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Transthyretin cardiac amyloidosis myocardiopathy （ATTR-CM） is an infiltrative cardiomyopathy characterized by the deposition of amyloidogenic material in the myocardial interstitium due to the misfolding of monomers following the dissociation of unstable transthyretin （TTR） tetramers. Previous treatments for ATTR-CM lacked specificity，primarily targeting symptomatic management of heart failure and arrhythmias. In recent years，researchers have developed two major classes of drugs addressing the pathogenesis of ATTR-CM. The first class stabilizes TTR tetramer structure （such as tafamidis and acoramidis）， while the second class interferes with TTR synthesis （such as patisiran）. Among these，tafamidis has been confirmed as the only currently effective treatment for ATTR-CM，while other drugs are still in clinical trial stages with limited clinical evidence. Concerning the management of comorbidities in ATTR-CM，treatment mainly focuses on common cardiac comorbidities （such as heart failure and arrhythmias）. Traditional drugs used to improve heart failure prognosis （such as β-blockers and renin-angiotensin- receptor blocker），have not demonstrated prognosis improvement in ATTR-CM patients and may even lead to adverse reactions. For ATTR-CM patients with concurrent atrial fibrillation，anticoagulation therapy is recommended to prevent thrombus formation，and amiodarone can be used for rhythm control. Despite significant advancements in pharmaceutical treatments for ATTR-CM，the overall prognosis remains poor，necessitating further research into the pathogenesis and target development to enhance the prognosis of ATTR-CM patients.
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Objective:To evaluate the effect of three teaching methods of case-based learning (CBL), problem-based learning (PBL) and blended learning (CBL+PBL) on the teaching of clinical clerkship of cardiovascular internal medicine among medical students.Methods:A total of 175 third-year medical students were divided into three groups (CBL, PBL and CBL+PBL). They entered the clinical clerkship in batches, and then received written examination and questionnaire survey after the teaching. The data were processed by SPSS 19.0 and were compared by one-way ANOVA or chi-square test (R × C) among groups.Results:The total average scores of students in CBL, PBL and CBL+PBL groups were 15.34±2.88, 14.67±2.98 and 17.13±2.82, respectively ( P<0.05), and the proportion of students with "excellent" scores were 27.4%(17/62), 14.5%(9/62) and 58.1%(36/162), respectively. Most students in CBL group did not agree that CBL helped to train literature access skills [70.7%(41/58)] or teamwork ability [82.8%(48/58)], compared with which 70.9%(39/55) in PBL group thought it helped to train literature access skills but only 7.3%(4/55) well accepted PBL. In addition, majority of students in CBL+PBL group believed it was helpful to gain learning interest [64.3%(36/56)] and train team cooperation ability [62.5%(35/56)], and [53.6%(30/56)] favored this teaching method. Conclusion:Compared with traditional CBL, PBL fails to attract students or improve teaching performance; while blended learning is benefited for the students and can improve teaching quality.
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There are some problems in clinical teaching of cardiovascular medicine, such as insuf-ficient attention to the "three bases" skills, not teaching trainees in accordance with their aptitude ade-quately, monotonous instructional mode, and assessment becoming a mere formality. Aiming at these prob-lems, we have explored the training methods of medical talents adapted to the modern medical model, and improved the clinical basic skills and thinking of the students and the quality of teaching through such measures as paying close attention to basic skills training, standardizing ward rounds, paying attention to teaching students in accordance with their aptitude, and reforming teaching methods and assessment modes.
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Objective To investigate does intracellular protein degradation pathway play an important role in decrease of endothelial nitric oxide synthase (eNOS) in human umbilical vein endothelial cells (HUVECs).MethodsTo establish a primary HUVECs culture methods,the HUVECs were incubated with concentration gradient group of TNF-α(0.01,0.1,1 and 10 ng/mL) in different time periods (24,48 and 72 h).The HUVECs were pretreated with NH4Cl or treated with caspase inhibitor or MG-132 1.5 h prior to incubation for an additional 24 h with TNF-α.The expression of eNOS was detected via Western blot assay.Results Treatment of the HUVECs with TNF-α(0.01-10 ng/mL) led to a dose-dependent reduction of eNOS expression.And treatment with TNF-α(1 ng/mL) reduced the eNOS expression in a time-depended manner.Compared with the TNF-α group,the protein expression level of eNOS was obviously increased in the co-working group of MG-123 and TNF-α.Conclusions TNF-α induces degradation of eNOS through a ubiquitin-proteasome pathway.
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Objective To investigate the impact of body mass index (BMI) on short-term and long-term prognosis in the patients with ST-segment elevation myocardial infarction (STEMI).Methods The clinical data of inpatients with STEMI in our hospital during 2014 were retrospectively collected.The patients conforming to the inclusion and exclusion criteria were divided into 4 groups according to BMI,low BMI group (n=31),normal BMI group (n=139),overweight group (n=71) and obesity group(n=26).The clinical baseline data were analyzed and compared among 4 groups,and the all-cause mortality on 7 d and within 1 year after myocardial infarction(MI) was followed up.Results The higher the BMI increased,the younger the patient's onset age (P＜0.01),the smaller the female proportion(P=0.001),among them,the albumin and hemoglobin levels in the obesity group were relatively higher(P=0.004;P =0.006);the all-cause mortality at 1 year after MI was significantly decreased with BMI increasing (P =0.003),while which on 7 d after MI had no statistical difference (P=0.287).Conclusion BMI is correlated with the long-term prognosis in the patients with STEMI,and "obesity contradiction" phenomenon exists in the patients with STEMI.However,the influence of BMI on the prognosis in the patients with STEMI should be comprehensively evaluated by combining with the multiple factors such as the patient's age,sex,complications and medication therapy.
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Objective To investigate the impact of body mass index (BMI) on short-term and long-term prognosis in the patients with ST-segment elevation myocardial infarction (STEMI).Methods The clinical data of inpatients with STEMI in our hospital during 2014 were retrospectively collected.The patients conforming to the inclusion and exclusion criteria were divided into 4 groups according to BMI,low BMI group (n=31),normal BMI group (n=139),overweight group (n=71) and obesity group(n=26).The clinical baseline data were analyzed and compared among 4 groups,and the all-cause mortality on 7 d and within 1 year after myocardial infarction(MI) was followed up.Results The higher the BMI increased,the younger the patient's onset age (P＜0.01),the smaller the female proportion(P=0.001),among them,the albumin and hemoglobin levels in the obesity group were relatively higher(P=0.004;P =0.006);the all-cause mortality at 1 year after MI was significantly decreased with BMI increasing (P =0.003),while which on 7 d after MI had no statistical difference (P=0.287).Conclusion BMI is correlated with the long-term prognosis in the patients with STEMI,and "obesity contradiction" phenomenon exists in the patients with STEMI.However,the influence of BMI on the prognosis in the patients with STEMI should be comprehensively evaluated by combining with the multiple factors such as the patient's age,sex,complications and medication therapy.
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The cardiovascular disease, accompanied by psychological disorder frequently, often re-quiresphysical and mental (double heart) treatment. The clinical teaching of cardiovascular graduate stu-dents is very important for cultivating qualified cardiovascular doctors. According to present situation, we improved the diagnosis rate and the doctor-patient communication skills by the strengthening of learning thedouble heart theory, the analysis ofdouble heart typical cases, and the clinical practice of double heart medical model. Accordingly, we enhanced the consciousness of double heart, which is helpful to reducing the conflicts between doctors and patients, promoted the rational use of medical resources, and fi-nally promoted the application ofdouble heartmedical model in clinical practice.
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Objective To explore the necessity and effect of the motivational interviewing/MIcurriculum in medical school students. Methods Helping smoking cessation in standard patients with coronary heart disease was assumed as the expected goal. MI was carried out for medical school students to master basal knowledge and skills of MI and help using MI methods in persuading smoking quitting. The teaching mode of MI curriculum was comprised of a lecture series and small group dis-cussion with videotaped practice in role plays. Motivational Interviewing Treatment Integrity (MITI) scoring tool was applied to assess the teaching effect of MI curriculum with students' performance videotapes. Questionnaire was used to evaluate the quality and efficacy of the MI curriculum, and SPSS 13.0 was used to t test measurement data. Results Analysis of the MITI scores showed students had general mastery of MI knowledge. Nevertheless, they did not reach recommended professional profi-ciency level. The scores of empathy and MI spirit in global ratings were (4.11 ±0.32) and (5.82 ± 0.17), respectively (recommended level, 6 score). In the videotape evaluation of behavior counts, MI adherentreached (70.96%±24.34%) (recommended level, 90%). Open question reached (31.42%±8.51%) (recommended level, 70%). Total refection counts were (7.84±3.22) counts per video (recom-mended level, 10). The standard questions recommended in MI for behavior change were better used by students. 93.75%and 87.50%students used ranking questions to evaluate the importance and con-fidence of smoking quitting. Nevertheless, the exploration questions about importance and confidence were less used to know the reason behind their ranking . The results of questionnaire showed that 83.33%students felt MI curriculum effective to help them improve confidence and skills in counseling with patients. 97.91%students thought the mastery of MI methods as an important skill for physicians to have. Conclusion The teaching practice of MI curriculum in medical school students is necessary and feasible with good teaching results. It is worth for professional counseling regarding unhealthy be-havior change in patients.
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Objective To evaluate the incidence of surgical site infection (SSI)in patients with colorectal cancer and identify the risk factors of SSI.Methods A total of 392 patients who underwent colorectal cancer resection at the First Affiliated Hospital of Chongqing Medical University between September 2012 and September 2013 were included and analyzed in terms of the presence of SSI.SSI risk factors were identified by both univariate and multivariate analysis.Results The overall incidence of SSI was 23.0%.Univariate analysis showed that duration of operation above 75 th percentile,colostomy,surgical procedure, type of surgical incision,and American Society of Anesthesiologists (ASA)score were significantly associated with higher risk of SSI (P <0.05).Binary logistic regression suggested that duration of operation above 75 th percentile (P = 0.000,OR =3.017),colostomy (P =0.008,OR=2.642),Contaminated incision (P =0.016,OR=3.311)and laparoscopic surgery (P =0.016,OR=0.523)were significantly different in terms of presence or absence of SSI.Conclusions Duration of operation above 75th percentile,colostomy and contaminated incision are independent risk factors,while laparoscopic surgery is a protective factor for SSI in patients with colorectal cancer.
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Objective To explore the follow-up value of phonocardiogram D/S ratio in CHF patients with treatment.Methods Forty-eight CHF patients who had never under-went regular treatment were collected in our hospital,given the regular anti-heart failure treatment for 3 months.NYHA heart failure classification,resting heart rate(RHR),and D/S ratio of phonocardiogram were recorded,six-minutes walk distance(6MWD),Left ventricular end diastolic diameter(LVEDd),the left ventricular ejection(LVEF) were tested before and after treatment.After 3-month treatment,the resting heart rate 65 times as the watershed,the patients were classified into two groups:one was up to standard,and the other was not up to standard.D/S ratio,RHR,6MWD,LVEDD,LVEF and the improvement of the heart function were compared between the two group.Results Exception the resting heart rate,the in-dicators had no significant improvement in the group of not up to standard compared with the before treatment,and D/S ratio, 6MWD,LVEF was improved significantly after three months treatment(P <0.05).In the group of up to standard,the D/S ratio was improved significantly after one months treatment(P <0.05),while after three months treatment all indicators were improved significantly(P <0.05).Comparison between the two groups,the RHR,D/S ratio were significantly improved(P <0.05 ),LVEF was significantly improved after three months treatment(P <0.05).At the same time,the D/S ratio,6MWD and NYHA classifica-tion of cardiac function was significant negatively correlated(P <0.05).Conclusion The D/S ratio could reflect heart functional im-provements in patients with CHF after anti-heart failure treatment,and it could reflect the heart functional improvement earlier and more significant in the group up to standard,it has a good clinic follow-up value in CHF patients with anti-heart failure treatment.
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Objective To get a view of the participation, motivation and barrier of voluntary activities in medical graduates, and to provide valuable advices for improving such behaviors. Methods The convenience sample method was used in medical graduates in 2014 and the total sample was 348. The data of voluntary service were collected by self-designed questionnaire, including whether partici-pating in voluntary service, times, types, motivations and barriers. SPSS 20.0 were used in statistic analysis and data were processed by description analysis and χ2 test. Results The effective response rate is 80.7%(281). The proportion of the post graduated students participation in voluntary activities is 65.8%(185), however, only 13.4%(28) claimed such activities more than 3 times. The proportion of participation in male, student leaders and party members were higher than those female, non-student leaders and non-party members, the different is statistically significant (P<0.05). The proportion of medical related voluntary activities is 52.6%. The primary motivation of voluntary behaviors is social responsibility (30.1%), while the primary obstacle is lack of medium (39.50%)and limitation of personal time and energy (30.0%). Conclusions The participation and persistence of voluntary activity in graduated students are not high enough. The colleges need to strength the organization and management of voluntary activities and focus on social responsible education, inspire and guide the postgradu ate students to participate in voluntary activities persistently by using their specialties.
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Objective To assess the clustering of cardiovascular risk factors and their effects on target organ damage in elderly patients with hypertension .Methods 421 treated elderly hypertension patients were divided into 5 groups based on the number of risk factors :hypertension without additional risk factor (group A ,25 cases) ,and the other 4 groups were complicated with 1 (group B ,76 cases) ,2(group C ,127 cases) ,3(group D ,128 cases)and ≥ 4 (group E ,65 cases) risk factors .The structure and function of heart and carotid artery were examined by ultrasonography in order to evaluate the damage of target organ and the morbidity .Re-sults The patient groups with three or more risk factors showed significantly higher levels of BMI ,plasma glucose ,triglyceride , LDL-C cholesterol ,serum creatinine and serum uric acid ,and needed greater number of antihypertensive drugs ,compared with other groups(P<0 .05) .The patient groups with two or more risk factors showed significantly higher levels of LVMI ,IMT and MAU/Cr compared with group A(P<0 .05) ,and significantly lower levels of the creatinine clearance (P<0 .05) .In addition ,they showed significantly higher incidences of coronary heart disease and cerebrovascular disease and chronic kidney disease compared with group A (P<0 .05) .Conclusion These results suggest that the hypertensive patients with clustering risk factors required greater number of antihypertensive drugs .The more additional risk factors exit ,the more target organ damages and higher morbidity occur ,and more intensive intervension are required to control not only blood pressure but also other complicated risk factors .
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The standardized training is an indispensible stage for the improvement of residents' comprehensive quality and for the training of high-qualified talents.The article preliminarily explored the standardized training model for residents,which was in accordance with the characteristics of the department of cardiology mainly from four aspects:the set-up of reasonable training program,the training of practical skills,the training of humanistic quality and the training of life-long learning ability.
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This article identified the main problems in current medical education and demonstrated the necessity to implement the outstanding doctor cultivation plan.The author proposed that medical education for outstanding doctors should set defined goals,reform current cultivation models and improve clinical practice as well as culture ability and capability to function internationally.Several ongoing cultivation plans for outstanding clinicians in domestic medical colleges and universities were also discussed.
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Objective:To investigate the relationship between serum adiponectin and high sensitivity C - reactive protein( hsCRP) in patients with acute coronary syndrome ACS). Methods; Serum adiponectin were measured by enzyme linked immunosorbent assay in patients with acute myocardial infarction(n =41 ) .unstable angina pectoris(n = 27) , stable angina pectoris(n =22) and control group (n =20) . Their serum hsCRP were measured by scatter velocity turbidimethy. All subjects were confirmed by coronary angiography. Results ; Serum adiponectin concentrations in ACS group were significantly lower than those in SAP group) P
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Objective:To evaluate the safety and importance of temporary artificial cardiac pacemaker during non-cardiac perioperative period.Methods:Forty-eight hospitalized surgery patients with bradycardia were implanted temporary cardiac pacemaker in cardiac catheter room.Results:91.6% patients were anesthesiaed and operated under the protection of artificial cardiac pacemaker.And 43.1% patients passed ICU early times.Conclusion:Old-aged patients with bradycardia who required surgical intervention were implanted routinely with temporary artificial cardiac pacemaker preoperatively.It was the temporary artificial cardiac pacemaker that not only enhanced the safety of anesthesia and operation,reduced occurrence of serious arrhythmia even sudden death surrounding operation period,also relieved distress and economic burden.
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0.05).3.The more cardiovascular risk factors,the more serious coronary artery disease.Conclusion:Besides BMI,conventional risk factors of cardiovascular contribute to coronary heart disease in this area,and they play an important and independent role in occurrence and progression of coronary artery disease.