Objective To understand employment status of the eight-year program medical graduates from different medical colleges and put forward reasonable proposals on the current prob-lems. Method Through questionnaire, we conducted research among eight-year program medical graduates of three different grades (Grade 04,05,06) on the general condition of employment, research level, actual working time, expectations and actual salary, satisfaction with jobs and so on. Data statis-tics was done by Excel 2007. Totally, our research involved 11 medical colleges and 389 questionnaires. Results 94.34% (367/389) of the eight-year program medical graduates work in top three hospitals. The top five factors affecting the employment were reputation of the school 86.38%(336/389), reputation of the Principal Investigator 66.83% (260/389), social relations 60.15% (234/389), scientific research level 52.96% (206/389) and gender 46.79% (182/389). The amount of published papers from those graduates and their satisfaction with jobs vary greatly. Conclusion Eight-year program medical grad-uates employment faces both opportunities and challenges, and a clear training objective and improve-ment of continuing medical education system for the eight-year program medical graduates will have great significance on the promotion of their employment.

Objective To study the impact of ribavirin cumulative dose on virological response rates in genotype 1 hepatitis C virus(HCV)infected patients.Methods The medical records of 225 genotype 1 chronic hepatitis C(CHC)patients treated with peginterferon α-2a plus ribavirin were retrospectively analyzed.These patients were divided into four groups according to ribavirin cumulative dose:>97%,80%-97%,60%-79%and<60%of standard cumulative dose.The relationship between ribavirin cumulative dose and virological response rates was studied.Data as analyzed by chisquare test or F test.Results The incidence of ribavirin cumulative dose<97%was 43.1%(97/225),which was higher than peginterferon alfa-2a(27.1%,61/225)(x2=12.641,P=0.001).The sustained virological response rate(SVR)was 27.8%(5/18)in group of ribavirin cumulative dose <60%,which was much lower than those in groups of ribavirin cumulative dose>97%(65.6%,84/128),80%-97%(60.5%,26/43),60%-79%(58.3%,21/36)(x2=9.538,P=0.023).The relapse rate was 61.5%(8/13)in group of ribavirin cumulative dose<60%,which was significantly higher than those in groups of ribavirin cumulative dose>97%(20.0%,21/105),80%-97%(23.5% ,8/34),60%-79%(27.6%,8/29)(x2=10.837,P-0.013).Among patients achieved rapid virological response(RVR),SVR in groups of ribavirin cumulative dose>97%,80%-97%,60%-79%and<60 % of standard dose were 92.0%(23/25),88.9%(8/9),85.7%(6/7)and 75.0%(3/4),respectively(x2=1.098,P=0.778).Conclusiom Mlid reduction of ribavirin dose not affect SVR of genotype 1 HCV infected patients.However,the relapse rate is high and SVR is low in patients treated with ribavirin cumulative dose<60% of standard dose.

Objective To investigate the corelation between neutropenia (ANC) incidence and infection during treatment with peginterferon alfa and ribavirin for chronic hepatitis C.Methods A retrospective cohort study of 399 patients treated with peginterferon and ribavirin derived from database of Department of Infectious Diseases, the Second Affiliated Hospital, Harbin Medical University was conducted.The incidence of infections and their relation with ANC were investigated.Potential risk factors for infection were identified by multivariate analysis.Results During treatment,neutropenia (ANC ＜ 1.50 ×109/L) occurred in 251 patients.Among which,mild neutropenia [ANC: ( ＞ 0.75-＜ 1.50) x 109/L],moderate neutropenia [ANC: ( 0.50-0.75 ) × 109/L]and severe neutropenia ( ANC ＜ 0.50 × 109/L)occurred in 132 patients,103 patients and 16 patients,respectively.A total of 80 infections (20.1％ )occurred,among which,14 infections were defined as severe.There was no significant difference in infection rate between patients with and without neutropenia ( 19.9％,50/251 vs 20.3％,50/251 ; x2 =0.007,P =0.933).There was no significant difference in infection rate between patients with and without peginterferon dose reduction ( 21.5％,31/144 vs 19.2％,49/255 ; x2 =0.307,P =0.580 ).In multivariate logistic regression analysis,the independent factors associated with infection were age (P =0.021),diabetes (P =0.004) and cirrhosis (P =0.012).Conclusions Infections during treatment with peginterferon alfa and ribavirin for chronic hepatitis C are irrelevant to neutropenia.The independent factors associated with infection are age,diabetes and cirrhosis.

Objective To investigate the methods of reducing radiation dose in CT coronary angiography through optimizing individualized scan dosage protocol.Methods Two hundred patients (group A)underwent coronary CTA examination which was performed with fixed 120 kV and variable mA according to their BMI.The mA was set as 150-300 mA(BMI ＜ 18.5 kg/m2),300-500 mA (18.5 kg/m2 ≤ BMI ＜ 25.0 kg/m2),and 500-800 mA(BMI ≥ 25.0 kg/m2).When all examinations were finished,a linear regression was employed to analyze the correlation between mA and BMI,body surface(Suf),image noise(SD)respectively.The results of the analysis were used to formulate a regression equation,which was further used to establish a table list for quick search on how much mA that individualized coronary CTA scan would need.Another 200 patients(group B)enrolled for the individualized scan were scanned under new protocol that previous study established.The tube voltage was 100 and 120 kV.The tube current was variable according to the data in the table list.One-way ANOVA and Kruskal-wallis H test were used for statistics.Results Regression equation between mA and BMI,Suf,SD was:mA =17.984 × BMI + 169.149 × Suf-2.282 × SD-361.039.The SD(group A:32.08 ± 5.80,group B:28.60±4.47),dose index volume(CTDIvol)[group A:(41.97 ± 11.37)mGy,group B:(33.18±10.07)mGy],effective dose(ED)[group A:(10.91 ±3.07)mSy,group B:(8.83 ±2.72)mSv]had significant differences between the two groups(F =43.45,63.71,49.07 respectively,P ＜0.01 for all).The SD and ED results obtained in group B were better than those in group A.Conclusion Better performances were obtained when BMI combined Suf was used as a new individualized protocol than when BMI was used only,which means good image quality and lower radiation dosage in coronary CTA examination.

ObjectiveTo investigate the effect of adding metformin to peginterferon alfa-2a and ribavirin on the efficacy in patients with genotype 1 chronic hepatitis C and insulin resistance.Methods Ninety-eight patients with genotype 1 chronic hepatitis C and insulin resistance were randomized into the treatment group (n=49) and the control group (n=49).The patients in the control group were treated with peginterferon alfa-2a and ribavirin,and those in the treatment group were treated with metformin in addition to peginterferon alfa-2a and ribavirin. The virologic response rate,the homeostasis model assessment for insulin resistence index (HOMA-IR) and incidence of side effects were compared between two groups.The related factors of sustained virological response (SVR) were studied by multivariate logistic regression analysis.ResultsThe SVR rate of the patients in the treatment group was significantly higher than that of the control group (59.2％ vs 38.8％; x2 =4.083,P=0.043).The HOMA-IR of patients in the treatment group at week 12,24,48 of treatment and week 24 of follow-up were 3.00±0.65,1.90±0.45,1.75±0.40 and 1.60±0.35,respectively,which were all lower than those in the control group (3.50±0.72,2.90±0.64,2.74± 0.48 and 2.60±0.55,respectively) (t=3.610,8.947,11.091 and 10.738,respectively; all P＜ 0.01).The incidence of diarrhea in the treatment group was higher than the control group (28.6％ vs 10.2％ ; x2 =5.288,P=0.021).In multivariate logistic regression analysis,the independent factors associated with SVR were metformin treatment (P =0.009) and HOMA-IR＜ 2 at week 24 of treatment (P=0.011 ). Conclusion The combination of metformin,peginterferon alfa-2a and ribavirin improves insulin sensitivity and increases SVR rate of patients with hepatitis C genotype 1 and insulin resistance with good safety profile.

Objective The aim of this study was to investigate the effect of hepatitis C virus (HCV) replication on expression of silent information regulator 1 (SIRT1) and glucose metabolism of hepatocytes using Huh 7.5 cells harboring HCV replicon.Methods The level of reactive oxygen species (ROS),value of nicotinamide adenine dinucleotide (NAD+)/reduced form of nicotinamide adenine dinucleotide (NADH) was detected by flow cytometry and chromatometry.The activity,mRNA expression,and protein level of SIRT1 were detected by a scintillation counter,real-time fluorescence quantitative polymerase chain reaction (RT-PCR),and Western blot,respectively.Glucose uptake by hepatocytes and gluconeogenesis were detected using radioactive isotope method and glucose oxidase method.The mRNA levels of SIRT1 downstream glucose-metabolism genes were measured by RT-PCR.Measurement date were compared by t test.Results In replicon cells,the level of ROS (3.8±0.5 vs 1.0±0.2; t=12.736,P＜0.01) was increased and the value of NAD+/NADH (0.03±0.01 vs 0.12±0.03; t=6.971,P＜0.01) decreased compared with Huh 7.5 cells.The activity (0.3±0.1 vs 1.0±0.2; t=7.668,P＜0.01),mRNA expression(0.4±0.1 vs 1.0± 0.3; t=4.648,P＜0.01) and protein level(0.3±0.1 vs 0.8±0.2; t=5.941,P＜0.01) of SIRT1 were reduced.Inhibition of SIRT1 not only increased insulin receptor substrate-1 (IRS-1) phosphorylation (0.7±0.2 vs 0.4±0.1; t=3.286,P＜0.01),decreased protein kinase B (Akt) phosphorylation (0.3 ± 0.1 vs 0.6 ± 0.2; t=3.286,P＜0.01),down regulated cell surface expression of glucose transporler 2 (GLUT2,0.4±0.1 vs 1.0 ± 0.2; t =6.573,P＜0.01) and suppressed cellular glucose uptake (count per minute:4600±500 vs 21 000±4600; t=8.682,P＜0.01); but also decreased phosphorylation of forkhead box O1 (FoxO1,0.2＝0.1 vs 0.5±0.1; t=5.196,P＜ 0.01),up-regulated phosphoenolpyruvate carboxykinase (PEPCK,2.8±0.6 vs 1.0±0.3; t=6.573,P＜0.01) and glucose 6-phosphatase (2.6±0.5 vs 1.0±0.2; t=7.278,P＜0.01) genes,and promoted glucose production (2.5±0.5 vs 1.0±0.2; t=5.543,P＜0.01).Conclusions HCV replication decreases NAD+/NADH ratio,which might down-regulate the activity and the expression of SIRT1,leading to changes in the expression profile of glucose metabolism related genes and causing glucose metabolism disorders of hepatocytes by a decrease in glucose uptake and an increase in glucose production,and promotes HCV replication.

AIM To determine the contents of arillanin A,tenuifoliside A and tenuifoliside C in raw Polygalae Radix (root barks),Polygalae Radix duramen,Glycyrrhizae Radix et Rhizoma-processed Polygalae Radix,waterboiling Polygalae Radix and honey-processed Polygalae Radix.METHODS The analyses of 50％ methanol extracts from samples were performed on a 30 ℃ thermostatic Kromasil C18 column (250 mm ×4.6 mm,5 μm),with the mobile phase comprising of acetonitrile-0.1％ formic acid flowing at 1.0 mL/min in a gradient elution manner,and the detection wavelength was set at 330 nm.RESULTS The contents of three oligosaccharide esters were the highest in raw Polygalae Radix,followed by those in honey-processed Polygalae Radix,and those in water-boiling Polygalae Radix were the lowest.These constituents also existed in Polygalae Radix duramen,but their contents were lower than those in root barks.CONCLUSION The ester bonds of oligosaccharide esters in Polygalae Radix may be hydrolyzed during processing,followed by the generation of small molecular organic acids.The medication of whole Polygalae Radix (root barks and duramen) can be taken into consideration in clinical practice to reduce toxicity and enhance efficacy.

Objective To analyze mutations in the ATP2A2 gene in a Kazakh family with Darier's disease.Methods Clinical data were collected from 49 members from a family with Darier's disease,and peripheral blood samples were obtained from 44 family members and 100 unrelated healthy people.Genomic DNA was extracted from these blood samples.PCR and DNA sequencing were performed to detect mutations in the ATP2A2 gene.Results Darier's disease was inherited in an autosomal dominant manner in this family.A G→A heterozygous mutation (1288-1G→A) was identified at position 1288-1 at the splice site in exon 12 of the ATP2A2 gene in 11 patients in this family,but not in 33 healthy members or 100 healthy controls.Conclusion Darier's disease in this family may be caused by the heterozygous mutation (1288-1G→A)at the splice site in exon 12 of the ATP2A2 gene.

Objective To study the epidemiological and clinical features of the patients with forest encephalitis. Methods The epidemiological, clinical and laboratory data and prognosis of forest encephalitis patients with forest encephalitis virus-specific antibody positive were retrospectively analyzed. Results The onsets of 79 patients with forest encephalitis were mainly in May to August. Fifty-six of them were forestry workers, 9 were forest beekeepers, 8 were inhabitants with experience of getting potherb and 6 were tourists. Of the 79 patients, cases with mild, moderate and severe type were 5, 35 and 39, respectively; 7 cases died and 13 presented sequelae, such as head drooping, paralysis of the upper extremities, epilepsy, trembling and psychonosema. All 79 patients presented fever, headache, nausea and vomiting; and some of them presented other symptoms including 32 (40.5%) conscious disturbance, 74 (93.7%) neck rigidity, 74 (93.7%) meningeal irritation sign positive, 20 (25.3%) convulsion, 38 (48.1%) complexion flush, conjunctiva and oral mucosa congestion, 19 (24.1%) neck, shoulder, upper extremity muscle and limbs paralyzed, 4 (5.1%) respiratory muscle paralysis and 3 (3.8%) dysphagia. The abnormal laboratory findings included that 60 (80.0%) elevated cerebrospinal fluid pressure, 66 (88.0%) increased cell counts, 65 (82.3%) diffused and scattered slow waves on electroencephalograms, 8 (10.1%) liver dysfuncted and 18 (22.8%) elevated cardiac muscle enzymes. Conclusions Forest encephalitis is characterized by hyperpyrexia and central nervous system damage. The morbidity of severe patients is high, and the sequelae are common as well, to which we should pay much attention.

Objective To investigate the prevalence of nutritional risk,malnutrition(undemutrition),overweight/obesity,and application of nutritional support in hospitalized patients with endocrine disorders.Methods Adult patients in Department of Endocrine of Peking Union Medical College Hospital(PUMCH)from September to December 2008 were consecutively enrolled.Nutrional Risk Screening 2002(NRS2002)war per-formed on the next morning after admission and nutritional support evaluation was performed on the 14th day of ad-mission or on the discharge day.The relationship between nutritional risk and nutritional support Was analyzed.Nu-tritional risk was defined as NRS2002 score≥3,and body mass index(BMI)<18.5 ks/m2 defined as unclernut-rition.Results A total of 152 patients were enroled,and NBS2002 scoring was performed in all patients.The prevalence of undernutrition Was 7.9%and the nutritional risk was 27.6%.The prevalence of nutritional risk in the elderly inpotients(≥60 years old)was significantly higher than in younger patients(18-59 years old)(36.8%vs 20.2%,P=O.023).Nine patients(21.4%)with NRS2002≥3 received nutrition support,and 12patients(10.9%)with NRS2002<3 received nutritional support.The average PN:EN ratio was 1:3.2.Conclu-siom NRS2002 is afeasible nutritional risk screening tool for inpatients with endocrine disorders.A large propor-tion of inpotients were at nutritional risk or undemutrition in the Department of Endocrine of PUMCH. The application of nutritional support currently is somehow inappropriate.Evidence-based guidelines are required to improve this situation