Glucocorticoids are among those most important hormones that maintain the energy metabolic homeostasis within body.The actions of glucocorticoids on target tissues,such as liver and adipose tissue,are not only dependent on circulating glucocorticoid levels but also on glucocorticoid receptor expression.The elevated level of circulating glucocorticoid caused by exogenous or endogenous reasons may contribute to insulin resistance and the other metabolic syndrome such as dyslipidemia,visceral obesity and hypertension.This review summarizes recent advances in the study of glucocorticoid receptor-mediated insulin resistance and its antagonists.

Bile reflux gastritis (BRG)has been recognized as a chemical gastropathy due to excessive duodenogastric reflux (DGR).Abnormalities in pyloric anatomic structure,as well as antropyloric and duodenal dysmotility are considered to be implicated in the occurrence of pathologic DGR.Bile acid may induce apoptosis of gastric mucosal cells,and high concentration of bile acid plays a crucial role in the induction of intestinal metaplasia in stomach.In this review article, advances in study on BRG,including the mechanisms of DGR,the pathogenic effect of bile acid on gastric mucosa,and the diagnosis and treatment of BRG were summarized.

Objective To investigate the mental health and the general well-being among Hangzhou scientific and technical workers,and the mediating effect of coping strategies in perceived level of stress and mental health status.Methods A stratified cluster sampling method were developed among engineering technicians,agrotechnicians,researchers,health works and teaching staff.510 participants were evaluated with perceived stress of different types,Trait Coping Style Questionnaire (TCSQ),General Well-Being Schedule (GWB),and Self-Reporting Questionnaire 20 (SRQ-20).Results There was significant difference among sub-groups with different educational backgrounds,different occupation,and different age group for total scores of perceived stress (F=5.026,5.637,6.421,P＜0.01).Female had significantly higher scores than male on total scores of negative coping factor of TCSQ,total scores SRQ-20 (26.33±6.29,4.36±3.84 vs 24.93±5.68,3.32±3.53) (all P＜0.05).Total scores of negative coping factor of TCSQ,total scores of positive coping factor of TCSQ,and total scores of perceived stress were the significant predictors of both total scores SRQ-20 and total scores of GWB (all P＜0.001).Both total scores of positive coping factor of TCSQ and total scores of negative coping factor of TCSQ mediated the effects of perceived stress on total scores of SRQ-20 (23.87％,29.33％,respectively) and total scores of GWB (24.29％,23.24％,respectively).Conclusion There do exist the mediating effects between coping strategies in perceived stress and mental health status,the improvement of coping modes of scientific and technical workers can be regarded as a useful intervention strategy to improve their mental health status.

Objective To explore the relationship between metabolic syndrome(MS) and cerebral stroke type,complication and prognosis.Methods Clinical data of 568 cerebral stroke patients with MS(MS group) and 209 cerebral stroke patients without MS(no-MS group) were compared and analyzed.Results In MS group,the incidence of cerebral infarction was significantly higher(93.0%) than that in the no-MS group(85.2%)(P

Objective:To explore the clinical presentations and symptom distribution in adults with attention-deficit/hyperactivity disorder(ADHD) among non-alcohol substance use disorder population,and to prove the effectiveness of adult ADHD diagnosis.Methods:Thirty adults with ADHD and thirty non-ADHD controls were selected from Beijing Compulsory Detoxification Center,matched with sex,age,and education.Data collection included the following:(1)Self-report measures of developmental history,employment history,social history and ADHD clinical symptoms.(2)Psychiatric interview using structured assessments included the Clinical Diagonsitic Interview Scale(CDIS)for Diagnostic and Statistical Manual of Mental Disorders(DSM-IV).(3)Evaluation for cognitive function with the Wechsler Adult Intelligence Scale-Revised Chinese(WAIS-RC).Results:(1)The clinical core symptoms(such as attention deficit,restlessness,and impulsive symptoms)among adulthood ADHD were similar to childhood ADHD except for some hyperactivity symptoms.(2)The symptoms of attention deficit,restlessness and impulsiveness were more frequently in both of adulthood and childhood ADHD than non-ADHD controls(P

Objective: To observed the efects of estrogen and wall-shear stress alone or in combination on the proliferation and function of rat osteoblast in vitro. Methods: Isolated and purified osteoblast from the calvaria of newborn SD rats were cultured and passaged.The cells of passes three to four were treated with 0.1 nmol/L estrogen (goup E),wall-shear stress at 80 r/min (group WSS) or 0.1 nmol/L combined with wall-sher stress at 80 r/min (group EWSS) respectively.Cell proliferation was studied by MTT assay and alkline phosphatase (ALP ) by a ALP test kit. Results: Both the estrogen and wall-shear stress alone caused the increase of cells proliferation and alkaline phosphatase (ALP) activity.But long period of wall-shear stress decreased the cell proliferation.Wall-shear stress increased ALP activity more quickly and more remarkably than the estrogen did.The combination of estrogen and wall-shear stress increased the cell proliferation and the ALP activity.In the early stage (6～24 h) of the cell proliferation, the combination functioned synergicly.The combination functioned antagonistically on ALP from 6 to 12 h while synergicly after 12 h. Conclusion: Estrogen and wall-shear stress can elevate the cell proliferation, ALP activity of osteoblasts in vitro.

Objective To observe the effect of comprehensive rehabilitation on breast cancer related lymphedema. Methods 70 patients with breast cancer related lymphedema were divided into experiment group (n=35) and control group (n=35). Both groups received intermittent pneumatic compression, while the experiment group received comprehensive rehabilitation including manual lymphatic drainage, muscle stretching, expanded the range of motion of shoulder, gradual resistance training, high frequency electrical therapy and health education. They were assessed with Disabilities of Arm, Shoulder and Hand Scale (DASH) and development of lymphedema before and 8 weeks after treatment. Results DASH scores and the development of lymphedema improved in both groups after treatment (P<0.05), and improved more in the experiment group than in the control group (P<0.05). Conclusion Comprehensive rehabilitation can further relieve breast cancer related lymphedema, and improve the upper extremity function.

Objective To explore the pathologic feature of children with kidney disease.Methods A retrospective analysis on renal bio-psy findings in 246 cases of children patients.Pathological classification was made according to the modified WHO criteria of 1995 for renal pathology.Results Of the 246 children,104 cases were diagnosed as primary glomerulonephritis,accounting for 42.28% of the total cases,136 cases as secondary glomerulonephritis,accounting for 42.28%,3 cases as hereditary nephritis,accounting for 1.22%,and 3 cases as unclassified renal disease,accounting for 1.22%.In primary glomerulonephritis,66 cases were diagnosed as nephrotic syndrome,23 cases as persistent glomeruloneplritis,8 cases as acute nephritis syndrome,3 cases as chronic nephritis syndrome,2 cases as isolated proteinuria,1 case as rapidly progressive glomerulonephritis,1 case as isolated hematuria.IgA nephropathy was the most frequent pathological type,accounting for 15.85%(39 cases),followed by mesangial proliferative glomerulonephritis,minimal change disease,endocapillary proliferative glomerulinephritis,IgM nephropathy,membranous nephropathy,focal segmental glomerulosclerosis,and minor lesion nephropathy.In secondary glomerulonephritis,Henoch-Schonlein purpura nephritis accounting for 48.37%(119 cases),followed by hepatitis B virus associated nephritis(11 cases) and lupus nephritis(6 cases).In hereditary nephritis,there were 2 cases with thin glomerular basement disease and 1 case with Alport syndrome.Conclusions Among the 246 cases of renal biopsy data,the secondary glomerulonephritis,especially Henoch-Schonlein purpura nephritis,is more common than primary glomerulonephritis.In primary glomerular diseases,IgA nephropathy is the most frequent pathological type.

Objective Diabetes is a common chronic disease in the elderly and needs long-term treatment. This study aims to determine the effect of extended nursing service in rehabilitation of army retired officers with diabetes. Methods We selected 78 ca-ses of military retired officers with diabetes from September 2010 to September 2012 in Nanjing General Hospital of Nanjing Military Region. According to the different intervention methods, patients were divided into experimental group and control group( n=39 cases) . The control group used conventional nursing service, and the experimental group added extended nursing service on the basis of the control group . After one year follow-up, the fasting blood glucose level, glycosylated hemoglobin ( HbAlc) , self-rating depression scale (SDS) evaluation and self-rating anxiety scale (SAS) and the changes of patients′ satisfaction of the two groups were observed. Results The fasting blood glucose levels and HbAlc of experimental group were significantly better than control group, with statisticalsignificance (P<0.05);The SAS scores (34.9±5.9)and SDS scores (36.9±4.5) of experimental group were significantly lower than the control group(52.3±4.2 and 55.9±3.9), with statistical significance ( t=5.489, t=5.226, P<0.05);The satisfaction degree of the exper-imental group was significantly higher than the control group (99.8%vs 79.9%, χ2=4.898, P<0.05). Conclusion the extension ofnursing service in health rehabilitation in the retired veteran cadres in the army with diabetes can effectively improve the patient′s fast-ing blood glucose levels, reduce depression, as well as improving the nursing service satisfaction.

Objective To explore the clinical effect of small incision phacoemulsification combined with trabeculectomy in tunnel in the treatment of glaucoma with cataract.Methods Thirty-six cases(38 eyes)who performed 2.8 mm small incision phacoemulsification combined with trabeculectomy in tunnel were enrolled in this study.The visual acuity,intraocular pressure(IOP),astigmatism and complications were assessed before and after operation.Results The visual acuity ≥ 0.4 was in 29 eyes(76.32％)postoperatively.After followed up 3-6 months,the IOP of all the patients had been effectively controlled.The IOP at 1 week[(12.24 ± 3.59)mm Hg(1 mm Hg =0.133 kPa)]and 3-6 months[(15.53 ± 5.26)mm Hg]after operation was significantly lower compared with before operation[(36.72 ± 4.34)mm Hg](P ＜ 0.05).There was no significant difference in astigmatism among before operation,1 month and 3-6 months after operation(P ＞ 0.05).Conclusion Small incision phacoemulsification combined with trabeculectomy in tunnel is an effective surgery for glaucoma with cataract,which can improve visual acuity and IOP.