Objective The study explored the feasibility of PBL teaching approach and mini-CEX scores evaluation method in hematology probation teaching practice. Methods 54 medical students of eight-year program were selected in the study and they were in hematology department of Sun Yat-sen Memorial Hospital for clinical probation. The study compared PBL teaching approach with traditional training method, and used mini-CEX to evaluate the students' clinical competence. Results The performance of PBL teaching group is better than traditional teaching group in the aspect of inquiry skill, clinical diagnosis, therapy plan and humanistic care (P<0.05). There is no significant difference of basic knowledge, physical examination skill and clinical operational skills between these two groups. More than 85％of the students in PBL group are satisfied with the teacher in the aspect of participation, feedback, guidance, correction and assistance. Conclusion Through this teaching practice, the study provides new methods for improving the teaching of pre-internal clinical practice in hematology department.

Objective: To study the shift of oVEMP frequency tuning of unilateral Meniere′s disease, by analyzing oVEMP of air-conducted tone bursts in various frequencies. Methods: From May 2016 to October 2017, 33 patients with unilateral Meniere′s from Aerospace Center Hospital were tested for oVEMP in 500 Hz and 1 000 Hz air-conducted tone bursts respectively, and 20 healthy subjects(40 ears), matched for age and sex, were used as healthy control. The amplitudes of the N1-P1 wave and the frequency amplitude ratios of 500/1 000 Hz in affected ears, unaffected ears and normal ears were compared; and receiver operating characteristic curve was analyzed for frequency amplitude ratios of 500/1 000 Hz. Results: By the 500 Hz tone-burst stimulus, the provocation rates of the oVEMP were 84.9%(28/33), 93.9%(31/33) and 97.5%(39/40) in affected ears, contralateral ears and the ears of normal controls, respectively. By the stimulus of 1 000 Hz tone-burst, the provocation rates of the oVEMP were 81.8%(27/33), 87.9%(29/33) and 82.5% (33/40) in affected ears, contralateral ears and normal control ears, respectively. Amplitudes of N1-P1 waveforms in 500 Hz air-conducted tone bursts in affected ears were under normal control ears and contralateral ears. There was significant difference between affected ears and healthy control ears (P<0.05). Amplitudes of N1-P1 waveforms in contralateral ears were also significantly smaller than those in normal control ears (P<0.05). There were no significant differences in amplitudes of N1-P1 waveforms between affected ears, contralateral ears and normal control ears in 1 000 Hz tone bursts stimulus(P>0.05). Frequency amplitude ratios of 500/1 000 Hz in affected ears were significantly under contralateral and normal control ears (P<0.05). According to ROC, the frequency amplitude ratio critical value of frequency tuning was set as 1.17, the positive rate of frequency tuning shift in affected ears was 54.5%(18/33) and significantly higher than in contralateral ears(18.2%, 6/33, χ²=9.429, P=0.002) and normal control ears (7.5%, 3/40, χ²=19.530, P=0.000). In contrast, there was no significant difference in the incidence of frequency tuning shift between contralateral ears and normal ears(χ²=1.909, P=0.167). Conclusions Frequency tuning oVEMP with Meniere′s disease will be changed.Frequency tuning of oVEMP with Meniere′s disease shifts from low frequency region to high frequency region in comparison with healthy people. Frequency amplitude ratio is helpful for diagnosis of Meniere′s disease.

To investigate changes in the angiotensin converting enzyme 2 (ACE2) and angiotensin (1-7) [Ang (1-7)] and to explore the role of ACE2-Ang (1-7)-Mas receptor axis in hypertension with heart failure with preserved ejection fraction (HFPEF).
 Methods: A total of 70 patients with primary hypertension and preserved left ventricular ejection fraction (LVEF>50%) were recruited and patients were divided into a hypertension group (HBP) and a heart failure with preserved ejection fraction group (HFpEF) according to the diagnostic criteria of HFpEF. Thirty-five healthy participants were selected randomly as a control group. Enzyme linked immunosorbent assays (ELISA) method was used to detect concentration of Ang (1-7), ACE2, angiotensin II (Ang II), brain natriuretic peptide (BNP) in plasma. Male Sprague- Dawley (SD) rats was randomly divided into 2 groups: An HFpEF group (n=16) and a sham group (n=8). Rats (n=8) in the AAC group were given Ang (1-7) [0.5 mg/(kg.d), intraperitoneally] for 6 weeks, and the rest were given equal dose normal saline. Then all the rats were killed, and the hearts were taken out for hematoxylineosin (HE) staining. The protein expressions of angiotensin converting enzyme (ACE), ACE2, and Mas receptor were detected by Western blot.
 Results: The BNP and Ang II were significantly increased in the HBP group and the HFpEF group compared with the control group (P<0.01). There were not significantly different in levels of ACE2 and Ang (1-7) between the HBP group and control group (P>0.05), whereas those levels were significantly increased in the HFpEF group compared with the HBP group and control group (P<0.01). HE staining showed obvious hypertrophy of myocardial cell in the AAC group compared with the sham group. Hypertrophy of myocardial cell in the AAC+Ang (1-7) group was significantly higher than that in the AAC group. Expressions of ACE, ACE2, and Mas receptor proteins were significantly higher in the AAC group than those in the sham group (P<0.05), while the expressions of ACE2 and Mas receptor proteins in the AAC+Ang (1-7) group were significantly higher than those in the AAC group (P<0.05). There was no significant difference in the ACE protein expression between groups (P>0.05).
 Conclusion: ACE2 and Ang (1-7) are important predictive factors for the severity of heart failure and myocardial remodeling of HFpEF with hypertension; ACE2-Ang (1-7)-Mas receptor axis may play a protective role in preventing myocardial remodeling in HFpEF with hypertension.
Angiotensin I ; physiology ; Angiotensin II ; Animals ; Atrial Remodeling ; physiology ; Case-Control Studies ; Enzyme-Linked Immunosorbent Assay ; Heart Failure ; metabolism ; physiopathology ; Humans ; Hypertension ; metabolism ; physiopathology ; Male ; Peptide Fragments ; physiology ; Peptidyl-Dipeptidase A ; physiology ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Receptors, G-Protein-Coupled ; physiology ; Stroke Volume ; Ventricular Function, Left ; physiology ; Ventricular Remodeling ; physiology

[Objective] To explore the risk factors for mortality of bloodstream infections in the patients with hematologic diseases,so as to provide evidence for reasonable and effective application of treatments.[Methods] The clinical data of 242 cases of bloodstream infections who were hospitalized from Jan 2012 to Jun 2016 were analyzed retrospectively,then the analysis was performed for risk factors.The statistical analysis was processed by SPSS 19.0.[Results] A total of 266 strains of pathogens were isolated,including 99 strains of gram-positive bacteria,accounting for 37.2％,and 164 strains of gram-negative bacteria,accounting for 61.7％.Multivariate analysis showed that the significant independent risk factors for mortality were active states of hematologic diseases (P =0.007,OR =5.622,95％ CI 1.586 ～ 19.924),presentation with septic shock(P =0.007,OR =4.978,95％ CI 1.560 ～15.884),cardiac insufficiency (P =0.001,OR =11.878,95％ CI 2.760 ～ 51.120),level of albumin less than 35 g/L (P =0.036,OR =3.468,95％ CI 1.087 ～ 11.066),polymicrobial infection (P =0.010,OR =6.024,95％ CI 1.540 ～ 23.563),and Staphylococcus haemolyticus (P =0.001,OR =19.308,95％ CI 3.392 ～ 109.888)/Enterococcus (P =0.002,OR =15.266,95％ CI 2.817 ～82.728) infection.The survival curves show that the inappropriate initial antimicrobial therapy group or presentation with any one of the independent risk factors had a lower probability of survival than the control group.[Conclusions] Bloodstream infections in patients may cause high mortality rate,so it is necessary that we use antibiotic reasonably and spare no effort to reduce the mortality rate by appropriate application of antimicrobial therapy and effective intervention of the risk factors.

Objective To investigate the association among cerebral lesions, mild cognitive impairment and artery stenosis.Methods In 685 cases which seek medical care in our hospital in recent years, we studied the cortical infarction lesions in this study, analysis of subcortical infarction in patients with cognitive impairment as well as the composition of the artery stenosis conditions were conducted .Results in this study, subcortical infarct patients with mild disturbance of consciousness accounted for 9.20%, while blood supply stenosis cases accounted for 49.34%.Elder than 70 years, long course of subcortical infarction, family history of alcohol consumption and dementia were associated with cortical (P <0.05), the incidence of subcortical infarct and mild cognitive disturbance were 2.138 times for infarct and mild disturbance of consciousness patients.Multivariate regression analysis showed that family history of hypertension and cerebrovascular disease were also risk factors.In addition, mild cognitive impairment can increase the risk of subcortical infarct and the incidence of vascular stenosis, OR was 2.077;elder than 70 years of age, subcortical infarct length, hypertension and family history of cerebrovascular disease were risk factors for subcortical infarction and stenosis of blood supply.In multivariate regression analysis, mild cognitive impairment, long duration of subcortical infarct, overweight and obesity, and hypertension showed to be risk factors of subcortical infarct and blood supply stenosis.Conclusion The artery stenosis and subcortical infarction with mild cognitive impairment show a positive correlation, while the presence of mild cognitive impairment and subcortical infarction and artery stenosis and an increased risk of an association, are related to each while age, duration and associated subcortical infarcts family history and other factors also affect the potential relationship between them .

Objective:To explore the dynamic variation of serum neuron‐specific enolase (NSE) and its clinical significance in patients with acute organophosphate poisoning .Methods:Ninety patients with acute organophosphate poisoning were enrolled into case group ,and other 90 healthy subjects were enrolled as control group .Venous blood samples of 3 .0 mL were collected from the all 180 subjects at admission .Apart from the 8 patients died on day 1 ,the other 172 subjects underwent collection of 3 .0 mL venous blood samples on day 2 ,day 3 ,day 5 ,day 7 .Serum NSE concentration was measured by enzyme‐linked immu‐nosorbent assay ,while cholinesterase(ChE) was determined by photoelectric colorimetry .Results:Eight patients in case group died on admission day ,of whom the average concentration of NSE and ChE were (131 .72 ± 10 .84) ng/mL ,(199 ± 228) U/L , respectively .Concentration of NSE of the rest 82 patients on day 1 ,day 2 ,day 3 were (54 .56 ± 5 .46) ng/mL ,(36 .18 ± 5 .27) ng/mL ,(20 .56 ± 4 .64) ng/mL ,respectively ,and concentration of the control group on the corresponding time points were (9 .72 ± 3 .92) ng/mL ,(9 .48 ± 3 .66 )ng/mL ,(9 .86 ± 3 .62)ng/mL ,respectively .Statistically significant differences were de‐tected between two groups(P< 0 .01) .Average concentration of ChE of the rest 82 patients on day 1 ,day 2 ,day 3 were (1628 .60 ± 112) U/L、(2113 .59 ± 324) U/L、(2474 .75 ± 711) U/L ,respectively ,and those in the control group on the corre‐sponding time points were (5982 ± 215) U/L ,(5651 ± 136) U/L ,(5783 ± 764)U/L ,respectively .Statistically significant differences were detected between two groups(P<0 .01) .The concentrations of NSE were in significantly negative correlation with that of ChE in mild ,middle and severe poisoning patients on day 1 ,day 2 ,day 3 ,and in positive correlation with the poi‐soning severity .The correlation coefficients rs>0 .05 ,P<0 .05 .Conclusions:Serum NSE may be used as an reference indica‐tor in the diagnosis and treatment of acute organophosphate poisoning .

Objective Our preliminary study demonstrates that quercetin can inhibit the proliferation of HL-60 cells. This sudy aimed to find some drugs which could have synergistic effects with quercetin on apoptosis of HL-60 cells. Methods HL-60 cells were cultured with bortezomib at different concentrations (1, 2, 4, 8, 16, and 32μmol/L) alone or combined with quercetin at different concentrations for 48 h. HL-60 cells were cultured with lenalidomide at different concentrations (5, 10, 20, 40, 80, 160, and 320 μmol/L) alone or in combination with quercetin at different concentrations for 48 h. The CCK-8 assay was used to determine the effects on proliferation of HL-60 cells. Results Bortezomib significantly inhibited the proliferation of HL-60 cells (P<0.01). IC50 of quercetin was 49.24μmol/L after cells treated by quercetin combined with bortezomib, which was 13.44μmol/L lower than that treated by quercetin alone. Isobolographic analysis revealed the two drugs had synergistic effect. The results of cell viability of HL-60 cells treated by lenalidomide at lower concentrations (5, 10, 20, 40, and 80μmol/L)were not different from those of the control group (P > 0.05). The results of cell viability of HL-60 cells treated by lenalidomide at higher concentrations (160 and 320μmol/L) were lower than those of the control group (P<0.05). IC50 of quercetin after cells treated by quercetin combined with bortezomib was not different from that treated by quercetin alone. Isobolographic analysis revealed the two drugs had no synergistic effect. Conclusions Bortezomib can inhibit the proliferation of HL-60 cells and it has a synergistic effect with quercetin on HL-60 cells. Lenalidomide has a weaker role in inhibition of the proliferation of HL-60 cells, and it has no synergistic effect with quercetin on HL-60 cells.

OBJECTIVE: To determine the correlation between interleukin-18 (IL-18) level and Global Registry of Acute Coronary Events (GRACE) risk score as well as risk stratification in patients with acute coronary syndrome (ACS), and to determine the clinical prognostic value of IL-18 for major adverse cardiac events (MACE) in ACS patients. METHODS: A total of 150 ACS patients were subjected to risk assessment and stratification with GRACE risk score. All ACS patients received conventional treatments and MACE was recorded. Plasma IL-18 was measured by enzyme-linked immunosorbent assay and the relationship between plasma IL-18 level and GRACE scores in ACS patients was analyzed. Predictive accuracy of IL-18 level and GRACE risk score for MACE were determined by receiver operating characteristic curve and the corresponding area under the curve. RESULTS: According to GRACE risk stratification, IL-18 level was significantly elevated in the high risk group (>140) compared with that in the middle risk group (109-140; P<0. 05), while IL-18 level was significantly elevated in the middle risk group compared with that in the low risk group (≤108; P<0. 05). According to the IL-18 level, patients were stratified into 4 groups by quartile (from the lowest to the highest, Q1-Q4). Compared with Q1-Q3 groups, the GRACE risk score and percentage of high risk patients were the highest in the Q4 group (P<0.05). Receiver operating characteristic curve analysis showed that IL-18 level was positively related with GRACE risk score and that the area under the curve of IL-18 level and GRACE risk score for predicting MACE in hospital patients were 0.887 and 0.914, respectively. CONCLUSION Both IL-18 level and GRACE risk score are valuable parameters for risk of MACE in patients with ACS. IL-18 may be an important biomarker in the prognosis of ACS patients.
Acute Coronary Syndrome ; diagnosis ; Biomarkers ; blood ; Enzyme-Linked Immunosorbent Assay ; Humans ; Interleukin-18 ; blood ; Prognosis ; ROC Curve ; Risk Assessment ; Severity of Illness Index

ABSTRACT:Objective To observe the clinical effects of and side reaction to gefitnib in treat-ment of non-small cell lung cancer (NSCLC),and to discuss related nursing interventions.Meth-ods A total of 110 NSCLC patients were administrated with gefitinib 250 mg per day.Response rate and side effects were observed regularly,and nursing experience was summarized after treat-ment.Results Overall response rate and disease control rate was 14.5% and 59%,respectively. Out of 110 patients,54 with skin rash,32 with diarrhea,14 with nausea and 13 with increased aminotransferase,but were reversible by nursing care.Conclusion Gefitnib shows effects in treat-ing NSCLC,and intensive nursing care is required to prevent side reactions.

ABSTRACT:Objective To observe the clinical effects of and side reaction to gefitnib in treat-ment of non-small cell lung cancer (NSCLC),and to discuss related nursing interventions.Meth-ods A total of 110 NSCLC patients were administrated with gefitinib 250 mg per day.Response rate and side effects were observed regularly,and nursing experience was summarized after treat-ment.Results Overall response rate and disease control rate was 14.5% and 59%,respectively. Out of 110 patients,54 with skin rash,32 with diarrhea,14 with nausea and 13 with increased aminotransferase,but were reversible by nursing care.Conclusion Gefitnib shows effects in treat-ing NSCLC,and intensive nursing care is required to prevent side reactions.