The pathogenesis of children's primary nephrotic syndrome has not been completely clear at present.In the past few years,The polymorphism of these genes,such as angiotensin-converting enzyme gene,apolipoprotein E gene,platelet-activating factor acetylhydrolase gene,human histocompatibility leukocyte antigen gene,glucocorticoid receptor gene and cytokine gene,ect have been discovered that were significantly correlated with susceptibility,pathological progress,steroid response,disease recurrence and prognosis of primary nephrotic syndrome.This article reviewed the research progress of PNS and gene polymorphism.

Pulmonary arterial hypertension is the result of a variety of heart,lung disease and finally leads to right heart failure and death.Pulmonary arterial hypertension is characterized by the progressive increasing of artery pressure and the gradually increasing of pulmonary vascular resistance,and its pathogenesis has not been fully elucidated.Recent studies have found that transforming growth factor beta/bone morphogenetic protein pathway plays an important role in pulmonary arterial hypertension.The research about transforming growth factor betal bone morphagenetic protein pathway provides a new theoretical basis for the prevention and treatment of pulmonary arterial hypertension.This review focuses on progress of transforming growth factor beta/bone morphogenetic protein pathway and genetic mechanisms of pulmonary arterial hypertension.

Objective To investigate the clinical risk factors of diabetic ketoacidosis (DKA ) combined with elevated serum amylase(AMS). Methods Totally 263 patients with DKA were enrolled in our study. They were divided into 2 groups according to the level of AMS:DKA with normal AMS (DKA,n=188);DKA with elevated AMS(HAMS,n = 75 ). HAMS patients then were divided into two subgroups according to the diagnosis with acute pancreatitis(AP)(HAMS+ AP,n = 25 )and without AP (HAMS,n = 50 ). TG,FPG and AMS were measured and analyzed with univariate analysis and multivariate analysis. Results HAMS group patients had a ratio of 28.5％ with elevated AMS and 9.5％ with AP.HAMS group had higher FPG,TG,HbA1 c,Na+ ,osmolality,BUN and Scr than DKA group(P <0.05).The levels of FPG,TG,osmolality,BUN and the time of CO2 CP recovery in HAMS+AP subgroup were all significantly higher than those in HAMS patients without AP (P < 0.05 ). Correlation analysis showed that HAMS was positively correlated with TG,FPG,Na+ ,Osmolality and BUN(P <0.05).Logistic regression analysis showed that hypertriglyceridemia was the independent risk factor of DKA combined with HAMS(OR 1.244,P <0.01),and was the independent risk factor of DKA combined with AP(OR 1.211,P <0.05). Conclusion Hypertriglyceridemia is the related risk factor of DKA combined with HAMS and AP. This study provides a theoretical basis to early screen patients with hyperamylasemia in DKA.

Objective To understand the current situation of smoking and quitting smoking in patients with cardiovascular disease. Methods 184 cases of inpatients or outpatients with cardiovascular disease treated in the First People's Hospital of Kunming were surveyed about quitting smoking, and the smoking and smoking cessation-related clinical features of patients with cardiovascular disease were analyzed. Results ( 1) Cardiovascular diseases in smokers was male-dominated (100%), mainly hypertension and/or coronary heart disease (179, 97.3%) . (2) Average age of starting smoking was 21.5, 97.8%of patients had smoked more than 10 years, with an average of 35.1 ±13.4 years, 69.6% of patients smoked ≥10 cigarettes/day, with an average of 16.3 ± 10.1 cigarettes/day, 65.8%of patients were in the low level of nicotine dependence, 81.5%of the patients thought that quitting smoking was important, 76.1% had quitting smoking ideas, 67.4% had confidence in the success of quitting smoking, 50.5%thought that it was difficult to quit smoking, 127 (69%) patients had seriously quit smoking. (3) 65 cases (51.2%) who seriously quit smoking had succeeded, 54 patients (83.1%) received varying degrees of medical staff advised to quit smoking, 62 cases (48.8%) in relapse, only 34 patients (54.8%) accepted medical personnel advised to quit. Two sets of chi-square test, p=0.000, prompted difference was statistically significant. Relapse reasons were pressure, craving and around other smokers. Conclusions Smoking patients with cardiovascular disease are mainly constituted by male patients with hypertension and/or coronary heart disease. Most of the patients recognize that quitting smoking is important, and have idea and seriously quit smoking. However, lack of confidence and smoking which has also become a lifestyle significantly affect the success of smoking cessation. The medical staffs' recommending smoking cessation persuasion can largely improve the success of smoking cessation for patients.

Objective: To analyze the present situation of the management of large-scale instruments in a medical school and give some reasonable suggestions. Methods: Through the research on the use of 85 large-scale instruments in our university, we tried to find out the methods of improving the utilization ratio of large-scale instruments. Results:There are many reasons of the poor management and low utilization rate of large-scale instruments in medical schools. Conclusion: Taking some measures could effectively improve the utilization rate of large-scale instruments in medical schools, such as simplifying the working procedure, solving the operating and repair expenses, strictly controlling argumentation, drawing up scientific evaluation and incentive measures and so on.

Objective To explore the effect of immobilization with plaster cast applying in children's rehabilitation after knee arthroscopic surgery,and discuss the clinical significance of immobilization with plaster cast in children's rehabilitation after knee arthroscopic surgery.Methods A total of 72 objectives suffered from knee joint diseases were chosen and received knee arthroscopic surgery from January 2013 to November 2014.They were classified into the experimental group and the control group with the random digit table with 36 patients in each group.The control only underwent the regular rehabilitation exercise.The experimental group was given fixation with plaster caster before they got rehabilitation exercise.The three indexes such as pain degree,the compliance of children knee function exercise and the range of knee motion in different time courses were compared after operation.Results The VAS pain scores of the experimental group and the control group were (2.12±0.70),(2.37±0.61) respectively with statistical significance,P＜0.05.On the third day,one week and two weeks after operation,the complete compliance of children with knee function exercise was 83.3％ (30/36) vs.8.3％ (3/36),97.2％ (35/36) vs.22.2％ (8/36),97.2％ (35/36) vs.22.2％ (8/36) in the experimental group and the control group,Z values were-6.343,-6.400,-6.400,P＜ 0.01.On the second,third and fourth weeks after operation,the good rates of knee motion range in the experimental group and the control group were 50.0％ (18/36) vs.16.7％ (6/36),94.4％ (34/36) vs.83.3 (30/36),97.2％ (35/36) vs.81.6％ (31/36),Z values were-3.345,-2.861,-2.012,P＜0.01.Conclusions The use of immobilization with cast plaster in children's rehabilitation after the knee arthroscopic operation could significantly relieve the pain brought by the surgery,as well as increase the level of appliance of knee function exercises and improve the range of knee motion greatly.Therefore,it could help children to restore the knee function earlier and furthermore to promote life quality after receiving knee arthroscopic surgery.

Allogeneic peripheral blood stem cells transplantation is the most effective method for maligant hematological disease. The author reviewed the indication of acceptance of HLA mismatch kinds and the prediction of the results by selecting the measures such as pretreatment,mobilization,stem cells disposal,immunity reconstruction,graft failure management in order to improve the engraft rate.

Objective To investigate the incidence of postoperation constipation in patients who experienced thoracolumbar fractures screw fixation surgery.Methods A prospective cohort study was performed by investigating 99 cases who experienced thoracolumbar fractures screw fixation surgery.The patients were followed up for 1 month.The postoperative constipation relief situation was observed.Kaplan-Meier method was used to draw a plot of survival,Cox proportional hazards regression model analysis was adopted for single factor and multiple factors analysis and the prediction model of constipation relief after surgery was established.Results The trend of postoperative constipation relief of patients showed a trend of first increased and then decreased,the number of cases reached high peak on the second week,the constipation relief median time was (14.00±0.76) days.Cox multiple factors regression analysis showed that prediction function model of postoperative constipation relief was h(t)=[h0(t)]e(-0.826X1+0.353X2+0.381X3-1.404X4).Conclusions There was a high incidence of constipation in patients with thora-columbar fractures after surgery and it is difficult to relieve,clinical nurses should pay more attention to the influencing factors of postoperative constipation relief and help patients reestablish normal bowel movement as soon as possible.

The efficacy and safety of pioglitazone in combination with insulin in type 2 diabetic patient were evaluated. CENTRAL, MEDLINE, EMBASE, CBM, CNKI(up to September 2014) were searched by computer. The quality of included randomized controlled trials(RCTs)was assessed according to the Cochrane Collaboration system review, and then meta-analysis was performed using Stata 12. 0. A total of 9 RCTs were included. The results of meta-analyses showed that HbA1C value was lower in the group taking pioglitazone plus insulin than in the group taking insulin without pioglitazone[standard mean difference -0. 48, 95% CI( -0. 55, -0. 40),I2 = 0. 0% ,P = 0. 531], but there were more patients with hypoglycaemic in the pioglitazone plus insulin groups than with insulin without pioglitazone[relative risk 1. 33, 95% CI(1. 21, 1. 46), I2 =75. 4% , P=0. 00].

The standardized resident training is an important and necessary way to cultivate high-quality medical talents.The goals between clinical and imaging residents in standardized training of ultrasound department are different.For clinical residents,the purpose is to understand the ultrasound images of various common diseases,combine clinical manifestation with ultrasound images,and improve the level of clinical diagnosis and treatment.For imaging residents,the goal is much higher and stricter;they need to master solid ultrasonic knowledge,independent operational and diagnostic ability,in order to provide reliable and accurate ultrasonic diagnosis.We individually design the teaching plan and methods in ultrasound department,in order to improve teaching efficiency and quality.