Red doctor’s spirit is an important part of China’s advanced revolutionary culture and a valuable resource for medical students’ ideological and political education. Under the background of the new era, integrating the red doctor’s spirit into the ideological and political course of medical students is not only conducive to encouraging medical students to bravely shoulder the responsibility of the times and actively participate in the cause of human health, but also helps medical students to inherit the red culture and strengthen cultural confidence, which is also of great significance to improving the vitality and effectiveness of ideological and political courses.Teachers of Ideological and political courses should deeply explore the new era connotation of the red doctor’s spirit and constantly improve the guiding force of ideological and political courses; using Virtual Reality technology to realize the visual expression of red medicine spirit and enhance the appeal of ideological and political course; skillfully use four kinds of classes to strengthen the recognition of ideological and political course.

Red doctor’s spirit is an important part of China’s advanced revolutionary culture and a valuable resource for medical students’ ideological and political education. Under the background of the new era, integrating the red doctor’s spirit into the ideological and political course of medical students is not only conducive to encouraging medical students to bravely shoulder the responsibility of the times and actively participate in the cause of human health, but also helps medical students to inherit the red culture and strengthen cultural confidence, which is also of great significance to improving the vitality and effectiveness of ideological and political courses.Teachers of Ideological and political courses should deeply explore the new era connotation of the red doctor’s spirit and constantly improve the guiding force of ideological and political courses; using Virtual Reality technology to realize the visual expression of red medicine spirit and enhance the appeal of ideological and political course; skillfully use four kinds of classes to strengthen the recognition of ideological and political course.

Aortic root enlargement or aortic annulus enlargement is one of the key strategies for managing the small aortic root or small aortic annulus. Surgeons may be conservative about the risks of this method, which has limited the application in clinical surgery. Recent large clinical studies have shown that aortic root enlargement does not increase the risk of surgery and is a safe surgical procedure. This article reviews the methods of aortic root enlargement surgery including new aortic root enlargement surgery-aortic root enlargement with replacement of the noncoronary sinus with a patch and clinical outcome, which aims to provide a guidance for clinical practice.

Objective To explore the interaction between tryptophan hydroxylase 2(TPH2) gene polymorphisms (rs4570625,rs11178997) and serotonin 1A receptor (5-HT1A) gene polymorpbisms (rs878567,rs1364043,rs6265) and the association with major depressive disorder (MDD) in a Chinese Han population.Methods The DNA isolated from peripheral blood samples of 288 MDD patients 288 healthy subjects was detected by single base primer extension assay (Snapshot).The generalized multifactor dimensionality reduction (GMDR) method was used to analyze the gene-gene interaction.Results Significant differences were found in the genotype (patients (TT:27,TA:152,AA:109),controls (TT:82,TA:105,AA:101),P＜0.01) and allele(patients (T:206,A:370),controls (T:269,A:307),P＜0.01) frequencies of rs1 1178997 within TPH2 between MDD patients and controls.Statistically,a greater risk of developing MDD was found in individuals with an rs1 1178997 A-allele(OR=1.574,95％CI=1.243-1.993).The interaction between TPH2 (rs4570625,rs1 1178997) and 5-HT1A (rs878567,rs1364043,rs6265) was considered as the best multi-locus model,and this showed a testing accuracy of 57.67％ and a CV consistency of 10/10.And this interaction had a significant effect on the risk of MDD (P=0.0107).Conclusion There may be an association between the interaction of TPH2 and 5-HT1A polymorphisms and MDD.

Objective To evaluate the effects of sodium-glucose cotransporter 2 ( SGLT2) inhibitors on the stroke risk for patients with type 2 diabetes mellitus (T2DM). Methods A systemic meta-analysis including 30 random control trails ( RCTs) was performed to compare the risk of stroke between type 2 diabetic patients treated with SGLT2 inhibitors and control drugs. Then their bias risk and quality were assessed and meta-analysis was conducted using Stata12.0 software. Results Thirty RCTs enrolling 74456 participants were selected for meta-analysis. The stroke incidence in the group receiving SGLT2 inhibitor monotherapy or combination therapy did not significantly differ from that in control group, with relative risk (RR) 1.01 (95％CI 0.93-1.10, P=0.978) and 1.00 (95％CI 0.92-1.09, P=0. 874 ) , respectively. Three SGLT2 inhibitors canagliflozin, dapagliflozin, and empagliflozin did not increase the risk of stroke, with similar RR values ( RR=0.91, 0.99, 1.13, respectively) . Subgroup analyses showed that there was no correlation between SGLT2 inhibitors and stroke risk in different gender, age, diabetes duration, body mass index, or HbA1C levels. Conclusions Whether administered as monotherapy or add-on therapy, SGLT2 inhibitors did not increase stroke incidence, and there were no significant within-class differences.

Objective To investigate the single nucleotide polymorphisms(SNPs) of 5-HT1BR(rs6298),5-HT2AR(rs6311,rs6313) and 5-HT2BR(rs765458) gene,and their gene-gene interactions on suicidal behavior in major depressive disorder.Methods The blood samples were taken from 281 depression patients with impulsive suicide attempt and 281 age-matched healthy controls from a hospital in Harbin city,Heilongjiang province.The DNA isolated from blood samples and was genotyped using TapMan SNP genotyping probe.χ2 test was used to compare differences in the distribution of gene alleles between cases and controls.Haplotype and linkage disequilibrium(LD) analysis was performed using Haploview 4.0 software.GMDR was used to analyze the gene-gene interaction.Results The rs6313 and rs6311 of the 5-HT2AR gene were in strong linkage disequilibrium (D=0.756,r2=0.375).There was a significant gene-gene interaction of 5-HT1BR (rs6298),5-HT2AR (rs6311,rs6313) and 5-HT2BR(rs765458) on suicidal behavior(P<0.05).In this model,the test accuracy was 0.6182 and CV value was 10/10.Conclusion A haplotype containing rs6311 and rs6313 of 5-HT2AR gene is associated with suicidal behavior.The interaction of 5-HT1BR gene (rs6298),5-HT2AR gene (rs6311,rs6313) and 5-HT2BR gene (rs765458) are associated with depression suicidal behavior.

Objective To explore the association between GNβ3 gene and depression,and to investigate the interaction of gene-environment(negative life events and childhood trauma) and potential possible pathogenesis of depression.Methods The sample of peripheral blood was collected from Chinese Northern patients(n=500) and controls(n=500).Snapshot technique was used to detect the genotype frequency and allele frequency of GNβ3 rs5443 polymorphism in cases and controls.The genotype and allele frequencies were analyzed by Chi-square test,the interactions of gene-environment were analyzed by Logistic regression.Results GNβ3 rs5443 genotype and allele frequencies were observed between patients and controls (x2 =20.249,P＜0.01;x2 =4.803,P＜0.05).There were genotype CC 102 and 158,genotype CT 280 and 217,genotype TT 118 and 125;allele C 484 and 533,allele T 516 and 467 between patients and controls,respectively.Logistic regression analysis showed that the interaction between rs5443 T+ and negative life events was associated with depression (P＜0.05,OR=1.957).In addition,individual carrying rs5443T+ genotypes and negative life events could increase risk of depression.Conclusion GNβ3 rs5443 is a possible susceptibility gene of depression.The interaction between rs5443 and negative life events is associated with depression.

Objective: To evaluate the efficacy and safety of maintenance therapy with reduced dose of rhTPO in the patients with primary immune thrombocytopenia (ITP) who attained stable platelet (PLT) counts after daily administration of rhTPO. Methods: Treatment was started with a daily administration of rhTPO (300 U/kg) for 2 consecutive weeks. Patients who attained stable PLT≥50×10⁹/L were enrolled to maintenance therapy starting with every other day administration of rhTPO, then adjusted dose interval to maintain platelet count (30-100) ×10⁹/L. Results: A total of 91 eligible patients were enrolled. Fourteen patients discontinued the study due to noncompliance (12/14) and investigator decision (2/14) . Among 77 patients who completed the study, 38 patients with the administration of rhTPO at every other day or less could maintain PLT≥30×10⁹/L for 12 weeks. The percentage of patients with a platelet response (PLT≥30×10⁹/L) at 4^th week, 8^th week and 12^th week of maintain therapy was 92.6% (63/68) , 82.7% (43/52) and 85.0% (34/40) , respectively. Median platelet counts remained in the range of (70-124) ×10⁹/L. The overall incidence of rhTPO-related adverse events was 7.7%. All the adverse events were generally mild. Conclusion Extending the dose interval of rhTPO is feasible to maintain stable platelet count in the patients with ITP, but the optimal dose interval is uncertain and might vary with individuals.

BACKGROUNDThe prevalence of metabolic syndrome (MetS) increased recently and there was still not a screening index to predict MetS. The aim of this study was to estimate whether brachial-ankle pulse wave velocity (baPWV), a novel marker for systemic arterial stiffness, could predict MetS in Chinese community population.

METHODSA total of 2 191 participants were recruited and underwent medical examination including 1 455 men and 756 women from June 2011 to January 2012. MetS was diagnosed according to the criteria of the International Diabetes Federation (IDF). Multiple Logistic regressions were conducted to explore the risk factors of MetS. Receiver operating characteristic (ROC) curve was performed to estimate the ideal diagnostic cutoff point of baPWV to predict MetS.

RESULTSThe mean age was (45.35±8.27) years old. In multiple Logistic regression analysis, the gender, baPWV and smoking status were risk factors to MetS after adjusting age, gender, baPWV, walk time and sleeping time. The prevalence of MetS was 17.48% in 30-year age population in Shanghai. There were significant differences (χ(2) = 96.46, P < 0.05) between male and female participants on MetS prevalence. According to the ROC analyses, the ideal cutoff point of baPWV was 1 358.50 cm/s (AUC = 60.20%) to predict MetS among male group and 1 350.00 cm/s (AUC = 70.90%) among female group.

CONCLUSIONBaPWV may be considered as a screening marker to predict MetS in community Chinese population and the diagnostic value of 1 350.00 cm/s was more significant for the female group.

Adult ; Ankle Brachial Index ; methods ; Female ; Humans ; Logistic Models ; Male ; Metabolic Syndrome ; diagnosis ; Middle Aged ; ROC Curve

Objective To determine the value of oxygenation index in assessing the outcome of mechanical ventilated patients with acute respiratory distress syndrome (ARDS).Methods From September 2008 to September 2013,patients meeting the Berlin definition of ARDS were evaluated in this retrospective study.Data included oxygenation index (PaO2/FiO2) on day before,and day 1 and day 3 after mechanical ventilation.The levels of PaO/FiO2 on day before and day 1 after mechanical ventilation were compared between 28-day survivors and non-survivors.Results There were 236 patients meeting the criteria of the Berlin Definition for diagnosis and treated with mechanical ventilation.The mean score of APACHIE Ⅱ and sequential organ failure assessment (SOFA) at the beginning were (19.1 ± 3.0) and (10.8 ±2.5),respectively,while oxygenation index on day before mechanical ventilation was (150.3 ± 62.6) mmHg.According to the hypoxemia grade,patients were divided into mild (n =36),moderate (n =122) and severe (n =78) ARDS,and their levels of PaO2/FiO2 were (80.1 ± 8.1),(162.3 ± 19.9) and (261.6 ± 22.3) mmHg,respectively.There were 92 non-survivors and 144 survivors.No obvious difference in oxygenation index of non-survivors among on day before、and day 1 and day 3 after mechanical ventilation.There was statistically significant difference in oxygenation index between on day before and day 1 after mechanical ventilation in survivors (P ＜ 0.05).Compared with the survivors,the score of APACHE Ⅱ,SOFA,and oxygenation index on day 3 were associated with increased mortality in the non-survivors,respectively (P ＜ 0.05).In respect to the mortality,the cut-off point of score of oxygenation index set at ＜ 180 mmHg on Day 3,an area under the receiver operating curve (AUC) was 0.749 with statistically significance (P ＜ 0.05),leading to sensitivity 61.7％ and specificity 93.2％.The relationship between prognosis and antibiotic resistance did not have statistically significance.Conclusions Data of oxygenation index on early phage of ARDS may be valuable to predict the outcome.A strong predictor of adverse outcome in such conditions was the score of oxygenation index on Day 3 ≤ 180 mmHg.