The number of circulating endothelial progenitor cells (EPCs) was found to increase in patients with breast cancer, but the alteration in EPC function remains to be elusive. We conducted this study to evaluate the number and function of peripheral EPCs of breast cancer patients and its possible underlying mechanism. Besides, the vascular endothelial growth factor (VEGF), VCAM-1, IL-6, and IL-34 levels were measured in blood samples and also in vitro in a medium of EPCs. We found that the number of circulating EPCs in breast cancer patients was significantly higher than that in normal control and remarkably augmented in a stage-dependent manner. Meanwhile, a similar enhancement was observed in the migratory, proliferative, and adhesive activity of circulating EPCs originating from breast cancer patients. More importantly, the VEGF level in blood samples was dramatically elevated in comparison to the control, which was correlated positively with the number and activity of circulating EPCs from breast cancer patients. Moreover, in vitro medium of EPCs from breast cancer patients highly expressed VEGF compared with that from the control, which also had a positive correlation with the number and activity of circulating EPCs from breast cancer patients. This is the first time to demonstrate that the number and function of circulating EPCs are promoted in breast cancer patients, which are positively related to an enhanced VEGF production. These may provide a novel target for improving the outcome of breast cancer.

The number of circulating endothelial progenitor cells (EPCs) was found to increase in patients with breast cancer, but the alteration in EPC function remains to be elusive. We conducted this study to evaluate the number and function of peripheral EPCs of breast cancer patients and its possible underlying mechanism. Besides, the vascular endothelial growth factor (VEGF), VCAM-1, IL-6, and IL-34 levels were measured in blood samples and also in vitro in a medium of EPCs. We found that the number of circulating EPCs in breast cancer patients was significantly higher than that in normal control and remarkably augmented in a stage-dependent manner. Meanwhile, a similar enhancement was observed in the migratory, proliferative, and adhesive activity of circulating EPCs originating from breast cancer patients. More importantly, the VEGF level in blood samples was dramatically elevated in comparison to the control, which was correlated positively with the number and activity of circulating EPCs from breast cancer patients. Moreover, in vitro medium of EPCs from breast cancer patients highly expressed VEGF compared with that from the control, which also had a positive correlation with the number and activity of circulating EPCs from breast cancer patients. This is the first time to demonstrate that the number and function of circulating EPCs are promoted in breast cancer patients, which are positively related to an enhanced VEGF production. These may provide a novel target for improving the outcome of breast cancer.

Objective To evaluate the clinical characteristics of acute pancreatitis (AP) concomitant with diabetic ketoacidosis (DKA) in a cohort from South China and identify factors associated with early detection of DKA in AP patients. Methods Inpatient medical records of AP concomitant with DKA were retrospectively reviewed. Results Forty-eight patients with AP concomitant with DKA were enrolled in this study. The results indicated that comorbidity history of diabetes mellitus and mental status of not alert on admission were factors associated with DKA in AP patients. Compared with patients without DKA, patients with DKA showed significantly higher rates of hypertriglyceridemia and lower rates of gallstones than those without DKA. AP patients with concurrent DKA had higher levels of serum triglycerides, longer lengths of hospital stays, and higher complication rates of systemic inflammatory response syndrome and acute kidney injury. Conclusion AP patients might have higher risks of concomitant DKA if presenting as not alert upon admission or if they have past medical histories of diabetes mellitus. Serum triglyceride levels were significantly higher in AP patients with DKA. DKA raised the severity of AP, but did not increase in-hospital mortality.

OBJECTIVE:The aim of this study was to explore the application of the flipped classroom approach in the training of Mass Casualty Triage (MCT) to medical undergraduate students.METHODS:In this study, 103 fourth-year medical students were randomly divided into a Flipped Classroom (FC) group (n = 51) and a Traditional Lecture-based Classroom (TLC) group (n = 52). A post-class quiz, simulated field triage (SFT) and feedback questionnaires were performed to assess both groups of students for their learning of the course.RESULTS:In the post-quiz, the median (IQR) scores achieved by students from the FC and TLC groups were 42(5) and 39(5.5), respectively. Significant differences were found between the two groups. In the SFT, overall triage accuracy was 67.06% for FC, and 64.23% for TLC students. Over-triage and under-triage errors occurred in 18.43% and 14.50% of the FC group, respectively. The TLC group had a similar pattern of 20.77% over-triage and 15.0% under-triage errors. No significant differences were found regarding overall triage accuracy or triage errors between the two groups.CONCLUSIONS:The FC approach could enhance course grades reflected in the post-quiz and improve students' satisfaction with the class. However, there was no significant difference of competency between the two groups demonstrated in the SFT exercise.

Objectives: This study aimed to analyze clinical characteristics and outcomes of critically ill patients with multiple myeloma (MM) admitted to the intensive care unit (ICU) and identify predictors of poor short-term prognosis.Methods: Data for patients with MM admitted to the ICU were extracted from the Medical Information Mart for Intensive Care III database. The risk factors leading to the ICU and hospital mortality were evaluated using logistic regression analysis.Results: Of 126 patients identified, 17 (13.5%) and 37 (29.4%) died in the ICU and hospital, respectively. Patients with ICU mortality showed higher median blood urea nitrogen (57.0 vs. 29.0) and poorer Acute Physiology Scores (APS, 70.0 vs. 46.0) than did surviving patients on the day of ICU admission. In-ICU deceased patients had higher proportion of mechanical ventilation (64.7% vs. 26.6%) and vasopressor use (64.7% vs. 17.4%) at admission and positive pathogenic culture during ICU stay (58.8% vs. 19.3%). The APS and positive pathogenic culture were independent prognostic factors for ICU mortality, while risk factors for hospital mortality included higher APS and relapsed/refractory disease.Conclusion: The short-term prognoses for patients with MM admitted to the ICU were mainly determined by the severity of organ failure, infection, and disease status.

Background. Men have a higher risk and earlier onset of cardiovascular diseases compared with premenopausal women. Hypertriglyceridemia is an independent risk factor for the occurrence of ischemic heart disease. Endothelial dysfunction is related to the development of ischemic heart disease. Whether sex differences will affect the circulating endothelial progenitor cells (EPCs) and endothelial function in hypertriglyceridemia patients or not is not clear. Methods. Forty premenopausal women and forty age- and body mass index (BMI)-matched men without cardiovascular and metabolic disease were recruited and then divided into four groups: normotriglyceridemic women (women with serum triglycerides level <150 mg/dl), hypertriglyceridemic women (women with serum triglycerides level ≥150 mg/dl), normotriglyceridemic men (men with serum triglycerides level <150 mg/dl), and hypertriglyceridemic men (men with serum triglycerides level ≥150 mg/dl). Peripheral blood was obtained and evaluated. Flow-mediated dilatation (FMD), the number and activity of circulating EPCs, and the levels of nitric oxide (NO), vascular endothelial growth factor (VEGF), and granulocyte-macrophage colony-stimulating factor (GM-CSF) in plasma and culture medium were measured. Results. The number and activity of circulating EPCs, as well as the level of NO in plasma or culture medium, were remarkably increased in premenopausal females compared with those in males both in the hypertriglyceridemic group and the normotriglyceridemic group. The EPC counts and activity, as well as the production of NO, were restored in hypertriglyceridemic premenopausal women compared with those in normal women. However, in hypertriglyceridemic men, the EPC counts and activity, as well as levels of NO, were significantly reduced. The values of VEGF and GM-CSF were without statistical change. Conclusions. The present study firstly demonstrated that there were sex differences in the number and activity of circulating EPCs in hyperglyceridemia patients. Hypertriglyceridemic premenopausal women displayed restored endothelial functions, with elevated NO production, probably mediated by estradiol. We provided a new insight to explore the clinical biomarkers and therapeutic strategies for hypertriglyceridemia-related vascular damage.

Background: Acute and severe infections are an absolute indication for the use of intravenous broad-spectrum antibiotics. However, previous studies have found inconsistent clinical advantages of prolonged (extended [>= 3-hour infusion] or continuous [24-hour fixed rate infusion]) over intermittent (6, or 8, or 12 interval hours infusion) infusion. The clinical superiority between prolonged and intermittent infusion in treating acute and severe infections thus continues to be elusive. We conducted a meta-analysis to summarize all published randomized controlled trials (RCTs), prospective and retrospective observational studies to determine whether prolonged infusion, compared to intermittent infusion, is correlated with lower mortality and better clinical outcome. Methods: We performed a literature search using MEDLINE (source PubMed, January 1, 1966 to August 31, 2018) and EMBASE (January 1, 1980 to August 31, 2018) with no restrictions to collect RCTs and observational studies comparing prolonged infusion with intermittent infusion of the same intravenous administered antibiotics among adult hospitalized patients. A total of 43 studies including 30 RCTs, 5 prospective observational studies and 8 retrospective observational studies were identified. Results: In comparison with intermittent infusion, prolonged infusion of antibiotics was associated with a reduction in all-cause mortality (pooled relative risk [RR] = 0.77, 95% confidence interval [CI] = 0.66-0.89) and improvement in clinical cure (RR = 1.11, 95% CI = 1.04-1.19), which was also observed in subgroups such as non-RCTs (mortality, RR = 0.63, 95% CI = 0.48-0.81; clinical cure RR = 1.33, 95% CI = 1.13-1.57) or studies with patients and APACHE II scores boxed times 15 (mortality, RR = 0.74, 95% CI 0.63-0.89; clinical cure RR = 1.19, 95% CI = 1.07-1.32). Moreover, in RCTs, mortality (RR = 0.86, 95% CI 0.72-1.03) between the two dosing strategies was not remarkably changed but clinical cure (RR = 1.07, 95% CI = 1.01-1.13) showed a significant advantage for prolonged infusion. Additionally, no significant differences in mortality between the two dosing strategies was found (RR = 0.87, 95% CI = 0.70-1.09) but a distinct improvement in clinical cure was observed (RR = 1.14, 95% CI = 1.02-1.28) in the prolonged infusion group for septic patients. Among two infusion modes, statistically significant severe adverse events were not reported (RR=0.83, 95% CI = 0.62-1.13). Conclusion: Better outcomes in hospitalized patients, especially in those who were critical ill, were reported in prolonged infusion of intravenous antibiotics compared with traditional intermittent infusion.

目的:探索Mini-CEX(Mini-clinical evaluation exercise,模拟临床演练评估)与DOPS(direct observa-tion of procedural skills,诊疗技能直接观察法)在临床医学专业本科生实习教学中的应用及价值.方法:选取2012年7月至2017年7月在中山大学附属第一医院实习的临床医学专业本科生作为研究对象.运用Mini-CEX与DOPS测评方法分别对每位实习医师在实习开始前、实习中期及实习结束时进行三次测评.比较三次测评的成绩,各组之间比较采用Kruskal-Wallis检验.结果:共有425名实习医师接受测评,共完成Mini-CEX量表评测1275次,DOPS量表评测7650次.实习医师各阶段得分呈逐步上升趋势,实习结束时得分情况较前均有明显提高,各阶段成绩比较差异具有统计学意义.结论:Mini-CEX与DOPS评估方法有利于评价及提高实习医师的临床综合病例诊治能力及操作技能,适合在医学本科教育中推广.

Acute type B aortic dissection(TBAD) complicated by malperfusion or rupture carries a high risk of death. Thoracic endovascular aortic repair(TEVAR) when anatomy is suitable, has been regarded as the preferable treatment to seal the primary entry tear, redirect and re-establish adequate true lumen

目的 分析2008-2017年广州登革热流行趋势,为制订防控策略提供依据.方法 通过国家传染病监测信息报告管理系统收集病例信息,对每起登革热暴发疫情均开展现场流行病学调查并完成调查处置报告.对收集的疫情资料进行描述性分析,并对2008-2012年和2013-2017年疫情资料分组,对比分析疫情规模、持续时间、波及范围、暴发强度、病毒型别等方面的变化趋势.结果 相比2008-2012年,2013-2017年广州市登革热总体疫情规模和年发病率呈上升趋势,输入疫情持续上升,本地疫情上升迅猛且疫情持续时间明显延长,本地疫情波及范围从2008-2012年波及的7个区59个街镇扩大到全部12个区和97.1％(165/170)的街镇,疫情强度从局部暴发规模上升到多次出现全市流行规模,此外,重症死亡病例增多,本地疫情的病毒型别也从4种血清型散发出现进展为1型和2型病毒持续出现.结论 广州地区登革热疫情强度的明显上升、流行趋势的转变以及相同病毒型别的持续,提示广州登革热流行正逐渐呈现由“输入引起的本地传播”向“本地化”进展的趋势.

目的:探讨红细胞体积与急性冠脉综合征(ACS)严重程度相关性.方法:连续收集2016年1到2016年4月在中山大学附属第一院急诊科因"胸痛、胸闷"为主诉的168例就诊患者,按照心电图、心肌酶学变化及临床表现分别ACS组(UA、NSTEMI、STEMI)50例和对照组118例.所有入选的病人均完成血常规、心梗组合等血液生化检查.结果:本研究入选168例患者,年龄范围20-90(65.59±11.21)岁,男性76例(45.24％);其中ACS组患者年龄在(68.98±13.11)岁,男性比例62％,高血压患病率64％,糖尿病患病率34％,高脂血症30％,吸烟率38％均高于对照组患者,ACS组红细胞体积也明显高于对照组[(91.96±4.51)vs(85.41±9.44),P<0.05].ACS各亚组较对照组均值明显升高,STEMI、NSTEMI组较UA组红细胞体积有所升高,比较有统计学差异(P<0.05),STEMI与NSTEMI组红细胞体积比较无统计学差异(P>0.05).结论:患者血液中红细胞体积可评估ACS严重程度,在临床上具有一定的研究价值.

Objective To explore the HEART risk score in predicting 30-day major adverse cardiovascu-lar events (MACE)for the patients presenting to Emergency Department (ED) with acute chest pain. Methods Patients presented in our ED with acute chest pain were enrolled from January,2016 to April,2016. All cause MACE of each patient were followed up at 30 days by Health insurance information management System and call . Results Total 209 patients were enrolled(mean age 65.28 ± 16.85 years;52.63%male). The age,hypertension, ratio of ACS,SpO2,in-patient number HEART score in MACE subject were significantly higher than that in non MACE patients(P<0.05). The blood pressure at admission of MACE patients was significantly decrease than that in non MACE patients(P<0.05). The MACE within 30 days was 5.74%. The respective areas under the curve (AUC)for 30-day MACE(95% CI)was 0.908(0.846 ~ 0.974). The percent of patients with 30-day MACE with HEART scores between 0% and 3,4 ~ 6,and 7 ~ 10 was 0%,2.5%,and 27%,respectively. Conclusion HEART score can be simple,rapid and accurate prediction of emergency department of patients with acute chest pain within 30 days of MACE,effective elimination of low-risk patients with MACE,it plays a very important role for disease assessment and diagnosis and treatment process in emergency department.

目的 观察结直肠癌肝转移(colorectal cancer with liver metastasis,CRCLM)患者行根治性切除的疗效,分析影响术后肝转移瘤复发的危险因素.方法 回顾性分析我院1993-2013年收治的行根治性切除术的结直肠癌肝转移患者164例资料,绘制其术后远期生存率及无瘤生存率曲线.对影响术后肝转移瘤复发的因素分别进行单因素分析和多因素分析.结果 术后第1、2、3、5年生存率分别为90.9％、72.1％、57.1％和26.0％,中位生存期为32(1 ～162)个月;术后第1、2、3、5年无瘤生存率分别为49.4％、38.4％、25.0％和14.0％,中位无瘤生存时间为12个月.术后并发症发生率为16.5％,术后30 d死亡率为1.2％.术后肝转移瘤复发率为46.3％,其中,边缘复发5例(6.6％),同一肝段复发7例(9.2％),邻近肝段复发7例(9.2％),远隔肝段复发13例(17.1％),多发肝段复发44例(57.9％).各复发类型相比差异无统计学意义(P =0.062).单因素分析显示原发瘤分化程度(P=0.035)、癌胚抗原(carcino-embryonic antigen,CEA) (P =0.013)、原发瘤区域淋巴结转移(P =0.043)和肝转移瘤切缘(P =0.012)与术后肝转移瘤复发相关;多因素分析显示原发瘤分化程度(P =0.021)和CEA(P =0.015)为影响术后肝转移瘤复发的独立危险因素.结论 结直肠癌肝转移根治性切除术后远期生存率高,原发瘤分化程度和术前血浆CEA水平为影响术后肝转移瘤复发的独立危险因素.

Objective To evaluate the diagnostic performance of a point-of-care testing for sensitive cardiac troponin Ⅰ (POCT-cTnI) in early diagnosis of chest pain patients who had a high pretest probability of acute myocardial infarction (AMI).Methods Total of 127 patients with new-onset chest pain at the emergency department were enrolled.Blood samples were drawn for the routine blood test,and determined POCT-cTnI and central laboratory testing for high sensitive cardiac troponin T (CLT-hscTnT) at admission,three and then at six hours after admission.All patients were divided into AMI group and non-AMI group according to the final diagnosis,which was adjudicated independently by two physicians who reviewed all available medical records for the 90-day follow-up period,and they were unaware of the results of the investigational assays of cardiac troponins.The receiver operating characteristic (ROC) curves were constructed to assess and compare the diagnostic performance of AMI of two cardiac troponin assays.The comparison of areas under the ROC curves (AUC) was performed by DeLong test,and the sensitivity,specificity,negative predictive values (NPV) and positive predictive values (PPV) for the target markers were calculated by applying a maker-specific cutoff value.Results The final diagnosis of AMI was made in 40 of 127 patients (31.5 ％).The diagnostic accuracy of the two assays oBtained at presentation,as quantified by AUC,was no statistically differences (AUC for POCT-cTnⅠ,0.901,95％ CI,0.901 to 0.947;and for CLT-hscTnT,0.907,95％ CI,0.842 to 0.951;Z =0.235,P =0.745).The AUC for POCT-cTnI at 3 hours after admission was significantly higher than that on admission (0.931 vs.0.858;Z =-2.038,P =0.042),while there was on further improvement at 6 hours after admission (0.931 vs.0.949;Z =-1.435,P =0.151).With use of POCT-cTnI (cutoff value 0.023 ng/mL,which was the 99th percentile upper reference limit) on adimission,the clinical sensitivity was 77.5％,and the specificity was 94.2％.A single sample of POCT-cTnI at 3 hours after admission improved the diagnostic accuracy,with a sensitivity of 96.4％,a specificity of 92.0％,and a NPV of 98.6％,a PPV of 81.8％.While,with use of CLT-hscTnT (cutoff value 0.014 ng/mL,was the 99th percentile upper reference limit) at 3 hours after admission,the NPV reached to 100％.Conclusions The use of a POCT-cTnI assay in chest pain patients can identify and exclude the AMI rapidly and exactly at three hours after admission,and the diagnostic performance is equivalent to CLT-hscTnT.

In this study, we explored the potential role of intra-myocardial BMSCs-IGF-1 transplanation in reducing cardiomyocyte apoptosis,mediating cell migration and restoring myocardial function. BMSCs were lentivirally transduced to express stable forms of IGF-1. AMI model was induced by ligation of left