Objective To study the correlation of personality characteristics and plasma cortisol levels in the patients with generalized anxiety disorder.Methods According to Diagnostic and Statistical Manual of Mental Disorders (DSM-Ⅳ), 38 patients with generalized anxiety disorder and 39 normal controls were assessed with Hamilton anxiety scale (HAMA) , generalized anxiety disorder scale (GAD-7) , penn state worry questionnaire (PSWQ) , symptom checklist-90(SCL-90) and eysenck personality questionnaire (EPQ).Electrochemiluminescence was used to test plasma cortisol concentration.Results The EPQ-N score in the patients was significantly higher than that in normal controls(t=14.307, P＜0.01).Furthermore,N score in the patients showed a significantly positive correlation with HAMA total score, SCL-90 total score, somatization score, interpersonal sensitivity score, depression score and anxiety score (r=0.492-0.977, P＜0.01).Plasma cortisol levels in patients with generalized anxiety disorder((668.50±60.22) nmol/L) were significantly higher than those ((345.35±58.91) nmol/L) in normal controls (t=23.802, P＜0.01).Plasma cortisol concentrations displayed a significantly positive correlation with N score, GAD-7, PSWQ, HAMA total score, SCL-90 total score, somatization score, interpersonal sensitivity score, depression score, and anxiety score (r =0.501-0.995, P＜ 0.01).Conclusion Plasma cortisol levels in the patients with generalized anxiety disorder are higher than those in normal controls.Plasma cortisol levels are related to the mental health.Patients with generalized anxiety disorder tend to be neuroticism.

Objective To study the alexithymia and personality characteristics in patients with somatoform disorders.Methods Totally 60 patients with somatoform disorders and 60 normal controls were tested with Toronto alexithymia scale (TAS) and Minnesota Multiphasic Personality Inventory (MMPI).Results The patients with somatization disorders showed alexithymia and personality base.The total and factor scores of TAS of study group((86.20 ± 11.15),(21.12 ± 3.28),(26.08 ± 3.86),(18.21 ± 4.69),(23.44 ±5.60)) were higher than controlled group((65.00 ± 10.12),(12.43 ±5.18),(15.64 ±5.57),(15.56 ±3.16),(18.71 ±4.30)) with significant difference (t =2.11-6.22,P =0.000-0.042).The MMPI scale scores of Hs (hypochondriasis),D (depression),Hy(hysteria),Men-Nancy(Mf),paranoid(Pa),psychotic(Pt) were higher in patients with somatoform disorders ((72.79 ± 10.50),(68.46 ± 13.63),(79.03 ± 12.12),(51.72 ± 7.74),(57.98 ± 10.60),(54.98 ±8.83)) than those in normal controls ((51.66 ± 10.11),(47.96 ±9.42),(51.47± 11.90),(43.66 ±8.77),(47.67 ± 6.69),(47.48 ±8.67)) with significant difference (t =2.56-6.86,P =0.000-0.015),especially the scale scores of Hy and Hs were the most significantly among those (T ＞ 70).There was close correlation between personality traits and alexithymia.Factor Ⅰ was positively related to depression,paranoid and psychotic,the relevancy was 0.454(P =0.023),0.405 (P=0.044),0.477 (P=0.016) respectively,besides Factor Ⅱ was also positively related to depression,and the relevancy was 0.437(P=0.029).Conclusion Patients with somatoform disorders have the alexithymia and the personality characteristics,and there are close relationship between them.

Refractory ulcer is a commonly seen disease clinically. We believe the therapeutic strategies for refractory ulcer should include changing life style, standardizing medication, tracing observation, and rechecking in regularity. Traditional Chinese medicine combined with western medicine can be used for the treatment. When the therapeutic effect is not good, diagnosis and therapeutic methods need to be re-judged.Local therapy and operation can be performed if necessary.

Objective To investigate the metabolites of serum samples from liver cirrhotic patients with or without minimal hepatic encephalopathy,and even overt hepatic encephalopathy,then to find out diagnostic markers for minimal hepatic encephalopathy.Methods High performance liquid chromatography-orbit trap mass spectrometry (UPLC/LTQ-Orbit trap MS) technology was applied to analyze the serum metabolites from 38 patients of liver cirrhosiswith hepatitis B and 33 healthy volunteers.Results The serum metabolites of patients with simple liver cirrhosis were different from those of patients with minimal or overt hepatic encephalopathy.The serum metabolites of patients with minimal hepatic encephalopathy was mostly similar with those of overt hepatic encephalopathy patients.Arginase,L-tyrosine,glutamic acid,two L-phenylalanine peptide,homovanillic acid,omithine,L-serine were increased in patients with minimal or overt hepatic encephalopathy,and hypoxanthine decreased in patients with minimal or overt hepatic encephalopathy patients.Conclusions The serum metabolites of patients with minimal hepatic encephalopathy are mostly similar to those of patients with overt hepatic encephalopathy.Arginase,L-tyrosine,glutamic acid,two L-phenylalanine peptide,homovanillic acid,ornithine,L-serine maybe the early metabolites biomarkers to diagnose minimal hepatic encephalopathy.Hypoxanthine is likely to be an effective complement to treat patients with hepatic encephalopathy.

Objective To investigate the changes of the expression of HIF-1α (hypoxia induciblefactor-1a) mRNA in myocardium of rats after cardiopulmonary resuscitation (CPR) and the intervention effects of exogenous hydrogen sulfide on it. Method Forty five male SD rats were randomly divided into three groups: control group ( n = 15 ), cardiopulmonary resuscitation group ( CPR group, n = 15 ) and NaHS + CPR group (n = 15 ) . Rats of control group were anesthetized and intubated without asphyxia and cardiac arrest. The rats of CPR group and NaHS + CPR group were operated to induce cardiac arrest by asphyxiation. In the rats of NaHS + CPR group, NaHS in dose of 50 ug/kg was administrated via the femoral venous line 1 minute before CPR. Hemodynamic was monitored continuously. The expression of HIF - lα mRNA in myocardium of rats in each group was determined by using RT-PCR and the activity of myeloperoxidase (MPO) in the myocardium of rats in each group was assayed by using a patent reagent box 6 h after CPR. The histopathological changes of myocardium were also observed. The t- test was used for statistical analysis. Results There was no statistically significant difference in hemodynamic changes between CPR group and CPR + NaHS group ( P ＞ 0. 05 ) . When compared with the control group, the activity of MPO and the expression of HIF-1α mRNA in CPR group and CPR + NaHS group were both increased, and those increased in CPR + NaHS group was more significant (P ＜ 0. 05) . When compared with CPR group, the expression of HIF-1α mRNA in CPR + NaHS group was higher, however, the activity of MPO in CPR + NaHS group was lower ( P ＜ 0. 05) . There were various histopathological changes of myocardium of rats found in CPR group and CPR + NaHS group, and the damage of myocardium of rats in CPR group was more obvious than that in CPR + NaHS group. Conclusions The expression of HIF-1α mRNA in myocardium of rats was increased after CPR. Exogenous hydrogen sulfide can protect myocardium cells from resuscitation-perfusion injury, and the protection is associated with increase in expression of HIF 1 αmRNA.

Objective To investigate the effects of hydrogen sulfide on sepsis-induced cardiac dysfunction in rats.Methods Male SD rats were randomly ( random number) divided into 4 groups:control group ( Ⅰ group),sepsis group ( Ⅱ group),sepsis + NaHS group (Ⅲ group),sepsis + PAG group (Ⅳ group). Cecal ligation and puncture technique was used in Ⅱ, Ⅲ, Ⅳ group. Hemodynamic was observed,and H2S synthesis,CSE (cystathionine-r-lyase) mRNA,MPO activity and the level of TNF-α,IL-1β were determined.The morphological changes and infiltration of inflammatory cells in myocardium were also observed.Results Compared with Ⅰ group,H2S synthesis,the levels of TNF-α,IL-1 β,the activity of MPO increased ( P ＜ 0.05 or P ＜ 0.01 ),and the expression of CSE-mRNA increased,and blood pressure of rats decreased significantly in Ⅱ group.Compared with Ⅱ group,H2S synthesis,the levels of TNF-α,IL-1β and the activity of MPO increased (P ＜ 0.05),the expression of CSE mRNA did not change noticeably ( P ＞ 0.05),and blood pressure of rats decreased more significantly in Ⅲ group.Compared with Ⅱ group, H2S level decreased,the levels of TNF-α,IL-1β and the activity of MPO decreased significantly,the expression of CSE mRNA decreased and blood pressure of rats decreased in Ⅵ group (P ＜0.05).Histopathological changes of myocardium were aggravated in the following severity order: Ⅰ ＜ Ⅳ ＜＜ Ⅲ.Conclusions CSE/H2S system of the myocardium was upregulated in sepsis rats.Hydrogen sulfide could raise the levels of MPO,TNF-α,IL-1β,aggravating myocardial injury. Contrarily,the inhibitor of H2S could counteract it.

ObjectiveTo study the effect of low molecular weight heparin sodium (LMWHS) therapy for exertional heat stroke (EHS) patients with pre-disseminated intravascular coagulation (pre-DIC).Methods A prospective randomized controlled trial (RCT) was conducted. Thirty-six patients with EHS with pre-DIC admitted to Department of Critical Care Medicine of 180th Hospital of Chinese PLA from April 2012 to November 2014 were divided into heparin sodium group (n = 20) and LMWHS group (n = 16) in accordance with the random number table. All patients received bundle treatment after being admitted to the hospital, including rapid cooling, fluid resuscitation, organ support (mechanical ventilation, hemopurification if necessary), supplement of pro-coagulation factors, etc. The patients in heparin sodium group were treated with continuous heparin sodium 12 500 U throughout 24 hours with intravenous pump for 5 days, and the patients in LMWHS group were given LMWHS 2 500 U subcutaneously, twice a day for 5 days.The incidence of DIC, incidence of bleeding and mortality of two groups were compared.The platelet count (PLT), prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (Fib) and D-dimer of each patient between pre and post treatment times were compared.Results No significant difference was found in the incidence of DIC and mortality between LMWHS group and heparin sodium group (31.2% vs. 30.0%,χ2 =0.007,P = 0.936; 6.2% vs. 5.0%,χ2 = 0.026,P = 0.871). Incidence of bleeding during treatment in LMWHS group was significantly lower than that in heparin sodium group (12.5% vs. 45.0%,χ2 = 4.425,P = 0.035). After treatment,PLT in both LMWHS group and heparin sodium group was significantly increased compared with that before treatment (×109/L: 140.5±17.5 vs. 110.5±16.5, 152.6±21.5 vs. 120.0±20.0, bothP< 0.05) and D-dimer was significantly decreased (mg/L: 0.5±0.1 vs. 3.2±1.2, 0.6±0.2 vs. 4.4±1.8, bothP< 0.05). APTT after treatment in heparin sodium group was significantly prolonged compared with that before treatment (s: 75.3±10.6 vs. 44.1±8.2,P< 0.05) while no change in APTT was found in LMWHS group (s: 38.6±5.5 vs. 42.1±8.4,P> 0.05). No significant difference was found in PT and Fib between pre and post treatment in all the patients.Conclusion When LMWHS was applied in EHS patients in pre-DIC stage, it could not only prevent DIC as efficiently as heparin sodium, but also results in lower incidence of bleeding. So LMWHS is safer.

To investigate the interaction and involvement of sodium hydrosulfide (NaHS), a H(2)S donor, on hippocampus of rats suffering from sepsis-associated encephalopathy, rats were subjected to cecal ligation and puncture (CLP)-induced sepsis. Adult male Sprague-Dawley rats were randomly divided into four groups: Sham group, CLP group, CLP+NaHS group and CLP+aminooxyacetic acid (AOAA, an inhibitor of H(2)S formation) group. The four groups were observed at 3, 6, 9, 12 h after treatment. We examined hippocampal H(2)S synthesis and the expression of cystathionine-β-synthetase (CBS), a major enzyme involved in the H(2)S synthesis in hippocampus. CBS expression was detected by reverse transcription polymerase chain reaction (RT-PCR). The concentrations of inflammatory cytokines (TNF-α, IL-1β) were determined in hippocampus by using enzyme-linked immunosorbent assay (ELISA). Neuronal damage was studied by histological examination of hippocampus. In CLP group, H(2)S synthesis was significantly increased in hippocampus compared with sham group and it peaked 3 h after CLP (P<0.05). Sepsis also resulted in a significantly upregulated CBS mRNA in hippocampus. The levels of TNF-α and IL-1β in the hippocampus were substantially elevated at each time point of measurement (P<0.05), and they also reached a peak value at about 3 h. Administration of NaHS significantly aggravated sepsis-associated hippocampus inflammation, as evidenced by TNF-α and IL-1β activity and histological changes in hippocampus. In septic rats pretreated with AOAA, sepsis-associated hippocampus inflammation was reduced. It is concluded that the rats subjected to sepsis may suffer from brain injury and elevated pro-inflammatory cytokines are responsible for the process. Furthermore, administration of H(2)S can increase injurious effects and treatment with AOAA can protect the brain from injury.

Objective To establish an appropriate diabetic retinopathy (DR) risk assessment model for patients with type 2 diabetes mellitus (T2DM).Methods A retrospective clinical analysis.From January 2016 to December 2017,753 T2DM patients in the Third Affiliated Hospital of Southern Medical University were analyzed retrospectively.Digital fundus photography was taken in all patients.Fasting plasma glucose (FPG),HbA1c,total bilirubin (TB),blood platelet,total cholesterol (TC),triglyceride (TG),high density lipoprotein cholesterol (HDL-c),low density lipoprotein cholesterol (LDL-c),apolipoprotein-A (apoA),apolipoprotein-B (apoB),serum creatinine,blood urea nitrogen (BUN),blood uric acid,fibrinogen (Fg),estimated glomerular filtration (eGFR) were collected.The patients were randomly assigned to model group and testify group,each had 702 patients and 51 patients respectively.Logistic regression was used to screen risk factors of DR and develop an assessment scale that can be used to predict DR.Goodness of fit was examined using the Hosmer-Lemeshow test and the area under the receiver operating characteristic (ROC) curve.Results Among 702 patients in the model group,483 patients were DR,219 patients were NDR.The scores for DR risk were duration of diabetes ≥4.5 years,4 points;total bilirubin ＜6.65 mol/L,2 points;apoA≥ 1.18 g/L,2 points;blood urea≥6.46 mmol/L,1 points;HbA1c ≥7.75％,2 points;HDL-c＜ 1.38 mmol/L,2 points;diabetic neplropathy,3 points;fibrinogen,1 point.The area under the receiver operating characteristic curve was 0.787.The logistic regression analysis showed that the risk factors independently associated with DR were duration of diabetes (β=1.272,OR=3.569,95％CI 2.283-5.578,P＜0.001),TB (β=0.744,OR=2.104,95％CI 1.404-3.152,P＜0.001,BUN (β=0.401,OR=1.494,95％CI 0.996-2.240,P=0.052),HbA1c (β=0.545,OR=1.724,95％CI 1.165-2.55,P=0.006),HDL-c (β=0.666,OR=1.986,95％CI 1.149-3.298,P=0.013),diabetic nephropathy (β=1.151,OR=3.162,95％CI2.080-4.806,P=0.013),Fg (β=0.333,OR=1.396,95％CI 0.945-2.061,P=0.094).The risk model was P=1/[1+exp-(-3.799+1.272X1+0.744X2+0.769X3+0.401X4+0.545X5+0.666X6+1.151X7+0.333X8)].X1=duration of diabetes,X2=TB,X3=apoA,X4=BUN,X5=HbA1c,X6=HDL-c,X7=diabetic nephropathy,X8=Fg.The area under the ROC curve was 0.787 and the Hosmer-Lemeshow test suggested excellent agreement (x2=10.125,df=8,P=0.256) in model group.The area under the ROC curve was 0.869 and the Hosmer-Lemeshow test suggested excellent agreement (x2=5.345,df=7,P=0.618) in model group.Conclusion The area under the ROC curve for DR was 0.787.The duration of diabetes,TB,BUN,HbAlc,HDL-c,diabetic nephropathy,apoA,Fg are the risk factors of DR in T2DM patients.

To investigate the interaction and involvement of sodium hydrosulfide (NaHS),a H2S donor,on hippocampus of rats suffering from sepsis-associated encephalopathy,rats were subjected to cecal ligation and puncture (CLP)-induced sepsis.Adult male Sprague-Dawley rats were randomly divided into four groups:Sham group,CLP group,CLP+NaHS group and CLP+aminooxyacetic acid (AOAA,an inhibitor of H2S formation) group.The four groups were observed at 3,6,9,12 h after treatment.We examined hippocampal H2S synthesis and the expression of cystathionine-β-synthetase (CBS),a major enzyme involved in the H2S synthesis in hippocampus.CBS expression was detected by reverse transcription polymerase chain reaction (RT-PCR).The concentrations of inflammatory cytokines (TNF-α,IL-1β) were determined in hippocampus by using enzyme-linked immunosorbent assay (ELISA).Neuronal damage was studied by histological examination of hippocampus.In CLP group,H2S synthesis was significantly increased in hippocampus compared with sham group and it peaked 3 h after CLP (P＜0.05).Sepsis also resulted in a significantly upregulated CBS mRNA in hippocampus.The levels of TNF-α and IL-1β in the hippocampus were substantially elevated at each time point of measurement (P＜0.05),and they also reached a peak value at about 3 h.Administration of NaHS significantly aggravated sepsis-associated hippocampus inflammation,as evidenced by TNF-α and IL-1β activity and histological changes in hippocampus.In septic rats pretreated with AOAA,sepsis-associated hippocampus inflammation was reduced.It is concluded that the rats subjected to sepsis may suffer from brain injury and elevated pro-inflammatory cytokines are responsible for the process.Furthermore,administration of H2S can increase injurious effects and treatment with AOAA can protect the brain from injury.