To investigate the expression of vascular endothelial growth factor (VEGF)and the levels of reactive oxygen species (ROS)in human mesangial cells cultured in high glucose and being intervened by pigment epithelium-derived factor (PEDF). The results showed that with increased glucose concentration, the expressions of VEGF and ROS generation also gradually increased and PEDF significantly downregulated VEGF expression and ROS generation in a dose-dependent manner. PEDF may delay the diabetic nephropathy progress by improving vascular permeability and inhibiting oxidative stress.

Objective To evaluate the effect of implementing quality control circle (QCC)activities on nurses’ knowledge about ventilator-associated infection(VAP),as well as head-of-bed (HOB)elevation and incidence of VAP in patients.Methods 100 patients who used ventilators in an intensive care unit(ICU)of a hospital were ran-domly selected,50 patients were selected before the implementation of QCC(January-June,2013),and 50 were se-lected after the implementation of QCC (July-December,2103).Condition of nurses and patients who used ventila-tors before and after implementation of QCC were investigated.Results After implementing QCC,the scores of nurses’recognition on knowledge about causes and risks of VAP,significance and standard of HOB elevation,and HOB elevation≥ 30°were all higher than before implementing QCC;the total score was higher than before imple-menting QCC ([18.32±3.14]vs [7.98 ±1 .12],P <0.05 );patients’compliance to HOB elevation was higher than before implementing QCC([96.00%,n=48]vs [44.00%,n=22],P <0.05);incidence of VAP was lower than before implementing QCC ([4.00%,n =2]vs [36.00%,n =18],P <0.05).Conclusion Implementation of QCC activities can effectively improve ICU nurses’recognition on knowledge about VAP and enhance patients’ compliance to HOB elevation,as well as reduce the incidence of VAP,it is helpful for improving healthcare-associat-ed infection management quality.

Antiaging effects or powdered Nelumbo nucifera seed were studied on wistar rats by comparing thcir viscera/body, T lymphocyte, SOD, LPO, GSH-Px between fed animals and control. Results showed that there was obvious increase of T lymphocyte in thorax cortex between fed and control, whereas distinct disparity of other indexes can not be found. These results implied that powdered N.nucifera seed has some functions of enforcing immunity.

BACKGROUND: Insulin resistance (IR) is associated with type 2 diabetes mellitus and its macrovascular complications. Euglycemic agent (rosiglitazone and metformin) can ameliorate IR, but its influences on other cardiovascular risk factors, including blood lipid, blood pressure and body mass need to be further studied.OBJECTIVE: To observe the effects of rosiglitazone and metformin on the blood glucose, blood lipid, blood pressure and body mass of patients with type 2 diabetes mellitus complicated by blood lipid disturbance.DESIGN: A clinical observation.SETTING: Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University.PARTICIPANTS: Forty-two patients with type 2 diabetes mellitus complicated by dyslipideamia, who received treatment in the Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University between June and September 2006 were recruited in this study. The involved patients, 27 male and 15 female, averaged (58±2)years ranging from 30 to 70 years old. Inclusive criteria:①Type 2 diabetes mellitus all met the diagnostic criteria of American Diabetes Association (2006).② Diagnostic criteria of blood lipid disturbance : total cholesterol(TC)＞ 4.68 mmol/L, triglyceride (TG) ＞ 1.7 mmol/L, low density lipoprotein cholesterol (LDL-C) ＞ 2.68 mmol/L, high density lipoprotein cholesterol (HDL-C) ＜ 0.9 mmol/L (female), ＜ 1.0 mmol/L (male). Informed consents were obtained from all the patients.METHODS：①Drug treatment：Dudng the 12-week treatment,all the patients received 0．75 g metformin(Lot No．051110 and 051214,0.25 g，lablel,Jiangsu Hengrui Medicine Co.，Ltd)and 4 mg rosiglitazone (Lot No．0511101,2 mg／tablet，Jiangsu Hengrui Medicine Co.，Ltd) daily．②Physical and laboratory measurements：Body mass index，blood pressure were taken，and blood lipid profile(TC,TG,C-LDL and C-HDL)，fasting and postprandial blood glucose were measured by colodmetdc method before,8 and 12 weeks after treatment．MAIN OUTCOME MEASURES：①Fasting and postprandial blood glucose level change．②Blood lipid，blood pressure and body mass index change．RESULTS：Forty-two patients with type 2 diabetes mellitus complicated by dyslipideamia were recruited，and three dropped out the experiment，one patient suffered from severe watery stool,one patient from severe abdominal distention,one patient from urinary tract infection, and the other thirty-nine patients completed the observation in the final analysis．Compared with pretraatment data,fasting and postprandial blood glucose levels 12 weeks after treatment were decreased(P＜0．01),TC increased(P＜0．05)，LDL-C decreased(P＜0．01)，HDL-C increased(P＜0．01),blood pressure did not change(P＞0．05) and body mass index increased(P＜0．01)．CONCLUSION：Combinatin of rosiglitazone and metformin significantly decreases blood glucose，decreases LDL-C,increases TC，HDL-C,body mass index,and has no obvious effects on TG and blood pressure．It is safe and bearable for type 2 diabetes mellitus patients with dyslipideamia．

Objective To explore application effect of evidence-based nursing in operation of rupture of liver and apleen. Methods 108 patients with rupture of liver and spleen received evidence-based nursing during perioperative period, that is, to determinate nursing problems needed to prove, retrieve and analyze related articles, make the best nursing mode and prevent complications. Results Complications appeared in 15 patients, intra-abdominal hemorrhage in 4 patients, infection in 7 patients and splenic fever in 4 patients. All were corrected in time, and no case showed thrombosis and organ failure. Conclusions EBN can prevent post-operative complications for patients with rapture of liver and spleen and improve nursing quality.

Objective To evaluate the importance of three-dimensional radiotherapy for elderly patients of stage Ⅳ non-small cell lung cancer (NSCLC).Methods Comparing with treatment outcome of ≥65 years 67 patients and ＜ 65 years 134 patients using concurrent chemotherapy and thoracic threedimensional radiotherapy during 2003 to 2010 years.Survival analysis was taken by Kaplan-Meier method.The multivariate prognosis was analyzed by Cox model.Results The follow-up was 97.8％.The percentage of ≥65 years and ＜ 65 years patients accepted with concurrent 4-5 cycles chemotherapy were 30％ and 55％,and with 42％ and 49％ patients with radiotherapy ≥63 Gy.The median survival time (MST) were 17 months and 14 months (x2 =0.76,P =0.384) for ≥65 years and ＜ 65 years patients accepted with concurrent 4-5 cycles chemotherapy concurrent ≥63 Gy radiotherapy respectively.The MST and 1-,2-,3year overall survival rate were 17 months and 8 months,65％ and 23％,30％ and 13％,24％ and 9％(x2 =7.90,P =0.005) for whole groups patients treated with chemotherapy concurrent ≥63 Gy and ＜ 63 Gy radiotherapy.And the MST of patients ≥ 63 Gy was significantly longer than those with ＜ 63 Gy either concurrent chemotherapy any cycles (x2 =9.54,P =0.023).The MST were 14 months and 8 months (x2 =1.82,P=0.178),17 months and 17 months (x2 =0.47,P=0.492) for ≥ 65 years and ≥ 63 Gy radiotherapy patients accepted with concurrent 4-5 cycles and 2-3 cycles chemotherapy concurrent respectively.Multivariate analysis showed local response (β =0.600,P =0.003) and numbers of tumor metastasis (β =0.670,P =0.040) were independent factors for survival.Conclusions For a part of elderly patients of stage Ⅳ NSCLC,concurrent chemotherapy and thoracic three-dimensional radiotherapy can prolong survival time with acceptable toxicity.Perhaps radiotherapy is more important.

Objective To explore high-risk factors that affect the severity of diabetic foot ulcers and the relationship between the severity of diabetic foot ulcers and the general somatic conditions by analyzing clinical data of 218 diabetic foot patients.Methods A retrospective analysis of the clinical data of 218 diabetic foot patients,admitted from 2006 to 2010 was performed.Fasting and postprandial blood glucose ( FBG and PBG ),glycosylated hemoglobin,hemoglobin,serum albumin,serum creatinine,as well as serum urea nitrogen and fibrinogen were determined in patients with different Wagner levels.The effects of peripheral arterial disease,neuropathy,infections and other factors on severity of diabetic foot ulcers,and the prognosis of those patients with different Wagner levels were analyzed.Results ( 1 ) FBG and PBG in Wagner 5 patients were significantly higher than those in Wagner 1,but there was no statistical significance in HbA1C difference.(2) Hemoglobin,total cholesterol,serum albumin in Wagner 5 patients were decreased significantly ; white blood cells,serum creatinine and fibrinogen were increased significantly ( P＜0.01 ).(3) The intima-media thickness(IMT) of femoral artery in Wagner 2-and-above patients was increased significantly compared with that in Wagner 1 ( P＜0.05 ).( 4 ) Logistic regression analysis showed that hemoglobin,fibrinogen,glycated hemoglobin,femoral artery intima-media thickness,and bacterial infection were correlated independently with the severity of diabetic foot ulcers.(5) The hospitalized days were increased with rising Wagner levels ; the prognosis of Wagner 5 patients was the worst,with the highest mortality in the group.Conclusions Changes in blood level of hemoglobin,fibrinogen,along with higher HbA1C and femoral artery IMT,as well as infections are high-risk factors of severity in diabetic foot patients.HbA1C is not a good indicator of blood glucose control in patients with Wagner 5 grade.The higher the Wagner grade,the longer the time spent in hospital,and the worse the prognosis wouldbe.

Objective To investigate the role of three-dimensional (3D) radiotherapy to the thoracic primary tumor in non-small cell lung cancer (NSCLC) patients with bone metastases during chemotherapy with concurrent 3D radiotherapy.Methods From 2003 to 2010,the clinical data of 95 stage Ⅳ NSCLC patients with bone metastases were collected.All patients received 3D radiotherapy to the thoracic primary tumor and at least 2 cycles of chemotherapy.Of the 95 patients,47 had only bone metastases,and 48 had metastases to bones and other organs.The Kaplan-Meier method was used to calculate overall survival (OS) rates.The log-rank test was used for survival difference analysis and univariate prognostic analysis.The Cox regression model was used for multivariate prognostic analysis.Results The follow-up rate was 95％.The 1-,2-,and 3-year OS rates were 44％,17％,and 9％,respectively.The univariate analysis showed that radiation dose to the planning target volume (PTV) of primary tumor of ≥ 63 Gy,response to treatment of primary tumor,and at least 4 cycles of chemotherapy were favorable prognostic factors for OS in all patients (P =0.001,0.037,and 0.009).Radiation dose to the PTV of primary tumor of ≥ 63 Gy remained the favorable prognostic factor for OS in patients with only bone metastases and those with metastases to bones and other organs (P =0.045 and 0.012).Among patients with only bone metastases,those with T1 + T2 primary tumors had longer OS than those with T3 + T4 primary tumors (P =0.048).The multivariate analysis showed that radiation dose to the PTV of primary tumor of ≥ 63 Gy and metastases to bones only were independent favorable prognostic factors for OS in all patients (P =0.036 and 0.035).Conclusions For NSCLC patients with bone metastases,3D radiotherapy to the thoracic primary tumor and its dose play an important role in improving OS during chemotherapy with concurrent 3D radiotherapy.

The relationship between visfatin.endothelin, and insulin resistance in the pathogenesis of type 2 diabetes mellitus was explored. Endothelin, visfatin, and other markers were compared. Plasma visfatin was reduced after therapy. Endothelin was positively correlated with fasting insulin, HOMA-IR, HOMA-p, and visfatin. Visfatin was positively correlated with endothelin, HbA1C , fasting insulin, and HOMA-IR. HOMA-IR was an independent related factor in influencing visfatin. The visfatin is related to endothelin and insulin resistance, which may contribute to the pathogenesis of insulin resistance and type 2 diabetes mellitus.

Objective:To evaluate the effect of presurgical nasal mode(PNM)combined with nasal diorthosis in the treatment of na-sal deformity and incomplete unilateral cleft lip(IUCL)in infants.Methods:35 infants with IUCL were treated by PNM followed by nasal diorthosis and cheiloplasty.The nasal asymmetry was analysed by measurments of nostrils height,nostrils width and nasal colu-mella angle skewness on the photographs at the initial visit(T0),pre-operation(T1),1 week after operation(T2),1 month after opera-tion(T3)and a year after operation(T4).The other 35 infants with IUCL without PNM treatment were served as the controls.Re-sults:Compared with the controls,the symmetry of nostrils height,nostrils width,nasal columella angle skewness in PNM treated children were significantly improved at T0-T1 and T1-T2(P ＜0.05).there was no significant difference at T2-T3 and T3-T4(P >0. 05).Conclusion:Nasal asymmetry can be improved by presurgical nasal mode treatment followed by preliminary nasal deformity di-orthosis and cheiloplasty.