Objective To discuss the curative effects and clinical safety of using valsartan combined with Bailing capsule to treat diabetic nephropathy ( DN) .Methods In our hospital ,90 patients with diabetic nephropathy were chosen and divided into the two groups ( 45 cases in each group ):the control group treated with 80mg/d of valsartan and the observation group given bailing capsules 9g/d on basis of the control group .Before and after 16 weeks treatment,two groups′24h urine trace albumin excretion rate (UAER),potassium,serum creatinine (SCr), urea nitrogen ( BUN) ,total cholesterol ( TC) ,triglycerides ( TG) ,fasting plasma glucose ( FPG) and blood rheology changes were recorded and compared .Results After treatment the observation group′s high shear viscosity ,low shear viscosity,whole blood reductive viscosity and blood plasma viscosity all significantly decreased ( t=6.236,10.659, 12.509 and 7.269,all P<0.05),and these indexes were significantly lower than those of the control group ( t=6.365,6.054,9.057 and 6.431,all P<0.05);Compared with before treatment 24h urine trace albumin excretion rate (UAER),potassium,serum creatinine (SCr),urea nitrogen (BUN),total cholesterol (TC),triglycerides (TG) and fasting plasma glucose ( FPG) of the two groups all decreased significantly ( t≥2.081,all P<0.05);After treat-ment,the observation groups′24h UAER,SCr,BUN,TC,TG and BUN all significantly decreased more than those of the control group (t≥2.211,all P<0.05);After treatment potassium,FPG,SBP and DBP of the two groups all had no significant difference (t≤1.976,all P>0.05);No adverse reactions such as heart ,liver and kidney happened in the two groups .Conclusion Using valsartan in joint with Bailing capsule for the treatment of diabetic nephropathy ( DN) has distinct curative effects and no obvious adverse reactions ,which is worthy of clinical promotion .

Objective To assess diagnostic value of Wells and Geneva seales in patients with suspected pulmonary embolism(PE).Methods Clinical data of 958 consecutive cases of suspected PE admitted to Shanghai Pulmonary Hospital form January 1,1995 to January 1,2009,were analyzed retrospectively,and all patients were assessed with Wells and Geneva scales,respectively for likelihood of PE,as compared to those diagnosed by lung imaging Results Three hundred and forty-seven patients with PE were diagnosed with lung imaging as gold standard,sensitivity,specificity,and positive and negative predictive values for Wells scale and Geneva scale in diagnosis for PE were 82.4%,58.1%,52.8%and 85.3%.and 88.8%,55.3%,53.1%and 89.7%,respectively,with positive and negative likelihood ratios.Youden index and crude agreement of 1.97,0.30,0.41 and 0.21,and 1.99,0.20,0.44 and 0.25.respectively.Area under the receiver operating characteristic(ROC) curve of Geneva scale(0.79)was significantly more than that of Wells scale(0.73)(Z=2.25,P＜0.05).As compared to Wells scale,sensitivity and specificity for Geneva scale in diagnosis for PE was significantly higher(χ2=7.12 and 6.84,respectively,P＜0.05).Conclusions Although there is a considerable gap in accuracy between clinical scales and lung imaging in diagnosis for PE.both Wells and Geneva scales can be used in clinical screening for PE to save unnecessary cost.however,Geneva scale is more practical and accurate than Wells scale,worthwhile to be popularized clinically.

To retrospectively analyze the clinical data of 48 patients with allergic bronchopulmonary aspergillosis (ABPA) at Shanghai Pulmonary Hospital.There were 23 males and 25 females with a mean age of (36 ± 15) years.Their clinical manifestations included wheeze,cough,sputum production,sputum plugs,fever,hemoptysis,weight loss,chest pain,weakness and night sweats.They had a high peripheral blood eosinophilia,a higher serum total IgE,a higher level of aspergillosis fumigatus-specific IgE and positive immediate skin-prick test to aspergillus fumigatus.Aspergillus species were detected in sputum samples of 26 patients.Chest computed tomography (CT) was performed in 48 patients.There were patchy infiltrations (n =45),transient infiltrations (n =40),central bronchiectasis (n =35) and mucoid impaction (n =18).Obstructive ventilation dysfunction was confirmed by lung function test.

Objective To study the value of Geneva score assessment combined with simplified rapid plasma D-dimer assay(SRPDDA)for early diagnosis of pulmonary embolism(PE).Methods Clinical data of 658 suspected cases of PE hospitalized at Shanghai Pulmonary Hospital during January 1,1995 to November 30,2007 were retrospectively analyzed.The patients were divided into three categories based on their Geneva score assessment,highly suspected with equal to or greater than 9 scores,intermediately suspected with 5-8 scores and mildly suspected with equal to or less than 4 scores,respectively.Clinical diagnosis for PE of the patients was made based on their probability Geneva score developed by Wicki,SRPDDA,and both Geneva score assessment and SRPDDA,respectively,and compared with results of lung imaging.Results Finally,PE diagnosis was established in 267 cases.Sensitivity for Geneva score and SRPDDA to diagnose PE was 88.4%and 90.3%,with negative predictive value(NPV)of 88.9%and 90.2%and Youden Index(YI)of 51.7%and 51.4%,respectively.And,sensitivity of both Geneva score assessment combined with SRPDDA wag 97.8%,with NPV and YI of 97.3%and 53.8%,respectively,with a likelihood ratio(LR)for both positive test results of 2.62 and a LB for both negative test results of 0.04,respectively.Conclusions As a routine and non-invasive diagnostic test,Geneva score assessment,as well as SRPDDA,play a screening role in early diagnosis for PE,which can help to save unnecessary cost of imping,and complement each other so to improve accuracy of diagnosis and reduce misdiagnosis.

Objective To explore the inflammatory mechanisms of pulmonary embolism ( PTE ) and/or deep venous thrombosis ( DVT ) in elders secondary to chronic obstructive pulmonary disease ( COPD) exacerbation.Methods A total of 26 elders with acute exacerbation of high-risk COPD secondary PTE and/or DVT and 26 patients with low-risk COPD during stable phase diagnosed during the period of January 2008 to December 2012 were enrolled.The relevant parameters of routine blood examination , blood viscosity, D-dimer, fibrinogen ( FIB), arterial blood gas, blood cytokine, erythrocyte sedimentation rate ( ESR ) and C-reactive protein ( CRP ) were retrospectively analyzed.Results The major nonspecific symptoms were cough, sputum and dyspnea.The mean of neutrophile percentage (N%), D-dimer, FIB, interleukin-6 (IL-6), tumor necrosis factor (TNF), C-reactive protein (CRP), low and high shear blood viscosity in blood samples of patients with acute exacerbation of high-risk COPD secondary PTE and ( or ) DVT were higher than those of the control group ( t =3.339, 2.700, 2.207, 2.431, 2.257, 2.143, 2.223, 2.797, all P<0.05).However arterial partial pressure of oxygen ( PaO2 ) was lower than that of lower-risk COPD patients (t=4.312, P<0.05).IL-6 in blood of patients with acute exacerbation of high-risk COPD secondary PTE and ( or) DVT was positively correlated with low-shear blood viscosity , D-dimer and FIB (r=0.437, 0.624, 0.429, all P<0.05).TNF in blood of patients with acute exacerbation of high-risk COPD secondary PTE and ( or ) DVT was positively correlated to FIB , low and high cut blood viscosity ( r =0.624, 0.519, 0.513, all P <0.05 ).Plasma CRP in blood of patients with acute exacerbation of high-risk COPD secondary PTE and/or DVT was positively correlated with D-dimer, FIB, IL-6 and TNF ( r=0.478, 0.541, 0.533, 0.491, all P<0.05).Conclusions Inflammation may exist in elders with acute exacerbation of high-risk COPD secondary thrombotic disease.IL-6 and TNF may promote thrombosis secondary to acute exacerbation of COPD disease.Early screening and/or prophylactic anticoagulation are necessary for prevention.