Objective To explore the clinical efficacy of captopril combined with nifedipine in the treatment of type 2 diabetes mellitus complicated with hypertension.Methods 100 patients with type 2 diabetes mellitus complicated with hypertension were divided into two groups by randomized single blind method.The two groups were given conventional hypoglycemic therapy,50 cases in the control group were treated with captopril,while 50 cases in observation group received captopril combined with nifedipine sustained -release tablets.The clinical therapeutic effect was compared between the two groups.Results The effective rate of the observation group was 94%,which of the control group was 80%,the difference was statistically significant (χ2 =9.65,P<0.05).After treatment,the diastolic blood pressure[(80.45 ±3.65)mmHg],systolic blood pressure[(128.67 ±5.66)mmHg],fasting blood glucose[(6.65 ±0.37)μmol/L],2h postprandial blood glucose[(9.76 ±1.22)μmol/L]of the observation group were significantly reduced than before treatment (t =8.06,8.18,8.00,7.94,all P <0.05),and diastolic blood pressure and systolic blood pressure were significantly different with the control group(t=8.66,7.90,all P<0.05). After treatment,the serum creatinine (97.44 ±6.32)μmol/L,urea nitrogen (4.20 ±0.30) mmol/L and 24h urinary albumin (17.99 ±4.10) mg/L of the observation group were significantly reduced compared with before treatment (t=7.67,8.27,8.32,all P<0.05),and the indicators had significant differences with the control group(t=7.23, 7.65,7.67,all P<0.05).Conclusion Captopril and nifedipine sustained-release tablets in the treatment of type 2 diabetic patients with hypertension can effectively reduce the blood pressure,improve renal function,and it has good clinical application and promotion value.

Fetal arrythmia is a common cardiac abnormality, which can be categorized into three major types: extrasystoles, tachycardia and bradycardia. Most fetal arrythmias do no harm to the fetus, but few severe fetal arrythmia, including supraventricular tachycardia, atrial flutter and conduction block do, resulting in congestive heart dysfunction, hydrops fetalis and even intrauterine death. Therefore, timely intrauterine management may help to improve the fetal outcomes. This article reviews intrauterine treatment strategies for different types of fetal arrythmia.

BACKGROUND : Chitosan, derived from chitin, has a poor solubility which limits its application greatly. For improving its dissolubility, according to the feature that intramolecular hydroxy and amino group in chitosan are easy to be chemically modified, and functional groups are introduced to improve its solubility and functionality to widen the range of its application, which has become one of the new trend of development for investigating the application of chitosan. OBJECTIVE: To sum up the research advancements in the application and modification of chitosan in carboxylation,acylation, alkylation, etherification, etc.RETRTEVE STRATEGY: The relevant articles published in English between 1998 and 2007 were searched for in Pubmed database with the key words of "chitosan, modification", and the relevant articles published between 1998 and 2007 were searched for in Elsevier Science database with the key words "chitosan, modification" and search "derivate" within search results in English. Articles closely related to the structural modification and application of chitosan were involved, and repetitive and old studies were excluded.LTTERATURE EVALUATION: Totally 154 articles were selected, and 30 of them are accorded with the inclusive criteria,including 5 are reviews, and the others are clinical or experimental studies.DATA SYNTHESTS: The intramolecular hydroxy and amino groups in chitosan are mostly modified because they are easy to be chemically modified. Recently, reports lay particular emphasis on the modification in carboxylation, acylation,alkylation, etherification, etc. Functional groups are introduced to improve its solubility and functionality to widen the range of its application.CONCLUSTON: The water-solubility of chitosan can be improved through structural modification and introducing multifunctional group, which can also bring about much more special efficacies.

Objective to investigate the clinical application value of endometriosis fertility index (EFI) in the evaluation of ab‐dominal surgery endometriosis(EMT) combined infertility patient .Methods the date of 105 cases of infertility EMT merge were retrospectively analyzed from January 2009 to January 2013 in the Yuanzhou MCH and the obstetrics and gynecology department of Yuanzhou people′s hospital .All patients were followed up for two years and the rates of cumulative pregnancy were compared .Re‐sults the rates of two year cumulative pregnancy rate were 64 .80% (68 cases) .The two year cumulative pregnancy rates of EFI score ≤ 4 points ,5 to 7 points ,8 to 10 points were 34 .48% ,57 .14% ,92 .68% (P<0 .05) .There were no difference in cumulative pregnancy rate of different types of EMT in patients(P>0 .05) .Conclusion EFI and EMT with infertility pregnancy after conser‐vative treatment has a close relationship ,and EFI score would provide important guidance for follow up treatment .

Objective To investigate the vaginal flora characteristics,clinical symptoms and signs of lactating women 6-8 weeks after delivery and the influence factors.Methods Two hundred and twenty-three puerpera 6-8 weeks after delivery who went to outpatient department of Peking University First Hospital for postpartum review (study group) and 200 normal non-pregnant women (control group) from April to May,2010 were enrolled into this study.All in study group were evaluated by a questionnaire regarding their symptoms,sexual behavior,breast-feeding situation and delivery mode.Vaginal secretions from upper 1/3 of vagina were collected and evaluated by vaginal microbial evaluation system.Bacterial vaginosis (BV) was diagnosed if Nugent score ≥ 7.Enumeration data between groups was compared by t test,and quantitative data by Chi-square test.Results The density of vaginal flora in study group was different from that of control group (x2 =96.302,P＜0.001) ; so did the flora diversity of two groups (x2 =69.871,P＜0.001).There was no difference between mean age of study group [(30.5 ± 3.9) years] and control group [(30.9 ± 2.4)years],P＞0.05.The cesarean section rate was 52.7％ (89/169),13 women (7.7％) had began their sexual behavior before interview,116 women (70.3％) took breast-feeding.Dominant bacteria in the vagina of lactating women were Gram-positive cocci (69/175,39.4％) and Gram-positive bacillus (54/175, 30.9％), which was different from control group (Gram-positive bacillus,180/189,95.2％),P＜0.001.The vaginal pH of study group was 5.0±0.5,which was higher than that (＜4.5) of control group.In study group,incidence of lower hydrogen peroxide level of vagina was 84.3 ％ (177/210) ; positive rate of sialidase was 6.7 ％ (14/210) ; positive rate of leukocyte esterase was 91.0％ (191/210).A large number of postpartum women had an abnormal Nugent score,most of them showed a state of intermediate BV (132/195,67.7％) or BV (8/195,4.1％),while a few patients had symptoms of BV (23.5％,33/140).Sexual behavior had no significant effect on postpartum vaginal flora.The proportion of abnormal vaginal flora in breast feeding mothers (74.1 ％,86/116) was significantly higher than that (57.1％,28/49) in artificial feeding mothers,P=0.034.Delivery mode also affected postpartum vaginal flora.Women underwent cesarean section were more susceptible to abnormal vaginal flora (77.5％,69/89) than those underwent vaginal delivery (57.5％,46/80),x2 =7.726,P=0.005.Conclusions Vaginal flora of postpartum women 6-8 weeks after delivery had significant difference from that of nonpregnant women.The incidence of asymptomatic abnormal vaginal flora was high.Breastfeeding and delivery mode are influence factors of abnormal vaginal flora.

Objective To study the relationship of gestational diabetes mellitus(GDM) and ~family history of diabetes (FHD), clinical characteristics and maternal and infant outcomes of GDM and gestational impaired glucose tolerance (GIGT). Methods A prospective case-control study was performed in 244 women with GDM/ GIGT, including 93 patients with family history of diabetes and 151 without FHD, and 244 normal OGTT cases as control from Feb. 2004 to Aug. 2004 in Dept of OB &GYN of Peking University First Hospital. Univariate analysis was used to estimate the odds ~ratios with 95% CI. Results (1)FHD was a risk factor of GDM/GIGT, OR=2.9.The co-effect of parents DM on transmission was excessive. (2)Maternal≥30 years old with FHD were greater than those without FHD (75.3% vs 62.9%). More intakes of fruits and carbohydrate per day and more weight gain during pregnancy in pregnant women with FHD were lower than those in patients without FHD. (3) The prevalence of GDM was indifferent ~between patients with and without FHD. 50 g OGCT plasma glucose (PG), fasting PG and 3 h PG in 75 g OGTT of patients with FHD were higher than those of patients without FHD. The number of pregnant women treated by insulin was significantly different between patients with and without FHD. (4) No difference was found between family and non-family history of diabetes in the prevalences of pre-eclampsia, FGR, polyhydramnios, preterm labor, LGA and SGA. Conclusions (1) FHD is a risk of GDM/GIGT, and exposure to a diabetic intrauterine environment is a mechanism responsible for this excessive maternal inheritance. (2)~Besides family history of diabetes, more intake of fruits or carbohydrate and larger gain of body weigh during pregnancy may result in GDM/GIGT.

Objective To decrease misdiagnosis and to improve the correct diagnostic rate of mammary tuberculosis .Methods 9 cases of mammary tuberculosis proved by operation and pathology misdiagnosed as other diseases were retrospectively analyzed.Results Among 9 cases,5 cases were misdiagnosed as mammary cancer,1 case as chronic mammary inflammation,1 case as mammary abcess,1 case as mammary hyperplasia,1 case as mammary fibroadenoma.Conclusion The reasons leading to misdiagnosis are unsuitable methods of examinations,lack of solid basic knowledge,and lack of experience.

Objective To observe the effect of motor imagery on unilateral spatial neglect (USN) in stroke patients. Methods 40 stroke patients with USN were divided into treatment group (n=20) and control group (n=20). Both groups received routine physical therapy training,while the treatment group received motor imagery in addition. All the patients were assessed with Chinese Behavioral Inattention Test (CBIT), Mini-mental State Examination (MMSE), Fugl-Meyer assessment (FMA) and modified Barthel index (MBI) before and 8 weeks after treatment. Results The scores of CBIT, MMSE, FMA and MBI were better in the treatment group than in the control group (P<0.01).Conclusion Motor imagery combined with routine physical treatment can improve the function of stroke patients with USN and their activities of daily living.

Objective To observe the effect of community-based rehabilitation stroke unit on the function of stroke patients. Methods 94 patients with stroke were divided into intervention group (n=47) and control group (n=47). The control group accepted routine community home care, while the intervention group accepted community-based rehabilitation stroke unit care. They were assessed with modified Barthel index (MBI), simple Fugl-Meyer assessment (FMA) and Social Disability Screening Schedule (SDSS) before and after intervention. Results There was not significant difference between the groups in scores of MBI, FMA and SDSS (P>0.05) before intervention. All the scores improved significantly in both groups (P<0.01) 3 months after intervention, and improved more in the intervention group than in the control group (P<0.05). Conclusion Community-based rehabilitation stroke unit can improve the functional recovery of stroke patients.

Objective To study the effect of intrauterine hyperglycemia on leptin level and offspring development in rats.Methods Female and male adult Wistar rats were mated,streptozotocin (STZ,50 mg/kg) was administered intraperitoneally on 5th day of gestation to induce diabetic model,diabetic pups (DP) were exposed to intrauterine hyperglycemia;control pups(CP) were exposed to controls,which was injected with citrate buffer,8 pups were choosed from each group.Weight gain between 3-10 weeks were recorded.Plasma leptin was detected by enzyme-linked immunosorbent assay (ELISA) when the rats were 11 weeks old,and the expression of leptin receptor in hypothalamus was measured at protein level by histomorphology and mRNA level measured by realtime PCR[expressed with integral absorbance(IA)]in 11weeks in order to discuss the relation of leptin and offspring development.Results The fasting blood glucose level was significantly higher in diabetic mother compared with the controls[(28.3±5.1) mmol/Lvs.(6.3±1.4) mmol/L,P＜0.05].However,there was no difference between the fasting blood glucose level in DP group and CP group[(5.1±0.8) mmol/L vs.(5.3± 0.6) mmol/L,P ＞ 0.05].The growth rate between 3-10 weeks was significantly higher in DP group 649.7% than CP group 479.2%,P ＜0.05.The base insulin level was lower in DP group[(0.76±0.37) μg/L vs.(1.06±0.14)μg/L,P ＜ 0.05];while there was no difference in plasma leptin and the expression of ieptin receptor in hypothalamns[(113±37) μg/L vs.(128±40) μg/L,P ＞0.05].The growth rate was not associated with plasma leptin in DP group (r=-0.501,P=0.311) but associated in CP group (r=-0.553,P=0.001).The protein level of DP group (4125±414) did not significantly differ from that of CP group (4244±511).The median of mRNA of leptin receptor in hypothalamus in DP group did not altered significantly compared with that of CP group(1.25 vs 1.80,P＞0.05).Conclusions Intrauterine hyperglycemia accelerated growth rate of offsprings between 3 and 10 weeks,however,plasma leptin was not discreased,which indicated leptin resistance.Intrauterine hyperglycemia did not influence the expression of leptin receptor in hypopthalamus in offsprings,this suggested the leptin resistance may be not caused by the quantity of leptin receptors.