OBJECTIVE: Foreign studies have reported that coronary artery disease (CAD) patients with high baseline low-density lipoprotein cholesterol (LDL-C) may have a good prognosis, which is called the "cholesterol paradox". This study aimed to examine whether the "cholesterol paradox" also exists in the Chinese population. METHODS: A total of 2,056 patients who underwent the first percutaneous coronary intervention (PCI) between 2014 and 2016 were enrolled in this retrospective cohort study and classified into two groups based on baseline LDL-C = 2.6 mmol/L (100 mg/dL). The outcomes of interest included major adverse cardiovascular events (MACE), all-cause mortality, recurrent nonfatal myocardial infarction, unexpected coronary revascularization, or any nonfatal stroke. RESULTS: All-cause mortality occurred in 8 patients (0.7%) from the low-LDL-C group and 12 patients (2.4%) in the high-LDL-C group, with a significant difference between the two groups (adjusted hazard ratio: 4.030, 95% confidence interval: 1.088-14.934; P = 0.037). However, no significant differences existed for the risk of MACE or other secondary endpoints, such as unexpected revascularization, nor any nonfatal stroke in the two groups. CONCLUSION In this study, a high baseline LDL-C was not associated with a low risk of clinical outcomes in CAD patients undergoing first PCI, which suggested that the "cholesterol paradox" may be inapplicable to Chinese populations.
Humans ; Cholesterol, LDL ; Retrospective Studies ; Percutaneous Coronary Intervention/adverse effects* ; Coronary Artery Disease/surgery* ; Cholesterol ; Cholesterol, HDL ; Stroke/etiology* ; Treatment Outcome ; Risk Factors

Objective: To evaluate heterogeneity and clonal evolution in pediatric ETV6-RUNX1⁺ acute lymphoblastic leukemia (ALL) in China. Methods: Totally 48 children (<14 years) with newly diagnosed ETV6-RUNX1⁺ ALL in Institute of Hematology and Blood Disease Hospital, CAMS and PUMC, from February 2006 to June 2011 were included. The copy number variations were analyzed by quantitative multigene fluorescence in situ hybridization (QM-FISH) in 48 patients. Non-normal distribution of measurement data were shown with Median (range) , count data were shown with percent (%) . Overall survival and event-free survival were estimated by the Kaplan-Meier method and compared with the log-rank test. Results: Forty-eight patients were tested by QM-FISH. Of 48 patients, 70.8% harbored one clone, 18.8% two subclones, and 10.4% three or more subclones. The clone heterogeneity was detected by two different models: the linear succession model and the branching evolution model. ETV6-RUNX1⁺ ALL relapse evolved from an ancestral clone or a new clone. The patients relapsed from a new clone got the worse outcome. Conclusion The clone evolution was detected in pediatric ETV6-RUNX1⁺ ALL in China. QM-FISH might be helpful to evaluate the outcome of relapsed patients. A new clone was associated with a poorer outcome.

Objective To investigate the implementing effect of team-based learning combined with situational simulation in clinical teaching of psychiatry.Methods A compendium was selected from "Psychiatric nursing",which was about the prevention and nursing of psychiatric crisis. We designed curriculums and wrote the scripts,and organized professional scenario walkthroughs. Eventually,we made them into videos and audio data. Firstly,60 nursing students were given team-based learning combined with situational simulation based on traditional teaching for 4 weeks. After teaching,the results of the theory and emergency skills examination and teaching satisfaction were compared.Results After 4 weeks,the professional theoretical examination of nursing students was (88.93±8.20) pints,and it was significantly higher than (83.27±5.31) points before teaching;meanwhile the emergency skills examination was (93.48±5.99) points,which was significantly higher than (85.87±7.34) points before training (t=-7.91,-9.12;P<0.01). The score of satisfaction of nursing students with teaching was (97.21±1.75),which was higher than (83.82±8.23) before training (t=10.78,P<0.01).Conclusions The team-based learning combined with situational simulation teaching not only cultivates nursing students' autonomous learning interest,which could improve independent study ability and effectiveness,but also improves their teamwork skills,which could improve clinical teaching quality and satisfaction.

Objective To discuss the implementation effects of the team-based learning combined with situational simulation in the standardized training in psychiatric.Methods A total of 70 psychiatric nurses in the standard training period from June to August 2015 were randomly divided into control group and experimental group, 35 respectively. Nurses in the control group received traditional teaching mode, while nurses in the experimental group used the teaching mode of the team-based learning combined with situational simulation. After the training, the theoretical knowledge, the comprehensive ability of emergency response, and the ability of team work of nurse in two groups were evaluated.Results After 6 months of standardized training, the scores of theoretical knowledge (87.13±7.50) and comprehensive ability of emergency response (95.57±4.19) of nurses in the experimental group were significantly higher than those in the control group (t=8.52, 7.81;P<0.01). The scores of different dimensions of team work ability were (6.58±2.11) of gregariousness, (5.16±2.65) of antorhythmicity, (4.73±2.18) of belongingness and (5.84±1.87) of valuable, which were significantly better than those in the control group (t=-3.36, -6.55, -5.89, -4.51;P<0.05).Conclusions The team-based learning combined with situational simulation model not only increases the knowledge level and comprehensive ability of emergency of nurses, but also improves the team work ability, which can enrich the forms and contents in psychiatric standardized training.

Objective To construct the risk model for healthcare-associated infection (HAI)with multidrug-re-sistant organisms(MDROs)in intensive care unit (ICU).Methods 836 patients who were admitted to ICU for more than 48 hours between October 2012 and September 2015 were analyzed retrospectively,logistic regression model of HAI was constructed,the model was conducted goodness of fit tests and the area under ROC curve analysis. Results Among 836 patients,incidence of HAI with MDROs was 14.23%(n=119).15 variables that were statis-tically significant in univariate analysis were included in logistic multivariate analysis,the results showed that the following variables entered into logistic regression equation:length of ICU stay (OR,2.493 [95%CI ,1 .816 -3.494]),underlying diseases (OR,1 .536 [95%CI ,1 .243 - 1 .898 ]),hypoproteinemia (OR,87.211 [95%CI , 36.165-210.304]),ventilator days (OR,1 .723 [95%CI ,1 .399-2.121 ]),fever(OR,20.639 [95%CI ,3.462 -123.043]),and primary pulmonary infection (OR,0.295 [95%CI ,0.133 -0.664]).Evaluation of model effect:sensitivity 95%,specificity 87.9%,the area under ROC curve 0.973.Conclusion Logistic regression model has a high goodness of fit in predicting HAI among ICU patients.

Objective To investigate the proliferation,apoptosis and cell cycle and possible mechanisms of different breast cell lines by difluoromethylorithine (DMFO).Methods The growth of breast cancer MDA-435 (ODC GG) cell lines and SK-br3 (ODC AA) cell lines treated with DFMO were observed.The apoptosis and cell cycle were detected by flow cytometry.PCR was applied to detect the changes of A and G alleles of ODC G316A in MCF-7 cells treated with DFMO.Results The growth inhibition rates of MDA-435 and SK-br3 cells treated with 10 mmol/L and 20 mmol/L DFMO after 48 h were 24.1％ and 33.6 ％,46.3 ％ and 53.5 ％,respectively,and there was statistical significance (t =2.134,P =0.021,t =2.213,P =0.019).The growth inhibition rates of MDA-435 and SK-br3 treated with 10 mmol/L and 20 mmol/L DFMO after 72 h were 28.9 ％ and 35.7 ％,54.3 ％ and 65.4 ％,respectively,and there was statistical significance (t =2.434,P =0.015,t =2.489,P =0.013).The apoptosis rates of MDA-435 (ODC GG) and SK-br3 (ODC AA) cells both dealt with 20 mmol/L of DFMO after 24 h,48 h and 72 h were (7.58± 2.06) ％ and (13.88±3.45) ％ (t =2.047,P =0.041),(43.28±14.28) ％ and (59.96±16.42) ％ (t =3.680,P =0.000),(77.87±30.25) ％ and (93.08±32.15) ％ (t =3.293,P =0.000 1),respectively.The proportions of S stage cells MDA-435 (ODC GG) and SK-br3 (ODC AA) cells under the same condition after 24 h,48 h and 72 h were (13.25±2.38) ％ and (12.89±2.21) ％ (P ＞ 0.05),(21.43±3.12) ％ and (12.24±3.55) ％ (t =2.638,P =0.012),(16.32±3.23) ％ and (15.24±3.01) ％ (P ＞ 0.05),respectively.After the treatment by DFMO,the expression of ODC G316A allele A in breast cancer cell line MCF-7 (ODC AG) was reduced (t =3.708,P =0.000),and the expression of G had no significant changes.Conclusion The proliferation inhibition and apoptosis in breast cancer cells treated by DFMO is different in breast cancer cells with different genetic type of ODC G316A.DFMO can inhibit the activity of ODC,and the mechanism may be that DFMO could selectively bind to ODC G316A allele A.

Objective To explore the influence of repeatedly PICC catheterized on catheter tip position. Methods We analyzed the catheter tip position of patients who located PICC in one level three class-A hospital in Beijing from May to October in 2014. A total of 381 effective medical records were collected and divided into having the history of catheterization group and having no history of catheterization group depending on patients whether catheterized before. The patients having the history catheterization were divided into ipsilateral catheter group(B1 group)and no ipsilateral catheter group(B0 group),the catheter tip position was compared. Results The best catheter tip position for patients having the history of catheterization was 30. 79% , which was lower than patients having no history group of 52. 66%(χ2 = 17. 565,P < 0. 01),and the patients of having catheterization history group had the incidence rate of shallow catheterization(47. 74% )higher than 35. 40% in the no catheterization history group(χ2 = 5. 817,P < 0. 05). The patients of having catheterization history group happened the incidence of catheter tip position acquired dystopia of venae subclavia higher than patients having no catheterization history group(P < 0. 05). The best catheter tip position had lower rate in the B1 group comparing with B0 group,but the patients acquired dystopia of venae subclavia in the B1 group was lower than the patients in the B0 group(P < 0. 05). Conclusions Multiple PICC catheterization reduces the accuracy of catheter tip position,and impacts the safety and reservation of PICC. We should minimize the non-planned extubation incidences. If patients require re-catheterizaiton,we should select the opposite limbs to catheterize without catheterizaiton contraindication to ensure the safe of PICC catheterization.

BACKGROUND: Cognitive function of simple leukoaraeosis (LA) and subcortical arterioselerotic encephalopathy (SAE) is a part of research in cerebrovascular neuropsychology, however, there is no contrast study on cognitive function between the two diseases. OBJECTIVE: To investigate the different features in cognitive function among patients with simple leukoaraeosis, subcortical arterioselerotic encephalopathy and simple leukoaraeosis combined with cerebral infarction. DESIGN: Randomized controlled observation SETTING: Department of Neurological Medicine, Qilu Hospital, ShandongUniversity. PARTICIPANTS: A total of 91 cases of patients with cerebrovasculardisease diagnosed in Department of Neurological Medicine of Qilu Hospital of Shandong University from March 1997 to May 2000 were selected. All the patients participated in the observation voluntarily. They were divided into 3 groups according to the type of disease, with 27 cases in simple leukoaraeosis group, 33 cases in subcortical arterioselerotic encephalopathygroup and 31 cases in simple leukoaraeosis + cerebral infarction group.Additionally, 30 healthy cases were selected as control group. All the subjects in the above groups participated in the observation voluntarily. METHODS: Assessment on cognitive function and memory ability was conducted on the subjects in each group, and contrast analysis was performed. Mini-mental state examination was used for detecting cognitive function. Patients whose score was less than 17, 20, 22, 23 respectively according to different educational degree (illiteracy, primary school, middle school, university), would be diagnosed as dementia. Clinical me mory scale A edited by Psychology Institute of Chinese Academy of Medical Sciences was used for detecting memory ability including associative learning, directive memory, recognition of nonsense figure, image free recall and portrait characteristics associative recall. Conversed the above 5 items of detecting results to scores of scales and calculated out the memory quotients. MAIN OUTCOME MEASURES: State of cognitive disorder and scoresof mini-mental state examination and clinical memory scale of subjects in each group. RESULTS: All the 91 cases of patients with cerebrovascular disease and 30 healthy control cases entered results analysis without any drop out. ① Comparison of the state of cognitive disorder among subjects in each group: There were 21 cases of mild cognitive disorder (77.8%) in simpleleukoaraeosis group, 8 cases of moderate cognitive disorder (24.2%) and 25 cases of dementia (75.8%) in subcortical arterioselerotic encephalopathy group, 6 cases of moderate cognitive disorder (19.4%) and 24 cases of dementia (77.4%) in simple leukoaraeosis + cerebral infarction group. ② Comparison of the scores of mini-mental state examination among and clinical memory scale: Scores of the two scales in simple leukoaraeosis group, subcortical arterioselerotic encephalopathy group and simple leukoaraeosis + cerebral infarction group were significantly lower than those in healthy control group (t=2.14-3.81, P ＜ 0.05-0.01). The scores in subcortical arterioselerotic encephalopathy group and simple leukoaraeosis+ cerebral infarction group were significantly lower than those in simple leukoaraeosis group (t=2.13-3.37, P ＜ 0.05-0.01).CONCLUSION: ① The cognitive impairment in simple leukoaraeosis is mainly mild cognitive disorder. ② The cognitive impairments in subcortical arterioselerotic encephalopathy and simple leukoaraeosis + cerebral infarction are mainly moderate cognitive disorder and dementia which are obviously severer than mild cognitive disorder. Cognitive function can be used as reference indicator for assessing simple leukoaraeosis and subcortical arterioselerotic encephalopathy.Liang LP, He Y, Guo HZ.A contrast between the cognitive function of patients with simple leukoaraeosis and subcortical arterioselerotic encephalopathy.

BACKGROUND: There is much clinical datum analysis on multi-organ dysfunction syndromes induced by cerebral hemorrhage, but there is lack of experiment on dysfunction of peripheral organs induced by acute cerebral vascular disease.OBJECTIVE: Collagenase of two dosages together with proper amount of heparin were used to duplicate animal model of multi-organ dysfunction syndromes induced by cerebral hemorrhage so as to probe into the best experimental prerequisite.DESIGN: Complete randomized control experiment.SETTING: Departments of Dermatology, Neurology and Cardiac Surgery of Qilu Hospital Affiliated to Shandong University and Department of Neurology of Jinan Railway Center Hospital.MATERIALS: The experiment was performed in Institute of Basic Medicine of Shandong Medical Scientific Academy from September to December 2002. Totally 96 adult healthy male Wistar rats were employed and randomized into normal control (6 rats), sham-operation group (6 rats), first hemorrhage group (42 rats) and second hemorrhage group (42 rats). Seven sub-groups of 4 hours, 8 hours, 12 hours, 24 hours, 36 hours, 48 hours and 72 hours successively were divided in first and second hemorrhage groups respectively, 6 rats in each sub-group.INTERVENTIONS: In the first hemorrhage group, mixed solution 2 μL of Ⅶ collagenase 0.4 U and heparin sodium 3.2 IU was infused slowly to the brain. In the second hemorrhage group, mixed solution 2 μL of Ⅶ collagenase 0.8 U and heparin sodium 3.2 IU was infused slowly to the brain. In sham-operation group, physiological saline of same volume was injected. The general situation of animals at every phasic point was observed after operation, including consciousness, mental state and limb movement, as well as the alternations on body temperature, respiration and heart rate. Examinations were done on blood routine, liver function (alanine aminopherase, ALT;aspartic acid translocase, AST), kidney function (urea nitrogen, BUN; creatinine CRE) and myocardial zymology (creatine kinase, CK; lactic dehydrogenase, LDH). Modified matrix coloration method was used to determine endotoxin content in plasma. Pathological alternations were observed optic microscopically on brain, lung, liver, small intestine and kidney.ternations on main organs of experimental animals.experimental animals after operation: In the first and second hemorrhage groups, body temperature, respiration, heart rate and leukocyte content were all higher remarkably than normal group and sham-operation group (P ＜ 0.05).Those in the first hemorrhage group were higher than second group [(39.56±0.59)C, (37.98±0.52)C;(124.23±4.12) times/minute, (92.56±2.95)times/minute; (325.96±84.53) times/minute, (258.16±75.42) times/minute,(P ＜ 0.05)], and the difference in peripheral leukocyte content was specially nation of ALT activity, AST activity, BUN content, CRE content, CK activity,LDH activity and endotoxin content in plasma: Those in the first and second hemorrhage groups were higher than normal group and sham-operation group (P ＜ 0.05 -0.01). Those in the first hemorrhage group were higher than second hemorrhage group [(35.04±7.54) μkat /L, (24.25±5.42) μkat/L;(51.61±10.47) μkat/L, (33.77±7.44) μkat/L; (21.12±2.93) mmol/L,(9.78±1.45) nmol/L; (68.57±5.24) μnol/L, (40.54±3.95) μmol/L; (706.44±44.92) μkat/L, (189.23±25.08) μkat/L; (357.96±40.95) μkat/L, (149.60±19.10)(P ＜ 0.05)] and the difference was especially remarkable in endotoxin content logical alternations on main organs of experimental animals: Inflammatory damage of various degrees presented in all of animal organ tissues at various phasic points during cerebral hemorrhage in rats. In the first hemorrhage group, pathological change of organs reached the peak in 24-36 hours, which recovered to be normal in 72 hours. In the second hemorrhage group, the inflammatory damage was more remarkable and persistent compared with first group, in which, pathological change of organs reached the peak in 24-48hours and inflammatory damage was still visible in 72 hours.CONCLUSION: It is indicated that 0.8 U collagenase model is a successful model of multi-organ dysfunction syndromes induced by cerebral hemorrhage. Such model is in conformity with the common induced factors in clinic and various index changes of functions in every organ and can reflect dynamically the occurrence of multi-organ dysfunction syndromes.

BACKGROUND: Leukoaraiosis is a group of changes in image. Since the firm pathogenic mechanism on leukoaraiosis has been unknown, the evaluation at the earlier stage of the disease has not been emphasized commonly and there is rather less recognition of the alternations on its electrophysiological system.OBJECTIVE: To probe into the clinical characteristics and alternations on image and evoked potential in simple leukoaraiosis and subcortical arteriosclerotic encephalopathy(Binswanger' s disease) and carry on the comparison with healthy people.DESIGN: Retrospective comparative study based on patients and healthy people.SETTING: Department of neurological internal medicine of one university hospital and department of neurological internal medicine of one railway central hospital.PARTICIPANTS: Outpatients or inpatients with cerebral vascular disorders in Qilu Hospital Affiliated to Shandong University were collected from August 1995 to March 2000. Totally 114 cases were leukoaraiosis, of which, 79 cases were males and 35 cases females. And 41 cases were Binswanger' s disease,of which, 28 cases were males and 13 cases females. Fifty healthy aged people who received routine physical check were randomized from the clinic of the hospital as the control.METHODS: The analysis was carried on the risk factors, clinical characteristics and CT exam in 114 cases of leukoaraiosis and 41 cases of Binswanger' s disease, of which, 74 leukoaraiosis cases and 35 Binswanger' s disease cases had received cranial MRI exam. Of those, 43 cases of simple leukoaraiosis associated with hypertension, 30 cases of Binswanger' s disease and 50 cases in the normal control were selected to carry on the examinations of body-sensory evoked potential, brain stem auditory evoked potential and visual evoked potential.coronary heart disease, diabetes, hyperlipemia, smoke, cerebral apoplexy,evoked potential and visual evoked potential.RESULTS: According to practical management analysis, 114 cases of leukoaraiosis, 41 cases of Binswanger' s disease and 50 cases in the control were diversification, mainly characterized as slightly declining of memory and loss of gait stability. Hypertension is predominated anong risk factors in Binswanger' s disease group (95.1% ), mainly characterized as physical signs of local neural focus, obvious cognitive disturbance and cerebral in CT exam that 70.2% (80/114) of cases presented brain whiter-matter abnormity in type Ⅰ. It was indicated in MRI exam that 72% (53/74) of cases presented brain whiter-matter abnormity, type Ⅰ, 27% (20/74) presented type Ⅱ and 1% (1/74) presented type Ⅲ. For Binswanger's disease patients, it was indicated in MRI exam that 54% (19/35) of cases presented brain white-matter abnormity, type Ⅲ, and 46% (16/35) presented type Ⅳ.Symmetrical extension of bilateral ventricles presented in Binswanger' s disbody-sensory evoked potential was 84% (36/43), of which, the mild abnormity occupied 60% (26/43) and moderate abnormity 23% (10/43); The abnormity rate of brain stem auditory evoked potential was 63% (27/43) and that of visual evoked potential was 54% (23/43). In Binswanger' s disease group, the abnormity rate of body-sensory evoked potential was 97% (29/30),of which, mild abnormity was 7% (2/30), moderate abnormity was 47%(14/30) and severe abnormity was 43% (13/30); The abnormity rate of brain stem auditory evoked potential was 87% (26/30) and that of auditory evoked potential was 83% (25/30).CONCLUSION: The risk factors of simple leukoaraiosis are diversified,without obvious physical signs of local neural focus. The diagnosis of it is mainly depended on abnormity Ⅰ of brain white matter described in images,manifested as remarkable dysfunction of cerebral eletrophysiology. Binswanger' s disease patients are mainly characterized as hypertension, relevantly obvious cognitive disturbance and common seizure of cerebral apoplexy. Abnormity Ⅲ of brain white matter indicated in CT exam, abnormity Ⅲ or Ⅳ of that in MRI exam are the image evidence for diagnosis. Remarkable abnormity also presents in cerabral electrophysiology, in which, abnormal body-sensory evoked potential is especially significant.