Objective To study the levels of Urotensin Ⅱ(UⅡ)in the different grades of obstructive sleep apnea syndrome(OSAHS)patients and the correlation of UⅡ to OSAHS.Methods Seventy-five OSAHS patients were divided into five groups according to light,medium,serious AHI,simple snorers and normal part;UⅡ levels of the plasma were measured and correlation analysed.Results UⅡ levels:light group(10.44?4.12)ng/L、medium group(38.55?15.8)ng/L、serious group(94.78?19.63)ng/L、simple snorers group(1.37?0.42)ng/L、normal group(1.14?0.65)ng/L.Statistic difference existed among these groups(P

Objective To investigate the clinical prediction value of chemokine CCL21 level for acute coronary syndrome.Methods Totally 212 patients receiving coronary arteriography were divided into acute myocardial infarction group(AMI,n=72),unstable angina pectoris group(UAP,n=76),and stable angina pectoris group(SAP,n=64).The serum level of chemokine CCL21 was detected by double-antibody sandwich enzyme-linked immunosorbent assay (ELISA)and the pathological changes of coronary artery were measured by Gensini scoring system.All patients were followed up for six months and the cardiovascular adverse events were recorded.Results The serum level of CCL21 was(169.72±14.64)ng/L in AMI group,(154.42±16.50)ng/L in UAP group,and(143.87±9.80) ng/L in SAP group,with statistically significant differences (F =99.818,P =0.000).Serum levels of CCL21 in ACS group and SAP group were positively correlated with Gensini score(r=0.474,P =0.000;r=0.350,P=0.049).Binary Logistic regression analysis revealed that chemokine CCL21 was an independent risk factor for predicting acute coronary syndrome (OR =1.049,P =0.022).The CCL21-judged area under the ROC curve in acute coronary syndrome group was 0.887 ± 0.028 (P =0.000),with diagnostic point of serum level of chemokine CCL21 at 159.15 ng/L,sensitivity of 0.635,specificity of 0.981.Serum level of CCL21 was higher in the patients with cardiovascular adverse events than in the patients without cardiovascular adverse events[(168.57±7.24)ng/L vs.(156.92± 6.53) ng/L],with statistically significant difference (t =16.100,P =0.000).Conclusions Serum level of chemokine CCL21 reflects the severity degree of coronary artery disease.The chemokine CCL21,as an independent and effective marker,can predict acute coronary syndrome.

Objective To assess the prevalence and risk factors associated with clopidogrel resistance in patients with acute myocardial infarction after primary PCI(percutaneous coronary intervention). Methods Using a retrospective case?control study,210 patients with acute myocardial in?farction who underwent primary PCI in the first hospital affiliated to China Medical University between October 2013 and September 2014 were re?viewed. Patients were divided into the normal group and the resistance group according to the platelet aggregation rate(PAR),and the incidence of clopidogrel resistance was calculated and the correlation between age,gender,smoking,alcohol drinking,blood pressure,blood lipid,glycosylated hemoglobin,and the clopidogrel resistance were analyzed. Results The incidence of clopidogrel resistance in patients underwent primary PCI was 36.67%. Platelet aggregation rates were 62.62 ± 9.23%and 32.71 ± 11.77%respectively in two groups(P<0.001). Multivariate logistic regression analysis found that clopidogrel resistance was positively correlated to high level of glycosylated hemoglobin(P=0.037,OR 1.241,95%CI 1.013?1.519). Conclusion High level of glycosylated hemoglobin was the independent risk factor of clopidogrel resistance. The risk of clopidogrel resis?tance will significantly increase in these diabetic patients who cannot control blood sugar well.

Objective To evaluate the treatment effects of middle and proximal phalangeal fractures with lateral fixation of mini-titanium plate.Methods From December 2011 to April 2015,56 patients (64 phalanges) suffered from closed middle and proximal phalangeal fractures were treated with lateral fixation of mini-titanium plate.There were 48 males and 8 females,aged from 17 to 65 years (average,36.3 years).Fractures included 25 cases of middle phalangeal fracture and 39 cases of proximal phalangeal fracture.According to site of fracture,12 cases were middle phalangeal condyle fractur,7 cases were middle phalangeal shaft fracture,6 cases were middle phalangeal base fracture,10 cases were proximal phalangeal condyle fracture,22 cases were proximal phalangeaal shaft fracture and 7 cases were proximal phalangeal base fracture.According to the type of fracture,13 cases were transverse,9 cases were short oblique,11 cases were long oblique,6 cases were spiral and 25 cases were comminuted fracture.All phalangeal fractures were exposed by lateral approach,in which the lateral band and oblique fibers of proximal phalanx were excised to fully expose proximal phalangeal fracture.After the reduction,the fractures were fixed with mini-titanium plate laterally.The Disabilities of the Arm,Shoulder and Hand (DASH)and the bilateral fingers total active motion (TAM) were employed to evaluate the functions.All patients took X ray during follow-up.Results All 56 patients were followed up from 9 to 47 months,average (14 ± 6) months.Phalangeal fractures were healed from 7 to 14 weeks,average (8.8 ± 2.4) weeks without loss of fixation or malunion.At final follow-up,DASH score were from 1.7 to 7.5,with an average of 4.8 ± 2.2.TAM of the fingers was excellent (＞ 90％ TAM of the contralateral side) in 33/64 (51.5％) cases,good (75％-90％ TAM of the contralateral side) in 30/64 (46.9％) cas es,fair (50％-75％ TAM of the contralateral side) 1/64 (1.6％) cases.Conclusion Lateral approach fully exposes middle and proximal phalangeal fractures and less interferes with the extensor mechanism.Lateral fixation with mini-titanium plate could provide stability and allow early motion.This technique may be an optional choice in clinical practice.

Objective To construct a perioperative management program for breast reconstruction with deep inferior epigastric perforator flap with breast cancer,and to provide references for clinical practice.Methods The databases at home and abroad were searched to obtain the relevant literature,and the perioperative management program of breast reconstruction with inferior epigastric artery perforator flap for breast cancer was preliminarily constructed.3 rounds of expert inquiries were conducted by Delphi method from October 2022 to January 2023 to determine the final content of the program.14 patients who received breast reconstruction with deep inferior epigastric perforator flap in a tertiary hospital in Zhejiang Province from January to May in 2023 were selected as application subjects to implement the modified program and evaluate the clinical effect.Results A total of 15 experts completed 3 rounds of consultation.In the third round of consultation,the Kendall's concordance coefficient of the importance of the first-level indicators was 0.347(P<0.05);the Kendall's concordance coefficients of the importance of the second and third-level indicators were 0.388 and 0.200(P<0.001);the coefficient of variation of each indicator was 0～0.224.The final program included 3 first-level indicators,18 second-level indicators and 67 third-level indicators.The incidence of flap complications in 14 patients decreased by 11.9%.Conclusion The perioperative management program of breast reconstruction with deep inferior epigastric perforator flap for breast cancer is preliminarily applied in clinical practice,which is scientific,reliable and practical,and it can provide references for clinical nursing.

Objective To investigate the growth, development and health management of children with type 1 diabetes, and to provide guidance for the treatment of children with type 1 diabetes. Methods From June 2018 to June 2021, 86 children with type 1 diabetes diagnosed and treated in the Department of Endocrinology of our hospital from January 2000 to December 2002 were selected, including 41 males and 45 females, the onset age of 6-9 years old, all of whom were followed up by telephone. Height, weight, age of onset of youth, age of menarche, blood glucose control and complications were recorded and analyzed from onset to adulthood. Results The initial height of children were lower than those of children of the same age (P<0.05), and there was no difference in height between children of the same age and children of the same age when they reached lifetime height (P>0.05).The median age of initiation of puberty in boys was (12.10±1.50) years later than that in the general population (P<0.05), and the median age of initiation of puberty and menarche in girls were (11.20±1.40) years and (14.90±2.10) years later than that in the general population (P<0.05). 11.63% (10/86) of children HbAl-c <7.0%, 30.23% (26/86) in children with HbAl-c is 7.00% -8.00%, 58.14% (50/86) in children with HbAl-c > 8.0%. There were 1 (1.16%) cases of retinopathy and 4 (4.65%) cases of microalbuminuria. 84 cases (97.67%) were monitored for blood glucose or urine glucose, and only 2 cases were not monitored. Conclusion Due to poor self-control and growth, the blood glucose control of children with type 1 diabetes is often not ideal. Although complications are rare, most blood glucose control is not ideal and blood glucose detection is not enough. Therefore, It is necessary to strengthen the publicity and education of diabetes and regularly monitor blood glucose.