Objective To investigate the serum expressions and clinical significance of Dickkopf-1 in patients with rheumatoid arthritis (RA). Methods The clinical data of 139 patients with RA were retrospectively analyzed, including the disease history, tender joint count (TJC), swollen joint count (SJC), platelet, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), anti-nuclear antibody (ANA), antikeratin antibody (AKA), anti-perinuclear factor (APF), anti cyclic citrullinated peptide antibody (anti-CCP), Dickkopf-1 and radiological (X-ray) staging. The disease activity scale (DAS) was evaluated, and the ESR and CRP levels were included. The relationship between Dickkopf-1 and the clinical data of RA, DAS44 score was analyzed. Results The serum level of Dickkopf-1 in patients with RA was (2.70 ± 0.46) μg/L. There was no relationship between serum Dickkopf-1 level and gender, age, course of disease, CRP, platelet, ANA, AKA, APF, RF, radiological staging in patients with RA (P>0.05). The serum Dickkopf-1 level was significantly associated with TJC, SJC, ESR, DAS44-ESR score, DAS44-CRP score and anti-CCP (r = 0.200, 0.291, 0.178, 0.222, 0.199 and 0.278, P = 0.019, 0.001, 0.037, 0.009, 0.028 and 0.012). Conclusions The serum Dickkopf-1 expression level is closely related to the occurrence and development of RA. Dickkopf-1 may contribute to diagnose the disease activity in patients with RA.

Objective:To prepare silybin ( SLB) lipid emulsions and evaluate the drug release behavior in vitro. Methods:Silybin lipid emulsions were prepared by high-pressure homogenization method. Under the guidance of single-factor test, the best formula of SLB lipid emulsions was obtained by orthogonal design. Results:The encapsulation efficiency of SLB lipid emulsions prepared by the optimal formula was (91. 45 ± 0. 005 2) % with the particle size of (74. 42 ± 14)nm and PDI of 0. 106, Zeta potential of ( -30. 2 ± 2. 13)mV and pH of (6. 48 ± 0. 04). The drug release of SLB lipid emulsions was up to 90% within 12 hours. Conclusion:The opti-mized preparation of SLB with sustained-release property is obtained successfully.

OBJECTIVE:To investigate the role of clinical pharmacists in the drug treatment of infected patients in neurosur-gery department. METHODS:Clinical pharmacists participated in the formulation of anti-infective treatment plan for a infected case after meningioma surgery. According to drug antibacterial spectrum,result of laboratory and image examinations and disease condition of patients,etc.,the patient was given cefoperazone sodium and sulbactam sodium (3 g,ivgtt,q8 h),rifampicin (0.45 g,ivgtt,q12 h)and vancomycin(1 g,ivgtt,q12 h);the body temperature of the patient increased again and clinical pharmacist suggested meropenem 1 g,ivgtt,q8 h and vancomycin 1 g,ivgtt,q12 h. RESULTS:After 53 d treatment,infection was timely brought under control. The patient was discharged from hospital after improved on 72th day. CONCLUSIONS:Through the partici-pation of clinical pharmacists in pharmaceutical care for anti-infective drug treatment in neurosurgery department contribute to ratio-nal drug use in the clinic and guarantee the safety of drug use.

OBJECTIVE: To explore the effective way for the development of hospital pharmaceutical care. METHODS: We analyzed and summarized the problems appeared in the practical work and the factors influencing pharmaceutical care. RESUL-TS & CONCLUSION: The factors that influence pharmaceutical care mainly consist of policy, idea, specialty and method. Att-aching great importance and having a clear understanding to the above factors is the key to facilitate the successful development of hospital pharmaceutical care.

Objective To investigate the expression and significance of caveolin-1 in femoral nerve of diabetic patients with foot amputation. Methods Forty patients with foot amputation were assigned to 3 groups according to their duration of type 2 diabetes: group A ( ＜6 years＝, group B (6-10 years), and group C ( ＞10 years). Hematoxylin and eosin (HE) stain and Weil's stain were used to examine the femoral nerve. Silver staining was used to observe the axons and to count the nerve fiber density. The expression of caveolin-1 in Schwann cells of femoral nerve was tested by immunohistochemisty. Results There were evident progressive pathological changes in femoral nerve in the 3 groups. The variance of nerve fiber density in the 3 groups reached statistical significance ( P＜0. 05 ＝, the nerve fiber density showed negative correlation with HbA1C( r =-0. 792, P＜0. 01 ＝ and duration ( r=-0.592, P＜0. 01 ＝. The expression of caveolin-1 in Schwann cells of femoral nerve was positive in all the 3 groups and the variance with statistical significance (P＜0. 01 ), it was negatively correlated with HbA1C (r=-0. 762, P＜0. 01 )and duration (r=-0. 532, P＜0. 01 ), and it was positively correlated with nerve fiber density (r=0. 721, P＜0.01 ), the partial correlation coefficient of caveolin-1 and HbA1Cwas-0. 505 ( P＜0. 01 ).Conclusion In patients with diabetic foot amputation, caveolin-1 may play a role in the development of diabetic peripheral neuropathy and diabetic foot.

Objective To investigate clinical features and antibiotic resistance of pseudomonas aeruginosa (PA) strains isolated from patients with diabetic foot infections (DFI) in Tianjin Metabolic Diseases Hospital.Methods Eighty-five PA strains were isolated from 428 patients with diabetic foot in the hospital from Jan 2008 to Dec 2010.The clinical features of patients were summarized.Relationships between the isolates and depth of ulcer or severity of infection were analyzed.The disk-diffusion method was performed to examine antimicrobial susceptibility.Results Gram positive (G+) and Gram negative (Gˉ) isolates were 50.47％ and 41.12％,respectively.Multidrug-resistant PA composed 32.9％ of the total PA isolates.The size of ulcers with PA infections was bigger than those with non-PA bacterial infections (P＜0.05).Compared to G+ strains,patients with PA strains were older,had lower hemoglobin,but higher serum sensitive C-reactive protein; and more frequently,they had ischemic ulcer and osteomyelitis.Compared to G+ strains,the PA strains were more frequently isolated from deeper ulcers and with more serious infections(P＜0.05).The resistant rates of PA to cephalosporins,fluoroquinolones,and aminoglycosides were between 32.9％-61.2％,37.6％-42.4％,and 37.6％-62.4％,respectively.Only one out of 85 PA strains was imipenem-resistant.However,sensitiveness of all PA isolates to cefoperazone and sulbactam reached 100％.Conclusion PA strains are mainly found in patients with deeper ulcers and more serious infections.Multidrug-resistant PA is common in DFI.It is important to isolate pathogens and determine their antibiotic resistance correctly in diabetic foot patients in order to provide appropriate drug administration and to reduce the production and dissemination of drug resistant strains.

Stroke is a prevalent acute cerebrovascular disease associated with significant morbidity and mortality,which highly demand effective prevention and treatment strategies.Glucagon-like peptide-1 receptor agonists(GLP-1RA)is a novel type of antidiabetic drug that exerts hypoglycemic and weight loss effects on GLP-1 receptors.Additionally,GLP-1RA possess the potential to reduce infarction size and promote nerve recovery by inhibiting inflammation,oxidative stress,apoptosis,and improving blood-brain barrier permeability and other pathologies.This paper provides a comprehensive summary of the role of GLP-1 in stroke occurrence while also explores the underlying mechanisms by which GLP-1RA influences stroke pathogenesis.Furthermore,it briefly reviews the therapeutic efficacy of GLP-RA in managing stroke.

Objective: To investigate the correlation between serum melatonin level and cardiac function, blood lipid in patients of heart failure with preserved ejection fraction (HFpEF). Methods: One hundred and seventy patients with HFpEF (HFpEF group) in Ninth Hospital of Xi′an City from May 2016 to May 2018 were selected. According to the cardiac function grading of New York Heart Association (NYHA), Ⅱ grade (cardiac function Ⅱ grade) was in 98 cases, and Ⅲ grade (cardiac function Ⅲ grade) was in 72 cases. Then, 32 healthy volunteers were selected as control group. The 2 groups were sampled at 2:00 and 7:00, and the level of melatonin was detected by enzyme-linked immunosorbent assay. The correlation between serum melatonin level and cardiac function, blood lipid were analyzed (Pearson correlation), including triglyeride (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein-cholesterol (HDL-C), N-terminal precursor brain natriuretic peptide (NTproBNP), hypersensitive C reactive protein (hs-CRP), ejection fraction, left ventricular end-diastolic volume index (LVEDVI), miral diastolic early and end-diastolic maximum blood flow velocity ratio (E/A) and peak value of early diastolic blood flow velocity in the mitral valve and peak value of the early diastolic velocity of the mitral annulus (E/e′). Results: The TG, TC, LDL-C, NTproBNP and hs-CRP in cardiac function Ⅲ grade patients were significantly higher than those in cardiac function Ⅱ grade patients: (1.51 ± 0.69) mmol/L vs. (1.15 ± 0.75) mmol/L, (4.03 ± 1.02) mmol/L vs. (3.47 ± 0.94) mmol/L, (1.42 ± 0.33) mmol/L vs. (1.17 ± 0.31) mmol/L, (3 438.54 ± 553.58) ng/L vs. (3 034.58 ± 557.35) ng/L and (4.26 ± 2.54) mg/L vs. (3.12 ± 2.13) mg/L, the HDL-C, ejection fraction and E/A were significantly lower than those in cardiac function Ⅱ grade patients: (2.44 ± 0.88) mmol/L vs. (2.97 ± 0.94) mmol/L, (56.23 ± 5.26)% vs. (61.11 ± 5.33)% and 0.82 ± 0.18 vs. 0.91 ± 0.17, and there were statistical differences (P<0.01). The melatonin levels at 2:00 and 7:00 in control group and cardiac function Ⅱgrade patients of HFpEF group were significantly higher than those in cardiac function Ⅲ grade patients of HFpEF group: (454.24 ± 123.54) and (432.68 ± 155.68) ng/L vs. (368.85 ± 98.52) ng/L, (483.25 ± 90.54) and (418.54 ± 103.57) ng/L vs. (345.85 ± 98.52) ng/L, the melatonin level at 7:00 in control group was significantly higher than that in cardiac function Ⅱ grade patients of HFpEF group, and there was statistical difference (P<0.01). In cardiac function Ⅱ grade patients of HFpEF group, the melatonin level was correlated with TG, TC, LDL-C and HDL-C (P<0.01); In cardiac function Ⅲ grade patients of HFpEF group, the melatonin level was correlated with NTproBNP, hs-CRP, ejection fraction, LVEDVI, E/A, E/e′, TG, TC, LDL-C and HDL-C (P<0.01 or <0.05). Conclusions The melatonin level is correlated with the level of blood lipid in HFpEF patients. Melatonin level is correlated with cardiac function Ⅲ grade patients, but this phenomenon is not observed in cardiac function Ⅱ grade patients.

Objective:To explore the role and mechanism of exogenous active peptide spexin in regulating insulin resistance in adipose tissue.Methods:High-fat diet induced obesity model(DIO) mice and diabetic model(db/db) mice were given intraperitoneal injection of spexin(50 μg/kg) for 3 consecutive weeks, while each control group was given an equal volume of saline. After the intervention, the body weight, visceral fat weight and plasma biochemical indexes of the mice in each group were analyzed. Real-time fluorescence quantitative PCR was used to detect mRNA levels of Krüppel-like transcription factor 9(KLF9), peroxisome proliferator-activated receptor γ coactivator-1α(PGC-1α) and glucose transporter 4(GLUT4); Western blotting was used to detect the protein levels of KLF9, PGC-1α, GLUT4 and p-p38/p38 in adipose tissue.Results:Compared with DIO control mice, spexin-treated DIO mice showed a significant reduction in body weight ( P=0.043), adiposity ( P<0.001), glucose ( P<0.001), insulin ( P=0.008), HOMA-IR ( P<0.001) and elevation in glucose tolerance ( P=0.006) and insulin tolerance levels ( P=0.002). Compared with db/db control mice, spexin-treated db/db mice showed a significant reduction in body weight ( P<0.001), adiposity ( P<0.001), glucose ( P=0.041), insulin ( P=0.009), HOMA-IR ( P=0.007) and elevation in glucose tolerance ( P=0.008) and insulin tolerance levels ( P=0.031). In addition, the gene and protein levels of KLF9, PGC-1α and GLUT4 were significantly increased in the adipose tissue of spexin-treated DIO mice compared with DIO control mice [genes ( P<0.001, P<0.001, P=0.005); proteins ( P=0.047, P=0.022, P=0.001)], while p-p38/p38 protein levels were significantly decreased in the adipose tissue of spexin-treated DIO mice compared with DIO control mice ( P=0.002). Moreover, the gene and protein levels of KLF9, PGC-1α and GLUT4 were significantly increased in the adipose tissue of spexin-treated db/db mice compared with db/db control mice [genes ( P<0.001, P<0.001, and P=0.005); proteins ( P=0.001, P=0.004, and P<0.001)], while p-p38/p38 protein levels were significantly decreased in the adipose tissue of spexin-treated db/db mice compared with db/db control mice ( P=0.001). Conclusion:These results suggested that spexin may play a role in ameliorating adipose tissue insulin resistance in DIO mice and db/db mice through regulating p38MAPK-mediated inflammation and KLF9-PGC-1α-GLUT4 pathway-mediated glucose uptake.