Objective To investigate the characteristics of cognitive changes in type 2 diabetes mellitus pa-tients complicated with stroke. Methods One hundred and one stroke patients were recruited and allocated to thetype 2 diabetes mellitus group (34 patients) and sixty-seven patients in the control group (67 patients) according tobeing with or without type 2 diabetes mellitus. All the patients were evaluated, after 3 weeks, 6 months and 12months of onset of stroke, with regard to their cognitive functions by using the Mini-mental State Examination(MMSE) and Montreal Cognitive Assessment (MOCA). Results Average scores obtained in MMSE and MOCAtests were significantly lower at 3 weeks and 6 months after onset in the type 2 diabetes mellitus group when comparingwith control group. In the type 2 diabetes mellitus group, no significant difference was observed between 3 weeks and6 months after onset of stroke with regard to scores of MMSE and MOCA ( P > 0.05 ), however, the score at 6 monthswas significantly lower than that at 12 months after onset (P <0.05). On the other hand, scores of MMSE (P >0.05 ) and MOCA (P > 0.05 ) in the control group were not any statistically different among various time points ofobservation. Conclusion Type 2 diabetes mellitus will aggravate cognitive dysfunctions of stroke patients, whichstarted to recover in 6 months of onset of the stroke.

Objective Researches showed that retinoic acid may be a signal molecular in the regulation of ocular axial length.Sclera is a target tissue of the pathogenesis of form deprivation myopia.Recently,guinea pigs are used to the study of the pathogenesis of form deprivation myopia.However,seldom studies are found in the change of retinoic acid level in the sclera of guinea pigs.This study was designed to investigate the role of retinoic acid of early form deprivation myopia in guinea pigs sclera.MethodsMonocular form deprivation models were established in 24 3-week-old guinea pigs by occluding the left eyes with facemask and randomly divided into form deprivation 15 days group and 24 days group.Other 6 normal guinea pigs were used as control group.The fellow eyes were used as internal control.Refraction was measured before and after experiment by using retinoscopy.Eyeballs were extracted immediately at the corresponding time points and ocular axial length was measured with outside micrometer.The level of retinoic acid in scleral samples was detected by high performance liquid chromatography.The use of animal followed the Regulations for the Administration of Affairs Concerning Experimental Animals by the State Science and Technology Commission.ResultsRefractive diptor reduced by -3.14±1.50 D in experimental eyes after form deprivation,showing statistically differences among before and various time points after form deprivation(F=23.053,P=0.000),and no significant difference was seen in reduce of refractive diptor in fellow eyes after form deprivation( -1.24±1.99 D)(F=1.506,P=0.240).The axial length was considerably increased in form deprivation eyes after experiment (F=14.551,P=0.000) but no evident change in fellow eys (F=3.612,P=0.060).The diopter and ocular axial length was significantly different between form deprivation eyes and fellow eyes (P＞0.05).The expression of retinoic acid in sclera of form deprivation eyes was higher than fellow eyes in both form deprivation 15 days and 24 days(P＜0.01).There was no significant difference in the level of retinoic acid between form deprivation 15 days and 24 days(P＞0.05).ConclusionForm deprivation myopia can be induced in 15 days after monocular occlusion.Retinoic acid levels in guinea pig sclera increased significantly during early form deprivation.

Objective To investigate whether systemic inflammatory response syndrome(SIRS) after cerebral infarction is associated with poor outcome and its associated clinical factors.Methods We prospectively studied 500 patients with cerebral infarction.recorded the associated clinical factors on presentation and calculated the mortality at 21 st day.Results There are 85 SIRS patients in 500 patients with cerebral infarction,31 with total anterior cerebral infarction(TACI),34 with partial anterior cerebral infarction(PACI),15 with posterior cerebral infarction(POCI)and 5 with lacunar cerebral infarction (LACI).The frequency of SIRS was positively correlated with mortality rate according to Oxfordshire Commanity Stroke Project(OCSP)subtypes in cerebral infarction patients with fever(Spearman correlation coefficient=1.0:P＜0.001).Single factor analysis showed that the risk factors for both SIRS and mortality of cerebral infarction were as follows:age,infection,48h Chinese Stroke Scale score,48h Glassgow score,OCSP subtypes and dysphagia.Diabetes Was the risk factor for SIRS.but had no effect on mortality.On Cox regression,48h Glassgow score was the sole independent risk factor of outcome.However.if SIRS was included in the formula.P＞0.05.ConclusionsSIRS is the predictor of poor outcome after acute cerebral infarction.It is important to prevent SIRS especially in TACI and POCI.Diabetes is the risk factor for SIBS.but has no effect on mortality.

Objective To investigate the effect of diaphragm training on respiratory function and the activities of daily living after cerebral apoplexy.Methods Seventy-eight patients with post-stroke fatigue were randomly divided into a treatment group and a routine therapy group,each of 39.Both groups were given conventional rehabilitation treatment,while the treatment group was additionally provided with diaphragm muscle training.Before and after 4 weeks of treatment,both groups were evaluated using pulmonary function tests,a fatigue severity scale (FSS),Fugl-Meyer motor function assessment (FMA) and the modified Barthel index (MBI).Results Vital capacity,forced vital capacity,forced vital capacity during the first second,and especially the maximum ventilatory volume of the treatment group were all significantly improved after the treatment.There was also significant improvement in that group's average FSS score,but not in that of the control group.The average FMA and MBI scores for both groups had improved significantly after the intervention,with the average FMA score of the treatment group significantly higher than that of the control group.However,no significant differences in the average MBI score were observed after the treatment.Conclusion Diaphragm training can significantly improve motor function and the daily life of stroke survivors.The mechanism may be related to improved respiratory function and decreased severity of fatigue.

Objective To explore the effect of azelastine hydrochloride nasal spray combined with desloratadine to inflammatory factors, cell function and IgE of patients with allergic rhinitis.Methods 92 cases of allergic rhinitis patients treated in the first affiliated hospital of wenzhou medical college hospital from June 2014 to December 2015 were divided into experimental group(n=46) and control group(n=46) according to the random number table method.The control group was given oral loratadine tablets, one piece per time, one time per day, while the experimental group was given azelastine hydrochloride nasal spray on the basis of the control group,each nostril one spray, one time in the morning and night.The clinical efficacy of two groups of patients would be observed after 4 weeks,ELISA would be used to detect serum levels of IFN-γ, IL-4, IL-8 and IgE level, and IFN-γ/IL-4 was the value of Thl/Th2,flow cytometry instrument was used to the determination of T cell subgroup CD4 +,CD8 + cells.Results 4 weeks after treatment,stuffy nose, nasal itching, runny nose, sneezing and nasal cavity change points are lower than before the treatment in both the two groups.Experimental group obviously lower than the control group, the difference was statistically significant ( P <0.05 ).The total effective rate of treatment group is higher than the control group,the difference was statistically significant(χ2 =4.389,P=0.036).The serum level of IFN-γis higher than before treatment in both the two groups.IL-4, IL-8 inflammatory factor levels were lower than before treatment,the experimental group was better than control group,the difference was statistically significant(P<0.05).CD4 +,CD8 +of T cells and Thl/Th2 values are higher than before the treatment in both the two groups,the experimental group was higher than control group, the difference was statistically significant ( P<0.05 ).Serum IgE levels were lower than before the treatment in both the two groups,the experimental group was lower than control group,the difference was statistically significant (P<0.05).Conclusion The therapy of azelastine hydrochloride nasal spray combined with desloratadine can improve the clinical effect of the treatment of allergic rhinitis,reduce inflammation,strengthen the body's immune function, improve thelevel of serum IgE.

Objective To investigate the percentages of T follicuLar helper cells (Tfh)and interleukin-21(IL-21)in the plasma of patients with rheumatoid arthritis,and the immunological mechanism of Tfh cells in the development of rheumatoid arthritis. Methods According to ACR and DAS28,patients with rheumatoid arthritis were divided into low,moderate and high activity group.The percentages of CD3 + CD4 + CXCR+ 、CD3 + CD4 + ICOS+ and CD3 + CD4 + CXCR+ ICOS+ Tfh cells were detected by Flow Cytometry.While the levels of IL-21 、RF-IgM and anti-CCP in plasma were measured by ELlSA test.The analysis was performed by t-test and Spearman′s correlation analysis.Results The expression of CD3 + CD4 + CXCR+ ICOS+ Tfh cells in PBMCs of rheu-matoid arthritis was significantly higher than that in the normal controls(P <0.05).Meanwhile the results of the three rheumatoid arthritis groups(low,moderate and high activity groups)showed that the expression of Tfh increased accordingly(P <0.05).The expression of Tfh in rheumatoid arthritis was positively related with the levels of IL-21 ,ESR,CRP,RF and anti-CCP respectively. Conclusion The expression of Tfh and IL-21 increases significantly and is closely related to the disease activity in rheumatoid ar-thritis.The results indicate that the abnormality of Tfh may play an important role in the pathogenesis of rheumatoid arthritis.

Objective The present study is to investigate the distribution of endogenous sulfur dioxide (SO2) in severe acute pancreatitis (SAP) rats.Methods Thirty-two SPF male Sprague-Dawley rats were randomized (random number) into sham operation group,SAP rat 3 h group (SAP 3 h),SAP rat 6 hgroup (SAP6h),SAP rat 12 hgroup (SAP 12 h),n=8 in each group.The SAPmodel rats were induced by retrograde cholangiopancreatic infusion of 5％ sodium taurocholate.Rats were sacrified 3 h,6 h or 12 h after treatment.,then we collected pancrease,liver,lung,kidney and serum.The SO2 concentration in each tissue or serum was detected by enzyme-linked immune sorbentassay.Results The concentration of SO2 in tissues of pancreas (1.72 ± 0.14) μmol/g,liver (1.62 ± 0.11) μmol/g,lung (1.65 ± 0.11) μ.mol/g,kidney (1.12 ± 0.06) μmol/g or serum (16.80 ± 1.27) μmol/g in SAP 3 h rats was not significant compared with the sham operation group (P ＞ 0.05 in each group).The SO2 content in the pancreas (1.89 ± 0.17) μmol/g,liver (1.92 ± 0.16) μmol/g,lung (1.91 ± 0.15) μmol/g,kidney (1.30 ± 0.10) μmol /g and serum (14.93 ± 1.00) μmol /g of SAP 6 h was significantly increased compared with sham operation group (P ＜ 0.05 each group).The content SO2 in the pancreas (2.31 ± 0.23) μmol /g,liver (2.22 ± 0.15) μmol /g,lung (2.17 ± 0.07)μmol /g,kidney (1.55 ± 0.15) μmol /gand serum (18.88 ± 1.56) μmol /g of SAP rats reached the peak 12Hafter treatment and was significantly higher compared with the sham operation group (P ＜ 0.05).Conclusions The increase of SO2 concentration in SAP might be,at least in our present opinion,involved into the pathogenesis of SAP rats.

Objective To investigate the progression of mild cognitive impairment (MCI) to Alzheimer's disease (AD) and the factors influencing the related changes in cognitive ability.Methods Seventy-five subjects with mild cognitive impairment (the MCI group),32 with Alzheimer's disease (the AD group) and 17 others with normal cognition (the NC group) were recruited.The Montreal Cognitive Assessment (MOCA) and the Mini-mental State Examination (MMSE) were used to assess their cognitive ability.At the same time,relevant clinical information such as their general condition and past history of disease were recorded.The subjects were followed up for 20 months on average to evaluate their annual rates of progression (APRs),and logistic regression was used to highlight any influencing factors.Results By the end of the follow-up,9 of the 75 MCI subjects had progressed to AD,with an APR of 5.25％.Thirteen cases had recovered normal cognitive functioning (97.6 per 1,000 person-years).Also,2 cases in the NC group (11.76％) developed MCI (69.1 per 1,000 person-years),but none of them had yet progressed to AD.Both hyperlipidemia and a body mass index (BMI) lower than 24 kg/m2 significantly predicted the deterioration of cognitive functioning.Heart disease was significantly correlated with cognitive improvement,and selfmanagement of cognitive function was also a significant protective factor.Conclusions Patients with MCI are at greater risk of developing AD than normal persons.Prevention and early treatment of hyperlipidemia as well as maintaining a normal BMI may delay the deterioration of cognitive functioning.Self-management of cognitive function can improve cognition.

ObjectiveTo investigate the clinical value of serum cystatin C(CysC) and urinary microalbumin(MA) in the diagnosis of early renal function injury in patients with essential hypertension.MethodsOne hundred and twenty patients with essential hypertension(hypertension group) were divided into three groups by the results of blood pressure:grade 1 with 48 cases,grade 2 with 47 cases,grade 3 with 25 cases.Thirty healthy subjects were selected as control group.Serum CysC,urinary MA and serum creatinine (Cr) were detected in all subjects.ResultsThe serum CysC and urinary MA in grade 1,2 and 3 hypertension group [(1.57 ±0.48),(2.12 ±0.72),(2.91 ± 1.09) mg/L and(18.12 ±5.43),(29.01 ±8.07),(46.06 ± 13.21 ) mg/L] were obviously higher than those in control group [ (0.71 ± 0.23 ),(9.35 ±5.17)mg/L](P＜ 0.05).The serum Cr had no significant difference between grade 1,2,3 hypertension group and control group (P ＞ 0.05 ).Serum CysC was positively correlated with urinary MA in hypertension group (r =0.613,P ＜ 0.05),serum CysC and urinary MA were both negatively correlated with estimated glomenlar filtration rate (eGFR)(r=-0.635,-0.563,P＜0.05).ConclusionsSerum CysC and urinary MA are sensitive indexes of early renal function injury in patients with hypertension.The combined determination of serum CysC and urinary MA can improve the detection rate of early renal function injury.

Objective To discuss the relationship of drip velocity of nitrate on blood pressure while treating coronary disease,in order to provide appropriate drip velocity for clinical treatment.Methods 155 patients with coronary disease using nitrate to lower blood pressure were selected.They were divided into the nitro glycerin group(85 cases) and the isosorbide mononitrate group( 70 cases) according to difference of medication.The velocity of drugs was adjusted on basis of blood pressure changes.The blood pressure changes at different drip velocities were observed and compared.Results The systolic pressure and the diastolic pressure between two groups showed no difference at 20 drops/min,but the results were the opposite at 30 drops/min.The systolic pressure and the diastolic pressure in the nitro glycerin group showed evident changes at different drip velocities,but in the isosorbide mononitrate group,these changes were not so significant.9 patients in the nitro glycerin group had headache during treatment,no headache occurred in the isosorbide mononitrate group.Conclusions Intravenous use of nitrate at a velocity of 20 drops/min is relative secure.The risk of hypotension will increase if the medication speed increases.lsosorbide mononitrate has little influence on blood pressure.