Education, Dental ; Oral Medicine ; education ; manpower

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BACKGROUND: In the management of critically ill patients, the assessment of volume responsiveness and the decision to administer a fluid bolus constitute a common dilemma for physicians. Static indices of cardiac preload are poor predictors of volume responsiveness. Passive leg raising (PLR) mimics an endogenous volume expansion (VE) that can be used to predict fluid responsiveness. This study was to assess the changes in stroke volume index (SVI) induced by PLR as an indicator of fluid responsiveness in mechanically ventilated patients with severe sepsis. METHODS: This was a prospective study. Thirty-two mechanically ventilated patients with severe sepsis were admitted for VE in ICU of the First Affiliated Hospital, Zhejiang University School of Medicine and Ningbo Medical Treatment Center Lihuili Hospital from May 2010 to December 2011. Patients with non-sinus rhythm or arrhythmia, parturients, and amputation of the lower limbs were excluded. Measurements of SVI were obtained in a semi-recumbent position (baseline) and during PLR by the technique of pulse indicator continuous cardiac output (PiCCO) system prior to VE. Measurements were repeated after VE (500 mL 6％ hydroxyethyl starch infusion within 30 minutes) to classify patients as either volume responders or non-responders based on their changes in stroke volume index (ΔSVI) over 15％. Heart rate (HR), systolic artery blood pressure (ABPs), diastolic artery blood pressure (ABPd), mean arterial blood pressure (ABPm), mean central venous pressure (CVPm) and cardiac index (CI) were compared between the two groups. The changes of ABPs, ABPm, CVPm, and SVI after PLR and VE were compared with the indices at the baseline. The ROC curve was drawn to evaluate the value of ΔSVI and the change of CVPm (ΔCVPm) in predicting volume responsiveness. SPSS 17.0 software was used for statistical analysis. RESULTS: Among the 32 patients, 22 were responders and 10 were non-responders. After PLR among the responders, some hemodynamic variables (including ABPs, ABPd, ABPm and CVPm) were significantly elevated (101.2±17.6 vs.118.6±23.7,P=0.03; 52.8±10.7 vs. 64.8±10.7,P=0.006; 68.3±11.7 vs. 81.9±14.4,P=0.008; 6.8±3.2 vs. 11.9±4.0,P=0.001). After PLR, the area under curve (AUC) and the ROC curve of ΔSVI and ΔCVPm for predicting the responsiveness after VE were 0.882±0.061 (95％CI 0.759–1.000) and 0.805±0.079 (95％CI 0.650–0.959) when the cut-off levels of ΔSVI and ΔCVPm were 8.8％ and 12.7％, the sensitivities were 72.7％ and 72.7％, and the specificities were 80％ and 80％. CONCLUSION: Changes in ΔSVI and ΔCVPm induced by PLR are accurate indices for predicting fluid responsiveness in mechanically ventilated patients with severe sepsis.

Objective To observe the biological activities of human doppel(Dpl) protein transiently expressed and Dpl-like protein PrP?32-121 on a human neuroblastoma cell line SH-SY5Y.Methods Recombinant mammalian expression plasmids containing human PRND gene and truncated PrP?32-121 fragment were generated by PCR.The expression and location of Dpl and PrP?32-121 post-transfection were observed by IFA.The cytotoxicity was measured by MTT analysis.Cellular apoptosis was investigated by flow cytometry and Western blot.Results Both Dpl and PrP?32-121 protein were expressed and mainly located on the cell membrane.Remarkable cytotoxicity was detected on SH-SY5Y cells after 24 h transfection.Meanwhile,more Annexin V/PI positively-stained cells as well as lower levels of cellular pro-caspase-3 and Bel-2 were detected in the cells receiving Dpl and PrP?32-121 expressing plasmids.Conclusion Dpl protein transiently expressed and PrP?32-121 can lead to the similar neural cytotoxicity,probably triggering the cell apoptosis program.

Objective To observe the biological activities of human doppel (Dpl) protein transiently expressed and Dpl-like protein PrPΔ32-121 on a human neuroblastoma cell line SH-SY5Y. Methods Recombinant mammalian expression plasmids containing human PRND gene and truncated PrPΔ32-121 fragment were generated by PCR. The expression and location of Dpl and PrPΔ32-121 post-transfection were observed by IFA. The cytotoxicity was measured by MTT analysis. Cellular apoptosis was investigated by flow cytometry and Western blot. Results Both Dpl and PrPΔ32-121 protein were expressed and mainly located on the cell membrane. Remarkable cytotoxicity was detected on SH-SY5Y cells after 24 h transfection. Meanwhile, more Annexin V/PI positively-stained cells as well as lower levels of cellular pro-caspase-3 and Bel-2 were detected in the cells receiving Dpl and PrPΔ32-121 expressing plasmids. Conclusion Dpl protein transiently expressed and PrPΔ32-121 can lead to the similar neural cytotoxicity, probably triggering the cell apoptosis program.

Objective To investigate the accuracy of the plasma DNA concentration in evaluating the prognosis in patients with sepsis.Methods One hundred and sixty patients with sepsis were enrolled as the sepsis group (group SE).Another 109 patients without sepsis hospitalized during the same period served as the control group (group C).The venous blood sample was taken on admission for determination of plasma DNA concentration by polymerase chain reaction,C reactive protein (CRP) concentration by ELISA.APACHE Ⅱ score and SOFA score were evaluated at 24 h after admission.The 160 patients with sepsis were divided into two groups according to the result of prognosis:survival group ( n =103) and death group ( n =57).Results Compared with group C,the plasma DNA concentration,CRP concentration,APACHE Ⅱ score and SOFA score were significantly increased in group SE (P＜0.05).Compared with survival group,the plasma DNA concentration,APACHEⅡ score and SOFA score were significantly increased in death group ( P ＜ 0.05).The areas under receiver operating characteristic (ROC) curves of the plasma DNA concentration was significantly larger than those of APACHE Ⅱ score and SOFA score (0.81(95％ CI,0.74-0.88) versus 0.68(95％ CI,0.60-0.77),or 0.72(95％ CI,0.63-0.82)).Conclusion The plasma DNA concentration can accurately evaluate the prognosis in patients with sepsis.As compared with the plasma CRP concentration,APACHE Ⅱ score and SOFA score,the plasma DNA concentration is more accurate to evaluate the prognosis in patients with sepsis.

Two hundred and five patients with hypertensive intracerehral hemorrhage (HICH) received mini-puncture hematoma scavenging technique (MPST; n=80), traditional craniotomy operation (TCO; n=78), or medicine expectant treatment (MET; n=47), respectively. Clinical data demostrated that consciousness level and Glasgow Coma Scale (GCS) was more obviously improved in the MPST group,while postoperative complication rate was relatively lower. The MPST group and TCO group saw no significant difference in over-all matality, although both were significantly lower than the MET group. Severe disability rate in the MPST group was significantly decreased. In comparison with the TCO or MET group, 1 to 3 class activity of daily life score, language function recovery and response rate in the MPST group significantly improved (all P<0.05). We suggest that because of lower severe disability rate, less postoperative complications, and improved quality of life, MPST should be a better treatment of choice for HICH patients.

Diabetes mellitus is a chronic disease, it is thus necessary for its patients to participate in its treatment and self-management. The emerging foreign and domestic methods for self-management of diabetes mellitus pa-tients were detected on different Websites and suggestions were proposed for its treatment and self-management in order to improve the quality of life in diabetes mellitus patients.

Objective To study the teaching effect of prevention in clinical epidemiology teaching.Methods 187 clinical medical students of Grade 2010 from China Medical University were selected as the research objectives.2 teaching hours of prevention content was increased in the clinical epidemiology teaching,and the anonymous questionnaire survey was used to assess the teaching effectiveness.A total of 187 questionnaires were issued and 187 valid questionnaires were collected.All the data were analyzed by SPSS 16.0.Results 82.9％ (155 people) of the students believed that the addition of preventive content was necessary,40.1％ (75 people) of the students believed that there was a significant increase in the content of the prevention.For the understanding of the content,only 11.2％ (21 people) of the students said they had a complete understanding of the class,but after teaching 51.3％ (96 people) of the students expressed a clear understanding of the content.82.4％ (154 people) of the students thought that the teaching contents of prevention was tightly combined with the clinical,and 74.9％ (140 people) of the students thought that 2 hours setting was appropriate.Students' demands for prevent content also included:1) how to strengthen prevention in daily life;2) tumor disease prevention,including current international popular tumor vaccine;3) of emergent public health event instance;4) occupational disease prevention measures,etc.Conclusion Increasing the contents of prevention in the clinical epidemiology teaching has made students of clinical medicine change their clinical concept and realize the key role of prevention in clinical treatment.At the same time,this study understands students' needs for the content of prevention,and provides a basis for the setting and op-timization of clinical epidemiology course in the future.

AIM: To investigate the effect of neferine (Nef) on human gastric carcinoma cell line with multidrug resistance (MDR). METHODS: The cytotoxic effect of vincristine (VCR) was evaluated by MTT assay. The cell apoptosis induced by VCR was determined by flow cytometry, and the expression of P-glycoprotein (P-gp) and multidrug-resistance-associated protein (MRP) in cells was examined by immunofluorescence flow cytometry. RESULTS: MTT assay showed that Nef at the concentration of 5 ?mol?L~(-1) to 10 ?mol?L~(-1) have no cytotoxicity to parent human gastric carcinoma cell line (SGC7901) and its VCR-resistant variant cell line (SGC7901/VCR). The IC_(50) value of VCR to SGC7901 cell line was 0.06 mg?L~(-1)and that of to SGC7901/VCR cell line was 2.32 mg?L~(-1), which indicated SGC7901/VCR cell line were 39 times more resistant to VCR in comparison with the parent SGC7901 cell line. After treatment with Nef at the concentrations of 2.5, 5 and 10 ?mol?L~(-1), the IC_(50) value of VCR to SGC7901/VCR cell line decreased to 0.34, 0.12 and 0.05 mg?L~(-1), respectively and those increased by 6.8-, 18.1- and 43.8- fold in the chemosensitivity, respectively. Flow cytometry showed that SGC7901/VCR cells were resistant to apoptosis induced by VCR. After 24 h treatment with Nef (2.5, 5 and 10 ?mol?L~(-1)) and VCR, the apoptosis of SGC7901/VCR cells increased, which indicated Nef could abolish resistance of SGC7901/VCR cells to VCR-induced apoptosis. Furthermore, the action of Nef was more potent than verapamil. The expression of P-glycoprotein and multidrug resistance associated protein was strongly positive in SGC7901/VCR cells, and the expression level of P-gp and MRP in SGC701/VCR cells was significantly down-regulated at 24 h after treatment with Nef (10 ?mol?L~(-1)). CONCLUSIONS: Nef can reverse MDR in multidrug-resistant human gastric carcinoma SGC7901/VCR cell line. Its mechanism might be associated with down-regulation of expression of P-gp and MRP in SGC7901/VCR cells.