Coronary Angiography Within 48 Hours Before Cardiac Surgery Increases the Risk of Postoperative Acute Kidney Injury.

BACKGROUND: Cardiac surgery and coronary examination, such as invasive coronary angiography (CAG), are both possibly associated with acute kidney injury (AKI). Preoperative CAG examination and cardiac surgery within a short interval may increase the incidence of AKI. METHODS: We retrospectively reviewed 1112 patients who underwent CAG examination within 30 days prior to the cardiac operation in this study. Postoperative AKI was defined, according to Kidney Disease Improving Global Outcomes Definition and Staging (KDIGO) criteria. RESULTS: The total incidence of AKI was 40.8% and cystatin C level was 1.260 (1.028, 1.672) mg/L. For patients who received CAG, age, body mass index, cardiopulmonary time, and the time interval between preoperative CAG examination and cardiac operation within 48h was shown to be independent predictors of postoperative AKI. The incidence of AKI in patients undergoing preoperative CAG within 48h was 11.2% higher than in those more than 48h (P < 0.001). Patients undergoing valve surgery with or without coronary artery bypass grafting (CABG) exhibited a higher AKI risk than those only accepting CABG. The in-hospital stay of patients who developed AKI was 2 days longer than those without AKI. However, undergoing CAG within 48h prior to cardiac operation did not prolong ICU length of stay or hospital length of stay, nor did it increase the risk of death or renal failure after an operation. CONCLUSION: Undergoing CAG within 48 hours before cardiac surgery increases the risk of postoperative AKI.

Early outcomes of Sun's procedure in elderly patients with acute aortic dissection: a single-center retrospective study.

OBJECTIVE: The effect of patient age on the outcome of Sun's procedure for acute type A aortic dissection (ATAAD) remains controversial. We retrospectively investigated the early outcomes of Sun's procedure in elderly patients with ATAAD in our single center. METHODS: This study involved 106 patients who underwent Sun's procedure. The patients were divided into the elderly group (≥70 years, n = 17) and younger group (<70 years). Baseline, intraoperative, and postoperative data were compared between the groups. RESULTS: The mean age in the elderly and younger groups was 75.7 and 50.7 years, respectively. The type of aortic root operations were not significantly different between the groups. Concomitant surgeries were more frequently performed in the elderly group, but without statistical significance. All intraoperative cardiopulmonary bypass variables as well as the in-hospital and 30-day mortality rates were similar between the groups. The incidences of most postoperative complications were also similar except for a higher incidence of sepsis in the elderly group. CONCLUSIONS: Emergency performance of Sun's procedure for patients with ATAAD characterized by dissection and/or entry tear in the aortic arch should not be denied on the basis of advanced age alone. Comparable early in-hospital outcomes can be achieved in elderly patients.

Relationship between Helicobacter pylori infection and osteoporosis: a systematic review and meta-analysis.

OBJECTIVES: Many studies have explored the association between Helicobacter pylori infection and osteoporosis. However, the results remain controversial. Therefore, we performed this systematic review and meta-analysis to evaluate the association between H. pylori infection and osteoporosis. DESIGN: Systematic review and meta-analysis of case-control studies. DATA SOURCES: Databases, including PubMed, Embase, Web of Science and Chinese Biomedical Literature Database, were screened from inception to 30 April 2018. ELIGIBILITY CRITERIA: Case-control studies aimed at assessing the association between H. pylori infection and osteoporosis. DATA EXTRACTION AND ANALYSIS: Study characteristics and study quality sections were reviewed. Studies were selected, and data were extracted by two reviewers. Pooled ORs and 95% CIs were calculated using random effects model if heterogeneity existed; otherwise, fixed effects model was used. Subgroup analyses were performed to explore the source of heterogeneity. Publication bias and sensitivity analyses were also tested. RESULTS: A total of 21 studies with 9655 participants were included in our analyses. Taking together, we found that H. pylori infection was associated with increased odds of osteoporosis (OR (95% CI): 1.39 (1.13 to 1.71)); there was no significant difference between osteoporosis and osteopaenia; the association between osteoporosis and H. pylori infection was relatively higher in men than women but did not reach significant level. However, the decrease of bone mineral density in H. pylori-positive patients was not significant when compared with H. pylori negative controls, which may due to the sample size. CONCLUSIONS: Our meta-analysis suggests an association between osteoporosis and H. pylori infection. The clinicians should pay more attention to the patients infected with H. pylori. Further studies were still needed to exploring the confounding factors among studies and to elucidate the underlying biological mechanisms.

Prevalence of hepatitis G virus infection among 67,348 blood donors in mainland China.

BACKGROUND: Hepatitis G virus (HGV) infection transmitted from blood donors is a concern in China, as many articles about HGV infection in Chinese blood donors from different provinces have been published. This study aimed to evaluate the overall prevalence of HGV infection in Chinese blood donors and analyse the potential risk of HGV infection through blood transfusion in China. METHODS: We performed a literature search in PubMed, EMBASE, Web of Science, the Chinese BioMedical Literature Database (CBM) and the China National Knowledge Infrastructure (CNKI) up to October 2018 regarding the prevalence of HGV in Chinese blood donors. Eligibility assessment and data extraction were conducted independently by 2 researchers, and meta-analysis was performed to synthesize the data. Heterogeneity was evaluated using Cochran's Q test and quantified using the I2 statistic. Subgroup analyses were performed to identify the possible sources of heterogeneity. Publication bias was assessed using both funnel plot and Egger's tests. RESULTS: A total of 102 studies with 67,348 blood donors published from 1996 to 2016 and covering 26 provinces or municipalities were included for further analyses. The pooled prevalence of HGV was 3.91% (95%CI: 3.18-4.71%) by enzyme immune assay/enzyme linked immunosorbent assay (EIA/ELISA) and 3.25% (95%CI: 2.35-4.26%) by polymerase chain reaction (PCR). The prevalence of HGV may be significantly affected by region, province or municipality and potentially by the paid/voluntary status of the blood donors. No significant difference was found between plasma and full blood donation. CONCLUSIONS: The prevalence of HGV in blood donors from China was similar to that in blood donors from many other countries and higher than that of some other hepatitis viruses, such as hepatitis B virus. The risk of transfusion-transmitted HGV still exists after routine blood donor screening, especially in those patients coinfected with other hepatitis viruses and/or HIV. On the basis of our study, we may suggest adding HGV screening for blood transfusions in mainland China in the future.

Chronic fatigue syndrome patients have alterations in their oral microbiome composition and function.

Host-microbe interactions have been implicated in the pathogenesis of chronic fatigue syndrome (CFS), but whether the oral microbiome is altered in CFS patients is unknown. We explored alterations of the oral microbiome in Chinese Han CFS patients using 16S rRNA gene sequencing and alterations in the functional potential of the oral microbiome using PICRUSt. We found that Shannon and Simpson diversity indices were not different in CFS patients compared to healthy controls, but the overall oral microbiome composition was different (MANOVA, p < 0.01). CFS patients had a higher relative abundance of Fusobacteria compared with healthy controls. Further, the genera Leptotrichia, Prevotella, and Fusobacterium were enriched and Haemophilus, Veillonella, and Porphyromonas were depleted in CFS patients compared to healthy controls. Functional analysis from inferred metagenomes showed that bacterial genera altered in CFS patients were primarily associated with amino acid and energy metabolism. Our findings demonstrate that the oral microbiome in CFS patients is different from healthy controls, and these differences lead to shifts in functional pathways with implications for CFS pathogenesis. These findings increase our understanding of the relationship between the oral microbiota and CFS, which will advance our understanding of CFS pathogenesis and may contribute to future improvements in treatment and diagnosis.

Cumulative evidence for relationships between multiple variants in the VTI1A and TCF7L2 genes and cancer incidence.

Genetic studies have linked the VTI1A-TCF7L2 region with risk of multiple cancers. However, findings from these studies were generally inconclusive. We aimed to provide a synopsis of current understanding of associations between variants in the VTI1A-TCF7L2 region and cancer susceptibility. We conducted a comprehensive research synopsis and meta-analysis to evaluate associations between 17 variants in this region and risk of seven cancers using data from 32 eligible articles totaling 224,656 cancer cases and 324,845 controls. We graded cumulative evidence of significant associations using Venice criteria and false-positive report probability tests. We also conducted analyses to evaluate potential function of these variants using data from the Encyclopedia of DNA Elements (ENCODE) Project. Eight variants showed a nominally significant association with risk of individual cancer (p < 0.05). Cumulative epidemiological evidence of an association was graded as strong for rs7903146 [odds ratio (OR) = 1.05, p = 4.13 × 10-5 ] and rs7904519 (OR = 1.07, p = 2.02 × 10-14 ) in breast cancer, rs11196172 (OR = 1.11, p = 2.22 × 10-16 ), rs12241008 (OR = 1.13, p = 1.36 × 10-10 ) and rs10506868 (OR = 1.10, p = 3.98 × 10-9 ) in colorectal cancer, rs7086803 in lung cancer (OR = 1.30, p = 3.54 × 10-18 ) and rs11196067 (OR = 1.18, p = 3.59 × 10-13 ) in glioma, moderate for rs12255372 (OR = 1.12, p = 2.52 × 10-4 ) in breast cancer and weak for rs7903146 (OR = 1.11, p = 0.007) in colorectal cancer. Data from ENCODE suggested that seven variants with strong evidence and other correlated variants might fall within putative functional regions. Collectively, our study provides summary evidence that common variants in the VTI1A and TCF7L2 genes are associated with risk of breast, colorectal, lung cancer and glioma and highlights the significant role of the VTI1A-TCF7L2 region in the pathogenesis of human cancers.

Acupuncture and moxibustion for chronic fatigue syndrome in traditional Chinese medicine: a systematic review and meta-analysis.

BACKGROUND: As the etiology of chronic fatigue syndrome (CFS) is unclear and the treatment is still a big issue. There exists a wide range of literature about acupuncture and moxibustion (AM) for CFS in traditional Chinese medicine (TCM). But there are certain doubts as well in the effectiveness of its treatment due to the lack of a comprehensive and evidence-based medical proof to dispel the misgivings. Current study evaluated systematically the effectiveness of acupuncture and moxibustion treatments on CFS, and clarified the difference among them and Chinese herbal medicine, western medicine and sham-acupuncture. METHODS: We comprehensively reviewed literature including PubMed, EMBASE, Cochrane library, CBM (Chinese Biomedical Literature Database) and CNKI (China National Knowledge Infrastructure) up to May 2016, for RCT clinical research on CFS treated by acupuncture and moxibustion. Traditional direct meta-analysis was adopted to analyze the difference between AM and other treatments. Analysis was performed based on the treatment in experiment and control groups. Network meta-analysis was adopted to make comprehensive comparisons between any two kinds of treatments. The primary outcome was total effective rate, while relative risks (RR) and 95% confidence intervals (CI) were used as the final pooled statistics. RESULTS: A total of 31 randomized controlled trials (RCTs) were enrolled in analyses. In traditional direct meta-analysis, we found that in comparison to Chinese herbal medicine, CbAM (combined acupuncture and moxibustion, which meant two or more types of acupuncture and moxibustion were adopted) had a higher total effective rate (RR (95% CI), 1.17 (1.09 ~ 1.25)). Compared with Chinese herbal medicine, western medicine and sham-acupuncture, SAM (single acupuncture or single moxibustion) had a higher total effective rate, with RR (95% CI) of 1.22 (1.14 ~ 1.30), 1.51 (1.31-1.74), 5.90 (3.64-9.56). In addition, compared with SAM, CbAM had a higher total effective rate (RR (95% CI), 1.23 (1.12 ~ 1.36)). In network meta-analyses, similar results were recorded. Subsequently, we ranked all treatments from high to low effective rate and the order was CbAM, SAM, Chinese herbal medicine, western medicine and sham-acupuncture. CONCLUSIONS: In the treatment of CFS, CbAM and SAM may have better effect than other treatments. However, the included trials have relatively poor quality, hence high quality studies are needed to confirm our finding.

Bakuchiol attenuates myocardial ischemia reperfusion injury by maintaining mitochondrial function: the role of silent information regulator 1.

Ischemia reperfusion (IR) injury (IRI) is associated with poor prognoses in the settings of both cardiac surgery and ischemic heart disease and causes mitochondrial oxidative stress and cell death. Silent information regulator 1 (SIRT1), a member of the histone deacetylase family, exerts anti-IRI effects. Bakuchiol (BAK), an analog of resveratrol and a monoterpene phenol isolated from the seeds of Psoralea corylifolia (Leguminosae), protects tissues from injury. This study was designed to investigate the protective effects of BAK treatment in the setting of myocardial IRI and to elucidate the potential mechanism of those effects. Prior to induction of IR, isolated rat hearts or cardiomyocytes were exposed to BAK in either the absence or presence of the SIRT1 inhibitors Sirtinol and SIRT1 siRNA. BAK exerted cardioprotective effects, as evidenced by the improvements noted in cardiac function following ischemia, attenuated myocardial apoptosis, and changes in several biochemical parameters (including increases in the level of the anti-apoptotic protein Bcl2, decreases in the level of the pro-apoptotic protein Bax, and decreases in the cleaved Caspase 3 level). However, Sirtinol and SIRT1 siRNA each blocked BAK-induced cardioprotection by inhibiting SIRT1 signaling. Additionally, BAK significantly increased the activities of mitochondrial succinate dehydrogenase, cytochrome c oxidase, and mitochondrial superoxide dismutase and decreased the production of malondialdehyde. These findings suggested that BAK significantly attenuated IR-induced mitochondrial oxidative damage. However, Sirtinol and SIRT1 siRNA abolished BAK-dependent mitochondrial function. In summary, our results demonstrate that BAK treatment attenuates IRI by attenuating IR-induced mitochondrial oxidative damage via the activation of SIRT1/PGC-1α signaling.

Effects of Sevoflurane Inhalation During Cardiopulmonary Bypass on Pediatric Patients: A Randomized Controlled Clinical Trial.

The effects of sevoflurane inhalation during cardiopulmonary bypass (CPB) on postoperative courses and serum cardiac troponin I (cTnI) concentrations in pediatric patients undergoing cardiac surgery have not been extensively investigated. In this single-center, prospective, randomized trial, an anesthetic regimen containing 2% sevoflurane used throughout the CPB process was compared with a total intravenous anesthesia (TIVA) regimen. One hundred and three patients undergoing congenital heart defect repair with CPB were included in this prospective randomized controlled study. They were randomized into two groups: the sevoflurane group, who received 2% sevoflurane during CPB via an oxygenator, and the control group, who received only an oxygen-air mixture. The pre- and intra-operative parameters were comparable between the two groups. There was a slight but significant increase of arterial diastolic pressure in the sevoflurane group immediately after CPB compared with control patients (46.9 ± 9.3 mm Hg vs. 43.6 ± 8.9 mm Hg; p = 0.033). There was no death in either group. The postoperative ventilation time (in mean [95% confidence interval]) was shorter in the sevoflurane group than that in the control group (26.1 [19.2, 33.0] h vs. 37.7 [24.4, 50.9] h; p = 0.014). The postoperative ICU time, hospital days, and serial serum cTnI concentrations were not significantly different between the two groups. Inhalation of 2% sevoflurane during CPB is beneficial to the recovery of pediatric patients undergoing cardiac surgery but has no significant effect on postoperative cTnI release.

Liver enzymes and metabolic syndrome: a large-scale case-control study.

Previous studies suggested that elevated liver enzymes could be used as potential novel biomarkers of Metabolic syndrome (MetS) and its clinical outcomes, although the results were inconsistent and the conclusions were underpowered. A case-control study with 6,268 MetS subjects and 6,330 frequency-matched healthy controls was conducted to systematically evaluated levels of four liver enzymes (ALT, AST, GGT and ALP), both in overall populations and in subjects with normal liver enzymes, with MetS risk using both quartiles and continuous unit of liver enzymes. We found significant associations were detected for all above analyses. Compared with quartile 1 (Q1), other quartiles have significant higher MetS risk, with ORs ranging from 1.15 to 18.15. The highest effected was detected for GGT, for which the OR value for the highest versus lowest quartile was 18.15 (95% CI: 15.7-20.9). Mutual adjustment proved the independence of the relations for all four liver enzymes. Sensitivity analyses didn't materially changed the trend. To the best of our knowledge, this study should be the largest, which aimed at evaluating the association between liver enzymes measures and MetS risk. The results can better support that liver enzyme levels could be used as clinical predictors of MetS.

Effectiveness of peer support for improving glycaemic control in patients with type 2 diabetes: a meta-analysis of randomized controlled trials.

BACKGROUND: To assess the effects of peer support at improving glycemic control in patients with type 2 diabetes. METHODS: Relevant electronic databases were sought for this investigation up to Dec 2014. Randomized controlled trials involving patients with type 2 diabetes that evaluated the effect of peer support on glycated hemoglobin (HbA1c) concentrations were included. The pooled mean differences (MD) between intervention and control groups with 95% confidence interval (CI) were calculated using random-effects model. The Cochrane Collaboration's tool was used to assess the risk of bias. RESULTS: Thirteen randomized controlled trials met the inclusion criteria. Peer support resulted in a significant reduction in HbA1c (MD -0.57 [95% CI: -0.78 to -0.36]). Programs with moderate or high frequency of contact showed a significant reduction in HbA1c levels (MD -0.52 [95% CI: -0.60 to -0.44] and -0.75 [95% CI: -1.21 to -0.29], respectively), whereas programs with low frequency of contact showed no significant reduction (MD -0.32 [95% CI: -0.74 to 0.09]). The reduction in HbA1c were greater among patients with a baseline HbA1c ≥ 8.5% (MD -0.78 [95% CI: -1.06 to -0.51]) and between 7.5 ~ 8.5% (MD -0.76 [95% CI: -1.05 to -0.47]), than patients with HbA1c < 7.5% (MD -0.08 [95% CI: -0.32 to 0.16]). CONCLUSIONS: Peer support had a significant impact on HbA1c levels among patients with type 2 diabetes. Priority should be given to programs with moderate or high frequency of contact for target patients with poor glycemic control rather than programs with low frequency of contact that target the overall population of patients.

A community-based comprehensive intervention program for 7200 patients with type 2 diabetes mellitus in Chongqing (China).

This study assessed the feasibility of community-based comprehensive intervention on Type 2 diabetes mellitus (T2DM) on a large population in China. An intervention study was conducted on 7200 T2DM patients within one year and consisted of six lectures on health issues, and four times face-to-face lifestyle counseling delivered by general health practitioners, at local primary health centers (PHCs). A "knowledge, attitude and practice" (KAP) survey and fasting plasma glucose (FPG) measurement were conducted at baseline and after the intervention, respectively. A total of 6586 T2DM patients completed the intervention. After one year intervention, patients' KAP level improved significantly (p < 0.001) and the average FPG has decreased from 8.53 mmol/L (standard deviation: 2.84) to 7.11 mmol/L (standard deviation: 1.34) (p < 0.001). Patients in rural areas and with lower education level showed higher FPG and poorer KAP level both before and after the intervention. In conclusion, community-based comprehensive intervention for T2DM is feasible on a large population. Improving and repeating the comprehensive strategy is greatly recommended in order to sustain the impact, especially in rural areas and for patients with lower education levels.

Prevalence of diabetes and impaired fasting glucose among residents in the Three Gorges Reservoir Region, China.

BACKGROUND: The Three Gorges Dam in China is the world's largest hydro-electric scheme in the contemporary world. After the construction of the Dam, great changes took place on the residents' lifestyles characterized by reduced physical activity due to the loss of arable land and a series of psychological problems caused by resettlement, which might be regarded as contributing factors to the development of diabetes in Three Gorges Reservoir Region (TGRR). However, there is no study that has been conducted targeting large population samples with the aim of determining the prevalence of diabetes in TGRR. This study purposed to estimate the prevalence of diabetes and impaired fasting glucose (IFG) in the adult population ≥18 years in TGRR and to evaluate the associated risk factors. METHODS: A total of 3721 randomly selected adults, aged ≥18 years and having lived in TGRR for at least one year, participated in questionnaire-based interview from April to May 2013 and had their physical examinations and standard glucose taken. 75 g oral glucose tolerance test (OGTT) was conducted on the subjects with fasting glucose levels being ≥ 5.6 mmol/L. Diabetes and IFG were defined according to WHO 1999 criteria. RESULTS: The age-standardized prevalence of diabetes and IFG were 7.6% (7.9% among men and 7.4% among women) and 9.0% (9.1% among men and 8.9% among women), respectively. Among the identified cases of diabetes in this study, 54.46% (171/314) were newly diagnosed. The prevalence of diabetes cases rose with age (4.0%, 4.5%, 8.1%, 11.2%, 12.4% and 12.9% among persons who were 18 to 29, 30 to 39, 40 to 49, 50 to 59, 60 to 69 and ≥ 70 years of age, respectively). The results of multivariate logistic-regression analyses showed that the diabetes was significantly linked to age, family history of diabetes, central obesity, educational level and hypertension for both men and women. In addition, smoking was significantly associated with diabetes in men. CONCLUSIONS: Diabetes has become a major public health problem in the TGRR with a large number of the cases undiagnosed. These results suggest that regular population-based diabetes screening should be conducted to identify early-stage diabetes and integrated strategies aimed at the prevention and treatment of diabetes initiated.

The efficacy and safety of Chinese herbal medicine, Rhodiola formulation in treating ischemic heart disease: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Rhodiola formulation is widely used in treating ischemic heart disease (IHD), angina pectoris in China. A number of clinical studies have reported and claimed that Rhodiola formulation can relieve the symptoms of IHD. This study provides the first Preferred Reporting Items for Systematic Reviews (PRISMA)-compliant systematic review to evaluate the efficacy and safety of Rhodiola formulation in treating ischemic heart disease either as a sole agent or in combination with routine western medicine (RWM). METHODS: Search strategy - PubMed, Science Direct, the Cochrane Library, China National Knowledge Infrastructure (CNKI), China Master Theses Full-text Database (CMTD), China Doctor Dissertations Full-text Database (CDMD), Wanfang Data (WF) databases were searched for all relevant studies on Rhodiola formulation that have been published in English and Chinese. The last search of all databases was performed on 31 January 2013. All randomized controlled trials (RCTs) of Rhodiola formulation for patients with IHD were included, and the quality of included RCTs was assessed with Cochrane risk of bias tool. The primary outcomes, including the effective size of symptomatic and electrocardiography (ECG) improvement were calculated as an odds ratio (OR) and 95% confidence intervals (CIs). Because of obvious heterogeneity in the studies with regard to herbal species, herbal formulations, treatment group medicines, control group medicines and outcome measurement, subgroup analysis and sensitivity analysis were performed to evaluate the effects of study characteristics of RCTs, including quality, the role of Rhodiola formulations in treatment group and the different control group medicines. RESULTS: A total of thirteen studies (n=1672) were included. most of included studies were found to be high risk of bias with low quality of methodology. The Rhodiola formulations used alone or in combination with RWM demonstrated a positive effect on both improvement of symptoms and ECG. For the subgroup analysis, the ORs of symptomatic improvement in Rhodiola formulations versus other Chinese herbal medicines (CHMs), Rhodiola formulations versus RWM, and Rhodiola formulations plus RWM versus RWM were 1.51, 2.64, 5.63, respectively. The ORs of symptomatic improvement for Rhodiola formulations versus other CHMs, Rhodiola formulations versus RWM, and Rhodiola formulations plus RWM versus RWM were 1.33, 3.11, 2.27, respectively. Overall, the effectiveness of Rhodiola formulations was higher compared to medicines in control groups, with statistically significant differences observed both in symptomatic improvement (OR=2.40, 95% CI: 1.57-3.66, P<0.0001) and ECG improvement (OR=1.48, 95% CI: 1.17-1.87, P<0.01). However, the sensitivity test indicated that overall effects of Rhodiola formulation versus other CHMs in ECG improvement were not stable (after removing the study by Yin, P=0.05); the differences of CHMs in the control group are a possible source of heterogeneity. CONCLUSION: Rhodiola formulations may have a positive effect on treating IHD alone and in combination with RWM. However, poor quality of methodology and heterogeneity of the included trials means that larger sample size, multi-center, placebo-controlled, double blind studies are needed.

Effectiveness of evidence-based medicine training for undergraduate students at a Chinese Military Medical University: a self-controlled trial.

BACKGROUND: To evaluate the effect of the integration of evidence-based medicine (EBM) into medical curriculum by measuring undergraduate medical students' EBM knowledge, attitudes, personal application, and anticipated future use. METHODS: A self-controlled trial was conducted with 251 undergraduate students at a Chinese Military Medical University, using a validated questionnaire regarding the students' evidence-based practice (EBP) about knowledge (EBP-K), attitude (EBP-A), personal application (EBP-P), and future anticipated use (EBP-F). The educational intervention was a 20-hour EBM course formally included in the university's medical curriculum, combining lectures with small group discussion and student-teacher exchange sessions. Data were analyzed using paired t-tests to test the significance of the difference between a before and after comparison. RESULTS: The difference between the pre- and post-training scores were statistically significant for EBP-K, EBP-A, EBP-P, and EBP-F. The scores for EBP-P showed the most pronounced percentage change after EBM training (48.97 ± 8.6%), followed by EBP-A (20.83 ± 2.1%), EBP-K (19.21 ± 3.2%), and EBP-F (17.82 ± 5.7%). Stratified analyses by gender, and program subtypes did not result in any significant changes to the results. CONCLUSIONS: The integration of EBM into the medical curriculum improved undergraduate medical students' EBM knowledge, attitudes, personal application, and anticipated future use. A well-designed EBM training course and objective outcome measurements are necessary to ensure the optimum learning opportunity for students.

Complete genome sequence of 285P, a novel T7-like polyvalent E. coli bacteriophage.

Bacteriophages are considered potential biological agents for the control of infectious diseases and environmental disinfection. Here, we describe a novel T7-like polyvalent Escherichia coli bacteriophage, designated "285P," which can lyse several strains of E. coli. The genome, which consists of 39,270 base pairs with a G+C content of 48.73 %, was sequenced and annotated. Forty-three potential open reading frames were identified using bioinformatics tools. Based on whole-genome sequence comparison, phage 285P was identified as a novel strain of subgroup T7. It showed strongest sequence similarity to Kluyvera phage Kvp1. The phylogenetic analyses of both non-structural proteins (endonuclease gp3, amidase gp3.5, DNA primase/helicase gp4, DNA polymerase gp5, and exonuclease gp6) and structural protein (tail fiber protein gp17) led to the identification of 285P as T7-like phage. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis and matrix-assisted laser desorption/ionization time-of-flight mass spectrometric analyses verified the annotation of the structural proteins (major capsid protein gp10a, tail protein gp12, and tail fiber protein gp17).

Type 2 diabetes mellitus and risk of malignant melanoma: a systematic review and meta-analysis of cohort studies.

BACKGROUND: Epidemiology studies have demonstrated inconsistent associations between type 2 diabetes mellitus and the risk of malignant melanoma. To this end, the aim was to perform a meta-analysis of cohort studies. METHOD: Medline, PubMed, Embase and the Cochrane Library were searched up to February 2014. Cohort studies addressing the relative risk of type 2 diabetes mellitus on malignant melanoma were included in this meta-analysis. The Newcastle-Ottawa Scale was applied for quality evaluation. The pooled relative risks with the corresponding 95% confidence intervals (95% CIs) were calculated by using random-effects or random-effects model. Heterogeneity and publication bias were evaluated by I (2) and funnel plot analysis, respectively. Data was analyzed using STATA 11.0. RESULTS: A total of 9 independent cohorts from 8 manuscripts were entered this meta-analysis. Type 2 diabetes mellitus was slightly associated with an increased risk of malignant melanoma, and the pooled relative risk was 1.15 (95% CI, 1.00-1.32) in diabetes compared with non-diabetes with significant evidence of heterogeneity among these studies (P=0.016, I (2) =57.6%). For the studies adjusted for age, gender and obesity, the relative risks were 1.21 (95% CI, 1.03-1.42), 1.17 (95% CI, 1.01-1.35) and 1.11 (95% CI, 1.00-1.24), respectively. For the population-based studies in which case cohort established, the relative risk was 1.85 (95% CI, 1.31-2.62). CONCLUSION: Type 2 diabetes might be an independent risk factor for malignant melanoma. Further studies are needed to specifically test the effect, and fully elucidate the underlying pathophysiologic mechanisms.

[Effects of distance between residence and hemodialysis unit on cardiovascular complications and treatments of maintenance hemodialysis patients].

OBJECTIVE: To explore the effects of etiological classification and the distance between residence and hemodialysis unit on cardiovascular complications and treatments in maintenance hemodialysis (MHD) patients. METHODS: A total of 756 MHD patients were collected from 12 hemodialysis centers of Guiyang, China between January 2011 and May 2012. Their distribution characteristics and correlations were based on medical records. And statistical analyses were performed. RESULTS: The ratio of males and females was 1.45: 1. And their mean age was (49.1 ± 14.7) years old. And 496 (65.6%) cases suffered from cardiovascular complications. The analysis of multi-factor Logistic regression revealed that distance between residence and dialysis unit was an independent risk factor of cardiovascular complications. The group of the farthest distance ( > 30 km) had the worst influence on dialysis adequacy Kt/V score, urea clearance rate, dialysis frequency and time per week. And the levels of blood phosphorus, triglyceride and cholesterol in the fourth group had marked elevations. It had a significant positive correlation with distance (P < 0.05). CONCLUSION: The distance between residence and dialysis unit is an independent risk factor of cardiovascular complications in MHD patients. The farthest distance ( > 30 km) has the greatest influence on dialysis adequacy.

A combined ultrafiltration strategy during pediatric cardiac surgery: a prospective, randomized, controlled study with clinical outcomes.

OBJECTIVE: To investigate the clinical effects of a combined ultrafiltration strategy on the surgical treatment of pediatric patients with congenital heart diseases. DESIGN: A prospective, randomized, controlled study. SETTING: A single-institution study in an affiliated hospital of a university. PARTICIPANTS: Sixty-five pediatric patients who underwent open heart surgery with cardiopulmonary bypass (CPB) to treat congenital heart disease were enrolled. The participants were randomized into 2 groups: conventional + modified ultrafiltration (MUF) (CM) group and prime + zero-balanced + MUF (PZM) group. INTERVENTIONS: In the CM group (n = 33), conventional ultrafiltration was performed after removal of the aortic clamp, and MUF was performed after the completion of CPB. In the PZM group (n = 32), ultrafiltration was performed for the circuit prime solution, zero-balance ultrafiltration was performed after removal of the aortic clamp, and MUF was performed after the completion of CPB. MEASUREMENTS AND MAIN RESULTS: The blood gas parameters and tumor necrosis factor alpha content in the priming solution and perioperative blood samples were analyzed. Postoperative parameters, including mechanical ventilation time, respiratory indices, intensive care unit time, and hospital time, also were recorded. One hospital death occurred in each group. No severe complications occurred in either group. The lactic acid, glucose, and tumor necrosis factor alpha contents in the priming solution and perioperative blood samples were significantly lower in the PZM group compared with the CM group. The respiratory indices were statistically significantly better in the PZM group compared with the CM group in the early postoperative period. No significant differences were found between the 2 groups regarding the postoperative ventilation time, inotropic support, homologous blood transfusion, drainage, intensive care unit time, or postoperative hospital time. CONCLUSION: The combined use of ultrafiltration of prime solution, zero-balance ultrafiltration, and MUF strategy is associated with a modest improvement in pulmonary function compared with the combination of conventional and MUF strategies in the early postoperative period, but the principal clinical outcomes are similar.