Objective · To investigate association between serum 25-hydroxyvitamin D3 [25(OH)D3] level and diabetic peripheral neuropathy (DPN) in elderly patients with type 2 diabetes mellitus and explore its value in clinical practice for early screening and prevention of DPN. Methods · A total of 188 elderly patients with type 2 diabetes mellitus were enrolled in this cross-sectional study, including 100cases with DPN and 88 cases without. Clinical data was collected and serum levels of 25(OH)D3, glycosylated hemoglobin (HbA1c), blood lipids and hepatic and renal functions were determined in all patients. Spearman correlation analysis was used to evaluate relationship between each index and 25(OH)D3, and Logistic regression was used for statistical analysis of risk factors for DPN. Results · The median of serum 25(OH)D3 level was significantly lower in the patients with DPN (34.95 nmol/L) than that of the patients without DPN (52.6 nmol/L)(P<0.01). Spearmancorrelation analysis showed that there existed a negative correlation between the level of 25(OH)D3 and age, HbA1c and fasting blood glucose (r=-0.37, -0.53, and -0.29, respectively, P<0.01). The multiple Logistical regression analysis revealed that the 25(OH)D3 level was an independent risk factor for DPN. The odds ratio of serum 25(OH)D3 was 15.5 (OR=15.50, 95% CI=2.00 ~ 119.62) for the lowest quartile versus the highest quartile. Conclusion · The decreased level of 25(OH)D3 may increase risks for the occurrence of DPN in the elders with type 2 diabetes mellitus and monitoring the level of 25(OH)D3 contributes to early detection of DPN.

Tetrahydrobiopterin (BH4) is an essential cofactor for all three nitric oxide synthase (NOS isoforms), which plays an important role in vascular diseases. GTP cyclohydrolase 1 (GCH 1) is the first-step and rate-limiting enzyme for BH4 biosynthesis in its de novo pathway. Common GCH1 gene variant C+243T in the 3'-untranslated region predicts NO excretion. The present study examined the predictive role of GCH 1 gene 3'-UTR C+243T variant in the long-term outcome of ischemic stroke. A total of 142 patients with first-onset ischemic stroke were recruited and detected for genotype of GCH1 3'-UTR C+243T by a TaqMan SNP Genotyping assay. Subsequent vascular events and death were determined over a 5-year follow-up period. The frequency of GCH1 3'-UTR +243 C/T or T/T genotype was significantly increased in patients with endpoint events as compared with those without events (74% vs 57.8%, P=0.06). Cox regression survival analysis indicated that an increased probability of death or new vascular events was found in patients with GCH1 3'-UTR +243 C/T or T/T genotype compared with those with GCH1 3'-UTR C/C genotype (40.6% vs 25.5%), GCH1 3'-UTR +243 C/T or T/T genotype relative to GCH1 3'-UTR C/C genotype was associated with the increased risk of death or vascular events even after adjustment for other risk factors (OR=2.171, 95% CI: 1.066-4.424, P=0.033). It was concluded that GCH1 3'-UTR C+243T variant was an independent predictor of worsening long-term outcomes in patients with first-onset ischemic stroke.

Objective To provide rationales for preventing and treating dyslipidemia by understanding the current status of lipids and related metabolic factors.Methods A total of 2 590 permanent residents aged ≥ 18 years were selected by random cluster sampling from three urbanized communities of Sijiqing Street.And the rate of abnormal lipid metabolism was calculated for different ages and genders.Spearman's correlation analyses were conducted for the levels of total cholesterol (TC),total triglyceride (TG),low density lipoprotein-cholesterol (LDL-C),high density lipoprotein-cholesterol (HDL-C),body mass index (BMI),waist circumference (WC),systolic blood pressure (SBP),diastolic blood pressure (DBP),fasting plasma glucose (FPG),glycated hemoglobin (HbA 1 c) and uric acid (UA) levels.Both x2 test and logisic regression were employed to examine the correlations between dyslipidemia and overweight/obesity,hypertension,hyperglycemia and hyperuricemia.Results ① The total rate of abnormal lipid metabolism was 60.0％ (1 554/2 590) with a standardized rate of 57.2％.High TC rate was 42.9％ (1 111/2 590) with a standardized rate of 40.5％.And the edge incremental rate was 31.7％ (822/ 2 590),the standardized rate 30.5％,the incremental rate 11.2％ (289/2 590) and the standardized rate 10.0％.High TG rate was 33.0％ (855/2 590) with a standardized rate of 30.7％.And the edge incremental rate was 15.3％ (397/2 590),the standardized rate 14.3％,the incremental rate 17.7％ (458/2 590) and the standardized rate 16.4％.High LDL-C rate was 30.4％ (787/2 590) with a standardized rate of 28.4％.And the edge incremental rate was 22.9％ (594/2 590),the standardized rate 21.7％,the incremental rate 7.5％ (193/2 590) and the standardized rate 6.7％.Low HDL-C rate was 12.6％ (327/2 590) with a standardized rate of 12.8％.The rates of high TC,high TG,high LDL-C,low HDL-C and abnormal lipid metabolism among gender showed no statistically significant difference (P ＞ 0.05);② For both males & females,high TC rate,high TG rate,high LDL-C rate and total rate of abnormal lipid metabolism increased with age (P ＜ 0.01) while low HDL-C rate did not change with age (P ＞ 0.05);③Spearman's correlation analysis showed that the levels of TC,TG and LDL-C were positively correlated with BMI,WC,SBP,DBP,FBG,HbA1C and UA (all P ＜0.01) while the level of HDL-C had negative correlations with BMI,WC,SBP,DBP,FBG,HbA1 c,and UA (all P ＜ 0.05);④The total rate of abnormal lipid metabolism and various types of abnormal lipid metabolism increased with a rising level of BMI in the upward trend (trend test P ＜ 0.01),various types of abnormal lipid metabolism rate between different groups (elevated & non-elevated) of blood pressure,glucose and uric acid also were statistically significant (all P ＜ 0.05);⑤ Non-conditional logistic regression analysis showed that,after adjusting for age and gender,overweight or obesity and hypertension were risk factors of high TC and high LDL-C;overweight or obesity,hyperuricemia was a risk factor for low HDL-C;overweight or obesity,hypertension,hyperglycemia and hyperuricemia were risk factors for high TG and total abnormal blood lipid.Conclusions Urbanized community groups have a high rate of dyslipidemia.And abnormal lipid metabolism is affected by overweight or obesity,hypertension,hyperglycemia and hyperuricemia.The target population should be regularly monitored and comprehensively controlled.

Objective To observe the effects of recombinant human bone morphogenetic protein-2 (rhBMP-2) on patients with type A thoracolumbar fractures treated by pedicle screw fixation via dorsal-approach and vertebral body bone graft.Methods A retrospective case-control study was conducted to analyze the clinical data of 64 patients with type A thoracolumbar fractures treated from June 2012 to July 2015.The patients were divided into control group (32 cases) and research group (32 cases) according to the random number table.There were 22 males and 10 females aged (48.2 ± 11.2)years old in control group.The injury was located at T11 in 2 cases,T12 in 4,L1 in 9,L2 in 7,L3 in 7 and L4 in 3 in control group.There were 24 males and 8 females aged (50.7 ± 11.4) years old in research group.The injury was located at T11in 2 cases,T12in 4,L1in 8,L2 in 8,L3 in 7 and L4 in 3.The control group was treated with posterior pedicle screw reduction,internal fixation and allograft cancellous bone grafting through pedicle of vertebral arch.The research group was treated with rhBMP-2 (mixed with cancellous bone implants) on the basis of the control group.The time of operation,the amount of bleeding during operation,the volume of postoperative bleeding,the amount of postoperative drainage,the recovery of the injured vertebra,the Lane-Sandhu score,the time of fracture healing,and the postoperative complications were compared.Results There was no difference between two groups on operation time,amount of bleeding during operation or amount of postoperative drainage (P ＞ 0.05).No difference existed in two groups about Cobb angle and injured vertebral leading edge height at one week after operation (P ＞ 0.05).At the time of last follow-up (12 months),in research group,Cobb angle was lower while injured vertebral leading edge height was much higher than that of control group (P ＜ 0.05),both of which were better than before (P ＜ 0.05).At 12 months after surgery,the lost Cobb angle of [(2.0 ± 0.7) °] and lost height of injured vertebral leading edge [(3.2 ± 1.0) ％] were smaller than those in control group [(5.6 ± 1.7) ° and (6.8 ± 2.4) ％ respectively] (P ＜ 0.05).The Lane-Sandhu score and healing time of fracture in research group were (8.9 ± 0.8) points and (6.9 ± 0.9) months,which were better than that (6.8 ±0.8)points and (8.4 ± 1.6)months in control group respectively (P＜0.05).The complication rate of research group was lower than that of control group,with no significant difference (P ＞ 0.05).Conclusion Compared with simple vertebral bone graft,posterior thoracolumbar vertebrae pedicle screw fixation with vertebral bone graft and hBMP-2 treatment for type A thoracolumbar fractures can restore vertebral stability,shorten the time of fracture healing and reduce the incidence of complications.

Objective Improve the level of education of medical information to promote faster and better development of medical information.Methods According to the disciplinary development lag,weak teachers' drawbacks of medical education and medical information technology status quo,research talent development solutions.Results Departure from the practice of medical information is proposed to establish and improve the incentive mechanism,curriculum system and teaching content changes,the establishment of hospital information system simulation laboratory recommendations.Conclusion For the development and maturation of the education of medical information,to promote the cultivation of medical information,certain referential significance.

Objective To evaluate the effect of aldosterone (Ald) on glomerular mesangial cells apoptosis and to explore the possible mechanisms.Methods Twenty-four Sprngue-Dawley rats were subcutaneously embedded with osmotic mini-pumps and randomly divided into 3 groups.Aldosterone (1.5 μg/h) was administrated subcutaneouly by osmotic mini-pumps in Ald group,eplerenone (Epl,100 mg·kg-1·d-1) and Ald (1.5 μg/h) was given to Epl group.And normal saline was used in control group (Con group).Systolic blood pressure and urinary albumin excretion rate (UAER) were detected on day 0,7,14,21,28.Blood and kidney samples were harvested on day 28.Plasma creatinine,potassium and aldosterone were measured.Renal paraffin sections were stained by PAS and the morphological changes were evaluated by light microscopy.Apoptosis index of mesangial cells were detected by TUNEL assay.The glomerular mesangial cells (MCs) were cultured in a DMEM-F12 media.MCs apoptosis was evaluated by staining cells with Annexin V and propidium iodide (PI) using flow cytometer.Expression of Bcl-2 and Bax mRNA was examined by RT-PCR.The protein level of Bad or phospho-Bad was measured by Western blotting.Results Ald-infused rats developed hyperaldosteronemia and hypokalemia.Rats in Ald group exhibited significant hypertension and marked albuminuria.Ald group rats showed increased number of TUNEL-positive mesangial cells when compared with control rats (P＜0.05).Aldosterone induced mesangial cells apoptosis in a time-dependent manner.Expression of Bcl-2 mRNA was decreased but Bax mRNA was increased in aldosterone treated MCs compared to that in Con group (P＜0.05).Aldosterone promoted dephosphorylation of cytosolic phospho-Bad compared with vehicle treated cells (P＜ 0.05).However,eplerenone attenuated these effects of aldosterone.Conclusion Aldosterone directly promotes mesangial cells apoptosis,and eplerenone can attenuate this effect of aldosterone.Dephosphorylation of cytosolic phospho-Bad may be the key role in the progression of mesangial cells apoptosis induced by aldosterone.

Objective To determine the surfactant protein A (SP-A) subtype distribution and expression in human renal tissue and cultured human renal tubular epithelial cells(HK-2), and to explore the influence of Lipopolysaccharide (LPS) on the expression of SP-A subtypes mRNA and SP-A protein. Methods lmmunohistochemical staining was performed using SP-A polyclonal antibodies. RT-PCR was performed with mRNA from HK-2 cells and normal human kidney.Restriction fragment length polymorphism(RFLP) and sequencing were used to evaluate the subtypes of SP-A. The relative content of SP-A mRNA in human kidney and human lung was compared by real-time PCR. Western blotting analysis for SP-A was performed on protein from renal tissue and cultured HK-2 cells SP-A protein in human urine and culture supernatant of HK-2 cells was measured by enzyme-linked immunosorbent assay (ELISA) and Western blotting respectively. HK-2cells were treated with LPS at various concentrations (0,0.1,1,2,5,10 mg/L) for 8 h and at 5mg/L for various time points (0,2,4,8,16,24 h). Expression of SP-A mRNA and protein was analyzed by RT-PCR and Western blotting. Results SP-A was localized in renal tubular epithelial cells of both proximal and distal convoluted tubules. SP-A1, SP-A2 mRNA and protein could be detected in normal HK-2 cells and human kidney. The significant secretion of SP-A [urine: (106.614172.772) nmol/L, n=30; culture supernatant: (85.533±58.622) nmol/L, n=10] was shown. The levels of SP-A1, SP-A2 mRNA and Sp-A protein in HK-2 cells were significantly decreased after treatment with LPS. Conclusions Human renal tubular epithelial cells can express both SP-A1 and SP-A2 genes which may play an important role in inflammation modulation of kidney.

Objective To investigate the effect of surfactant protein D(SP-D)overexpression on lipopolysaccharide(LPS)-induced monocyte chemoattractant protein-1(MCP-1)expression in human renal proximal tubular epithelial cells(HK-2)and its mechanism. Methods HK-2 cells were treated with LPS at various concentrations (0, 0.1, 1, 2, 5, 10 mg/L)for 8 h and at 5 mg/L for various time points(0, 2, 4, 8, 16, 24 h). Expression of SP-D was detected by Western blotting and real-time PCR. Expression of MCP-1 was determined by ELISA and real-time PCR. Human SP-D cDNA eukaryotic expression vector pEE14-hSP-D was transfected to HK-2 cells. The changes in transfected cells of SP-D protein were observed by Western blotting. Expression of MCP-1 was detected by ELJSA and real-time PCR. Results SP-D was expressed in HK-2 cells. The levels of SP-D protein and mRNA in HK-2 cells were significantly decreased after treatment with LPS(P<0.05). Expression of MCP-1 protein and mRNA was increased remarkably after treatment with LPS(P<0.05). HK-2 cells transfected with pEE14-hSP-D showed up-regulated expression of SP-D. The overexpression of SP-D inhibited the LPS-inducedexpression of MCP-1(P<0.01). Conclusions SP-D inhibits LPS-induced expression of MCP-1 in HK-2 cells. SP-D may play an important role in the modulation of renal inflammation.

Objective To investigate the correlation of dynamic contrast-enhanced (DCE) MRI features with microvessel density (MVD) and vascular endothelial growth factor (VEGF) in non-small cell lung cancer(NSCLC).Methods Conventional MR imaging and dynamic contrast-enhanced scan in thirty-three patients with NSCLC confirmed by pathologyn were performed. MVD and VEGF were stained with immuno-histochemical technique in all cases. Some parameters of DCE MRI, including maximum slope(Smax) and time to peak(TTP) were put more analysis. The relationship between the results of DCE MRI (Smax and TTP) and that of immuno-histochemistry (MVD and VEGF) was analysed.Results The Smax of adeno carcinoma was higher than that of squamous cell carcinoma,but TTP was lower. The difference was obvious difference(t=3.22,P

Objective Promote the use of medical record information, the depth of excavation,provide strong support for clinical research and hospital management.Methods Medical Record Information lower utilization reasons put forward need to build the whole structure of the paperless electronic medical records, electronic medical records for research concluded that the key to building elements to provide support.Results Pointed out that the construction of paperless electronic medical records from the storage structure of the building medical record systems, and data warehouse technology combined start, outpatient and inpatient medical records while achieving interoperability, building regional health care, improve follow-up system, and finally pointed out the key technical implementation.Conclusions It is to promote the utilization of medical records, medical records for research to improve support efforts to promote development and progress of medicine and enhance the hospital's soft power has great significance.