Standardized training for specialist is recognized as the growth pathway to clinical medical experts worldwide. The United States has established a comprehensive specialist training system with a detailed assessment and evaluation system. This article introduces the evaluation tools of competency-oriented nephrology specialist training in the United States, including milestones evaluation system and EPAs (entrustable professional activities), which is of great significance for improving the evaluation tools of specialist training in China.

OBJECTIVETo evaluate the effects of environmental low-dose exposure to crocidolite on people's health and the society. METHODS The mortality data of cancer between 1994 and 2003 in an environmental crocidolite-contaminated area was obtained from hospital medical records of Dayao Center for Disease Prevention and Control, and Dayao Public Health Bureau. The years of life lost with premature death (YLLs), was used to measure and assess the death, health losses and social burden of cancer in this area.

RESULTSIn the environmental crocidolite-contaminated area, lung cancer was the prime cause of death in all kinds of cancers between 1994 and 2003, followed by liver cancer, mesothelioma stomach cancer and colorectal cancer, with mortality 10.15/10(5), 9.04/10(5), 8.48/10(5), 3.96/10(5) and 3.55/10(5) respectively. The mortality of main cancer in male and female increased with age growing except that of breast cancer in female. Results showed that the types of leading cancers of YLLs were liver cancer, lung cancer, mesothelioma, leukemia and stomach cancer with YLLs 1981.39 person-year, 1886.63 person-year, 1799.23 person-year, 948.01 person-year and 754.18 person-year respectively. The distribution of YLLs was similar in both sexes, higher in the middle age group (aged from 15 to 44 years and 45 to 59 years) and lower in other age groups. The indirect economic loss resulting from lung cancer (15.02% of the total loss), liver cancer (13.98% of the total loss) and mesothelioma (13.01% of the total loss) was relatively great. The YLLs and the indirect economic loss attributable to environmental low-dose exposure to crocidolite were 3092.23 person-year and 5,175,800 Yuan respectively.

CONCLUSIONLung cancer, liver cancer, mesothelioma, leukemia and breast cancer are the major cancers with an important impact on people's health and premature mortality in the environmental crocidolite-contaminated area. The impact of cancer mortality is more severer in those aged over 45 years. Social burden of cancer is the greatest in persons aged from 15 to 59 years. Policies and plans should be worked out for the protection of environment and the prevention of cancer.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Asbestos, Crocidolite ; adverse effects ; Child ; Child, Preschool ; China ; epidemiology ; Cost of Illness ; Environmental Exposure ; Environmental Pollution ; adverse effects ; Female ; Humans ; Infant ; Life Expectancy ; Male ; Middle Aged ; Neoplasms ; mortality ; Young Adult

OBJECTIVE CYP2D is one of the most abundant subfamily of CYPs in the brain, especially in the cerebellum. Brain CYP2D is responsible for the metabolism of endogenous neurotransmitters such as tyramine and serotonin. Our previous studies have shown brain CYP2D can be regulated by exogenous and endogenous substances with tissue- specificity. The purpose of this study is to examine the effects of cerebral CYP2D on the mice behavior and the regulatory mechanism of brain CYP2D by growth hormone. METHODS Mice received the stereotaxic injection with CYP2D inhibitor quinine in deep cerebellar nuclei of cerebellum. The animals were tested with rotarod apparatus, balance beam, water maze, elevated plus maze and open field. The changes in CYP2D22, PPARαand PPARγ in brain regions and liver were assayed in male growth hormone receptor knockout mice, SH-SY5Y cells and HepG2 cells. RESULTS The inhibition of cerebellum CYP2D significantly affected the spatial learning and exploring ability of mice. Compared with WT mice, CYP2D expression was lower in brain regions from GHR(-/- ) male mice; however, hepatic CYP2D level was similar. Pulsatile GH decreased PPARα mRNA level, and increased mRNA levels of CYP2D6 and PPARα in SH- SY5Y cells. In HepG2 cells, pulsatile GH resulted in decreases in PPARα and PPARγ mRNA levels, but not CYP2D6. PPARα inhibitor induced CYP2D6 mRNA and protein by 1.32-fold and 1.43-fold in SH-SY5Y cells. PPARγ inhibitor decreased CYP2D6 mRNA and protein by 74.76% and 40.93%. PPARα agonist decreased the level of CYP2D22 mRNA in liver and cerebellum, while PPARγ agonist rosiglitazone resulted in diametrically increases. The luciferase assay showed that PPARγ actived the CYP2D6 gene promoter while PPARα inhibited its function. Pulsatile GH declined the binding of PPARα with CYP2D6 promoter by 40%, promoted the binding of PPARγ with CYP2D6 promoter by approximate 60%. The levels of brain and liver PPARα expression in male GHR(-/- ) mice is obviously higher than those in WT mice. The level of PPARγ in male GHR(-/- ) mice was decreased in the frontal cortex and hippocampus, while remained stable in the cerebellum and striatum; meanwhile, PPARγ was increased in the liver. CONCLUSION Brain CYP2D may be involved in learning and memory functions of central system. Masculine GH secretion altered the PPARs expression and the binding of PPARs to CYP2D promoter, leading to the elevated brain CYP2D in a tissue- specific manner. Growth hormone may specifically alter the metabolic and synthetic of important endogenous substances in the central nervous system (such as serotonin) through the specific regulation of brain CYP2D expression.

OBJECTIVETo observe the influence of aminoguanidine on cardiac troponin (cTnI) and nitric oxide (NO) levels in serum and myocardium in severely scalded rats.

METHODSSeventy-two Wistar rats were subjected to 30% TBSA full-thickness scald and randomly divided into scald group(S) and aminoguanidine group (A, with intraperitoneal injection of 40 mg/kg aminoguanidine before scald). The venous blood and myocardial tissue of the rats were harvested for the determination of the level of cTnI and nitrite in both serum and myocardium before scald and at 1, 3, 6, 12 and 24 post-burn hours(PBH). Six sham scalded rats served as control group. The changes in the cTnI level and myocardial function were determined among control group, A and S groups at 6PBH.

RESULTSThe serum level of NO in S group [(59.6 +/- 5.4) micromol/L] was obviously higher than that before scald [(24.6 +/- 0.8) micromol/L, P < 0.01], and it peaked at 6 PBH, then decreased obviously at 24 PBH, which was still markedly higher than that in A group (P < 0.01). The changes in NO level in myocardium were similar to the above tendency. Compared with S group, the level of cTnI was significantly increased in A group at each time-point. Compared with A group at 6 PBH, the inhibition of the cardiac function was relatively reduced in S group at 6 PBH.

CONCLUSIONInhibition of NO synthesis by aminoguanidine aggravates cardiac damage and impairment of cardiac function of scalded rats, indicating that NO exerts protective effect on myocardium at early stage after a scald injury.

Animals ; Burns ; metabolism ; Disease Models, Animal ; Myocardium ; metabolism ; Nitric Oxide ; blood ; metabolism ; Random Allocation ; Rats ; Rats, Wistar ; Troponin T ; blood

OBJECTIVEThe study aimed to evaluate the value of plasma NT-proBNP in diagnosing heart failure in patients with previous myocardial infarction.

METHODSPlasma concentration of NT-proBNP was measured in patients with previous myocardial infarction by ELISA method at admission. Patients were divided into non heart failure group (NYHA class I) and heart failure group (NYHA class II-IV). The NT-proBNP levels were compared between NYHA class I, II, III and IV, and between heart failure group and non heart failure group. ROC analyses were performed to evaluate the diagnosing value of plasma NT-proBNP for heart failure and to identify the optimal cut-off point for diagnosing heart failure patients.

RESULTSTotal 586 patients [aged from 25 - 83 (58 ± 11) years, 80% male] with previous myocardial infarction were enrolled in his study (n = 374 of NYHA class I, n = 99 of NYHA classes II, n = 82 of NYHA class III, n = 31 of NYHA class IV). Plasma NT-proBNP levels in these four NYHA classes were 484.7 (381.6, 647.8) pmol/L, 907.6 (516.6, 1290.3) pmol/L, 1420.2 (879.5, 2336.2) pmol/L, 2442.6 (1695.4, 3670.7) pmol/L, respectively (P < 0.01). The plasma NT-proBNP level in heart failure group was significantly higher than in non heart failure group [1148.2 (707.9, 2145.3) pmol/L vs. 484.7 (381.6, 647.8) pmol/L, P < 0.01]. Plasma NT-proBNP level in patients with age ≥ 60 years was significantly higher than patients with age < 60 years [702.3 (472.4, 1208.5) pmol/L vs. 526.6 (392.1, 855.6) pmol/L, P < 0.01]. ROC analysis showed that the area under the curve (AUC) for diagnosing heart failure was 0.844 (95%CI: 0.809 - 0.880, P < 0.01), the optimal plasma NT-proBNP cut-off point for diagnosing heart failure was 700 pmol/L with a sensitivity of 75.9%, a specificity of 79.9%, an accuracy of 78.3%, a positive predictive value of 67.9% and a negative predictive value of 85.3%. The optimal plasma NT-proBNP cut-off point was 600 pmol/L for patients ≥ 60 years old and 800 pmol/L for patients < 60 years old.

CONCLUSIONPlasma NT-proBNP level is a valuable parameter for diagnosing heart failure in patients with previous myocardial infarction.

Adult ; Aged ; Aged, 80 and over ; Female ; Heart Failure ; diagnosis ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; diagnosis ; Natriuretic Peptide, Brain ; blood ; Peptide Fragments ; blood ; Predictive Value of Tests ; Sensitivity and Specificity

A rapid and accurate method of DNA typing for HLA was established to compensate the unsatisfactory serological typing for HLA before transplantation. DNA typing for HLA using by reverse polymerase chain reaction with sequence-spcific oligo probe (reverse PCR-SSOP) could detect HLA-A(*0101 - 8001) and B(*07021 - 8201). The results showed that HLA-AB alleles were successfully analysed in 60 matching subjects and 16 control DNAs from UCLA by reverse PCR-SSOP without false negtive and false positive results. The results were concordance with those of UCLA. The error rate of serological typing was 6.4% for HLA-A and 7.4% for HLA-B. The serological typing missed HLA-A24 and HLA-B46 for two patients with leukemia respectively. Our results suggest that DNA typing for HLA by reverse PCR-SSOP has proved to be a high-resolution, high-specificity, rapid and accurate technique, suitable for clinical application with a greater precision than serological typing.

OBJECTIVETo explore the mechanism of electroacupuncture(EA) at "Fenglong" (ST 40) in hyperlipidemia (HLP) rats.

METHODSForty health SD rats were randomly divided into a normal control group (group A), a high fat forage feed group (group B) and a high fat forage feed treatment group (group C), a high fat forage + normal forage feed group (group D) and a high fat forage + normal forage feed treatment group (group E), eight rats in each group. EA was applied at "Fenglong" (ST 40) for the rats in group C and group E, once daily. After treatment of 30 days, blood lipid levels of rats, including total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) in plasma were tested. Real time polymerase chain reaction (RT-PCR) and Western Blotting were applied to detect the gene expression changes of the contents of ATP-binding cassette transporter A1 (ABCA1), peroxisome proliferator-activated receptor alpha (PPARalpha), liver X receptor alpha (LXR-alpha) and retinoid X receptor alpha (RXR-alpha) in liver tissue of rats.

RESULTSCompared with group A, the contents of TC, LDL-C were significantly elevated in group B and group D (all P < 0.01); compared with group B, above indices were significantly decreased in group D (all P < 0.01). After the treatment of EA at "Fenglong"(ST 40), the contents of TC, LDL-C were significantly decreased (all P < 0.01), and the contents of TG, HDL-C did not change obviously (all P > 0.05). Compared with group A, the mRNA and protein contents of ABCA1, PPARalpha, LXR-alpha and RXR-alpha were decreased obviously in group B and group D (all P < 0.01). But compared with group B, the above indices were decreased in the group D. There were signficantly increasing in the protein content of ABCA1, PPARalpha, RXR-alpha and LXR-alpha mRNA after the treatment of EA (all P < 0.05).

CONCLUSIONEA at "Fenglong" (ST 40) has some therapeutic effect on decrease the content of TC, LDL-C in rats of hyperlipemia and improve the gene expression of ABCA1, PPARalpha, LXR-alpha and RXR-alpha mRNA so as to promote reverse cholesterol transport.

ATP-Binding Cassette Transporters ; genetics ; Acupuncture Points ; Animals ; Cholesterol ; blood ; Cholesterol, HDL ; blood ; Electroacupuncture ; Humans ; Hyperlipidemias ; blood ; genetics ; metabolism ; therapy ; Male ; PPAR alpha ; genetics ; metabolism ; Rats ; Rats, Sprague-Dawley ; Triglycerides ; blood

Objective: To analyze the trend of adolescent health risk behaviors in Shanghai, and to provide reference for the comprehensive intervention of middle school students health risk behaviors. Methods: Based on the health risk behavior questionnaire of Chinese Center for Disease Control and Prevention, the questionnaire was adapted according to the actual monitoring needs. It was divided into junior high school version and senior high school version. From 2004 to 2019, using the method of multistage stratified cluster random sampling, 59 209 middle school students who completed the questionnaire in 6 surveys were selected for analysis. Results: From 2004 to 2019, in the 7 days prior to the survey, 9.2%-50.6% of middle school students drank a glass of soda more than or equal to once a day and 54.2%-76.1% of middle school students reported eating dessert twice or more. Within 7 days, 48.3%-60.7% of middle school students had≥60 min of exercise per day for less than or equal to 3 days, and 16.1%- 35.2% of middle school students reported too much extracurricular activities, and the reporting rate increased year by year with the annual percent change ( APC ) of 5.15%( t =9.28, P <0.01). The reporting rate of long time online learning was 6.0%-13.6%, which showed an upward trend among high school students, with the APC of 5.35%( t =3.14, P <0.05). The reporting rate of middle school students pedestrian safety problems decreased from 69.1% in 2004 to 27.6% in 2019, with the APC of -6.28%( t =-8.18, P <0.01), but the reporting rate of cycling safety problems have increased in recent years. The reporting rate of intentional injury behaviors decreased by year such as fighting, bullying, etc. The reporting rate of initial smoking age ≤13 years old decreased, but attempted drinking behavior increased in junior middle school students, and the APC was 1.61%( t =3.48, P <0.05). A total of 1.6%-3.4% of middle school students had an Internet addiction behavior tendency. The detection rate of Internet addiction tendency was increasing in high school students and girls, and APC was 6.59% and 10.29% respectively( t =6.37, 8.62, P <0.01). Conclusion From 2004 to 2019, unintentional injury behavior, intentional injury behavior and substance addiction behavior of middle school students in Shanghai have improved. However, unhealthy diet and physical inactivity are still high. In the follow up. It need to focus on adverse diet and lack of physical activity behavior and take comprehensive intervention measures to control them.

Objective To investigate the ability of magnetic resonance imaging (MRI) in tracking magnetically labeled mesenchymal stem cells (MR-MSCs) in a swine myocardial infarction (MI) model.Methods Adult Chinese mini-pigs (n = 6) were subjected to open-chest experimental MI operation.Their antegeneic bone marrow-derived mesenchymal stem cells ( MSCs ) was cultured and doubly labeled with ferumoxides and DAPL On the 14 th day after MSCs transplantation, the size and location of the myocardial infarction were assessed by using delayed-enhancement MRI (DE-MRI). Then the labeled MSCs were injected intramyocardially into peri-infarct zone and normal myocardium. At 24 hrs and 3 weeks after injection, the contrast and the volume of the MR-MSCs hypointense lesion from the MR images were acquired, and the contrast was determined using the difference in signal intensity between the hypointense and normal myocardium divided by signal intensity of the normal region.After humane euthanasia, the heart was excised and histology corresponding to MRI slices that demonstrated MR-MSCs lesions was performed.Repeated-measures ANOVA and a paired t test were used for comparison of the contrast and the volume of the MR-MSCs hypointense lesion at different time points. Comparisons between independent groups were performed with the standard Student t test.Results The labeling efficiency of ferumoxides and DAPI was 100% . On the 14 th day after the MI operation, the average percentage of infracted myocardial area was (33.6±8.9)% .Twenty- four hours after MSCs transplantation, MSCs injection sites appeared as ovoid hypointensive lesions with sharp border on T2 * images. At 24 h after injection, the signal contrast [(67.00±5.48)% vs (61.92 ±7.76)%,t = 1.65,P =0.1158] and the size [(0.56 ±0.24) cm2 vs (0.52 ± 0.25 ) cm2, t = 0.39, P = 0.7044 ] of the lesions showed no statistical difference between the peri infarct zone and the normal myocardium.At 3 weeks after injection, the signal contrast decreased and the size diminished both in the peri-infarct zone and in the normal myocardium. Moreover, the contrast of the lesions in peri-infarct zone decreased more significantly than that in normal myocardium [(26.88 +7.27)%vs (15.00 :t:4.51)%, F =20.08, P =0.0003].Post mortem analysis found the fluorescontly labeled MSCs demonstrated on histological sections.There were much more dense fluorescently labled MSCs per high power fields at injection sites of normal myocardium than at injection sites of peri-infarct zone [ (106 ±25 )/HPF vs ( 143 ± 31 )/HPF, t = - 2.47, P = 0.0293 ].In MSCs injection sites of the peri-infarct zone,the capillary density was significantly higher than that in control sites [ (13.4 ± 4.0 )/HPF vs (9.4 ±3.1 )/HPF, t = 2.49, P = 0.0229].At 3 weeks after injection, ferumoxide was contained within partial original MSCs.Conclusion Magnetic resonance imaging of MSCs is a feasible method for the in vivo tracking of transplanted stem cells and could reflect the tendency of the local stem cell quantity, but there still has limitation for the semi-quantitation of the transplanted stem cells.

OBJECTIVETo evaluate the roles of plasma mast cell carboxypeptidase and chymase in the diagnosis of allergic diseases by measuring the contents of both in children.

METHODSA total of 59 children with allergic diseases and 53 healthy children were recruited into the study. Plasma levels of mast cell carboxypeptidase and chymase were measured using ELISA.

RESULTSThe plasma levels of mast cell carboxypeptidase and chymase in children with allergic children were 1.089 ± 0.752 ng/mL and 0.905(0.375-2.318) ng/mL, respectively, which were significantly higher than those in healthy children [0.593 ± 0.380 ng/mL and 0.454 (0.097-1.077) ng/mL respectively; P<0.05]. There was a significantly positive correlation between plasma mast cell carboxypeptidase and chymase levels in children with allergic diseases (r=0.684, P<0.01).

CONCLUSIONSPlasma levels of mast cell carboxypeptidase and chymase increase in children with allergic diseases, suggesting that mast cell carboxypeptidase and chymase may serve as the indexes for the diagnosis of allergic diseases.

Adolescent ; Carboxypeptidases ; blood ; Child ; Child, Preschool ; Chymases ; blood ; Female ; Humans ; Hypersensitivity ; diagnosis ; enzymology ; Infant ; Infant, Newborn ; Male ; Mast Cells ; enzymology