Objective To explore the clinical eficacy of umbilical cord blood stem cell transplantation in treatment of decompensated cirrhosis.Methods Thirty patients with decompensated cirrhosis were given umbilical cord blood stem cell transplantation (treatment group) and 30 patients with decompensated cirrhosis were given traditional treatment (control group).Liver function and blood coagulation function was tested after 4,8 weeks treatment respectively,and adverse effects were recorded at the same time.Results After 8 weeks treatment,total bilirubin,albumin and prothrombin time in treatment group was improved compared with that before treatment[(71.3 ± 37.8) μ mol/L vs.(107.3 ± 53.2) μ mol/L,(30.1 ± 4.9) g/L vs.(27.5 ± 5.1) g/L,(15.0 ± 2.9) s vs.(16.7 ± 3.9) s],and there was significant difference (P ＜ 0.05).There was no significant difference in the index before and after treatment in control group (P＞ 0.05).No obvious adverse reactions were observed in the process of umbilical cord blood stem cell transplantation.Conclusion Umbilical cord blood stem cell transplantation is safe and effective in treatment of deeompensated cirrhosis.

Objective To investigate the relationship between soluble tumor necrosis factor-like weak inducer of apoptosis levels (sTWEAK) and cardiovascular events in patients with maintenance hemodialysis (MHD).Methods A prospective cohort study was conducted in 64 MHD patients(MHD group).The plasma level of sTWEAK was measured by enzyme-linked immunosorbent assay,N-terminal pro-brain natriuretic peptide (NT-proBNP) and high-sensitive C-reactive protein (hs-CRP) levels were measured by enzyme-linked immunofluorescence method,left ventricular end-diastolic diameter (LVEDd),left ventricular posterior wall thickness (LVPWT),end-diastolic ventricular septal thickness (IVST),left ventricular ejection fraction (LVEF) was determined by echocardiography.The general situation,clinical indicators and occurrence of cardiovascular events of MHD patients were recorded and followed up for 2 years.Fifty healthy people were selected as control group.Results The plasma level of sTWEAK was higher in MHD group than that in control group [(589 ± 122) ng/L vs.(346 ± 127) ng/L],and there was significant difference (P＜ 0.01).During the follow-up period,12 patients underwent cardiovascular events(3 patients died).The plasma level of sTWEAK in cardiovascular event patients was significantly higher than that in non-cardiovascular event patients (695 ng/L vs.458 ng/L),and there was significant difference (P ＜ 0.01).The plasma level of sTWEAK was positively correlated with NT-proBNP in MHD patients(r =0.698,P ＜ 0.05).Logistic repression analysis showed that sTWEAK was the predictor of cardiovascular events of MHD patients.Conclusion The plasma level of sTWEAK probably predicts the ocurrence of cardiovascular event in MHD patients.

Objective To discuss the efficacy and safety of sitagliptin combined with metformin in treatment of type 2 diabetes mellitus(T2DM).Methods One hundred patients with T2DM were divided into two groups by random digits table method with 50 cases each.The patients in study group were given phosphate sitagliptin (100 mg,day 1 oral) combined with metformin (500 mg,day 3 oral).The patients in control group were given repaglinide (1 mg,day 3 oral) combined with metformin (500 mg,day 3 oral).They were treated for 12 weeks and fasting plasma glucose(FPG),2 h postprandial blood glucose(2 h PG),glycosylated hemoglobin (HbA1c),fasting insulin (FINS),body mass index (BMI) and the incidence of hypoglycemic events were detected before and after treatment.Results After treatment,the level of FPG,2 h PG,HbA1c was significantly lower than that before treatment in two groups,and there was significant difference (P ＜ 0.01).The level of B MI after treatment was significantly decreased [(24.45 ± 2.13) kg/m2 vs.(25.46 ±2.62) kg/m2] and FINS was significantly increased [(13.36 ± 1.89) mU/L vs.(12.36 ± 1.80)mU/L] compared with that before treatment in study group (P ＜ 0.05 or ＜ 0.01).But the level of BMI and FINS had no significant difference before and after treatment in control group (P＞ 0.05).The incidence of hypoglycemic events had significant difference between study group and control group [0 vs.12％ (6/50)] (P ＜ 0.05).Conclusions Sitagliptin combined with metformin is safe and effective in treatment of type 2 diabetes mellitus,which is the preferred solution treatment.The risk of hypoglycaemia events is obviously reduced,also it can control and reduce weight and other advantages.

Objective To observe the effects of continuous blood purification(CBP) on extravascular lung water and permeability index in patients with severe extrapulmonary acute respiratory distress syndrome (ARDSexp).Methods Fifteen patients with severe ARDSexp were treated with CBP.The level of extravascular lung water index (EVLWI) and pulmonary vascular permeability index (PVPI) was measured before and after treatment,and at the same time the changes of inflammatory indicators were recorded.Results Compared with that before treatment,EVLWI and PVPI was decreased obviously after treatment (P ＜ 0.01),the level of C-reactive protein and interleukin 6 (IL-6),calcitonin and systemic inflammatory response syndrome score and the acute physiology and chronic health Ⅱ score was significantly decreased (P ＜ 0.01).Conclusion CBP can improve the level of EVLWI,PVPI and inflammatory indicators and also the prognosis of severe ARDSexp.

Objective To investigate the application of statins in secondary prevention of ischemic stroke in different risk groups,and to identify the factors influencing the comphcance of statins.Me.ods Ischemic stroke patients from December 2011 to October 2012 were collected.All clinical characterisitcs and possible factors influencing the compliance of statins was recorded in 3 months.The multivariate Logistic regression analysis was used to analyze the influencing factors of the compliance of statins.Results All 368 patients were collected,and 67.9％(250/368) patients were prescribed statins for therapy during hospitalization.The application rate of statins in accordance with guidelines in high-risk,extremely high-risk Ⅱ and extremely high-risk Ⅰ patients was 28.1％ (18/64),44.1％ (30/68) and 72.3％ (136/188),respectively.Logistic regression analysis showed that the statins application during hospitalization was associated with the presence of carotid vulnerable plaques (OR =5.308,P =0.000) and diabetes history (OR =1.789,P =0.032).Routine discharge instructions had high compliance.Conclusion The compliance of statins in secondary prevention of ischemic stroke still has a large gap between clinical practice and guidelines,and routine discharge instructions on statins application increase the compliance of statins.

Objective To explore the change of serum thyroid hormone levels in elderly congestive heart failure patients with depression.Methods A total of 122 elderly congestive heart failure patients were divided into two groups:combined group (combined with depression,53 cases) and control group (without depression,69 cases).The serum thyroid hormone levels were determined and the Hamilton Depression Inventory assessment was evaluated.The serum thyroid hormone levels and the incidence of low T3 syndrome were compared between two groups.Results The serum free three iodine thyronine,free thyroxine,thyroid stimulating hormone concentration in combined group was lower than that in control group [(3.12 ± 0.91) pmol/L vs.(3.94 ± 1.09) pmol/L,(12.93 ± 3.89) pmol/L vs.(15.71 ± 4.01) pmol/L,(2.25 ± 0.63) mU/L vs.(2.86 ± 0.83) mU/L],and there was significant difference (P ＜ 0.01 or ＜ 0.05).The incidence of low T3 symdrome in combined group (43.40％,23/53) was higher than that in control group (13.04％,9/69),and there was significant difference (P ＜ 0.05).Conclusion The serum thyroid hormone levels decrease obviously in elderly congestive heart failure patients with depression and low T3 syndrome occurrs easily,so this should arouse more attention in clinic.It is necessary to do regular thyroid function tests.

Objective To investigate the value of high-sensitivity C-reactive protein (hs-CRP) combined with high-sensitivity cardiac troponin T (hs-cTnT) for prognosis of patients with acute coronary syndrome (ACS).Methods One hundred and eighteen patients with ACS were selected from July 2011 to December 2012.According to the clinical feature,they were divided into unstable angina pectoris (UAP) group (38 cases),non ST segment elevation myocardial infarction (NSTEMI) group (38 cases) and ST segment elevation myocardial infarction (STEMI) group(42 cases).They were followed up for 3 months,and the incidence of cardiovascular events and cardiac death was observed.Twenty healthy people were selected as control group.Results The serum level of hs-CRP on admission in UAP group,STEMI group,NSTEMI group was higher than that in control group,and NSTEMI group was highest.And there was significant difference between NSTEMI group and STEMI group,and also between NSTEMI group and control group (P ＜ 0.05).The serum level of hs-cTnI was increased in STEMI group and NSTEMI group.The increased degree in STEMI group was higher than that in NSTEMI group,and there was significant difference (P ＜0.05).The incidence of cardiovascular events and cardiac death within 3 months after discharge in patients with the serum level of hs-CRP ≥ 3 mg/L on admission in UAP group and NSTEMI group,STEMI group was 6/11,40.0％ (12/30),46.4％ (13/28),which was higher than that in patients with the serum level of hs-CRP ＜ 3 mg/L[11.1％(3/27),3/8,5/14],and there was significant difference(P＜ 0.05).The incidence of cardiovascular events and cardiac death within 3 months after discharge in patients with the serum level of hs-cTnT≥ 1.0 μ g/L on admission in NSTEMI group and STEMI group was 16.7％(5/30) and 18.4％(7/38),which was higher than that in patients with the serum level of hs-cTnT ＜ 1.0 μ g/L (1/8,1/4),and there was significant difference (P ＜ 0.05).Conclusion Significantly increased hs-CRP is an important predictor of poor prognosis of ACS patients.hs-CRP combined with hs-cTnT is helpful in early identification of high-risk patients.Giving intensive treatment to these patients in time and monitoring closely after discharge can reduce the happening of cardiovascular events.

Objective To analyze the distribution and drug resistance of pathogens causing hospital-acquired pneumonia (HAP) in stroke patients,and provide references for proper clinical application of antibiotics.Methods A retrospective investigation was performed to analyze the pathogens and the drug resistance of 143 stroke patients with HAP.Results Among 168 strains of isolated pathogens,the Gram-negative bacteria accounted for 61.90％ (104/168),including Klebsiella pneumoniae,Pseudomonas aeruginosa,Escherichia coli,Acinetobacter baumannii,Enterobacter cloacae and so on.Gram-positive bacteria accounted for 25.60％ (43/168).Staphylococcus aureus ranked the first,followed by Coagulase negative staphylococcus and Enterococcus faecalis.Fungi accounted for 12.50％(21/168),mainly including Candida albicans.They had varying degrees of resistance to commonly used antibiotics.Conclusions Gram-negative bacteria is predominant in stroke patients with HAP.Drug resistance is very serious,and the antibiotics should be selected in clinic according to the result of drug susceptibility test.

Objective To investigate the relations between serum adiponectin and coronary artery calcification score (CACS) and to find the risk factors for coronary artery calcification in maintenance hemodialysis(MHD) patients.Methods Twenty-seven MHD patients(MHD group) and 13 healthy persons (control group) were enrolled in this study.The serum adiponectin was measured by enzyme-linked immunosorbent assay method.CACS was calculated by multi-row spiral CT.The circulating parameters such as hemoglobin (Hb),calcium,phosphate,calcium-phosphate product,intact parathyroid hormone (iPTH),total cholesterol (TC),low density lipoprotein cholesterol (LDL-C),albumin (Alb),high sensitive C-reactive protein (hs-CRP),and so on were detected.Results The level of serum adiponectin in MHD group [(15.00 ± 7.47) mg/L] was significantly higher than that in control group [(2.07 ± 0.83) mg/L],and there was significant difference (P＜ 0.01).Coronary artery calcification(CACS ＞ 0 score) was observed in 88.9％ (24/27) in MHD group and 10/13 in control group.The mean CACS in MHD group was significantly higher than that in control group [655 (0-3 570) scores vs.126 (0-731)scores],and there was significant difference (P ＜ 0.05).Eleven MHD patients and 1 healthy person had severe coronary artery calcifications,(CACS ≥ 400 scores).There was significan t difference in dialysis duration,diastolic pressure,phosphate calcium-phosphate product and adiponectin (P ＜ 0.05 or ＜ 0.01).Spearman analysis showed that CACS of MHD patients was positively correlated with dialysis duration,phosphate,calcium-phosphate product,serum creatinine and adiponectin (P ＜ 0.01 or ＜ 0.05).Only calcium-phosphate product remained as independent predictor of CACS in multivariate analysis (P ＜0.01).Conclusion Coronary artery calcification is common in MHD patients and which is correlated with dialysis duration,serum phosphate,calcium-phosphate product,serum creatinine and adiponectin.

Objective To study the correlation between fractional excretion of uric acid (FEUA) and blood uric acid,body mass index (BMI),blood pressure,blood glucose,blood lipid and other metabolic factors in patients with primary gout.Methods Sixty-two patients with primary gout (gout group) and 32 healthy people (control group) were selected in this study.Gout group was divided into uric acid excretion decreasing group (FEUA ＜ 7％,29 cases),mixed group (7％ ≤FEUA ≤ 12％,25 cases) and uric acid production increasing group (FEUA ＞ 12％,8 cases) according to the level of FEUA.The fasting blood glucose (FPG),2-hour postprandial blood glucose (2 h PBG),blood lipid,serum creatinine,blood uric acid,glycosylated hemoglobin were tested.24 hours urine was collected and urinary uric acid and urinary creatinine was measured,FEUA was calculated and analyzed.Results BMI,mean arterial pressure,blood uric acid,glycosylated hemoglobin,total cholesterol,2 h PBG in gout group was higher than that in control group,and high density lipoprotein cholesterol,FEUA was lower than that in control group,and there was significant difference (P ＜ 0.05).There was no significant difference in age,FPG,low density lipoprotein cholesterol,triacylglycerol between two groups (P＞ 0.05).There was no significant difference in age,blood uric acid,FPG,2 h PBG,glycosylated hemoglobin,total cholesterol,low density lipoprotein cholesterol,high density hpoprotein cholesterol among uric acid excretion decreasing group,mixed group and uric acid production increasing group (P ＞ 0.05),and there was significant difference in BMI,mean arterial pressure,triacylglycerol,FEUA among three groups(P＜ 0.05).FEUA was negatively correlated with blood uric acid in control group and gout group (r =-3.900,-0.476,P ＜0.05).FEUA was positively correlated with 24 h urinary uric acid in gout group (r =0.465,P =0.001),and nagatively correlated with triacylglycerol (r =-0.304,P ＜ 0.05).Pearson analysis showed that FEUA was negatively correlated with blood uric acid in uric acid excretion decreasing group (FEUA ＜ 7％) (r =-0.392,P ＜ 0.05),FEUA was positively correlated with blood uric acid in non uric acid excretion decreasing group (FEUA ≥7％)(r =0.437,P ＜ 0.05),but 24 h urinary uric acid was not correlated with blood uric acid(P ＞ 0.05).Multi-stepwise regression analysis showed that blood uric acid,glycosylated hemoglobin,FEUA was significantly correlated with the onset of the gout (P ＜ 0.05).Conclusions Besides blood uric acid level,there are significant changes in primary gout in blood pressure,serum glucose and lipid levels.FEUA could be used to estimate the ability of renal excrete the uric acid.Mean arterial pressure,glycosylated hemoglobin and FEUA are the risk factors for gout.