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There are some disadvantages in internal medicine practice teaching now. To find a new teaching model, and implement a teaching reform is the key to improve teaching quality. We try to apply the case introduction to the teaching method of evidence based practice in the department of internal medicine . The new teaching model which combined case base study with evidence-based medicine in internal medicine practice can help put forward questions and guide students to analyze questions by the case. It also helps find evidence and solve questions by evidence-based method. The organic combination of the two, not only can stimulate students' learning enthusiasm and initiative, de-velop the correct clinical thinking, but also can effectively promote students' self-learning ability to update their knowledge. It is worth widely developing in internal medicine practice.
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Objective To explore the ultrasonic imaging features of malignant thyroid nodules risk fac-tors by logistic regression.Methods Two hundreds and forty patients with thyroid nodules by ultrasonic examina-tion and surgical treatment for patients with definited pathological diagnosis were included in this study.The pre-operative sonographic features of the nodules were put into the logistic regression model to explore the risk factors of ultrasonic imaging features of malignant thyroid nodules.Results By logistic regression model analysis,hypoe-cho,taller than wide≥1 and micro calcification were found to be significantly statistical variables for thyroid car-cinoma.Micro calcification could predict thyroid cancer for lymph node metastases.Conclusoin During clinical diagnosis,hypoecho,taller than wide more than 1 and micro calcification could be used as indicators by ultrasound doctors to judge malignant thyroid nodules and lymph node metastases.Prospective larger similar research is still very necessary to explore the indicator for thyroid carcinoma in the future.
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Objective To explore the reliability of assessing the renal damage and prognosis with enhance-lfow (E-Flow) in patients with systemic lupus erythematosus (SLE) by detecting hemodynamics indexes of intrarenal arteries. Methods There were 50 SLE patients who were treated in the Second Hospital Afifliated to Harbin Medical University from May 2012 to March 2013. The 50 SLE patients were divided into 2 groups:28 patients with LN and 22 ones without LN, and 30 healthy persons were served as the control group who were from the health check centre. All patients underwent renal ultrasonic examination, and two-dimensional images were observed. E-Flow technique were used to measure the peak systolic velocity (PSV), end-diastolic velocity (EDV) and vascular resistance indexes (RI) of the segmental, interlobar, arcuate and interlobular arteries. ANOV was used to compare the PSV, EDV and RI of segmental, interlobar, arcuate and interlobular arteries in the three groups, and LSD-t was used to compare the indexes between the two groups. A linear correlation analysis was used to determine the correlation between the RI of the intrarenal arteries in patients with LN and the levels of serum creatinine. Results The two-dimensional images of kidneys in patients without LN were normal. There were 8 cases with renal parenchymal diffused change in patients with LN. The spectrums of interlobular arteries in patients without LN were similar with those of control subjects, and the turgor curve of diastolic phase reduced slightly. The spectrums of interlobular arteries in patients with LN were blunt, with high resistance and hypoperfusion. Compared with the control subjects, PSV of the interlobar, arcuate and interlobular arteries in patients with LN decreased statistically (t=-2.46,-2.40,-3.49, P<0.05 or 0.01). EDV of the intrarenal arteries in patients with or without LN decreased statistically (patients with LN:t=-5.50,-5.95,-5.83,-5.01, all P<0.01;patients without LN:t=-3.41,-3.69,-3.29,-2.49, P<0.05 or 0.01). Compared with patients without LN, PSV and EDV of the arcuate and interlobular arteries in patients with LN all decreased statistically (PSV:t=-2.00,-2.16, both P<0.05;EDV:t=-2.13,-2.16, both P<0.05). Compared with the control subjects, RI of the intrarenal arteries in all SLE patients increased signiifcantly (patients with LN:t=12.78, 13.30, 11.95, 9.52, all P<0.01;patients without LN:t=9.88, 10.05, 8.71, 5.30, all P<0.01). Compared with patients without LN, RI of the the intrarenal arteries in patients with LN increased signiifcantly (t=2.05, 2.38, 2.43, 3.57, P<0.05 or 0.01). There were positive correlations between the RI of the intrarenal arteries in patients with LN and the level of serum creatinine (r=0.684, 0.752, 0.755, 0.851, all P<0.01). Conclusions E-Flow could clearly display the branches of intrarenal arteries and assess the progress and prognosis of the patients with SLE by measuring intrarenal arteries hemodynamics.
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Objective To select sonogram features for the differential diagnosis of benign and malignant thyroid small nodules by Logistics regression analysis,and to contribute the binary Logistic regression model of sonogram features as independent variable and evaluate the value of conventional ultrasonography and ultrasound elastography (UE) in the differential diagnosis of benign and malignant thyroid small nodules.Methods 166 thyroid nodules (≤ 10 mm) in 140 patients were reviewed and analyzed by 2D ultrasound,color Doppler flow imaging and UE.A Logistic model was obtained based on pathology as golden diagnosis criteria.The odds ratio of variables in the equation were compared to assess various variables,especially the efficacy of elastography in the diagnosis.Results Four statistically significant features were finally entering the Logistic stepwise regression model,including shape,calcification,the internal component of nodules and elasticity score.And the odds ratio of the elasticity score was higher than other features.Conclusions The analysis of binary Logistic regression can select the valuable variables for the diagnosis of pathological nature of thyroid small nodules.UE has much more dominances than other features.The combinated application of UE and 2D ultrasonic features plays a great clinical role in the final diagnosis of thyroid small nodules.
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Objective To investigate the relationship between watching television time and impaired glucose regulation (IGR) , type 2 diabetes mellitus in Chongqing City .Methods Population-based cross-sectional study was conducted to investigated the local permanent staff(lived in Chongqing more than 5 years) who were 40 years old or elder in Chongqing City .Results The overall prevalence rate of IGR and T 2DM was 6 .3% ,5 .6% respectively .The average weekly watching TV time of the samples was (12 .3 ± 10 .1) h .After adjusting for possible confounding factors ,the prevalence rate of IGR and T2DM in patients watching TV time >14 h per week was significantly higher than those watching TV time ≤ 7 h per week(Adjust .OR = 1 .528 ,95% CI = 1 .034 - 2 .121 ;OR = 1 .482 ,95% CI = 1 .133 - 2 .047 ,respectively ) .Conclusion Siting and watching TV time were positively correlated with the risk of IGR ,T2DM .So ,we should actively encourage and promote healthy lifestyles to reduce siting and watching TV time .
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ObjectiveTo investigate the renal protective effect of recombinant lentivirus encoding adiponectin gene on streptozocin-induced early diabetic nephropathy(DN) mice,and to explore its potential mechanism.Methods Forty C57BL/6 mice were randomly divided into normal control group(NC group,n=10),diabetic nephropathy group(DN group,n=10),LentiIRES-EGFP treatment group(DL group,n=10) and Lenti-Acdc-IRES-EGFP treatment group (DA group,n=10).After 8 weeks of recombinant lentivirus injection,kidney to body weight ratio (KW/BW),mean glomerular volume(MGV),fractional mesangial area(FMA),24 h urinary protein excretion(UTP),Scr,BUN,serum albumin and adiponectin were measured.Renal pathological changes were evaluated by electron microscopy.Proliferation of glomendar and tubulointerstitial cells was assessed by immunohistochemistry using PCNA antibody.The phosphorylation of AMP-activated protein kinase(AMPK) and mammalian target of rapamycin protein(mTOR) were detected by Western blotting.Results Adiponectin was successfully over-expressed in STZ-induced DN mice after lentivirus injection.KW/BW,MGV,FMA and UTP were significantly decreased in DA group as compared to DN group and DL group(P＜0.05),but were increased as compared to NC group(P＜0.05).DA group animals had significantly fewer PCNA-positive cells than DN group and DL group(P＜0.01).DA group mice had higher p-AMPK level and lower p-mTOR level as compared to DN group and DL group(P＜0.01).Conclusion Over-expression of adiponectin has beneficial effect on early DN and attenuates aberrant proliferation of renal cells via AMPKmTOR pathway.
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Objective To evaluate the effects of recombinant lentivirus encoding human apM1 gene ( LentiapM1-EGFP) on platelet-derived growth factor (PDGF) induced human mesangial cell (HMC) proliferation and intracellular AMP-activated protein kinase(AMPK) signaling pathway.Methods Protein expression of apM1 in cell culture supernatant of HMC transfected with Lenti-apM1-EGFP was detected by ELISA.The effect of human adiponectin on cell proliferation and cell cycle was assessed by [ 3 H ] thymidine incorporation assay and Flow cytometry respectively.The phosphorylation of AMPK was detected by Western blotting.Results Lenti-apM1-EGFP had no significant toxicity on HMC.The 50 multiplicity of infection (MOI) of the Lenti-apM1-EGFP efficiently infected HMC,and made it stable expression of adiponectin protein ( 149.6 ± 12.8 ) μg/L.PDGF-induced HMCs proliferation was significantly inhibited by adiponectin.When co-treatment with compound C,an AMPK inhibitor,the inhibitory effort was reversed.The phosphorylation level of AMPK was increased in HMC transfected Lenti-apM1-EGFP compared to that of control.Conclusions Adiponectin antagonizes stimulatory effect of platelet-derived growth factor on mesangial cell proliferation by AMPK signaling.
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Objective:To investigate the effect and potential mechanism of combined paclitaxe and tumor necrosis factor-related poptosis-inducing ligand(TRAIL) on apoptosis of human gastric cancer cell in vitro.Methods:SGC7901 cells were cultured with paclitaxe at different concentrations(1,5,10,20,40?g/ml) and different time(12,24,36,48h).Methyl thiazolyl tetrazolium (MTT) assay was used to measure the anticancer activity of paclitaxe.The ability of TRAIL alone,paclitaxe alone and TRAIL in combination with paclitaxe to induce apoptosis was measured by a flow cytometer.Expression of DR4,DR5 mRNA was examined by RT-PCR.Results:The apoptosis rate of control group(C group),paclitaxe group(P group),TRAIL group(T group) and combination group(T+P)in 24h were 2.09%,10.65%,7.79% and 24.51% respectively.T+P group was significantly higher than that in C group,T group and P group(P
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Background and purpose:Tumor necrosis factor related apoptosis-inducing ligand (TRAIL) is a death receptor ligand that can induce apoptosis in a variety of cancer cell lines, but not all cancer cells . Past studies suggested that some chemotherapeutic drugs intensified the sensitivity of TRAIL induced apoptosis.We investigated the effect and potential mechanism of combined paclitaxel and TRAIL on apoptosis of human gastric cancer cell in vitro. Methods:SGC7901 cells were cultured with paclitaxel at different concentrations(1,5,10,20,40 ?g/ml) and different time(12,24,36,48 hr), methyl thiazolyl tetrazolium (MTT) assay was used to measure the anticancer activity of paclitaxel.The ability of TRAIL alone,paclitaxel alone and TRAIL in combination with paclitaxel to induce apoptosis was measured by a flow cytometer. Expression of DR4,DR5, DcR1,DcR2,Caspase-8 and Bcl-2 mRNA was examined by RT-PCR.Results:The apoptosis rates of control group(C group),paclitaxel group(P group),TRAIL group (T group)and combination group(T+P)in 24 hr were 2.09%,10.65%,7.79% and 24.51%, respectively. The apoptosis rate in T+P group was significantly higher than that in C group, T group and P group(P
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Objective To study the significance of discrimination of scarce cardiac masses by echocardiography. Methods Twenty-nine patients with cardiac masses selected randomly were examined by transthoracic echocardiography and transesophageal echocardiography to observe their shape, internal echo, margins, membrane and blood flow. Results Twenty-three patients in twenty-nine cases were confirmed by surgery and pathology including eight benign masses and fifteen malignant masses, but the other six patients with metastasis carcinoma had no pathologic results. Eighteen patients got correct diagnosis, nine patients weren′t diagnosed in character and two patients were made a wrong diagnosis. Conclusions Echocardiography is the only noninvasive method which can provide reliable evidences for clinic before surgery to discriminate scarce cardiac masses.
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Aim To investigate the effects of dipfluzine(Dip) on proliferation and collagen synthesis in cultured neonatal rat cardiac fibroblasts(CFB)stimulated by angiotensin Ⅱ(AngⅡ),and to explore the action mechanisms of dipfluzine.Methods CFB were treated with AngⅡ to induce fibrosis model.The effect of Dip on proliferation of CFB was observed by MTT coloricmetric assay;synthesis of collagen was observed by the hydroxyproline concentration detemined;cell cycle distribution and PCNA proein were determined with flow cytometer(FCM);The expression of collagenⅠmRNA,collagen Ⅲ mRNA and TGF-?_1 mRNA was examined using semi-quantitative RT-PCR analysis;The protein expression of cPKC? and ERK_1 in CFB was observed by immunohistochemical staining.Results ① Within a concentration coverage,Dip inhibited CFB proliferation and collagen synthesis(P