Acute Disease ; Humans ; Pulmonary Embolism ; therapy

Animals ; Atherosclerosis ; etiology ; metabolism ; Gene Expression Regulation ; Humans ; Lipase ; analysis ; genetics ; physiology ; Lipoproteins ; metabolism ; Lipoproteins, HDL ; metabolism ; Lipoproteins, LDL ; metabolism ; Polymorphism, Genetic ; Tissue Distribution

The application of MOOCs (massive open online courses) in internal medicine education is feasible with the construction of MOOCs in internal medicine, internet and mobile terminal availability, and the improvement of college student quality. We reviewed the progress of MOOCs in the medical teach-ing. The chapter of coronary heart disease was exemplified to illustrate how to apply MOOCs in internal medicine teaching. The MOOCs was carried out with the following steps: the share of MOOCs courses, self-guided learning, online question and answer section, in-class teaching and exams post MOOCs, which achieved good teaching effect, enhanced students' subjectivity, and promoted the sharing of high-quality medi-cal teaching resources. At the same time, in view of the limited nature of MOOCs in internal medicine, we need to overcome it in the development of teaching practice.

Anemia, Aplastic ; therapy ; Child ; Female ; HLA Antigens ; genetics ; immunology ; Humans ; Mesenchymal Stem Cell Transplantation ; Peripheral Blood Stem Cell Transplantation

OBJECTIVE:To compare the efficacy and safety of ferrous succinate or Shengxuening in the adjuvant treatment of renal anemia in patients with diabetic nephropathy peritoneal dialysis (CAPD). METHODS:64 diatetic nephropathy CAPD pa-tients with renal anemia were randomly divided into observation group (32 cases) and control group (32 cases). All patients re-ceived subcutaneous injection of insulin for blood glucose control (adjusted the insulin dosage based on fasting blood glucose lev-els),hypertension patients actively controlled blood pressure,corrected acid-base and electrolyte balance disorders,orally received fo-lic acid and vitamin B12,ambulant CAPD,then rhEPO was subcutaneously injected with initial dose of 100-150 U/(kg·week) for 2-3 times and other conventional treatment. Based on it,observation group received 1 g of Shengxuening tablet,3 times a day;control group received 0.2 g Ferrous succinate tablet,3 times a day. The treatment course for both groups was 16 weeks. The rhEPO dose was monthly adjusted to make Hb 100-120 g/L. Clinical efficacy,serum iron,serum ferritin,total iron binding capacity,transfer-rin saturation before and after treatment,Hb,Hct,hs-CRP,rhEPO dose before treatment and after 4,8,12 and 16 weeks of treat-ment,and the incidence of adverse reactions in 2 groups were observed. RESULTS:There was no significant difference in the total effective rate between 2 groups (P>0.05). After treatment,serumiron,total iron binding capacity,transferrin saturation,Hb and Hct in 2 groups were significantly higher than before,and it gradually increased by treatment time,serum ferritin,hs-CRP was sig-nificantly lower than before,and it gradually decreased by treatment time,the differences were statistically significant(P<0.05);but there was no significant difference between 2 groups(P>0.05). The rhRPO dose in observation group 8,16 and 16 weeks af-ter treatment and in control group 8 weeks after treatment were significantly lower than 4 weeks after treatment,and 12 and 16 weeks after treatment in observation group were lower than control group,the differences were statistically significant (P<0.05). The incidence of adverse reactions in observation group was significantly lower than control group,the difference was statistically significant(P<0.05). CONCLUSIONS:Based on conventional treatment,both ferrous succinate and Shengxuening show good ef-ficacy in the adjuvant treatment of renal anemia with diabetic nephropathy CAPD,both can improve anemia and iron metabolism, while Shengxuening is superior to ferrous succinate in terms of improving microinflammatory state and reducing rhEPO dose,with better safety.

Objective To determine the usefulness of tricuspid annular displacement(TAD),based on twodimensional speckle tracking imaging, for assessment of right ventricular(RV)systolic function.Methods Eighteen patientswith dilated cardiomyopathy and 20 age-matched healthy volunteers were in volved. Twodimensional and real-time three-dimensional(RT3D)imaging were obtained in all patients at apical four-chamber view.The parameters of TAD were derived from off-line QLAB software.RT3D-RV ejection fraction(RVEF)was calculated by using 4D RV function software.Results TAD data were acquired in all 38 cases, while RT3D-RVEF was done in 30 out of 38.The parameters of TAD correlated well with RVEF(P<0.01).The parameters of TAD in dilated cardiomyopathy group were significantly lower than the corresponding values in healthy subjects (P<0.01).The intra-and interobserver variabilities for measurement of TAD were(0.49±2.69)mm and(0.21± 0.60)mm, respectively.Conclusions TAD,based on two-dimensional speckle tracking imaging,proved to be a rapid and reproducible method in determining RV global systolic function.

BACKGROUND: Fructose-1,6-diphosphate (FDP) of certain dosage plays a protective role in the pancreatic islets damaged by interleukin-1 beta (IL-1β), and there are different effects of FDP of low and high dosages.OBJECTIVE: To investigate the effects of FDP of low and high dosages on the islet cells damaged by IL-1β.DESIGN: A grouped design and controlled animal experiment.SETTING: Department of Physiology, North Sichuan Medical College.MATERIALS: The experiments were carried out in the Tumor Laboratory and Central Laboratory of Rheumatology and Immunology, Department of Surgery, North Sichuan Medical College between July 2004 and February 2006. Twenty Wistar rats within 1-3 days after birth were selected.METHODS: The pancreases of the rats were removed to collect islet cells, and then the cells were divided into normal control group, IL-1β damaged group, IL-1β+1, 25, 50 mmol/L FDP groups. The cellular activity was detected with methyl-thiazol-tetrazolium (MTT) assay, basic amount of insulin secretion and that stimulated by high glucose with radioimmunoassay, content of nitric oxide and activity of nitric oxide synthase (NOS) with nitric oxide and NOS kits, and the with [Ca2+]i with Fura-2fluorescent assay.MAIN OUTCOME MEASURES: Activity of islet cells; basic amount of insulin secretion and that stimulated by high glucose; content of nitric oxide and activity of NOS; [Ca2+]i.RESULTS: ① The activities (A values) of the islet cells in the IL-1β damaged group, IL-1β+1, 25, 50 mmol/L FDP groups were obviously lower than that in the normal control group (0.116±0.012, 0.129±0.008, 0.125±0.015, 0.120±0.016, 0.252±0.020, P ＜ 0.01). The activities (A values) of the islet cellswere not significantly different from that in the IL-1β damaged group (P ＞ 0.05) when the FDP dosage was too low (1 mmol/L) or too high (25 mmol/L). ② The basic amount of insulin secretion and that stimulated by glucose were significantly lower in the IL-1β damaged group, IL-1β+1, 25, 50 mmol/L FDP groups than in the normal control group [(237.00±22.21), (230.83±11.58), (225.16±12.46), (220.50±15.63),(425.67 ±16.85) mIU/L; (90.17 ±6.11), (96.62 ±8.64), (87.66-±8.24),(85.46±9.59), (204.50±10.78) mIU/L, P ＜ 0.01], and there were no significant differences between the FDP groups of Iow and high dosages and the IL-1β damaged group (P ＞ 0.05). ③ The NOS activity and content of nitric oxide in the supernatant were obviously higher in the IL-1β damaged group than in the normal control group [(332.07±25.34), (144.86±12.17) μkat/L;(457.64±19.29), (84.67±10.23) μmol/L, P ＜ 0.01], and those in the IL-1β+1, 25, 50 mmol/L FDP groups were not significantly different from those in the IL-1β damaged group. ④ The [Ca2+]i concentration in islet cells was obviously higher in the IL-1β damaged group than in the norrmal control group [(328.50±26.28), (73.42±1.79) nmol/L, P ＜ 0.01], but obviously lower in the IL-1β+1, 25, 50 mmol/L FDP groups than in the IL-1β damaged group [(152.72± 11.86), (216.39±15.32), (233.61±21.76),(328.50±26.28) nmol/L, P ＜ 0.01].CONCLUSION: FDP of low and high dosages can not protect the islet cells damaged by IL-1β.

AIM:To investigate the effect of intense pulsed light on the meibomian gland dysfunction ( MGD) , and to observe whether the intense pulsed light can improve the symptoms and objective indexes of the patients with meibomian gland dysfunction. · METHODS: A retrospective noncomparative interventional case series was conducted. Totally 21 MGD patients (42 eyes) were selected from November 2016 to February 2017 in Renmin Hospital of Wuhan University, the results of the following tests is recorded:OSDI score, corneal fluorescein staining, tear break-up time, ocular surface analyzer, scanning confocal microscopy, all patients respectively were received intense pulsed light treatment 3 times at 3wk intervals, and followed up after 1mo. Paired sample t test was used to analyze the difference in outcome. ·RESULTS: In the 21 cases ( 42 eyes ) , the OSDI score decreased, the mean value before treatment was 30. 18 ± 4. 07, and the mean value after treatment was 24. 87±4. 32. The first tear film break-up time ( first, BUT) increased, the mean value before treatment was 5. 37 ± 0. 82s, the mean value after treatment was 7. 12 ± 0. 74s. The mean value of meibomian gland secretion scores before the treatment was 1. 57 ± 0. 52,the mean value after treatment was 1. 22 ± 0. 52. The mean value of corneal fluorescence staining before treatment was 0. 82 ± 0. 41, and the mean value after treatment was 0. 51 ± 0. 53, the difference was statistically significant (t=11. 2, 2. 68, 3. 31, 2. 78, 2. 61;P<0. 05). · CONCLUSION: Intense pulsed light can effectively improve the subjective symptoms of patients with MGD and alleviate the obstruction of meibomian glands. It is an important method for MGD treatment.

Objective To analyze the clinicopathological features and prognosis of patients with occult breast cancer ( OBC) , as well as to explore the best treatment .Methods The clinical data of 72 patients with OBC confirmed by pathology were retrospectively analyzed , while 320 cases with other kind of breast cancer were the control group .Results Axillary mass was the first sign of the 72 patients with OBC.The diagnosis rate of MRI was higher than mammary graphy ( 71.4% vs 53.5%) .The difference had statistical significance (χ2 =11.876, P=0.001) .The characteristics of OBC with axillary lymph node metastasis was mainly moderately or low differenti -ated, usually with diffuse infiltrative cancer cells , flaky, like large Apocrine cells.Compared with the control group, the positive rate of CK7, CK20 and TTF-1 had no statistical differences (χ2 =0.058, P=0.810).The posi-tive rate of ER and PR was 46.7% and 36.7%, lower than the control group (χ2 =4.535, P=0.033).Clinical stage, operating method and the number of lymph node metastasis may be the independent factors influencing prog -nosis.Conclusions Axillary mass is the first symptom of OBC .To combine MRI with immunohistochemistry is helpful in diagnosis and differential diagnosis of the disease .The positive rate of ER and PR for OBC patients is low.Modified radical mastectomy combined with adjuvant therapy may be the better choice .

OBJECTIVETo observe the short-term clinical effectiveness of bone ring graft technique and to summarize the key points of related surgical operation to provide comprehensive clinical guidelines.

METHODSFifteen patients with severe alveolar bone absorption were selected to receive bone ring grafting and immediate dental implant. Final fixed prostheses were cemented five months after initial implantation. Cone beam CT scans were conducted on all subjects before the procedure, as well as four months post-operation to evaluate alveolar bone height and level of bone height and absorption around the implants. Four to six months after prosthesis installation, each implant's Jemt classification, gingiva attachment, and probing depth (PD) were analyzed. The difference of PD between implants and adjacent teeth, as well as the difference of the bone absorption between labial and lingual sides, was compared. The survival rate of the bone ring and the retention rate of implants were calculated. Complications and patient satisfaction were also investigated.

RESULTSBone graft survival rate was 94.4% and dental implantation retention rate was 100% four months post-operation. Average bone level increase was (6.06 +/- 1.06) mm, average bone absorption was (1.33 +/- 0.84) mm, and average bone thickness at the neck of the dental implant body was (6.94 +/- 0.73) mm. Approximately 4 to 6 months after crown restoration, average bone level increase was (5.62 +/- 1.03) mm, average bone absorption was (1.51 +/- 1.02) mm, and average bone thickness at the neck of the dental implant body was (6.77 +/- 0.72) mm. The PD around the implant body and the adjacent teeth was statistically insignificant. No major post-operative complication was observed, restorations were successful, and patient satisfaction level was high.

CONCLUSIONBone ring graft technique and immediate dental implantation are relatively simple to perform, and these techniques facilitate reduction in required treatment time. Short-term effect is reliable and satisfactory, whereas long-term outcomes require further follow up and study.