Objective To observe the effect of berberine to islet ?-cell function in type 2 diabetes mellitus (damp-heat type). Methods 60 patients with type 2 diabetes mellitus (damp-heat type) were randomly divided into 2 groups, under basic treatment of 2 weeks with metformin, the treatment group was given berberine. After 8 weeks, the changes in the levels of blood glucose, insulin, HbA1c, CRP and the grade of traditional Chinese medicine individual event symptom and general integral symptom were observed. Apply the formular to evaluate the pancreas's function. Results Each group had notable difference before and after the experiment in many aspects, especially in treatment group. There was a notable difference in 2 groups. Conclusion Berberine has obvious effect on increasing insulin releasing level, improving insulin sensibility, lightening insulin resistance and improving islet ?-cell function.

Objective:To discuss the effect of transitional care on the quality of life ( QOL) and psychology in acute myocardial infarction patients after PCI. Methods:The acute myocardial infarction patients accepted PCI in our university affiliated hospitals were selected and divided into experimental group and control group randomly. The control group received routine care during the period of hospitalization. The experimental group received transi-tional care including home visits, massed learning, telephone follow-up, and the establishment of WeChat and QQ group. The QOL, anxiety, and depression were investigated pre-intervention and six months post-interven-tion to evaluate the effect of transitional care. Results:After transitional care six months later, the QOL scores in the experimental group were significantly higher than those in the control group, SAS and SDS scores were lower in experimental group than those in the control group ( P<0 . 05 ) . Conclusions:Transitional care for acute myocar-dial infarction patients after PCI could improve their QOL, and relieve their anxiety and depression level in different degrees.

OBJECTIVE:To investigate clinical efficacy and safety of tiopronin combined with lamivudine in the treatment of pulmonary tuberculosis complicated with chronic hepatitis B. METHODS:150 cases diagnosed as pulmonary tuberculosis with chronic hepatitis B were randomly divided into group A(drug combination group),group B(lamivudine group)and the group C (control group),with 50 cases in each group. 3 groups were given isoniazid+rifapentine+ethambutol+levofloxacin(2HTELfx/4HT) anti-TB treatment and liver protection treatment,etc. Group B was additionally given Lamivudine tablet orally,0.1 g,qd;group A was additionally given Tiopronin tablet 0.3 g,tid,on the basis of group B. The treatment course of 3 groups lasted for 6 months. Liver damage,serum fibrosis indexes of 3 groups were observed in 3 groups before and after treatment as well as hepatitis B virolo-gy indexes,clinical efficacy and the occurrence of ADR after treatment. RESULTS:After treatment,serum levels of ALT,AST and TBIL weresignificantly increased in group C,significantly decreased in group A,with statistical significance(P<0.05).There was no statistical significance in above indexes of group B before and after treatment(P>0.05). Serum levels of ALT,AST and TBIL after the treatment:group A0.05). Serum fibrosis indexes of group A and B decreased significantly compared to before treatment,with statistical significance (P<0.05);serum fibrosis indexes after the treatment:group A0.05). CONCLUSIONS:Tiopronin combined with lamivudine can significantly reduce liver function damage caused by an-ti-TB drugs. It is conducive to the smooth progress of tuberculosis chemotherapy with fewer adverse reactions.

Objective To explore the value of combining pulmonary rehabilitation with heat and magnetic vibration (HMV) therapy and tiotropium for patients with stable but severe chronic obstructive pulmonary disease (COPD). Methods This was a paralleled, controlled, randomized study. Thirty-seven patients with stable severe COPD were enrolled and divided into two groups at random. One was the tiotropium group (T group) , while the other combined tiotropium therapy with HMV (the T + HMV group). The time span was 4 weeks. The examinations were performed at week 0, week 2 and week 4. The examinations included pulmonary function tests, arterial blood gas analysis, the 6 minute walking test (6MWT) , Borg's score and St George's Respiratory Questionaire (SGRQ). Results Inspiratory capacity (IC) increased in both groups. Forced expiratory volume in one second ( FEV1.0) , percent predicted FEV1.0 and FEV1.0/forced vital capacity ( FVC) increased significantly only in the T + HMV group. The average parameters of the pulmonary function test in the T + HMV group were significantly higher than in the T group. In both groups, alveolar PO2 ( PaO2) improved but alveolar PCO2 ( PaCO2 ) did not change and in this there was no significant difference between the groups. The 6 minute walking distance increased and the average Borg score decreased in both groups, and there was no difference between the groups. SCRQ dropped more than 4 scores in both groups, but the decrease in the T + HMV group was significantly greater. Conclusions Tiotropium can play an important role in the rehabilitation of patients with stable severe COPD. The combination of tiotropium with HMV therapy is superior to tiotropium alone in pulmonary rehabilitation for stable but severe COPD patients.

Objective To investigate the distribution and drug resistance of clinical bacteria infection in the Second Affiliated Hospital of Kunming Medical University,so as to provide reference for the treatment of bacterial infections.Methods 4 802 strains of bacteria isolated from this hospital,from January 2013 to December 2013,were retrospectively analysed.The isolates were identi-fied by using VITEK-2 Compact bacterial identification system.Drug resistance was measured by using disc diffusion test,and its results were interpreted according to the breakpoints of Clinical and Laboratory Standards Institute(CLSI)2013.WHONET 5.6 was applied for analysis.Results These pathogens were mainly isolated from urine,sputum,blood,secretions and pus,accounted for 31.7%,21.4%,1 9.7%,1 1.7% and 7.0%,respectively.In the clinical isolates,gram negative bacilli accounted for 55.8%, which was mainly Escherichia coli(26.3%).Gram positive cocci accounted for 31.7%,,which was mainly coagulase negative staph-ylococcus(1 5.0%).Fungi accounted for 3.1%,which was mainly Candida albicans.Escherichia coli and Klebsiella pneumonia were most sensitive to carbapenem,resistance rate was less than 10.0%.The detection rates of Escherichia coli and Klebsiella pneumoni-ae producing extended-spectrumβ-lactamases(ESBLs)was 61.1% and 49.1%,respectively.Among non-fermentative gram nega-tive bacilli,excepting Pseudomonas aeruginosa had good sensitivity to Amikacin,Pseudomonas aeruginosa and Acinetobacter bau-mannii showed high resistance to most antibiotics(resistance rate was more than 50.0%).Among gram positive bacteria,the detec-tion rates of meticillin-resistant Staphylococcus aureus and methicillin-resistant coagulase negative Staphylococcus were 42.3% and 65.6%,respectively.The resistance rates of Enterococcus faecium to most of antibacterials were higher.Except for linezolid and teicoplanin,the resistances of Enterococcus faecium to other antibacterials were higher than those of Enterococcus faecalis.Only a strain of Enterococcus faecium resistant to vancomycin was isolated.Conclusion Resistance monitoring might have significance in guiding the clinical rational use of antimicrobial agents,and reducing the spread of antibiotic resistance in bacteria.

Objective To explore the correlation of metabolic disorder of newly diagnosed type 2 metabolism(T2DM) and nonalcoholic fatty liver disease (NAFLD).Methods A total of 117 patients with newly diagnosed T2DM in Beijing Ditan Hospital Affiliated to Capital Medical University from June 2014 to June 2015 were enrolled.Patients were divided into two groups:T2DM with NAFLD of 57 cases and T2DM without NAFLD of 60 cases.Body mass index (BMI),waist circumference (WC),liver and kidney function,serum lipid,glycosylated hemoglobin A1c (HbA1c),fasting glucose,fasting insulin and C-peptide (FCP) were detected.The insulin resistance and β-cell function were assessed by homeostasis model assessment insulin resistance (HOMA-IR) and HOMA-β.Results The incidence of NAFLD in T2DM patients was 51％ (that was,60 cases of T2DM patients with NAFLD),compared with 2TDM group,the metabolic index of T2DM without NAFLD was significantly increased (blood triglyceride (TG):(2.58 + 1.8) mmol/1 vs.(1.22 + 0.4) mmol/l,fasting blood glucose:(11.5+6.1) mmol/l vs.(9.2+4.3) mmol/l,serum uric acid:(465.3+65) umol/l vs.(325.3+72) umoL/l;P =0.03,0.03,0.02);HOMA-IR was more serious ((4.9 ± 2.8) vs.(3.8 ± 2.7);P =0.03);insulin β-cell function was compensatory more obvious ((49.2 ± 27) vs.(29.5 ± 18);P =0.02);prevalence rate of obesity,hypertension and diabetic ketoacidosis (DKD),diabetic retinopathy (DR),diabetic peripheral neuropathy(DPN) were significantly increased(P＜0.05).Logistic regression analysis showed that,smoking(OR=1.405,95％CI:1.262-1.567),male(OR=1.037,95％CI:1.015-1.063),BMI(OR=1.113,95％CI:1.278-2.531),WC (OR =1.624,95％ CI:1.162-1.761) and TG (OR =1.823,95％ CI:1.2822.563) were risk factors of NAFLD (P ＜ 0.05).Conclusion T2DM patients with NAFLD have severer insulin resistance than those without NAFLD.The β-cell function of those patients is compensatory increased.NAFLD prevalence rate significantly increase in patients with obesity,especially in male diabetic patients who smoking.

Objective To investigate the duration for silicon gastric tube to indwell in stomach of aged patients.Methods One hundred elderly patients needing long-term nutrition support were equally randomized into two groups: control group and observation group.The former had the gastric tubes indwelled in the stomach for 4 weeks and the latter for 3 weeks.The two groups were compared about the used tubes in terms of the color of tube at the length of the first 10cm,the indentation by reflection for 10 seconds at the tube of first 10 cm,the hardness of the tube at the length of the first 10 cm and the springback angle of tube at the first 10cm after reflection.Results The tubes in the observation group were significantly better than those in the control group in terms of color,indentation,hardness and springback angle(all P<0?01).Conclusion The duration of indwelling silicon gastric tubes in stomach can be three weeks for old patients needing long-term nutrition support via indwelling silicon tubes in their stomach.

Objective:To explore the value of lactic acid (Lac), procalcitonin (PCT), sequential organ failure assessment (SOFA) score and acute physiology and chronic health evaluationⅡ (APACHEⅡ) score in assessing the severity and predicting the prognosis in sepsis shock.Methods:A retrospectively study was conducted. Patients with septic shock hospitalized in the department of critical care medicine of the Affiliated Hospital of Jining Medical University from April 2015 to June 2019 were enrrolled. The patient's gender, age, body mass index (BMI), infection site, organ dysfunction status; Lac, PCT, C-reactive protein (CRP), heart rate and body temperature immediately after admission to the intensive care unit (ICU); APACHEⅡ and SOFA scores within 24 hours, and 28-day prognosis were collected. According to the 28-day prognosis, the patients with septic shock were divided into the survival group and the death group, and the differences in the indicators between the groups were compared. Multivariate Logistic regression analysis was used to screen the risk factors of 28-day death in patients with septic shock; receiver operating characteristic curve (ROC curve) was used to analyze the value of Lac, PCT, SOFA, APACHEⅡ, and age in predicting the 28-day prognosis of patients with septic shock.Results:A total of 303 septic shock patients were enrolled, of which 124 cases survived and 179 died on the 28th day, and the 28-day mortality was 59.08%. ① Compared with the survival group, patients in the death group were older (years old: 66.58±15.22 vs. 61.15±15.68), APACHEⅡ, SOFA, proportion of lung infections, Lac increased [APACHEⅡ score: 22.79±7.62 vs. 17.98±6.88, SOFA score: 9.42±3.51 vs. 5.65±1.59, proportion of lung infections: 53.63% (96/179) vs. 39.52% (49/124), Lac (mmol/L): 5.10±3.72 vs. 3.71±2.56], oxygenation index (PaO 2/FiO 2) and ICU body temperature decreased [PaO 2/FiO 2 (mmHg, 1 mmHg = 0.133 kPa): 198.94±80.15 vs. 220.68±72.06, ICU body temperature (℃): 37.47±1.08 vs. 37.80±1.14], and the differences were statistically significant (all P < 0.05).②Multivariate Logistic regression analysis results: after adjusted for potential confounding factors, APACHEⅡ, PCT, Lac, age and SOFA were independent risk factors for death in patients with septic shock [APACHEⅡ: odds ratio ( OR) =1.05, 95% confidence interval (95% CI) was 1.01-1.10, P = 0.039; PCT: OR = 0.99, 95% CI was 0.98-1.00, P =0.012; Lac: OR = 1.23, 95% CI was 1.08-1.40, P = 0.002; age: OR = 1.03, 95% CI was 1.01-1.05, P =0.009; SOFA score: OR =1.88, 95% CI was 1.59-2.22, P < 0.001]. ③ROC curve analysis showed that APACHEⅡ, Lac, age and SOFA could predict the prognosis of patients with septic shock [APACHEⅡ: the area under the ROC curve (AUC) = 0.682 4, 95% CI was 0.621 7-0.743 1, P = 0.000; when the best cut-off value was 18.500, its sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio were 72.63%, 54.84%, 69.89%, 58.12%, 1.608 1 and 0.499 2, respectively. Lac: AUC = 0.604 5, 95% CI was 0.540 8-0.668 2, P = 0.002; when the best cut-off value was 3.550 mmol/L, the sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio were 50.84%, 73.39%, 73.39%, 50.94%, 1.910 3 and 0.669 9, respectively. Age: AUC = 0.599 1, 95% CI was 0.535 4-0.662 7, P = 0.003; when the best cut-off value was 72.500 years old, the sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio were 42.46%, 75.00%, 71.03%, 47.45%, 1.698 3 and 0.767 2, respectively. SOFA: AUC =0.822 3, 95% CI was 0.776 7-0.867 9, P = 0.000; when the best cut-off value was 7.500, its sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio were 68.72%, 87.90%, 89.13%, 66.06%, 5.680 4, 0.355 9 respectively]. The combined prediction had a good sensitivity (72.63%) and specificity (84.86%), and AUC (0.876 5) was higher than that of a single variable, suggested that the multivariate combination was more accurate in predicting the short-term outcome of septic shock. Conclusion:Lac, PCT, SOFA score, APACHEⅡ score and age were independent risk factors for death in patients with septic shock, and the accuracy of Lac, SOFA score, APACHEⅡ score and age in predicting short-term prognosis of septic shock was better than that of single variable, and the diagnostic value was higher.

Objective To understand the pathogenesis of primary hypothyroidism associated with polymyositis-like syndrome.Method Four cases were presented and the clinical characteristics were analyzed.Results All of the four patients were male.Complaints of weakness primarily affecting proximal muscles and elevation of muscle enzymes were presented.Primary hypothyroidism was diagnosed after clinical examination.Complaints of weakness and the elevated muscle enzymes were all improved after the substitution of thyroxine.Conclusion Hypothyroidism could cause polymyositis-like syndrome,and thyroid function should be screened when elevation of muscle enzymes is presented.

Objective To clone and express translocation intimin receptor(Tir)of enterohemorrhagic Escherichia coli(EHEC)O157:H7,and to analyze the effect of different routes on the induction of immunity to the recombinant protein.Methods The tir eucoding genes were amplified from EHEC O157:H7 strain guangzhou 246 genome,and genes were cloned into the vector pET-30a(+).The pET-30a(+)tir recombinant was transformed into E.coli BL21.and expression was induced bv IPTG.The expressed product was analyzed by SDS-PAGE and purified by Ni-IDA affinity chromatography.The immunized mice sera and fecal against the recombinant protein was detected.Resuits The length of the tir is 1677 bp,with the initiation codon ATG and the termination codon TAA.Double enzyme digestion and DNA sequencing confirmed that the recombinant expression plasmid pET-30a(+)-tir was constructed.The recombinant protein was expressed in Escherichia coli expression system,and was purified by Ni-IDA affinity chromatography.The mice were able to produce a high serum IgG antibody titer after both subeutaneous and intranasal immunizations.Meanwhile,the intranasal immunization induced serum and fecal IgA antibody titer was significantly higher than that of the subcutaneous immunization group.Conclusion Tir molecule is potential vaccine candidate for preventing EHEC disease.