OBJECTIVETo compare the efficacy of high and low dose atorvastatin on preventing contrast induced nephropathy (CIN) in patients underwent diagnostic and therapeutic coronary intervention.

METHODSAll patients received atorvastatin 10 mg/d on the basis of hydrated therapy (n = 100) and high dose group received additional atorvastatin 80 mg at 12 to 24 hours before procedure (n = 50). Scr, Ccr, blood beta(2)-M, urine NAG/Cr, and urine osmolality before and after the procedure were compared between the groups.

RESULTSBaseline demographic characteristics and nephropathy risk factors were similar between groups. Ccr was significantly reduced while blood beta(2)-M and uric NAG/Cr were significantly increased in low dose group (all P < 0.05). Blood beta(2)-M in the high dose group was significantly lower than that in the low dose group at day 1 [(2.35 +/- 0.52) mg/L vs. (2.67 +/- 0.64) mg/L, P = 0.008], day 3 [(2.49 +/- 0.55) mg/L vs. (2.80 +/- 0.64) mg/L, P = 0.011] and day 5 [(2.29 +/- 0.53) mg/L vs. (2.56 +/- 0.66) mg/L, P = 0.026] post-procedure respectively;urine NAG/Cr in the high dose group was also significantly lower than that in the low dose group at day 1 [(1.19 +/- 0.30) U/mmol vs. (1.46 +/- 0.34) U/mmol, P < 0.001], day 3 [(1.30 +/- 0.30) U/mmol vs. (1.59 +/- 0.33) U/mmol, P < 0.001], and day 5 [(1.10 +/- 0.30) U/mmol vs. (1.34 +/- 0.35) U/mmol, P = 0.001] post-procedure respectively;Ccr in the high dose group was significantly higher than that in the low dose group at day 1 [(73.69 +/- 20.99) ml/min vs. (65.19 +/- 18.72) ml/min, P = 0.035], day 3 [(64.04 +/- 15.82) ml/min vs. (56.79 +/- 14.50) ml/min, P = 0.019]post-procedure respectively.

CONCLUSIONHigh dose atorvastatin use before angiography is superior than low dose atorvastatin on attenuating contrast induced renal dysfunction.

Aged ; Atorvastatin Calcium ; Contrast Media ; adverse effects ; Coronary Angiography ; methods ; Female ; Heptanoic Acids ; administration & dosage ; therapeutic use ; Humans ; Kidney Diseases ; chemically induced ; prevention & control ; Kidney Failure, Chronic ; chemically induced ; prevention & control ; Male ; Middle Aged ; Pyrroles ; administration & dosage ; therapeutic use

Mastery learning is a competency-based mixed education method, which divides complex medical education contents into several teaching units according to the degree of difficulty and sets minimum passing standard for each teaching unit. Formative assessment was used to evaluate whether the learners had reached the mastery standard and finally mastered the knowledge through pass-continue or fail-repeat approach. The learners who had reached the mastery standard were usually able to use their knowledge more freely in clinical practice, and were able to accomplish more complex tasks through their own judgment with less supervision.

OBJECTIVETo investigate the clinical, pathological and genetic characteristics in a family with autosomal dominant Emery-Dreifuss muscular dystrophy (AD-EDMD).

METHODSClinical data and skeletal muscle specimens were collected from two patients (the proband and her daughter) for pathological analysis. DNA samples of the proband and her family members (7 persons from 3 generations) were obtained for PCR amplification and direct DNA sequencing of the lamin A/C (LMNA) gene. Haplotype analysis was performed after the identification of mutation.

RESULTSThe proband had typical clinical manifestation of EDMD: joint contracture, progressive muscle weakness and atrophy and cardiac conduction dysfunction. Muscular pathology revealed myopathic changes combined with slight neuropathic changes. A heterozygous missense mutation 1583 (C to G)(T528R) was identified in exon 9 of the LMNA gene in the two patients, but not in other family members. Haplotype analysis indicated that the proband and her daughter shared the same causative haplotype.

CONCLUSIONThis is the first report of the phenotype and genotype of AD-EDMD in Chinese.

Adult ; Asian Continental Ancestry Group ; genetics ; Base Sequence ; Child ; DNA Mutational Analysis ; Female ; Haplotypes ; genetics ; Heterozygote ; Humans ; Immunohistochemistry ; Male ; Muscular Dystrophy, Emery-Dreifuss ; genetics ; metabolism ; pathology ; physiopathology ; Mutation ; Pedigree ; Phenotype

This study was aimed to investigate the effect of SNS-032 (C17 H24 N4O2S2) on cell cycle, apoptosis, differentiation and self-renewal of hematopoietic stem cells (HSC) in mice. The self-renewal capability of bone marrow cells was measured by cobblestone forming cell test. The expressions of self-renewal regulation genes, cell cycle-related genes, apoptosis-related genes were measured by real-time PCR. The cell cycle status and apoptosis of HSC and HPC were detected by flow cytometry. The results showed that there was no significant difference of the frequency of HSC between SNS-032 and control group. The expressions of CDK1, CDK2, CDK7 and p27 decreased in HSC (P < 0.05) while the expressions of CDK4, CDK6, p21, p18, p19, Bcl-2, Bax, Puma, p53, Bim1, Sall4 and Notch1 showed no difference between SNS-032 group and control group (P > 0.05). The fraction of viable HSC in each phase of cell cycle remained unchanged after the treatment of SNS-032 (P > 0.05). Furthermore, there was no statistical difference in the apoptotic fractions between control and drug-treated groups (P > 0.05). It is concluded that SNS-032 induce apoptosis of cancer cells. Interestingly, SNS-032 has no significant inhibitory effect on self-renewal and differentiation of normal HSC, as well as no obvious effect inducing apoptosis of normal HSC and HPC.
Animals ; Apoptosis ; drug effects ; Apoptosis Regulatory Proteins ; metabolism ; Cell Cycle ; drug effects ; Cell Cycle Proteins ; metabolism ; Cells, Cultured ; Hematopoietic Stem Cells ; cytology ; drug effects ; Mice ; Mice, Inbred C57BL ; Oxazoles ; pharmacology ; Thiazoles ; pharmacology

Objective To evaluate the application of spacer oligonucleotide typing (Spoligotyping) and mycobaeterial interspersed repetitive unit-variable-number tandem repeat (MIRU-VNTR) analysis in the molecular-epidemiological study of tuberculosis and to discuss the characteristics of pediatric Mycobacterium (M.) tuberculosis strains in Chongqing. Methods M. tuberculosis strains isolated and typed by Spoligotyping and MIRU-VNTR respectively, from the children patients in Chongqing and to compare the results from both methods, epidemiologically. Results By means of Spoligotyping, 210 clinical isolates were divided into 2 gene groups, displaying 44 genotypes. Among them, the biggest group was M. tuberculosis Beijing family, including 130 strains (61.90%) ,using the Spoligotyping. From the results of MIRU-VNTR, 24 loci showed different polymorphism and the HGI of different loci set (12 old loci, 15 basic loci and 24-loci set) increased accordingly. The subtle difference in HGI was originated from one locus ETR-B, which was included in the 24-locus system. The diversity of each loci and MIRU-VNTR set for non-Beijing genotype strains was higher than that of the Beijing genotype strains. Conclusion In this study, it was preliminarily confirmed the existence of high polymorphism of M. tuberculosis while the Beijing Family was the main genotype and main prevalent strain in children of Chongqing area. Spoligotyping prior to 15-locus with ETR-B combination seemed more suitable for the massive epidemiological investigation of pediatric tuberculosis patients.

Objective To investigate the immediate oral feedback after objective structure clinical examination (OSCE) for postgraduate year 1 & 2 surgery residents (PGY1 & 2).Methods 37 PGY1 and 38 PGY2 wereevaluated.The examination was composed of 6 stationsand limited to15 minutes per station.Each station was evaluated by centesimal system score.Immediate oral feedback was given in the last2 minutes.A questionnaire was given to each resident and examiner at the end of OSCE.All data analyses were conducted using SPSS version 22.0,repeated measures ANOVA and LSD test were used,and correlations were tested by the Pearson correlation test.Results The average scores for PGY1 & 2 were (68.97 ± 5.40) and (68.35 ± 5.00),the between-and inter-round differences in average score were not statistically significant.There was no significant correlation about theevaluation of the residents' performance during OSCE between the examiners and the residents.The necessity and effectiveness of immediate oral feedback were confirmed by both the examiners and the residents.Conclusions Immediate oral feedback isfeasible with limited impact on OSCE score,but the plan should be furtherrefined.Follow-up study isnecessary to identify the long-term effect on the clinical competency.

【Objective】Diabetes mellitus is a risk equivalent for coronary heart disease. This retrospective study was designed to investigate the risk factors of the progression of coronary lesions in patients with type 2 diabetes（T2DM）and Non- diabetes Mellitus（NDM）.【Methods】 526 patients with T2DM and 425 patients with NDM at the Third Affiliated Hospital of Sun Yat-sen University between March 2001 and January 2017 who underwent coronary imaging studies（coronary angiography or coronary CTA）twice during the same period were enrolled. The effects of cardiovascular risk factors on the progression of coronary lesions were analyzed in parallel in these two types of patients.【Results】Risk factors of the progression of coronary lesions in T2DM patients included smoking（OR = 1.836，95% CI：1.030~3.371，P = 0.04），Lp（a） ［OR = 1.001，95% CI：1.000~1.002，P = 0.004（baseline）；OR = 1.001，95% CI：1.000~1.002，P = 0.009（re-examined）］，HbA1c leve［l OR = 1.471，95% CI：1.030~2.100，P = 0.034（re-examined）］，uncontrolled LDL-C（OR = 1.882，95% CI：1.091~3.245，P = 0.023），TC［OR = 2.029，95% CI：1.028~4.008，P = 0.041（re-examined）］and low HDL-C ［OR = 0.017，95% CI：0.040~0.729，P = 0.017（re-examined）］. Comparative risk factors in NDM included BMI［OR =1.746，95%CI：2.462~2.712，P = 0.026（baseline）；OR = 0.001，95%CI：0~0.394，P = 0.025（re-examined）］，uncontrolled LDL-C（OR = 2.875，95%CI：1.669~4.952，P < 0.001）and low ApoA［OR = 0.282，95%CI：0.082~0.971，P = 0.045 （baseline）；OR = 0.117，95%CI：0.038~0.835，P = 0.029（re-examined）］. Lowest level of progression was found in the group with HbA1c<6.5%［0（0~3.4）points/year vs 0.3（0~3.0）points/year vs 1.0（0~5.1）points/year，P = 0.049. 0（-0.4~2.7）points/year vs 0.6（0~4.0）points/year vs 0.9（0~4.2）points/year，P=0.029］in T2DM patients.【Conclusion】Except for achievement of LDL- C goals，there might be some differences in risk factors for progression of coronary lesions between T2DM and NDM patients. Smoking，Lp（a），TC，HDL- C and control levels of HbA1c are independent predictors in T2DM as well as BMI and ApoA in NDM. Lowering HbA1c to less than 6.5% may delay progression of lesion.

This study was to investigate the effects of DAPT (N-[N-(3,5-difluorophenacetyl-L:-alanyl)]-S-phenylglycine-butyl ester) on cell cycle, apoptosis, differentiation and expansion of hematopoietic stem cells (HSC) of mouse and to elucidate the possible mechanisms. The mRNA expressions of cell cycle-related genes p18, p21, p27, CDK1, CDK2, CDK4, CDK6, and apoptosis-related genes Bcl-2, Bcl-xl, mcl-1, Bax, Bim, p53, Puma were measured by real-time PCR. The cell cycle and apoptosis of Lin(-)c-kit(+)Sca-1(+) marked cells and CD34(-)Lin(-)c-kit(+)Sca-1(+) marked cells in bone marrow cells were detected by flow cytometry. The differentiation level of HSC was determined by single cell culture. The expansion of HSC were measured with long-term culture. The results indicated that the mRNA expression of the cell cycle related-genes CDK1, CDK2, CDK4, CDK6, p27 in Lin(-) c-kit(+)Sca-1(+) marked cells increased (P < 0.05), the expression of p18, p21 decreased (P < 0.05), the expression of the apoptosis related-genes Bcl-2, Bcl-xl, Bax, p53, Puma in Lin(-) c-kit(+)Sca-1(+) marked cells increased (P < 0.05), the expression of Bim decreased (P < 0.05), the expression of Mcl-1 had not changed (P > 0.05) after treatment with DAPT 1 µmol/L for 5 d. The changes of cell cycle of Lin(-)c-kit(+)Sca-1(+) marked cells in bone marrow had no statistical significance after treatment with DAPT 1 µmol/L for 5 d, CD34(-)Lin(-)c-kit(+)Sca-1(+) marked cells in bone marrow at G(0) phase decreased and at G(1) phase increased after treatment with DAPT 1 µmol/L for 5 d (P < 0.05); the apoptotic fractions of Lin(-) c-kit(+) Sca-1(+) marked cells and CD34(-)Lin(-)c-kit(+)Sca-1(+) marked cells in bone marrow increased after treatment with DAPT 1 µmol/L for 5 d (P < 0.05). The changes of colony number, average number of cells in wells and their differentiation had no statistical significance (P > 0.05) after treatment with DAPT 1 µmol/L for 10 d. Expansion of HSC in bone marrow of mouse decreased after treatment with DAPT 1 µmol/L for 3 d. It is concluded that DAPT not only enhances the exhaustion of CD34(-)Lin(-)c-kit(+)Sca-1(+) marked cells in bone marrow cells of mouse, but also enhances the apoptosis of Lin(-)c-kit(+)Sca-1(+) marked cells and CD34(-)Lin(-)c-kit(+)Sca-1(+) marked cells in bone marrow cells of mouse. DAPT also reduces the expansion of HSC. However, the changes of survival and differentiation of single CD34(-)Lin(-)c-kit(+)Sca-1(+) marked cells in mouse bone marrow cells have no statistical significance.
Animals ; Apoptosis Regulatory Proteins ; metabolism ; Bone Marrow Cells ; metabolism ; Cell Cycle Proteins ; metabolism ; Dipeptides ; pharmacology ; Hematopoietic Stem Cells ; drug effects ; metabolism ; Mice ; Mice, Inbred C57BL ; Signal Transduction

Humans ; Hydrogen-Ion Concentration ; Malassezia ; growth & development ; physiology ; Staphylococcus epidermidis ; growth & development ; physiology

Objective To study the clinical and pathological features and pathogenesis of mitochondrial disorders (MIDs).Methods The clinical,laboratory,pathological and ultrastructure characteristics of 29 patients with MIDs,admitted to our hospital from 2005 to 2012,were analyzed.Results Main clinical manifestations of MIDs were exercise intolerance,amyosthenia,amyotrophy,external ophthalmoplegia and disturbance of intelligence,psychonosema,epilepsy and cerebral apoplexy;serum creatine kinase (CK) levels were normal or high; lactic acid levels were increased in many patients;myogenic or neurogenic changes/normals were showed by electromyograph examinations; part of them were with EEG abnormalities; MRI showed that encephalatrophy,myelinopathy and multifocal lesions not conforming to the distribution of major arteries existed.In muscle biopsy,plenty of ragged red fibers (RRF) scattered; the activity of cytochrome coxidase (COX) was decreased or absent in some fibers; in the succinodehydrogenase (SDH) stained small vessels,strong SDH-reactive blood vessels (SSV) was observed.Transmission electromicroscope analysis revealed that disordered mitochondria were markedly increased.Conclusions The clinical manifestations of MIDs are some diseases with multisystem disorders and their main symptoms include muscle and brain changes.Plenty of RRF scatter or SSV phenomenon is the main pathology.Skeletal muscle biopsy and pathological analysis are trustworthy methods for the definite diagnosis of MIDs; clinical manifestations often provide clews for typing and gene analysis.