Background Diabetiretinopathy(DR) icommon ophthalmivasculadisease which can lead to blindness,and itpathogenesiicomplex.C-peptide iby-producin insulin synthesis,and loof studieindicate thaC-peptide iclosely related with diabetimicrovasculacomplications.Objective Thistudy wato explore the clinical significance of the detection of C-peptide to assesthe prognosiof non-proliferative DR(NPDR).Methodretrospective case-observational study wadesigned.The clinical datof 205 casewith NPDwere collected in Wuhan Puren Hospital from January 1,2009 to January 1,2010.The patientwere diagnosed by fundufluorescein angiography (FFA) and the stageof theidiseasewere determined based on the Dstaging developed by the Chinese Ophthalmological Society fundustudy group.Twenty-seven-month follow-up waperformed fothe patientto record the parameterof theiblood biochemistry,changein theiphysical conditions,and changein theiblood pressure and DM.The patientwere assigned to the PDgroup and NPDgroup athe end of the follow-up.The independenrisk factofoNPDwaanalyzed using the univariate analysis,and multivariate logistiregression analysiwaused to evaluate the correlation of varioufactorwith pooprognosiof NPDR.Receiveoperating characteristi(ROC) curve wadrawn to assesthe prediction efficiency of C-peptide fothe prognosiof NPDR.ResultThe clinical datof 205 patientwith NPDwere reviewed,and 15 patientfailed to show up fovisitarate of 7.3％.One hundred and ninety patientwith NPDfinished follow-up with mean age of (41.54± 8.15)years.Of the 190 patients,69 patient(36.3％) advanced to PDR,and 121 patient(63.7％) were NPDduring the follow-up.Significandifferencewere seen in age,hypertension history,smoking history,DM course and C-peptide levelbetween the PDgroup and PDgroup (age:=13.78,P＜0.05 ; hypertension history:x2 =21.57,P＜0.05 ;smocking history:x2 =26.96,P＜0.05;DM course:t=6.89,P＜0.05;C-peptide:t=20.50,P＜0.05).pooprognosiwacorrelated with age (OR:1.04,95％ CI:1.01-1.07),hypertension history (OR:1.05,95％ CI:1.02-1.08),smokinghistory (OR:1.07,95％CI:1.04-1.11),DM course (0R:1.18,95％CI:1.13-1.25) oC-peptide conten(0R:1.09,95％ CI:1.06-1.12).The areundethe ROcurve wa0.835 (P＜0.05,95％ CI:0.818-0.843) when the C-peptide waincluded,buwalarge than 0.769 (P ＜ 0.05,95％ CI:0.754-0.780) when Cpeptide waexcluded.ConclusionThe levelof blood C-peptide are lowein the PDpatientthan those in the NPDpatients,and the lowelevel of blood C-peptide in the NPDpopulation increasetheirisk of developing PDR.Testing foblood C-peptide level can benefithe prognosiof NPDR.

Objective To describe nursing assistants' experience of caring for dementia patients with behavioral symptoms.Methods A descriptive qualitative design was used in this study.Twelve nursing assistants for dementia patients were recruited.A semi-structured interview was used to collect the data.The interview was related to nursing assistants' experience of caring for patients with behavioral symptoms.Content analysis was used to explicate the meaning of the interview data.Results Three themes were extracted:having multiple stressors; learning by practice; seeking mutual support from other nursing assistants.Conclusions Nursing assistants had multiple stressors from caring dementia patients with behavioral symptoms.Continuing supply of training on strategies of coping with behavioral symptoms as well as the emotional support are especially required.

Objective To explore the features of clinical manifestations and electrophysiology of spinal muscular atrophy(SMA) in children.Methods The clinical features and laboratory data were analyzed in 32 children with SMA,electromyography tests were carried out in 28 patients and the muscle biopsy were performed in 24 cases.Results The 32 cases were subdivided into 3 clinical groups,15 cases were SMAⅠ,12 cases were SMAⅡ,5 cases were SMAⅢ.They were all characterized by progressive muscle weakness associated with hyptonia and atrophy.The clinical distinction between SMAⅠto SMAⅢ reflected different age of onset and disease severity.All cases of SMAⅠhad symptoms of respiratory disability,only 1 case of SMAⅡ had paradoxical breathing and none of SMAⅢ had similarly symptoms.Electromyographic studies showed a pattern of denervation with no sensory involvement.The rate of spontaneous potential was 87%,with gentle strain,the duration of motor unit was extended(30%-150%) and the amplitude of it was increased(90%-450%),the motor nerve conduction velocity was reduced slightly in 28% patients.The muscle biopsy provided evidence of skeletal muscle denervation with groups of atrophy.Conclusions The clinical features,the changes of electromyography and the muscle biopsy are valuable for diagnosis of SMA.Respiratory management will prolong survival and improve the quality of life for these patients.

OBJECTIVE To study the clinical characteristics,prevention and treatment of nosocomial fungemia.METHODS Fifty four consecutive patients with nosocomial fungemia were studied in clinical retrospective manner.RESULTS Sixty fungal strains were isolated from blood.Candida was the predominant pathogenic organism(86.7%),6 cases had mixed infection causing by two fungal species(11.1%).Twenty two cases had concomitant bacteremia(40.7%).Overall mortality rate was 68.5%,directly related mortality rate in treatment group was significantly lower than that in nontreatment one(28.9% vs.88.9%,χ2=11.268，P＜0.01).Effective rate of amphotericin B was 68.8%,fluconazole 70.8%,combined treatment 80.0%.CONCLUSIONS Fungal infection has become prominently fatal cause of critically ill patients.Removing predisposing factors,monitoring fungal pathogen and effective antifungal therapy are important measures to reduce the incidence and mortality of fungal infection.Fluconazole and amphotericin B are effective drugs of treating deep fungal infection.

Objective To investigate the effects of sufentanil postconditioning and sevoflurane postconditioning on myocardial ischemia/reperfusion (I/R) injury in isolated rat hearts. Methods Healthy male SD rats weighing 230-250 g were anesthetized with intraperitoneal 5% chloral hydrate 8 ml/kg. Their hearts were excised and perfused in a Langendorff apparatus with modified K-H solution saturated with 95% O2-5% CO2 at 37℃. Forty isolated rat hearts with I/R injury were randomly assigned into 4 groups ( n = 10 each): Ⅰ I/R group, Ⅱ sevoflurane postconditioning group, Ⅲ sulfentanil postconditioning group and Ⅳ postconditioning with sevoflurane and sulfentanil group. After 30 min of stablization, the hearts were subjected to 40 min of global ischemia followed by 120 min of reperfusion. Fifteen minutes of drug postconditioning were performed in group Ⅱ , Ⅲ and Ⅳ:3.0% sevoflurane was introduced into K-H solution in group Ⅱ , 100 nmol/L sulfentanil was added to K-H solution in group Ⅲ , sevoflurane postconditioning and sulfentanil postconditioning were performed simultaneously in group Ⅳ . Left ventricular systolic pressure (LVSP), left ventricular end-diastolic pressure ( LVEDP), left ventricular developed pressure (LVDP), maximum increase in rate of LVDP ( + dp/dtmax), maximum decrease in rate of LVDP ( - dp/dtmax), HR and coronary flow (CF) were measured at the end of 30 min stablization (baseline), and at 15, 30, 60, 90 and 120 min of reperfusion. Coronary effluent was collected at 5 min of reperfusion for determination of activities of creatine kinase (CK) and lactate dehydrogenase (LDH). Myocardial tissues were obtained at the end of reperfusion for determination of infarct size (by triphenyltetrazolium chloride staining) and expression of Bcl-2 and Bax (by Western blot). The ratio of Bcl-2/Bax was calculated. Results LVSP, LVDP, ± dp/dtmax,CF, Bcl-2 expression and ratio of Bcl-2/Bax were significantly higher, LVEDP, activities of CK and LDH and Bax expression were significantly lower, and the infarct size was smaller in group Ⅱ , Ⅲ and Ⅳ than in group Ⅰ (P ＜ 0.05 or 0.01 ). There were no differences in the indices mentioned above between Ⅱ , Ⅲ and Ⅳ groups.Conclusion Sufentanil postconditioning can attenuate myocardial I/R injury, and there is no enhancement of myocardial protection when combined with sevoflurane postconditioning. The mechanism of myocardial protection is related to the inhibition of cell apoptosis via up-regulation of Bcl-2 expression and down-regulation Bax expression.

Objective To evaluate the effects of ischemic time factors on reduction of myocardial ischemia-reperfusion injury by sulfentanil postconditioning in rats .Methods Healthy adult male Sprague-Dawley rats ,weighing 230-250 g ,were heparinized and anesthetized with intraperitoneal 5% chloral hydrate 8 ml/kg .The hearts were excised and perfused in a Langendorff apparatus with K-H solution .After 30 min of stabilization ,48 isolated rat hearts were randomly assigned into 6 groups (n=8 each) using a random number table .In I/R1-3 groups ,the hearts were subjected to 30 ,45 ,and 60 min of myocardial ischemia ,respectively ,followed by 90 min of reperfusion . In SP1-3 groups , the hearts were subjected to 30 , 45 , and 60 min of myocardial ischemia , respectively ,followed by 90 min of reperfusion ,and sulfentanil 100 nmol/L was added to K-H solution at 15 min of reperfusion for postconditioning . Left ventricular end-diastolic pressure (LVEDP ) , left ventricular developed pressure (LVDP) ,+dp/dtmax ,-dp/dtmax ,HR and coronary flow (CF) were measured at the end of equilibration and 15 ,30 ,60 and 90 min of reperfusion .Creatine kinase (CK) and lactate dehydrogenase (LDH) activities in coronary effluent were measured at 5 min of reperfusion .Myocardial infarct size was determined in 5 hearts chosen randomly at 90 min of reperfusion .Results LVEDP was significantly higher ,and LVDP , ± dp/dtmax and CF were lower at each time point of reperfusion than at the end of equilibration in I/R1-3 groups ( P<0.05) .Compared with I/R1 and I/R2 groups ,LVEDP was significantly increased ,and LVDP and ± dp/dtmax were decreased at 30 ,60 and 90 min of reperfusion ,HR and CF were decreased ,and CK and LDH activities in coronary effluent and infarct size were increased at 15 and 30 min of reperfusion in group I/R3 ,and LVEDP was significantly decreased ,LVDP , ± dp/dtmax and CF were increased ,CK and LDH activities in coronary effluent and infarct size were decreased at 30 , 60 and 90 min of reperfusion in groups SP1 and SP2 ( P< 0.05 ) . Compared with group I/R3 , LVDP was significantly decreased at 30 ,60 and 90 min of reperfusion ( P<0.05) ,and no significant change was found in CK and LDH activities in coronary effluent and infarct size in group SP3 ( P>0.05 ) .Conclusion Sulfentanil postconditioning can attenuate myocardial ischemia-reperfusion injury when the rats are subjected to 30 or 45 min of ischemia ,however ,it provides no myocardial protection when the rats are subjected to 60 min of ischemia .

After the history of health-promoting Qigong was described, the collation and digitalization plan of Qigong in formulas or rhymes was put forward, then a Qigong in formulas or rhymes database was constructed based on their indexing, the health preserving and cultural value of Qigong in formulas or rhymes was mined.

Objective To investigate the effect of gender factors on the reduction of ischemia-reperfusion (I/R) injury by sevoflurane postconditioning in isolated rat cardiomyocytes. Methods Sixty 2-month-old SD rats (30 male, 30 female) were used in this study. Male rats were randomly assigned into 2 groups (n = 15 each):control group (group MC) and sevoflurane postconditioning group (group MS). Female rats were also randomly assigned into 2 groups (n= 15 each): control group (group FC) and sevoflurane postconditioning group (group FS).The rats were anesthetized with intraperitoneal pentobarbital 60 mg/kg. Their hearts were excised and perfused in a Langendorff apparatus with K-H solution saturated with 95% O2-5% CO2 at 37 ℃. I/R was produced by 40 min of global ischemia followed by 120 min of reperfusion. Control groups received perfusion with K-H solution saturated with O2 . Sevofiurane postconditioning groups received 10 min of perfusion with K-H solution saturated with 3%sevoflurane and O2 and then 110 min of perfusion with K-H solution saturated with O2 . HR, left ventricular enddiastolic pressure (LVEDP) and left ventricular developed pressure (LVDP) were measured before ischemia and during reperfusion. Coronary effluent was collected at 5 min of reperfusion for determination of LDH activity and infarct size. The total Akt (t-Akt) and phosphorylated Akt (p-Akt) expression in cardiomyocytes was detected. The ratio of p-Akt to t-Akt (p-Akt/t-Akt) was calculated. Results LVDP, p-Akt expression and p-Akt/t-Akt were significantly higher, LVEDP and LDH activity were significantly lower, and the infarct size was smaller in group MS and FC than in group MC (P ＜ 0.05). LVDP was significantly lower, LVEDP and LDH activity were significantly higher, and the infarct size was larger in group FS than in group MS. There was no significant difference in LVDP and LVEDP between group FC and FS (P ＞ 0.05). Conclusion There are gender differences in the reduction of I/R injury by sevoflurane postconditioning in isolated rat cardiomyocyes, the protective effect is stronger in male rats than in female rats, and the differences may be related to the activation of Akt.

Humans ; Hyperthyroidism ; Infant, Newborn

Animals ; Female ; Gonads ; physiopathology ; Hypothermia ; chemically induced ; physiopathology ; Male ; Rats ; Rats, Wistar ; Sex Factors ; Soman ; adverse effects ; pharmacology