Objective To observe and evaluate the effect of ultrasound guided percutaneous ethanol injection for hyperparathyroidism secondary to chronic renal failure. Methods Fifty-three patients with secondary hyperparathyroidism in Nanjing General Hospital Military Command from January 2011 to May 2013 were treated by percutaneous ethanol injection. The echogenicity, size and blood supply of parathyroid glands were observed by color Doppler ultrasound before and after treatment. Parathyroid hormone (PTH) and volumes of parathyroid glands were analyzed and compared with non-paired t test. Results Before treatment, the parathyroid gland volume was (5.28±0.84) cm3. The enlarged parathyroid glands had homogeneous hypoechogenicity and abundant blood supply, and the PTH was (1041.6±37.1) ng/L. After treatment, the size of solitary parathyroid gland was (3.93±0.67) cm3 which did not change significantly compared with that before treatment. The echogenicity of parathyroid glands enhanced and blood supply decreased after injection ethanol into solitary parathyroid. PTH [(509.2±27.6) ng/L] decreased obviously (t=3.792, P < 0.05). Conclusion Color Doppler ultrasound guided percutaneous injection of ethanol has an important role in the treating of secondary hyperparathyroidism and the curative effect can be observed timely.

Objective To establish a assessment system for comprehensive clinical competency of general practice residents.Methods An assessment system for comprehensive clinical competency of general practice residents was developed with modified Delphi expert consultation during November 2010 to October 2011.Thirty three experts in clinical practice,education and administration of general practice were invited for two-round Delphi questionnaire consultation.Results In two-round consultation,the expert activity coefficient was 100％,the authority coefficient was 0.852 and 0.855,and the coordination coefficient for the importance of the indicators was 0.228 and 0.245 respectively (P =0.000).The opinions among the experts became consistent from round 1 to round 2.An assessment system was established,which consisted of 5 first-level (professionalism,communicate skills,clinical competency and professional development ability) and 36 second-level indicators.Conclusion The index system established in this study may be used as references for evaluating comprehensive clinical abilities of general practitioners systematically and objectively.

Background Misfolding of Myocilin protein plays an important role in the pathogenesis of primary open angle glaucoma (POAG).GRP78 can transfer the misfolded proteins out endocytoplasmic reticulum and keep the protein synthesis function of endoplasmic reticulum.However the relationship between GRP78 and Myocilin in the pathogenesis of POAG has not been elucidated.Objective This study was to investigate and analyze the coexpressions of GRP78 and Myolicin in trabecular meshwork cells (TMCs) of POAG.Methods The trabecular meshwork tissues were obtained during the surgery of POAG and healthy donor for the isolated and in vitro culture of TMCs,and the morphology of the cells was compared between POAG-derived TMCs and donor-derived TMCs.The expression of specific factors for TMCs were detected by immunochemistry.The cells were divided into normal control group,tunicamycin (Tm)-treated group and staurosporine (STS)-treated group,and the cells were cultured by regular medium,the 1 μ mol/L Tm medium or 0.1 μmol/L STS medium for 24 hours respectively.The co-expression of GRP78 and Myocilin in the cells were detected using immunofluorescence assay.This study was approved by Ethics Committee of Xi'an No.4 Hospital,and written informed consent was obtained from each patient before surgery.Results Primarily cultured cells showed the fiat star-like and irregular appearance with 3-5 processes,round nuclei,abundant cytoplasm and black engulf particles.The 3-7 generations of POAG-derived cells grew well,showing positive expressions of laminin (LN),fibronectin (FN),neuronal specific enolase (NSE) and Vimentin.Immunofluorescence assay showed positive expressions of GRP78 and Myocilin in the cells of the Tm group,STS group and normal control group,with the reddish and green fluorescence separately.Incomplete co-expression of GRP78 and Myocilin was seen in donor-derived TMCs,and complete co-expression of GRP78 and Myocilin was found in the POAG-derived TMCs in the normal control group.Complete co-expression of GRP78 and Myocilin was exhibited in both donor-and POAG-derived TMCs in the Tm group and STS group.In addition,accumulation of GRP78 protein around nucleus was seen in both donor-and POAG-derived TMCs in the Tm group.Conclusions GRP78 and Myocilin proteins are completely co-expressed in POAG-derived TMCs,inferring that GRP78 and Myocilin play an interaction role in the pathogenesis and development of POAG.GRP78 may play a cytoprotective role against the apoptosis of TMCs caused by endoplasmic reticulum stress.

The experiment included three potassium levels (K0 0 g x kg(-1), K1 0.33 g x kg(-1), K2 0.67 g x kg(-1)) and two water gradients (well watered and drought stress), then measured growth indicators, SOD, POD, CAT activities and concents of osmotic regulation substances. To explore the effects of K fertilizer and water on growth and physiological characteristics of Isatis indigotica, providing reference for improving drought resistance of I. indigotica. The result showed drought stress inhibited the growth and decreased the biomass of I. indigotica but K fertilizer can alleviate the drought stress. Compared with K0 treatment, K1, K2 treatment increased the biomass of overground part of by 89. 13% ,60. 87% under drought stress. The corresponding increase in soluble sugar content was 16.67%, 5.00%, and in proline content was 42.41%, 65.62%, respectively. SOD,POD and CAT activities was significantly improved in K1, K2 treatment in comparison with K0 treatment under drought stress, but soluble protein content significantly reduced. The conclusion is that appropriate amount of K fertilizer can increase the activities of antioxidase and the content of osmoregulation substance under drought stress, and improve drought resistance of I. indigotica.
Fertilizers ; analysis ; Isatis ; chemistry ; enzymology ; growth & development ; metabolism ; Peroxidase ; metabolism ; Plant Proteins ; metabolism ; Potassium ; analysis ; metabolism ; Seedlings ; chemistry ; enzymology ; growth & development ; metabolism ; Superoxide Dismutase ; metabolism ; Water ; analysis ; metabolism

Objective To explore relationship between different HBV genotypes and peripheral blood HBV specific and nonspecific CTL of patients with cirrhotic hepatitis B and its significance. Methods HBV genotypes were tested in 91 patients with cirrhotic hepatitis B, differences of HBV specific and nonspecific CTL between patients infected with genotype B and C were compared and its significance was explored. Results In 91 cases of cirrhotic hepatitis B, 55 cases (60.44% ) belong to genotype C, 35 cases (38. 46% ) belong to genotype B, 1 case (1. 1% ) belongs to mixture genotype B and C. In genotype C,27 cases (49.09% ) had positive (HLA)-A2, HBV specific CTL was 0. 18% ±0.03%. In genotype B, 18 cases (51.43% ) had positive HLA-A2, HBV specific CTL was 0. 38% ± 0.04% , higher than that in genotype C,t =5. 01, P <0. 01. Nonspecific CTL: genotype C (11. 87% ± 1. 50% ) ; genotype B( 11. 90%± 1. 51% ), t =0. 14, P ＜0. 05. HBV DNA level; genotype C (6. 01 ± 0. 81) log10 copy/ml, higher than that in genotype B (5.01 ± 0.54) log10 copy/ml, t =5.01, P ＜0.01. ALT; genotype C (251. 13 ± 131. 11) U/L, higher than that in genotype B (121. 25 ± 63. 21) U/L, t =3. 61, P <0. 01. TBil (45. 61± 15.11) μmol/L, higher than that in genotype B (28.11 ±6.25) μmol/L, t = 3.05, P ＜ 0.01. Conclusion Compared with patients infected with genotype B of cirrhotic hepatitis B, HBV specific CTL of patients infected with genotype C was lower, resulting in higher level of HBV DNA and more severe damage of liver function.

Objective The factors influencing the dose distribution of intracavitary brachytherapy for moderately advanced and advanced uterine cervical cancer was studied.Methods Ninty-five patients with cervical cancerⅡ～Ⅲb who received radical radiation therapy in our department from Aug,2004 to Nov,2005,were treated with after-loading brachytherapy using,first,the self-designed“Mutipurpose Hori- zontal Transit Table”(MPHTT) for locating and treatment before the intracavitaray brachytherapy proper. The deviation of isodose curve based on A-B reference system,and the dose of deviation was defined by measuring in a practical standard phantom.Results There were significant influence on the deviation of i- sodose curve in pathology and para-metrial infiltration of cervical cancer and operating skill,but negative to clinical stage.The degree of deviation of isodose curve could not be lowered with the increase in sessions of intracavitary brachytherapy.Conclusions It is necessary to perform the locating,by use of mphtt,before the proper brachytherapy for patients with cervical cancer,not only for the identification of the deviation of i- sodose curve,but also to provide the evidence for revising the plan for dose adjustment of conformal radiation therapy in the pelvic cavity.

Objective To analyze the influencing factors of having clinical meaningful recanalization (CMR)after revascularization therapy in acute phase of ischemic stroke. Methods A total of 267 consecutive patients with ischemic stroke admitted to the Department of Neurology,Xuanwu Hospital, Capital Medical University and received intravenous thrombolysis or endovascular intervention in acute stage from March 2011 and March 2015 were enrolled retrospectively. CMR was used as a primary endpoint event. They were divided into either a CMR group (n = 92)or a non-CMR group (n = 175)according to whether they had CMR. The baseline data of the patients in both groups were compared by using the Rank sum test and Pearson Chi-Square test. A multivariate logistic regression model was established to analyze the independent influencing factor of CMR. Results The median (interquartile range)age of 267 patents was 60 (51 -69)years,and 69 of them were females (25. 8%);the median (interquartile range)time from onset to treatment was 250 (195 -305)min,and the median (interquartile range)NIHSS score was 10 (6 -15). The baseline NIHSS score,body mass index,blood glucose level,and proportion of diabetes of the CMR group were significantly lower than those of the non-CMR group (all P≤0. 05). The results of multivariate logistic regression analysis showed that the baseline NIHSS (OR,0. 93,95% CI 0. 88 -0. 98;P = 0. 01),intravenous thrombolysis (with respect to endovascular intervention)(OR,0. 35, 95% CI 0. 17 -0. 73;P = 0. 01),and baseline blood glucose (OR,0. 87;95% CI 0. 77 -0. 98;P =0. 02)were the independent negative predictors of CMR. Conclusion The baseline NIHSS,intravenous thrombolysis (with respect to endovascular intervention),and high blood glucose are the negative influencing factors for achieving CMR in the acute phase of ischemic stroke,suggesting blood sugar intervention and endovascular intervention in acute phase may contribute to the improvement of clinical prognosis.

Objective To develop criteria for trainers of general practitioners in clinical training bases.Methods A primary version of criteria was established through literature review and expert interview.Thirty-two experts with middle-level professional title or above,who had 10 years of working experience or more in general practice,teaching and administration,were invited for 3 rounds of Delphi consultation during March and October 2013.Results The criteria consisted of 3 first-grade indicators and 12 second-grade indicators were established.The first-grade indicators included professional quality,clinical competence and teaching capability.The weight coefficient of first-grade indicators were 0.332 0,0.336 0 and 0.332 0,respectively.For 3 rounds of consultation the activity coefficient of experts was all 100％ ; the authority coefficients of experts were 0.881,0.897 and 0.883,respectively; and the harmonious coefficient of importance of the evaluation were 0.136,0.127 and 0.204,respectively (P ＜ 0.01).Conclusion The established criteria are credible and important for the selection of trainers of general practitioners in clinical bases,which would improve the quality of standardized training for general practitioners.

Objective To establish a set of accreditation standards for trainers of general practitioner (GP) in community health service centers.Methods A modified Delphi expert consultation was conducted during December 2012 and September 2013.Thirty two experts of general practice from different teaching hospitals and community health service centers were invited for three rounds Delphi questionnaires.A set of accreditation standards for GP trainers in primary care was established through data analysis,synthesis and process.Results Expert activity coefficients were 100.0％ for three rounds consultation,the authority coefficients were 0.894,0.882 and 0.893,respectively.The opinion coordination coefficients of experts were 0.156,0.166 and 0.215,respectively (P =0.000).The developed accreditation standards system comprised of three first-grade indicators and 14 second-grade indicators.The weight coefficients of three first-grade indicators,namely professional profiles,clinical competences in primary care and teaching abilities,were 0.339 8,0.335 6 and 0.324 6,respectively.Conclusions The established accreditation standard system is credible,which would appropriately guide the selection of GP trainers in primary care from three dimensions and enhance the quality of standardized training of general practitioners.

Objective To study needs of training of trainers(ToT)in mini-clinical evaluation exercise(mini-CEX)and its effectiveness.Methods One hundred and fourteen doctors involved in TOT for mini-CEX were interviewed with questionnaire before and after training for their satisfaction of training and fifty of them scored the training videos.Results Before the training.39%(44/114)of doctors involved in TOT knew mini-CEX and 97%(111/114)of them hoped to know how to carry out mini-CEX thronsh training.When the training finished,30%(34/114)tO 55%(63/114)of them could completely understand seven items of examinations of mini-CEX.Fifty doctors involved in TOT scored the training videos after the training.There was signifieant difference in scores between TOT and standard scoring on training video 1 for teaching of coronary heart disease and video 2 for teaching of hematochezia(P<0.05).No significant difference Was found in scores between TOT and standard scoring on the video 3 for teaching of abdomihal pain(P>0.05).as well as those between TOT with five or less years experience and those with more than five years experience(P>0.05).Conclusions Currently,doctors involved in TOT have more demands on mini-CEX.However,effectiveness of short-course training for mini-CEX is not satisfactory,and pattern of its training should be improved further.