Diagnosis, Differential ; Humans ; Medicine, Chinese Traditional

Scientific and rigorous management system is the prerequisite for specialists to standardize training.In order to cultivate and promote the actual clinical ability,the First Clinical College of Harbin Medical University establish a scientific,reasonable,standard and strict evaluation system in specialist training - the Mini-CEX.This system was employed to test on completion of a course and meet the current medical development of specialist training and evaluation mode.

Comprehensively improving the quality of postgraduate education is the main theme of reform and development of postgraduate education. A series of effective measures was taken in the First Affiliated Hospital of Harbin Medical University according to the various aspects of postgraduate education, implementing the whole quality control, enhancing the quality of postgraduate education, in order to accommodate the new situation of postgraduate education.

Objective:To assess the safety and efficacy of riboflavin/ultraviolet-A-induced accelerated epithelium-off corneal collagen cross-linking (CXL) for teenagers with keratoconus.Methods:In this case series study, 25 eyes of 18 patients with primary keratoconus who underwent riboflavin/ultraviolet-A-induced accelerated epithelium-off CXL in Zhengzhou Second People's Hospital from January 2017 to February 2018 were included, and the average age of patients was (14.4±1.3) years.The uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), spherical equivalent (SE), maximum keratometry reading (K max), thinnest corneal thickness (TCT), posterior corneal elevation (PCE) and endothelial cell density (ECD) were measured before and after CXL.The patients were followed up for one year.The complications and adverse reactions were recorded.The study adhered to the Declaration of Helsinki and was approved by an Ethics Committee of Zhengzhou Second People's Hospital (No.KY2017002). Written informed consent was obtained from each patient and their guardian prior to the surgery. Results:The mean UCVA (LogMAR) was 0.96±0.35 at baseline, which was significantly improved to 0.84±0.33 at 1 year postoperatively ( t=-5.765, P<0.01). The mean BCVA (LogMAR) was 0.45±0.22 preoperatively, which was significantly improved to 0.34±0.26 at 1 year postoperatively ( t=-4.843, P<0.01). The mean SE was (8.66±5.11)D at baseline, which was significantly higher than (8.07±5.21)D at 1 year postoperatively ( t=-3.253, P=0.003). The K max was reduced from (58.58±9.07)D preoperatively to (56.25±9.98)D at 1 year postoperatively, with significant difference between the two time points ( t=-4.357, P<0.01). The K max was reduced more than 1 D in 17 eyes (68%), was stable in 6 eyes(24%), and was increased more than 1 D in 2 eyes (8%). The TCT was reduced from (485.0±32.5)μm at baseline to (475.3±35.5)μm at 1 year postoperatively, with significant difference between the two time points ( t=-4.266, P<0.01). The differences of PCE and ECD between preoperative and postoperative 1 year were not statistically significant ( t=1.023, P=0.316; t=-1.424, P=0.167). There was one eye suffering peripheral sterile corneal infiltrate 2 days postoperatively, and favorable prognosis was achieved after the topical steroids application.No complication was encountered in other subjects. Conclusions:Riboflavin/ultraviolet-A-induced accelerated epithelium-off CXL is safe and effective in teenagers with keratoconus during the 1-year follow-up.The long-term effects need further observation.

The abnormality of ubiquitin proteasome pathway is an important factor leading to the imbalance of protein homeostasis. In this process, the deubiquitinase responsible for removing the ubiquitin chain of protein substrate is very important. Its abnormal activity or expression can cause the functional changes of key oncogenic/tumor suppressor proteins, which directly or indirectly lead to the occurrence, development and malignant evolution of tumors. Based on this, the discovery and research of small molecule inhibitors targeting deubiquitinases have become a hot field of anti-tumor candidate drugs. This review will focus on the regulatory effect and mechanism of ubiquitin proteasome pathway, especially deubiquitinase on tumor, introduce the application of deubiquitinase small molecule inhibitors in tumor treatment, and discuss the research status and latest progress of small molecule inhibitors, so as to provide ideas for the research of new anti-tumor strategies based on deubiquitinase.

OBJECTIVETo observe the inhibiting effect of acupuncture on blood lipid, myocardial hypertrophy and fibrosis in mice with hyperlipemia, and explore its possible action mechanism.

METHODSTen inbred mice (C57) were applied. Forty ApoE(-/-) mice who removed gene of apolipoprotein E were randomly divided into a control group, a non-acupoint group, an acupoint group and a medication group. The points 0. 5 cm and 1 cm next to the end of mice tail were respectively punctured in the non-acupoint group; "Neiguan" (PC 6) and "Fenglong" (ST 40) were punctured in the acupoint group; intragastric administration of simvastatin was applied in the medication group. After 8 weeks of treatment, the changes of total cholesterol (TC) and ratio of heart to body mass in each group were measured; changes of cardiac muscle fiber and ventricular wall thickness were observed; enzyme linked immunosorbent assay (ELISA) was used to test the level of angiotensin II (Ang I ) in plasma, and western blotting method was used to test protein content of angiotensin II type 1 receptor (AT1R) and endothelin-1 type A receptor (ETAR) in the heart.

RESULTSAfter 8 weeks of intervention, compared with the control group, rising range of blood lipid was obviously decreased (P<0.01) in the acupoint group and medication group, ratio of P<0.01), myocardial heart to body mass was decreased (P<0.05), thickness of ventricular wall was reduced (P fibrosis was relieved, levels of Ang II and ET-1 in plasma were decreased (P<0. 05), content of NO was increased (P<0. 05), and protein content of AT1R and ETAR was decreased in the heart (P<0. 05).

CONCLUSION40) could inhibit the rising of blood lipid in ApoE(-/-) mice, lower the levels of Ang II and ET-1 in peripheral blood, increase the content of NO and inhibit the expression of AT1R and ETAR in heart tissue, which could relieve myocardial hypertrophy and fibrosis to play a protective role on heart.

Acupuncture Points ; Acupuncture Therapy ; Angiotensin II ; metabolism ; Animals ; Blood Pressure ; Disease Models, Animal ; Heart ; physiopathology ; Heart Diseases ; etiology ; metabolism ; physiopathology ; prevention & control ; Humans ; Hyperlipidemias ; complications ; physiopathology ; therapy ; Male ; Mice ; Mice, Inbred C57BL ; Myocardium ; metabolism

OBJECTIVETo compare the difference in the efficacy on thoracic facet joint disorder between the combined therapy of electroacupuncture and manual reduction and the simple manual reduction.

METHODSOne hundred and sixty patients were randomized into an electroacupuncture and manual manipulation group (group A) and a simple manual manipulation group (group B), 80 cases in each one. In the group A, Ashi points and three pairs of Jiaji (EX-B 2) bilateral to the painful sites were selected. The perpendicular puncture was used at Ashi points, the oblique puncture was used at Jiaji (EX-B 2) and connected with electric stimulation for 20 min, additionally, the corresponding manual reduction was adopted at the sites of facet joint disorder. In the group B, the simple manual reduction was applied to the affected sites. Acupuncture was given once every day, the manual reduction was applied once every 10 days. The treatment of 10 days made one session. The efficacy was analyzed statistically at the end of two sessions of treatment. Before and after treatment, McGill pain scale was adopted for the value statistical analysis. PRI score, VAS score and PPI score of patients were calculated before and after treatment and compared in the two groups. The efficacy was compared between the two groups.

RESULTSThe curative rate was 56.3% (45/80) in the group A, which was better than 18.8% (15/80) in the group B (P< 0.01). The total effective rate was 95.0% (76/80) in the group A, which was better than 76.3% (61/80) in the group B (P<0.01). The scores of PRI, VAS and PPI after treatment were all improved significantly in the two groups (all P<0.05), in which, the results in the group A were better than those in the group B (PRI: 4.00 +/- 0.97 vs 5.44 +/- 1.16, VAS: 3.29 +/- 0.72 vs 3.87 +/- 0.81, PPI: 1.07 +/- 0.74 vs 1.64 +/- 0.90, all P<0.05).

CONCLUSIONThe combined therapy of electroacupuncture and manual manipulation achieves the superior efficacy on thoracic facet joint disorder as compared with the simple manual manipulation. The combined therapy relieves the symptoms of thoracic facet joint disorder and reduces the severity of disorder.

Acupuncture Points ; Acupuncture Therapy ; Adult ; Aged ; Electroacupuncture ; Female ; Humans ; Male ; Middle Aged ; Thoracic Diseases ; therapy

Objective To evaluate the occupational competency of clinical post-graduate students by the 360-degree feedback system.Methods The occupational competencies of the 102 clinical post-graduate students were evaluated by department directors, teachers, the superior band taught physicians, peers, post-graduate themselves using a self-designed questionnaire.The evaluation content of professional competence included 12 core elements, such as medical knowledge, clinical skills, and professional ethics and so on.EpiData 3.02 was used to establish the database, SPSS 19.0 software was used to carry on the statistical analysis, and the statistical analysis method was mainly for the descriptive statistics analysis, the single factor analysis of variance.Results 5 kinds of evaluation subjects were statistically significant (P＜0.05) in medical knowledge, clinical skills, clinical thinking ability, lifelong learning ability, professional ethics, team cooperation ability, self cognition and management ability and total score.Students themselves and their peers scored high in various aspects, teaching superior doctors rated middle and the director and mentor gave low grade in all aspects and the scores rated by the department directors and teachers were lower than students themselves(P=0.003, P=0.047).Conclusion The 360-degree evaluation system can comprehensively and objectively evaluate the clinical post-graduate students' occupational competency and offer beneficial assistant to clinic and practice.

Objective To evaluate the relationship between Henoch-Schonlein purpura (HSP) accompanying renal impairment and helicobater pylori(Hp) infection.Methods This study consisted of 304 patients with HSP.The patients were divided into 2 groups(group A and group B) based on Hp infection or not(91 cases in group A and 213 cases in group B).Compared with the rates of accompanying renal impairment in 2 groups.And observed the recovery from renal impairment between the patients who were turned into negative(group C)and patients still were positive after the anti-Hp therapy(group D).Numeration data were analyzed by ?2 test.Results Group A which was with Hp infected,the accompanying renal impairment ratio was 65.9%.Group B which was without Hp infected,the ratio was 35.2%.There was significant difference between 2 groups(?2=24.378 P

Objective To learn the prevalence and trends of Brucella disease in Ningxia, in order to provide scientific basis for effective control of the disease. Methods Data of Brucella cases reported through city network from 2004 to 2009 in Yinchuan city, Shizuishan city, Wuzhong city, Guyuan city and Zhongwei city of Ningxia were reviewed and retrospectively analyzed. The data included demographic characteristics, treatment conditions and medical history so on related information. Analytical indicators include reported incidence;with patients' gender, age, regional distribution, urban and rural distribution;become chronic and associated factors;distribution of the cases reporting unit and so on. Results From 2004 to 2009, Ningxia had reported 349 cases of Brucellosis, no deaths, the annual incidence rates reported were 0.017/10 million, 0.543/10 million, 0.151/101 (295/54);The proportion of 34- to 40-year-old age group was higher than other age groups(27.5%, 96/349);Occupational distribution of patients was mainly farmers and herdsmen(70.2% ,245/349), in regional distribution of the patients, the highest percentage was Wuzhong city(61.9%,216/349), followed by Yinchuan city(22.9%,80/349);The proportion of patients in rural areas(97.4% ,340/349) was higher than urban(2.6% ,9/349);the proportion of patients converted to chronic was 11.2% (39/349). With age, the chance of patients converted to chronic was in a decreasing trend(odds ratio was 0.966);cases reported by Centre for Disease Control and Prevention accounted for 74.8%(261/349), by hospital accounted for 25.2%(88/349). Conclusions The reported incidence of Brucellosis in Ningxia is in a rapid upward trend year by year, the patients is mainly young men, the rate of converted to chronic is higher and the ability of hospital in founding and reporting of the cases is weaker.Comprehensive measures should be taken to increase funding, strengthen monitoring, and continuously improve the level of awareness and diagnosis of medical personnel for further strengthen the prevention and control of Brucellosis.