Application of standardized patients in the teaching of preoperative evaluations of anesthesia residents / 基础医学与临床

Standardized patients (SPs) are trained to portray a specific patient in a consistent, standardized fash-ion. SPs are widely used in many medical schools,and its efficacy for education and evaluation in the medical com-munity has been well established. Preoperative evaluation by anesthesiologist is a critical aspect of patient safety. But there are several defects in the current anesthesia education of preoperative evaluation and management. The residents are not provided with enough skills that are needed in the clinical practice and this sbortage may be com-pansated by SPs simulation. As a supplement of traditional teaching methods,SPs may improve the efficiency in the teaching of preoperative evaluation and enhance the competence of anesthesia residents.

Prevalence of thrombocytopenia among Chinese adult antiretroviral-naïve HIV-positive patients / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The prevalence of thrombocytopenia among Chinese antiretroviral therapy (ART)-naïve HIV-infected adults has not been well-described. The aim of this study was to investigate the prevalence and associated risk factors of thrombocytopenia among Chinese ART-naïve HIV-infected adults.</p><p><b>METHODS</b>We performed a cross-sectional study of Chinese adult ART-naïve HIV-infected patients from September 2005 through August 2014. Socio-demographic variables and laboratory results including platelets, CD4+ cell count, and viral load were obtained from medical records. Factors and outcomes associated with thrombocytopenia were assessed using logistic regression.</p><p><b>RESULTS</b>A total of 1730 adult ART-naïve HIV-infected patients was included. The mean age was 38 years. The prevalence of thrombocytopenia was 4.5%. There were significant differences in the prevalence of thrombocytopenia between patients <30 years of age (2.8%) and 30-39 years (4.0%) compared with patients greater than 50 years (7.0%) (P = 0.006 and P = 0.044, respectively). The prevalence of thrombocytopenia was also significantly different between patients with CD4+ counts of 200-349 cells/mm 3 (3.3%) and >350 cells/mm 3 (2.8%) compared with patients with CD4+ counts of 50-199 cells/mm 3 (7.1%) (P = 0.002 and P = 0.005, respectively). The prevalence of thrombocytopenia was significantly different by hepatitis C virus antibody (HCV-Ab) seropositivity (10.2% for HCV-Ab positive vs. 3.9% for HCV-Ab negative, P = 0.001). We observed differences in prevalence of thrombocytopenia by mode of transmission of HIV infection: Blood transmission (10.7%) versus men who have sex with men (3.9%) (P = 0.002) and versus heterosexual transmission (3.9%) (P = 0.001). In binary logistic regression analyses, age ≥ 50 years, HCV-Ab positivity and having a CD4+ cell count of 50-199 cells/mm 3 were significantly associated with thrombocytopenia with adjusted odds ratio of 2.482 (95% confidence interval [CI]: 1.167, 5.281, P = 0.018), 2.091 (95% CI: 1.078, 4.055, P = 0.029) and 2.259 (95% CI: 1.028, 4.962, P = 0.042), respectively.</p><p><b>CONCLUSIONS</b>Thrombocytopenia is not common among adult ART-naïve HIV-infected patients in China. Older age (age over 50 years), HCV-Ab positivity and lower CD4+ cell count are associated with an increased risk of thrombocytopenia. Therefore, early diagnosis and treatment of thrombocytopenia in these patients are necessary.</p>

Serum HBV DNA level at week 12 is superior to viral response at week 24 in predicting long-term treatment outcome of telbivudine for chronic hepatitis B patients / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Telbivudine, one of the five nucleos(t)ide antiviral drugs, was reported to be superior to lamivudine in a better biochemical, virological, and histological response for treatment-naive patients in the GLOBE trial. The aim of this study was to determine the antiviral potency, viral resistance, and the signifcance of early response for long-term telbivudine treatment.</p><p><b>METHODS</b>We recruited 161 patients of chronic hepatitis B (CHB) on telbivudine between January 2009 and September 2011 in Macau, China. The serum hepatitis B virus DNA levels, hepatitis B e antigen (HBeAg) seroconversion, alanine aminotransferase (ALT) normalization, and viral resistance were analyzed.</p><p><b>RESULTS</b>The median age and follow-up duration were 48 years and 16.9 months. All patients were followed up for at least 6 months, while data were collected for 132, 120, 95, and 53 patients at 12, 24, 48, and 96 weeks respectively. The cumulative HBeAg seroconversion rate was 20.8% and only three patients (1.9%) presented with telbivudine low level resistance. The ALT normalization rates were 76.9% at 48 weeks and 77.6% at 96 weeks. Undetectable HBV DNA was achieved by 1.8%, 31.6%, 60%, and 74.1% in HBeAg positive patients and 29.3%, 60.3%, 84%, and 84.6% in HBeAg negative patients at each time point. Week 12 HBV DNA level < 1000 copies/ml (< 200 IU/ml) was a better predictor of viral suppression at 2-year follow-up (P = 0.001, OR = 27.00) than undetectable HBV DNA level at week 24 (P = 0.120, OR = 4.81).</p><p><b>CONCLUSIONS</b>Two-year telbivudine treatment yielded high rates of viral suppression and ALT normalization. Serum HBV DNA level at week 12 is a superior predictor for long-term viral suppression.</p>

Comparative study on effect of crude and different processed products of epimedium on pharmacokinetics characteristics in mice / 中国中药杂志

To study different impacts of crude epimedium and extracts from different processed epimedium on pharmacokinetic characteristic parameters in mice. To explore the rationality of its processed products, mice were orally administered with crude epimedium and extracting solutions from heated epimedium and processed epimedium. With increased SOD value as an indicator, the relationship between time and equivalent body dose was obtained by using the pharmacological effect method. DAS 2.0 software was adopted to compare their pharmacokinetic parameters. The results showed significant differences in such pharmacokinetic parameters as Cmax and AUC of processed epimedium, heated epimedium and crude epimedium, namely processed epimedium > heated epimedium > crude epimedium. We could come to the conclusion that heated epimedium showed increased bioavailability, while epimedium processed with sheep oil could further promote in vivo absorption.

Protective effect of total glucosides of Picrorhiza scrophulariiflora against oxidative stress in glomerular mesangial cells induced by high glucose / 药学学报

Total glucosides of Picrorhiza scrophulariiflora (TGP) is the active principal in Picrorhiza scrophulariiflora which has antioxidant effect. Since oxidative stress plays a key role in diabetic nephropathy, we investigated the effects of TGP on oxidative stress in bovine glomerular mesangial cells (MC) induced by prolonged high glucose. Bovine glomerular mesangial cells were cultured and passages 2-3 were used for the experiment. Mesangial cells were cultured in high glucose medium, and treated with TGP for 3 weeks. Then collagen IV excreted by mesangial cells were detected, and the percentages of cell cycle were observed by flow cytometry technique. The levels of reactive oxygen species (ROS), mitochondrial membrane potential (MMP) and [Ca2+]i were measured by flow cytometry after loaded with fluorescent probe DCFH-DA, Rh123 and fluo-3-acetoxymethylest. TGP significantly decreased the excretion of collagen IV and cell hypertrophy induced by high glucose, reduced the levels of ROS and [Ca2+]i, and increased MMP. Therefore we conclude that TGP could protect mesangial cells against oxidative stress induced by high glucose.

Clinical characteristics of 143 Chinese HIV/AIDS patients / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the clinical characteristics of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) patients in China.</p><p><b>METHODS</b>Totally 143 HIV/AIDS patients who were first diagnosed in Peking Union Medical College Hospital form January 1988 to April 2006 were enrolled in this study. Clinical characteristics were retrospectively analyzed.</p><p><b>RESULTS</b>Among 143 HIV/ AIDS patients, 57 patients had no clinical symptoms and were confirmed by routine examinations; 86 patients had clinical symptoms, including fever (n = 50), weight loss (n = 18), and discomforts involving respiratory system (n = 34), gastrointestinal system (n = 16), and derma and mucosa (n = 17). Opportunistic infections (OIs) such as pneumocystis jiroveci pneumonia (PCP) (n = 27), oropharyngeal candidiasis (n = 16), tuberculosis (n = 15) , and cytomegalovirus (CMV) infection (n = 9) were also observed in patients whose CD4 + T cell counts were less than 200/mm3. Most CMV infection and cryptococcal meningitis occurred in patients whose CD4 + T cell counts were less than 100/mm3. CD4 + T cell count was negatively correlated with plasma viral load (r = -0.420, P = 0.001).</p><p><b>CONCLUSIONS</b>Fever, dyspnea, and weight loss are the most common symptoms in the patients of this study. The respiratory system, gastrointestinal system, derma and mucosa are the most commonly affected areas by OIs, and PCP is the most common OI. The occurrence of OIs corelates with CD4 + T cell count.</p>

Dynamic changes of T lymphocyte subsets in the long-term follow-up of severe acute respiratory syndrome patients / 中国医学科学院学报

<p><b>OBJECTIVE</b>To study the dynamic changes of T lymphocyte subsets in severe acute respiratory syndrome (SARS) patients.</p><p><b>METHODS</b>Sequential anti-coagulated blood samples were collected from 62 seropositive SARS patients during the first week, the second week, the first month, the 2nd-3rd month, and 1 year after disease onset. T-lymphocyte subsets including CD4 + T cells, CD8 + T cells, and naive and memory CD4 + T cells were detected by flow cytometry. Samples from 56 healthy blood donors were also detected as healthy controls.</p><p><b>RESULTS</b>A rapid restoration in T-lymphocyte subsets was observed during a short period after infection. During the 2-3 months after disease onset, CD8 + T cell count returned to the normal level. At the same time point, CD4 + T cell and naive CD4 + T cell counts increased to (534 +/- 197)/mm3 and (175 +/- 75)/mm3 respectively. Total lymphocytes, T lymphocyte, CD4 + T and naive CD4 + T cell were still significantly lower than the normal levels even one year after disease onset.</p><p><b>CONCLUSION</b>The periphery T lymphocyte subsets in SARS infection shows transient decrease and then rapid recovery.</p>

Dynamics of T lymphocyte subsets in SARS patients / 中国医学科学院学报

<p><b>OBJECTIVE</b>To study dynamics of T lymphocyte subsets in severe acute respiratory syndrome (SARS).</p><p><b>METHODS</b>Sequential anti-coagulated blood samples were collected from 46 cases of SARS patients during the 1st week, the 2nd week, the 3rd-5th week and the 8th-12th week after the infection. T lymphocyte subsets including CD3+CD4+ cells, CD3+CD8+ cells, naive CD4+ cells (CD4+CD45RA+CD62L+) and activated CD8+ cells (CD8+CD38+) were detected by 3-color flow cytometry. Fifty-six normal healthy blood donors were also detected as normal controls.</p><p><b>RESULTS</b>Compared with the results of normal controls, both of the percentages of CD4+ cells and CD8+ cells of SARS patients were in normal levels during the 1st week, but the cell counts decreased significantly to (306 +/- 140)/mm3 and (270 +/- 143)/mm3, respectively. The cell count of naive CD4+ subset also remarkably decreased to (96 +/- 49)/mm3, and the percentage of CD8+CD38+ subset was higher than that of normal controls [(59.3 +/- 12.6)% vs (44.9 +/- 12.5)%]. During the 3rd-5th week, the CD8+ cell count and the percentage of CD8+CD38+ subset reached normal values, which were (581 +/- 356)/mm3 and (40.1 +/- 17.6)%, respectively. During the 8th-12th week, the cell counts of CD4+ cell [(578 +/- 193)/mm3] and naive CD4+ subset [(176 +/- 64)/mm3] were still less than those of normal controls, while compared with those of the 1st week, the increments were remarkable.</p><p><b>CONCLUSIONS</b>T lymphocytes of SARS patients decreased dramatically but could be obviously resumed in a short time. It will take more than 8-12 weeks for CD4+ cell and naive CD4+ subset to reach to normal levels.</p>