Objective To explore the medical characteristics of end of-life care in elderly inpatients for improving their quality life and distributing appropriately the end-of-life medical expenditure.Methods The historical cohort study was used to survey the characteristics of admission disease,diagnosis and treatment and hospitalization expenditure.The patients were divided into the elderly group (age 60 years and over,228 cases) and control group (age ＜60 years,156 cases).Results There was a statistically significant difference in the admission disease proportion between elderly group and control group (x2 =91.345,P ＜ 0.0001),but the malignant tumor proportion had no differences between the two groups (x2 =9.761,P=0.082); the operation proportion in elderly group (16 cases,7.0％) was lower than in control group (28 cases,17.9％) ; the hospital stay time was longer in elderly group (12.5 days) than in control group (5 days),and the salvage times of elderly group (3 times)was more than that of control group,but the usage of medical device had no differences between the two groups (x2 =0.029,P =0.864).The hospitalization expenditure,medicine expenditure,western medicine expenditure,traditional Chinese medicine expenditure,and medicine proportion were higher in elderly group (15356.0 yuan,6448.3 yuan,5070.0 yuan,895.5 yuan,40.2％,respectively) than in control group.Conclusions Most of the elderly patients with chronic diseases at the end of life have no indication of operation and rely on medicine to maintain life for a long time,and the end-of-life medical expenditure is higher.

Type 1 diabetes mellitus ( T1DM),arising through a complex interaction of immune,genetic and environmental factors,results from autoimmune destruction of insulin-producing β cells.In up to one third of patients the autoimmune attack is not limited to β cells,but expands into autoimmune polyendocrine syndromes(APS).APS are characterized by functional insufficiency of multiple endocrine organs due to an immunologically mediated destructive process.APS can commonly be divided into three types,including APS type Ⅰ,APS type Ⅱ and immune dysregulation,polyendocrinopathy,enteropathy,X-Linked syndrome (IPEX).Here,we discuss the susceptible factors,clinical manifestation,screening and treatment of APS,with the perspective of the clues they can offer to the pathogenesis and treatment of type 1 diabetes mellitus.

Anti-Bacterial Agents ; poisoning ; Education, Veterinary ; Ethers ; poisoning ; Veterinary Drugs ; poisoning

Objective Based on the mathematical models established in Department of Thoracic Surgery of Peking University People's Hospital for predicting malignant probability for solitary pulmonary nodules ( SPN),another continuous 145 patients with SPN were assessed to verify the accuracy of the model comparing with foreign models (Mayo model and VA model).Methods A retrospective cohort study in our institution included 145 patients with definite pathological diagnosis of SPN from Oct 2009 to Aug 2011,72 males and 73 females,average age (59.4 ± 12.2 ) years old.Clinical data included age,gender,course of disease,symptoms,history and quantity of smoking,time of smoking cessation,history of tumor,family history of tumor,tumor site,diameter,calcification,speculation,border,lobulation,traction of pleural,vascular convergence sign,and cavity.These raw data were incorporated into our model,Mayo model and VA model,the probability of malignant in every patient was calculated separately according to methods described before.The sensitivity and specificity of these 3 models were evaluated then.Afterwards,calibration of the 3 models was assessed by the Hosmer-Lemeshow (H-L) test.Discrimination was tested by calculating the area under curve ( AUC ) after the receiver operating characteristic (ROC) curve was drawn.Results 32.4％ (47 in 145 patients) of the nodules were malignant,and 67.6％ (98 in 145 patients) were benign in this group.Verified the accuracy of our model with sensitivity of 94.9％,specificity of 66.0％,positive predictive value of 85.3％ and negative predictive value of 86.1％.The H-L test showed good fitting in all models ( P ＞0.05 ).The AUC for our model was 0.874 ±0.035,and 0.784 ± 0.041 in Mayo model (P =0.004 compared to our model),0.754 ± 0.041 in VA model (P =0.002 compare to our model).And,there was not significant statistical difference between Mayo model and VA model (P ＞0.05 ).Our model has the best precision indexed by AUC,which were statistically significant differential compared with Mayo model and VA model.Conclusion The model established by our center has superior value than foreign counterparts in predicting the probability of malignant or benign in patients with SPN.

Objective To investigate the possible pathogenesis of type 2 diabetes mellitus (T2DM) combined with Alzheimer's disease (AD). Methods Wistar rats were randomly divided into control, T2DM, AD and T2DM +AD groups. The blood glucose levels were assayed, and the behavior changes were tested by Morris water maze. The glycogen synthase kinase-3β (GSK-3β) and hyperphosphorylation of tau protein were detected by immunohistochemistry staining. Results Compared with the control rats, the learning and memory abilities were weakened significantly in the model rats (F=28. 65, P<0.001). The expression of GSK-3β was higher in T2DM + AD group (4319. 02±653. 24) than in AD group (304. 39 ± 175. 83), T2DM group (540.43 ± 558.49) and control group (315. 56 ± 91. 64, H=19. 335, all P<0. 01). The level of hyperphosphorylation of tau protein was significantly increased in T2DM + AD group (8583. 81 ± 2236. 11) and AD group (2799. 61±1070. 02) than in control group (252. 02 ± 58. 37) and T2DM group (287. 75 ± 192. 53, H=32. 950, P< 0.001). There was no significantly difference of hyperphosphorylation of tau between T2DM group and control group (H = 32. 950, P>0. 05). Conclusions The increasing of GSK-3β activity in T2DM may be caused by hyperphosphorylation of tau.

Objective To explore the changes of the serurn cardiac enzymes in patients with acute massive pulmonary thromboembolosm(PIE),sub-massive PTE and non-massive FIE between pre-therapy and past-therapy and its relationship.Method The prospective multi-centres trial included 519 patients with confirmed PTE from 24 joint hospitals in Beijing,consisting of 54 massive FIE,195 sub-massive PTE and 270 non-massive PIE.Thrombolytic treatment was used in massive and sub-massive PTE patients with employment of urokinase and recombinant tissue plasminogen activator(rt-PA),and anti-coagulative therapy with unfractionated heparin and low molecular heparin was used in non-massive PTE.Results(1)The values of serum CPK and LDH in massive PTE patients before therapeutical intervention were obfiously higher than those in sub-massive and non-massive PTE patients(P<0.01);(2)Of 45 patients with high pulmonary pressure,24(54.4%)patients had high serum LDH(P<0.01).Of 169 patients with right ventrieular dysfunction,68(40.2%)ones has high serum LDH(P=0.049).Of 48 patients suffered from poor prognosis,15(30.8%)ones had high serum.LDH(P=0.039).Conclusions ①The vMues of serum CPK and LDH in acute PTE patients increase without elevation of CK-MB.②Serum LDH associates with pulmonary presure,right ventrieular function and prognosis.

Objective To observe the changes of STAT3 signaling transduction pathway and autophagy activity in human glomerular mesangial cells cultured in high glucose, as well as the effect of STAT3 on autophagy, exploring whether SAT3 further influence extracellular matrix proteins type IV collagen secretion through the regulation of autophagy. Methods Culture human renal mesangial cells under different conditions, STAT3 pathway was inhibited with specific blocking agent S3I?201 and siRNA respectively. The experiment was divided into: (1) Control group: normal glucose concentration; (2) High glucose group: divided into 12 h, 24 h, 48 h, 72 h incubation group. (3) High glucose+S3I?201 group: pretreated cells with 30 μmol/L S3I?201 (Selleck S1155) for 1 h, then incubation with high glucose for another 24 hours. (4) High glucose+STAT3?siRNA group: siRNA transfection firstly, then incubation with high glucose for 24 hours. (5) High glucose+S3I?201+3?MA group: pretreated cells with 2 mmol/L 3?MA (Selleck S2767) and 30 μmol/L S3I?201 for 1 h, then incubation with high glucose for another 24 hours. Western blot was employed to detect the protein of STAT3, p?STAT3 and autophagy related protein LC3, p62 expressions. The changes of autophagosome quantity was observed with transmission electron microscope. The extracellular matrix protein collagen IV expression was measured with ELISA. Results Compared with the control group, glomerular mesangial cells cultured with high glucose for 24h, the expressions of STAT3 and p?STAT3 increased (P<0.01), while the expression of autophagy related proteins LC3II/LC3I decreased. The expression of p62 increased and the number of autophagosome reduced under transmission electron microscope, which all indicated the decrease of autophagy activity (P<0.05). Blocking STAT3 signaling pathway with S3I?201 and STAT3?siRNA respectively, compared with high glucose group, LC3II/LC3I was up?regulated and p62 was down?regulated, and the number of autophagosome was increased significantly, which all indicated the increase of autophagy activity (P<0.05). Extracellular matrix proteins collagen IV expression of cells cultured with high glucose was higher than the control group (P<0.05), and the application of S3I?201 blocking STAT3 pathway caused type IV collagen expression to decrease (P<0.05). The application of the autophagy inhibitor 3?MA could convert the result and lead to an increase of type IV collagen expression (P<0.01). Conclusions High glucose could active STAT3 signaling pathway of human renal mesangial cell and increase STAT3, p?STAT3 expression. High glucose could inhibit autophagy activity of human renal mesangial cells. Inhibition of STAT3 pathway activation may reduce the inhibitory effect of high glucose on autophagy of human renal mesangial cells. High glucose leads to an increase of type IV collagen secretion of human glomerular mesangial cells. The activation of STAT3 pathway may increase type IV collagen secretion through negative regulation of autophagy, which eventually leads to diabetic nephropathy.

Objective To demonstrate the frequency changes in immune cells on secreting interleukin-10 (IL-10),interferon-? (IFN-?),tumor necrosis factor-? (TNF-?) and interleukin-4 (IL-4) under the stimulation of a mimic 7-amino acid peptide of HCV HVR1 (7P),and to explore the mechanism of such changes. Methods The peripheral blood mononuclear cells (PBMCs) were isolated from healthy people and co-cultured with 7P. Intracellular cytokine staining was performed using antibodies against IL-10,IFN-?,TNF-? and IL-4. The related cells were harvested on a FACSCalibur flow cytometer,and then analyzed with FACSCalibur software. Results Compared to the controls,the frequency of immune cells secreting IFN-? was significantly increased in both CD4+CD8-,CD4-CD8+ T cells and NK,NKT cells (P

Objectives To explore the process and regularity of graft after vascularized bone allograft. Methods An adult rabbit model of massive femoral defect was established and reconstmcted with vascularized bone allograft based by laterial rotating femoral vessel.The experiments were carried out in two groups,the experimental group(vascularized bone allograft)and the control group(nonvascularized bone allograft).Then observation on periosteum,cortex and marrow was performed after operation containing in ink-infused specimen. Results The revascularization in the experimental grouD was observed synchronicly on periosteum,cortex and marrow after operation,while the phenomenon of vascularization took place from periosteum to marrow in the control group.The density of micro-vessel in experimental group were 10.0±1.8,15.8±1.5 and 13.8±1.5,13.8±1.5 respectivly after 2,4,8 and 16 weeks.and those were 2.8±0.8,6.0±0.9,5.5±1.0,6.0±1.1 in control group.The ink-infused experiment demonstrated a better revascularization in the experimental group. Conclusion The vaseularization can promote revascularization of graft during bone allograft.

Objective To evaluate the efficacy and safety of intravenous thrombolysiswith urokinase combined with emergency interventional therapy acute myocardial infarction(AMI).Methods 128 patients with AMI were randomized to thrombolysis plus PCI group and primary PCI group,the patency rate of infarct related artery(IRA) before intervention,the procedural success rate,the incidence of bleeding complications and acute ischemic events during hospitalization and the left ventricular ejection function(LVEF) measured by echocardiography before discharge were compared.Results The IRA patency rate in the thombolysis plus PCI group(65.7%) was significantly higher than that in the primary PCI group(24.3%)(P