Objective To study the relationship between microalbuminuria and inflammation media of C-reactive protein(CRP) and interleukin-6(IL-6) in type 2 diabetes mellitus,and to explore the clinical significance.(Methods)Ninety-six patients with type 2 diabetes mellitus were divided into 3 groups according to the urine albumin excretion rate(UAER): normal albuminuria group(NA),microalbuminuria group(MA) and clinical proteinuria group(CP).The serum levels of CRP,IL-6,fasting plasma glucose,creatinine and fasting insulin were measured in all the cases. Results The levels of CRP and IL-6 in MA group were significantly higher than those in NA group(P

Objective To investigate the effects of lentiviral-mediated RNA interference (RNAi) targeting tumor necrosis factor-α(TNF)-αgene on the expression of TNF-α, interleukin (IL)-1β, IL-6 of murine macrophages RAW264.7, and the efficiency of RNAi experimental gene therapy for the murine collagen-induced arthritis (CIA). Methods The RAW264.7 macrophages were infected by lentivirus-RNAi particles, then stimulated by Lipopolysaccharides (LPS). The TNF-α, IL-1β, IL-6 expression of RAW264.7 macrophages were measured with real-time polymerase chain reaction (PCR) and enzyme linked immunosorbent assay (ELISA). CIA models were esta-blished in DBA/1 mice using bovine type Ⅱ collagen. The treatment effect of lentivirus-RNAi on CIA were observed through arthritis scores, serum TNF-α measurement and hind paw paraffin section hematoxylin/eosin staining after lentivirus-RNAi particles tail vein injection. Results The TNF-αmRNA relative expression level of lentiviral RNAi group was 0.291 ±0.021, significantly lower than that of negative control group 0.925±0.013 (t=25.4, P<0.01). The inhibition rate in mRNA levels was 68.5%. The serum TNF-α level of lentiviral RNAi group was [(249 ±11) ng/ml], significantly lower than that of negative control [(382±6) ng/ml] (t=10.31, P<0.05). The inhibition rate of protein levels was 34.7%. It had no effect on the IL-1β and IL-6 mRNA expression. On the 8th day after systemic administration, the arthritis score of lentivirus-RNAi group was 2.50±0.19, which was significantly lower than that of blank controls (3.63 ±0.18) and negative controls (3.75 ±0.16) (F=42.8, P<0.01). From now on, arthritis score of lentivirus-RNAi group and positive control decreased slowly to at least 2 weeks after treatment induction. The serum TNF-α levels of lentivirus-RNAi group and positive controls were [(35±6) pg/ml] and [(32±7) pg/ml] significantly lower than that of negative controls [(47±3) pg/ml] (t=3.03, 4.11, P<0.01) respectively. Morphological examination showed that the lentivirus-RNAi decreased CIA pathological manifestations. Conclusion Lentiviral-mediated RNAi targeting murine TNF-α gene can effectively inhibit TNF-α expression both in vitro and in vivo, which also effectively improve the CIA arthritis score. Lentiviral-mediated RNAi targeting TNF-αgene provides a potential strategy for rheumatoid arthritis (RA) treatment.

Objective Meta-analysis the efficacy and safety of Exenatide and insulin therapy oral hypoglycemic drugs effect of obesity with type 2 diabetes .Methods According to the research purpose to set up the screening of related literature and exclusion criteria; formulatethe searching strategy, through PubMed、the Chinese Biological Medicine Datebase(CBM)、 CNKI、Wanfang Data Knowledge Service Platform, VIP to retrieve all theliterature selection of efficacy and safety by Exenatide oral hypoglycemic drugs and insulin therapy of obese type 2 diabetes mellitus.Choose met inclusion exclusion criteria, the complete data information randomized controlled trial (RCT) as the research object; Apply to the international commonly used Jadad score method to evaluate quality included in the test; To process the relevant data in the test ; Apply the ReviewManager 5.1 software to analysis the extracted research data.Analysis the results and put forward conclusions.Results Participants included 11 RCT , meta analysis results showed that compared with the Exenatide, in terms of reducing fasting glucose ,insulin effect more apparent [MD = 0.35, 95％CI: (0.11, 0.59), P = 0.004)]. In control effect of glycosylated hemoglobin, there was no statistically significant difference[MD=-0.04 ,95％CI:(-0.20,0.11), P=0.58],between Exenatide and insulin. Compared with the insulin, Exenatide reduce BMI more apparent[MD=-2.77,(95％CI: -3.34,-2.20),P<0.00001]; Compared with the insulin, Exenatide reduce insulin resistance index, the effect is more obvious[MD=-1.67,95％CI:(-1.93,-1.41), P<0.00001]; Adverse reaction in the process of treatment, the insulin is more likely to lead to hypoglycemia, [OR = 0.32, 95％ CI: 0.19, 0.54), P<0.0001]; While Exenatide are more likely to lead to gastrointestinal adverse reaction [OR = 4.04, 95％ CI: 2.35, 6.93), P<0.00001).Conclusion According to the Meta-analysis: Exenatide can be used in the treatment of oral hypoglycemic drugs of adult obesity with type 2 diabetes, and obvious effects of treatment of insulin resistance, long-term results still needs a large number of samples of high quality RCT to verify.

OBJECTIVETo explore the mechanism of polypeptide extract from scorpion venom (PESV) on inhibiting angiogenesis.

METHODSThe H22 hepatoma tumor model was established by subcutaneously implanting H22 hepatoma cells into mice. The tumor-bearing mice were randomly divided into 4 groups, i.e., the control group, the high dose PESV group, the low dose PESV group, and the 5-fluorouracil (5-Fu) group, 10 mice in each group. The intervention was lasted for 14 days. The growth curve of the tumor volume was drawn and the inhibition rate calculated. Pathological changes of the tumors were observed by HE staining. The microvessel density (MVD) was detected using SP method. The protein expression levels of phosphatidylinositol 3-kinase (P13K), phosphoprotein kinase B (P-Akt), hypoxia-inducible factor-1 alpha (HIF-1 )alpha, and vascular endothelial growth factor-A (VEGF-A) were detected by immunohistochemical assay and Western blot.

RESULTSThe tumor inhibitory rate was 64.8%, 43.7%, and 32.4% in the 5-Fu group, the high dose PESV group, and the low dose PESV group. Compared with the control group, the protein expression of PI3K, P-Akt, HIF-1alpha, and VEGF-A were obviously inhibited by PESV and 5-Fu (P <0. 05,P <0. 01). The MVD also decreased in the high and low dose PESV groups (P < 0.05).

CONCLUSIONSPESV could inhibit the angiogenesis of H22 hepatoma. The mechanisms might be associated with suppressing the expression of PI3K, P-Akt, HIF-1 alpha, and VEGF-A.

Angiogenesis Inhibitors ; pharmacology ; Animals ; Cell Line, Tumor ; Fluorouracil ; pharmacology ; Hypoxia-Inducible Factor 1, alpha Subunit ; metabolism ; Liver Neoplasms ; Male ; Mice ; Peptides ; pharmacology ; Phosphatidylinositol 3-Kinases ; metabolism ; Proto-Oncogene Proteins c-akt ; metabolism ; Scorpion Venoms ; pharmacology ; Vascular Endothelial Growth Factor A

Objective To review the experience d EBUS-TBNA for staging of lung cancer and the value in diagnosing thoracic diseases in our single center.Methods The data of 343 patients who underwent EBUS-TBNA from September 2009 to August 2011 in our institution were retrospectively reviewed.There were 219 males and 124 females with an average age of (59.4 ± 13.6 ) years.Based on their primary indication,patyients were divided into three categories:group A:with known or strongly suspected lung cancer and enlarged mediastinal lymph nodes on chest radiographic examination ( short axis ≥ 1.0cm) ; group B:with enlarged mediastinal lymph nodes or mediastinal masses of unknown origin; and group C:with pulmonary parenchymal mass located close to the central airways.Results The average short axis diameter of the thoracic lesions was ( 1.94 ± 1.01 ) cm ( range from 0.5 to 8.0cm),and 2.66 punctures were performed per lesion.In group A ( n =208 ),151 patients were confirmed to have mediestinal lymph nodes metastasis while 51 showed negative results.Four patients were diagnosed as tuberculosis and two were confirmed to be stage Ⅱ sarcoidosis.37 in the 51 patients with negative EBUS-TBNA underwent thoracoscopic or thoracotomy for pulmonary resection and mediastinal lymph node dissection.Postoperative pathology confirmed that 32 patients did not have lymph nodes metastases.The diagnostic sensitivity,specificity,accuracy,positive predictive and negative predictive of EBUS-TBNA for the mediastiral staging of lung cancer were 96.8％ (151/156),100.0％ (32/32),97.3％ ( 183/188 ),100％ ( 151/151 ) and 86.5％ (32/37),respectively.In group B ( n =94),22 patients had malignancy and 72 had benign diseases.Thirteen patients received operative validation in the 23 cases which were diagnosed as proliferative lymph nodes by EBUS-TBNA,and by further operation two and three patients were confirmed as malignancy and other benign diseases respectively.The sensitivity,negative predictive value ( NPV ) and accuracy of EBUS-TBNA in distinguishing malignant mediastinal diseases was 88.0％ (22/25)、100％ (73/73) 、95.9％ (70/73)and 97.9％ (92/94),respectively.In group C( n =41 ),malignant diagnosis was achieved in 33 patients,while 4 patients confirmed as malignancy by further operations in the other 8 negative cases.The diagnostic sensitivity and accuracy of EBUS-TBNA for the diagnosis of unknown pulmonary parenchymal mass were 89.2％ (33/37) and 90.2％ (37/41),respectively.All the procedures were uneventful and no complication occurred.Conclusion EBUS-TBNA is a highly effective and safe procedure in the diagnosis of thoracic diseases and staging.of lung cancer.

OBJECTIVETo study the psychology of infertility patients from the perspective of economic sociology so as to prevent the patients from medical frauds in seeking medical treatment.

METHODWe investigated 902 infertility patients of the Third Hospital of Peking University from September 2005 to January 2006 using a randomized questionnaire.

RESULTSOf the total number, 84.4% had education below college level; the majority had a low monthly family income, 36.6% below Y1,000, 19.7% from Y1,000 to Y2,000, 16.5% from Y2,000 to Y3,000, 7.8% from Y3,000 to Y4,000 and 19.4% above Y4,000; 88.7% had a strong desire for a child; 60.3% were psychologically stressed. As for the advertisements for the treatment of infertility, 50.2% of the patients disbelieved them, 6.2% wanted to have a try and about 43.6% accepted them to be true. Regarding the treatment in individual hospitals, 55.2% disbelieved in it, 5.8% wanted to try it and about 39.0% believed in it.

CONCLUSIONInfertility patients of low economic status usually have a lower educational level but a higher desire for children, and therefore are more likely to be the victims of medical frauds and more psychologically stressed. It calls for our attention how to provide them with medical help.

Educational Status ; Health Knowledge, Attitudes, Practice ; Humans ; Infertility, Male ; economics ; psychology ; therapy ; Male ; Socioeconomic Factors ; Surveys and Questionnaires

Objective To explore the feasibility and advantages of establishment of retrograde amnesia (RA) model in mice with such methods as electric shock,anoxia,and anesthesia.Methods Kunming mice were divided into control group and 5 treatment groups,including treatments with electric shock,anoxia,propofol,electric shock+anoxia,electric shock+propofol.At first,every group received the same dark avoidance training to establish the behavior of dark avoidance,then the 5 treatment groups were treated with the methods of 120-180 V electric shock,anoxia within a closed container,intraperitoneal injection of 0.3 mL of propofol,electric shock+anoxia,electric shock+propofol,respectively.Next day,step-in latency (Lat) of mousse were measured with the dark chamber in all groups and changes of dark avoidance behavior were analyzed.Results The Lat in the control group 24 h after dark avoidance training was (111.7+17.2) s.In the treatment groups of electric shock,anoxia,electric shock+anoxia,electric shock+propofol,significantly shortened Lat,which limited to 30 s in some mice 24 hatter corresponding treatment,was observed as compared with that in the control group (P<0.05).Except for the propofol treatment group did not changed obviously,the incidence rate of shortened Lat was 43.8%,45.4%,66.7% and 60% in the electric shock treatment group,anoxia treatment group,electric shock+anoxia treatment group,and electric shock+propofol treatment group,respectively.On the 5th and 8th d,some mice recovered from the shortened Lat.Conclusion RA model can be established successfully in some mice treated with electric shock,anoxia,electric shock+anoxia,electric shock+propofol and the highest modeling rate was found in the electric shock+anoxia treatment group.RA can recover in the later stage in some modeling mice and use of pmplfol alone call not induce RA.

BACKGROUNDTracheostomy should be considered to replace endotracheal intubation in patients requiring prolonged mechanical ventilation (MV). However, the optimal timing for tracheostomy is still a topic of debate. The present study aimed to investigate whether early percutaneous dilational tracheostomy (PDT) can reduce duration of MV, and to further verify whether early PDT can reduce sedative use, shorten intensive care unit (ICU) stay, decrease the incidence of ventilator associated pneumonia (VAP), and increase successful weaning and ICU discharge rate.

METHODSA prospective, randomized controlled trial was carried out in a surgical ICU from July 2008 to June 2011 in adult patients anticipated requiring prolonged MV via endotracheal intubation. Patients meeting the inclusion criteria were randomly assigned to the early PDT group or the late PDT group on day 3 of MV. The patients in the early PDT group were tracheostomized with PDT on day 3 of MV. The patients in the late PDT group were tracheostomized with PDT on day 15 of MV if they still needed MV. The primary endpoint was ventilator-free days at day 28 after randomization. The secondary endpoints were sedation-free days, ICU-free days, successful weaning and ICU discharge rate, and incidence of VAP at day 28 after randomization. The cumulative 60-day incidence of death after randomization was also analyzed.

RESULTSTotal 119 patients were randomized to either the early PDT group (n = 58) or the late PDT group (n = 61). The ventilator-free days was significantly increased in the early PDT group than in the late PDT group ((9.57 ± 5.64) vs. (7.38 ± 6.17) days, P < 0.05). The sedation-free days and ICU-free days were also significantly increased in the early PDT group than in the late PDT group (20.84 ± 2.35 vs. 17.05 ± 2.30 days, P < 0.05; and 8.0 (interquartile range (IQR): 5.0 - 12.0) vs. 3.0 (IQR: 0 - 12.0) days, P < 0.001 respectively). The successful weaning and ICU discharge rate was significantly higher in early PDT group than in late PDT group (74.1% vs. 55.7%, P < 0.05; and 67.2% vs. 47.5%, P < 0.05 respectively). VAP was observed in 17 patients (29.3%) in early PDT group and in 30 patients (49.2%) in late PDT group (P < 0.05). There was no significant difference between the two groups in the cumulative 60-day incidence of death after randomization (P = 0.949).

CONCLUSIONSThe early PDT resulted in more ventilator-free, sedation-free, and ICU-free days, higher successful weaning and ICU discharge rate, and lower incidence of VAP, but did not change the cumulative 60-day incidence of death in the patients' anticipated requiring prolonged mechanical ventilation.

Aged ; Aged, 80 and over ; Critical Illness ; Female ; Humans ; Male ; Middle Aged ; Respiration, Artificial ; Time Factors ; Tracheostomy ; methods

Background Tracheostomy should be considered to replace endotracheal intubation in patients requiring prolonged mechanical ventilation (MV).However,the optimal timing for tracheostomy is still a topic of debate.The present study aimed to investigate whether early percutaneous dilational tracheostomy (PDT) can reduce duration of MV,and to further verify whether early PDT can reduce sedative use,shorten intensive care unit (ICU) stay,decrease the incidence of ventilator associated pneumonia (VAP),and increase successful weaning and ICU discharge rate.Methods A prospective,randomized controlled trial was carried out in a surgical ICU from July 2008 to June 2011 in adult patients anticipated requiring prolonged MV via endotracheal intubation.Patients meeting the inclusion criteria were randomly assigned to the early PDT group or the late PDT group on day 3 of MV.The patients in the early PDT group were tracheostomized with PDT on day 3 of MV.The patients in the late PDT group were tracheostomized with PDT on day 15 of MV if they still needed MV.The primary endpoint was ventilator-free days at day 28 after randomization.The secondary endpoints were sedation-free days,ICU-free days,successful weaning and ICU discharge rate,and incidence of VAP at day 28 after randomization.The cumulative 60-day incidence of death after randomization was also analyzed.Results Total 119 patients were randomized to either the early PDT group (n=58) or the late PDT group (n=61).The ventilator-free days was significantly increased in the early PDT group than in the late PDT group ((9.57±5.64) vs.(7.38±6.17) days,P ＜0.05).The sedation-free days and ICU-free days were also significantly increased in the early PDT group than in the late PDT group (20.84±2.35 vs.17.05±2.30 days,P ＜0.05; and 8.0 (interquartile range (IQR):5.0-12.0)vs.3.0 (IQR:0-12.0) days,P ＜0.001 respectively).The successful weaning and ICU discharge rate was significantly higher in early PDT group than in late PDT group (74.1％ vs.55.7％,P ＜0.05; and 67.2％ vs.47.5％,P ＜0.05respectively).VAP was observed in 17 patients (29.3％) in early PDT group and in 30 patients (49.2％) in late PDT group (P ＜0.05).There was no significant difference between the two groups in the cumulative 60-day incidence of death after randomization (P=0.949).Conclusions The early PDT resulted in more ventilator-free,sedation-free,and ICU-free days,higher successful weaning and ICU discharge rate,and lower incidence of VAP,but did not change the cumulative 60-day incidence of death in the patients' anticipated requiring prolonged mechanical ventilation.

Objective To investigate the characteristics of MRSA colonization and their influence to the prognosis of patients in respiratory intensive care unit (RICU),so as to provide the basis for the caring of the RICU patients.Methods A prospective study included 246 cases of patients admitted to RICU in our hospital during Jan 2010 to Neb 2011.Swab specimens from nares,pharynx,axillae,groin,chest and hands of the patients were collected and cultured at the first day in RICU,and then repeated every 3 days.The patients were divided into MRSA colonization group (n =30) and MRSA non-colonization group (n =216) according to MRSA culture results.Results The MRSA colonization rate was 12.19％ in RICU patients,including 16 cases of hospital-acquired colonization.No significant difference was found in the gender,the APACHE Ⅱ score and APACHE Ⅲ between MRSA colonization group and the MRSA non-colonization group (P ＞ 0.05).The mean age in MRSA colonization group was significantly greater than that of the MRSA non-colonization group [(81.13 ± 6.86) vs (74.78 ± 11.89) ; t =2.955,P =0.003)] ; The number of hospitalization and the mortality in one year of the MRSA colonization group was significantly more than those of MRSA non-colonization group [(1.83 ±1.216) vs (1.06 ±0.257),40.0％ vs 16.7％ ;t =2.998,x2 =9.132;P＜0.01)].MRSA was mainly colonized in nares.Conclusions MRSA colonization has an important impact on the prognosis of RICU patients.More than 50％ of MRSA colonization cases are hospital-associated,suggesting that we should strengthen the bedside care,prevention of cross infection.