A total of 2794 diabetic patients admitted in the PLA Hospital N. 306 from 2000 to 2004 were analyzed for their in-patients cost, based on database according to the ICD-9 code and the standard forms for the investigation of medical expenditure. The average total medical cost of these in-patients Was 6557,6887,8235,9633 and ll785 RMB Yuan (1 US Dollar=8.1 RMB Yuan) from 2000 to 2004, respectively. Comparing with that in 2000, the average medical cost for these in. patients increased 5%,26%,47% and 80% from 2001 to 2004, respectively; of which 17%,19%,47% and 96% for drugs; 5%,29%,56% and 92% for the examinations. The total medical cost, drug and examination cost increased 1.01,1.14 and 1.10 times for the diabetic patients with cerebral infarction, 1.16,1.37 and 1.12 times with hypertension, and 1.124,1.11 and 1.18 times with cholecystitis and/or gallstones, as compared with their counterparts without diabetes mellitus.

Objective To compare the fibrinolysis in the patients undergoing nasal polypectomy under different methods of anesthesia.Methods Forty ASA physical status Ⅰ or Ⅱ patients,scheduled for elective nasal polypectomy,were randomized into 2 groups (n =20 each) using a random number table:propofol-based anesthesia group (group P) and sevoflurane-based anesthesia group (group S).Venous blood samples were taken before induction of anesthesia (T1),at 30 min after the beginning of operation (T2),and at the end of operation (T3) for determination of the levels of plasma cortisol,adrenocorticotropic hormone (ACTH),D-dimer (DD),tissue-type plasminogen activator (t-PA) and plasminogen activator inhibitor 1 (PAI-1).Results Compared with the baseline value at T1,the plasma cortisol and ACTH levels were significantly decreased at T2,and no significant change was found at T3 in the two groups,and there was no significant difference between the two groups.The plasma DD,t-PA and PAI-1 levels were significantly higher at T2,3 than at T1.Compared with group P,the plasma DD and t-PA levels were significantly decreased at T2,3,while the plasma PAI-1 level was increased at T2.3 in group S.Conclusion Propofol-based anesthesia provides higher degree of enhancement in fibrinolysis than sevoflurane-based anesthesia and it is more suitable for the patients undergoing nasal polypectomy.

OBJECTIVETo investigate protective effect of paeonol (Pae) on human umbilical vein endothelial cells (HUVECs)injured by hyperlipidemic serum and explore its possible mechanism.METHODS The injury model was induced by 20％ hyperlipidemic serum incubating HUVECs for 24 h.Pae 124,247 and 495.μmol· L-1 were given followed by administration of hyperlipidemic serum for 24 h.The morphological changes were observed under inverted microscope,cell survival rate was evaluated by MTT method,the nitric oxide (NO) content was measured by nitric acid reductase method and the endothelial nitric oxide synthase (eNOS) mRNA expression was determined by RT-PCR.RESULTSCompared with normal contorl group,most cells in model group split and exfoliated.However,the morphology was tending to normal level after intervention with Pae.Pae significantly improved cell viability(P ＜0.01).Compared with model group,the survival rate increased from (53.0 ±10.1 ) ％ to ( 68.4 ± 9.1 ) ％,( 84.5 ± 6.7 ) ％ and (98.1 ± 7.5 ) ％,respectively.The NO content and eNOS mRNA expression both increased greatly in Pae groups(P ＜ 0.01 ).Compared with model group,content of NO increased from 54 ± 4 to 79 ± 6,115 ± 5 and ( 136 ± 6) μmol · L- 1,respectively.The expression level of eNOSmRNA improved from 0.215 ± 0.060 to 0.451 ± 0.045,0.563 ± 0.013,0.704 ± 0.068,respectively.CONCLUSIONPae exerts protective effect on HUVECs injured by hyperlipidemic serum by increasing eNOS mRNA expression,which might therefore improve the content of NO.

Objective To discuss the indication , feasibility and curative effect of endovascular treatment for vascular injuries. Methods 7 patients with vascular injuries were treated by endovascular treatment, including 1 cases of pseudoaneurysm ,2 arteriovenous fistula , 3 closed arteriorrhexis and 1 arterial stenosis after vascular operation . All of the patients were treated by twelve stent - grafts and one introcoil stent. Results All cases were technically successful during follow - up for about 3 to 30 months. The blood flow was rebuild and the diseased region was removed effectively after stent operations. There was no extremity ischemia , hemorrhage , engorgement , stent shift ,fragmentation, angiostegnosis and reinjury appeared in these cases during follow - up. Conclusion Endovascular intervention is a new therapeutic approach with advantages of safety , efectiveness and minimal invasiveness. Its long - term eficacy needs to be further evaluated.

Objective:To construct I-Ad/IgG2b Fc baculovirus expression vector and express I-Ad/IgG2b Fc dimer fusion protein in Sf9 insect cells.Methods:I-Ad α,I-Ad β and IgG2b Fc gene sequences were amplified from BALB/c mouse lymphocytes by RT-PCR.I-Ad α and I-Ad β were connected with the leucine zipper sequence Fos and Jun respectively by overlapping PCR to form I-Ad α-Fos and I-Ad β-Jun.I-Ad α-Fos and IgG2b Fc fragments were ligated by restriction sites Xba I to form I-Ad α-Fos-IgG2b Fc recombination sequence.I-Ad α-Fos-IgG2b Fc and I-Ad β-Jun fragments were inserted to PPH and PP10,which were the downstream of the promoters in the plasmid pFastBacTMDual,to form pFastBacTMDual+[I-Ad/IgG2b Fc] recombinant plasmids.The constructed vector was identified by PCR,restriction endonuclease and sequencing.The recombinant plasmids pFastBacTMDual+[I-Ad/IgG2b Fc] was transferred into the DH10Bac competent cell to form recombinant baculovirus Bacmid+[I-Ad/IgG2b Fc].The recombinant baculovirus was transfected into Sf9 insect cells by liposome transfection reagent.After infected with Sf9 insect cells,the supernatant was collected and concentrated by PEG20000 to obtain I-Ad/IgG2b Fc dimer fusion protein.The fusion protein was detected by double-antibody sandwich ELISA and Western blot.Results:PCR,restriction enzyme digestion and sequencing confirmed that the recombinant vector pFastBacTMDual+[I-Ad/IgG2b Fc] had the correct sequence.The double antibody sandwich ELISA and Western blot showed that recombinant bacmid could successfully infect Sf9 insect cells,and the expressed fusion protein had the correct conformation.Conclusion:The pFastBacTMDual+[I-Ad/IgG2b Fc] baculovirus expression vector was successfully constructed and expressed in Sf9 insect cells,laying a foundation for the study of I-Ad-restricted T cells.

Objective To explore the value of multislice spiral computed tomography ( MSCT ) in predicting the resectability of pancreatic cancer ( PC) .Methods The MSCT images of 102 PC patients ( 62 men, mean age, 61 ±9 years;40 women, mean age, 60 ±9 years) confirmed by postoperative pathology were analyzed retrospectively .The images were analyzed and evaluated by 2 senior radiologists who were double blinded.The relationship between tumor and vessels was investigated based on consensus statement on the radiological diagnosis of PC of the Society of Abdominal Radiology and the American Pancreatic Association in 2014 .The diagnostic criterion on the resectability of PC was based on the 2015 NCCN Clinical Practice Guidelines on PC . Image analysis included the lesion location , size and density , the characteristics of pancreatic and bile ducts , relationship of tumor and adjacent vessels , the extrapancreatic findings as well as T staging and resectability.Results The locations of PC were found in the pancreatic head (n=71,69.6%), body (n=23, 22.5%) and tail (n=8, 7.8%).The long-and short-axis diameter were (28.9 ±8.8)mm and (23.8 ±8.0)mm in head, and respectively, (31.2 ±11.0)mm and (23.8 ±6.3)mm in body and tail, respectively.The imaging findings included hypo-(n=98, 96.1%) and iso-density masses (n=4, 3.9%) on pancreatic phase, intra-and extrahepatic bile duct dilation (n=63, 61.8%), main pancreatic duct cut-off with dilation (n=46, 45.1%), the pseudocyst (n=4), acute pancreatitis (n=1) and chronic pancreatitis (n=2).T staging evaluation by MSCT observed T1 (n=3), T2 (n=7), T3 (n=78) and T4 (n=14), respectively.MSCT assessment for T staging was correct in 98 (96.1%), but wrong in 4 (3.9%), which was quite consistent with pathological T staging (K=0.88, P<0.05).MSCT assessment for the resectability was correct in 98 (96.1%), but wrong in 4 (3.9%).Sensitivity, specificity, positive and negative predictive values, and area under curve of MSCT in the assessment of the resectability were 96.8%, 87.5%, 98.9%, 70.0%and 92.2%, respectively.Conclusions MSCT could improve the diagnostic accuracy for T Staging and resectability of PC .

Objective:To investigate the changes of circulating tumor cells in locally advanced esophageal squamous cell carcinoma pa-tients treated with concurrent chemoradiotherapy. The effect of these alterations on the patients’prognosis was also analyzed. Meth-ods:Circulating tumor cells were detected by immunomagnetic enrichment and fluorescence in 48 cases of locally advanced esopha-geal carcinoma patients treated with concurrent chemoradiotherapy. The dynamic changes of circulating tumor cells were compared between pre-and post-chemoradiotherapy. Moreover, the association of these changes with the clinical characteristics and two-year survival rate were analyzed. Results:The positive rate of circulating tumor cells was closely associated with the T stage, lymph node metastasis, and clinical stage (P<0.05), and the positive rates in pre-and post-chemoradiotherapy were 52.1%(25/48) and 20.8%(10/48), respectively. The difference was statistically significant (P<0.05). Kaplan-Meier analysis showed that the positive rate of circulating tumor cells predicted an adverse two-year survival rate in both pre-and post-chemoradiotherapy (P<0.05). Cox regression analysis showed that the clinical stage and circulating tumor cells after concurrent chemoradiotherapy were independent prognostic factors in the patients with esophageal carcinoma. Conclusion:Circulating tumor cells can reflect the disease progression in patients with locally advanced esophageal cancer. These cells can also predict the prognosis of esophageal cancer patients treated with concurrent chemo-radiotherapy.

Objective To discuss the risk factors of free wall rupture (FWR) in acute ST-segment elevation myocardial infarction (STEMI) patients. Methods We retrospectively reviewed all patients (n=1247) with STEMI hospitalized in CCU from January 2005 to July 2010. Results FWR occurred in 29 patients(2.3%). Of these 1247 patients, 128 (10.2%) patients received thrombolytic therapy, 623 (50.0%) patients underwent primary PCI. Compared to No-FWR group, FWR group has signiifcant differences in age (62.4±6.4 y vs. 66.6±8.3 y, P<0.05), hypertenion (29.7%vs. 21.8%, P>0.05), diabetes mellitu (55.2%vs. 23.5%, P=0.022), presence of heart failure on admission (Killip≥Ⅱ) ( 16.4%vs. 34.0%, P<0.05), Peak value of hCRP[20.33 (15.02, 81.25) vs. 43.35 (16.56, 126.78)], no-history of pervious MI (10.3%vs. 18.4%, P=0.018). Multivariate logistic regression showed that age (≥70 years old), Killip≥Ⅱ, hCRP ( > 100 mg/L) and thrombolytic therapy were independent risk factors of FWR. Conclusions STEMI patients with advanced age, Killip≥Ⅱ, hCRP and thrombolytic therapy were more vulnerable of FWR.

Objective To investigate the effects of ulinastatin on the expression of Toll-like receptor 4 (TLR4) during myocardial ischemia/reperfusion (I/R) in rats and the possible mechanism.Methods Thirty adult Sprague-Dawley rats,weighing 250-280 g,were randomly divided into 3 groups (n =10 each):sham operation group (group S),I/R group and ulinastatin group (group U).Myocardial ischemia was induced by 30 min occlusion of left anterior descending coronary artery followed by reperfusion.Ulinastatin 1 × 104 IU/kg was injected intravenously at 5 min before reperfusion in group U,while the equal volume of normal saline was given in groups S and I/R.The animals were sacrificed at 5 h of reperfusion and myocardial specimens were obtained for microscopic examination and determination of myocardial apoptosis (using TUNEL),TLR4 expression (by immuno-histochemistry) and TNF-α content (by ELIAS).The apoptotic index was calculated.Results Compared with S group,the apoptotic index,TLR4 expression and TNF-α content were significantly increased in groups I/R and U (P ＜0.05).Compared with I/R group,the apoptotic index,TLR4 expression and TNF-α content were significantly decreased (P ＜ 0.05),and the pathological changes were significantly reduced in group U.Conclusion The mechanism by which ulinastatin alleviates myocardial I/R injury is related to inhibition of TLR4 expression and reduction of inflammatory responses during early I/R in rats.

Objective To evaluate the efficacy of siege scheme of TCM for acute cerebral infarction bowel and visceral strike (block pattern). Methods Totally 110 patients were randomly divided into TCM siege scheme group (55 cases) and control group (55 cases) by randomized parallel controlled study with foresight and multicenter. The control group was treated with the standardized treatment, and TCM siege scheme group was treated with TCM siege scheme, including mild hypothermia TCM pillow therapy, TCM rectal enema, and other multiple treatments based on the standardized treatment. The Glasgow Coma Scale (GCS), the time of pulling out urine tube and nasal feeding tube, and the number of tracheotomy caused by illness changes of the two groups were compared. Results The baseline data of two groups have good comparability (P>0.05). On 10, 15 d of treatment, the number of lucid people in the TCM siege scheme group was significantly more than that in the control group (P<0.05). Compared with the control group, treatment group had less number of tracheotomy, and shorter time of success pulling out urine tube and nasogastric feeding tube (P<0.05). Conclusion TCM siege scheme can improve the consciousness of ischemic stroke in patients with acute cerebral infarction bowel and visceral strike, reduce complications, shows shorter successful pull urine tube and nasogastric feeding, and provides guarantee conditions for further rehabilitation treatment.