Objective To explore the clinical efficacy of captopril combined with nifedipine in the treatment of type 2 diabetes mellitus complicated with hypertension.Methods 100 patients with type 2 diabetes mellitus complicated with hypertension were divided into two groups by randomized single blind method.The two groups were given conventional hypoglycemic therapy,50 cases in the control group were treated with captopril,while 50 cases in observation group received captopril combined with nifedipine sustained -release tablets.The clinical therapeutic effect was compared between the two groups.Results The effective rate of the observation group was 94%,which of the control group was 80%,the difference was statistically significant (χ2 =9.65,P<0.05).After treatment,the diastolic blood pressure[(80.45 ±3.65)mmHg],systolic blood pressure[(128.67 ±5.66)mmHg],fasting blood glucose[(6.65 ±0.37)μmol/L],2h postprandial blood glucose[(9.76 ±1.22)μmol/L]of the observation group were significantly reduced than before treatment (t =8.06,8.18,8.00,7.94,all P <0.05),and diastolic blood pressure and systolic blood pressure were significantly different with the control group(t=8.66,7.90,all P<0.05). After treatment,the serum creatinine (97.44 ±6.32)μmol/L,urea nitrogen (4.20 ±0.30) mmol/L and 24h urinary albumin (17.99 ±4.10) mg/L of the observation group were significantly reduced compared with before treatment (t=7.67,8.27,8.32,all P<0.05),and the indicators had significant differences with the control group(t=7.23, 7.65,7.67,all P<0.05).Conclusion Captopril and nifedipine sustained-release tablets in the treatment of type 2 diabetic patients with hypertension can effectively reduce the blood pressure,improve renal function,and it has good clinical application and promotion value.

BACKGROUND : Chitosan, derived from chitin, has a poor solubility which limits its application greatly. For improving its dissolubility, according to the feature that intramolecular hydroxy and amino group in chitosan are easy to be chemically modified, and functional groups are introduced to improve its solubility and functionality to widen the range of its application, which has become one of the new trend of development for investigating the application of chitosan. OBJECTIVE: To sum up the research advancements in the application and modification of chitosan in carboxylation,acylation, alkylation, etherification, etc.RETRTEVE STRATEGY: The relevant articles published in English between 1998 and 2007 were searched for in Pubmed database with the key words of "chitosan, modification", and the relevant articles published between 1998 and 2007 were searched for in Elsevier Science database with the key words "chitosan, modification" and search "derivate" within search results in English. Articles closely related to the structural modification and application of chitosan were involved, and repetitive and old studies were excluded.LTTERATURE EVALUATION: Totally 154 articles were selected, and 30 of them are accorded with the inclusive criteria,including 5 are reviews, and the others are clinical or experimental studies.DATA SYNTHESTS: The intramolecular hydroxy and amino groups in chitosan are mostly modified because they are easy to be chemically modified. Recently, reports lay particular emphasis on the modification in carboxylation, acylation,alkylation, etherification, etc. Functional groups are introduced to improve its solubility and functionality to widen the range of its application.CONCLUSTON: The water-solubility of chitosan can be improved through structural modification and introducing multifunctional group, which can also bring about much more special efficacies.

Objective to investigate the clinical application value of endometriosis fertility index (EFI) in the evaluation of ab‐dominal surgery endometriosis(EMT) combined infertility patient .Methods the date of 105 cases of infertility EMT merge were retrospectively analyzed from January 2009 to January 2013 in the Yuanzhou MCH and the obstetrics and gynecology department of Yuanzhou people′s hospital .All patients were followed up for two years and the rates of cumulative pregnancy were compared .Re‐sults the rates of two year cumulative pregnancy rate were 64 .80% (68 cases) .The two year cumulative pregnancy rates of EFI score ≤ 4 points ,5 to 7 points ,8 to 10 points were 34 .48% ,57 .14% ,92 .68% (P<0 .05) .There were no difference in cumulative pregnancy rate of different types of EMT in patients(P>0 .05) .Conclusion EFI and EMT with infertility pregnancy after conser‐vative treatment has a close relationship ,and EFI score would provide important guidance for follow up treatment .

Fetal arrythmia is a common cardiac abnormality, which can be categorized into three major types: extrasystoles, tachycardia and bradycardia. Most fetal arrythmias do no harm to the fetus, but few severe fetal arrythmia, including supraventricular tachycardia, atrial flutter and conduction block do, resulting in congestive heart dysfunction, hydrops fetalis and even intrauterine death. Therefore, timely intrauterine management may help to improve the fetal outcomes. This article reviews intrauterine treatment strategies for different types of fetal arrythmia.

Objective To observe the long-term effects of maternal mild hyperglycemia on the growing development and glucose and lipid metabolism in intergenerational rat offspring.Methods Streptozotocin (25 mg/kg) was administered to 14 pregnant Wistar rats intraperitoneally on the first day of gestation to induce an animal model of mild intrauterine hyperglycemia,which was successful in nine rats.Seven pregnant rats without streptozotocin intervention served as controls.Female first-generation offspring (F1) rats were intercrossed with normal male rats to obtain the second-generation offspring (F2) rats.F1 and F2 rats were divided into 8 groups:female group (group F1-G-♀) or male group (group F1-G-♂) exposed to intrauterine hyperglycemia;female group (group F1-C-♀) or male group (group F1-C-♂) exposed to intrauterine euglycemia;transgenerational female group (group F2-G-♀) or male group (group F2-G ♂)exposed to intrauterine hyperglycemia;and transgenerational female group (group F2-C-♀) or male group (group F2-C-♂) exposed to intrauterine euglycemia.Body weight of the offspring was recorded.At the age of 28 weeks,the weight of pancreas and visceral fat,fasting plasma glucose (FPG),fasting insulin,total triglyceride,total cholesterol,high-density lipoprotein-cholesterol,low-density lipoprotein-cholesterol were measured in all groups.Two sample t test was used for statistical analysis.Results (1) At 4,24 and 28 weeks old,the body weight of group F2-G-♀ [(177.3± 12.3),(314.5± 13.9) and (322.3± 16.2) g] was remarkably increased compared with group F2-C-♀ [(164.3±6.0),(290.2± 18.3) and (300.2± 16.2) g,t=-2.324,-2.584and-2.359,all P ＜ 0.05].(2) At 28 weeks,the pancreas weight and the ratio of pancreas weight to body weight of group F1-G-♀ [(0.53 ±0.05) g and (0.17±0.02)％] were decreased significantly compared with group F1-C-♀ [(0.65±0.04) g and (0.21±0.02)％,t=4.159 and 2.483,both P ＜ 0.05].The pancreas weight,ratio of pancreas weight to body weight,visceral fat weight and fat weight of mass ratio in groups F2-G-♂ and F2-G-♀ were not remarkably different from groups F2-C-♂ and F2-C-♀,respectively (all P ＞ 0.05).(3)The level of FPG at three weeks of age in F2-G-♀ group was higher than in F2-C-♀ group [(6.5±0.8) vs (4.9±1.2) mmol/L,t=-2.786,P ＜ 0.05],and it was also higher in F2-G-♂ group than in F2-C-♂ group [(6.3±0.8) vs (4.7± 1.0) mmol/L,t=-2.696,P ＜ 0.05].At 28 weeks,the FPG level was (6.7±0.6) and (8.4±2.2) mmol/L in F2-G-♀ and F2-G-♂ groups,being higher than in F2-C-♀ and F2-C-♂ groups,respectively [(5.8±0.5) and (6.2± 1.0) mmol/L,t=-2.695 and-2.337,both P ＜ 0.05].Compared with F1-C-♀ group [(0.61 ±0.10) mmol/L],the high-density lipoprotein-cholesterol level was lower in F1-G-♀ group [(0.47±0.05) mmol/L,t=2.433,P ＜ 0.05].(4) In groups F1-G-♀,F2-G-♀ and F2-G-♂,the structure of the islet cells was obviously atrophic and disordered,and β-cells were slightly decreased and distributed unevenly,but group F1-G-♂ had significantly increased β-cells with hypertrophic islet size compared with control group.Conclusions F 1 rat offsprings exposed to mild intrauterine hyperglycemia experience excessive weight gain after birth,impaired structure of the islet,metabolic abnormality,increased visceral fat weight and glucose and lipid metabolism disorder,which show intergenerational inheritance and gender differences.

Objective To compare the diagnostic values of the detection of urine exfoliated cells by FISH and cytology technolo‐gy in bladder urothelial tumor .Methods The combination probes of CSP3/CSP7 and GLPp16/CSP17 were both used in the FISH detection of urine exfoliated cells from suspected patients with bladder urothelial tumor .The urine exfoliated cells were detected by cytology technology at the same time .The sensitivity and the specificity of the two methods were compared .Results The sensitivi‐ty and specificity of FISH for bladder urothelial tumor screening were 92 .5% and 85 .0% respectively ,and those of cytology tech‐nology were 27 .5% and 90 .0% respectively .The sensitivity of FISH was significantly higher than that of cytology technology (P<0 .05) ,however ,the specificity differences between FISH and cytology technology were not statistically significant (P>0 .05) .Conclusion FISH is expected to become a new method for the screening of bladder urothelial tumor .

Objective To investigate the long-term effects of intrauterine mild hyperglycemia exposure and postnatal high fat diet on the body weight and metabolism of offspring through a pregnant rat model of intrauterine mild hyperglycemia.Methods Twenty-one pregnant Wistar rats were randomly divided into intrauterine hyperglycemia group and control group.Twenty percent streptozotocin (STZ,25 mg/kg)was given to rats of intrauterine hyperglycemia group by a single intraperitoneal injection to induce intrauterine mild hyperglycemia; control group rats received an equal volume of citric acid-sodium citrate buffer.Off springs were divided into 4 groups:exposed to intrauterine hyperglycemia and fed with normal diet group(group DN)or high fat diet group (group DF) ; exposed to intrauterine euglycemia and fed with normal diet group(group CN)or high fat diet group(group CF).The blood glucose levels of pregnant rats in two groups and body weights of offsprings in four groups were recorded.At the age of 28 weeks,the mesenteric fat amount,epididymal amount,perirenal fat amount,total triglyceride (TG)and high density 1 ipoprotein-cholestrol(HDL-C) were measured in all four groups.Results (1) The average blood glucose level of intrauterine hyperglycemia group[(16.6 ± 3.4) mmol/L] was significantly higher than that of the control group [(5.8 ± 1.1) mmol/L,P ＜ 0.01].(2) On the birth day,3 weeks and 4 weeks,the body weight of group DN [(7.4 ± 0.6),(44.1 ± 5.9),(79.6 ± 7.4) g] and group DF [(7.4 ± 0.2),(43.9 ±6.9),(76.1 ± 5.8) g] were remarkably increased compared with group CN [(6.6 ± 0.5),(35.6 ± 4.4),(71.5±6.8) g,P＜0.05]; but the body weight in group CF [(6.7 ±0.5),(33.0 ±6.5),(66.1 ±10.2) g] had no statistical difference compared with group CN(P ＞ 0.05).(3)From then on,the bodyweights of the offsprings in four groups presented an increasing trend,but there was no statistical difference until 28 weeks(P ＞0.05).(4) The perirenal fat amount of group DN,group CF and group DF [(13.8 ±3.3),(14.3 ± 3.2),(18.4 ± 1.3) g] were remarkably increased compared with group CN [(9.7 ± 3.5) g,P ＜ 0.05] ; the epididymal fat amount of group CF and group DF were also significantly increased compared to group CN(P ＜ 0.05) ; the mesenteric fat amount in four groups had no statistical difference (P ＞ 0.05).(5) The TG level of group DN,group CF and group DF[(0.52 ±0.14),(0.52 ±0.09),(0.54 ±0.17)mmol/L] were significantly higher compared to group CN [(0.41 ± 0.09) mmol/L,P ＜ 0.05],but there was no statistical difference within the first three groups (P ＞ 0.05) ; the HDL-C level in four groups had no statistical difference(P ＞ 0.05).Conclusions In intrauterine mild hyperglycemia environment,there were some evidently metabolic changes observed in the offspring,including body weight increasing on birth day and early postnatal period,visceral fat amount increasing and lipid metabolism disorders,which could be aggravated by postnatal high fat diet.

Objective To study the relationship of gestational diabetes mellitus(GDM) and ~family history of diabetes (FHD), clinical characteristics and maternal and infant outcomes of GDM and gestational impaired glucose tolerance (GIGT). Methods A prospective case-control study was performed in 244 women with GDM/ GIGT, including 93 patients with family history of diabetes and 151 without FHD, and 244 normal OGTT cases as control from Feb. 2004 to Aug. 2004 in Dept of OB &GYN of Peking University First Hospital. Univariate analysis was used to estimate the odds ~ratios with 95% CI. Results (1)FHD was a risk factor of GDM/GIGT, OR=2.9.The co-effect of parents DM on transmission was excessive. (2)Maternal≥30 years old with FHD were greater than those without FHD (75.3% vs 62.9%). More intakes of fruits and carbohydrate per day and more weight gain during pregnancy in pregnant women with FHD were lower than those in patients without FHD. (3) The prevalence of GDM was indifferent ~between patients with and without FHD. 50 g OGCT plasma glucose (PG), fasting PG and 3 h PG in 75 g OGTT of patients with FHD were higher than those of patients without FHD. The number of pregnant women treated by insulin was significantly different between patients with and without FHD. (4) No difference was found between family and non-family history of diabetes in the prevalences of pre-eclampsia, FGR, polyhydramnios, preterm labor, LGA and SGA. Conclusions (1) FHD is a risk of GDM/GIGT, and exposure to a diabetic intrauterine environment is a mechanism responsible for this excessive maternal inheritance. (2)~Besides family history of diabetes, more intake of fruits or carbohydrate and larger gain of body weigh during pregnancy may result in GDM/GIGT.

Objective To investigate the vaginal flora characteristics,clinical symptoms and signs of lactating women 6-8 weeks after delivery and the influence factors.Methods Two hundred and twenty-three puerpera 6-8 weeks after delivery who went to outpatient department of Peking University First Hospital for postpartum review (study group) and 200 normal non-pregnant women (control group) from April to May,2010 were enrolled into this study.All in study group were evaluated by a questionnaire regarding their symptoms,sexual behavior,breast-feeding situation and delivery mode.Vaginal secretions from upper 1/3 of vagina were collected and evaluated by vaginal microbial evaluation system.Bacterial vaginosis (BV) was diagnosed if Nugent score ≥ 7.Enumeration data between groups was compared by t test,and quantitative data by Chi-square test.Results The density of vaginal flora in study group was different from that of control group (x2 =96.302,P＜0.001) ; so did the flora diversity of two groups (x2 =69.871,P＜0.001).There was no difference between mean age of study group [(30.5 ± 3.9) years] and control group [(30.9 ± 2.4)years],P＞0.05.The cesarean section rate was 52.7％ (89/169),13 women (7.7％) had began their sexual behavior before interview,116 women (70.3％) took breast-feeding.Dominant bacteria in the vagina of lactating women were Gram-positive cocci (69/175,39.4％) and Gram-positive bacillus (54/175, 30.9％), which was different from control group (Gram-positive bacillus,180/189,95.2％),P＜0.001.The vaginal pH of study group was 5.0±0.5,which was higher than that (＜4.5) of control group.In study group,incidence of lower hydrogen peroxide level of vagina was 84.3 ％ (177/210) ; positive rate of sialidase was 6.7 ％ (14/210) ; positive rate of leukocyte esterase was 91.0％ (191/210).A large number of postpartum women had an abnormal Nugent score,most of them showed a state of intermediate BV (132/195,67.7％) or BV (8/195,4.1％),while a few patients had symptoms of BV (23.5％,33/140).Sexual behavior had no significant effect on postpartum vaginal flora.The proportion of abnormal vaginal flora in breast feeding mothers (74.1 ％,86/116) was significantly higher than that (57.1％,28/49) in artificial feeding mothers,P=0.034.Delivery mode also affected postpartum vaginal flora.Women underwent cesarean section were more susceptible to abnormal vaginal flora (77.5％,69/89) than those underwent vaginal delivery (57.5％,46/80),x2 =7.726,P=0.005.Conclusions Vaginal flora of postpartum women 6-8 weeks after delivery had significant difference from that of nonpregnant women.The incidence of asymptomatic abnormal vaginal flora was high.Breastfeeding and delivery mode are influence factors of abnormal vaginal flora.

Objective To investigate the effect of solution-focused therapy on the care burden and negative emotions of the primary caregivers with elderly patients with hip fractures. Methods One hundred and sixty-eight elderly patients with hip fractures and caregivers were divided into intervention group and control group with 84 pairs by random digits table method, and the two groups were given continual nursing care. At the same time, the primary caregivers of intervention group accepted the solution-focused therapy. Caregiver Burden Inventory (CBI), Self-rating Anxiety Scale (SAS), and Self-rating Depression Scale (SDS) were used as the evaluation indexes. Results Before intervention, the score of CBI, SAS,SDS was (42.07 ± 4.24), (50.75 ± 11.21), (51.59 ± 13.18) points in control group and (42.10 ± 3.96), (50.48 ± 12.59), (52.96 ± 13.51) points in intervention group, and there was no significant differences between two groups (P>0.05). After intervention, the score of CBI, SAS, SDS was (40.49±3.17), (50.64±11.33), (50.14±10.25) points in control group and (28.95±2.87), (36.73±9.45), (41.60±8.23) points in intervention group, and there was significant differences between two groups (t=5.42, 8.73, 7.45, all P<0.05). Conclusions Solution-focused therapy can effectively reduce the care burden of the primary caregivers of elderly patients with hip fractures and alleviate their anxiety and depression.