Objective To investigate the correlation between the-308 site,-238 site gene polymorphism of TNF-αa promoter region in hypemricemh and its metabolic phenotype.Methods HUA patients 188,normal people(NHU)51,the-308G/A site single nu-cleofide polymorphism of TNF-a gene promoter region was decided by Polymerase chain reaction-restriction fragment length polymor-phism(PCR-RFLP)method.The level of serum uric acid is detected by uricase.blood glucose by glucose oxidase.Selective inhibition assay for total cholesterol,triglyceride and high-density lipoprotein cholesterol.All these tests were complted within three hours afterextraction.Keep blood samples at-20℃ to detect the concentration of insulin using immunoradiometrie assay.HUA patients 35.NHU 39,the -238G/A site single nucleofide polymorphism of TNF-a gene promoter region was decided by the same method.Results By smdying two single nucleotide polymorphism,the GA+AA frequency of-308 site(23.94%)in HUA was significantly higher than NHU(11.76%)(P=0.0001);the genotype frequencies of GA and GG in-238 site had no significant difference between the two groups(P=0.08).Meanwhile,comparing GA+AA genotype and CG group of-308 site,waist-hip ratio,systolic and diastolic blood pressure,uric acid,triglycerides differences were statistically significant(P=0.05-0.01);the difference in-238 site between the two genotypes waft no significance.Conclusion The results of this study show-308A carriers of TNF-α promoter region in HUA individual is correlated with hyperuficemia and its metabolic phenotype.

Objective To investigate the relationship between serum visfatin levels and glycometabolism in gestational diabetes mellitus(GDM). Methods 80 cases pregnant women were divided into two groups: GDM group and normal glucose tolerance group(control group). The levels of serum visfatin、fast insulin(FIN)、fast plasma glucose(FPG)、1h、2h、3h plasma glucose after glucose loading(1hPG、2hPG、3hPG )were measured. Insulin resistance index(HOMA-IR) was calculated. Results (1)The levels of visfatin、FPG、1hPG、2hPG、3hPG、HOMA-IR、FIN were significantly higher in GDM group than control group(P＜0.01). (2)There was a positive correlation between visfatin and HOMA-IR and 2hPG(P＜0.01). Multiple regression analysis showed that 2hPG was independent related factor. Conclusion Increased serum levels of visfatin represents a compensatory mechanism aimed at high glucose levels in women with GDM.[Key Words] Visfatin;Diabetes;Gestational;Insulin resistance

Objective To assess the predictive value of FBG concentration in-hospital outcome in the old patients with AMI.Methods 256 old patients (≥60 years old) with AMI precluding that with history of diabetes were divided into two groups according to serum FBG level:group A,n = 136,FBG ≥7.0mmol/L;group B,n = 120,FBG < 7.0mmol/L FBG concentrations after 7 days,mortality and total cardiac affairs in-hospital were recorded. Results:Among the two group,there were no significance in age,history of hypertension,hyperlipdemia. Compared with group B,the patients with high FBG levels in 7th day were more than group A, about 21% of group A(P< 0.05). Numbers of disease vessels were more than group A(P < 0.05). Cardiac shock,in-hospital mortality and total cordial affairs were significanfly higher in group A(12%vs0% in cardiac shock, 12%vs4% in mortality ,61%vs34% in MACE)(P< 0.05). Conclusion A part of the old patient with high FBG concentrations and AMI have impaired glucose metabolism, admission glucose levels are predictive for in hospital mortality and total cardial affairs.

Objective To compare the clinical features and severity of thoracoabdominal combined injuries(TACI) and thoracoabdominal multiple injuries(TAMI) so as to guide the diagnosis and management of trauma. Methods A total of 167 cases of chest trauma complicated by abdominal trauma were reviewed and divided into two groups. Group TACI(132 cases) was associated with diaphragmatic rupture but group TAMI(35 eascs)not. The injury features and the clinical characteristics of both groups were analyzed and the trauma severity of two groups e-valuated by trauma score system. Results The overall mortality was 9.6 %(16/167)of all the cases. The mortality was 14.3% in group TACI (5/35)and 8.3% in group TAMI(11/132). There was no significant difference in revised trauma score(RTS) and thoracic Abbreviated Injury Scale(MS) between the two greups(P> 0.05),but the patients in the TACI group had higher Glasgow Coma Scale(C, CS)and abdominal AIS (P < 0.05), and the patients in the TACI group had higher injury severity scale (ISS) (P < 0.01). Conclusion TACI and TAMI have differ-ence in clinical characteristics,injury severity and treatment results. So it is necessary to take different measurements to reduce the complica-tions and improve the prognosis.

Objective To explore the clinical significance of combined detection of anti-nucleosome(AnuA),anti-SM,anti-double-stranded DNA(ds-DNA),anti-ribosomal P protein(ARPA)antibodies in systemic lupus erythematosus(SLE). Methods 186 SLE patients and 89 rheumatic diseases patients were studied. Latter included. Results Tour kinds of masculine gender rates(86.5%)of antibody consociation ex-aminations were high to examine in the any and single item antibody in the SLE(62.7%, 50.0%, 28.4%, 15.7%)and were 9.0%, 11.2%,5.6%, 2.2% respectively in control groups. They were markedly higher than those of control groups(P< 0.05). The sero-positive rate of ds-DNA an-tibody was markedly higher than anti-SM antibody and ARPA in SLE patients with negative AnuA(P< 0.05). The sero-positive rate of AnuA was markedly higher than other two antibody in SLE patients with negative ds-DNA antibody ,anti-SM, antibody and ARPA respectively(P< 0.05). Conclusion Combination of AnuA,anti-SM,ds-DNA and ARPA antibodies can significantly improve the precision in diagnosis of SLE.

Objective To evaluate the efficacy,safety and points of Nursing care of intravenous anesthesia with remifentanil and propefol for painless gastroscope. Methods 180 patients scheduled for painless gastroscope were randomly allocated into remifentanil group and fentanyl given a bolas injection of fentanyl at 1.0 μg/kg intravenously. One minute later,all the patients were given a loading dose of propefol of 0.4mg/kg followed by boluses of propofol(0.2mg/kg)administered intermittently until Ramsay sedation scale Ⅲ～Ⅳ. The induction time of anesthesia,in-tubation time of gastroscope,time of recovery from anesthesia and stay in the post anesthesia care unit(PACU)were recorded. The mean arterial pressure(MAP),heart rate(HR),ptdse oxygen saturation(SPO2)and respiratory rate(RR)were measured and recorded with noninvasive moni-toring. The body movement,apnea,hypotension and bradycardiac were recorded during operation. All the patients were reviewed for satisfaction after the operation. Results The time of anesthesia induction,intubation time of gastroecope,time of recovery from anesthesia and stay in PACU in remifentanil group were shorter than those in fentanyl group(P < 0.05) ,and propofol eousumption was signitlcantly less in the former group (P < 0.05). Greater MAP decrement was observed in remifentanil group (P < 0.05). Much higher incidence of bradyeardia or hypotensian in remifentail groups was found than that in fentanil group(P < 0.05). Fewer patients had body movement while more had respiratory depression in remifentanil group than in fentanyl group(P < 0.05). No significant difference(P> 0.05)was observed between remifentanil group and fentanyl group in terms of the incidence of hypoxemial. The rate of patient-reed satisfaction was significantly higher in remifentanil group (P < 0.05). Conclusion Intravenous anesthesia with remifentanil and propofol for gastteseope is safe and reliable,Intravenous remifentsnil and propofol for gastroscopy provides more bradycanfia or hypoteusio compared with intravenous fentanyl and propofoL Cautions should be taken by the quent occurrence of hypoxemia with intravenous remifentani. The guardianship and the nursing care are important to painless gastroscope.

Objective To investigate the rehtionship between serum levels of TNF-α and IL-1 β afer head injury groups and intracranial pressure. Methods A total of 125 cases head injury were divided into the moderate and severe injury groups,comprising 45 and 80 cases re-spectively. Alterations in intracranial pressure were dynamically monitoried for 7 consective days,and the serum levels of TNF-α and IL-1 β were measured 1,3 and 7 days after injury. Results The levels of TNF-α ,IL-1β and intracranial pressure were markedly higher in the se-vere injury group than the control group,with significant differences between two groups at varying point after surgery(all P< 0.01). The in-tracranial pressure was positively related to TNF-α (r= 0.986,P< 0.05)as well as IL-1 β (r= 0.979,P< 0.01) in moderate injury group. The same condition was noted in the severe injury group. Conclusion Serum levels of the TNF-α and IL-1 β are considerably elevated,reflect-ing to some degree the disease severity and intracranial pressure change in head injury.

Objective To observe the effect for the patients with esophageal carcinoma surgery by guben decotion combined with radiotherapy. Methods 64 cases of patients with esophageal carcinoma after surgery were randomly divided into two groups, patients in control group(n = 30) were treated by radiotherapy only. Patients in treatment group(n = 34) were treated by guben decotion combined radiotherapy. Investigated the digestive tract response,the marrow suppression,the radioactive response and the lifetime,the Kamofsky grading after the radiotherapy,contrasted two group of tumor patient's poisonous side reaction and the curative effect. Results B group of Karnofsky grading is higher than A group obviously;B group of lifetimes surpass A group obviously;B group of poisonous side reactions are lower than A group obviously. Conclusion The lifequality and lifetime of the patients with esophageal carcinoma after surgery treated by guben decotion combined with radiotherapy were improved obviously,and the poisonous side reaction of the radiotherapy were reduced obviously.

Objective To analyze the etiology and clinical features of drug-induced liver damage,in order to draw more attention to this problem. Methods Two hundred and fifty-six cases over a 10-year period were retrospectively analyzed. Results A variety of drugs,in-cluding traditional Chinese medicines(23.8% of our total cases)and immunosuppressive agent(11.7%)caused liver damage. The main clinical manifestations of it were fatigue,nausea,vomiting and jaundice. In 78.5% of our cases,the symptoms were relieved or completely disappeared, but there was still 6.6% mortality rate. Conclusion The clinical features of drug-induced liver damage are of no specificity,and the mortality of it is high. Liver function should he monitored when suspected are prescribed.

Objective To discuss the relationship and clinical significance between anterior rectocele and resultant constipation by the obstruction of functional outlet. Methods The clinical and dynamic defecography materials of 417 cases with resultant constipation by the obstruction of functional outlet were retrospectively reviewed. Dynamically replaying the cases of anterior rectocele and analyzed the representation. Results ①310 cases with anterior rectocele,392 cases with internal rectal prolapse,353 cases with perineum descending,69 cases with pelvic spasm or puborectalis thickening. 95.20% (397/417) cases with more than 2 abnormalities simultaneously,no cases with only anterior rectocele. The difference between men and women was statistically significant(P< 0.01) of anterior rectocele,perineum descending、pelvic spasm or puborectalis thickening. There was no difference with internal rectal prolapse(P> 0.05). ②Dynamically replaying the cases of anterior rectocele:226 cases could drain almost all of the barium of rectum and the distal rectum mucosal fold hypertrophy,account for 72.90% (226/310);71 cases could not drain any or drained driply and prolapse of rectal mucosa or pelvic spasm or puborectalis thickening,account for 22.90% (71/310); 13 cases with protruded sac reduced not obsolete and rearward the sac internal rectal prolapse, account for 4.20% (13/310). Conclusion Anterior rectocele is not the main cause of constipation,to make sure the relationship between anterior rectocele and resultant constipation by the obstruction of functional outer can provide instructional significance for the cure scheme.