Teaching of clinical skills is an important bridging phase from preclinical medicine to clinical practice.It is also an important element of medical students'clinical skills training.According to the character of internal medical cardiology,we should enhance the training of their clinical thinking ability,medical communication competence,and clinical operating ability to get satisfactory teaching effect.

China ; Humans ; Occupational Health ; statistics & numerical data ; Physical Examination ; trends

Humans ; Occupational Exposure ; Occupational Health

Objective To investigate the clinical value of serum soluble intercellular adhesion molecule-1 (sICAM-1 )in patients with primary biliary cirrhosis (PBC)and autoimmune hepatitis (AIH).Methods Sixty-one PBC patients and 59 AIH patients,who were hos-pitalized or visited the outpatient department from June 2012 to September 2013,as well as 50 healthy controls,were included in the study. The PBC patients included 29 incipient cases,21 cases in remission,and 11 recurrent cases;the AIH patients included 26 incipient cases, 20 cases in remission,and 13 recurrent cases.Serum sICAM-1 level was measured by double-antibody sandwich enzyme-linked immu-nosorbent assay,and serum levels of alanine aminotransferase (ALT)and total bilirubin (TBil)were determined by biochemical enzyme as-say.Comparison between groups was made by analysis of variance;Pearson correlation analysis was performed.Results Among PBC pa-tients,the incipient group and recurrent group had significantly higher serum sICAM-1 levels than the remission group and control group (P=0.000 for all);there was no significant difference in serum sICAM-1 level between the incipient group and recurrent group (P=0.484);the remission group had a significantly higher serum sICAM-1 level than the control group (P=0.000).Among AIH patients, the incipient group and recurrent group had significantly higher serum sICAM-1 levels than the remission group and control group (P=0.000 for all);there was no significant difference in serum sICAM-1 level between the incipient group and recurrent group (P=0.802);no significant difference in serum sICAM-1 level was seen between the remission group and control group (P=0.281).For patients with PBC and AIH,serum sICAM-1 level was positively correlated with serum levels of ALT (r=0.664,P=0.000;r=0.784,P=0.000) and TBil (r=0.715,P=0.000;r=0.580,P=0.000).Conclusion Serum sICAM-1 may be involved in the immunologic injury in PBC and AIH.In patients with PBC and AIH,the elevation of serum sICAM-1 level is closely correlated with the severity of liver damage. Clinical monitoring of serum sICAM-1 level may play an important role in severity assessment,prognostic evaluation,and therapy guidance among patients with autoimmune liver diseases.

Objective To establish a new and convenient assay for whole blood lead concentration. Methods Whole blood sample was digested by nitric acid-perchloric. Under the condition of pH 0.8～1.0, lead concentration was examined by Hydridegeneration Atomic Fluorescence Spectrometry.Results The method had good linearity when lead concentration were between 0 to 600 ?g/L, r =0.999. The within-run CV of the method for high, middle and low lead level were 4.1%, 3.6% and 3.5% respectively. The between-run CV were 4.9%, 4.6% and 4.7% respectively. The recovery rates were 105.4%, 98.5% and 94.8% respectively. The single-blind test result of series standard lead samples provided by Chinese Academy of Preventive Medicine were within the acceptable range. The detecting Limit of this method was 0.3 ng. There was no significant interference from main two-valence positiveion. The sample can be storage at lest for 1 months at 4℃. Samples of 869 children from Tianjin were tested by this method. The mean value was 91.9 ?g/L, median was 83.8 ?g/L, all data were within 23.1～386.3 ?g/L. The result showed out positive skewness distribution.Conclusion This method were sensitive, accurate, precise, quick and low-cost. It was suitable for use in clinical laboratories.

Objective To investigate the changes and significance of plasma level of homocysteine (Hcy) in Parkinson disease (PD) patients with cognitive dysfunction. Methods Ninety-two PD patients were enrolled. Among them, 51 patients had mild cognitive impairment (CI), and the other 41 had not CI. Forty healthy subjects were enrolled as control group. The information including gender, age, illness duration, years of education and Hoehn and Yahr (H-Y) stage were recorded. Cognitive function of all the patients with PD and the controls were measured by using Montreal Cognitive Assessment (MoCA) scale. Plasma levels of Hcy, folic acid and vitamin B12 were measured by high performance liquid chromatography or radioimmunoassay. Results The plasma level of Hcy in PD group was significantly higher than that in control group: (16.72 ± 5.52) μmol/L vs. (13.65 ± 5.16) μmol/L, there was statistical difference (P<0.05). The plasma level of Hcy in patients with CI was (18.13 ± 4.67)μmol/L, and the patients without CI was (15.44 ± 3.71) μmol/L, the plasma levels of Hcy in patients with CI and without CI were significantly higher than that in control group, furthermore the plasma level of Hcy in patients with CI was significantly higher than that in patients without CI, there were statistical differences (P<0.05). The plasma level of folic acid in PD group was significantly lower than that in control group:(7.15 ± 3.54) μg/L vs. (8.73 ± 3.78) μg/L, there was statistical difference (P<0.05). The plasma level of folic acid in patients with CI was (7.11 ± 3.95) μg/L, and the patients without CI was (7.36 ± 3.84) μg/L, the plasma levels of folic acid in patients with CI and without CI were significantly lower than that in control group, there were statistical differences (P<0.05). But there was no statistical difference in the plasma of folic acid between patients with CI and patients without CI (P>0.05). There was no statistical difference in the plasma of vitamin B12 between the 2 groups (P>0.05). There was a negative relationship between plasma levels of Hcy and folic acid (r =-0.576, P<0.01). The plasma level of Hcy in early PD patients was significantly lower than that in middle-late patients:(15.14 ± 5.31)μmol/L vs. (17.75 ± 5.87) μmol/L, there was statistical difference (P<0.05), and there were no statistical differences in the plasma levels of folic acid and vitamin B12 between early PD patients and middle-late patients (P>0.05). The correlation analysis results showed that MoCA score was positive correlation with years of education (β = 0.541, P = 0.000), MoCA score was negative correlation with illness duration, H-Y stag and plasma level of Hcy (β=-0.417, -0.367 and-0.515;P=0.026, 0.037 and 0.000), but MoCA score was not correlation with age, plasma levels of folic acid and vitamin B12 (P>0.05). Conclusions The changes of plasma level of Hcy may be involved in the pathogenesis of patients with PD. The elevated plasma level of Hcy is significantly correlated with CI, it is an important risk factors of CI in patients with PD.

BACKGROUND: Thermosensitive hydrogel has made great progresses in drug carrier and tissue engineering. However, its phase-transition temperature is lower than human body temperature, so it has not been used as implants. OBJECTIVE: To prepare and evaluate the biocompatibility of a thermosensitive hydrogel poly-(N-isopropylacrylamide-co-N-hydroxymethylacrylamide)[P(NIPAAm-co-NHMPA)] In vitro so as to assess its safety as a medical implant.DESIGN, TIME AND SETTING: Material experiment was performed at the Central Laboratory of Union Hospital of Tongji Medical College, Huazhong University of Science & Technology and Key Laboratory of Biomedical Polymers, Ministry of Education, Wuhan University Chemical Department from January to October 2007.MATERIALS: L929 mice fibroblast line was provided by Professor Chen, Stomatology Hospital of Wuhan University. N-isopropylacrylamide and N-hydroxymethylacrylamide were purchased from Aldrich.METHODS: Using ammonium persulfate and tetramethylethylenediamine as oxidateion-reduction initiation system and N, N'-methylene bisacrylamide as crosslinking agent, mass fraction 8.5% N-hydroxymethylacrylamide was added to the reaction system. The N-isopropylacrylamide and N-hydroxymethylacrylamide were dissolved in deionized water and reacted with N, N'-methylene bisacrylamide, ammonium persulfate and tetramethylethylenediamine at room temperature for 3 hours. The colorless transparent cylinder gel was obtained, soaked in deionized water and dried.MAIN OUTCOME MEASURES: Biocompatibility in vitro of the material was validated by cytotoxicity test, cells/scaffolds interaction test, hemolysis test and pyrogen test in vitro.RESULTS: Synthesized hydrogel showed thermosensitive character as expected and the lower critical solution temperature was 38 ℃. The toxicity rate was grade 0-1. Through the scanning electron microscopy, cells and scaffolds were tightly attached, producing a perfect interface, and the shape of cells was all right. Hemolysis rate was 2.54%. No pyrogen reaction was found. CONCLUSION: P(NIPAAm-co-NHMPA) has been successfully prepared with good biocompatibility in vitro and might become a good medical implant for clinical use.

To investigate the relationship between intracellular free Ca2+ concentration ([Ca2+]i) and calcium-activated chloride (Clca) channels of pulmonary artery smooth muscle cells (PASMCs) in rats under acute and chronic hypoxic conditions, acute hypoxia-induced contraction was observed in rat pulmonary artery by using routine blood vascular perfusion in vitro. The fluorescence Ca2+ indicator Fura-2/AM was used to observe [Ca2+]i of rat PASMCs under normal and chronic hypoxic condition. The effect of Clca channels on PASMCs proliferation was assessed by MTT assay. The Clca channel blockers niflumic acid (NFA) and indaryloxyacetic acid (IAA-94) exerted inhibitory effects on acute hypoxia-evoked contractions in the pulmonary artery. Under chronic hypoxic condition, [Ca2+]i was increased. Under normoxic condition, [Ca2+]i was (123.63 +/- 18.98) nmol/L, and in hypoxic condition, [Ca2+]i was (281.75 +/- 16.48) nmol/L (P<0.01). Under normoxic condition, [Ca2+]i showed no significant change and no effect on Clca channels was observed (P> 0.05). Chronic hypoxia increased [Ca2+]i which opened Clca channels. The NFA and IAA-94 blocked the channels and decreased [Ca2+]i from (281.75 +/- 16.48) nmol/L to (117.66 +/- 15.36) nmol/L (P<0.01). MTT assay showed that under chronic hypoxic condition NFA and IAA-94 decreased the value of absorbency (A value) from 0.459 +/- 0.058 to 0.224 +/- 0.025 (P<0.01). Hypoxia increased [Ca2+]i which opened Clca channels and had a positive-feedback in [Ca2+]i. This may play an important role in hypoxic pulmonary hypertension. Under chronic hypoxic condition, Clca channel may play a part in the regulation of proliferation of PASMCs.

Objective To compare the diagnostic performances of strain elastography (SE) and shear-wave elastography (SWE) in differentiating benign and malignant solid breast lesions. Methods From January 2015 to December 2015, 150 patients with 155 lesions were examined with SE and SWE respectively in the First Affiliated Hospital with Nanjing Medical University. Elasticity scores on a improved 5-point scale,strain ratio (SR), maximum elasticity (Emax), mean elasticity (Emean), standard deviation of the elasticity (Esd) and the lesion-to-fat elasticity ratio (Eratio) were assessed. The receiver operating characteristic (ROC) curve of SE and SWE parameters were plotted to assess the value in distinguishing benign and malignant breast lesions. The results were compared using the area under the ROC curve (AUC). The accuracy of the parameters with the largest AUC were compared between SE and SWE by McNemar test in different breast imaging reporting and data system (BI-RADS) categories. Results The AUC of elasticity scores, SR, Emax,Emean, Esd and Eratio were 0.823, 0.810, 0.877, 0.835, 0.881 and 0.853, respectively. The SE and SWE parameter with the largest AUC were elasticity scores and Esd respectively. The accuracy of Esd was higher than that of elasticity scores(86.3% vs 64.7%)in 4A lesions (2=4.639, P < 0.05). There were no significant differences in accuracy in other BI-RADS categories. Conclusions Both SE and SWE were helpful for the differentiation of benign and malignant solid breast lesions, and the diagnostic performance of SE and SWE was similar. The optimization of elastography can be achieved by combination with BI-RADS.

Objective To investigate the expression and activity of transforming growth factor-β1 (TGF-β1)and endothelial nitric oxide synthase(eNOS) in the cavernous vascular structural remodeling of diabetic rats.Methods 52 adult male SD rats were randomly assigned to experimental group(DM) and control group(NDM).In DM group,diabetes was induced in rats 4 days after intraperitoneal injection with streptozotocin.HbA1c was measured on 2,4,8,and 16 weeks after injection.Penile tissues were harvested.The protein expression of TGFβ1 and eNOS in situ was evaluated by the Envision immunohistochemistry.Results Compared to NDM group,the expression of the HbA1c increased significantly in DM group on the 16th week(P ＜0.01),both the penile erection rate and penile erectile times decreased significantly in DM group on the 16th week (P ＜ 0.01),and the value of eNOS decreased on the 16th week(P ＜0.01).The expression of TGF-β1 went up in DM group compared to NDM group on the 8th week (P ＜ 0.01) and sustained to the 16th week (P ＞ 0.05).In DM group,we found that TGF-β1 protein in cavernous body of penis was positively related with age in weeks(r =0.947,P ＜0.01) ; and eNOS in cavernous body of penis was negatively related with age in weeks (r =-0.945,P ＜ 0.01).Meanwhile,the expression of TGF-β was negatively related with the eNOS(r =-0.891,P ＜0.01).Conclusion Our results indicate that TGF-β1 plays an important role in the pathogenesis of diabetic erectile dysfunction(ED) and TGF-β1 inhibition may be a promising strategy to prevent development of diabetic ED.