To enhance interns' comprehensive ability and qualification in medical laboratory , ISO 15189 quality system that was widely accepted at home and abroad was applied in practice teaching management. First teaching experience was shared with each other, teaching competition was encouraged to improve the qualification of teaching, and then relevant academic conference and the application of scientific or new projects were also advocated to promote the construction of teaching staff. Second, the management system of the intern was improved, the rules of the management of the intern files were optimized, the train-ing and study were regularly organized, the teaching system was perfected, and the practice appraisal was standardized. Practice proved that the graduates had strong ability to work, to master the quality management of ISO 15189 elements and could solve the common problems in clinical work and at the same time they had certain scientific research thinking.

Objective Our study is to observe the effects of conjugated equine estrogen (CEE) combined with medroxyprogesterone acetate (MPA) on hemorheology in postmenopausal women in order to evaluate mechanism responsible for the increase in the incidence of cardiovascular disease after menopause and also to provide proper instruction and advice of hormone replacement therapy (HRT) for postmenopausal women Methods 60 healthy postmenopausal women were assigned to 3 groups randomly, 20 cases in each group Group A: CEE 0 625 mg/d+MPA 2 mg/d+calcium carbonate co. (Ca D) 600 mg/d Group B: CEE 0 3 mg/d+MPA 2 mg/d+Ca D 600 mg/d Group C: Ca D 600 mg/d only served as control Measurements of hemorheological parameters were performed before and 6 months after treatment Results After 6 months of HRT, group A: blood viscosity under the shear rate of 94 5 s -1 dropped from (5 23? 0 37) mPa?s to (5 03? 0 43) mPa?s ( P 0 05) Conclusion Both different dosages of CEE have favor effects on blood viscosity and erythrocyte deformabillity, which could play the role in preventing cardiovascular disease in postmenopausal women

Objective To investigate the role of nurses in civil cardiac death organ donation work.Methods Cooperating,propagating and promoting in civil cardiac death organ donation; building a bridge between the families of organ donation,donor coordinators,physicians and hospital ethics committees; participating in organ donation medical ethics assessment work; cooperating with the doctors do intend to maintain organ donation,access and preservation; protecting donors remains.Results During the time of July 2011 to November 2013,we successfully completed 52 cases of civil cardiac death organ donation cooperating with doctors,and got 41 liver,which entered the national organ allocation system for distribution.Conclusions The nurses will play a more and more important role in work of civil cardiac death organ donation cooperating with doctors.

The teaching method of critical thinking was introduced in the course of medical physics for undergraduate students by means of case teaching,PBL teaching,Bio-Physics teaching and research-oriented teaching patterns.The teaching quality and both the abilities of critical thinking and innovation of the students were enhanced.

Objective:To analyze the clinical materials of 2 patients with lung cancer complicated with syndrome of inappropriate secretion of antidiuretic hormone (SIADH),and to improve the clinical awareness and management.Methods:One patient was treated with lung cancer chemotherapy alone for 7 courses.The other patient received the strictly limited for liquid intake and tolvaptan by oral against hyponatremia without chemotherapy.Results:With the relapsing and advancing of lung cancer,the hyponatremia and its relevant symptoms of the first patient were poorly relieved.While the level of serum sodium of the second patient returned to the normal level 3 d after administration of tolvaptan.Conclusion:About one-third of the patients with hyponatremia have SIADH.The etiological treatment and symptomatic therapy of hyponatremia should be given to the patients in clinical treatment.

OBJECTIVETo investigate the effects of two different dosages of conjugated equine estrogen (CEE) on preventing bone loss and relieving the symptoms of menopausal syndrome in women at an early stage of menopause.

METHODSA total of 236 postmenopausal women were randomly allocated to one of the following groups: Group A: 0.625 mg CEE + 2 mg medroxyprogesterone acetate (MPA) + 1 tab Caltrate-D per day; Group B: 0.3 mg CEE + 2 mg MPA + 1 tab Caltrate-D per day; Group C: 1 tab Caltrate-D per day as the control group. The study was continued for 2 years.The following parameters were monitored: (1) L2-4 bone mineral density (BMD) (measured with dual energy X-ray absorptiometry (DEX)), (2) menopausal syndrome improvement (assessed by comparing Kupperman scores), (3) vaginal bleeding rate, and the thickness of the endometrium and breast in each group.

RESULTSOverall, 213 cases (90%) completed the 1-year study and 176 cases (75%) completed the 2-year study. The percentage changes in L2-4 BMD at the 12th and 24th month in Group A were +2.3% and +3.7%, respectively, with the posttreatment values being significantly higher than pretreatment values (P < 0.001). The percentage changes were +2.7% at 12th month (P < 0.05) and +0.7% at 24th month (P > 0.05) in Group B. And that of Group C were -0.4% at 12th month and -1.6% at 24th month (P > 0.05). L2-4 BMD in both Group A and B was significantly higher than that in Group C at 12th and 24th month (A vs C, P < 0.001; B vs C, P < 0.05). Kupperman Scores were significantly reduced after 1, 3, 6, 12 and 24 months in all 3 groups when compared with baseline (P < 0.001). Scores in Group A and Group B were significantly lower than that in Group C (P < 0.001). However, the vaginal bleeding rates in Group A were significantly higher than that in Group B or in Group C. There was no atypical hyperplasia of endometrium in the 3 groups by the end of the study. One patient in Group A developed superficial thrombophlebitis by the end of 12th month.

CONCLUSIONContinuous combination of CEE and MPA is effective in preventing bone loss and relieving the symptoms of menopausal syndrome in women at an early stage of menopause. The vaginal bleeding rates in the Group treated with 0.625 mg/d CEE were significantly higher than those treated with 0.3 mg/d CEE.

Alkaline Phosphatase ; blood ; Bone Density ; drug effects ; Endometrium ; pathology ; Estrogens, Conjugated (USP) ; administration & dosage ; Female ; Hormone Replacement Therapy ; adverse effects ; methods ; Humans ; Menopause ; Middle Aged ; Progestins ; administration & dosage ; Uterine Hemorrhage ; epidemiology

OBJECTIVETo detect potential mutations of COL1A1 and COL1A2 genes in four Chinese pedigrees affected with osteogenesis imperfecta (OI) and provide prenatal diagnosis for a fetus at 18th gestational week.

METHODSAll coding regions and exon/intron boundaries of the COL1A1 and COL1A2 genes were analyzed with targeted next-generation sequencing (NGS). Suspected mutations were confirmed with Sanger sequencing in the probands, unaffected relatives and 200 unrelated healthy individuals. Prenatal diagnosis for a high-risk fetus was carried out through Sanger sequencing.

RESULTSThe probands of families 1 and 2 have respectively carried a c.760G>A (p.Gly254Arg) and a c.608G>T (p.Gly203Val) mutation of the COL1A1 gene. For family 3, the proband and his daughter have carried a novel c.299-1G>C splicing mutation of the COL1A1 gene. The same mutation was not found in the fetus of this family. For family 4, the proband has carried a novel c.1990G>C (p.Gly664Arg) mutation of the COL1A2 gene. The four mutations were not found in the unaffected relatives and 200 unrelated healthy individuals.

CONCLUSIONThe mutations of the COL1A1 and COL1A2 genes probably underlie the disease in the four families. NGS combined with Sanger sequencing can provide an effective and accurate method for their genetic and prenatal diagnosis.

Adult ; Child, Preschool ; Collagen Type I ; genetics ; DNA Mutational Analysis ; Female ; High-Throughput Nucleotide Sequencing ; Humans ; Infant, Newborn ; Male ; Mutation ; Osteogenesis Imperfecta ; genetics ; Prenatal Diagnosis

Objective:To investigated the clinical, biochemical, and immunohistological characteristics of patients with aldosterone producing adenoma(APA)and different gene mutations.Methods:The clinical and biochemical data of 206 patients with APA who received unilateral adrenalectomy were collected. Sanger sequencing was used to identify the mutation in the hot-point of KCNJ5 and other genes. The tumor samples were stained by 11β-hydroxylase(CYP11B1)and aldosterone synthase(CYP11B2), which was quantified by McCarty′s H-score system.Results:The gene mutations were identified in 166 out of 206(80.6%)patients with APA, of which 158 cases were KCNJ5 mutation, 2 ATP1A1 mutation, 5 ATP2B3 mutation, and 1 CTNNB1 mutation. Age, duration of hypertension, and serum potassium in APA patients with genetic mutant were significantly lower than those without genetic mutation( P<0.05) while the proportion of female, systolic blood pressure, diastolic blood pressure, aldosterone/renin ratio(ARR), and plasma aldosterone concentration(PAC)post saline infusion test(SIT)were significantly higher( P<0.05). Subgroup analysis showed that age, duration of hypertension, systolic blood pressure, and proportion of left ventricular hypertrophy in APA patients with ATP1A1 and ATP2B3 mutations were significantly higher than those with KCNJ5 mutation( P<0.05)while the PAC post SIT and tumor diameter were significantly lower( P<0.05). The positive rates of CYP11B2 in APA with different mutations were not significantly different. The H-score of CYP11B1 was significantly higher [160.0(127.5, 193.5) vs 80.0(27.5, 152.3), P=0.020] and the H-score of CYP11B2 was significantly lower [155.0(123.0, 190.0) vs 240.0(140.0, 270.0), P<0.01] in APA with KCNJ5 mutation compared with those with ATPase mutation. Conclusion:The types of genetic mutation are closely correlated with the clinical, biochemical, and immunohistological phenotypes in patients with APA.

Objective:Aimed to investigate the value of adrenocorticotropic hormone (ACTH) stimulation in adrenal venous blood sampling (AVS).Methods:Patients who diagnosed as primary aldosteronism (PA) and completed successful bilateral cannulation judged by selection index (SI) for routine and(or) ACTH stimulation AVS were enrolled. The lateralization index(LI) was calculated to compare the effect of ACTH stimulation on AVS cannulation success rate and lateralization judgment.Results:A total of 73 patients with PA were enrolled in the study, of whom 28 were confirmed as aldosterone producing adenoma (APA) after unilateral adrenalectomy. Cortisol and aldosterone in peripheral and adrenal veins were significantly increased after ACTH stimulation. The left SI was increased from 6.5(3.0-13.6) to 26.8 (16.9-40.3) ( P<0.01) and the right SI from 20.8(4.8-34.8) to 57.6(35.7-80.9) ( P<0.01) after ACTH stimulation. There was no significant difference on LI before and after ACTH stimulation [7.7(2.3-19.6) vs 5.6(1.9-14.6), P=0.14]. The success rates of left and right adrenal cannulation were increased by 15% and 10% respectively after ACTH stimulation. For 57 patients who were determined in successful cannulation by both routine and ACTH stimulation AVS, 27 patients were determined to have lateralization by both AVS methods, 21 patients were determined to have bilateralization, and the consistency of lateralization by both AVS methods was 84%(48/57). Among the 28 patients who were confirmed to be APA after unilateral adrenalectomy, the correct rate of lateralization by both AVS methods was 89% (25/28). Conclusion:ACTH stimulation is able to improve the success rate of bilateral adrenal vein cannulation, and is helpful to judge AVS results. For patients with successful cannulation, there is no significant difference in lateralization judgment for routine and ACTH stimulation AVS.

Objective To assess the diagnostic value of saline infusion test ( SIT) and its optimal cutoff in the diagnosis of primary aldosteronism ( PA ), and to analyze whether the dietary salt intake affects the SIT accuracy. Methods This is a prospective study. All 236 patients with a high risk for PA underwent the screening test, SIT and the fludrocortisone suppression test (FST) in separate days. The diagnosis of PA was established according to the FST criteria. According to the 24 h urinary sodium level, the patients were divided into low salt, normal salt, and high salt groups respectively, and the effect of salt intake on SIT was analyzed. Receiver operating characteristic (ROC) analysis was performed to compare the diagnostic accuracies. Results Finally, in 236 patients with high risk for PA, 134 patients with PA and 102 patients with essential hypertension ( EH) were diagnosed. Using post-test plasma aldosterone concentration (PAC) for diagnosis, the area under the ROC curve (AUCROC) of the SIT was 0.974 (0.957, 0.991), which was significantly higher than that of the post-test plasma aldosterone to renin ratio (ARR) [0.900 ( 0. 862, 0. 938)] and that of the PAC suppression percentage [ 0. 752 ( 0. 690, 0. 813)] ( both P<0.01). Considering both sensitivity and specificity, an optimal cutoff of PAC post-SIT was set at 8 ng/dl, resulting in a sensitivity of 88. 1% and a specificity of 95. 1%. The PAC post-SIT, whether in PA or EH patients, had no statistically significant differences among low salt, normal salt, and high salt groups (P>0.05). Conclusion SIT is reliable for the diagnosis of PA. PAC post-SIT more than 8.0 ng/dl is recommended to confirm PA.