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.

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 .

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.

Objective To observe the long-term effects of maternal mild hyperglycemia on the growing development and glucose and lipid metabolism in intergenerational rat offspring.Methods Streptozotocin (25 mg/kg) was administered to 14 pregnant Wistar rats intraperitoneally on the first day of gestation to induce an animal model of mild intrauterine hyperglycemia,which was successful in nine rats.Seven pregnant rats without streptozotocin intervention served as controls.Female first-generation offspring (F1) rats were intercrossed with normal male rats to obtain the second-generation offspring (F2) rats.F1 and F2 rats were divided into 8 groups:female group (group F1-G-♀) or male group (group F1-G-♂) exposed to intrauterine hyperglycemia;female group (group F1-C-♀) or male group (group F1-C-♂) exposed to intrauterine euglycemia;transgenerational female group (group F2-G-♀) or male group (group F2-G ♂)exposed to intrauterine hyperglycemia;and transgenerational female group (group F2-C-♀) or male group (group F2-C-♂) exposed to intrauterine euglycemia.Body weight of the offspring was recorded.At the age of 28 weeks,the weight of pancreas and visceral fat,fasting plasma glucose (FPG),fasting insulin,total triglyceride,total cholesterol,high-density lipoprotein-cholesterol,low-density lipoprotein-cholesterol were measured in all groups.Two sample t test was used for statistical analysis.Results (1) At 4,24 and 28 weeks old,the body weight of group F2-G-♀ [(177.3± 12.3),(314.5± 13.9) and (322.3± 16.2) g] was remarkably increased compared with group F2-C-♀ [(164.3±6.0),(290.2± 18.3) and (300.2± 16.2) g,t=-2.324,-2.584and-2.359,all P ＜ 0.05].(2) At 28 weeks,the pancreas weight and the ratio of pancreas weight to body weight of group F1-G-♀ [(0.53 ±0.05) g and (0.17±0.02)％] were decreased significantly compared with group F1-C-♀ [(0.65±0.04) g and (0.21±0.02)％,t=4.159 and 2.483,both P ＜ 0.05].The pancreas weight,ratio of pancreas weight to body weight,visceral fat weight and fat weight of mass ratio in groups F2-G-♂ and F2-G-♀ were not remarkably different from groups F2-C-♂ and F2-C-♀,respectively (all P ＞ 0.05).(3)The level of FPG at three weeks of age in F2-G-♀ group was higher than in F2-C-♀ group [(6.5±0.8) vs (4.9±1.2) mmol/L,t=-2.786,P ＜ 0.05],and it was also higher in F2-G-♂ group than in F2-C-♂ group [(6.3±0.8) vs (4.7± 1.0) mmol/L,t=-2.696,P ＜ 0.05].At 28 weeks,the FPG level was (6.7±0.6) and (8.4±2.2) mmol/L in F2-G-♀ and F2-G-♂ groups,being higher than in F2-C-♀ and F2-C-♂ groups,respectively [(5.8±0.5) and (6.2± 1.0) mmol/L,t=-2.695 and-2.337,both P ＜ 0.05].Compared with F1-C-♀ group [(0.61 ±0.10) mmol/L],the high-density lipoprotein-cholesterol level was lower in F1-G-♀ group [(0.47±0.05) mmol/L,t=2.433,P ＜ 0.05].(4) In groups F1-G-♀,F2-G-♀ and F2-G-♂,the structure of the islet cells was obviously atrophic and disordered,and β-cells were slightly decreased and distributed unevenly,but group F1-G-♂ had significantly increased β-cells with hypertrophic islet size compared with control group.Conclusions F 1 rat offsprings exposed to mild intrauterine hyperglycemia experience excessive weight gain after birth,impaired structure of the islet,metabolic abnormality,increased visceral fat weight and glucose and lipid metabolism disorder,which show intergenerational inheritance and gender differences.

Objective To compare the diagnostic values of the detection of urine exfoliated cells by FISH and cytology technolo‐gy in bladder urothelial tumor .Methods The combination probes of CSP3/CSP7 and GLPp16/CSP17 were both used in the FISH detection of urine exfoliated cells from suspected patients with bladder urothelial tumor .The urine exfoliated cells were detected by cytology technology at the same time .The sensitivity and the specificity of the two methods were compared .Results The sensitivi‐ty and specificity of FISH for bladder urothelial tumor screening were 92 .5% and 85 .0% respectively ,and those of cytology tech‐nology were 27 .5% and 90 .0% respectively .The sensitivity of FISH was significantly higher than that of cytology technology (P<0 .05) ,however ,the specificity differences between FISH and cytology technology were not statistically significant (P>0 .05) .Conclusion FISH is expected to become a new method for the screening of bladder urothelial tumor .

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.

ObjectiveTo understand the implementation effect and its influencing factors of clinical medical undergraduates' talents cultivation scheme in Xinjiang Medical University. Methods 421 clinical medical students completed questionnaire. The main contents of the survey are general situation, the factors and the implementation effect of the cultivation scheme, and so on. Results①The talents cultivation scheme is reasonable and feasible. ②The main factors which affect talents cultivation scheme of our school are the teaching plan arrangement and practical course arrangement. ③Talents cultivation scheme in the implementation process achieved some success, but the cultivation of humanistic quality should be enhanced, etc. ConclusionRenewed the education conception, optimize the clinical teaching structure, integrated teaching contents, updated teaching methods and means, and strengthened students' humanistic quality are the key factors of the higher medical institutions to cultivate high quality and comprehensive talents.

Objective Study the effects of early overfeeding in the adult offspring of mother with severely hyperglycaemia in pregnancy to islet development and insulin resistance. Methods Thirty healthy female Wistar rats were mated with 10 male Wistar rats and the morning on which sperm were found in three different visual fields of the vaginal smear was designated pregnancy day 1. The pregnant rats were intraperitoneally administered with Streptozotocin (STZ, 50 mg/L) on 5th day of pregnancy, and blood glucose exceeded 20 mmol/L to induce severely gestational diabetes mellitus (SDM) model. The pregnant Wistar rats were assigned to two experimental groups: SDM (n = 16) and control (n = 8). Litter size reduction in the lactation period induced early postnatal overfeeding model. Offspring were divided into three groups according to the level of blood glucose in pregnancy and feeding patterns in lactation: ( 1 ) control group (CG):euglycemia in pregnancy, eight pups in lactation;(2) severely gestational diabetes mellitusnormal feeding (SDM-N):severely gestational diabetes mellitus, eight pups in lactation; (3) severely gestational diabetes mellitus-overfeeding (SDM-O): severely gestational diabetes mellitus, four pups lactation. At the end of the lactation period, all pups were fed standard laboratory chow adlibitum until the date of the experiments. Offspring body weight was measured weekly after ablactation. Serum insulin was measured by enzyme-linked immunosorbent assay (ELISA) and pancreatic islet morphology was analyzed by immunohistochemistry (IHC) in all three groups at 26 weeks of age. Results (1) Blood glucose of pregnant Wistar rats: SDM (28.3 ±5.1 ) mmol/L was statistically higher than control (6.3 ± 1.4) mmol/L ( P ＜ 0.05 ). (2) Growth rates of body weight in 3 - 7 weeks and 3 - 9 weeks: SDM-N: (4. 6 ± 1.3) % and (6.8±2.5)%, SDM-O:(3.2±0.7)% and(4.6±1.2)%,CG:(2.9 ±0.6)% and(4.1 ±0.8)%.The growth rates of body weight in SDM-N and SDM-O were both significantly higher than those in CG ( P ＜0.05 ). (3) Body weight at 26 weeks: CG: (486 ± 132) g, SDM-N: ( 387 ± 115 ) g, SDM-O: ( 382 ± 122) g.There was no statistical difference among the three groups (P ＞0.05). (4) Fasting plasma glucose ( FPG),fasting insulin (FINS), homeostasis model of insulin resistance (HOMA-IR) and insulin sensitivity index (ISI): at 26 weeks, the SDM-offspring has nomal FPG, but more insulin was needed to keep it normal. The insulin level of SDM-O[ ( 12.6 ± 3.3) mU/L ] was statistically higher than those of SDM-N [ ( 10.9 ± 3.3 )mU/L] and CG [ ( 8.6 ± 0.8 ) mU/L ] ( P ＜ 0.05 ). The ISI of SDM-O ( 0.020 ± 0.006 ) was significantly smaller than its HOMA-IR(2.40 ±0.62,P ＜0.05). (5)The morphological change of pancreatic islet: The islets of CG and SDM-N were round or ellipse and have clear boundary between endocrine and exocrine parts and the β cells distributed equally. However, SDM-O islets were not of uniform size and most of islets were hyperplasia and hypertrophy. (6) Relative β cell area of pancreas, β-cell area and islet size: SDM-O:(1.81 ±0.31)%, (57.1 ±3.2)% and(39 067 ±3308)μm2; SDM-N:(1.34 ±0.43)%,(60.9 ±0.6)% and ( 30 570 ± 4824 ) μm2; CG: ( 1.11 ± 0.26 )%, ( 63.7 ± 2.7 )% and ( 26 443 ± 4431 ) μm2.SDM-O has significantly increasing β-cell mass, hypertrophic islet size and slightly decreasing β-cell percentage compared with other two groups (P ＜ 0.05 ). Conclusions The exposure of severely hyperglycemia in pregnancy induces low weight infant and postnatal catch-up growth leading to the possibility of insulin resislance (IR) in adult and early postnatal overfeeding will accelerate such course. Islet morphology of SDM-N has no significant change, indicating that maternal diabetes mainly affected β-cell function but not islet morphological features. SDM overfeeding results in early impairment of islet morphology and function, indicating that the compensation ability of islets has already been impaired and the risk of further development of impaired glucose tolerance (IGT) and diabetes. In conclusion, the nutritonal environment in early life ( duration of pregnancy and lactation) participate in the metabolic programming in adulthood.

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.