OBJECTIVETo study the expression difference in MicroRNA-21 (miRNA-21) levels of the plasma between the patients with coronary heart disease and the subjects without coronary artery lesions, and its clinical significance.

METHODSPlasma was obtained from the patients with coronary heart disease(trial group,56 cases) and the subjects without coronary artery lesions(control group, 10 cases), patients with coronary disease were divided into angina(AP, 39 cases) and acute myocardial infarction(AMI, 17 cases)subgroup, the contents of miRNA-21 were detected using qRT-PCR method, and the differential expression of miRNA-21 in each group was analyzed. The levels of creatine kinase isoenzyme (CK-MB), high sensitive troponin I(cTnI), B type natriuretic peptide urea (BNP), Gensini, left ventricular ejection fraction (LVEF), integral value of coronary left ventricular end diastole diameter (LV) and homocysteine (HCY) were determined and the correlation between miRNA-21 and these clinical indexes was analyzed.

RESULTSCompared with control group, there was a significant difference in expression of miRNA-21 in patients with angina and AMI (P < 0.05), and miRNA-21 expression in AMI group was much higher than that in AP group. There was statistical significance in CK, CK-MB, cTnI, Genisis integral comparison between AMI group and control group (P < 0.05). The correlation analysis showed that there was a positive correlation between expression of CK, CK-MB, cTnI and the level of circulating miRNA-21 in patients with acute myocardial infarction. And there was a negative correlation between BNP, Gensini integral, LVEF value of coronary artery, LV and circulating miRNA-21.

CONCLUSIONmiRNA-21 was significantly elevated in acute myocardial infarction subgroup than the control group. The level of miRNA-21 associates with the degree of coronary artery stenosis, and might be a potential marker for the diagnosis of acute myocardial infarction. miRNA-21 may play an important role in protecting myocardium from ischemia/reperfusion injury.

Acute Disease ; Biomarkers ; blood ; Coronary Disease ; blood ; Creatine Kinase, MB Form ; metabolism ; Humans ; MicroRNAs ; blood ; Myocardial Infarction ; blood ; Natriuretic Peptide, Brain ; metabolism ; Troponin I ; metabolism

Objective To establish a assessment system for comprehensive clinical competency of general practice residents.Methods An assessment system for comprehensive clinical competency of general practice residents was developed with modified Delphi expert consultation during November 2010 to October 2011.Thirty three experts in clinical practice,education and administration of general practice were invited for two-round Delphi questionnaire consultation.Results In two-round consultation,the expert activity coefficient was 100％,the authority coefficient was 0.852 and 0.855,and the coordination coefficient for the importance of the indicators was 0.228 and 0.245 respectively (P =0.000).The opinions among the experts became consistent from round 1 to round 2.An assessment system was established,which consisted of 5 first-level (professionalism,communicate skills,clinical competency and professional development ability) and 36 second-level indicators.Conclusion The index system established in this study may be used as references for evaluating comprehensive clinical abilities of general practitioners systematically and objectively.

OBJECTIVETo develop a HPLC for the determination of plasma concentration of glycyrrhetic acid (GA) and study the pharmacokinetics of GA in rats.

METHODTo sample blood from rat which were injected GA by 1.0 mg x kg(-1) at 0.08, 0.17, 0.25, 0.33, 0.5, 0.75, 1, 2, 3, 4, 6 h and use HPLC to determine the concentration of GA in it, the pharmaeokinetie parameters were accessed by DAS 1.0.

RESULTThe calibration curve was linear (r = 0.999 7) within the range of 50-2 000 ng x mL(-1) for GA in plasma. The average recovery was (105.2 +/- 2.23)%, (102.5 +/- 2.95)%, (98.4 +/- 2.32)%. The within-day and between-day derivation (RSD) were less than 4%. GA was fitted to a two compartment open pharmaeokinetie model in rats. The mainly pharmaeokinetie parameters were: t1/2alpha = (0.153 +/- 0.023) h, t1/2beta = (2.365 +/- 0.866) h, C(max) = (2.074 +/- 0.100) mg x L(-1), CL = (0.715 +/- 0.082) L x h(-1) x kg(-1), V(d) = (2.427 +/- 0.872) L x kg(-1), AUC(0-6 h) = (1.302 +/- 0.151) mg x h(-1) x L(-1).

CONCLUSIONThe method can be used to determine the concentration and to investigate the pharmacokinetics of GA in rat. GA was disposed extensively and rapidly in rats.

Animals ; Calibration ; Chromatography, High Pressure Liquid ; Glycyrrhetinic Acid ; pharmacokinetics ; Male ; Rats ; Reproducibility of Results ; Sensitivity and Specificity

Objective To develop an assessment criteria for general practitioner (GP) trainers in clinical training base.Methods Based on the extensive literature review and expert interview,a preliminary index system was established with 4 first-grade indicators and 45 second-grade indicators for GP trainers in clinical training base.During 2012 to 2013,a two-round Delphi consultation was conducted to establish the assessment criteria.Results Thirty seven experts engaged in clinical practice,training and managers of GP training program from clinical training bases,medical schools,or health bureau in Shanghai were invited for Delphi consultation.Among them 64.8 (24/37) ％ were engaged in GPs training over 5 years,78.4％ (29/37) worked as GP trainers,70.2％ (26/37) with high-level professional title.In two round consultations,the activity coefficient of the experts were 97.3％ and 100.0％,authority coefficient were 0.817 and 0.855,and harmonious coefficient of importance of the evaluation were 0.188 (P ＜ 0.01) and 0.278 (P ＜ 0.01),respectively.The opinions among the experts were consistent from the first round to the second round.The assessment criteria for GP trainers in clinical training bases was established with 4 firstgrade indicators and 27 second-grade indicators.The 4 first-grade indicators were professionalism,clinical practice components,teaching quantity & components,basic conception of general practice,with weight coefficient of 0.253,0.253,0.251 and 0.243,respectively.Conclusion The established assessment criteria for GP trainers is credible and comprehensive,which can be applied in evaluating the comprehensive capacity of trainers in clinical training bases.

Objective To develop criteria for trainers of general practitioners in clinical training bases.Methods A primary version of criteria was established through literature review and expert interview.Thirty-two experts with middle-level professional title or above,who had 10 years of working experience or more in general practice,teaching and administration,were invited for 3 rounds of Delphi consultation during March and October 2013.Results The criteria consisted of 3 first-grade indicators and 12 second-grade indicators were established.The first-grade indicators included professional quality,clinical competence and teaching capability.The weight coefficient of first-grade indicators were 0.332 0,0.336 0 and 0.332 0,respectively.For 3 rounds of consultation the activity coefficient of experts was all 100％ ; the authority coefficients of experts were 0.881,0.897 and 0.883,respectively; and the harmonious coefficient of importance of the evaluation were 0.136,0.127 and 0.204,respectively (P ＜ 0.01).Conclusion The established criteria are credible and important for the selection of trainers of general practitioners in clinical bases,which would improve the quality of standardized training for general practitioners.

Objective To establish a set of accreditation standards for trainers of general practitioner (GP) in community health service centers.Methods A modified Delphi expert consultation was conducted during December 2012 and September 2013.Thirty two experts of general practice from different teaching hospitals and community health service centers were invited for three rounds Delphi questionnaires.A set of accreditation standards for GP trainers in primary care was established through data analysis,synthesis and process.Results Expert activity coefficients were 100.0％ for three rounds consultation,the authority coefficients were 0.894,0.882 and 0.893,respectively.The opinion coordination coefficients of experts were 0.156,0.166 and 0.215,respectively (P =0.000).The developed accreditation standards system comprised of three first-grade indicators and 14 second-grade indicators.The weight coefficients of three first-grade indicators,namely professional profiles,clinical competences in primary care and teaching abilities,were 0.339 8,0.335 6 and 0.324 6,respectively.Conclusions The established accreditation standard system is credible,which would appropriately guide the selection of GP trainers in primary care from three dimensions and enhance the quality of standardized training of general practitioners.

Thirty four residents of general practice and 11 students of junior college to undergraduate program were evaluated with the mini-clinical evaluation exercise (mini-CEX) when they were rotated to community clinics or the ward of general practice in Zhongshan Hospital from September 2009 to February 2010. The reliability and validity of mini-CEX for rotation examination in general practice training was assessed. Forty five trainees and 9 clinical faculty members completed 81 mini-CEX evaluations. The Cronbach's alpha coefficient was 0. 932. Criterion-related validity for mini-CEX overall competence with the end examination of rotation was O.53 ( P ＜ 0.001 ). The results indicate that mini-CEX may be an appropriate evaluation tool for rotation examination in general practice training.

Objective To study needs of training of trainers(ToT)in mini-clinical evaluation exercise(mini-CEX)and its effectiveness.Methods One hundred and fourteen doctors involved in TOT for mini-CEX were interviewed with questionnaire before and after training for their satisfaction of training and fifty of them scored the training videos.Results Before the training.39%(44/114)of doctors involved in TOT knew mini-CEX and 97%(111/114)of them hoped to know how to carry out mini-CEX thronsh training.When the training finished,30%(34/114)tO 55%(63/114)of them could completely understand seven items of examinations of mini-CEX.Fifty doctors involved in TOT scored the training videos after the training.There was signifieant difference in scores between TOT and standard scoring on training video 1 for teaching of coronary heart disease and video 2 for teaching of hematochezia(P<0.05).No significant difference Was found in scores between TOT and standard scoring on the video 3 for teaching of abdomihal pain(P>0.05).as well as those between TOT with five or less years experience and those with more than five years experience(P>0.05).Conclusions Currently,doctors involved in TOT have more demands on mini-CEX.However,effectiveness of short-course training for mini-CEX is not satisfactory,and pattern of its training should be improved further.

XI Hong, a famous acupuncturist in the Southern Song Dynasty, has an important influence and status in history of Chinese acupuncture and moxibustion. After he moved to Linchuan, Jiangxi province, his descendants passed acupuncture from generation to generation. According to records, it was passed to 12 generations. After the tenth generation, it was also passed to apprentices besides descendants, such as accomplished acupuncturists CHEN Hong-gang, LIU Jin and others, forming XI Hong acupuncture school of thought. The poem of acupuncture and moxibustion XI Hong Fu is the representative work about XI Hong academic thought, which was additionally compiled or written by XI Hong's apprentices according to XI Hong academic thought. The poems are of characteristics in acupuncture application and association of acupoints. The academic thought and therapeutic methods of acupuncture in the poems still are widely used in modern clinical acupuncture practice.
Acupuncture ; education ; history ; Acupuncture Points ; Acupuncture Therapy ; history ; China ; History, Ancient ; Humans ; Male ; Medicine, Chinese Traditional ; history

OBJECTIVETo analyze the in-hospital mortality and factors affecting in-hospital mortality for patients with transposition of the great arteries (TGA) undergoing arterial switch operation (ASO).

METHODSBetween January 2004 and December 2007, ASO was performed in 169 patients [129 male, 40 female; mean age (11.71 ± 26.3) months] with TGA. The patients were divided in intact ventricular septum group (n = 56): TGA with intact ventricular septum and ventricular septal defect group (n = 113): TGA with ventricular septal defect. Multiple logistic regression analysis was performed to identify the risk factors of in-hospital mortality.

RESULTSThe overall in-hospital mortality was 11.24% (19/169). The yearly in-hospital mortality was similar between intact ventricular septum group and ventricular septal defect group. With the improvement of perioperative treatment, the in-hospital mortality decreased from 16.67% in 2004 to 3.92% in 2007. The multivariate analysis revealed that body weight ≤ 3 kg (OR: 4.571, P = 0.0409), complicating ventricular septal defect (OR: 4.444, P = 0.0406), complex TGA (OR: 4.321, P = 0.0140), coronary anomalies (OR: 4.867, P = 0.0104) and non-type A coronary arteries (OR: 3.045, P = 0.0243) were independent predictors for poor early postoperative survival.

CONCLUSIONBody weight ≤ 3 kg, complicating ventricular septal defect, complex TGA, coronary anomalies are independent predictors for increased in-hospital mortality in patients with transposition of TGA and undergoing arterial switch operation.

Arteries ; surgery ; Body Weight ; Cardiac Surgical Procedures ; mortality ; Child, Preschool ; Female ; Heart Septal Defects, Ventricular ; complications ; mortality ; surgery ; Hospital Mortality ; Humans ; Infant ; Logistic Models ; Male ; Risk Factors ; Transposition of Great Vessels ; mortality ; surgery