Netrin-3 Suppresses Diabetic Neuropathic Pain by Gating the Intra-epidermal Sprouting of Sensory Axons / 神经科学通报·英文版

Diabetic neuropathic pain (DNP) is the most common disabling complication of diabetes. Emerging evidence has linked the pathogenesis of DNP to the aberrant sprouting of sensory axons into the epidermal area; however, the underlying molecular events remain poorly understood. Here we found that an axon guidance molecule, Netrin-3 (Ntn-3), was expressed in the sensory neurons of mouse dorsal root ganglia (DRGs), and downregulation of Ntn-3 expression was highly correlated with the severity of DNP in a diabetic mouse model. Genetic ablation of Ntn-3 increased the intra-epidermal sprouting of sensory axons and worsened the DNP in diabetic mice. In contrast, the elevation of Ntn-3 levels in DRGs significantly inhibited the intra-epidermal axon sprouting and alleviated DNP in diabetic mice. In conclusion, our studies identified Ntn-3 as an important regulator of DNP pathogenesis by gating the aberrant sprouting of sensory axons, indicating that Ntn-3 is a potential druggable target for DNP treatment.

Recommendations on the diagnosis and treatment of osteoarthritis in China / 中华内科杂志

Osteoarthritis (OA) is the most common form of arthritis and the leading cause of old age disability, affecting an estimated 302 million people worldwide. OA is seriously overlooked in the world. The awareness of OA and the popularization of standardized diagnosis and treatment are all lacking. Knees, hips, and hands are the most commonly affected joints in OA. Based on the experience of diagnosis and treatment, consensus and guidelines, we formulated this diagnosis and treatment standard in order to standardize the diagnosis and treatment of OA. We hope that our standard can reduce misdiagnosis and mistreatment and improve the prognosis of OA.

Quantitative analysis of visual field loss after 577 nm krypton pan-retinal photocoagulation for diabetic retinopathy / 中华眼底病杂志

Objective To observe the visual field loss after 577 nm krypton pan-retinal photocoagulation (PRP) in the treatment of diabetic retinopathy (DR).Methods A prospective clinical studies.Forty-six eyes of 26 patients with proliferative DR (PDR) and severe non-proliferative DR (NPDR) diagnosed by clinical examination from No.306 Hospital of PLA during January 2014 and December 2015 were included in this study.Among them,21 eyes of NPDR and 20 eyes of PDR;13 eyes with diabetic macular edema (DME) (DME group) and 28 eyes without DME (non-DME group).All eyes underwent best corrected visual acuity (BCVA),fundus color photography,fundus fluorescein angiography (FFA) and optical coherence tomography (SD-OCT) examinations.The visual field index (VFI) and visual field mean defect (MD) values were recorded by Humphrey-7401 automatic visual field examination (center 30° visual field).The BCVA of DR eyes was 0.81 ± 0.28;the VFI and MD values were (89.8± 8.4)％ and-7.5 ± 3.85 dB,respectively.The BCVA of the eyes in the without DME group and DME group were 0.92±0.20 and 0.57±0.27,the VFI were (90.86±7.86)％ and (87.46± 9.41)％,the MD values were-6.86± 3.43 and 8.87 ± 4.48 dB.PRP was performed on eyes using 577 nm krypton laser.The changes of VFI,MD and BCVA were observed at 1,3,and 6 months after treatment.Results Compared with before treatment,the VFI of DR eyes decreased by 12.0％,12.3％ and 14.8％ (t=7.423,4.549,4.79;P＜0.001);the MD values were increased by-4.55,-4.75,6.07 dB (t=-8.221,-5.313,-5.383;P＜0.001) at 1,3 and 6 months after treatment,the differences were statistically significant.There was no difference on VFI (t=1.090,-0.486;P＞0.05) and MD value (t=-0.560,-0.337;P＞0.05) at different time points after treatment.Compared with before treatment,the BCVA was significantly decreased in DR eyes at 1 month after treatment,the difference was statistically significant (t=2.871,P＜0.05).Before and after treatment,the BCVA of the DME group was lower than that of the non-DME group,the difference were statistically significant (t=4.560,2.848,3.608,5.694;P＜0.001);but there was no differences on the VFI (t=1.209,0.449,0.922,0.271;P＞0.05) and MD values (t=1.582,0.776,0.927,1.098;P＞0.05) between the two groups.Conclusion The range of 30° visual field loss is about 12％-14.8％ after 577 nm krypton laser PRP for DR.VFI and MD can quantitatively analyze the and extent of visual field loss after PRP treatment.

Investigation on grass-roots nurses' core competency in Jiangsu Province / 中华护理杂志

Objective To investigate the core competency of grass-roots nurses in Jiangsu Province,and to provide references for training grass-roots nurses.Methods The Competency Inventory for Registered Nurse(CIRN)was used to investigate 593 grass-roots nurses in Jiangsu Province.Results The overall score of importance judgement for core competency was 4.45±0.73.The overall execution frequency was 4.26±0.69.There were significant differences in the importance judgment of clinical care,interpersonal relationship,leadership,and professional development among nurses with different job titles(P＜0.05).There were significant differences in the execution frequency of clinical care,interpersonal relationship,ethical/legal practice,critical thinking and scientific research among nurses with different job titles (P＜0.05).There were certain differences in the importance judgment and the execution frequency for core competency among nurses with different job titles and nurses from different institutions.Conclusion The score for grass-roots nurses' core competency in Jiangsu Province was not high and unbalanced.There were differences between the importance judgment and the execution frequency.Hospital managers should take appropriate measures to address existing problems and improve the grass-roots nursers' core competency according to different characteristics.

Correlations between the expressions of Smad4, estrogen receptor and the clinicopathological features of breast cancer / 国际肿瘤学杂志

Objective To explore the expressions of Smad4 and estrogen receptor (ER) and their interrelation,and the relationship with the clinicopathological features of breast cancer.Methods The immunohistochemical SP method was used to detect the expressions of Smad4 and ER in 50 case of invasive cancer,12 cases of carcinoma in situ and 15 cases of normal breast tissues.The differences in different clinical stages,differentiation degrees and nodal metastases were analyzed.The correlation between Smad4 and ER was explored.Results The positive expression rate of Smad4 in invasive cancer was 52.00％,which lower than that in normal breast tissue (93.33％),with a significant difference (x2 =8.329,P =0.004),positive expression rates of ER were 60.00％ and 40.00％ respectively,with no significant difference (x2 =1.868,P =0.172).The positive expression rates of Smad4 in carcinoma in situ and invasive cancer were 75.00％ and 52.00％ respectively,with no significant difference (x2 =2.082,P =0.149).The positive expression rates of ER were 58.33％ and 60.00％ respectively,with no significant difference (x2 =0.011,P =0.916).The positive expression of Smad4 was related to the TNM stage (x2 =6.392,P =0.011) and the lymph node metastasis (x2 =6.738,P =0.009),but it was not associated with the histologic grade (x2 =0.542,P =0.462).The positive expression of ER was related to the lymph node metastasis (x2 =4.133,P =0.042) and histologic grade (x2 =5.357,P =0.021),but it was not associated with the TNM stage (x2 =1.159,P =0.282).There was positive correlation between Smad4 and ER in breast cancer tissue (r =0.263,P =0.032).Conclusion Smad4 is expressed at lower level in breast cancer than in normal breast tissue.The expressions of Smad4 and ER are related to the different clinicopathological features of breast cancer with positive correlation.

Prenatal caffeine exposure induces high susceptibility to metabolic syndrome in offspring adult female rats and possible mechanism / 中国药理学与毒理学杂志

OBJECTIVE To observe the increased susceptibility to metabolic syndrome (MS) in offspring adult female rats which experienced prenatal caffeine exposure (PCE) and underwent early postnatal catch-up growth and late chronic stress, and to explore the underlying mechanism. METHODS Starting from gestational day 11, pregnant Wistar rats were intragastrically administered with caffeine at the dose of 120 mg·kg-1 per day until delivery. The female offspring rats were fed a high-fat diet from postnatal week 4 (PW4) to PW24, and then exposed to two weeks of unpredictable chronic stress at PW38-PW40. Blood glucose and serum adrenocorticotropic hormone, corticosterone, insulin, triglycer? ides, total cholesterol, low-density lipoprotein-cholesterol (LDL-C) and high-density lipoprotein-cholesterol (HDL-C) levels were detected. Meanwhile, the mRNA expression of adrenal steroidogenic acute regulatory protein, P450 side- chain cleavage enzyme, 3β- hydroxysteroid dehydrogenase, steroid 11β- hydroxy? lase, steroid 21β- hydroxylase, hepatic insulin receptor, insulin receptor substrate 2 and glucose trans? porter 2 (GLUT2) were examined by real- time quantitative PCR. The morphological changes of the adrenal gland, pancreas and liver were observed using hematoxylin-eosin staining. RESULTS Compared with control group〔(13.9±2.8) g〕, the body mass of the PCE offspring female rats at PW1〔(10.5±1.0) g〕 was significantly lower (P<0.01), which lasted until PW40 (P<0.05, P<0.01). However, the gain rate of body mass was higher in the PCE group at PW4- PW16 (P<0.05, P<0.01). Levels of blood glucose〔(5.9±0.3) mmol·L- 1〕and serum insulin〔(100±31) mU·L-1〕, the insulin resistance index (26.3±5.7), LDL-C〔(0.55±0.05) mmol·L-1〕level and LDL-C/HDL-C ratio (0.87±0.11) were increased compared with (4.3±0.3) mmol·L-1, (45±4) mU·L-1, 8.3±0.9, (0.38±0.04) mmol·L-1 and 0.66±0.07 in the control group, respectively (P<0.05, P<0.01). The mRNA expression of hepatic GLUT2 in the PCE group was lower than in the control group (P<0.05). Furthermore, the thicknesses of the adrenal zona fasciculata was re?duced and the area of pancreatic islets became smaller, but there was no significant change in liver morphology. CONCLUSION PCE offspring adult female rats display high susceptibility to MS, which is mainly manifested as insulin resistance, characterized by hyperglycemia and hyperinsulinemia, lipid metabolism disorder and structural and functional abnormalities of multiple organs. The mechanism is possibly related to the disorder of hypothalamic-pituitary-adrenal axis-associated neuroendocrine meta? bolic programming.

Current situation and strategy of surgical awareness training in surgical resident standardized training / 中华医学教育探索杂志

Standardized training of resident doctors has become a necessary way to train qualified doctors. In order to unify the training standards, standardize management and improve the training effect, the relevant state departments have issued a series of documents, but there are still many regulations in the process of non-standard situation. Especially in surgical inpatients of standardized training of residents, we only pay attention to the training of students' operation skills but infusion of the operation consciousness such as whether the surgery should be done, when operation should be done, what kind of surgery should be implemented as well as operative effectis insufficient. Based on the problems existing in the clinical study and work of the surgical residents in the affiliated hospital of a university, we discuss the effective strategies for the standardized training of surgical residents.

Treatment strategy for pediatric infectious diseases / 中华实用儿科临床杂志

The widespread use of antibiotics has been effectively controlled serious life-threatening infections.The trituration,exploitation and use of antibiotics has been rapidly developed and applied to many fields.Due to the extensive use of various antibiotics,the emergences of drug-resistant bacteria and the rates of bacterial resistance have increased unceasingly which has been a common focus in the world.Resistant pathogen can reduce the effectiveness of antibiotics,and which is a serious threat to human health.De-escalation therapy of antibiotics can quickly and effectively control serious infections,and avoid bacterial resistance,and induce fungal infections.The rational use of antibiotics in pediatrics is very imperative,which includes strengthening management of antibiotics,and improving awareness and vigilance of the adverse reactions of antibiotics,and consummating specification of medication.Then,realize the correct,safe,rational medication of antibiotics.

Progress of bronchiolitis obliterans in children / 中华实用儿科临床杂志

Bronchiolitis obliterans(BO) is chronic airflow obstruction syndrome characterized by small airway obstruction and airflow limitation.In children, BO is secondary to severe infection of respiratory tract, and its development is related with inflammation and immune response.At present, the diagnosis of BO mainly is depended on the clinical manifestation, lung function and examination results of high resolution computed tomography (HRCT) because of difficulty of lung biopsy.Pulmonary HRCT is a non-invasive examination, and worthy of generalization.Currently, BO has no accepted effective treatment,early diagnosis and treatment can block the progression of BO.Due to lack of realization of BO, doctors and parents fail to give enough attention, BO has a prolonged course and very poor prognosis.

The significance of SOD detection in diagnosis of the central nervous system leukemia / 重庆医学

Objective To explore the value of SOD activity in diagnosis of central nervous system leukemia (CNSL )by detec-ting SOD activity of cerebrospinal fluid of patients with CNSL .Methods The cerebrospinal fluid of 55 patients from department of hematology of Nanfang hospital of southern medical university were collected from January 2008 to January 2009 ,in which 30 pa-tients suffered with central nervous system leukemia (CNSL group) ,the other 25 patients suffered with acute leucemia without im-paired central nervous system(control group) .The SOD activity of cerebrospinal fluid was detected by the xanthine oxidase meth-od ,while the routine test ,biochemistry test and cell smear of cerebrospinal fluid was detected .Results There were statistics differ-ence in the level of white cell and protein in cerebrospinal fluid between CNSL and control group (P0 .05) .There was statistics difference in the level of SOD activity between CNSL and control group(P<0 .05) .The white cell quantity and the protein level in cerebrospinal fluid had negative corre-lation with the activity of SOD ,(r=0 .871 ,P=0 .000 ;r=0 .518 ,P=0 .003) .The activity of SOD in the cerebrospinal fluid had sta-tistics difference before and after intrathecal chemotherapy (P<0 .05) .The activity of SOD in the cerebrospinal fluid whose under 45 year-old (755 .64 ± 345 .77) ,which was significant lower than that of the paitents whose equal with or above 45 year-old (1 420 .49 ± 307 .69)(P<0 .05) .Conclusion The changes of the SOD activity in the cerebrospinal fluid had relation with central nervous system leukemia ,and the SOD activity might be a auxiliary diagnosis index used in central nervous system leukemia by revi-sing age factor .

The efficacy and impact of recombinant human cytotoxic T lymphocyte-associated antigen-4 fusion protein on human tumor necrosis factor-α and CX3CL1 in active rheumatoid arthritis patients / 中华风湿病学杂志

Objective To evaluate the efficacy,safety and impact of recombinant human cytotoxic T lymphocyte-associated antigen (CTLA)-4 fusion proteins (rhCTLA-4Ig) on serum human tumor necrosis factor (TNF)-α and CX3CL1 in active rheumatoid arthritis (RA) patients.Methods Forty-four RA patients were treated with rhCTLA-4Ig and placebo.Clinical response was assessed by American College of Rheumatology (ACR) criteria and disease activity score in 28 joints (DAS28).The levels of serum TNF-α and CX3CL1 were determined in 44 RA patients and 20 healthy controls by enzyme-linked immunosorbent assay (ELISA).Comparisons between groups were performed by t-test or x2 test.Results At week 12,ACR20,ACR50and ACR70 responses in RA patients with rhCTLA-4Ig were achieved by 95％(20/21 ),76％( 16/21 )and 19％(4/21) respectively,but no patient with placebo achieved ACR20,ACRS0 and ACR70 responses.There were significantly statistical differences in ACR20 and ACR50 responses (x2=39.17,26.69,P＜0.01 ).At week 12,the mean DAS28 in the rhCTLA4Ig group was 3.1±1.3 versus 6.2±1.1 at baseline (P＜0.01).Similarly,health assessment questionnaire (HAQ) improved significantly,declining from 1.4±0.5 at baseline to 0.4±0.5 at week 12 (P＜0.01).However,the mean DAS28 in the placebo group was 5.8±1.2 versus 6.0±0.7 at baseline (P＞0.05),HAQ declined from 1.6±0.4 to 1.6±0.6 (P＞0.05).In addition,there were higher levels of TNF-α and CX3CL1 in the active RA patients than those of the healthy controls (P＜0.01).After 12 weeks therapy,Serum TNF-α and CX3CL1 levels in the rhCTLA-4Ig group decreased significantly (P＜0.01).There weren't decline in the placebo group (P＞0.05).Conclusion This study has shown that rhCTLA-4Ig is very effective in reducing disease activity,improving function during the 12 weeks treatment.rhCTLA-4Ig therapy for 12 weeks can lead to significant decrease of serum TNF-α and CX3CL1.

Comparison of reproducibility of different contour methods in measuring vascularization of cervical carcinoma with VOCAL system / 中华超声影像学杂志

Objective To assess the reproducibility of vascularization measurement in cervical carcinoma using transvaginal three-dimensional power Doppler angiography (3D-PDA) with virtualorgan computer-aided analysis ( VOCAL), and compare the reproducibility of two different contour mode (manual and automatic mode) of VOCAL. Methods Eighty patients with cervical carcinoma were examined by observer 1 using transvaginal 3D-PDA. The two acquired volume datasets were analyzed using manual and sphere automatic contour mode of the VOCAL imaging program for assessing carcinoma vascularization index( VI), flow index(FI), and vascularization flow index(VFI). Forty patients of them were examined randomly by observer 2 by the same method. Reproducibility of vascularity measurement was assessed by calculating intraclass (intra-CC) and interclass (inter-CC) , limits of agreement, 95% confidence interval definition. The contribution of various factors (examiner, measurement, contour mode and patient) to intrasubject variance was estimated using different analysis of variance models (ANOVA). Results For intraobserver,manual contour mode was more valid than sphere automatic contour mode for each observer (0. 92～0. 99 vs 0. 75～0. 94) ,and it also had smaller standard deviation,narrower limit of agreement range, 95% confidence interval and higher intra-cc than those of sphere automatic contour mode. Interobserver agreement of manual contour vascular measurements was similar to the intraobserver agreement for manual contour vascular measurements ( 0. 89 ～ 0. 97 vs 0. 92 ～ 0. 99 ) , but interobserver agreement for sphere automatic contour vascular measurements dramatically reduced (0. 52～0. 72). Conclusions Manual contour mode for 3D-PDA vascular measurement has better reproduciblity than sphere automatic contour mode, especially useful for irregular shape tissue.

Mechanism of tumor necrosis factor-like weak inducer of apoptosis on the synthesis of Matrix meta-lloproteinase-1 in fibroblast-like synoviocytes of rheumatoid arthritis / 中华风湿病学杂志

Objective To study whether p38 mitogen-activated protein kinases (p38MAPK) signal pathway were activated in the process of tumor necrosis factor-like weak inducer of apoptosis (TWEAK) which then induces rheumatoid arthritis (RA) fibroblast-like synoviocyte (FLS) to synthesize matrix metalloproteinase-1 (MMP-1) and look for the relative mechanisms of how TWEAK was involved in the destruction of articular bones and cartilage. Methods RA FLS were primarily cultured and stimulated with TWEAK. FLS were pretreated with SB203580 or not. ELISA was used to detect the concentration of MMP-1 in cell-cultured supernatant. Western blotting was used to detect the expression of p-p38MAPK and P65 in RA FLS. Results TWEAK (100 ng/ml) could induce RA FIS to synthesize MMP-1. SB203580 could partially inhibite the expression of MMP-1 producted by RA FLS which was induced by TWEAK. TWEAK could make p38MAPK phosphorylated and increase the expression of P65 protein in the cell nucleus. Conclusion TWEAK induces RA FLS to synthesize MMP-1. In this process, p38MAPK signal transduction pathway is activated and then induce the expression of NF-κB.

Mechanism of TWEAK on the synthesis of MMP-9 in fibroblast-like synoviocytes of rheumatoid arthritis / 中华微生物学和免疫学杂志

Objective To discuss the role of p38MAPK signal pathway in the process of TWEAK inducing rheumatoid arthritis(RA) fibroblast-like synoviocyte(FLS) to synthesize MMP-9 and look for a new target for RA treatment. Methods RA FLS were primarily cultured and stimulated with TWEAK. Western blot was used to detect the expression of p-p38MAPK and p65 in RA FLS. FLS were pretreated by SB203580 or not. ELISA was used to detect the concentration of MMP-9 in cell-cultured fluid. The mRNA expression of MMP-9 was measured by RT-PCR. Results TWEAK( 100 ng/ml) can make p38MAPK phosphorylated and increased the expression of p65 protein in the cell nucleus. SB203580 can partially inhibit the expression of MMP-9 and MMP-9 mRNA produced by RA FLS which is induced by TWEAK. Conclusion TWEAK induced RA FLS to synthesize MMP-9, in that process, the p38MAPK signal trausduction pathway was in active state, and induced the expression of NF-κB.

Management of Disinfection and Control of Nosocomial Infection in Bronchoscopy Room / 中华医院感染学杂志

OBJECTIVE To explore administrative measures in preventing infection.for reducing the cross infection during bronchoscopy. METHODS The hidden infection during sterilizing the bronchoscopes was analyzed and the measures of preventing infection were provided. RESULTS By taking standardized management to avoid the cross infection,the quality of medical treatment and nursing was raised and ensured the safety of patients and medical staff. CONCLUSIONS It plays an important role on the control of nosocomial infection with the establishment of the strict protecting measures and sterilizing procedures.

Transplantation of free latissmus dorsi osteocutaneous flap using bridge-like vascular anastomosis in treatment of tibial defect:5-case report / 中华全科医师杂志

From September 2002 to May 2006, five patients ( age range, 24 to 46; mean, 32) with tibial defect underwent transplantation of free latissmus dorsi osteocutaneous flap using bridge-like vascular anastomosis. All the osteocutaneous flaps survived without any serious complications, and tibial defects were improved completely. After 1.5 to 4.5 years' follow-up ( mean, 2.6), no remarkable dysfunction was found at donor sites, and local injury was reduced. This study indicates that transplantation of free latissmus dorsi osteocutaneous flap using bridge-like vascular anastomosis might be useful in leg reconstructive surgery if only one vessel is remained.

Inducibility of ?-Lactam Antibiotics to AmpC ?-Lactamase in Enterobacter cloacae / 中华医院感染学杂志

OBJECTIVE To analyze the resistance of Enterobacter cloacae AmpC ?-lactamase with/without being induced by imipenem(IMP),cefepime(FEP),ceftriaxone(CRO) and aztreonam(ATM).The ampD genes of mutant strains were sequenced. METHODS Five wild type strains and 5 hyper-inducible type strains of E.cloacae were selected and induced by the tested antibiotics in vitro.At the same time,antibiotic susceptibility tests,3-D test,isoelectric focusing(IEF) and inhibit experiment were detected to identify hyper-producing AmpC ?-lactamase.ampD Gene sequencing was preformed in part of mutant strains. RESULTS There wasn′t obvious alteration in MIC with IMP,FEP,CRO and ATM for wild type strains whether they were induced or not.But,for the hyper-inducible type,there was apparent increasing in MIC after antibiotics inducing,especially CRO and ATM,up to 10.7-128 times.The DNA sequences analysis in the mutation strains showed there existed the replacement of the single base in multiple sites,and a few sites of amino acid were altered. CONCLUSIONS Mutant sites in ampD gene sequences are identical even though antibiotics as inducer are different.

Eduction of operation sense of surgery residents / 中华医学教育探索杂志

Compared with"Global Minimum Essential Requirements in Medical Education",our standardized surgery resident educating training performance is basically identical at training requirements and even more advanced in some aspects according to the situation of our country.But many"no standard"things still exist in course of practing.We have analyzed the problems of educ-tion of operation sense of them and make suggestions in the article for eduction of operation sense.

Comparison of the ceftazidime for AmpC ?- lactamase induction to Serratia marcescans and Cloaca Enterobacter / 中国实用内科杂志

Objective To provide the scientific foundation for the rational antibiotic therapy.Methods The wild type (10 strains)and hyper-inducible type(5 strains)of trial strains,which were chosen in the First Affiliated Hospital of China Medical University from June 2003 to June 2004,were screened by ceftazidime,and then AmpC ?-lactamase activity was detected.Three dimensional test was used to detect phenotype mutation ,and the mutation rate was calculated.Results None of AmpC ?-lactamase activity was detected in the wild type of Serratia marcescans、Cloaca Enterobacter and hyper-inducible type Serratia marcescans.For the hyper-inducible type Cloaca Enterobacter,there was marked difference compared with the AmpC ?-lactamase activity induced by the 2 MIC ceftazidime for that of MIC and 1/2 MIC(P

Test Methods of Helicobacter pylori Infection in Children / 中华医院感染学杂志

0.05).(2)CagA-positive H.pylori strains of children were only 21.4%. CONCLUSIONS(1)The detection of protein chips technology against H.pylori infection is compared with antral biopsy specimens.The result is without significant difference.(2)Protein chips technology can discover different types of H.pylori strains infection and determine present infection.It is a rapid,accurate method and can detect more factors.It′s a potential detecting method and worthy of using widely.