HbA1c comparison and diagnostic efficacy analysis of multi center different glycosylated hemoglobin detection systems / 中华预防医学杂志

Objective: Compare and analyze the results of the domestic Lanyi AH600 glycated hemoglobin analyzer and other different detection systems to understand the comparability of the detection results of different detectors, and establish the best cut point of Lanyi AH600 determination of haemoglobin A1c (HbA1c) in the diagnosis of diabetes. Methods: Multi center cohort study was adopted. The clinical laboratory departments of 18 medical institutions independently collected test samples from their respective hospitals from March to April 2022, and independently completed comparative analysis of the evaluated instrument (Lanyi AH600) and the reference instrument HbA1c. The reference instruments include four different brands of glycosylated hemoglobin meters, including Arkray, Bio-Rad, DOSOH, and Huizhong. Scatter plot was used to calculate the correlation between the results of different detection systems, and the regression equation was calculated. The consistency analysis between the results of different detection systems was evaluated by Bland Altman method. Consistency judgment principles: (1) When the 95% limits of agreement (95% LoA) of the measurement difference was within 0.4% HbA1c and the measurement score was≥80 points, the comparison consistency was good; (2) When the measurement difference of 95% LoA exceeded 0.4% HbA1c, and the measurement score was≥80 points, the comparison consistency was relatively good; (3) The measurement score was less than 80 points, the comparison consistency was poor. The difference between the results of different detection systems was tested by paired sample T test or Wilcoxon paired sign rank sum test; The best cut-off point of diabetes was analyzed by receiver operating characteristic curve (ROC). Results: The correlation coefficient R2 of results between Lanyi AH600 and the reference instrument in 16 hospitals is≥0.99; The Bland Altman consistency analysis showed that the difference of 95% LoA in Nanjing Maternity and Child Health Care Hospital in Jiangsu Province (reference instrument: Arkray HA8180) was -0.486%-0.325%, and the measurement score was 94.6 points (473/500); The difference of 95% LoA in the Tibetan Traditional Medical Hospital of TAR (reference instrument: Bio-Rad Variant II) was -0.727%-0.612%, and the measurement score was 89.8 points; The difference of 95% LoA in the People's Hospital of Chongqing Liang Jiang New Area (reference instrument: Huizhong MQ-2000PT) was -0.231%-0.461%, and the measurement score was 96.6 points; The difference of 95% LoA in the Taihe Hospital of traditional Chinese Medicine in Anhui Province (reference instrument: Huizhong MQ-2000PT) was -0.469%-0.479%, and the measurement score was 91.9 points. The other 14 hospitals, Lanyi AH600, were compared with 4 reference instrument brands, the difference of 95% LoA was less than 0.4% HbA1c, and the scores were all greater than 95 points. The results of paired sample T test or Wilcoxon paired sign rank sum test showed that there was no statistically significant difference between Lanyi AH600 and the reference instrument Arkray HA8180 (Z=1.665,P=0.096), with no statistical difference. The mean difference between the measured values of the two instruments was 0.004%. The comparison data of Lanyi AH600 and the reference instrument of all other institutions had significant differences (all P<0.001), however, it was necessary to consider whether it was within the clinical acceptable range in combination with the results of the Bland-Altman consistency analysis. The ROC curve of HbA1c detected by Lanyi AH600 in 985 patients with diabetes and 3 423 patients with non-diabetes was analyzed, the area under curve (AUC) was 0.877, the standard error was 0.007, and the 95% confidence interval 95%CI was (0.864, 0.891), which was statistically significant (P<0.001). The maximum value of Youden index was 0.634, and the corresponding HbA1c cut point was 6.235%. The sensitivity and specificity of diabetes diagnosis were 76.2% and 87.2%, respectively. Conclusion: Among the hospitals and instruments currently included in this study, among these four hospitals included Nanjing Maternity and Child Health Care Hospital in Jiangsu Province (reference instrument: Arkray HA8180), Tibetan Traditional Medical Hospital of TAR (reference instrument: Bio-Rad Variant Ⅱ), the People's Hospital of Chongqing Liang Jiang New Area (reference instrument: Huizhong MQ-2000PT), and the Taihe Hospital of traditional Chinese Medicine in Anhui Province (reference instrument: Huizhong MQ-2000PT), the comparison between Lanyi AH600 and the reference instruments showed relatively good consistency, while the other 14 hospitals involved four different brands of reference instruments: Arkray, Bio-Rad, DOSOH, and Huizhong, Lanyi AH600 had good consistency with its comparison. The best cut point of the domestic Lanyi AH600 for detecting HbA1c in the diagnosis of diabetes is 6.235%.

Evaluation of Visual Acuity of Ametropia with Visual Event-Related Potential Nogo-P3 Component / 法医学杂志

OBJECTIVES@#To analyze the Nogo-P3 component of event-related potential (ERP) in the process of visual acuity processing, to provide electrophysiological evidence for objective evaluation of visual acuity.@*METHODS@#Twenty-six subjects with no other ocular diseases except for ametropia were recruited, and all subjects had uncorrected visual acuity both eyes 1/10 (evaluated using Monoyer chart). Block letter E with different visual angles and directions were used as graphic stimuli. The Go/Nogo paradigm was used for ERP studies. The visual angle of Go stimulation angle was 1°15', Nogo stimuli were 1°15', 55', 24' and 15'. The visual acuity test was performed on each of the two naked eyes separately in all subjects, and the characteristics of the Nogo-P3 component were analyzed.@*RESULTS@#The latency of Nogo-P3 showed no difference between the stimuli of 1°15' and 55', and between Nogo stimulation angle 24' and 15'. There was significant difference between Nogo stimulation angle 1°15' and 24', and between Nogo stimulation angle 1°15' and 15' (P<0.05). There was significant difference between Nogo stimulation angle 55' and 24', and between Nogo stimulation angle 55' and 15' (P<0.05). No significant differences were observed in the Nogo-P3 amplitude among Nogo stimulation.@*CONCLUSIONS@#In the Go/Nogo paradigm, Nogo-P3 can reflect the cognitive response of subjects to Nogo stimulation, which can be used for objective evaluation of visual acuity.

Comparison of ASSR, ABR and 40 Hz AERP Response Thresholds at Different Frequencies and Their Forensic Applications / 法医学杂志

OBJECTIVES@#To explore the relationship between the frequency characteristics and response threshold of auditory steady-state response (ASSR), auditory brainstem response (ABR) and 40 Hz auditory event related potential (40 Hz AERP), and their application values in forensic medicine.@*METHODS@#Thirty volunteers with normal hearing (60 ears) were selected to perform pure tone audiometry (PTA) threshold and ASSR, ABR and 40 Hz AERP response threshold tests in the standard sound insulation shielding room, and the results were statistically analyzed by SPSS 22.0 software.@*RESULTS@#At 0.5 kHz and 1.0 kHz frequencies, the correlation between 40 Hz AERP response threshold and PTA threshold was good, which was better than that of ASSR and ABR response threshold. At 2.0 kHz and 4.0 kHz frequencies, the correlation between ASSR and ABR response thresholds and PTA threshold was good, which was better than that of 40 Hz AERP response threshold.@*CONCLUSIONS@#To evaluate the hearing at 0.5 kHz and 1.0 kHz frequencies, it is recommended to use 40 Hz AERP and ASSR to comprehensively assess the PTA threshold of the subjects. To evaluate the hearing at 2.0 kHz and 4.0 kHz frequencies, ABR and ASSR are recommended to assess the PTA threshold of subjects comprehensively. The combination of ASSR, ABR and 40 Hz AERP can improve the accuracy of hearing function evaluation.

Significance and research status of quality management of cardiopulmonary resuscitation training for Chinese public / 中国实用护理杂志

The quality of public cardiopulmonary resuscitation training plays an important role in improving the survival rate of patients with cardiac arrest. Various forms of training have been carried out all over China, which plays a great role in promoting the work of cardiopulmonary resuscitation. However, there is still a lot of room for improvement in the quality management and effect sustainability of training. This paper reviews the current situation and deficiencies of quality management of public cardiopulmonary resuscitation training, and the role of training quality in enhancing people's self-confidence in learning and rescue, training contents, training methods, quality evaluation indicators, evaluation methods, and quality influencing factors and retraining time requirements, and so on. And it puts forward some practical suggestions on the quality management of public cardiopulmonary resuscitation training in China. Such as it will more emphasize standardized training, deliberate practice, proficient training, National Training, long-term maintenance of knowledge and skills, and using useful tools to improve the quality of cardiopulmonary resuscitation training, etc. In order to improve the training quality management level of the public, so that the trainees can really master cardiopulmonary resuscitation skills, so as to improve the rescue rate and survival rate of patients with cardiac arrest. To promote the sustainable development of people's health.

Clinical characteristics and risk factors of rheumatoid arthritis with ulcerative keratitis / 北京大学学报(医学版)

OBJECTIVE@#To investigate the clinical characteristics, risk factors and prognosis of ulcerative keratitis (UK) in patients with rheumatoid arthritis (RA).@*METHODS@#Sixteen patients with UK (the UK group) were screened among 4 773 RA patients hospitalized at Peking University People's Hospital from January 2003 to May 2021, and 72 patients with RA without UK in the control group were selected by propensity score matching (PSM). The clinical features, laboratory data and medications between the two groups were collected and analyzed.@*RESULTS@#The average age of the patients with RA was 60 years at the time of the complication of UK. UK appeared on average in the 16th year of RA, with the majority of UK occurring in the 7th year of RA and beyond (14 cases), however, a minority of UK was the first symptom of RA (1 case). UK associated with RA manifested as simple marginal UK in 8 cases, marginal UK with perforation in 5 cases, marginal UK with uveitis in 2 cases and central UK with perforation in 1 case. The number of swollen joints was significantly higher in the UK group than in the control group [6.0(2.5, 23.0) vs. 3.0(1.0, 9.8), Z=-2.047, P=0.041], and the proportion of secondary Sjögren syndrome (SS, 37.5% vs. 6.9%, χ2=11.175, P=0.004) and interstitial lung disease (ILD, 37.5% vs. 8.3%, χ2=9.456, P=0.008) were significantly higher in the RA patients with UK than the patients without UK. The uses of sulfasalazine (12.5% vs. 48.6%, χ2=7.006, P=0.008), leflunomide (31.3% vs. 63.9%, χ2=5.723, P=0.017) and gold salt(6.3% vs. 33.8%, χ2=4.841, P=0.032)were significantly lower in the UK group than in the control group. However, there was no statistically significant comparison between the two groups for the 28-joint disease activity score-erythrocyte sedimentation rate (5.3±1.8 vs. 5.1±1.6, t=0.309, P=0.761). Logistic analysis showed the number of swollen joints (OR=1.148), secondary SS (OR=79.118), complicated with ILD (OR=6.596) and the use of sulfasalazine (OR=0.037) were independent relevant factors (P < 0.05) for UK in RA patients.@*CONCLUSION@#The number of swollen joints, secondary SS, complicated with ILD and the use of sulfasalazine are independent relevant factors for UK in patients with RA.

Impacts of smoking status on the clinical outcomes of coronary non-target lesions in patients with coronary heart disease: a single-center angiographic study / 中华医学杂志(英文版)

BACKGROUND@#Coronary atherosclerotic plaque could go through rapid progression and induce adverse cardiac events. This study aimed to evaluate the impacts of smoking status on clinical outcomes of coronary non-target lesions.@*METHODS@#Consecutive patients with coronary heart disease who underwent two serial coronary angiographies were included. All coronary non-target lesions were recorded at first coronary angiography and analyzed using quantitative coronary angiography at both procedures. Patients were grouped into non-smokers, quitters, and smokers according to their smoking status. Clinical outcomes including rapid lesion progression, lesion re-vascularization, and myocardial infarction were recorded at second coronary angiography. Multivariable Cox regression analysis was used to investigate the association between smoking status and clinical outcomes.@*RESULTS@#A total of 1255 patients and 1670 lesions were included. Smokers were younger and more likely to be male compared with non-smokers. Increase in percent diameter stenosis was significantly lower (2.7 [0.6, 7.1] % vs. 3.5 [0.9, 8.9]%) and 3.4 [1.1, 7.7]%, P = 0.020) in quitters than those in smokers and non-smokers. Quitters tended to have a decreased incidence of rapid lesions progression (15.8% [76/482] vs. 21.6% [74/342] and 20.6% [89/431], P = 0.062), lesion re-vascularization (13.1% [63/482] vs. 15.5% [53/432] and 15.5% [67/431], P = 0.448), lesion-related myocardial infarction (0.8% [4/482] vs. 2.6% [9/342] and 1.4% [6/431], P = 0.110) and all-cause myocardial infarction (1.9% [9/482] vs. 4.1% [14/342] and 2.3% [10/431], P = 0.128) compared with smokers and non-smokers. In multivariable analysis, smoking status was not an independent predictor for rapid lesion progression, lesion re-vascularization, and lesion-related myocardial infarction except that a higher risk of all-cause myocardial infarction was observed in smokers than non-smokers (hazards ratio: 3.00, 95% confidence interval: 1.04-8.62, P = 0.042).@*CONCLUSION@#Smoking cessation mitigates the increase in percent diameter stenosis of coronary non-target lesions, meanwhile, smokers are associated with increased risk for all-cause myocardial infarction compared with non-smokers.

Frequency Characteristics of AEPs in Normal Young Adults and Comparison of Their Response Threshold and Pure Tone Audiometry Threshold / 法医学杂志

Objective The tests of three types of auditory evoked potentials （AEPs） were performed on normal young adults, to understand the frequency characteristics of different testing methods and the relationship between response threshold and pure tone audiometry threshold of different methods, and to discuss the forensic value of 3 types of AEPs to evaluate hearing function. Methods Twenty normal young adults were selected, their standard pure tone audiometry threshold, short-term pure tone audiometry threshold and the response threshold of 3 types of AEPs （tone burst-auditory brainstem response, 40 Hz auditory event-related potential and slow vertex response） at 0.5 kHz, 1.0 kHz, 2.0 kHz and 4.0 kHz were recorded. The relationship between the response threshold and standard pure tone audiometry threshold, short-term pure tone audiometry threshold of 3 types of AEPs at different frequencies as well as the differences between different types of AEPs were analyzed. Results The short-term pure tone audiometry threshold was higher than the standard pure tone audiometry threshold at each frequency. The response threshold and standard pure tone audiometry threshold of the 3 types of AEPs all had a certain correlation, and the response threshold of the 3 types of AEPs was higher than short-term pure tone audiometry threshold and standard pure tone audiometry threshold at each frequency. The differences in the differences between the response threshold and standard pure tone audiometry threshold of the 3 types of AEPs at different frequencies had statistical significance. Linear regression mathematical models were established to infer the standard pure tone audiometry threshold （hearing level） from response threshold （sound pressure level） of 3 types of AEPs of normal young adults. Conclusion When using response threshold of different types of AEPs to estimate pure tone audiometry threshold, conversion and correction are needed. Combined use of different types of AEPs could improve the accuracy of hearing function evaluation.

The effect of research on the distance education in the mixed teaching mode of clinical skills / 中国实用护理杂志

Objective@#To explore the effect of distance education in the teaching mode of medical clinical skills, and to provide theoretical and practical basis for finding a better teaching mode to promote the combination of theory and practice.@*Methods@#A total of 172 trainees of clinical skill training in the training center were divided into the control group and the observation group (the observation group was divided into pre-class long-distance group, in-class long-distance group, after-class long-distance group). There were 43 trainees in each group. The control group adopted traditional teaching methods in clinical basic skills courses, and the observation group adopted mixed teaching mode under long-distance education. The satisfaction of teachers and students under the two teaching modes were investigated, and the performance of each group of students in skills, human-computer dialogue, and team first aid comprehensive test were compared.@*Results@#There were significant differences in teacher satisfaction between the control group and the pre-class and in-class distance groups (χ2 = 15.315, P = 0.000). There were significant differences in student satisfaction between the control group and the pre-class and in-class distance groups in terms of interactive participation, liveliness, interesting training skills and teaching level (χ2=4.497-17.153, P = 0.000-0.034). The results of each group reached the expected teaching goals. There were significant differences between the skill test score control group and the pre-class and in-class remote groups (t=25.357, 14.712, all P =0.000). There were significant differences between the human-machine dialogue test control group and the three observation groups (t=14.561, 19.420, 3.821, all P =0.000). There were significant differences between the team emergency comprehensive test control group and the three observation groups (t=14.561, 19.420, 3.821, all P=0.000).@*Conclusions@#Distance education has flexible in the mixed teaching mode of clinical skills, especially in pre-class and in-class. It can rapidly improve the basic clinical skills, theoretical knowledge and team mobilization ability of students. It is one of the best bridges to communicate their clinical theory and practice.

A multicenter cross-sectional study on chronic critical illness and surgery-related chronic critical illness in China / 中华胃肠外科杂志

Objective@#To understand the prevalence, diagnosis and treatment of chronic critical illness (CCI) in China.@*Methods@#The clinical data of 472 adult patients admitted to ICU in 53 hospitals, including basic information, disease-related data, nutrition program, etc., were collected on May 10, 2019, by means of multi-center cross-sectional study. If surgical intervention was needed or the occurrence of the disease was directly related to the surgery, ICU patients were regarded as surgical ICU cases (n=211). In this study, the diagnostic criteria for CCI were: (1) admission to ICU >14 days;(2) combined with persistent organ dysfunction. The prevalence,distribution and treatment of CCI and surgery-related CCI were recorded and analyzed. The Mann-Whitney U test, chi-square test or Fisher exact test were used for comparative analysis.@*Results@#Among the 472 ICU patients from 53 hospitals, 326 were male (69.1%) and 146 were female (30.9%). The prevalence of CCI was 30.7% (145/472). Among 211 surgery-related ICU patients, 57 developed CCI with a prevalence of 27.0%. As compared to non-CCI patients, higher APACHE II score [median (IQR) 13.5 (10.0, 18.3) vs. 11.0 (7.0, 16.0), U=2970.000, P=0.007], higher Charlson comorbidity index [median (IQR) 4.0 (2.0, 7.0) vs. 3.0 (1.0, 5.0), U= 3570.000, P=0.036] and higher ratio of breath dysfunction [68.4% (39/57) vs. 48.1% (74/154), χ2=6.939, P=0.008] and renal dysfunction [42.1% (24/57) vs. 18.2% (28/154), χ2=12.821, P<0.001] were found in surgery-related CCI patients. While SOFA score, Glasgow coma score and other visceral function were not significantly different between surgery-related CCI and non-CCI patients (all P>0.05). NUTRIC score showed that surgery-related CCI patients had higher nutritional risk [43.9% (25/57) vs. 26.6%(41/154), U=5.750, P=0.016] and higher ratio of mechanical ventilation [66.7% (38/57) vs. 52.3% (79/154), χ2=3.977, P=0.046] than non-CCI patients. On the survey day, the daily caloric requirements of 50.2% (106/211) of surgery-related ICU patients were calculated according to the standard adult caloric intake index (104.6 to 125.5 kJ·kg-1·d-1, 1 kJ=0.239 kcal), and the daily caloric requirements of 46.4% (98/211) of patients were calculated by physicians according to the severity of the patient′s condition. 60.2% (127/211) of nutritional support therapy was enteral nutrition (including a combination of enteral and parenteral nutrition), while the remaining patients received parenteral nutrition (24.6%, 52/211), simple glucose infusion (9.0%, 19/211), or oral diet (6.2%, 13/211). The target calorie of CCI group was 104.6 (87.9, 125.5) kJ·kg-1·d-1, and the actual calorie intake accounted for 0.98 (0.80, 1.00) of the target calory. In the non-CCI group, the target calorie was 104.6 (87.9, 125.5) kJ·kg-1·d-1, and the actual calorie consumed accounted for 0.91 (0.66, 1.00) of the target calorie. There was no statistically significant difference between two groups (P=0.248, P=0.150).@*Conclusion@#The prevalence of CCI and surgery-related CCI in ICU is high, along with severe complications, respiratory and renal dysfunction and mechanical ventilation. Surgical patients admitted to ICU are at high nutritional risk, and active and correct nutritional support is essential for such patients.

Characteristics of Pattern Visual Evoked Potential in Two Eyes with Varying Visual Acuity in One Eye and Forensic Application / 华中科技大学学报（医学）（英德文版）

In this study,we aimed to study the pattern visual evoked potentials (P-VEPs) in two eyes with varying visual acuity in one eye and to provide an objective estimation of visual acuity by comparing P-VEPs in one and two eyes.Thirty subjects were chosen,who had one eye with an acuity of 5.0,4.85,4.6,4.0,or scieropia and obstructed vision and the other eye with an acuity of 5.0,respectively.P-VEPs were detected under the large grating stimuli at 3×4 spatial frequency,moderate grating stimuli (12× 16 spatial frequency) and small grating stimuli (48×64 spatial frequency).Under large grating stimuli,there was no significant difference in P100 peak latency between the groups,nor was there a significant difference between the amplitude of two eyes and the amplitude of one normal-vision eye.Under moderate and small grating stimuli,there was a significant difference in P100 peak latency between the group with both eyes having an acuity of 5.0 and the group with visual acuity below 4.0 in one eye.There was a significant difference in P100 amplitude between the group with visual acuity of 5.0 in both eyes and the group with one normal-vision eye.There was no significant difference in the amplitude of two eyes and the amplitude of one normal-vision eye between any other two groups.In forensic identification,characteristics and variability of P-VEPs in one and two eyes can be used to identify malingering or decline in visual acuity.

Characteristics of Pattern Visual Evoked Potential in Two Eyes with Varying Visual Acuity in One Eye and Forensic Application / 华中科技大学学报（医学）（英德文版）

In this study,we aimed to study the pattern visual evoked potentials (P-VEPs) in two eyes with varying visual acuity in one eye and to provide an objective estimation of visual acuity by comparing P-VEPs in one and two eyes.Thirty subjects were chosen,who had one eye with an acuity of 5.0,4.85,4.6,4.0,or scieropia and obstructed vision and the other eye with an acuity of 5.0,respectively.P-VEPs were detected under the large grating stimuli at 3×4 spatial frequency,moderate grating stimuli (12× 16 spatial frequency) and small grating stimuli (48×64 spatial frequency).Under large grating stimuli,there was no significant difference in P100 peak latency between the groups,nor was there a significant difference between the amplitude of two eyes and the amplitude of one normal-vision eye.Under moderate and small grating stimuli,there was a significant difference in P100 peak latency between the group with both eyes having an acuity of 5.0 and the group with visual acuity below 4.0 in one eye.There was a significant difference in P100 amplitude between the group with visual acuity of 5.0 in both eyes and the group with one normal-vision eye.There was no significant difference in the amplitude of two eyes and the amplitude of one normal-vision eye between any other two groups.In forensic identification,characteristics and variability of P-VEPs in one and two eyes can be used to identify malingering or decline in visual acuity.

Predictive Value of IABP-SHOCKⅡRisk Score for 30-day Mortality in Chinese Patients With Cardiogenic Shock After Acute Myocardial Infarction / 中国循环杂志

Objectives:To investigate the predictive value of IABP-SHOCKⅡ risk score for 30-day mortality in Chinese patients with cardiogenic shock after acute myocardial infarction. Methods:A total of 212 hospitalized Chinese patients with cardiogenic shock after acute myocardial infarction were enrolled from June 2014 to July 2017. The IABP-SHOCKⅡrisk score was calculated at admission. The endpoint of this study was all-cause 30-day death. The predictive value of IABP-SHOCKⅡ risk score for these patients was assessed by calculating the area under receiver operating characteristic (ROC) curve. Results:According to the IABP-SHOCKⅡrisk score at admission, the patients were divided into 3 groups:score 0-2 group, n=106; score 3-4 group, n=56 and score 5-9 group, n=50. Patients were older, incidence of cerebral stroke, lactic acid, glucose at admission and creatinine levels were higher. while incidence of TIMI grade 3 was lower in score 3-4 group and score 5-9 group than in score 0-2 group (all P＜0.05). Percent of male patients was lower in score 5-9 group than in score 0-2 group (P＜0.05). Incidence of cerebral stroke, lactic acid, and creatinine levels were higher. while incidence of TIMI grade 3 was lower in score 5-9 group than in score 3-4 group (all P＜0.05). Sixty-eight patients died during the 30 days follow-up, mortality was 6.6%, 37.5% and 80% in the score 0-2 group, score 3-4 group, and score 5-9 group, respectively (P＜0.05). The ROC curve analysis showed that AUC was 0.853, and 95%CI was 0.796-0.911. Conclusions:IABP-SHOCKⅡ risk score is suitable for risk stratification and assessment of 30-day mortality in Chinese patients with cardiogenic shock after acute myocardial infarction and may facilitate the clinical decision making to improve the outcome of these patients.

Correlation Study Between Serum Level of Cardiac M2-muscarinic Receptor Autoantibody and Hypertrophic Cardiomyopathy / 中国循环杂志

Objectives: To study serum level of M2-muscarinic receptor autoantibody (M2-AAb) in hypertrophic cardiomyopathy (HCM) patients with its relationship to relevant clinical parameters. Methods: Our research included in 2 groups: HCM group, 133 patients and they were divided into 3 subgroups:Obstructive hypertrophic cardiomyopathy (HOCM) subgroup, 72, Latent obstructive hypertrophic cardiomyopathy (LHOCM) subgroup, 22 and Non-obstructive hypertrophic cardiomyopathy (NOCM) subgroup, 39; since there was no obstruction of left ventricular outflow tract (LVOT) in LHOCM and NOCM patients at resting, LHOCM and NOCM patients were combined as LHOCM+NOCM subgroup, 61 in comparison with HOCM subgroup. And Control group, 40 subjects had no organic heart disease and autoimmune diseases which were confirmed by 12 lead ECG, transthoracic echocardiography and routine hematological tests, they were not using β-blockers, glucocorticoids and immune-suppressants. Serum levels of M2-AAb were examined by ELISA, the relationship between M2-AAb and relevant clinical parameters were studied. Results: Compared with Control group, HCM group had increased serum level of M2-AAb [22.91 (17.21, 29.64) ng/ml] vs (17.14±5.66) ng/ml, P<0.01; M2-AAb was similar among HOCM, LHOCM and NOCM subgroups; M2-AAb in female patients were higher than male, P=0.001. Further investigation presented that the patients with family history of sudden death had the higher M2-AAb, P<0.05; patients with atrial fibrillation (AF) or left atrial diameter (LAD)≥50 mm or moderate to severe mitral regurgitation (MR) had the higher M2-AAb than those without such problems, all P<0.05. In HCM group, log M2-AAb was positively related to resting LVOT gradient (r=0.178, P=0.040); in HOCM subgroup, log M2-AAb was marginal positively related to resting LVOT gradient (r=0.224, P=0.058). Conclusions: Serum M2-AAb was elevated in HCM patients; gender, family history of sudden death may affect M2-AAb level; patients combining AF or LAD≥50 mm or moderate-severe MR had the higher M2-AAb and it was related to resting LVOT gradient.

Application of micro-lectures combined with high simulation human in clinical skills teaching for nursing students / 中国实用护理杂志

Objective To explore the effect of micro-lectures withadvanced simulation man in improving the practical skills teaching of nursing students, so as to promote the students' post competency. Methods Totally the 186 nursing internswere divided into control group and observation group by random number method with 93 people in each group. The control group used the traditional teaching modein the teaching of practical skills.The observation group used the micro-lectures with high simulation teaching.Comparing the two groups of nursing students comprehensive assessment test simulation results in the theory, skills, scenarios, and nursing students the evaluation of the curriculum. Results The scores of the two groups were all above the qualification line, but the scores of the observation group were significantly higher than those of the control group (P<0.05). The theoretical examinations and the situation simulation comprehensive testswas(77.89 ± 7.79), (75.60 ± 7.92)points in control group, and (93.87 ± 3.90),(92.87 ± 4.08)points in observation group, there was significant difference between two groups (t=17.67, 18.70,all P=0.000). The curriculum evaluation results of improving learning initiative, active curriculum atmosphere, clear operation demonstration, exercise clinical thinking, improve the clinical interest were 81.72％(76/93), 72.04％(67/93), 93.55％(87/93), 60.22％(56/93), 67.74％(63/93)in control group, and 96.77％(90/93), 95.70％(89/93), 100.00％(93/93), 92.47％(86/93), 98.92％(92/93)in observation group, there was significant difference between two groups(χ2=20.39, P=0.016).Conclusions The effect is significant of micro-lectures combined with high simulation of human using in clinical skills teaching. Thismold can conducive to the cultivation of clinical thinking of nursing students, and improve clinical comprehensive ability, and promote the promotion of nursing students post competency.

Soluble programmed death-1 and soluble programmed death ligand 1 protein expression and immune status in patients with recurrent aphthous ulcer / 华西口腔医学杂志

<p><b>OBJECTIVE</b>This study aims to investigate the possible role and significance of soluble programmed death-1 (sPD-1)  /soluble programmed death ligand 1 (sPD-L1) in the immune pathogeneses of recurrent aphthous ulcer (RAU).</p><p><b>METHODS</b>A total of 30 RAU cases (18 cases of minor RAU, 5 cases of major RAU, and 7 cases of herpetiform ulcers) were enrolled in this study. A total of 18 healthy people served as controls. Lymphocyte subsets (CD3⁺, CD4⁺, CD8⁺, CD19⁺, and CD16⁺+56⁺) were investigated by flow cytometric analysis. Humoral immunity (IgG, IgA, IgM, C3, and C4) was explored by nephelometry immunoassay. The sPD-1 and sPD-L1 protein levels in the sera of RAU patients were investigated by enzyme-linked immunosorbent assay. The correlations of the sPD-1 and sPD-L1 protein levels with the immune status and clinical characteristics of the RAU patients were analyzed by SPSS 19.0.</p><p><b>RESULTS</b>The number of CD4+ T cells decreased and the levels of IgM antibodies increased in the RAU patients relative to those in the normal controls (P<0.05). The sPD-1 and sPD-L1 protein levels in the RAU patients were significantly higher than those in the control group (P<0.05). Meanwhile, the sPD-1 and sPD-L1 protein levels in the patients with minor and major RAU were significantly higher than those in the control group (P<0.05). By contrast, no significant difference was found in the patients with herpetiform RAU (P>0.05). Positive correlations were noted between the sPD-1 protein level and the CD19+ cell frequency or C4 level (r₁=0.389, P₁=0.034; r₂=0.382, P₂=0.037).</p><p><b>CONCLUSIONS</b>Cellular immune hypofunction and humoral immunity disorders were found in the RAU patients. The PD-1/PD-L1 signaling pathway, which might be influenced by the involvement of sPD-1 and sPD-L1 proteins to a certain extent, may play some roles in the immune pathogenesis of RAU.</p>

Qualitative and quantitative identification of Vitex negundo var. cannabifolia fruits and Vitex negundo fruits / 中草药

Objective To provide experimental basis for the identification of Vitex negundo var. cannabifolia fruits and V. negundo fruits by comparative study. Methods The original plant identification, morphological identification, microscopic identification, TLC and HPLC identification were adopted to distinguish the two kinds of materials. Results It is difficult to tell the difference of these two medicinal fruits in term of original plant identification and morphological identification to their similarity, while microscopic identification, TLC and HPLC identification revealed that the characteristics of sclereid could be used to distinguish these two fruits. Conclusion Microscopic identification on the sclereid characteristics of fruits powder, combined with TLC and HPLC identification can be the feasible method that used to distinguish V. negundo fruits and V. negundo var. cannabifolia fruits.

Efficacy evaluation on electroacupuncture for Alzheimer's disease / 针灸推拿医学（英文版）

Objective: To observe the clinical efficacy of electroacupuncture (EA) on Alzheimer's disease (AD). Methods: A total of 50 AD patients were randomly allocated into a Western medication (WM) group (n=25) and an acupuncture plus medication (APM) group (n=25). Patients in the WM group took oral huperzine A capsules. In addition to huperzine A capsules, patients in the APM group also received EA at Shenting (GV 24), Baihui (GV 20), Dazhui (GV 14), Fengfu (GV 16), Mingmen (GV 4) and Yongquan (KI 1). The needles on the above points were connected to G6805-Ⅱelectric stimulator [3 pairs: Shenting (GV 24) and Baihui (GV 20); Dazhui (GV 14) and Fengfu (GV 16); and bilateral Yongquan (KI 1)]. The needles were retained 25 min. The treatment was done once a day, and 10 times made up a course of treatment. The patients received a total of 3 treatment courses. There was a 3-day interval between two courses. The mini-mental state examination (MMSE) and Hasegawa dementia scale revised (HDS-R) were conducted before and after treatment. The clinical efficacies were evaluated when the treatment was completed. Results: Before treatment, there were no between-group statistical differences in MMSE and HDS-R scores (both P>0.05). After treatment, the MMSE and HDS-R scores in the APM group were significantly higher than those in the WM group (both P<0.05). The total effective rate in the APM group was 88.0%, versus 76.0% in the WM group, showing a statistical difference (P<0.05). Conclusion: EA is effective for AD and can improve clinical symptoms in AD patients.

1H-NMR-based metabonomics studyon urine of rat with Spleen-Qi deficiency pattern / 中国药理学通报

Aim To establish the rat model of Spleen-Qi deficiency, analyse the metabolic pathways and investigate the connection between the changed urinary metabolites and Spleen-Qi deficiency, in order to explore the potential mechanisms of Spleen-Qi deficiency.Methods With the binding methods of diarrhea induced by bitter and cold, abnormal of starvation and excessive tiredness, the rat Spleen-Qi deficiency model was established.Then the activity of creatine phosphokinase(CPK) was detected.The endogenous metabolites in the urine were detected by NMR, and the data were analyzed with multivariate and statistical methods.Then the metabolites were selected that could be clearly distinct in the two groups with the fold change value(>1.2) and the P<0.05 of Student′s t-test.Both the pathway analysis and enrichment analysis were performed with Metabo Analyst 3.0.Results Compared with the normal rats, the activity of CPK decreased significantly in model rats(P<0.05).A significant separation appeared in the principal components analysis(PCA) score plot when the control group and the model group were compared, indicating that the Spleen-Qi deficiency model was successfully duplicated.The 33 differential metabolites, which mainly involved in the metabolic pathways, were distinguished from the comparision of Spleen-Qi deficiency model group and control group.The metabolic pathways was related to energy metabolism, amino acid metabolism, nucleotide metabolism and disturbance of gut microbes.Conclusions The main energy metabolic pathways (tricarboxylic acid cycle, glycolysis and liquid oxidation) may be disturbed in Spleen-Qi deficiency rats.The energy supply function is suppressed, which leads to the fatigue and weight loss in rats.

Clinical effect of a combined ultrasound and pneumatic lithotripter on intrahepatic and extrahepatic bile duct stones / 中国现代普通外科进展

Objective:The application of a combined ultrasound and pneumatic lithotripter for cholelithiasis was investigated.Methods:A total of 59 cases of cholelithiasis diagnosed by ultrasonography and CT were included in the study.All the patients had surgical treatment from January 2013 to December 2015,in which 30 patients were treated with a combined ultrasound and pneumatic lithotripter protocol (EMS group),and 29 patients were treated with traditional choledochoscope protocol(control group).All the patients were followed up for 3 months postoperation.The outcomes of patients in EMS group and control group were compared.Results:The postoperative stone free rate after the first operation is higher in EMS group than in control group(P＜0.05).The operation time and total lengths of hospital stay were shorter in EMS group than in control group(P＜0.05).There was no significant difference in intraoperative hematobilia rate,intraoperative bile duct injury rate,postoperative biliary tract infection rate,hepatic biochemical index and mortality between two groups(P＞0.05).Conclusion:The combined ultrasound and pneumatic lithotripter is useful for treatment of cholelithiasis.

Research advance of functional plant pharmaceutical cycloartenol about pharmacological and physiological activity / 中国中药杂志

Cycloartenol, a phytosterol compound, also one of the key precusor substances for biosynthesis of numerous sterol compounds, has a variety of pharmacological activities such as anti-inflammatory, anti-tumor, antioxidant, antibiosis and anti-alzheimer's disease. Furthermore, cycloartenol also plays an important role in the process of plant growth and development. This article reviewed the research progress on cycloartenol pharmacological activity in domestic and foreign articles, and summarized the effect of cycloartenol and "cycloartenol pathway" on the plant growth and development, laying foundation for the its further study, development and utilization.