SummaryTo investigate the combination of high-sensitivity C-reactive protein (hs-CRP) and Low-density lipoprotein (LDL)-C as the targets for statin treatment in patients with acute coronary syndrome (ACS). This single-center, prospective, randomized study was performed in 400 patients treated with atorvastatin 40 mg/day for 1 month and then with atorvastatin 20 mg/day as maintenance. The patients were randomized to the LDL group (LDL-C target of < 2.07 mmol/L according to the Chinese dyslipidemia guidelines) and to the LDL-CRP group (LDL-C target of < 2.07 mmol/L and hs-CRP target of < 3 mg/L). The patients were followed up for major adverse cardiac events (MACE) at 6, 12, and 18 months. The two groups had similar baseline characteristics and 391 patients completed the follow-up. No differences were found in LDL-C between the two groups, but a difference was found in hs-CRP at 12 and 18 months. There was a significant difference in revascularization (8.7% versus 3.6%, P = 0.04) and MACE (16.8% versus 9.7%; P = 0.04) between the LDL and LDL-CRP groups at 18 months. Compared to LDL-C as the single target, targeting both LDL-C and hs-CRP by statin therapy in patients with ACS could further reduce the incidence of MACE and the residual cardiovascular risk.(Int Heart J Advance Publication)
Background During the coronavirus disease 2019 (COVID-19) pandemic, medical colleges in China had to use online teaching. This study explored the effect of COVID-19 knowledge learning online in a flipped classroom based on micro-learning combined with case-based learning (CBL). Methods There were 74 undergraduate medical students who were randomly grouped to an observation group and a control group with 37 participants in each virtual classroom on the Network Teaching Platform. Students learning in the control group utilized face-to-face lecture with PowerPoint pre-provided, while students learning in the observation group were conducted in a flipped classroom based on micro-learning combined with CBL. We compared the effect of both formats of COVID-19 knowledge learning online and the impact on clinical practice attitude in two groups. Results All 74 students (100%) responded pretest, posttest and retention test, and completed the questionnaire online. Both formats significantly improved COVID-19 knowledge acquisition at the conclusion of online COVID-19 curriculum. Students’ knowledge test scores including total score and scores of five knowledge dimensions of COVID-19 were significantly higher in the observation group than those in the control group ( P <0.05). Compared with students in the control group, students in the observation group performed better in retention test and had a significantly more positive clinical practice attitude ( P <0.05 in all items). Conclusion A flipped classroom based on micro-learning combined with CBL showed greater effectiveness in COVID-19 knowledge gain in undergraduate medical students and made their attitude toward clinical practice more positive.
BackgroundHashimoto’s thyroiditis (HT) is a common autoimmune disease characterized by high levels of thyroid peroxidase antibody (TPOAb) and thyroid globulin antibody (TgAb) as well as infiltration of lymphocytes in thyroid. In recent years, metformin has been proven to be effective in a variety of autoimmune diseases, such as systemic lupus erythematosus, rheumatoid arthritis and multiple sclerosis.MethodsThis study systematically explored the therapeutic effect of metformin on HT and its underlying mechanism by comprehensively utilizing methods including animal model, in vitro cell culture and differentiation, mRNA sequencing and 16S rRNA sequencing.FindingsWe found that metformin indeed had a therapeutic effect on mice with HT mainly by reducing TgAb and lymphocyte infiltration in thyroid tissue. In addition, metformin also significantly suppressed the number and function of Th17 cells and M1 macrophages polarization in HT mice. Furthermore, metformin can inhibit the differentiation and function of Th17 in vitro. The results of mRNA sequencing of thyroid tissue illustrated that the therapeutic effect of metformin on HT was mainly achieved by regulating immune pathways. 16S RNA sequencing of the intestinal flora found that the intestinal flora of HT mice differs significantly from that of the normal mice and also were altered by metformin treatment.InterpretationThese experiments provided a preliminary theoretical basis for the clinical application of metformin in the treatment of HT.
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