep observing the dynamic change of PCT and analyzing PCTc is more useful. The PCTc levels may provide evidence of disease progression and helpful in risk stratification in patients with VAP,and lower level of PCTc may accompany serious infection and predict poor prognosis.

Objective To investigate the clinical features and disease-causing mutations of familial hypomagnesaemia with hypercalciuria and nephrocalcinosis.Methods In February 2016,a 24 year old female patient with left kidney stone and nephrocalcinosis in bilateral kidneys was admitted to our hospital.One month prior to this admission,she had been treated by PCNL to remove the most part of left kidney stone in otherhospital.Mter admission,She was found hypomagnesaemia (serum magnesium 0.65 mmol/ L) and hypercalciuria (24h urine calcium 364.0 mg) but with normal renal function (serum creatinine 101.5μmol/L).And the remained part of left kidney stone was removed by flexible ureteroscope.As she was considered probably with an autosomal recessive FHHNC,an analysis of CLDN16 and CLDN19 gene mutations was performed using her and her parents'peripheral white blood cells.Results Mutation analysis revealed this patient had two heterozygous mutations in the CLDN16.One is an one-base deletion mutation in the 123th codon in exon 2:368delA.The other is a missense mutation in the 139th codon in exon 2:416C →T which resulted in an amino acid change Ala139Val.Her parents respectively had one of each heterozygous mutation.In the six months follow-up,an oral administration with hvdrochlorothiazide,potassium citrate,and calcium magesium supplements significantly reduced her hypomagnesaemia (serum magnesiun 1.0 mmol/L) and hypercalciuria (24-h urine calcium 156.0 mg),and no stone recurrence and aggravation of nephrocalcinosis and renal dysfunction occurred.Conclusions We diagnosed a patient with FHHNC who had a novel compound heterozygous mutation of CLDN16.This rare disease should be suspected if there are three constant clinical features of hypomagnesaemia,hypercalciuria and nephrocalcinosis,and verified with CLDN16 and CLDN19 gene test.Currently the option for treatment of FHHNC is symptomatic treatment until severe deterioration of renal function.The hydrochlorothiazide,potassium citrate,and calcium magesium supplements may have considerable effects on hypomagnesaemia and hypercalciuria.

Objective To study the potential effects of angiopoietin 1(Ang1) via adenovirus mediated gene transfer on ischemic heart disease in rabbits. Methods Forty-five male New Zealand white rabbits underwent high positioned double-ligation of the anterior descending left coronary artery, and were divided into three groups: Ang1 group (n=15) received direct myocardium injection of Ang1 recombinant adenovirus; DMEM group (n=15) and LacZ group (n=15) received only DMEM and LacZ recombinant adenovirus as controls respectively. The myocardial infarcted size was evaluated by N-BT macroscopic standing and the degree of angiogenesis was assessed by use of immunohistochemical analysis. The echocardiographic changes were measured on before operation and the 7 th, 14 th, and 28 th postoperative days. Results Animals in three groups had no significant difference in the percentage of infarction size of left ventricle at the 7 th, 14 th day and capillary density at the 7 th day. Animals in Ang1 group showed less infarcted size than DMEM group or LacZ group at the 28 th day and higher capillary density at the 14 th and the 28 th day. The results from echocardiographic measurements showed that animals in all three groups had no significant difference in the left ventricular systolic function before operation and at the 7 th , 14 th day, but the left ventricular systolic function in Ang1 group was better than that in DMEM group or LacZ group at the the 28 th day(P

Objective To construct lentivirus containing CXCR4 gene and transfect MCF-7 cells , and obtain CXCR4 high-expressing MCF-7 cells. Methods CXCR4 gene was amplified by RT-PCR to construct CXCR4/pSin-EF2, which was transfected into HEK293T cells with psPAX2 and pMD2G vector for lentivirus packing. Packaged lentivirus was used to transfect human breast cancer cells MCF-7, with empty lentivirus as control. CXCR4 mRNA and protein expression levels were detected by RT-PCR and Western blot before and after transfection. And flow cytometry was used to detecte cell surface CXCR4 expression. Results The recombinant plasmid CXCR4/pSin-EF2 was constructed successfully,identified by double digestion and sequencing, and transfected into HEK293T cells to obtain high-titer lentivirus. RT-PCR and Western blot confirmed that the expression of CXCR4 in MCF-7 cells increased significantly after CXCR4 lentivirus transfection. Flow cytometry results showed that the CXCR4 positive rate increased from 26.78% to 99.29%, while there is no significant difference in CXCR4 expression between vector-transfected MCF-7 cells and non-transfected MCF-7 cells. Conclusion CXCR4 lentivirus and the breast cancer cell line with high and stable expression of CXCR4 (MCF-7CXCR4) were successfully constructed.

OBJECTIVESTo investigate the association between susceptibility to aflatoxin B1(AFB1)-related hepatocellular carcinoma (HCC) and the polymorphism of detoxication gene GSTM1.

METHODSThe peripheral white blood cell DNA samples were obtained from all the subjects including 140 HCC cases and 536 controls from an AFB1 high risk area in Guangxi province. The GSTM1 polymorphism was detected using PCR technique.

RESULTS(1) The GSTM1-present was associated with a decreased HCC risk. The GSTM1-null was associated with an increased HCC risk [adjusted OR (95% CI)= 2.07 (1.20-3.57)]. (2) In the cohorts of both low/median and high exposure levels of AFB1, GSTM1-null genotype was associated with a conspicuous significantly increased risk for HCC [adjusted OR (95% CI) = 1.92 (0.92-4.00) and 1.80 (0.77-4.17)].

CONCLUSIONThe results suggest that genetic polymorphism of GSTM1 was susceptible to HCC and individuals who are GSTM1-null have an increased risk of developing HCC. There is evidence of interaction between GSTM1 polymorphism and AFB1 exposure, especially with low/median degrees of AFB1 exposure.

Aflatoxin B1 ; genetics ; Carcinoma, Hepatocellular ; genetics ; Genetic Predisposition to Disease ; Glutathione Transferase ; genetics ; Humans ; Liver Neoplasms ; genetics ; Polymorphism, Genetic

Objective To explore humor experience and its relationship with theory of mind in patients with schizophrenia. Methods sixty?one schizophrenic patients without treatment and sixty?three healthy subjects were assessed with the Humor Picture Test ( HPT) ,Humor Video Test ( HVT) and the Theory?of?Mind Picture?Se?quencing Task ( ToM?PST) . Results Compared with healthy subject in HPT,schizophrenic patients showed sig?nificantly higher non?humor picture rating score (24.41 ± 8.82 vs 28.41 ± 11.56, P<0.05),and less humor picture rating score (45.65 ± 11.49 vs 34.41 ± 13.06, P<0.05). Compared with healthy subject in HVT,schizophrenic patients also showed significantly less humor video rating score (3.56 ± 0.57 vs 2.46 ± 0.79, P<0.01) and the number of standard humorous moments (3.68 ± 1.19 vs 2.42 ± 1.40, P<0.01) and the sensitivity of standard hu?morous moments?d’(humor) score (1.11 ± 0.46 vs 0.47 ± 0.42, P<0.01). Schizophrenic patients had significant?ly less total score (39.89 ± 12.33 vs 58.76 ± 0.64, P<0.01) of ToM?PST compared to normal control. Correlation analysis showed a negative correlation between d’ ( humor) score and the Positive and Negative Syndrome Scale ( PANSS) total score ( r=-0.380, P<0.01) for the patients. There was significantly negative correlation between non?humor picture rating score and ToM?PST total score ( r=-0.316, P<0.05) ,and positive correlation between d’ (humor) score and ToM?PST total score ( r=0.400, P<0.01) in schizophrenic patient. After controlling for the PANSS total score,the correlation between d’(humor) score and ToM?PST total score remained significant. Conclusion Schizophrenic patients have poor humor experience,which is related to the impairments of theory of mind.Humor experience deficit may share a common neuropsychological base with the impairment of theory of mind.

OBJECTIVETo obtain a specific antagonist of CXCR4, SDF-1P2G54 by mutating SDF-1 second proline (P) into glycin (G) and removing the α-helix of its C-terminal.

METHODSSDF-1p2g54 gene amplified by PCR was inserted into the vector pET-30a (+) and transformed into Escherichia coli (E. coli) strain BL21. After IPTG induction of E. coli, the expressed recombinant protein was purified with nickel-affinity chromatography column under denaturing conditions and refolded with gradient dilution and ultra-filtration. The chemotactic effect of SDF-1P2G54 on Jurkat cells and its antagonistic effect against SDF-1 were determined by transwell assay; flow cytometry was used to assay the ability of SDF-1P2G54 to induce calcium influx and CXCR4 internalization in MOLT4 cells.

RESULTSThe recombinant protein SDF-1P2G54 completely lost the functions to activate CXCR4 or to induce transmembrane migration of Jurkat cells and calcium influx in MOLT4 cells, but maintained a high affinity to CXCR4. SDF-1P2G54 effectively inhibited the chemotactic effect of wild-type SDF-1 to Jurkat cells, and induced rapid CXCR4 internalization in MOLT4 cells.

CONCLUSIONSDF-1P2G54 is a new antagonist of CXCR4 with a potential value as an effective inhibitor of HIV-1 infection, cancer metastasis or other major diseases.

Cell Line ; Chemokines, CXC ; biosynthesis ; genetics ; Escherichia coli ; genetics ; metabolism ; Humans ; Mutant Proteins ; biosynthesis ; genetics ; Receptors, CXCR4 ; antagonists & inhibitors ; Recombinant Proteins ; biosynthesis ; genetics

OBJECTIVETo study the association between susceptibility to aflatoxin B1 (AFB1)-related hepatocellular carcinoma(HCC) and the null genotypes of detoxication gene gstM1 and gstT1.

METHODSPeripheral blood white blood cells DNA samples were obtained from all the subjects including 140 HCC cases and 536 controls from AFB1 high risk area Guangxi. gstM1 and gstT1 polymorphisms were detected by polymerase chain reaction technique.

RESULTS(1) gstM1- and gstT1-present were associated with decreasing risk of HCC. gstM1- and gstT1-null were associated with the increasing risk of HCC [adjusted OR (95 % CI) = 2.07 (1.20-3.57) and 1.44 (0.85-2.45), respectively]; (2) The appearance of both gstM1- and gstT1-null genotypes were more susceptible to HCC than either one of them(adjusted OR and 95% CI are 2.43 and (1.19-4.97); (3) From low/median to high level of AFB1 exposure, both gstM1- and gstTl-null genotypes were associated with significantly conspicuous increasing risk of HCC [adjusted OR(95% CI) = 12.76(5.38-30.24) and 7.82(3.61-16.90) respectively].

CONCLUSIONIt was suggested that: genetic polymorphisms of gstM1 and gstT1 were susceptible to HCC; individuals who were gstM1- or gstT1-null would have an increasing risk of developing HCC while individuals with both nulls were more susceptible. There was evidence of interaction between gstM1- and gstT1-null and the level of AFB1 exposure which was associated with the increasing risk of HCC.

Adult ; Aflatoxin B1 ; toxicity ; Aged ; Alleles ; Asian Continental Ancestry Group ; genetics ; Carcinoma, Hepatocellular ; complications ; etiology ; genetics ; Case-Control Studies ; China ; Environmental Exposure ; adverse effects ; Female ; Genetic Predisposition to Disease ; Genotype ; Glutathione Transferase ; genetics ; Hepatitis B ; complications ; Humans ; Liver Neoplasms ; complications ; etiology ; genetics ; Male ; Middle Aged ; Polymorphism, Genetic

Objective To explore the best time point for the ipsilateral hepatocellular apoptosis and the contralateraI hepatic hypertrophy after selective portal vein embolization(SPVE)in rabbit.Methods In a randomized study design,forty rabbits were divided into 5 groups with 8 rabbits per-group,including one as the control and the other 4 were treated with SPVE during open surgery.The rabbits were killed postoperatively,in 3,7,14,21 days respectively after the embolization.The hepatic lobes volume,the ipsilateral hepatocellular necrosis rates and apoptosis index,and liver functions were determined as well. Results In the treatment groups,the average amount of the right liver volumes decreased from 46.4 cm~3 preoperatively to 46.0,44.4,42.0,39.7 cm~3 in groups of 3,7,14,21 days postoperatively;meanwhile,the left liver volumes increased from 54.0 cm~3 preoperatively to 54.5,56.3,61.7,63.9 cm~3 respectively during 3, 7,14,21 days after the procedures.The rates of future remaining live volumes(FRLV)increased from 53.8% preoperatively to 54.2%,55.9%,59.0%,61.0% at 3,7,14,21 days postoperatively.The apoptosis indexes of hepatocells from group A to E were 8.1%,12.2%,19.4%,20.1%,14.2% respectively.Conclusions SPVE leads to atrophy of the ipsilateral hepatic lobe and hypertrophy of contralateral lobe,indicating that hepatocytes undergone apoptosis,rather than necrosis.The time point is 7 to 14 days.