This study examines the clinical utility of the increased lactate/albumin ratio as an indicator of multiple-organ dysfunction syndrome (MODS) and mortality in severe sepsis and septic shock.We designed a prospective cohort study in an intensive care unit, and 54 patients with severe sepsis or septic shock were included. Data were used to determine a relationship between lactate/albumin ratio and the development of MODS and mortality. These associations were determined by the Mann-Whitney test, multiple logistic regression, plotting the receiver operating characteristic curve and Spearman test.Lactate/albumin ratio level was higher in MODS patients on day 1 (median [interquartile range, or IQR], 2.295 [1.818-3.065]; n = 30, P < .0001) than in those without (median [IQR], 1.550 (1.428-1.685); n = 24), and on day 2, (median [IQR], 1.810 [1.377-2.448]; n = 26, P = .0022) it was higher than in those without (median [IQR], 1.172 (1.129-1.382); n = 23) on day 2. We found that lactate/albumin ratio was an independent predictor of the development of MODS (odds ratio, 5.5; P = .033; 95% confidence interval, 1.1-26.1) during intensive care unit stay. The area under the receiver operating characteristic curve showed that lactate/albumin ratio could predict MODS (0.8458) and mortality (0.8449). Furthermore, the higher the Acute Physiology and Chronic Health Evaluation II score, the more lactate/albumin ratio was discovered on day 1 (r = 0.5315, P < .0001) and day 2 (r = 0.5408, P < .0001), whereas the lower partial pressure of oxygen in arterial blood/fraction of inspired oxygen ratio, the more lactate/albumin ratio was illustrated on day 1 (r = − 0.5143, P < .0001) and day 2 (r = − 0.5420, P < .0001).Increased lactate/albumin ratio correlates with the development of MODS and mortality in patients with severe sepsis and septic shock.

我国的医学研究生教育正逐步由培养科学型人才为主向以培养应用型人才为主转变,医学专业学位研究生的招生规模和学科类别不断扩大.文章就医学专业学位研究生培养模式在培养目标、培养方式等方面进行探讨,并据此提出相应的对策和建议,为调整和优化研究生教育结构、提高医学专业学位教育质量提供参考依据.

Rosuvastatin is a highly effective statin medication with favorable effects on atherogenic, lipid and inflammatory parameters [ [1] Nicholls S.J. Uno K. Kataoka Y. Clinical experience with rosuvastatin in the management of hyperlipidemia and the reduction of cardiovascular risk. Expert Rev Cardiovasc Ther. 2011; 9: 1383-1390 Crossref PubMed Scopus (4) Google Scholar ], which have been associated with significant regression of coronary atherosclerosis [ 2 Nicholls S.J. Ballantyne C.M. Barter P.J. et al. Effect of two intensive statin regimens on progression of coronary disease. N Engl J Med. 2011; 365: 2078-2087 Crossref PubMed Scopus (596) Google Scholar , 3 Han S.H. Chung W.J. Kang W.C. et al. Rosuvastatin combined with ramipril significantly reduced atheroma volume by anti-inflammatory mechanism: comparative analysis with rosuvastatin alone by intravascular ultrasound. Int J Cardiol. 2012; 158: 217-224 Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar ] and reduction of periprocedural myocardial infarction [ 4 Yun K.H. Jeong M.H. Oh S.K. et al. The beneficial effect of high loading dose of rosuvastatin before percutaneous coronary intervention in patients with acute coronary syndrome. Int J Cardiol. 2009; 137: 246-251 Abstract Full Text Full Text PDF PubMed Scopus (96) Google Scholar , 5 Yun K.H. Oh S.K. Rhee S.J. Yoo N.J. Kim N.H. Jeong J.W. 12-month follow-up results of high dose rosuvastatin loading before percutaneous coronary intervention in patients with acute coronary syndrome. Int J Cardiol. 2011; 146: 68-72 Abstract Full Text Full Text PDF PubMed Scopus (46) Google Scholar ]. However, only few data are available about its potential antiarrhythmic properties [ 6 Adam O. Frost G. Custodis F. et al. Role of Rac1 GTPase activation in atrial fibrillation. J Am Coll Cardiol. 2007; 50: 359-367 Abstract Full Text Full Text PDF PubMed Scopus (141) Google Scholar , 7 Xia W. Yin Z. Li J. Song Y. Qu X. Effects of rosuvastatin on asymmetric dimethylarginine levels and early atrial fibrillation recurrence after electrical cardioversion. Pacing Clin Electrophysiol. 2009; 32: 1562-1566 Crossref PubMed Scopus (40) Google Scholar , 8 Li J. Xia W. Feng W. Qu X. Effects of rosuvastatin on serum asymmetric dimethylarginine levels and atrial structural remodeling in atrial fibrillation dogs. Pacing Clin Electrophysiol. 2012; 35: 456-464 Crossref PubMed Scopus (9) Google Scholar ]. In the past few years, there is also increasing interest regarding the role of statins in AF prevention [ 9 Liu T. Li L. Korantzopoulos P. Liu E. Li G. Statin use and development of atrial fibrillation: a systematic review and meta-analysis of randomized clinical trials and observational studies. Int J Cardiol. 2008; 126: 160-170 Abstract Full Text Full Text PDF PubMed Scopus (119) Google Scholar , 10 Fauchier L. Pierre B. de Labriolle A. Grimard C. Zannad N. Babuty D. Antiarrhythmic effect of statin therapy and atrial fibrillation a meta-analysis of randomized controlled trials. J Am Coll Cardiol. 2008; 51: 828-835 Abstract Full Text Full Text PDF PubMed Scopus (231) Google Scholar , 11 Winchester D.E. Wen X. Xie L. Bavry A.A. Evidence of pre-procedural statin therapy a meta-analysis of randomized trials. J Am Coll Cardiol. 2010; 56: 1099-1109 Abstract Full Text Full Text PDF PubMed Scopus (154) Google Scholar , 12 Rahimi K. Emberson J. McGale P. et al. Effect of statins on atrial fibrillation: collaborative meta-analysis of published and unpublished evidence from randomised controlled trials. BMJ. 2011; 342: d1250 Crossref PubMed Scopus (103) Google Scholar , 13 Fang W.T. Li H.J. Zhang H. Jiang S. The role of statin therapy in the prevention of atrial fibrillation: a meta-analysis of randomized controlled trials. Br J Clin Pharmacol. 2012; 74: 744-756 Crossref PubMed Scopus (75) Google Scholar , 14 Bang C.N. Greve A.M. Abdulla J. Kober L. Gislason G.H. Wachtell K. The preventive effect of statin therapy on new-onset and recurrent atrial fibrillation in patients not undergoing invasive cardiac interventions: a systematic review and meta-analysis. Int J Cardiol. 2013; 167: 624-630 Abstract Full Text Full Text PDF PubMed Scopus (24) Google Scholar ]. The most recent meta-analysis [ [13] Fang W.T. Li H.J. Zhang H. Jiang S. The role of statin therapy in the prevention of atrial fibrillation: a meta-analysis of randomized controlled trials. Br J Clin Pharmacol. 2012; 74: 744-756 Crossref PubMed Scopus (75) Google Scholar ] on 20 randomized controlled trials (RCTs) with any statins (including 11 trials of atorvastatin, 4 trials of pravastatin, 3 trials of rosuvastatin, and 2 trials of simvastatin) demonstrated that treatment with statins was significantly associated with a decreased risk of AF. However, subgroup analyses showed that these beneficial effects were found only in atorvastatin and simvastatin subgroups, but not in pravastatin and rosuvastatin subgroups. Also, a just published meta-analysis [ [14] Bang C.N. Greve A.M. Abdulla J. Kober L. Gislason G.H. Wachtell K. The preventive effect of statin therapy on new-onset and recurrent atrial fibrillation in patients not undergoing invasive cardiac interventions: a systematic review and meta-analysis. Int J Cardiol. 2013; 167: 624-630 Abstract Full Text Full Text PDF PubMed Scopus (24) Google Scholar ] in that included GISSI-HF data regarding the effect of rosuvastatin on AF prevention in patients with chronic heart failure failed to show favorable effects of rosuvastatin as well. After the publication of these meta-analyses which analyzed the literature before July 2011, a post hoc analysis on AF from the JUPITER trial [ [15] Pena J.M. MacFadyen J. Glynn R.J. Ridker P.M. High-sensitivity C-reactive protein, statin therapy, and risks of atrial fibrillation: an exploratory analysis of the JUPITER trial. Eur Heart J. 2012; 33: 531-537 Crossref PubMed Scopus (83) Google Scholar ] was published. We therefore performed the first meta-analysis of RCTs investigating the impact of rosuvastatin therapy on AF prevention.

课程体系建设是医学研究生培养的重要环节,通过对当前我国医学专业学位硕士研究生课程体系建设现状全面、系统的分析,探讨现行课程体系不足,并提出改进建议,为提高我国医学专业学位硕士研究生培养质量提供依据。

With the transformation of medical model and health concept, a large number of high level clinical medical professionals with prevention medicine knowledge are needed. The paper analyzed the situation and existing problems of preventive medicine education for clinical medical postgraduates, and put forward countermeasures accordingly to strengthen the prevention medicine quality of clinical medical postgraduate to adapt the "prevention first" strategy requirement.

Based on the individual and social needs of medical doctoral students, a highly interactive, whole- English teaching medical English course was designed as English for specific purposes ( ESP),aims to provide the student with cutting edge medical knowledge and English language skills training to help cultivate intemafional medical professionals with comprehensive skills of English listening, reading, medical writing and communication.

The application of problem -based learning(PBL) in graduate medical education is at the preliminary stage without a scientific evaluation system,which hampers its promotion in China.This paper uses Document Selection Method and Delphi Method to screen evaluation indicators.The weight of indices are calculated by Analytical hierarchy process(AHP) .PBL evaluation system for graduate medical education comprises three-level indices.Since the positivity,authority and consistency of the selected experts are well established,the evaluation system proves to be highly reliable and may provide a basis for further development of PBL in China's medical education.

Economic globalization and internationalization of medical science raise a higher demand for medical doctoral students' English ability.To ensure and enhance the quality of medical doctoral student education and to improve the English teaching effect,this paper investigates and analyzes the situation of English learning to explore English learning needs of content of course,teaching method and model,etc.Thus the authors have provided objective and reliable theoretical basis to carry out further English teaching reform for medical doctoral students.

Evidence-based medicine(EBM) is medicine based on evidence.Introducing EBM concept to medical graduate training is an important strategy for improving quality of medical graduate training.We advocate applying EBM in the whole process of medical graduate training,including academic curriculum,clinical practice and scientific research phases.It will promote the transformation of medical education concept and education mode,encourage medical graduates to practice,innovate and re-practice to promote the development of medical science.

In this article, in order to provide reference for enhancing the quality of postgraduate education, the situation of postgraduate education was analyzed through questionnaire investigation among the postgraduates in two medical schools. Field-survey, questionnaires posted and distributed on-spot were adopted to investigate the teaching resources, academic program, scientific research and other education quality related issues. The results showed that resources, academic programs and training process of medical postgraduate education need to be improved. Medical schools should carry on with some measures to increase the investment, promote teaching reform, regulate training process and strengthen tutors' awareness of responsibility accordingly to achieve balanced development for scale and quality of postgraduate education.

Recent observational studies have shown that implantable cardioverter defibrillator (ICD) patients with chronic kidney disease (CKD) have increased mortality and therefore the value of device therapy in this group has been questioned. The purpose of this meta-analysis was to systematically analyse the effect of renal dysfunction on mortality of ICD patients.Pubmed, Cochrane clinical trials database, and EMBASE were searched until December 2008. In addition, a manual search was performed using review articles, reference lists of papers, and abstracts from conference reports. Of the 90 initially identified studies, 11 observational studies with 3010 patients were analysed. The meta-analysis of these studies showed that CKD was associated with higher mortality risk (HR = 3.44, 95% CI 2.82-4.21, Z = 12.09, P < 0.001) while there were no significant differences between individual trials (P = 0.09, I(2) = 37.8%). A subgroup analysis which included the four studies that used estimated glomerular filtration rate (GFR) <60 mL/min/1.73 m(2) to define CKD showed a higher mortality in the CKD group as well (HR = 3.06, 95% CI 2.31-4.04, Z = 7.84, P < 0.001) without significant heterogeneity (P = 0.38, I(2) = 5.2%).Our meta-analysis suggests that CKD is associated with increased mortality in patients who receive ICD therapy. Undoubtedly, prospective studies are needed in order to elucidate the impact of different stages of CKD in this setting. Given that the CKD prevalence is rapidly increasing, there is an imperative need for better risk stratification of ICD therapy candidates.

This paper analyzed the problems in traditional medical graduate education.Based on the practice of problem-based learning(PBL) in medical education and students' different characteristics with various educational backgrounds,we analyzed the feasibility of applying PBL in graduate medical education in China.We concluded that PBL is an effective way to improve the quality of medical graduates.Finally,we gave some suggestions on how to implement PBL in practice.

Current evidence links atrial fibrillation (AF) to the inflammatory state. Also, increased C-reactive protein (CRP) levels have been associated with greater risk of recurrence of AF after successful electrical cardioversion (EC). We conducted a meta-analysis of observational studies to examine the association between baseline CRP levels and the immediate success of EC in persistent AF. We searched the literature published November 2007 or earlier. In addition, a manual search was performed using all review articles on this topic, reference lists of studies, and abstracts from conference reports. Of the 342 initially identified studies, 6 prospective observational studies with a combined 366 patients (297 with successful and 69 with failed EC) were analyzed. Overall, CRP levels were greater in patients with failed EC. The standardized mean difference in the CRP levels between patients with successful and those with failed EC was -0.41 units (95% confidence intervals -0.68 to -0.14) and the Z score for overall effect was 2.98 (p=0.003). The heterogeneity test showed that there were no significant differences between the individual studies (p=0.36; I(2)=9.1%). In conclusion, our meta-analysis suggests that increased CRP levels are associated with greater risk of EC failure. CRP assessment before cardioversion may provide prognostic information regarding the success of the procedure.

OBJECTIVES:We conducted a systematic review and meta-analysis of observational studies to examine the association between baseline C-reactive protein (CRP) levels and the recurrence of atrial fibrillation (AF) after successful electrical cardioversion (EC). BACKGROUND:Current evidence links AF to the inflammatory state. Inflammatory indexes such as CRP have been related to the development and persistence of AF. However, inconsistent results have been published with regard to the role of CRP in predicting sinus rhythm maintenance after successful EC. METHODS:Using PubMed, the Cochrane clinical trials database, and EMBASE, we searched for literature published June 2006 or earlier. In addition, a manual search was performed using all review articles on this topic, reference lists of papers, and abstracts from conference reports. Of the 225 initially identified studies, 7 prospective observational studies with 420 patients (229 with and 191 without AF relapse) were finally analyzed. RESULTS:Overall, baseline CRP levels were greater in patients with AF recurrence. The standardized mean difference in the CRP levels between the patients with, and those without AF was 0.35 units (95% confidence interval 0.01 to 0.69); test for overall effect z-score = 2.00 (p = 0.05). The heterogeneity test showed that there were significant differences between individual studies (p = 0.02; I(2) = 60.2%). Further analysis revealed that differences between the CRP assays possibly account for this heterogeneity. CONCLUSIONS:Our meta-analysis suggests that increased CRP levels are associated with greater risk of AF recurrence, although there was significant heterogeneity across the studies. The use of CRP levels in predicting sinus rhythm maintenance appears promising but requires further study.

Objective:To develop the instrument for the evaluation of the report quality of clinical trials with the modified Delphi method in combination with panel discussions, and assess its validity and reliability. Method: For the development of the instrument, the modified Delphi method in combination with a panel discussion was applied. The consulting panel included pharmacologists, clinical doctors, epidemiologists, statisticians and editors of journal. 30 reports for the therapy of hypertension published in 2000 were selected for the estimation of the instrument of the validity and reliability. The interclass correlation coefficient (ICC) was used to test the reliability. The CONSORT statement was used as a control, and a Kendall correlation was worked out to estimate the validity. Result:A total of 10 specialists took part in the consultation. During the first round of consultation, the expert harmonious coefficient (W) reached to 0. 505 and 19 items were identified. A total of 100 scores were distributed to the 19 items in the second round, and finally the scale was completed. After scoring the 30 reports on hypertension therapy by two readers independently, the interclass correlation coefficients (ICC) of the total score were 0.921,and 0.987 in the introduction part, 0.875 in materials and methods, 0.902 in results, and 0.966 in the discussion and others, P <0.01. In comparison with the result of CONSORT statement, the Kendall coefficient of the result of evaluation was 0.723, P<0.01, which indicated that the validity was good. Conclusion: The scale has been developed in a relatively strict procedure, and the validity and reliability are good.

Background: Inflammation and oxidative stress have been associated with atrial fibrillation (AF). On the other hand, accumulating evidence suggests that statins may have antiarrhythmic effects due to pleiotropic properties. However, inconsistent results have been reported with respect to AF.Aims: We conducted a systematic review and meta-analysis of randomized clinical trials (RCTs) and observational studies to examine the association between statin use and development of AF.Methods: PubMed, Cochrane clinical trials database, and EMBASE were searched until November 2006. In addition, a manual search was performed using all review articles on this topic, reference lists of papers, and abstracts from conference reports. Of the 309 initially identified studies, 6 RCTs and 10 observational studies with 7041 patients were finally analyzed.Results: The analysis of RCTs showed no significant effect of statins on AF development (RR = 0.76, 95% CI: 0.55-1.05, P = 0.09), and significant heterogeneity between individual studies (P = 0.0008, I-2 = 74.0%). Subgroup analysis revealed that differences in AF detection methodology may be the cause of heterogeneity. The analysis of observational studies demonstrated that statin use reduced the relative risk for AF by 23% ( 95% CI: 0.70-0.85, Z = 4.95, P < 0.00001) without significant differences between the trials (P = 0.08, I-2 = 41.2%). This favorable effect was greatest in the post-operative patients (RR = 0.61, 95% CI: 0.49-0.76, Z = 4.30, P < 0.0001).Conclusion: Our meta-analysis suggests that statins may be effective in AF prevention especially in the post-operative setting. However, there are insufficient data for the widespread use of statins solely for AF prevention. Larger RCTs with long-term follow-up in different clinical settings, and more sensitive methods of arrhythmia detection are needed to clarify the impact of statins on AF. (c) 2007 Elsevier Ireland Ltd. All rights reserved.

不合理应用抗菌药除造成资源浪费和毒副作用外,由此引发的细菌耐药已成为全球重要的公共卫生问题.耐药菌的出现和蔓延一方面与临床不规范用药有关,另一个容易被人们忽视的方面是自我药疗过程中抗菌药的误用和滥用.

Objective:To review whether prophylactic amiodarone has any preventive effects on the incidence of atrial fibrillation( AF) in patients undergoing cardiac surgery. Method:With the help of electronic databases and hand searches, prophylactic effects of post-operative atrial fibrillations with amiodarone compared with placebo were collected to perform some randomized controlled tests and then statistical combinations were conducted with the meta-analysis. Result: A fixed-effect model of meta-analysis was conducted and 15 identified studies were in accordance with the exclusive criterion. The combined relative risk (RR) was 0.66(95% CI:0.58 -0.75). The subgroup analyses showed that the time of initial administration of amiodarone or the way of the administraions presented no effects on the postoperative atrial fibrillation. The stability of the result was approved by sensitivity analysis. Conclusion:Compared with that of the placebo group, the result demonstrated the effectiveness of amiodarone in decreasing the risk of the atrial fibrillation after heart surgery.

Objective: The purpose of this study is to discuss the influential factors contributing to left atrium dimension (LAD) in patients with nonvalvular atrial fibrillation(AF). Methods: Three hundred and twenty nine patients with nonvalvular AF were included in our study. Clinical and echocardiographic features correlating with LAD were evaluated by multivariate regression analyses. Results: The duration of AF, AF attacking at the time of echocardiography, left ventricular end-diastolic dimension(LVED) and mitral regurgitation were significantly correlated with the LAD in patients with nonvalvular AF (P 0.01). Conclusion: Multiple factors appear to contribute to the LAD in patients with nonvalvular AF, especially AF attacking at the time of echocardiography and LVED.