Objective To observe the clinical efficacy of enhanced external counterpulsation (ECP) in the treatment of non-proliferative diabetic retinopathy (NPDR).Methods It was a case-control study.83 patients (166 eyes) of NPDR were randomly divided into ECP treatment group (ECP group) and conventional therapy group (drug group) by date of visit odd and even number,each with 42 patients of 84 eyes and 41 patients of 82 eyes respectively.The blood glucose,glycated hemoglobin (HbAlc),low-density lipoprotein (LDL-C),corrected visual acuity,stages of diabetic retinopathy (DR) and hemodynamic index such as peak systolic velocity (PSV),diastolic velocity (EDV),resistance index (RI) of ophthalmic artery (OA) and central retinal artery (CRA) were not statistically different between these two groups (P＞ 0.05).All patients were regularly educated for lifestyle management and diabetes mellitus.The following parameters were controlled by drugs including blood glucose＜8.0 mmol/L,HbA1c＜7.5 ％,blood pressure ＜140/90 mmHg (1 mmHg=0.133 kPa) and LDL-C＜3.1 mmol/L.The ECP group received both ECP and medical treatments.The ECP parameters were gasbag pressure 0.35-0.45 kg/cm2,40 min/each time,1 time/d.35 days of ECP was one course,one course each year for 3 years.The treatment effectiveness was determined at the end of follow-up after 3 years of treatment.The blood glucose,HbA1c,blood pressure,LDL-C,visual acuity,fundus changes and hemodynamic index of OA and CRA before and after treatment were comparatively analyzed.Improved or stable visual acuity and fundus condition was judged as effective treatment.Results At latest follow up,the differences of blood glucose,HbA1c,blood pressure and LDL-C were not statistically significant (P＞0.05).Compared to drug group,the PSV and EDV of OA and CRA were increased,but RI of OA and CRA was decreased in ECP group (P＜0.05).The vision effective ratio was 91.67％ and 30.49％ in ECP group and drug group respectively with a significant different (x2 =65.56,P＜0.05).The fundus effective ratio was 92.86％ and 48.78％ in ECP group and drug group respectively with a significant different (x2 =43.38,P＜ 0.05).During follow-up,1 eye (1.19％) progressed to proliferative DR (PDR) in ECP group,while 6 eyes (7.32％) progressed to PDR in drug group.The difference of PDR incidence rate between two groups was significant (x2 =3.87,P＜ 0.05).During the ECP treatment,there were 2 patients with small blisters in the skin of lower limb and cured finally.There were no other treatment-related complications.Conclusion ECP in the treatment for NPDR can improve PSV and EDV,reduce RI of OA and CRA;improve vision and fundus state,reduce the incidence of PDR.

Objective To study the renal pathology and expression of vascular endothelial growth factor (VEGF) in rats with hypothyroidism caused by iodine deficiency.Methods The rats were randomly grouped into test group and normal group,and the test group was further randomly divided into model group and L-T4 group.Observation were made when the hypothyroid model was formed after maneuvering for 21 days and the medication had been taken for 56 days.The observed data included the morphogy of the kidney,serum TT3,TT4,TSH,blood urea nitrogen (BUN),serum creatinine (SCr),and VEGF expression.Results (1) After medication for 56 days,compared to normal group,BUN and SCr levels in L-T4 and model groups showed apparently increasing [BUN (5.55 ± 0.50,5.80 ± 0.66 vs 5.00 ± 0.24) mmol/L,P＜0.05 ; SCr (26.83 ± 0.75,27.0 ± 3.41 vs 22.5 ± 2.07) μmol/L,P＜0.05],and L-T4 group showed slightly lowered BUN and SCr levels compared with model group (P＞0.05).(2) By 21 days,in the model group there was moderate mesangial hyperplasia involving focal glomeruli.By 56th day of medication,entire glomeruli showed moderate mesangial hyperplasia with lessened number of dilated capillaries in the model group.However,in the L-T4 treated group,mesangial hyperplasia was much less and capillaries though dilated appeared wholesome,as compared with the model group.(3) By 21th day,the IODA value of VEGF in the model group was higher than that in the normal control (44.64 ± 14.99 vs 29.05 ± 9.14,P＜0.01).After medication for 56 days,there was no significant difference in the IODA value of three groups.Conclusions The characteristics of renal pathology in rats with hypothyroidism caused by iodine deficiency consist of mesangial hyperplasia and loss of glomerular capillaries.The expression of VEGF is raised early in the course of renal damage,but lowered thereafter.L-T4 can not reverse the sustained kidney damage and impaired renal function.

Objective To investigate the fatigue in patients with type 2 diabetes mellitus (T2DM),and analyze its related factors.Methods A total of 211 patients with type 2 diabetes were investigated with Chinese version of Multidimensional Fatigue Inventory-20 (MFI-20),Medical Outcomes Study Health Status Short Form-Vitality (SF-36-VT) and demographic survey questionnaire.T test,one-way AVOVA and multiple linear regression analysis were used to analyze the data.Results The fatigue incidence of 211cases of patients with type 2 diabetes was 63.5％ (134/211),the mean score of MFI-20 was 54.10±15.63,and women's score (57.89±15.32) was significantly higher than that of men (51.54±15.37)(t=2.949,P ＜ 0.01).Physical fatigue got the highest score of the three dimensions in MFI-20,which was 2.99±1.03,the mental fatigue scored 2.67±0.82.Multiple linear regression analysis showed that fatigue was related to the sports,2hPBG,rest situation,cerebrovascular complications and the number of complications,which could totally explain 30.7％ of the variance.Conclusions More attention should be paid to fatigue of T2DM patients.Effective interventions should be carried out to relieve the fatigue status of T2DM patients and improve their self-management ability and quality of life.

Objective To observe the effect of low molecular weight heparin(LMWH) in treatment of diabetic foot.Methods Fifty-four patients were divided into test group and control group randomly.Both two groups were given routine therapy including mediating blood glucose with Insulin,anti-infection and changing dressings,while the test group were givon LMWH 5000IU once datly every 12 hours for 15 days besides the routine treatment.Then the endothelin(ET),thromboxaneB2(TXB2),hemorheology,ankle-brachial index(ABI),ulcer healing,fibrinogen(FIB),prothrombin time(PT) and avtivated parital thromboplastin time(APTT) were observed.Results Compared to that of before treatment,there are ET,TXB2,hemorheology and better ulcer heals after treatment,The improvement in test group patients was superior to that of control group(P0.05) after treatment in two groups.No hemorrhage and other complications occurred.Conclusion LMWH is effective and safe for treatment of diabetic foot.

Objective To study the effects of flunarizine on the contents of SOD、 MDA、 NO、 NOS in serum and brain tissue and pathological changes in gerbils of ischemia-reperfusion cerebral injury. Methods Twentyone gerbils were randomly divided into three groups: ischemia-reperfusion group, flunarizine pretreatment group and control group. There were seven gerbils in each group. The levels of SOD, MDA, NO and NOS in the serum and brain tissue were determined, and pathological changes of brain were observed by microscopy. Results It was found that the group of ischemia-reperfusion had characteristic changes of ischemia-reperfusion injury. Compared with the control group, serum and brain contents of MDA, NO and NOS were higher but the content of SOD was lower,and the differences were significant(all P

Objective To study the protective effects of estrogen on brain injured by cerebral ischemia-reperfusion in ovariectomized rats.Methods 30 d after bilateral ovariectomy,the benzestrofol 100 ?g/(kg?d)were intramusculari injected in to the models of ovariectomied rats for 14 d. Then the rat models of focal cerebral ischemia-reperfusion were made. The expressions of CD54 and TNF-? in brain tissue were detected by immunohistochemistry. The apoptotic cells were assayed by TUNEL,and the ultramicrostructural changes of neuron membrane was observed by electron microscope. Results Compared with the ischemia-reperfusion group and ovariectomized group,the expressions of CD54 and TNF-? of brain tissue in the estrogen group were significantly lower,and the apoptosis was reduced (all P

AIM: To observe the effects of Salvia miltiorrhiza Bunge.f.alba. (Sal) on the mitochondrial ultra-structure, oxidative stress and apoptosis induced by ischemia injury in a rat model of focal cerebral ischemia and reperfusion.METHODS: The middle cerebral artery occlusion/reperfusion (MCAO/R) rat model was established by a modified Longa occlusion method. Adult male SD rats were randomly divided into control group, simple ischemia reperfusion group, Sal with ischemia reperfusion group and butylphthalide with ischemia reperfusion group. To study the protective effects of Sal and its mechanism, the intervention of Sal was given and the ultra-structure of mitochondria, functions of mitochondria under oxidative stress and the incidence of apoptosis of brain cells were determined.RESULTS: Many electron dense toxic granulation and vacuolus in mitochondria were observed in the rat brain of focal cerebral ischemia and reperfusion. Under the condition of ischemia and reperfusion, the mitochondria membrane was disaggregative, and the tubular cristae of mitochondrion disappeared. MDA content was obviously increased and the activity of glutathione peroxidase decreased significantly. The apoptosis of brain cells were observed in a great quantity. The changes of ultra-structure of mitochondria and the activity of GSH-Pxase were significantly improved by the treatment of Sal. Furthermore, treatment with Sal delayed the decrease of GSH-Pxase activity, and inhibited the increase in MDA content in brain tissue after ischemia and reperfusion. The incidence of apoptosis of brain cells was also decreased.CONCLUSION: Sal protects the brain tissue from ischemia injury.

Objective To investigate the influence of acpuncture on free calcium in rat brain cells after focal cerebral ischemia reperfusion.Methods 145 adult male SD rats were randomly divided into control group,simple ischemia reperfusion group and acupuncture with ischemia reperfusion group.The middle cerebral artery occlusion/reperfusion (MCAO/R) rat model was established by the modified Longa occlusion method. ①The part of free calcium in rat brain cells,focal cevebral ischemia model of rats were made by thread locking up the blood vessel for 15 min.30 min later after reperfusion, the Baihui and Shuigou Point in Du meridian were acupunctured electrically 30 min.After 3h, 6h and 12h, the rat was killed and its brain cells were made into single cell suspension,marked by Fluo-3/AM.The fluorescence optical density was recorded by laser confocal microscopy.②The part of nerve functional reconstruction, focal cevebral ischemia model of rats were made by thread locking up the blood vessel for 12 hours.30 min later after reperfusion, the Baihui and Shuigou Point in Du meridian were acupunctured electrically 30 min.After 7 d, 14 d,30 d,60 d and 90 d, the rat was forced to detect it's strength of the dog.Results ①Free calcium in rats of acupuncture therapy group(6h:10.96±1.18;2h:20.9±4.37) was significantly less than that in control group in 6 h and 12 h after reperfusion (6 h: 16.87 ± 3.56,12 h: 34.10 ±1.06)(P<0.05).②The dog in rats of acupuncture therapy group was significantly more than that in control group in 7 d, 14 d after reperfusion (P＜ 0.05 ).No difference of the dog was detected in 30 d ,60 d and 90 d after reperfusion between the two groups.Conclusion Acupunture could decreases the concentration of free calcium and the expression of Caspase-3 mRNA in rat brain cells after focal cerebral ischemia reperfusion, and it can facilitate the recovery of nerve function.

Objective Mining and exploring the positive experience of family caregivers of diabetic foot,aims to deepen the conceptual framework of positive aspects of caregiving and to provide a basis for interventions. Methods A qualitative study design was used guided by the conceptual framework of positive aspects of caregiving.Ten family caregivers of patients with diabetic foot were surveyed. The Colaizzi qualitative analysis method and the framework method were used to analysis the qualitative data. Results The caregivers′positive experience was described from 4 aspects:quality of caregiver/care receiver daily relationship, caregiver′s feeling of accomplishment, meaning of the caregiver′s role in daily life and the caregivers′gain. The caregivers′positive experience was influenced by the caregiver′s sense of self-efficacy and the enrichment events in daily life. Conclusions Family caregivers of diabetic foot get positive experiences in caregiving. The conceptual framework of positive aspects of caregiving explains the relationship between caregivers′positive experience and the determine factors, and it will be helpful to the designing and implementing of interventions. The positive experience should be considered when an intervention program will be conducted for supporting family caregivers.

Objective To study the characteristic of chromogranin A(CgA),synaptophysin(SYN) and neuron-specific enolase(NSE) in cortex and medulla of adrenal.Methods Immunohistochemical method was used to detect the expression of CgA,SYN and NSE in routinely processed tissue specimens from human adrenal neoplasm and hyperplasia.Results The expression of CgA was detected in cortex of adrenocortical adenoma,adrenal neoplasm and chromophile tumor,but not in that of hyperplasia and normal adrenal.The expression of NSE was detected in cortex of adrenal cortical hyperplasia,cortical adenomas and pheochromocyte carcinoma,but not in that of pheochromocytoma and normal adrenal.The expression of SYN was detected in cortex of corticohyperplassia,cortical adenomas,medull neoplasm,chromophile tumor and pheochromocyte carcinoma,but not in that of cortical adenocarcinoma and normal adrenal.The expressions of CgA,NSE and SYN were detected in the medulla of all cases.Conclusion The characteristic of CgA,SYN and NSE in cortex and medulla of adrenal are useful in the differential diagnosis of tumor and hyperplasia in the adrenal.The relationship between the adrenal cortex and medulla is close.Besides the classical hypothalamus-pituitary-adrenal axis(HPAA) and rennin-angiotensin-aldosterone system(RAAS),the adrenal cortex and medulla have the basis of anatomy and endocrinology.