Objective To investigate and analyze the data of continuing medical education in order to understand the real need of the learners.Methods Reviewing and making statistic analysis of the data of Renji hospital's continuing medical education courses from 2007 to 2012,including the amount,title,discipline,geographical distribution,training content and the questionnaire survey.Results It shows that the learners from coastal and developed areas have a higher demand for cuttingedge technology and the new progress in medicine(49.1％),while the learners from inland and western regions prefer to learn the basic medical theory and technology (41.9％).Senior doctors tend to study cutting-edge technology and new progress medical courses (51.7％) while the junior persons prefer the basic medical knowledge (46.6％).These mean that the needs of content of continuing medical education is associated with the regions and the level of the doctors (P＜0.05).Conclusion The conclusions prompt that medical development between different regions of China may be unbalanced.Chinese government should pay more attention in terms of allocation of health resources and personnel training.It also provides advice for future courses so that it may improve the efficiency of the medical education resources.

Objective To compare the different methods for treating aerobic vaginitis and mixed clinical effects of infection.Methods A randomized controlled method was used,298 cases of aerobic vaginitis and mixed infections were randomly divided into control group(149 cases):the use of combination anti -infective therapy,the treatment group(149 cases):the use of combination anti -infective at the same treatment plus lactobacillus vaginal medication.And the therapeutic effect was evaluated.Results The difference of the clinical efficacy of aerobic vagi-nitis treatment of mixed infections was not statistically significant (total effective rate of 95.3% in the treatment group,92.6% in the control group).With the time of treatment extended,the effective rate increased,the use of com-bination anti -infective therapy at the same time plus lactobacillus vaginal administration group of aerobic bacteria vaginosis and recurrence rate was significantly reduced in patients with mixed infection (recurrence rate was 6.0% in the treatment group and 12.8% was in the control group,χ2 =3.941 3,P <0.05).Conclusion The combination of anti -infective therapy at the same time plus lactobacillus vaginal drug treatment aerobic mixed infections and vagini-tis has slightly higher effective rate than the use of combination anti -infective treatment,the former relapse rate was significantly reduced.

Background The introvitreal injection of triamcinolone acetonide (TA) before vitrectomy for retinal with choroidal detachment (RD/CD) can alleviate inflammatory response,but it easily lead to complications under the low intraocular pressure.The study on the efficiency and safety of subtenon injection of TA for treatment of RD/CD is lack.Objective This study was to evaluate the efficiency and safety of subtenant injection of TA with vitrectomy for treatment of RD/CD.Methods A retrospective study was adopted.The data of 22 eyes of 22patients who received subtenon injection of TA with vitrectomy for RD/CD were collected and analyzed in Affiliated Eye Hospital of Wenzhou Medical University from May 2010 to June 2014.TA of 40 mg in 0.4 ml was administered subtenantly 5 days before RD repair surgery.After initiating the treatment,the therapeutic effects on uvitis were analyzed.Intraocular pressure was monitored and CD height and range were determined by B type ultrasonography before injection and 5 days after injection respectively.In addition,blood glucose and blood pressure of the patients were evaluated.Results Ocular inflammation alleviated to some degree after TA injection in all 22 eyes.The mean intraocular pressure was (5.4±2.9) mmHg (1 mmHg =0.133 kPa) in pre-injection and (8.2±4.3) mmHg in postinjection,showing a significant difference between them (t =3.430,P ＜ 0.01).The mean maximum CD height was 5.2 (3.1,6.6)mm in pre-injection and 0.9 (0,3.8)mm in post-injection,with a significant difference between the before and after injection (Z=-4.198,P＜0.01).The mean CD range was 12 (10,12) clock before injection and 3(0,6) clock after injection,and no significant difference was found between before and after injection (all at P＞0.05) (Z=-4.124,P＜0.01).There were no statistically significant difference in the changes of blood glucose and blood pressure between before and after injection.The LogMAR visual acuities were 2.14±0.46,1.29±0.57 and 1.17±0.55 before injection and 1 month,3 months after injection,respectively,with a siginificant difference among them (F =22.060,P＜0.001).The retinal reattachment rate was 95.5 ％.Conclusions Subtenon injection of TA seems to be a good option for perisurgical management of RD/CD patients,which can alleviate uvitis,increase intraocular pressure,reduce CD height and CD range.

Objective To explore the role of viral infection in the development of drug eruption in patients with HIV infection, and to evaluate the efficacy of antiviral treatment. Methods This study enrolled 87 HIV-positive patients, including 11 with and 76 without drug eruption, all of whom received highly active antiretroviral therapy(HAART). Clinical data on, baseline CD4+ and CD8+ T cell counts and CD4/CD8 ratio in these subjects were retrospectively analyzed. Results The severity of drug eruption was mild in the 11 HIV-positive patients, with a mean latency period of (14.00 ± 8.10)(range, 8 - 34)days. Of the 11 patients with drug eruption, 7 had liver function impairment, which was not in accordance with the severity of skin lesions. Drug eruption was controlled in all the 11 patients after anti-anaphylactic treatment without withdrawal of antiviral drugs. Compared with 75 HIV-positive patients without drug eruption, the 11 HIV-positive patients with drug eruption showed significantly increased baseline CD4 + T cell counts (493.00 ± 245.68 (range, 42 - 810)/μl vs. 347.81 ± 167.00 (range, 11 - 814)/μl, t = 647.50, P < 0.05), but decreased proportion of patients with baseline CD4+ T cell counts below the lower limit of normal(3/11 vs. 48/75(64.00%), X2 = 3.95, P < 0.05). There were no significant differences between 10 patients with drug eruption and 69 patients without drug eruption in the baseline CD8+ T cell count(1472.30 ± 858.55/μl vs. 1356.59 ± 684.06/μl, P > 0.05), CD4/CD8 ratio(0.40 ± 0.27 vs. 0.29 ± 0.16, P > 0.05), or percentage of patients with a CD4/CD8 ratio below the lower limit of normal (9/10 vs. 68/69 (98.55%), P >0.05). Conclusions The latency period of drug eruption seems to be long in HIV-positive patients receiving HAART, and mild drug eruption can be complicated by liver function impairment in the patients. Relatively high CD4 + counts may be a risk factor for the development and aggravation of drug eruption in HIV-positive patients.

A simple, reliable and sensitive liquid chromatography-isotope dilution mass spectrometry (LC-ID/MS) was developed and validated for quantification of olanzapine in human plasma. Plasma samples (50 microL) were extracted with tert-butyl methyl ether and isotope-labeled internal standard (olanzapine-D3) was used. The chromatographic separation was performed on XBridge Shield RP 18 (100 mm x 2.1 mm, 3.5 microm, Waters). An isocratic program was used at a flow rate of 0.4 m x min(-1) with mobile phase consisting of acetonitrile and ammonium buffer (pH 8). The protonated ions of analytes were detected in positive ionization by multiple reactions monitoring (MRM) mode. The plasma method, with a lower limit of quantification (LLOQ) of 0.1 ng x mL(-1), demonstrated good linearity over a range of 0.1 - 30 ng x mL(-1) of olanzapine. Specificity, linearity, accuracy, precision, recovery, matrix effect and stability were evaluated during method validation. The validated method was successfully applied to analyzing human plasma samples in bioavailability study.

Objective:To assess the prevalence of metabolic syndrome(MS) and its relationship with hyperuricemia(HUA) in perimenopausal women in Anning city, Yunnan province.Methods:This is a cross-sectional survey. In May 2021, a multi-stage stratified sampling method was used to collect demographics and clinical data [ethnicity, living community, height, weight, waist circumference, blood pressure, fasting plasma glucose, triglycerides(TG), serum uric acid, high density lipoprotein-cholesterol(HDL-C), alanine transaminase(ALT), etc] in a total of 6 721 perimenopausal women aged 45-60 years.Results:A total of 6 721 perimenopausal women were included in this study. The prevalences of MS and HUA were 14.05%(95% CI 13.22%-14.88%) and 6.46%(95% CI 5.88%-7.07%), respectively. The average age, HDL-C, urea, direct bilirubin, and albumin levels in the perimenstrual HUA population were lower than those in the non-HUA population while the levels of TG, ALT, heart rate, body mass index(BMI), and creatinine were higher(all P<0.05). The prevalence of HUA in perimenopausal women with ethnic minorities and family history of chronic diseases was higher than that in Han nationality and without family history of chronic diseases. The prevalence of MS in perimenopausal women was increased with the increase of serum uric acid( Z=-15.313 8, P<0.001). Multivariate logistic regression model showed that HUA was positively correlated with MS( OR=1.526, 95% CI 1.192-1.954) after adjusting for covariates such as BMI and ethnicity, and the incidence of MS in perimenopausal women in HUA group was 1.526 folds higher than that in non-hyperuricemia group. Conclusion:HUA is highly positively correlated with MS in perimenopausal women. The management of uric acid level in perimenopausal women should be strengthened.

Objective:To explore the application value of silent MR angiography (MRA) in imaging of brain arteriovenous malformation (BAVM) in children.Methods:A total of 20 children with BAVM confirmed by digital subtraction angiography (DSA) were retrospectively collected. All children were imaged by silent MRA and time-of-flight MRA (TOF MRA) in the same examination. The image quality of feeding artery, nidus and drainage vein of BAVM was evaluated using the four-point method. Wilcoxon rank-sum test was utilized to compare the image quality scores between silent MRA and TOF MRA. Weighted Kappa statistics used to evaluate the inter-modality agreement of silent MRA and TOF MRA with DSA in displaying of angioarchitecture characteristics and determination of Spetzler-Martin grading.Results:Among the 20 BAVMs, significant differences in image quality scores of the nidus (2.75±0.55 versus 2.20±0.70) and drainage vein (2.60±0.68 versus 2.20±0.77) were observed between silent MRA and TOF MRA ( Z=-3.05, P=0.002; Z=-2.13, P=0.033, respectively). The agreement between silent MRA and DSA was excellent in nidus size grading, deep venous drainage, associated aneurysm and SM grading (Kappa 0.91, 1.00, 0.83 and 0.93, respectively); The agreement between TOF MRA and DSA was fair to moderate (Kappa 0.46, 0.59, 0.35 and 0.47, respectively). Conclusions:Silent MRA showes better image quality compared to TOF MRA and improves the evaluation of angioarchitecture characteristics and Spetzler-Martin grading of BAVMs in children.

Background:Acute lung injury(ALI)is the most common organ dysfunction in severe acute pancreatitis(SAP).Somatostatin analogue octreotide is a common used drug in acute pancreatitis.Aims:To explore the protective mechanism of octreotide on lung injury in SAP mice.Methods:In the first part,the experimental mice were randomly assigned into four groups.SAP model was induced by caerulin and lipopolysaccharide,and the mice were sacrificed 24 hours,48 hours and 72 hours after establishment.HE staining was used to observe the pathological score of pancreas and lung.Serum amylase and lung tissue myeloperoxidase(MPO)activity were detected.Real-time quantitative PCR was used to detect mRNA expressions of pyroptosis-related molecules apoptosis-associated speck-like protein containing a CARD(ASC),caspase-1,Gasdermin D(GSDMD),interleukin(IL)-1β,IL-18 and inflammatory factors IL-6,tumor necrosis factor(TNF)-α,high mobility group protein B1(HMGB1)in lung tissue.Western blotting was used to detect protein expressions of NOD-like receptor thermal protein domain associated protein 3(NLRP3),caspase-1,GSDMD and IL-1β in lung tissue.In the second part,mice were randomly divided into control group,SAP group,and octreotide group.HE staining was used to observe the pathological score of pancreas and lung.Serum amylase and lung tissue MPO activity were detected.Real-time quantitative PCR was used to detect mRNA expressions of pyroptosis-related molecules caspase-1,ASC,IL-1β,IL-18 and inflammatory factors IL-6,TNF-α,HMGB1.Immunofluorescence was used to detect protein expressions of NLRP3,caspase-1,GSDMD,ASC,IL-1β in lung tissue.Results:In the first part,compared with control group,pathological score of pancreas and lung tissue,serum amylase and MPO activity were significantly increased in SAP group(all P<0.05),mRNA expressions of pyroptosis-related molecules caspase-1,ASC,GSDMD,IL-1β,IL-18 and inflammatory factors IL-6,TNF-α,HMGB1 were significantly increased(all P<0.05),protein expressions of NLRP3,caspase-1,GSDMD and IL-1β in lung tissue were significantly increased(all P<0.05),especially in 24 hours after establishment group.In the second part,compared with SAP group,pathological score of pancreas and lung tissue,serum amylase were significantly decreased in octreotide group(all P<0.05),mRNA expressions of pyroptosis-related molecules caspase-1,ASC,IL-1β,IL-18 and inflammatory factors IL-6,TNF-α,HMGB1 were significantly decreased in lung tissue in octreotide group(all P<0.05),protein expressions of NLRP3,caspase-1,GSDMD,ASC and IL-1β in lung tissue were significantly decreased(all P<0.05).Conclusions:Cell pyroptosis is involved in the occurrence and development of lung injury in SAP mice,and octreotide may attenuate lung injury in SAP mice by inhibiting pyroptosis.

OBJECTIVE: In order to distinguish the traditional Chinese medicine Bupleurum falcatum and its adulterants effectively and develop a better understanding of the factors affecting synonymous codon usage, codon usage patterns of chloroplast genome, we determine the complete chloroplast (cp) genome of B. falcatum and clarify the main factors that influence codon usage patterns of 78 genes in B. falcatum chloroplast genome. METHODS: The total genomic DNA of fresh leaves from a single individual of B. falcatum was extracted with EASYspin plus Total DNA Isolation Kit and 2 μg genome DNA was sequenced using Illumina Hiseq 2500 Sequencing Platform. The cp genome of B. falcatum was reconstructed with MITObim v1.8 and annotated in the program CPGAVAS2 with default parameters. Python script and Codon W were used to calculate the codon usage bias parameters. RESULTS: The full length of B. falcatum cp genome was 155 851 bp, 132 different genes were annotated in this cp genome containing 80 protein-coding genes, 30 tRNA genes, and four rRNA genes. The codon usage models tended to use A/T-ending codons. The neutrality plot, ENC plot, PR2-Bias plot and correspondence analysis showed that both compositional constraint under selection and mutation could affect the codon usage models in B. falcatum cp genome. Furthermore, three optimal codons were identified and most of these three optimal codons ended with G/U. CONCLUSION The cp genome of B. falcatum has been characterized and the codon usage bias in B. falcatum cp genome is influenced by natural selection, mutation pressure and nucleotide composition. The results will provide much more barcode information for species discrimination and lay a foundation for future research on codon optimization of exogenous genes, genetic engineering and molecular evolution in B. falcatum.

Objective Effect of hawthorn and melanoidins on the in-vitro growth of Bifidobacterium and E.coli. Methods According to methods of the Chinese pharmacopoeia (2015),the charred hawthorn was prepared. The melanoidins in charred hawthorn were separated and purified by the macroporous resin extraction process. Ultraviolet spectrophotometry was used to detect melanoidins. The gas chromatography was used to detect the effects of hawthorn, charred hawthorn and melanoidins on the content of the acetic acid in Bifidobacterium and E.coli during growth, stable and decay period. Results In the early stage, the effects of hawthorn and charred hawthorn on bacteria were greater than melanoidins. In the middle and late stage, melanoidins inhibited the growth and metabolism of E.coli by changing the generation of acetic acid, and contributed to that of Bifidobacterium and also promoted the generation of acetic acid and regulate the intestinal flora. Conclusion Hawthorn, charred hawthorn and melanoidins all promote digestion by promoting the growth and metabolism of intestinal flora. Among them, charred hawthorn has a better effect on intestinal flora.