Objective To investigate the relationship among the leptin receptor(lepr) gene exon 20,nucleotide 3057 G→A transition and lipid metabolism,insulin sensitivity index,high blood coagulation in type2 diabetes mellitus.Methods Polymerase chain reaction(PCR) and restriction fragment length polymorphism(RFLP) were used to detect the variation of leptin receptor gene nucleotide 3057 G→A transition;Simultaneusly,we detected some parameters,including blood lipids,height,weight,blood glucose,waistline to hipline ratio(WHR).The body mass index(BMI),fat percent,insulin sensitivity index(ISI) were calculated out in all subjects.Results The variation frequency at 3057 nucleotide G→A transiton was 80% in type 2 diabetic group,though it was 68% in control group(P

Mild traumatic brain injury (MTBI) is defined as a mild brain trauma resulting in a short loss of consciousness and alteration of mental status. It may also occasionally develop persistent and pro-gressive symptoms. It has been confirmed that MTBI causes changes of anatomic structures in central nervous systemand biomarkers in the body fluid. How ever, there is no sufficient research on relevance among threshold for the brain injury, individual vulnerability and duration of disturbance of conscious-ness. Furthermore, there are no reliable diagnostic methods to establish w hether a blow to the head is sufficient to cause the brain injury. T his review provides references for biomarkers in cerebrospinal fluid and blood associated w ith T B I. It also provides application status and potential prospects for further as-sessment and diagnosis of MTBI.

Objective To analyze the effect of clinical pathway management for capillary bronchitis in Department of Pediatrics.Methods 75 children with capillary bronchitis after the implementation of clinical pathway management were selected as the observation group,and 68 children with capillary bronchitis before the implementa-tion of clinical pathway management were selected as the control group.The hospitalization cost,average hospital stay, antibiotic use rate,cure rate,nonsocomial infection rate,rehospitalization rate within two weeks,service satisfaction and other comprehensive indices were compared.Result The total cost of drug of the observation group[(1 198.49 ± 397.48)yuan]was lower than (1 324.05 ±376.57)yuan of the control group(Z =2.00,P <0.05).The average hospital stay of the observation group[(6.99 ±2.39)d]was shorter than (8.01 ±2.22)d of the control group(Z =2.62,P <0.05).The service satisfaction rate of the observation group(95%)was higher than 82% of the control group(χ2 =5.44,P <0.05).The antimicrobial use rate of the observation group(49%)was apparently lower than 95% of the control group (χ2 =27.59,P <0.01).There were no statistically significant differences between the two groups in cure rate(hospital discharge rate),nosocomial infection rate and rehospitalization rate within two weeks(all P >0.05).Conclusion Clinical pathway management for capillary bronchitis in Department of Pediatrics of primary hospital can play a role in standardizing medical practice,reducing average hospitalization days,controlling medical cost,and improving service satisfaction under the precondition of ensuring medical quality.

Objective To investigate the influence of synergistic effect of estradiol and testosterone on the level of lipids and coagulation function in mice with hyperlipidemia .Methods We established a maouse model in hyperlipidmia , giving estradiol (1 μg/d), testosterone (7 μg/d) or estradiol combined testosterone (1 μg/d E2 +7Tμg/d), respectively.After 14 weeks, we collected the blood from the mice , separated the serum to detect the lipids level , separated the plasma to test the coagulation function .Result Compared with controls , after high-fat diet , the serum level of total cholesterol ( TC) , triglyceride ( TG) , high density lipoprotein ( HDL) were significantly increased , PT and APTT were shorter ( P<0.05 ).However, after treating with estradiol combined testosterone , compared with cases, the serum level of C, TG and HDL were lower and PT , APTT were longer ( P <0.05 ), had no significance with controls . Conclusion The synergistic effect of estradiol and testosterone can mediate the lipids , reduce the level of LDL , regulate the coagulation function , reduce the risk of coronary heart disease , and also provide a new strategy for hormone therapy in coronary heart disease .

Objective To evaluate operative methods and the clinical effect for comminuted calcaneal fractures.Methods 21 cases(24 feet)of comminuted calcaneal fractures were treated by one stage bone grafting plus open reduction and internal fixation with plastic calcaneus titanium plate.The fractures were classified according to the Sanders system into Sanders Ⅱ,Ⅲ and Ⅳ subgroups.Results All cases were followed up for 9～20 months(14months in average).All cases recovered with good healing of fracture.According to Maryland score,the results were excellent in 14 feet,good in 7 feet,fair in 2 feet,and poor in 1 foot.The excellent and good rate was 87.5％.Conclusions By using the method of internal fixation with plastic calcaneus titanium plate,fracture site can be well exposed,which is helpful to recover calcaneus to its normal length,width,height,Gissane angle and Bohler angle.A reliable internal fixation is helpful for early stage functional excise after surgery,which can maximize the recovery of the ankle function.

Objective: To identify the related psychosocial risk factors of emotional disorders in children. Methods:To use case-control approach in which. Diagnosis was made by clinical interview according to ICD-10 criteria. Eighty eight cases and controls separately filled out general condition inventory. The results were put into Logistic regression model for analysis. Results: The children with timid personality, without kindergarten education, or with parents who were administrative or technical personnel, were apt to have emotional disorders. The children who were usually counseled by their mothers had less emotional disorders than those were beaten. Conclusion: The emotional disorders were the results of multiple factors. Prevention of children's emotional disorders should be focused on the children's personality and family education.

It elaborates streaming media technology and the principle of it's work, introduces the selection of streaming media system and recounted the constitute of the Windows Media Technology system and the method of making medical teaching lesson pieces using streaming media technique. At last, it discusses the application in the LAN.

Objective To evaluate the accuracy of Cr measurement value from commonly used homogenous detection systems,to investigate the variation among different systems and the corresponding bias of eGFR.Methods According to the CLSI EP14-A2 protocol,commutability of LN24 was validated among 10 enzymatic assays and 1 picrate assay.LN24 included 6 vials of solution with Cr values assigned by IDMS at NIST,and concentrations of Cr for each vial were 68.1,126.9,185.7,244.5,303.2 and 361.9μmol/L LN24 was used to evaluate the accuracy of the included systems and the variation among them,and the assigned values were taken as the target values.eGFR were calculated by MDRD equation using IDMStraced picrate Cr and CKD-EPI equation using enzymatic Cr.Results Commutability was exist among the 11 systems for LN24 detection.Four systems showed bias ＜ 4.4 μmol/L at each level of LN24,two system showed bias ＞4.4 μmol/L at each level of LN24,one system showed a fixed negative bias( -4.2 ±0.7)μ mol/L,the other 4 systems showed diverse bias at different levels.Cr-bias-caused eGFR bias could reach 14.9 ml · min-1 · (1.73 m2) -1 at Cr level of 68.1 μmol/L SD among systems ascended with Cr level (2.6 -6.1 μmol/L) ;CV among systems descended with Cr level(4.0％ - 1.7％ ) ;After the 2 systems with obvious negative bias were removed,SD,CV among systems and eGFR bias decreased obviously.By measuring fresh serum,it was found that Cr bias among enzymatic systems was mostly ＜ 10 μmol/L;that between enzymatic assays and picrate assay was much diffused(from - 15 to 20 μmol/L).When Cr ＜ 100μmol/L,the eGFR difference between result of MDRD equation and that of CKD-EPI equation ranged from - 18 to 40 ml · min-1 (1.73 m2) -1.Conclusions Some enzymatic systems show good accuracy.Difference of Cr value is relatively fixed among enzymatic systems,and comparability can be reached through mathematic way.Un-acceptable difference between picrate assay and enzymatic assays still exists,thus comparability cannot be reached through mathematic way.At low Cr level,bias of Cr and using different equations may lead to significant bias of eGFR.We recommend that clinical laboratory should pay much attention to the accuracy and comparability at low level of Cr,and use uniform equation to calculate eGFR.

Objective To investigate the relationship between human leptin receptor(LEPR)gene G3057A polymorphism and type 2 diabetes complicated with non-alcoholic fatty liver disease(NAFLD).Methods 216 cases of newly diagnosed type 2 diabetes(104 cases complicated with NAFLD)and 108 cases of normal glucose tolerances(NGT)were recruited.Hemi-nested PCR-RFLP and PCR direct sequence analysis were conducted to detect the polymorphisms of LEPR G3057A polymorphism.The plasma leptin and insulin levels were measured by ELISA kit.Plasma lipid and glucose metabolic parameters were measured routinely.Liver ultrasound scanning Was carried out among all subjects.Results Type 2 diabetic patients complicated with NAFLD had higher plasma alanine aminotransferase(ALT),triglycerides(TG),low density lipaprotein cholesterol(LDL-C),leptin levels and lower plasma insulin levels than those cages without NAFLD and NGT.The variant frequency at nucleotide 3057 G to A transversion Was 76.0% in type 2 diabetic patients complicated with NAFLD,which Was also significant higher than those cases without NAFLD(62.1%)or NGT cases(53.2%)(x2=14.63,P＜0.01).Conclusions The polymorphism of LEPR gene 3057 probably contributes to the onset of NAFLD in type 2 diabetes by regulating lipid metabolism and affecting insulin sensitivity.

The job burnout level and psychological status of 109 medical staff in Shennongjia forest region were investigated, and the Chinese maslach burnout inventory (CMBI) and symptom check list-90(SCL- 90) were adopted in the survey. The survey revealed that 69.7% (76/109) of the subjects had job burnout, including 53.2% (58/109) had slight burnout, 12. 8% (14/109) moderate burnout and 3. 7%(4/109) severe burnout. The single-factor detection rates of job burnout were 56.9% (62/109) for diminished personal accomplishment, 17.4% (19/109) for depersonalization, and 15.6% (17/109) for emotional exhaustion. Both the interpersonal sensitivity factor score and the positive symptom average score of SCL-90 were significant lower than those of Chinese norm ( P ＜ 0. 01 ), the total average score and the other factor scores of the subjects had no significant differences from those of Chinese norm ( P ＞ 0. 05 ). The results suggest that the majority of medical staff in the study region have experienced the job burnout, the main manifestation is the feeling of diminished personal accomplishment, on the other hand the psychological status of the subjects is similar with those in the general population.