Objective To investigate clinical characteristics and risk factors in elderly patients with type 2 diabetes mellitus (T2DM) complicated with chronic kidney disease (CKD).Methods Two hundred and two T2DM patients aged ≥60 y admitted in Tongren Hospital from August 2009 to February 2012 were enrolled in the study,including 64 cases complicated with CKD (CKD group)and 138 cases without CKD (non-CKD group).Hemoglobin (Hgb),albumin (ALB),glycated hemoglobin A1C (HbA1 c),fasting plasma glucose(FBG),postprandial glucose (PBG),serum creatinine (Scr),blood urea nitrogen (BUN),uric acid (UA),total cholesterol (TC),triglyceride (TG),high densitylipoprotein (HDL-C),low density lipoprotein (LDL-C) were measured and ratio of urinary albumin to creatinine (UAER/CR) were calculated,ankle brachial index (ABI) and ambulatory blood pressure was examined.Results The duration of diabetes in CKD group was longer than that in non-CKD group [(13 ± 11) vs.(10 ± 7) y,t =2.35,P ＜ 0.05].Hgb and ALB in CKD group were lower than those in non-CKD group [(12.1 ± 1.7) vs.(13.3 ±1.3) g/L,(34.4±2.6) vs.(36.8 ±3.4) g/L,t=-5.73,-4.75,allP＜0.01]; UA,TG,24 h systolic blood pressure (SBP),24 h pulse pressure (PP)in CKD group were higher than those in non-CKD group [(367 ± 81) vs.(323 ± 74) μmol/L,(1.6 ± 0.9) vs.(1.3 ± 0.7) mmol/L,(133 ± 14) vs.(127±16)mmHg,(65 ±12) vs.(58 ±12)mmHg,t =3.82,2.50,2.47,3.68,all P＜0.1].The UAER/CR in CKD group and non-CKD group was 86.2 mg/g (24.6-374.8 mg/g) and 6.0 mg/g (3.6-17.8 mg/g),respectively (P ＜ 0.01) and ABI in CKD group and non-CKD group was 0.94 ± 0.18 and 1.03 ±0.18 (-2.78,P ＜0.05).There were no significant differences in FBG,PBG,HbA1c,TC,HDL-C andLDL-C between two groups(t =-2.02,1.47,1.48,-0.53,-1.20,-0.76,all P＞0.05).Logistic regression analysis showed that ALB,TG and UAER/CR were the independent risk factors of CKD in T2DM patients(OR:0.79,3.63 and 1.04,95％ CI:0.62-1.01,1.45-9.01 and 1.00-1.08).Spearman correlation analysis demonstrated that eGFR was positively associated with Hgb,ALB,ABI (r =0.38,0.33 and 0.28,all P ＜ 0.01),negatively associated with age,BUN,Cr,UA,TG,UAER/CR,24 hSBP and PP in all diabetes patients(r =-0.32,-0.63,-0.89,-0.34,-0.18,-0.65,-0.16 and -0.248,all P ＜0.01).Conclusions ALB,TG,UAER/CR are the independent risk factors of chronic kidney disease in elderly patients with type 2 diabetes mellitus.

Objective To explore the targeted nursing care for patients with severe traumatic brain injury complicated with intracranial infection. Methods 35 patients of severe traumatic brain injury complicated with intracranial infection from January, 2009 to December, 2011 were reviewed. Results There were 10 cases cured, 12 cases improved very well, 4 cases improved, 5 cases invalid and 4 cases died. The total effective rate was 62.86%and the fatality rate was 11.43%. Conclusion Intracranial infection can be controlled effectively by the venous and intrathecal injection of antibiotics and targeted care in the patients with severe traumatic brain injury.

Objective To study the preparation technique for Jiegeng Zaogan capsules (capsules of total saponins from the roots of Platycodon grandiflorum A.DC).Methods The optimal preparation technique for Jiegeng Zaogan capsules was investigated by L9(34) orthogonal test with the Platycodin D content as the observation index.Results The optimized extraction procedure was as follows:extracting for 3 hours each time and 3 times in total,adding 10-fold water,alcohol sedimentation concentration at 65 %,and alcohol sedimentation solution staying for 48 hours.Conclusion The preparation process of Jigeng Zaogan capsules is reliable with stable quality,which offers a feasible method for the industrialization production of the capsules.

Objective To study the relationship between Caspase-12 expression and the hyperoxia-induced corpus callosum damage. Methods A total of 12 groups of C57 / BL6 mice were randomly assigned into hyperoxia group (80% O2 ) and control group (21% O2 ) at day 6 after birth (P6). The pups were sacrificed after 24 h and 48 h of hyperoxia exposure and at P10, P12, P15 and P30. Immunohistochemical ( IHC) method was used to detect the expression of myelin basic protein (MBP) in corpus callosum. Real-time PCR, Western Blot and IHC were used to detect the expression of mRNA and protein of Caspase-12 in corpus callosum. The corpus callosum apoptosis was measured using terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling ( TUNEL ) method. Results The expression of MBP in hyperoxia group were significantly lower than the control group at P10 and P12 (P = 0. 004 and 0. 016); however, no significant differences existed between the two groups at P15 and P30 (P > 0. 05). The expression of Caspase-12 mRNA after 24 h and 48 h hyperoxia exposure were significantly higher than the control group [24 h: (1. 549 ± 0. 098) vs. (1. 080 ± 0. 101); 48 h:(1. 333 ± 0. 076) vs. (1. 022 ± 0. 089); P < 0. 05]. The expression of cleaved Caspase-12 protein after 24 h and 48 h hyperoxia exposure were also significantly higher than the control group [24 h: (1. 582 ± 0. 010) vs. (0. 994 ± 0. 078); 48 h: (1. 370 ± 0. 095) vs. (0. 978 ± 0. 069); P < 0. 05] . The Caspase-12 positive cell were significantly increased after 24 h and 48 h hyperoxia exposure comparing with the control group. The apoptosis index in hyperoxia group was significantly higher than the control group at P10 and P12 [P10: (18. 742 ± 2. 503) vs. (4. 587 ± 2. 353); P12 (36. 184 ± 3. 655) vs. (5. 351 ± 2. 678); P < 0. 05]. Conclusions Hyperoxia exposure induces corpus callosum damage in newborn mice. Over-expressed Caspase-12 may induce corpus callosum cell apoptosis excessively.

Objective To evaluate the efficiency of combined screening for chromosomal abnormalities in the first trimester and the ultrasound characteristics of these fetuses.Methods Retrospective study for 5000 singleton pregnancies by combined screening of trisomies 21,18,13 and Turner syndrome.Risk algorithms were developed for calculation of patient-specific risks for each of the three trisomies based on maternal age,fetal nuchal translucency,free β human chorionic gonadotropin and serum pregnancy associated plasma protein A at 11 to 13 +6 weeks of pregnant.The value of nuchal translucency (NT) and β-hCG and pregnancy-associated plasma protein A (PAPP-A) level were inputted computer,and calculate the risk value (≥ 1 ∶ 270) by automatic analysis software.Two hundred and four cases with high risk were performed transabdominal chorionic villus biopsy to detect the fetal chromosomal karyotypes.Meanwhile,other ultrasonic characteristics of fetal were elevated.Results (1) Five thousand cases of pregnant women were detected,including 4983 normal cases,62 cases were induced labor for a variety of reasons in the second trimester,including 40 cases with normal karyotype but with congenital heart disease,17 cases of chromosome abnormalities (9 cases trisomy 21,2 cases trisomy 18,1 cases trisomy 13,4 cases 45X),2 cases spina bifida,2 cases digestive tract obstruction,1 cases giant bladder.One case with low risk of fetal chromosomal abnormalities in combined screening,but high risk of age (maternal age were over 40 years old),it was 21 trisomy syndrome after the prenatal diagnosis.(2) Five cases of nasal bone loss in 9 cases of trisomy 21 (5/9),5 cases with three tricuspid regurgitation (5/9),4 cases of venous ductus a wave flow reverse (4/9),3 cases of fetal nasal bone loss accompanied by tricuspid regurgitation and venous ductus a wave flow reverse (3/9).One case of nasal bone loss in 2 cases of trisomy 18,2 cases were tricuspid regurgitation and venous ductus a wave flow reverse.Two cases in 4 cases of 45X had venous ductus a wave flow reverse.There were 8 cases (0.16％) nasal bone absence in 4983 cases of normal karyotype fetus,48 cases (0.96％) of tricuspid regurgitation and 44 cases (0.88％) of venous ductus a wave flow reverse.Thirty-two cases in 40 cases (80％) of fetal congenital heart disease were tricuspid regurgitation,30 cases of venous ductus a wave flow reverse (75％).Eight cases of nasal bone absence normal karyotype fetus were found the nasal bone at 20 weeks gestation.Conclusion Combination screening of nuchal translucency with serum markers in the first trimester were high detection rate and low false positive rate; a wave reversion and fetal nasal bone absence accompanied by tricuspid regurgitation can improve the detection rate of abnormal karyotype; abnormalities ultrasound marker may be associated with fetal congenital heart disease at 11-13 +6 weeks of pregnancy.

Objective To assess the clinical value of fetal chromosomal aneuploidy diagnosed by free fetal DNA in maternal plasma in 11-13+6 gestational weeks.Methods A total of 2 650 pregnant women who had prenatal care in Tianjin Center Hospital of Obstetrics and Gynecology from January 1,2010 to December 31,2010 were included.Each of them had an ultrasound scan to measure fetal nuchal translucency thickness.Maternal serum free β-human chorionic gonadotropin and pregnancy-associated plasma protein A test was performed as part of screening for chromosomal abnormalities.Results of ultrasound and maternal plasma biochemical analysis were entered into the database,and converted into multiple of median (MoM) by factors such as maternal age,weight,ethnicity,smoking history and mode of conception.The cutoff value was 1 ∶ 270.Meanwhile,20 cases had cell free fetal DNA (cffDNA) test and the ratio of the single nucleotide polymorphism on two alleles of plancenta-specific 4 (PLAC4) were measured in 16 cases.T-test,rank sum test,MannWhitney U test and Chi-square test were used as statistical methods.Results (1) A total of 74 cases were judged as high-risk,among which 35 cases underwent transabdominal chorionic villus sampling (18 cases had cffDNA test),37 cases underwent amniocentesis at the week of 20,and two cases of Rh negative did not receive the invasive examination.Totally 20 cases,including two Rh negative cases,had the cell-free fetal DNA test.(2) By cffDNA test of maternal plasma,two cases of 21 trisomy,one case of 18 trisomy,two cases of 45,XO and one case of balanced translocation were diagnosed.(3) In the two cases of 21 trisomy,maternal plasma G/A ratio ofPL4C4 RNA-single nucleotide polymorphism alleles was 1.00 (0.98,1.02) ; in 14 pregnancies with normal chromosome,the ratio was 1.055 (1.02,1.13,Z=3.5).There was no significant difference (P=0.066).Conclusion Diagnosing of fetal chromosomal aneuploidy by cffDNA in maternal plasma is feasible and noninvasive with high negative predictive value,and can be used in Rh-negative pregnant women for prenatal screening and diagnosis.

Objective To investigate the resistance rates of the Candida albicans strains isolated from patients with vulvovaginal candidiasis to 5 antifungal agents and examine the mechanism of azole resistance in these strains.Methods A total of 1 646 C.albicans strains were collected in Obstetrics and Gynecology Hospital of Fudan University from January to December 2015.The resistance rates of these isolates to five antifungal agents were analyzed.Azole-resistant (n=30),dose dependent sensitive (S-DD) (n=13),and susceptible isolates (n=10) were randomly selected from the microbiology laboratories of three obstetrics and gynecology hospitals in Shanghai.The expression levels of drug efflux pump related gene CDR1,CDR2,MDR1 and drug target enzyme gene ERG11 were analyzed by real-time fluorescence quantitative polymerase chain reaction (PCR).At the same time,the ERG11 and ERG3 genes were amplified by PCR and sequenced,and analyzed for resistance-related mutations.Results Of the 1 646 C.albicans strains,5.2％,3.2％,2.5％ and 2.1％ were resistant to itraconazole,voriconazole,fluconazole and 5-fluorocytosine,respectively.All isolates were sensitive to amphotericin B.The expression of ERG11 gene was significantly higher in S-DD group and azole-resistant group than in azole-sensitive group (P＜0.05).The expression of CDR1,CDR2 and MDR1 did not show significant difference among the three groups.There were 13 missense mutations in the ERG11 gene,of which T123I,P98S and Y286D amino acid substitutions were newly discovered.Both T123I and Y132H were identified in 26 resistant isolates,of which 16 gene mutation was detected in two pan-azole-resistant isolates.Conclusions The C.albicans strains isolated from vulvovaginal candidiasis showed higher resistance rates to azole antifumgal agents than that to 5-fluorocytosine and amphotericin B.Mutation and over-expression ofERG11 gene may be one of the prevalent molecular mechanisms underlying azole resistance in C.albicans.were pan-azole-resistant.In addition,the ERG3 heterozygous

Objective To understand the air microorganisms pollution and the community structure and distribution characteristics of outdoor airborne microbes in Xi'an in autumn.Methods Airborne microbes were sampled by fallen plates method in autumn,2006 in Xi'an at three typical sites,factories region,garden greenbelt region and main traffic region.Results The results showed that the total concentration of airborne microbes at the factories region and garden greenbelt region,main traffic region was 2 500 cfu/m~3,1 354 cfu/m~3 and 4 404 cfu/m~3 respectively.Bacteria and fungal genus were predominant.Gram positive bacteria were much more than Gram negative bacteria.There were 20 genera of bacteria and 8 fungal genus were detected. Micrococcui,Bacillus,Staphylococcus and Pseudornonus were predominant.The most frequently isolated fungal genus were Penicillium,Paecilomces,Cladosporium and Nonsporulatiny mycelia.The community structure of airborne fungal genus and the dominant genus in different function region was significantly different.The distribution characteristic of airborne microbe concentration in different function region was different.The concentration of airborne bacteria was significantly lower in garden greenbelt region than factories region and main traffic region,whereas the concentration of airborne fungi in garden greenbelt region was higher than that in factories region and main traffic region.Conclusion The distribution of the airbome microbes shows a characteristic of time and space,it is affected not only by the environment and pollution,but also by the other factors such as human activities,animals and plants.

Objective To investigate blood gas analysis and lactic acid evaluation in aerobic forearm exercise and the significance of aerobic forearm exercise for the auxiliary diagnosis of mitochondrial myopathy and encephalopathy patients.Methods Forty-two patients with mitochondrial myopathy and encephalopathy patients, 40 healthy control, and 40 patients control were studied.They performed a protocol under aerobic exercise conditions, consisting of intermittent forearm exercise for 4 minutes at 40% of intented maximal voluntary contraction force.Blood samples were collected to monitor blood gas and plasma lactate before, during arid after exercise.Results During exercise venous PO_2(mm Hg, 1 mm Hg=0.133 kPa)decreased in mitochondrial myopathy and encephalopathy patients from 41.2?12.6 to 39.5?16.2, whereas PO_2 fell from 50.5?14.4 to 30.8?13.1 in healthy control and from 50.1?7.9 to 44.3?35.5 in patient control.Venous PO_2 decreased much more in healthy control group than the other 2 groups(F= 6.34,P

OBJECTIVETo observe the clinical effect and safety of blood activating stasis removing method (BASRM) on intracerebral hemorrhage patients.

METHODSA multi-center, prospective, randomized, open, controlled and blinded endpoint design was adopted. Totally 228 intracerebral hemorrhage patients were assigned to the treatment group and the control group, 114 in each group by center randomized method. All patients received basic treatment of Western internal medicine. Patients in the treatment group received intravenous infusion with Xingnaojing Injection (XI) from the 1st day of grouping, 20 mL per day for 14 days. Then they took or were nasally fed with Chinese medical granules (by syndrome typing as complicated with wind syndrome, fire syndrome, and phlegm syndrome) for 21 days. Finally they took Naoxueshu Oral Liquid (NOL), 10 mL each time, 3 times per day till the 3rd month of incidence. Patients' disability degree, activities of daily living, neurological impairment, the effective rate, physiologic functions, mental status, social relationship, and degree of treatment satisfaction were assessed using Modified Rankin Scale (MRS), Barthel index (BI), National Institute of Health Stroke Scale (NIHSS), and patient reported outcome (PRO). Head CT was performed to evaluate the absorption of hematoma at the 1st and 7th day of grouping. The safety was also assessed.

RESULTSTotally 108 patients in the treatment group and 112 patients in the control group completed the trial. There was no statistical difference in the total effective rate between the two groups after 3 months of treatment (P>0.05). The MRS score was obviously lower in the treatment group than in the control group (P<0.01) at month 3 after attack (P<0.01). There was statistical difference in the difference between pre-post hematoma volume between the two groups after 7-day treatment (P<0.05). The NIHSS score of two groups at the 7th, 14th, 21st day, and 3rd month decreased significantly (P<0.05). Compared with the control group, the decremenit of NIHSS score decreased more obviously in the treatment group at day 7, 21, and 3rd month (P<0.05). Compared with the control group, the BI increased (P<0.01); physiologic fupctions, social relationship, treatment satisfaction and total score in PRO scale were all lower in the treatment group than in the control group (P<0.05, P<0.01). The incidence of adverse events occurred in 7 cases (6.14%) in the treatment group and 5 cases (4.39%) in the control group, with no statistical difference (P>0.05).

CONCLUSIONBASRM could lower the deformity rate of intracerebral hemorrhage patients at month 3, effectively promote hematoma absorption within 7 days, improve neurologic impairment, and elevate living abilities at month 3 of onset.