Objective To analyze the relationship between the serum CysC,lipoprotein(a) [Lp(a)] and the urinary microalbumin/creatinine ratio in elderly type 2 dibetic (T2CM) patients.Methods A total of 102 elderly patients with T2CM who were treated in our hospital from December 2014 to December 2015 were selected.The patients were divided into diabetic nephropathy(DN) group(mALB≥20 μg/min,48 cases)and non-diabetic nephropathy(NDN) group (mALB<20 μg/min,54 cases) according the levels of urinary mALB,while 30 cases of healthy controls were selected from physical examination center.The biochemical indexes,CysC,Lp(a) and UACR were detected among all cases.The correlation between indexes and UACR was analyzed by Pearson correlation analysis,risk factors for UACR among DN patients were analyzed by Logistic regression analysis.Results There were significant differences in levels of low density lipoprotein cholesterol(LDL-C),Lp(a),urea,creatinine,fasting blood glucose(FBG),glycosylated hemoglobin(HbA1c),Cysc,and UACR among these groups (P<0.05).No correlation between CysC、Lp(a) and UACR was found in normal-control group and non-diabetic nephropathy group.In diabetic nephropathy group,there was a positive correlation between CysC,Lp(a) and UACR(r=0.658,P<0.01;r=0.525,P<0.05).The Logistic regression analysis showed that diabetes duration,CysC,Lp(a) were independent risk factors for UACR(P<0.05).Conclusion In patients with diabetic nephropathy,CysC,Lp(a) are positively correlated with UACR,and CysC is a sensitive index that reflect early renal damage in T2DM patients.Lp(a) level is one of the independent risk factors for UACR,which can reveal the kidney damage in DN patients.

Objective To investigate the correhtion between cognitive impairment and cerebral atherosclerosis in patients with acute ischemic stroke.Methods Acute ischemic stroke patients without cognitive impairment were recruited before symptom onset.The Montreal cognitive assessment (MoCA) was used to evaluate the cognitive function.Magnetic resonance imaging (MRI) was used to identify the infarct locations and sides.Magnetic resonance angiography,CT angiography and digital subtraction angiography were used to identify atherosclerotic arteries.Resul~ A total of 101 patients with acute ischemic stroke were enrolled,including 75 (74.3％) with cognitive impairment.The proportions of age (54.54 ± 12.59 years vs.64.43 ± 10.37 years;t =-3.960,P ＜0.001),years of education ≤6 years (50.7％ vs.11.5％;x2 =12.257,P ＜ 0.001),and cerebral atherosclerosis (89.3％ vs.50.0％;x2 =18.137,P ＜0.001) of the cognitive impairment group were significantly higher than those of the normal cognitive function group.Multivariate logistic regression analysis showed that cerebral atherosclerosis was an independent risk factor for cognitive impairment in patients with acute ischemic stroke (odds ratio 1.720,95％ confidence interval 1.005-2.942;P=0.048).MoCA score was negatively correlated with the offending vessels (r=-0.365,P＜ 0.001) and the most severe vessels of atherosclerotic degree (r=-0.243,P =0.014).Conclusions Most patients with acute ischemic stroke had cognitive impairment in the early stage after onset,and the MoCA scores was negatively correlated with the degree of cerebral atherosclerosis.Cerebral atherosclerosis was an independent risk factor for cognitive impairment in patientswith acute ischemic stroke.

Objective:To study the effect of Levocarnitine preconditionon on the myocardial ultrastructure of ischemic rats and the long last calcium channel. Methods: We randomly divided 30 rats into a control group, a Levocarnitine group and a Dihydrochloride group. After the establishment of ischemic models, we observed the ultrastructure of the ischemic myocardium with optical and transmission electron microscopes, and detected the influx of calcium in the long last calcium channel with the patch clamp. Results: Levocarnitine protected the ultrastructure of ischemic myocardium and inhibited the influx of calcium in the long last calcium channel. Conclusion: Levocarnitine can reduce the severity and extent of ischemia-induced damage to the myocardium, protect mitochondria, stabilize its oxidation, inhibit the long last calcium channel of ischemic ventricular myocytes and lessen the injury induced by calcium overload.

Objective To investigate the relationship between plasma docetaxel concentration and the efficacy as well as toxic and side effects in patients with breast cancer after chemotherapy.Methods Seventy -one patients with breast cancer who accepted AC sequential T chemotherapy regimen as first line treatment were selected from April 2015 to September 2015 in Hubei Provicial Tumor Hospital.The plasma concentration of docetaxel was detected by latex immunoturdidimetry after the docetaxel continuous infusion in each cycle.The three groups were assigned according to the concentration distribution of docetaxel:group A (plasma concentration docetaxel ≤ 2.0mg·h -1 · L -1 ),group B (2.1 -2.5mg·h -1 ·L -1 )and group C (≥2.6 mg·h -1 ·L -1 ).The relationship between the drug plasma concentration,therapeutic efficacy and adverse reactions in different docetaxel plasma concentration was analyzed retrospectively by Chi -square tests.Results The average plasma concentrations of docetaxel of the three groups were (1.55 ±0.36)mg·h -1 ·L -1 ,(2.28 ±0.13)mg·h -1 ·L -1 ,(2.87 ±0.38)mg· h -1 · L -1 respectively.The adverse reactions were enhanced with the increasing of docetaxel plasma concentration (χ2 =5.169, 4.463,3.630,P =0.023,0.035,0.047).The therapeutic efficacy of group C and group B was same(95.8%),which was higher than 87.0% of group A,but there was no statistically significant difference (χ2 =1.559,P =0.24). Conclusion Breast cancer patients whose plasma concentration of docetaxel is between 2.1 ~2.5mg·h -1 ·L -1 has a better prognosis,and its adverse reactions are controlled in a certain extent.

Objective To investigate the effect of intermittent hypoxia (IH) with pulmonary emphysema on the ex-pression of hypoxia inducible factor-1α(HIF-1α),Bax and Bcl-2, and the mechanism underlying the role of HIF-1αin he-patocyte apoptosis thereof. Methods Sixty rats were randomly divided into four groups: normal control group, rats were treated normally;IH group, rats were treated by 30 s nitrogen and then 90 s air, and rats were treated by from 9:00-17:00 daily;pulmonary emphysema group, rats were treated by smudging for half an hour, twice a day (8:00 and 18:00);IH with pul-monary emphysema group, rats were treated by 30 s nitrogen and then 90 s air from 9:00-17:00 daily. After exposure four-teen weeks, rats were killed. qRT-PCR assay was conducted to detect the expression of HIF-1α mRNA, Bax mRNA and Bcl-2 mRNA in live tissues. Results The expressions of HIF-1αmRNA, Bax mRNA and Bax/Bcl-2 were significantly higher in IH with pulmonary emphysema group than those in control group,IH group and pulmonary emphysema group (P<0.05). The expression level of Bcl-2 mRNA was significantly lower in IH with pulmonary emphysema group than that of con-trol group and pulmonary emphysema group (P < 0.05), but no significant difference compared with that of IH group (P >0.05). The levels of HIF-1αand Bax were positively correlated with the level of Bax/Bcl-2 (r=0.732 and 0.699),but the lev-els of HIF-1αand Bax were negatively correlated with the level of Bcl-2 (r=-0.705). Conclusion The expression levels of HIF-1αmRNA, Bax mRNA and Bcl-2 mRNA were over-regulated in hepatocytes induced by intermittent hypoxia with pul-monary emphysema. The HIF-1αexpression was correlated with Bax and Bcl-2, suggesting that HIF-1αmay promote the hepatocyte apoptosis through transcriptional co-activators, Bax and Bcl-2.

Objective To observe the effect of exposure of emphysema with intermittent hypoxia on oxidative stress injury of myocardial cells in rats. Methods Sixty male Wistar rats were divided randomly into four experimental groups(each n=15). The normal control group was bred normally. The emphysema group was exposed to cigarette smoke twice a day(once 30 minutes). The intermittent hypoxia(IH)group was exposed to intermittent hypoxia circumstance 8 hours/day,and the emphysema with IH group was exposed to cigarette smoke twice a day (once 30 minutes)and intermittent hypoxia circumstance 8 hours/day. Each group was exposed for 8 weeks. At the beginning of 9 weeks,the blood gas analysis was performed in 5 rats selected randomly from each group,and the rest rats were sacrificed and their hearts and lungs were taken. Under light microscope,the lung tissues stained with hematoxylin-eosin(HE)were examined. The lung pathology and the results of blood gas analysis showed that the emphysema with IH rat model was established successfully. The levels of malonaldehyde(MDA)and superoxide dismutase(SOD)in rat myocardium were measured by enzyme-linked immunosorbent assay(ELISA),and the subunit p22phox mRNA expressions of nicotinamide adenine dinucleotide phosphate(NADPH)-oxidase were detected by real-time reverse transcription-polymerase chain reaction(RT-PCR). Results Compared with the normal group, the MDA levels and p22phox mRNA expressions were increased obviously in emphysema group, IH group and emphysema with IH group〔MDA(μmol/g):2.93±0.54, 3.58±0.63, 4.51±0.72 vs. 1.75±0.56, p22phox mRNA:0.043±0.004,0.067±0.015,0.123±0.016 vs. 0.018±0.002,all P<0.05〕,but the activities of SOD were decreased significantly(U/mg:36.07±4.79,33.51±7.12,24.29±5.36 vs. 46.08±5.12,all P<0.05). In emphysema with IH group,the increase of MDA levels and p22phox mRNA expressions and decrease of SOD levels were more remarkable compared with those in emphysema group and IH group(all P<0.05). The expression of p22phox mRNA was positively correlated with MDA level(r=0.734,P<0.001). Conclusion The myocardial tissue oxidative stress injury in rats induced by emphysema with intermittent hypoxia exposure is more serious than that induced by exposure of either emphysema or intermittent hypoxia alone,NADPH oxidase possibly being the important medium of myocardial cell response to oxidative stress.

Objective To observe the expression of cytokeratin 14,15 (CK14,CK15) expression level in normal esophageal tissues and esophageal squamous cell carcinoma tissues of different differentiation degree and to analyze the relationship between occurrence,development of esophageal squamous cell carcinoma and CK14,CK15 expression level.Methods Esophageal squamous epithelial tissue from 55 cases of carcinoma tissues and 55 cases of adjacent tissues were collected.Immunohistochemical method was used to compare CK14,CK15 and PCNA expression levels in esophageal squamous carcinoma.Results Expression positive rates of CK14,CK15 and PCNA in esophageal squamous carcinoma were 72.7 ％ (40/55),63.6 ％ (35/55) and 65.5 ％ (36/55),respectively,and PCNA expression was correlated with CK14 or CK15 expression (C =0.585,P ＜ 0.001; C =0.405,P ＜ 0.001).CK14 and CK15 levels were higher in high differentiation carcinoma tissue than those in low differentiation carcinoma tissue,and PCNA expression level was increased in low differentiated carcinoma tissue.CK14,CK15 and PCNA were expressed located in base layer of esophageal squamous epithelial adjacent to carcinoma tissue,and their expression positive rates were 56.4 ％ (31/55),52.7 ％ (29/55) and 56.4 ％ (31/55).CK14 and CK15 levels were higher in esophageal squamous epithelial tissues of far-cut edge than those in tissues of near-cut edge (intraepithelial neoplasia).There were no associations between CK14,CK15 expression and the clinical parameters (P ＞ 0.05).Postoperative survival time in patients with CK14 or CK15 positive expression was shorter than that of patients with negative expression (P ＜ 0.05).Conclusions CK14 or CK15 positive expressions localized to base layer of esophageal squamous epithelial adjacent to carcinoma tissue may play some roles in generation and differentiation of esophageal squamous cell cancer.CK14 or CK15 positive expression in esophageal squamous carcinoma involves in differentiation process.Joint detection of CK14 and CK15 expression has clinical application value for early diagnosis,the degree of differentiation and prognostic judgment in esophageal squamous carcinoma.

Objective To design the risk and difficulty degree of common clinical nursing operation items with the purpose of offering much fair and scientific theoretical basis for the performance evaluation. Methods Self-designed questionnaires of risk and difficulties of nursing operation items were applied on 270 clinical nurses from 5 Third-level Grade A hospitals and 15 nursing training experts from different domains. Using the methods of clustering methodology to evaluate the risk and difficulty degree of nursing operation items. Results The risk and difficulties of 45 items of common nursing technical operations were ranked into 3 levels of rank and difficulties, in which the high level included 15 risk indexes (4.0 to 10.0 points) and 14 difficulty indexes (4.0 to 10.0 points), the middle level includes 18 risk indexes (0.9 to 3.0 points) and 17 difficulty indexes (0.5 to 3.0 points), low level includes 12 risk indexes (-10.0 to-0.8 points) and 14 difficulty indexes (-10.0 to-0.4 points). Conclusions The risk and difficulty of nursing operation are ranked in this study. What′s more, it is applied on the basis of nursing performance evaluation. Thus, it is offered much fair and scientific basis for the performance evaluation and human resources arrangement of nursing. And it also benefits for clinical nursing quality and the satisfaction of nurses.

Objective: To observe whether an Xingnaojing 醒脑静 injection could improve the prognosis of patients, by increasing rifampicin penetration through the blood-brain barrier. Methods: Patients with severe tuberculous meningitis were enrolled in this study. The concentrations of Xingnaojing in cerebrospinal fluid and blood in patients treated with Xingnaojing and control were determined by high performance liquid chromatography. The changes in cerebrospinal fluid and the improvement of clinical symptoms and signs, were evaluated two weeks after admission. The long-term prognosis of the patients in the two groups were evaluated by the Glasgow Outcome Scale (GOS). Results: The concentration of rifampicin in cerebrospinal fluid was significantly higher in the Xingnaojing group (1.77±0.17 μg/mL), than in the control group (1.27±0.16 μg/mL, p<0.05). The difference in concentration of rifampicin in the blood was not significant (P>0.05). The short-term effective rate of the Xingnaojing group was 92.5% (37/40), which was significantly higher than that of the control group (80%, 32/40, p<0.05). After 6 months, 75% (30/40) of the Xingnaojing group had good prognosis according to the GOS score, whereas that of the control group was 50% (20/40) showing significantly better long-term treatment effect of the Xingnaojing group compared to the control group (P<0.05). Conclusion: Xingnaojing injection improved rifampicin penetration into the central nervous system. The increase in rifampicin concentration in cerebrospinal fluid improved outcomes in patients with severe tuberculous meningitis.

The cardiovascular disease has become one of the important chronic health problems for humans. At present, the research on the traditional risk factors of cardiovascular disease has been studied from the relevance to the mechanism. In this paper, the recent progress of the traditional risk factors of CVD and the impact mechanism are reviewed in order to provide a basis for the prevention, treatment and nursing of cardiovascular diseases.