Objective To investigate the curative effect of leflunomide in the treatment of diabetic nephropathy-Ⅳ (DN-Ⅳ).Methods Sixty cases with DN-Ⅳ were assigned to the leflunomide treatment group and the control group.Both groups were given hypoglycemic,antihypertensive,regulate lipid and angiotensin converting enzyme inhibitors or angiotensin Ⅱ inhibitor class of drugs.Meanwhile patients in the treatment group were orally administered leflunomide once daily for two month with a dose of 50 mg/d in the first three days and 20 mg/d afterwards.24 hour pre-and post-treatment values of urinary protein,C-reactive protein (CRP),endogenous creatinine clearance rate (Ccr),triglyceride (TG),total cholesterol (TC),albumin (ALB),glycosylated hemoglobin (HbA1c) and blood pressure were measured.Analyzed the correlation of Ccr with other laboratory indicators after treatment for one year.Results At 24 hour before treatment,after treatment for two months and one year,the level of 24 h urinary protein of the treatment group (n =26) were (3.75 ± 0.94)g/24 h,(2.02 ± 0.45) g/24 h,and (2.46 ± 0.55) g/24 h respectively,and the level of Ccr were (69.04 ± 13.35) ml/min,(71.35 ± 11.25) ml/min,and (67.48 ± 10.58) ml/min respectively.While in the control group(n =28),the 24 h urinary protein level of were (3.68 ± 1.03) g/24 h,(3.43 ± 0.65) g/24 h,and (5.46 ±0.47) g/24 h respectively at the three time points,and the Ccr level were (68.55 ± 10.09) ml/min,(66.76 ± 9.45) ml/min,(57.50 ± 15.75) ml/min respectively.The levels of 24 h urinary protein in the treatment group after treatment for two months and one year were significantly lower than before treatment in the treatment group as well as at the corresponding period of the control group (P ＜ 0.05),while the level of Ccr in the treatment group was higher than that of the control group at the same period,and the difference was statistically significant(P ＜ 0.05).The levels of CRP,TG,TC,HbAlc and systolic pressure in the treatment group after treatment for two months and one year were significantly lower than that of control group at the same period,while ALB was significantly higher than before treatment in the treatment group as well as at the corresponding period of the control group (P ＜ 0.05).The 24 h urine protein,TC,systolic blood pressure were significantly correlated with Ccr after treatment for one year (β =-0.771,-0.682,0.656,-0.530respectively;P ＜0.01).Conclusion Leflunomide treatment of diabetic nephropathy was safe and effective,but the duration of leflunomide treatment and second selection time of leflunomide therapy needed to further study.

Objective To investigate the effect of renal anemia variability on the progression of renal function in patients with chronic kidney disease and hemoglobin variability on the incidence of cardiovascularevents,mortality and re-hospitalization rate.Methods one hundred and twenty-three patients with chronickidney disease with stage Ⅲ-Ⅴ were enrolled in this study.The information of hemoglobin variability,creatinineclearance rate (Ccr),renal function,the incidence of cardiovascular events,mortality and rehospitalization rate,the incidence of cardiovascular events,mortality and rehospitalization rate were recorded and analyzed.ResultsThe change of hemoglobin level was (20.6 ± 10.7) g/L and Ccr change level was (16.3 ± 4.1) ml/min inpatients,and the pearson correlation coefficient was 0.82.Multiple covariance analysis showed that Ccr increaselevel was higher in CKD Ⅲ-Ⅴ period patients with hemoglobin fluctuations than that of hemoglobin stabilitypatients after adjusting smoking history,blood pressure,24 h urinary protein quantitative factors (F =7.6,9.1,4.3;P＜0.05).The incidence of cardiovascular events in patients,mortality,rehospitalization rate of hemoglobinwave group were higher than those of hemoglobin stabilizing group(x2 =26.9,5.1,10.6,P＜0.05 or P＜0.01).Conclusion The fluctuation of hemoglobin is able to aggravate quickly of renal function development,increasethe incidence,mortality and rehospitalization rate of cardiovascular events.

Acute appendicitis is the most common surgical or acute abdomen in childhood.Rapid and correct diagnosis is the premise of rational therapy,but there are still some problems in diagnosis and differential diagnosis.Sufficient comprehension about clinical features and differential diagnostic diseases,typical clinical symptoms,physical examination,laboratory examinations,ultrasonography or CT would make a definite diagnosis.Laparoscopy is also used to make a diagnosis if necessary.

Objective To study the influencing factors on the time of acute cerebral apoplexy patients visiting the hospital.Methods 64 patients with acute ischemic stroke were researched.The clinical data of all patients were collected.The influencing factors on treatment time were analyzed by univariate and multivariate Logistic regression analysis.Results In the 64 patients, 26 cases of the visiting time≤6 h(40.63%), 38 cases of visiting time>6 h(59.37%).The results of single factor analysis showed that the relationship between the time of treatment,pre-hospital transfer mode (x2=6.650,5.081,all P<0.05),educational level,living location,MRS score,whether or not know the stroke(x2=4.561,6.557,8.788,4.146,all P<0.05);the disturbance of consciousness and symptoms ≥3 symptoms compared with the visiting time had significant difference(x2=5.133,5.926,all P<0.05);in the multiple factors Logitic regression analysis,the degree of education(OR=2.332,95%CI:1.402~3.904),severity of illness(OR=3.956,95%CI:1.934~7.446),understanding of stroke(OR=3.621,95%CI:1.563~8.125),disturbance of consciousness(OR=4.336,95%CI:2.394~11.374),pre-hospital transport mode(OR=5.658,95%CI:2.546~12.554) were the risk factors of treatment time.Conclusion There is a close relationship with extension and various factors of acute ischemic stroke patients,in the future,not only need to improve the pre-hospital emergency care system,but also need to strengthen the public understanding of the disease.

Objective:Spectrophotometer is a device to be verified obligatory in hospital. This article introduced some techniques to avoid ordinary mistakes in measurement. Methods:We introduced principle and verification regulation of spectrophotometer. Such methods as parameter configuration, proper maintenance can reduce our mistakes. Results: This article analyzed some common problems in measurement and also offered solutions. Conclusion: In the measurements of spectrophotometers, because the operators have less spectrophotometer operation experience, they often get inaccurate data which lead to an error. Conclusion: To avoid these mistakes, strictly regulate operations in spectrophotometer’s verification and proper routine maintenance are necessary.

[Summary] This review summarized the evolution of surgical timing and procedure skills of postnatal repair in the treatment of congenital diaphragmatic hernia ( CDH ) .Minimally invasive repair of diaphragmatic hernia was highlighted.The current status, difficulties, and future trends of surgical intervention for CDH were analyzed.

Objective To investigate the relationship between pluse pressure(PP) and serum levels of C-reactive protien(Hs-CRP) in elderly patients with HBP.Methods To measure serum levels of Hs-CRP,total cholesterol(TC),triglyceride(TG),high density lipoprotein-cholesterol( HDL-C),low density lipoprotein-cholesterol(LDL-C) and FBG in 160 patients. Patients were divided into four groups according to the levels of their PP,100mmHg whose serum levels of Hs-CRP were compared.Results Hs-CRP rose with the levels of PP,and were significantly higher in four groups(P

Objective To explore the electrophysiological properties and the disparity of visual cortical neurons in developing rats. Methods Whole cell patch clamp recording and intracellular labeling of brain slices were performed on rats at postnatal 14 and 28 days. The electrophysiological data were analyzed according to the cellular input resistance and resting membrane potential. Results When the input impedance of visual cortical neurons(IR) was lower, increased peak value of postsynaptic currents(PSCs), prolonged rise and decay time were found. At postnatal 14th day(before eyes opened), the intermediate cells and mature cells were 59.2% and 14.9% respectively, but at postnatal 28th day(14 days after eyes opened), the mature cells and immature cells were 62.5% and 12.5% respectively. Conclusion During the period of postnatal development, the visual cortical neurons become mature gradually, but maturation is not completely correlated with age.

Modern medical staff are facing the challenge to survive in competitions and develop through cooperation.Thus it is of great importance for the future medical staff,that is,medical students to cultivate and enhance their teamwork for future demand.Cultivating approaches mainly include creating a collaborative environment,carrying out cooperative scientific research,creating teamwork in the curriculum,and launching community service activities.

Objective To detect mutations in the OSMR gene in 2 Chinese families with familial primary cutaneous amyloidosis (FPCA),and to analyze their relationship with clinical manifestations.Methods Clinical data were collected from 2 families with FPCA,and genomic DNA was extracted from peripheral blood samples.PCR was performed to amplify 18 exons and their flanking sequences of the OSMR gene followed by DNA sequencing in 2 probands and their family members.One hundred healthy individuals served as controls.Results In the first family,a heterozygous mutation (c.2081C ＞ T) in exon 15 of the OSMR gene,which leads to a codon change at amino acid position 694 (p.P694L),was identified in the proband,as well as in the other 4 patients.In the second family,a heterozygous mutation (c.1538G ＞A) in exon 11 of the OSMR gene,which causes a codon change at amino acid position 513 (p.G513D),was identified in the other proband and her mother,suggesting the cosegregation of the gene mutation with the disease.None of the above mutations were detected in the healthy family members or controls.Conclusion The heterozygous mutations p.P694L and p.G513D in the OSMR gene may be associated with primary cutaneous amyloidosis.