Hierarchical medical system is a high priority in China ’s health reform,bearing significant impacts on remolding of its healthcare system,in which tertiary public hospitals must redefine its role.Five strategies have been proposed as follows:the first is internal management;The second is high-tech;Third is paring assistance;Fourth is telemedicine;Fifth is better medical conditions.

BACKGROUND: Long-term sustained release naltrexone has been reported in clinical application near one year that it can improve emotional state and relieve addiction; therefore, the effect of long-term sustained release naltrexone on memory restoration at neuropsychology level were explored. OBJECTIVE: To observe the effect of long-term sustained release naltrexone on memory ability of opioid addicts. DESIGN, TIME AND SETTING: A contrast observational study was performed at Drug Rehabilitation Centers of Wuhan, Changde, Zhengzhou, and Jiangyang between October and December 2006. Healthy controls were tested in Shenzhen Hospital of Peking University in October 2006. PARTICIPANTS: A total of 88 males with opioid addicts were divided into naltrexone group (n=35), compulsory detoxification group (n=26), and non-treatment group (n=27). Another 22 healthy subjects were considered as the controls. METHODS: At 6-12 months before testing, naltrexone (3.1 g) was subcutaneously implanted into bilateral abdominal wall in the naltrexone group; patients in the compulsory detoxification group underwent completely compulsory detoxification for 6 months, and the examination results, including diamorphine, methadone, and buprenorphine in urine, were negative on the immediately testing day. Event related potential and its wave form were recorded from the opioid addicts in the three groups and from healthy controls who finished semantic recognition between new and old words using portable-type event related potential working system. MAIN OUTCOME MEASURES: Correct rate and response time of semantic memory; latency and amplitude of language related potential-N400. RESULTS: ①There were significant differences in correct rate and response time between three expedmental groups and healthy control group (P ＜ 0.001 ); in addition, correct rate was significantly increased, and response time was significantly shortened in the naltrexone group compared to compulsory detoxification group and non-treatment group (P＜ 0.05). ② N400 latency in the three experimental groups was significantly longer than healthy control group (P ＜ 0.01), while N400 amplitude in the naltrexone group was increased, which was no significant difference compared to healthy control group (P> 0.05) but was significant difference compared to compulsory detoxification group and non-treatment group (P ＜ 0.01). CONCLUSION: Long-term sustained release naltrexone can effectively improve neural function and enhance semantic memory of the opioid addicts.

Objective To assess the risk factors of intradialytic-hypotension (IDH) among maintaining hemodialysis (MHD) patients and to explore the relation between NT-proBNP and IDH,thus to provide clinical evidence for the prevention and treatment of IDH.Methods A total of 202 MHD patients during March 2009 to May 2009 in our dialysis center were enrolled in the study.Intradialytic blood pressure (BP) was measured during a 3-month period.IDH was defined as an event characterized by a sudden drop in systolic BP more than 20 mm Hg or in mean artery pressure (MAP) more than l0 mm Hg.Logistic regression analysis was used to assess the risk factors of IDH.ROC curve was used to evaluate the diagnostic efficacy of serum NT-proBNP.Results The incidence of IDH was 42.1％.One hundred and seventeen patients with no-IDH (＜1/10 hypotensive events per 3 months) were served as controls.Fifty-five patients with o-IDH (≥ 1/ 10 but ≤1/3 hypotensive events per 3 months) and 30 patients with f-IDH (＞1/3 hypotensive events per 3 months) were identified among 202 patients.Multivariate regression analysis showed that age,gender,ultrafiltration rate,serum NT-proBNP,serum albumin,aortic root dimension (AoRD) were associated with IDH among MHD patients.Serum NT-proBNP was positively correlated with IDH.The area under the ROC curve (AUC) of NT-proBNP was 0.76 (95％ CI 0.69 to 0.83,P＜0.01).The cut-off value of serum NT-proBNP for IDH was 1746.5 ng/L,with a sensitivity of 88.61％ and a specificity of 51.10％.Furthermore,the AUC of NT-proBNP for f-IDH was 0.65 (95％ CI 0.53 to 0.763,P＜0.01).The cut-off value of serum NT-proBNP for f-IDH was 8208.0 ng/L,with a sensitivity of 33.33％ and a specificity of 91.30％.Conclusions Elderly,female,high ultrafiltration rate,high level of serum NT-proBNP,hypoalbuminemia,shorter AoRD are independent risk factors of IDH among MHD patients.Serum NT-proBNP can be used as a predictor of IDH.

Objective To investigate the effects and relations of carvedilol on heart rate turbulence and secretion of sympathetic nerve in patients with myocardial infarction. Methods Sixty-six patients selected with acute myocardial infarction were randomized to enroll into experimental group ( n = 33 ) treated with earvedilol and control group( n = 33 ) treated with metoprolol for 12 months follow-up treatment. The concenrrarions of plasma norepinephrine(NE) and epinephrine (E) and 24 hour Holter monitoring were messured respectively before the treatment ,after 6 months and 12 months; and new cardiac events were supervised for all cases. Quantification of heart rate turbulenee(HRT) were carried out by computer analyzing two factors: turbulence onset(TO) and turbulence slope(TS) from the data of 24 hour Holter monitoring. NE,E,TO,TS and the occurrence rate of new cardiac events were compared between two groups and in different times of treatment. The correlation between TO,TS and NE,E was analysed. Results Before the treatment, there was no significant differences between two groups to the comparisons of NE,E,TO and TS(P＞0.05). After treating 6 and 12 months, NE, E and TO of experimental group were all lower than control group's significantly, accordingly TS were all higher(P＜0.05). By comparing 3 times( before,after 6 and 12 months of treatment), NE, E and TO of two groups dropped, meanwhile TS rose; experimental group showed significant changes( P＜0.05 ), but control group showed no significant differences(P＞0.05 ). The occurrence rate of new cardiac events of experimental group was lower than control group's significantly (P＜0.05 ).There was significant correlation between NE, E and TO, TS (P＜0.05 ). Conclusion Carvedilol treatment can block the secretion of sympathetic nerve after myocardial infarction and prevent the occurrences of new cardiac events significantly; the changes of the secretion of sympathetic nerve can play an important role for heart rate turbulence (HRT) ,the changes of HRT would be hopeful to predict new cardiac events alter myocardial infarction.

Objective To study the effects of carvedilol on the stability of plasma catecholamine in patients with post-acute myocardial infarction during consecutive periods. Methods Thirty-slx patients selected with acute myocardial infarction were randomized to experimental group treated with the nonselective beta-blocker earvedilol( n=18) and control group treated with the selective beta-blocker metoprolol(=18) for 12-months follow-up. In the two groups,the concentrations of plasma norepinephrine and epinephrine were measured before the treatment and after 2 months,4 months,6 months,8 mouths,10 months and 12 months and new cardiac events were supervised. Results After the treatment, in each point of periods, experimental group showed lower concentrations of plasma norepinephrine and epinephrine statistically than control group(P<0.05) ,and a stable dynamic change during 12 months of treat-ment( P>0.05 ) ;the occurrence rate of new cardiac events was lower significantly in experimental group than in con-trol group(P<0.05). Conclusion Carvedilol can decrease the spillover of sympathetic nerve, control more stably cardiac sympathetic nerve activity and then decrease more sharply the occurrence rate of new cardiac events in pa-tients with acute myocardial infarction than metoprolol.

Objective:To investigate the effects of ursolic acid (UA) on the proliferation and differentiation of osteoclasts (OC), and to explore its role in orthodontic force-induced root resorption and its relationship with OC.Methods:The mononuclear / macrophage cells RAW264.7 were induced to the OC.Tacrolimus acid phosphatase (TRAP) staining and bone resorption lacunae observation were used to identify the induction.CCK-8 method was used to select the appropriate concentration of UA for RAW264.7 cell-free biotoxicity and to observe its effect on the proliferation and differentiation of RAW264.7.In experimental groups, UA with gradient concentrations (1.0,2.5,5.0,10.0,20.0and 40.0 μmol·L-1)were added.UA was not added in control group.Results:The TRAP staining and bone resorption lacunae observation showed that after the RAW264.7 cells were induced for 5 d, the TRAP staining positive cells were found;the resorption lacunae were rounded,and oval, etc,the bottom wall was coarser,and the boundary was clear,which indicated that the RAW264.7 cells were successfully differentiated into the osteoclasts.The CCK-8 detection results showed that high concentration of UA (> 10.0 μmol·L-1) significantly inhibited the proliferation of OC;the appropriate concentration of UA (5.0 μmol·L-1) was in the biological safety concentration range and could inhibit the OC proliferation;low concentration of UA (<2.5 μmol·L-1) had no effect.Conclusion:RANKL can induce the differentiation and maturation of RAW264.7 cells.UA is correlated with the proliferation and differentiation of OC;UA has inhibitory effect on OC at the appropriate concentration (5.0 μmol·L-1) in a time-dependent manner.

Objective:To study the changes of oral health indexes in adolescent orthodontic patients under different brushing time, and to provide basis for the orthodontists to give effective dental health promotion in clinic.Methods:A total of 123 adolescent orthodontic patients were included, and they were divided into 1-3min, 3-5 min, 5-7 min and 7-10 min groups based on the brushing time recorded in the period of orthodontic treatment.The relationship between different brushing time and oral health indexes was evaluated 1,3,and 6 months after experiment, such as sulcus bleeding index(SBI),plaque index(PLI), debris index-simplified(DI-S) and enamel demineralization index(EDI).Results:Compared with 1-3 min and 3-5 min groups, the SBI, PLI, and DI-S of the patients in 5-7 min group were significantly reduced(P<0.05).There was no significant differences of SBI, PLI, DI-S , and EDI between 5-7 min group and 7-10 min group (P>0.05).Conclusion:Brushing teeth more than 5 min can improve the oral hygiene significantly and the best time is 5-7 min;the orthodontists should require the patients to brush teeth at least for 5 min.

Objective To search for the neutralizing epitopos on hepatitis E virus (HEV) capsid besides the known neutralizing epitope (aa459-606). Methods By analysis of several strains of monoclonal antibodies against HEV capsid and their recognized epitopes, the neutralizing activity of epitope (aa394-458) at N-terminus was compared with that of an immunodominant neutralizing epitope (an459-606). Re-suits The research showed a novel potential neutralizing epitope in aa423-437 of HEV ORF2 though detec-ting and comparing the characteristics of several antibodies and corresponding determinations. The epitope is a linear non-immunodominant epitope which is different from the other neutralizing epitope in aa459-606.And the amino acids sequence of this novel epitope is conservative. Conclusion ORF2 aa423-437 is a no-vel potential neutralizing leaner epitope of HEV. It is believed that the present work adds fundamental knowl-edge to our understanding of HEV capsid domain and contributes to the prevention and control of this dis-ease.

OBJECTIVE: To report the clinical manifestation and genetic characteristics of a child with Thiamine metabolism dysfunction syndrome 5. METHODS: Clinical data and genetic results were collected and analyzed. Peripheral blood samples of the child and their parents were collected for whole exome sequencing, and the functional effect of the variants on the TPK1 enzyme activity was verified by an in vitro assay. RESULTS: A four-year-old boy presented with preschool onset of ataxia were characterized. High-throughput sequencing identified a novel homozygous variant of TPK1 gene c.382G>A (p.Leu128Phe). His father and mother were both found carrying the variant. The variant protein showed a 30.9% reduction in TPK1 enzyme activity compared with the wildtype. CONCLUSION A novel pathogenic variant has been identified in a boy with thiamine metabolic dysfunction syndrome type 5.
Child, Preschool ; Genetic Testing ; Homozygote ; Humans ; Male ; Mutation ; Thiamine ; Whole Exome Sequencing

Objective To analyze the clinical phenotypes and mutation types of children with X-linked Alport syndrome(XLAS)with mutations in COL4A5 gene,and to explore the relationship between children with XLAS and nephrotic syndrome nephritic type.Methods Thirty-two children with COL4A5 gene mutations detected by second-generation sequencing and finally diagnosed with Alport syndrome at Guangzhou Red Cross Hospital affiliated with Jinan University and the First People's Hospital of Guangzhou between April 2016 and April 2023 were included,and their clinicopathological features and gene mutation characteristics were retrospectively analyzed.Results The mean age of onset of disease in children with XLAS was(3.68±2.07)years old,the mean age at diagnosis(6.56±2.95)years old,12 cases(37.5%)started with isolated hematuria,8 cases(25%)started with hematuria and proteinuria,12 cases(37.5%)started with nephrotic syndrome nephritic phenotype,and the positive family history of the children was found in 11 cases(34.4%),ocular lesions were found in 3 cases(9.37%),ear lesions in 6 cases(18.75%),and 7 cases(21.87%)were found to have developed chronic kidney disease(CKD)in the later follow-up.21 children underwent renal tissue puncture biopsy,and electron microscopy showed thinning of the basement membrane(diffuse or segmental)in 13 cases(61.9%),and uneven thickness of the basement membrane in 8 cases(38.09%);light microscopy showed thinning of the basement membrane in 13 cases(61.9%);light microscopy showed thinning of the basement membrane in 8 cases(38.09%);and light microscopy showed thinning of the basement membrane in 3 cases(11.5%).(38.09%);light microscopy:focal segmental glomerulosclerosis(FSGS)in 2 cases(9.52%),mesangial proliferative glomerulonephritis(Ms PGN)in 11 cases(52.38%),and minimal change disease(MCD)in 8 cases(38.09%).The type of mutation was categorized as missense mutation in 12 cases(37.5%),shear site mutation in 9 cases(28.12%),nonsense mutation in 6 cases(18.75%),deletion mutation in 3 cases(9.37%),and code shift mutation in 2 cases(6.25%).Genetic mutations were present in 22 cases(68.75%);spontaneous mutations were present in 10 cases(27.02%).Conclusions Children with XLAS have atypical clinical manifestations and pathologic features in the early stage of the disease,and the progress is slow,and some of them are easy to be misdiagnosed as nephrotic syndrome nephritis type in the early stage,so it is important to improve the genetic test for this disease as early as possible,and to make reason-able drug choices to predict the prognosis scientifically.