Objective To explore the related risk factors of type 2 diabetic nephropathy,and to provide theoretical basis to make the strategy of prevention of diabetic nephropathy.Methods By case-control study method,98 patients with type 2 diabetic nephropathy were selected as the observation group.98 diabetes mellitus patients without kidney disease were selected as control group.Single factor analysis and non-conditional logistic regression analysis were conducted in two groups.Results The results of single factor analysis showed that type 2 diabetic nephropathy was closely related to family history of diabetes,course of diabetes,high blood pressure,diabetic retinopathy,BMI,coronary heart disease,HbAlc,FPG,2hPG,CRP (P ＜ 0.05).The results of multiple factors of logistic regression showed that type 2 diabetic nephropathy was closely related to course of diabetes and diabetic retinopathy,CRP,HbA1c,FPG(P ＜0.05).Conclusion Course of diabetes and diabetic retinopathy,CRP,HbA1c,FPG are independent risk factors for type 2 diabetic nephropathy.

Objective To evaluate the efficacy and security of combined recombinant human endostatin with GP chemotherapy for the treatment of advanced non-small-cell lung cancer (NSCLC).Methods Non- randomized concurrent control was used.32 patients were treated by recombinant human endostatin combined with chemotherapy as test group,40 patients of control group only received chemotherapy.The response rate (RR),the clinical benefit rate (CBR) and the time to progression (TTP) were observed.Results The total RR in two groups were 40.6 ％ and 20.0 ％ (x2 =3.66,P =0.07).The total CBR were 68.8 ％ and 42.5 ％ (x2 =4.93,P =0.034).The total time to progression were 5.2 months and 3.9 months (P =0.042).Incidence of adverse reactions of experimental group and control group was no significant difference.Conclusion Combined recombinant human endostatin and chemotherapy can improve the curative effect (RR,CBR and TTP) of advanced NSCLC.

Objective To observe the incidence and the rate of embolism in patients undergoing hysteroscopy procedures by using the transesophageal echocardiography (TEE), as well as the changes of respiratoric and haemodynamic variables. Methods Fourty ASA Ⅰ~Ⅱ patients undergoing hysteroscopy procedures under general anesthesia received intraoperative TEE monitoring. The systolic pulmonary artery pressure, the incidence of the venous gas embolism (VGE) and the eegmental wall motion abnormality (SWMAs) were observed. Results In the 40 patients, 38 patients received intravenous anesthesia hysteroscopic surgery, with the intraoperative TEE to monitor the intracardiac VGE. The degree of gas embolism was related with the perfusion and the usage of monopolar or bipolar diathermia (P<0.05). The systolic pulmonary artery pressure promoted and SWMAs were also observed. Conclusions The continue TEE monitor during hysteroscopy could detect the intracardiac gas embolism in time , contributing to early diagnosis and avoiding the occurrence of malignant arrhythmias or myocardial ischemic events.

Objective To discuss the correlation between MSCT morphological index of emphysema and pulmonary function test (PFT) indexes. Methods We randomly selected 33 cases with chronic obstructive pulmonary disease (COPD),and conducted CT and PFT in a week. The whole lung was scanned by MSCT at the end of deep aspiration,and the post-processing workstation was used for quantitative determination of a total of 12 morphological indexes,including the density of lung, pulmonary diameter line,lung volume,and etc,then their correlation with lung function index was analyzed.Results FEV1.0%had correlation with upper right lung density ( =0.391, =0.391), lower right lung density ( =0.465, =0.038),the mean lung density ( =0.576,=0.576), and total lung capacity (=0.471, =0.471),upper right lung volume ( =0.413, =0.049) . FEV1.0/FVC had correlation with left lower lung density ( =0.392, =0.024), the mean lung density ( =0.703, = 0.000), total lung transverse diameter ( = 0.521, = 0.521), upper right lung maximum transverse diameter ( =0.627, =0.627), and total lung capacity ( =0.549, =0.549) correlation. FVC had correlation with upper right lung maximum transverse diameter ( = 0.378, = 0.378), characterized by maximum transverse diameter (=0.349, =0.037) . TLC had correlation with mean lung density (=0.523,=0.523), upper right lung maximum transverse diameter ( =0.454, =0.454), and total lung capacity (= 0.001), the right lung volume ( = 0.492, = 0.492) . Conclusion MSCT lung morphology quantitative indicators have good clinical application value in the diagnosis and assessment of emphysema patients.

OBJECTIVETo summarize the method and experience of cardiopulmonary bypass (CPB) with vacuum-assisted venous drainage technology (VAVD) in the minimally invasive cardiac surgery (MICS).

METHODS35 cases of patients undergoing MICS were achieved femoral arterial cannula and femoral venous cannula. During the course of the CPB, we used the VAVD technology. At the same time, we selected 35 cases as control group.The time of the CPB, mechanical ventilation and ICU, and the amount of the urine, blood products, and chest drainage were recorded.

RESULTSThe time of mechanical ventilation and ICU staying, the volume of the blood products and the volume drainage within 48 h postoperatively in the MICS group were significantly shorter and less than that in control group (P < 0.05).

CONCLUSIONThe use of VAVD in the MICS can increase the vena cava drainage effectively, and ensure the surgery safe and successful.

Adolescent ; Adult ; Aged ; Cardiac Surgical Procedures ; methods ; Drainage ; methods ; Female ; Humans ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; methods ; Vacuum ; Veins ; Young Adult

ObjectiveTo explore the relationship between the negative co-inhibitor programmed death-1 ( PD-1 ) and the pathogenesis of myasthenia gravis ( MG), by detecting the expression of PD-1 and programmed death ligand-1 ( PD-L1 ) on peripheral blood mononuclear cells (PBMCs) and soluble PD-1 (sPD-1) in plasma from myasthenia gravis patients. MethodsPeripheral blood samples were collected from 45 MG patients and 33 healthy persons without prednisone or other immunodepressant treatment during the half year ahead of withdrawal.The expression of PD-1 and PD-L1 on PBMCs were detected using immuno-fluorescence labeling and flow cytometry, and the concentrations of sPD-1 in plasma were measured using an ELISA kit. Results(1) The proportion of CD4+ PD-1 + T cells, as well as CD14+ PD-L1 +monocytes of the MG group was higher than that of the control group. There were no significant differences in the proportion of CD4+ PD-1 + T cells or CD14+ PD-L1 + monocytes in the MG sub-groups between different genders or MG types. While the proportion of CD4+ PD-1 + T cells of the late-onset MG (age ≥40) group was higher than that of the early-onset MG group (age ＜40). And it was higher in the MG patients with thymoma or thymus hyperplasia than that from the MG patients with normal thymus. The proportion of CD14+ PD-L1 +monocytes from the MG patients with thymoma or thymus hyperplasia group decreased obviously compared with that of the patients with normal thymus group; but no difference could be found between the late-onset group and early-onset group. (2)The concentration of sPD-1 in the plasma from the group of MG patients was(6. 92 ±0. 72) ng/ml,which was higher than that of the healthy control group ( (3.28 ±0. 42) ng/ml),even more, it was significantly higher in the early-onset MG group than that of the late-onset MG group,there was a negative correlation( r =-0. 526, P =0. 000) between the age of onset and the concentration of sPD-1. ConclusionsThe increased expressions of PD-1 on CD4+ T cells and PD-L1 on CD14+ monocytes in MG patients suggested the involvement of the couple of molecules in the pathogenesis of MG.Higher concentration of soluble PD-1 in the plasma of patients with MG suggested that it might disturb the ligation of PD-1 and PD-L1 on T cells and antigen presenting cells, which might result in the abnormal transportation of the negative modulating signal, and accelerate the pathological progress of MG.

Objective To study application of Chinese general practice assessment questionnaire (GPAQ)consultation version 2.0 in evaluating patients' satisfaction with community health-care service (CHS).Methods First,origihal GPAQ consultation version 2.0 in English was translated into Chinese language by three experts in general practice/family medicine field,then translated it back into English,finally a Chinese version of GPAQ was formed.Ten medical doctors who were on duty on 25 April,2008 at each out-patient clinic from CHS of Daxing,Nancaiyuan,Yongning and Hancunhe were selected randomly as targets for evaluation of service satisfaction.A sample of the first 30 patients(1200 in total)aged more than 16 years who visited the clinic on that day were selected to fill out the Chinese GPAQ consultation version 2.0 to express their satisfaction with the medical doctors they visited,and reliability and validity of the questionnaire was then evaluated.Results Cronbach's alpha ranged 0.734 to 0.813 for each domain of the Chinese version of GPAQ2.0.and cumulated contribution of three common factors with the eigen-value more than one reached 58.722%.Scores of patients' satisfaction withreceptionists,access,continuity,doctor's communication skills andpatient enablement were significantly lower,as compared to those of national bench-mark in the United Kingdom,with t-values of -6.397,-11.729,-6.328,-59.871 and -2.210,and all P＜0.05.respectively.Conclusions The Chinese version of GPAO 2.0 achieves good reliability and modcrate validity,and can be used as an instrument for evaluating patient's satisfaction with quality of CHS in China as further revision in the future studies.

Objective To investigate the effects of immediate exercise training in acute myocardial infarction(MI)patients treated by radial artery coronary intervention.Methods Totally 120 patients with acute MI that received radial artery coronary intervention were randomized into two groups:60 cases in the control group and 60 cases in the experimental group.The experimental group started immediate exercise training right after the radial artery coronary intervention.The control group received routine exercise training,which started one week after the radial artery coronary intervention.The Activity of Daily Living Scale (ADL),left ventricular ejection fraction(LVEF),and length of hospital stay were compared in both groups before the intervention and 7 days after the start of the intervention.The patients' quality of life and the incidence of adverse cardiac events were investigated 6 months after the intervention.Interviews of the patients were conducted to have a comprehensive evaluation on the results.Results One week after the start of the intervention,the LVEF in the experimental group was significantly higher than that in the control group(P＜0.01),and the ADL was significantly higher in the experimental group(P＜0.01).The length of hospital stay in the experimental group was shorter than that in the control group (P＜0.01).The follow-up results after 6 months showed that the experimental group had better quality of life(P＜0.01),but lower incidence of angina and arrhythmia (P＜0.05).There were no differences in heart failure and coronary artery in-stent restenosis between two groups (P＞0.05).Results of the interviews showed that the patients were satisfied with the improved comfort through immediate exercise training and expressed willingness to cooperate.Conclusion Immediate exercise training improved the LVEF in patients with acute myocardial infarction after emergent coronary artery intervention,shortened the length of hospital stay,improved patients' quality of life as well as reduced the incidence of angina and arrhythmia.

Objective To survey the requirement of objective structured teaching evaluation (OSTE) use for general practice (GP) trainers and the station design.Methods A questionnaire survey on the requirement of OSTE use was conducted among 161 hospital trainers and 110 community trainers from a national key GP trainers training workship in April 2016.The survey included basic information,OSTE use requirements,frequency of clinical teaching scenarios,and frequency of teaching methods.Results The survey showed that 86.3％(234/271) of trainers were willing to use OSTE for assessing teaching competence and 92.3％ (250/271) for training teaching competence.The proportion of “having been observed and being given feedback from superior trainers for teaching process” was higher in hospital trainers than that in community trainers [68.3％(110/161)vs.40.9％(45/110),x2=20.060,P＜0.001].In the part of frequency of teaching scenarios,the proportion of “often” plus “always” was higher in “instructing students to write the medical records” [64.6％(175/271)],“teaching doctor-patient communication skills” [60.9％(165/271)] and “observing students' consultation and giving feedback” [57.9％(157/271)];there were no significant differences in above questions between the two types of trainers (all P＞0.01).In the part of frequency of teaching methodS,the proportion of “often”plus “always”was higher in “clinical supervisor's report” [60.9％ (165/271)],“applied knowledge test” [52.4％(142/271)] and “problem-based learning” [38.0％(103/271)];there were no significant differences in above questions between the two types of trainers (all P＞0.01).Conclusion The requirements of assessment and training by using OSTE are strong in GP trainers.The OSTE stations should be designed based on the routine teaching scenarios and methods for both hospital trainers and community trainers without discriminations.