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.

Thirty four residents of general practice and 11 students of junior college to undergraduate program were evaluated with the mini-clinical evaluation exercise (mini-CEX) when they were rotated to community clinics or the ward of general practice in Zhongshan Hospital from September 2009 to February 2010. The reliability and validity of mini-CEX for rotation examination in general practice training was assessed. Forty five trainees and 9 clinical faculty members completed 81 mini-CEX evaluations. The Cronbach's alpha coefficient was 0. 932. Criterion-related validity for mini-CEX overall competence with the end examination of rotation was O.53 ( P ＜ 0.001 ). The results indicate that mini-CEX may be an appropriate evaluation tool for rotation examination in general practice training.

The authors designed to separate, purify and determine the monosaccharide composition of the polysaccharide from Cordyceps militaris, and study its effect on reverse cholesterol transport in vivo by isotope tracing assay. Polysaccharides were separate and purify by ion exchange column Q-sepharose Fast Flow and size exclusion column Sephacryl S200HR; the molecular weight and monosaccharide composition of the polysaccharides were determined by high performance gel permeation chromatography and high performance liquid chromatography coming with pre-column derivation, respectively. Finally, three purified polysaccharides CMBW1, CMBW2 and CMYW1 were obtained, their total carbohydrate contents were 87%, 89%, 95%, respectively; their protein contents were 6.5%, 1.3%, 2.8%, respectively; their molecular weights were 772.1, 20.9, 13.2 kDa, respectively; CMBW1 was composed of mannose, glucosamine, rhamnose, glucuronic acid, glucose, galactose and arabinose with a molar ratio of 7.25: 0.17: 1.29: 0.23: 6.30: 11.08: 0.79; CMBW2 was composed of mannose, glucosamine, galactose and arabinose with a molar ratio of 2.40: 0.16: 2.92: 0.24; CMYW1 was composed of mannose, glucosamine, glucuronic acid and glucose with a molar ratio of 0.59: 0.57: 0.45: 25.61. Polysaccharide at 50 mg x kg(-1) could significantly improve the transport of 3H- cholesterol to blood and excretion from feces. All of the three purified polysaccharides CMBW1, CMBW2 and CMYW1 were heteropolysaccharide; and they could improve reverse cholesterol transport in vivo, the underlying mechanisms are being studied.
Animals ; Biological Transport ; drug effects ; Cholesterol ; metabolism ; Chromatography, High Pressure Liquid ; instrumentation ; methods ; Cordyceps ; chemistry ; Mice ; Monosaccharides ; analysis ; isolation & purification ; Polysaccharides ; chemistry ; isolation & purification ; pharmacology ; Tritium

Objective To investigate the clinical value of virtual touch tissues quantification in the evaluation of kidney stiffness in patients of diabetic nephropathy .Methods A total of 90 cases of diabetic nephropathy were divided into 3 groups:infinitesimal albuminuria ,microalbuminuria and massive proteinuria groups.And other 30 health subjects were taken as control group.The shears wave velocity ( Vs) which reflected the tissue elasticity was measured.The Vs values were compared among different groups.Results In all groups,the highest Vs was present in renal cortex .And compared with the renal cortex ,the Vs of the renal medulla and renal sinus have statistically significant differences [ the normal control group:( 3.65 ± 0.26)m/s,(2.72 ±0.35) m/s,(1.83 ±0.54) m/s,t =9.30,18.20,both P <0.05;Infinitesimal albuminuria group:(2.98 ±0.28)m/s,(2.47 ±0.33)m/s,(1.65 ±0.31)m/s,t=5.97,15.57,both P<0.05;microalbuminuria group:(2.55 ±0.22) m/s,(2.22 ±0.28) m/s,(1.54 ±0.21) m/s,t =3.86, 11.83,both P<0.05;massive proteinuria group:(1.99 ±0.28)m/s,(1.49 ±0.30)m/s,(1.01 ±0.39)m/s, t=5.85,11.48,both P<0.05].The renal cortex Vs of Infinitesimal albumonuria group ,microalbuminuria group and massive proteinuria group show a gradually decreasing trend .And the renal cortex Vs of microalbuminuria group and massive proteinuria group have statistically significant differences compared with the normal control group(t=11.79,17.79,both P<0.05).Conclusions Virtual touch tissues quantification technique can reflect the renal tissue elasticity .It will contribute to the assessment of renal function in patients with early diabetic nephropathy .

Objective To summarize the domestic design for placebo acupuncture and the placebo effect and explore an ideal design for placebo acupuncture.Method Three large Chinese databases CNKI, Wan Fang and Vip were searched to systematically review the application of placebo acupuncture in randomized controlled trials published at home in recent 5 years (2011.01—2016.11).Results and conclusions A total of 48 articles were included according the inclusion and exclusion criteria. An analysis was made of the kinds of diseases for acupuncture study, the methods of designing placebo acupuncture, the effects of placebo acupuncture and comparisons with foreign placebo acupuncture. Pain syndrome and insomnia were the main kinds of diseases for acupuncture study, accounting for 10 and 8 articles respectively. Acupuncture needles were the main kind of needles for placebo acupuncture, accounting for 66.6%. Sites beside acupoints were the main positions selected for placebo acupuncture, accounting for 58.3%. Not penetrating the skin predominated in the depth of needle insertion, accounting for 37.5%. The kinds of needles for placebo acupuncture were fewer than abroad. The effects of placebo acupuncture were not superior to those of acupuncture.

OBJECTIVETo investigate the potential molecular mechanism underlying down-regulation of albumin expression induced by lipopolysaccharide (LPS) in rat hepatocytes.

METHODSThe albumin mRNA expression and albumin protein levels in the supernatant were observed at 0, 2, 8, 12 and 24 hours after 1 micro g/ml LPS treatment. The albumin mRNA expression was determined by RT-PCR, and albumin protein levels were assayed with EIA in the supernatant of hepatocytes pretreated with specific inhibitors of extracellular signal-regulated kinase (PD98059) and p38 kinase (SB203580).

RESULTSThe albumin mRNA expression was reduced to 70% of baseline value, meanwhile, the albumin protein concentration in the supernatant was reduced by 50% compared with the controls after 24 hours of LPS treatment. Pretreatment with PD98059 and SB203580 did significantly inhibit the reduction of albumin by LPS at the given dose.

CONCLUSIONThe results indicate that LPS can induce the reduction of albumin synthesis by down-regulation of albumin mRNA expression at transcription level, and the process may be related to the signal transducation of extracellular signal-regulated kinase and p38 kinase.

Albumins ; genetics ; metabolism ; Animals ; Calcium-Calmodulin-Dependent Protein Kinases ; antagonists & inhibitors ; Dose-Response Relationship, Drug ; Down-Regulation ; Enzyme Inhibitors ; pharmacology ; Enzyme-Linked Immunosorbent Assay ; Flavonoids ; pharmacology ; Hepatocytes ; drug effects ; metabolism ; Imidazoles ; pharmacology ; Lipopolysaccharides ; toxicity ; Male ; Mitogen-Activated Protein Kinases ; antagonists & inhibitors ; Pyridines ; pharmacology ; RNA, Messenger ; genetics ; metabolism ; Rats ; Reverse Transcriptase Polymerase Chain Reaction ; Time Factors ; p38 Mitogen-Activated Protein Kinases

To establish a UPLC-MS/MS method for the simultaneous determination of geniposide, genipin 1-O-beta-D-gentiobioside and geniposidic acid in rat brains and study the brain pharmacokinetics of the three iridoid glycosides in stroke rat after the oral administration of Xingnaojing. In this experiment, brain samples were precipitated with protein for twice. Acquity BEH C18 column was adopted, with acetonitrile-0.1% formic acid-water as the mobile phase for gradient elution. ESI source was adopted for mass spectra; multiple reaction monitoring (MRM) was conducted to detect negative ions. The time for sample analysis was 3.5 min. the results showed good linear relations among the three iridoid glycosides, with the extraction recovery between 99.6% and 114.3%, good intra- and inter-day precisions and accuracies and stability in line with the requirements. The t1/2 and MRT in the three components were similar in brains of stroke rats. Geniposide and genipin 1-O-beta-D-gentiobioside showed double peaks; where as geniposidic acid showed a single peak. In conclusion, the method is so specific, sensitive, accurate and reliable that it can be used to study the brain pharmacokinetics of Xingnaojing oral preparation.
Animals ; Brain ; metabolism ; Brain Chemistry ; Chromatography, High Pressure Liquid ; methods ; Drug Stability ; Drugs, Chinese Herbal ; chemistry ; pharmacokinetics ; Iridoids ; chemistry ; pharmacokinetics ; Male ; Rats ; Rats, Sprague-Dawley ; Tandem Mass Spectrometry ; methods

Background The severity of hypoalbuminemia has been shown to be related to morbidity and mortality in some critical illnesses, illustrating the need for better understanding of molecular mechanism of hypoalbuminemia. Lipopolysaccharide (LPS) is a key mediator inducing hypoalbuminemia in sepsis and septic shock. The present study was designed to identify if the reduction of albumin expression is directly induced by LPS and modulated by activated extracellular signal-regulated protein kinase (ERK) and p38 mitogen-activated protein kinase (MAPK) in rat hepatocytes.Methods Primary rat hepatocytes were divided into five groups. In two of them, hepatocytes were treated with normal saline or 1 μg/ml LPS, then albumin mRNA expression was observed at 0, 2, 8, 12 and 24 hours after treatment. In another group, hepatocytes were pretreated with 100, 40 or 20 μmol/L of cycloheximide (CHX, an inhibitor of protein synthesis) for 30 minutes followed by 1 μg/ml LPS for 24 hours. Then the RNA was extracted from the cells for RT-PCR to detect the expression of albumin. The other two groups were administered 1 μmol/L, 10 μmol/L and 50 μmol/L of SB203580 (p38 MAPK inhibitor) or PD98059 (ERK inhibitor) 30 minutes prior to 1 μg/ml LPS treatment. After 24 hours of LPS treatment, the supernatant was collected and assayed for albumin concentrations. Data were analyzed by one-way analysis of variance, followed by the Newman-Keul test; a P<0.05 was considered significant.Results There was no marked change in albumin mRNA expression in the control group during 24-hours treatment with normal saline. The reduction did not occur until 24 hours after LPS treatment, and albumin mRNA decreased by 30% approximately compared to the control group at 24 hours (0.587 vs 0.832, P=0.007). CHX could inhibit the decline of albumin mRNA induced by LPS and the effect was correlated with the dose of CHX. The ERK inhibitor PD98059 caused a significant increase in LPS-induced albumin production at the three concentrations (119.7, 111.4 and 80.0 ng/ml vs 44.4 ng/ml, P=0.0013, 0.0025 and 0.009, respectively), whereas SB203580 obviously blocked albumin reduction in LPS-treated cells at the concentrations of 10 and 50 μmol/L (87.5 and 93.6 ng/ml vs 44.4 ng/ml, P=0.0076 and 0.0049, respectively).Conclusions LPS can induce the reduction of albumin expression by new synthesized proteins indirectly, and the process may be related to the signal proteins of ERK and p38 kinase. The ERK and p38 kinase are critical signaling pathways in LPS-induced hypoalbuminemia which is worthwhile to understand in studying the molecular mechanism of hypoalbuminemia in sepsis and septic shock.

Kidney transplantation (KT) is one primary treatment of end-stage renal disease (ESRD). As reported by different centers, 10-year survival rate of transplanted kidneys fluctuates from 75% to 80%. Capable of reducing all-cause mortality in renal failure, KT can significantly improve survival rate and quality-of-life of ESRD patients. The risk of post-transplant rejection is much higher in pre-sensitised recipients than in non-sensitised ones due to the pre-existing anti-human leukocyte antigen antibodies. However, with a rapid development of various desensitisation techniques, transplantation rate and postoperative human/kidney survival rate of recipients have been greatly enhanced. And presensitisation is no longer a contraindication to KT. This review focused upon the latest advances in desensitisation therapeutic agents for pre-sensitised KT.

ObJective To summarize the microsurgieal techniques through direct Sylvian fissure approach. Methods A retrospective analysis was conducted in 62 patients undergoing microsurgeries through direct Sylvian fissure approach, including 4 with cavernous angioma in the Sylvian fissure, 5 with insular lobe tumors, 33 with middle cerebral artery aneurysms, 15 with glioma spanning or invading the Sylvian fissure, 1 with metastatic tumor, 2 with arteriovenous malformations, and 2 with temporal lobe epilepsy. Results All the vascular lesions were exposed satisfactorily and managed appropriately. Of the 19 cases ofgliomas and metastatic tumors, total resection was achieved in 13 cases, and subtotal resection in 6 cases. Transient aphasia or hemiparesis occurred postoperatively in a few patients but all recovered within 1 or two months. Conclusions The Sylvian fissure provides a good surgical route as a subarachnoid space between the frontal, parietal, temporal and insular lobes. The Sylvian fissure should be carefully separated under the operating microscope with high-power magnification, and tension-free retaction is critical in important language areas. In the management of tumors involving the Sylvian fissure, we recommend that extended resection be performed after exposure and appropriate preservation of important blood vessels in the fissure.