Objective To investigate the influence of 1,25(OH)2D3 (VD3) on proliferation and dif-ferentiation of human preadipocytes in high-glucose condition .Methods Primary culture of human preadipo-cytes were divided into 4 groups:the control group, high glucose group, control+VD3 group, and high glucose+VD3 group.Oil red O staining and extraction with isopropyl alcohol were employed to detect the total amount of fat in different groups .Real-time polymerase chain reaction was used to detect the mRNA levels of vitamin D receptor (VDR), CCAAT/enhancer binding protein a (C/EBPa) and peroxisome proliferator activated receptor gamma ( PPARγ) in each group .Results Compared with the control group , the fat amount was significantly increased in the high glucose group (0.231 ±0.033 vs.0.362 ±0.045 , P=0.037 ) and high glucose +VD3 group (0.231 ±0.033 vs.0.358 ±0.057, P=0.033), decreased in the control +VD3 group (0.231 ± 0.033 vs.0.174 ±0.029, P=0.016), but no significant difference in the glucose+VD3 group (0.362 ±0.045 vs.0.358 ±0.057, P=0.450);VDR mRNA level was decreased in the high glucose group (0.397 ± 0.029 vs.0.069 ±0.003 , P=0.022 ) , but VD3 increased the VDR mRNA levels in both the control +VD3 group and the high glucose +VD3 group (0.397 ±0.029 vs.1.103 ±0.044 , P=0.035;0.069 ±0.003 vs. 0.152 ±0.021 , P=0.041 );the mRNA levels of C/EBPa and PPARγwere up-regulated in the high glucose group (0.135 ±0.048 vs.0.788 ±0.063, P=0.018;0.498 ±0.026 vs.0.795 ±0.037, P=0.021), VD3 decreased the PPARγmRNA level in the control +VD3 group ( 0.498 ±0.026 vs.0.237 ±0.011 , P =0.029), but had no significant effect on C/EBPa mRNA (0.788 ±0.063 vs.0.843 ±0.049, P>0.05) and PPARγmRNA (0.795 ±0.037 vs.0.813 ±0.041, P>0.05) expressions in the high glucose +VD3 group or C/EBPa mRNA in the control+VD3 group (0.135 ±0.048 vs.0.156 ±0.022, P>0.05).Conclusion VD3 may lose the ability to inhibit the proliferation and differentiation of human preadipocyte due to reduced biologi -cal activity when exposed to high-glucose environment in vitro.

Objective To evaluate the change situation of cognitive function in the patients with chronic renal failure (CRF) complicating obstructive sleep apnea syndrome(OSAS) .Methods Sixty‐two inpatients with non‐dialysis CRF in our hospital from September 2013 to January 2015 were selected and divided into the group O (complicating OSAS ,31 cases) and group N(without complicating OSAS ,31 cases) ,and contemporaneous 33 individuals undergoing the physical examination were taken as the control group(group C) .The cognitive function was evaluated by the Montreal cognitive assessment (MoCA) .The apnea hypopnea index (AHI) and lowest pulse oxygen saturation(LSpO2 ) at night were measured with a portable sleep monitor .The comparative analysis was performed .Results In the group O ,there was 14 cases of patients(45 .16% ) whose MoCA total score was less than 26 points , while there was only 3 cases(9 .68% ) in the group N ,the difference was statistically significant (P<0 .05) .The MoCA total score , scores of visuospatial and executive function ,attention ,delayed recall and orientation in the group O and N were lower than those in the group C ,while the MoCA total score ,attention and delayed recall in he group O were lower than those in the group N ,the score of language was lower than that in the group N and C ,the differences were statistically significant (P< 0 .05) .The MoCA total score was negatively correlated with serum creatinine and AHI (r= -0 .374 ,r= -0 .408 ,P<0 .05) ,and positively correlated with the GFR level and night LSpO2 (r=0 .382 ,r=0 .519 ,P<0 .05) .Conclusion The patients with CRF complicating OSAS increase the risk of cognitive impairment .

ObjectiveTo observe the effect of nursing interventions on improvement of psychological actions and quality of life of patients with Alzheimer disease. Methods50 patients with senile dementia diagnosed in our hospital were chosen.They were divided into the observation group and the control group with 25 patients in each group.All patients were taken with AD routine nursing care after admission.The observation group was taken with rehabilitation nursing interventions based on AD routine nursing care.The mini-mental state examination (MMSE)and the daily life ability scale (ADL)were used to evaluate the quality of life after nursing intervention. ResultsThe patients' MMSE score in the observation group was significantly higher than the control group,the difference was statistically significant.The ADL score of the observation group was significantly lower than the control group,the difference was statistically significant. ConclusionsThe use of integrated care intervention can significantly improve the cognitive function in AD patients,and improve daily living ability and quality of life significantly.

Objective To observe the cyclooxygenase-2(COX-2) expression of gastric tumor tissue ,and to study the relationship between cagA + Helicobacter pylori(Hp cagA+ ) infection and COX-2 .Methods 42 specimens of gastric cancer tissue (including gastric carcinoma ,paracancerous hyperplastic tissue and paracancerous normal gastric mucosa ) in our hospitals from January 2010 to August 2011 were collected and detected the Hp cagA expression by PCR .Results The COX-2 protein positive rate in the gas-tric tcancer tissue was significantly higher than that in the paracancerous hyperplastic tissue and normal gastric mucosa (P<0 .01) . Among 42 cases of gastric cancer specimens ,Hp cagA+ was in 25 cases ,Hp cagA - was in 17 cases .The COX-2 protein positive rate was 88 .0% (22/25) in the Hp cagA+ group and 35 .3% (6/17) in the Hp cagA - group .The COX-2 protein positive rate in the Hp cagA+ gastric tissue was significantly higher than that in the Hp cagA - gastric tissue(P<0 .01) .Conclusion Abnormal ex-pression of COX-2 exists in gastric tcancer tissue ,cagA+ Helicobacter pylori infection may promote the occurrence and development of gastric cancer by regulating the expression level of COX-2 .

BACKGROUND: There are many drawbacks with hormone replacement therapy for menopausal syndrome. The blood levels of 5-HT and norepinephrine are lower. Fluoxetine hydrochlorde(ProzacR) is a selective serotonin reuptake inhibitor which is widely used in treating anxiety and depression,OBJECTIVE: To evaluate the effect of combined antidepressant and estrogen therapy compared to estrogen alone in the treatment of perimenopausal syndrome in this prospective open study.DESIGN: Randomized comparative study.SETTING: Department of Obstetrics and Gynecology of the First Affiliated Hospital of Chongqing Medical University PARTICIPANTS: From November 2003 to December 2004, 60 female patients with diagnosed menopausal syndrome of 3-12 month duration, aged (46±3) years, from Department of Obstetrics and Gynecology of the First Affiliated Hospital of Chongqing Medical University were enrolled into the study after giving their informed consents. The patients were randomly divided into two equal groups with Group 1 (n=30) receiving a combination of antidepressant + estrogen and Group 2 (n=30) receiving estrogen only.METHODS: Patients in Grgup 1 received fluoxetine hydrochloride (ProzacR) 20 mg orally every morning plus oral estradiol 1 mg once every two weeks for 2 months. Patients in Group 2 received only oral estradiol 1 mg once every two weeks for two months. Patients were not taking any other drug during the treatment period. At the end of two month treatment all patients were evaluated with the following 3 assessment tools: ①female menopausal symptom evaluation with the following 4 categories: Complete symptom relief, markedly improved, improved and no effect. Overall efficacy was defined as 50% symptom improvement. ② Hamilton Depression Scale which reflects energy level and psychosomatic factor of sleep and anxiety. ③Menopause index: Which are description of clinical evaluation and adverse effects; this would help to assess the safety of using both drugs in treating the menopausal syndrome.MAIN OUTCOME MEASURES: female menopausal symptom assessment, hamilton depression scale, and menopause index.RESULTS: ① In female menopausal symptom assessment group 1 showed better results in the complete relief and markedly improved scores. ②Hamilton Depression Scale group 1 also showed better scores than Group2(In Groupl, the scores at week 1 to 8 were 25,18,15,10,8,5,5,4 respectively ,in Group 2, the scores at week 1 to 8 were 25,17,15,14,13,12,13,13 respectively). ③ Group 3 showed a significant better score in the menopausal index with improvement in sleep disorder, anxiety and depression than Group 2 (In Group 1 the scores at week 1-8 were 32,22.5,15,15,14,15,15,14 respectively,In group 2, the scores at week 1 to 8were 33,21,16,14,13,12,13,13 respectively) ,there was no significant difference of incidence of adverse events as compared with Group 3 .CONCLUSION: Combined therapy of fluoxetire hydrochlarde(PROZAC)plus estrogen showed better efficacy in the treatment of menopausal syndrome than estrogen alone.

Objective To investigate the value of CysC-based CFR in comparison with creatinine-based GFR (CG-GFR and MDRD-GFR) as an accurate serum marker in the prediction of early diabetic nephropathy. Methods A tatal of 133 type 2 diabetic patients (74 males and 59 females, aged 58.1 ±12.3) were enrolled. The level of diabetic nephropathy (normoalbuminuric, microalbuminuric and macroalbuminuric) was staged and estimated GFR based on serum creatinine and cystatin C(CysC) was calculated. The plasma clearance of Tc-DTPA, serum CysC, creatinine, BMI, HbA1c, serum lipid and blood pressure were measured. Results 99mTc-DTPA-GFR was used as golden standard. At 90 and 75 ml· min-1· (1.73 m2)-1 cut-points, diagnostic efficiencies of CysC-GFR (89% and 92%) were better than those of CG-GFR (79%=86%, P=0.004, 0.04) and MDRD-GFR (80%-86%, P=0.02, 0.04). At 60 ml · min-1 · (1.73 m2)-1 cut-point, diagnostic efficiencies of CysC-GFR,CG-GFR and MDRD-GFR were 92%, 90% and 92% respectively (P= 0.49, P=0.71). The Logistic regression analyses showed that retinopathy, HbA1c, CysC, diabetic duration, and CysC-GFR were indicators to predict the development of microalbuminuria. Conclusion CysC-GFR is more valuable than CG-GFR and MDRD-GFR in the prediction of early diabetic nephropathy and should be applied clinically.

n clinic.

Objective To comparative analysze of the applications value of breast-conserving surgery and improved surgical in breast cancer patients.Methods One hundred and sixty-eight female breast cancer patients from February 2005 to October 2010 in the People's Hospital of Rizhaoour hospital were selected.The patients were divided into breast-conserving surgery group (n =80) and improved surgical group (n =88).The patients in two groups were followed-up and investigated for three years.Operative time,blood loss,postoperative drainage,postoperative drainage time and hospital stay,incidence of complications,local recurrence,distant metastasis and survival after 3 year,satisfaction ratio of breast cosmetology,psychological anxiety scores and quality of life scores after 3 years of the patients in two groups were compared and analyzed.Results The complication rate of breast-conserving surgery group was 12.50％ (10/80),lower than the improved surgical group,and the difference was significant statistically (29.55％ (26/88),x2 =7.23,P＜0.05).The operative time ((72.68±5.28) min),blood loss ((39.21 ± 8.59) ml),postoperative drainage ((162.25 ± 28.56) ml),postoperative drainage time((8.16±2.58) d) and the length of hospital stay((11.43±1.98) d) of the patients in breast-conserving surgery group were lower than those of the improved surgical group,and the differences of two groups were significant statistically ((92.48 ± 6.01) min,(68.26 ± 10.23) ml,(343.29 ± 62.18) ml,(16.59±4.96) d,(18.47±2.94) d;t =22.72,19.99,24.61,13.99,18.35;P＜0.05).The satisfaction rate after 3 years of breast-conserving surgery group was 92.50％(74/80),higher than that of the improved surgical group,and the difference was significant statistically (81.82％ (72/88),x2 =4.20,P＜ 0.05).The psychological anxiety scores after 2 and 3 years of breast-conserving surgery group were (40.02 ± 2.63) points and (34.26 ± 3.59) points,lower than those of improved surgical group((42.58±2.37) points and (39.85±2.10) points),the quality of life scores after 3 years of breast-conserving surgery group was (67.58± 11.26)points,higher than that of improved surgical group ((50.85 ± 10.42) points),and the differences were significant statistically (t =6.60,12.16,9.96;P ＜ 0.05).Conclusion Breast-conserving surgery could reduce the incidence of complications and psychological anxiety situations,improve clinically relevant indicators and satisfaction ratio of breast cosmetology and quality of life for the breast cancer patients.

Objective To evaluate the serum 25-hydroxyvitamin D [25 (OH)D3] levels in non-diabetic people in Taiyuan community,and its relationship with obesity and abdominal obesity.Methods This crosssectional study enrolled 417 non-diabetic people in Tainyuan community from July to September in 2011 [225 males and 192 females,mean age (47.6 ±7.8) years].For all the enrolled subjects,we collected data about anthropometric indexes,medical history,blood glucose,lipid profile,25 (OH) D3,fasting insulin (Fins) level,homeostasis model assessement for insulin resistance (HOMA-IR),body fat content (％) measured with dualenergy X-ray absorptiometry (DEXA),and intra-abdominal adipose tissue (IAAT) and abdominal subcutaneous adipose tissue (SCAT) calculated based on magnetic resonance imaging at the 4th to 5th lumbar disc level (IAAT≥80 cm2 was considered abdominal obesity).Correlation analysis was performed to assess the relationships of serum 25 (OH) D3 levels with biochemical and body fat indexes.Results The average serum level of 25 (OH) D3 was 44.5 nmol/L in the 417 people,with vitamin D deficiency in 261 cases (62.6％) and vitamin D insufficiency in 109 cases (26.1％).Of the vitamin D deficient and insufficient people,77.6％ had abdominal obesity according to IAAT (IAAT ≥ 80 cm2).According to Pearson analysis result,lg 25 (OH)D3 was negatively correlated with lg Fins,lg HOMA-IR,waist circumference,systolic blood pressure,diastolic blood pressure,total abdominal adipose tissue (TAAT),IAAT (all P ＜0.05).It was also negatively correlated with waist-to-hip-ratio,body mass index (BMI),and body fat content (％),but without statistical significance (all P ＞0.05).In stepwise multiple linear regression model,lg HOMA-IR (t =-4.278,P =0.001) and TAAT (t =-5.146,P =0.002) were independently correlated with lg 25 (OH) D3.Conclusions About 90％ of all non-diabetic population in Taiyuan community have vitamin D deficiency or insufficiency,of whom 4/5 have abdominal obesity.Serum 25 (OH)D3 level is negatively correlated with abdominal adipose tissue,but not significantly associated with BMI.HOMA-IR and TAAT are independent risk factors for vitamin D deficiency.

Objective To assess the volume of epicardial adipose tissue(EAT) and intrathoracic adipose tissue(IAT) and the correlation of EAT,IAT and the EAT/IAT ratio with the severity of coronary artery atherosclerosis in patients with metabolic syndrome(MS) and coronary heart disease(CHD).Methods Ninty-seven MS subjects without coronary atherosclerosis and one hundred and eighteen MS subjects with CHD were enrolled in this study.The volumes of EAT,PAT and IAT were measured using axial data from base to apex traced manually with a dedicated semiautomatic software program-volume.Results (1)Compared with MS subjects without coronary atherosclerosis,MS subjects with CHD had significantly increased age[(60.6± 1 1.4)years vs.(57.9 ± 8.7) years,P=0.001],positive family history of cardiovascular disease(29.7％ vs.21.6％,P=0.03),EAT[(98.3±41.4) cm3 vs.(82.2±39.7) cm3,P=0.001],IAT [(171.3±64.1) cm3 vs.(156.2±48.1) cm3,P=0.001] and HbA1c[(7.1 ± 1.8)％ vs.(6.6±2.3)％,P=0.02],but siginificantly reduced total cholesterol[TC,(4.9 ± 1.2)mmol/L vs.(5.4 ± 1.0) mmol/L,P=0.003],low-density lipoprotein cholesterol[LDL-C,(3.0±1.1) mmol/L vs.(3.6±1.0) mmol/L,P=0.03] and high-density lipoprotein cholesterol[HDL-C,(1.0 ± 0.4) mmol/L vs.(1.1 ± 0.3) mmol/L,P=0.04].(2) In MS subjects without coronary atherosclerosis,the volumes of EAT,pericardial adipose tissue(PAT) and IAT were associated with gender,body mass index(BMI),waist circumference(WC),diabetes mellitus and hyperlipidemia(all P＜0.05); however,in MS subjects with CHD,the volumes of EAT,PAT and IAT were associated with BMI and WC (both P＜0.05).(3) The volumes of EAT and IAT were correlated with calcification grades(r values were 0.45 and 0.50,P values were 0.017 and 0.013,respectively) and Gensini score(r values were 0.476 and 0.563,P values were 0.015 and 0.017,respectively) instead of coronary artery calcifacation score(CACS).Moreover,the EAT/IAT ratio was negatively correlated with CACS(r=-0.321,P=0.028).Conclusions Compared with MS subjects without coronary atherosclerosis,MS subjects with CHD have significantly increased EAT and IAT volumes.In our subjects,the volumes of EAT,PAT and IAT were associated with BMI and WC.Only in MS subjects with CHD,the volumes of EAT and IAT were correlated with caleification and Gensini score.