OBJECTIVE To evaluate the value of blood lactic acid in elder pneumonia patients and indicate its relation with the classification of peverity of patients.METHODS Seventy-five elder patients with pneumonia and 50 younger patients were divided into sepsis group and no sepsis group.The sepsis group was divided into MODS and non-MODS sub groups.The level of blood lactic acid,CRP and PaO2 in them were measured.RESULTS The incidence of sepsis was remarkably higher in the elder pneumonia patients group than in the younger one.There was a significent difference of the blood lactic acid between them((1.74?0.33)mmol/L vs(1.35?0.66)mmol/L,P

OBJECTIVE To investigate pulmonary fungal infection spectrum and its resistance in older COPD patients with mechanical ventilation.METHODS Retrospective study were performed in 67 cases of COPD patients with mechanical ventilation treatment who were admitted to our ICU from Jan 2004 to Doc 2007.Bronchoalveolar lavage fluid was cultured,differentiation and antifungal susceptilibity testing were taken.RESULTS Seventy-eight fungi strains were cultured in 78 cases,among them,41 strains were Candida albicans(52.56%),14 of C.tropicalis,9 of C.krusei,5 of C.parapsilosis,7 of yeast-like fungi and 2 of Aspergillus.CONCLUSIONS There were increasing fungal infection rate in older COPD patients with mechanical ventilation and C.albicans is still the most frequent type.The resistance to triazole antifungal drug is also increasing.

Repeat cervical cytologic testing,human papillomavirus(HPV)testing and immediate colposcopy are currently the most general managements in women with atypical squamous cells of undetermined significance(ASCUS)result.However,the efficacy of these three methods is hampered by strong subjectivity,high false negative and positive rates.With the development of the aetiology of cervical cancer,there is good evidence that biomarkers for persistent HPV infection,HPV integration,instability of host genes and malignancy triage ASCUS more objectively and efficiently.The three-dimensional multiparameter biomarker-based detection may be the predominant method for the triage of women with abnormal cervical cancer screening result.

Objective To investigate the effects of Metformin on serum proprotein convertase subtilisin/kexin type 9(PCSK9)level in patients with type 2 diabetes(T2DM). Methods 48 healthy people with normal glucose tolerance were selected as the controls (NGT group). 93 newly diagnosed T2DM were randomized to Metformin treated group (Met,n= 47 )and Glipizide treated group (Gli,n=46).Serum PCSK9 was measured by ELISA in all participants. After treatment,the changes of serum PCSK9 were observed in Met group and Gli group. Results Serum PCSK9 levels in Met group and Gli group were higher than NGT group(P<0. 01). PCSK9 level was positively correlated with FPG,HbA1 c, HOMA-IR,FIns,TC,LDL-C,TG,hsC-RP,TNF-αand BMI (r= 0. 578,0. 638,0. 556,0. 610,0. 578, 0. 592,0. 589,0. 638,0. 561,0. 552;P<0. 05 or P<0. 01),and negatively correlated with HDL-C(r=-0. 614,P<0. 01). The levels of PCSK9 significantly decreased after treatment with Metformin(P<0. 05). PCSK9 levels had no significant differences before and after treatment with Glipizide. Multiple regression analysis showed that TNF-αand HOMA-IR were independent related factors of PCSK9. Conclusion T2DM patients have high levels of serum PCSK9 which can be decreased by Metformin.

Objective To explore a new evaluation framework for talented professionals in science and technology, and design an appropriate methodology and management mechanism.Methods Key evaluation indicators were set according to the organization′s strategic objectives and innovation elements.Following the introduction to new concepts of evaluation, methods and steps were designed that could analyze evaluation results using the radar chart to achieve full-dimensional identification of different indicators, scopes or levels.Results and Conclusion A pluggablehierarchical management mechanism was established, and an organic architecture that involved data, evaluation logics and operation management was constructed.A pilot study was carried out in an institution of military medical sciences to verify the applicability of this framework.

Objective To explore the level of angiopoietin‐like protein 4 (ANGPTL4) in patients with early chronic kidney disease (CKD ) in diabetes and the influence of pioglitazone on the level. Methods 92healthypeoplewithnormalglucosetolerancewereselectedasthecontrols(NCgroup).89 newly diagnosed T2DM were selected (T2DM group ). 90 cases of CKD group were divided into pioglitazone (PGZ) and glimepiride (GLI) treated subgroups ,45 cases in each subgroup. After treatment , serum ANGPTL4 levels were observed in CKD group. Results There were significant differences in serum ANGPTL4 levels among NC ,T2DM and CKD groups [(34.8 ± 4.75) vs (31.1 ± 3.65) vs (27.1 ± 3.52)ng/ml ,P<0.05 or P<0.01]. ANGPTL4 level was positively correlated with SOD ,TG (r=0.635 , 0.526 ,P< 0.05 or P< 0.01) ,and negatively correlated with BMI ,FPG ,HbA1c ,hsC‐RP ,UAlb/Cr , VEGF ,FIns ,HOMA‐IR (r= -0.502 ,-0.624 ,-0.542 ,-0.520 ,-0.538 ,-0.566 ,-0.576 ,-0.509 ,P< 0.05 or P < 0.01 ). In PGZ subgroup after treatment ,ANGPTL4 levels were significantly increased and UAlb/Cr significantly decreased [(31.51 ± 3.87 ) vs (27.60 ± 3.58 )ng/ml ,P < 0.05 ;(88.50 ± 8.90 ) vs (116.20 ± 10.30 )mg/24 h ,P < 0.01 ]. In GLI subgroup after treatment ,there were no significant difference in FPG and HbA1 c as compared with PGZ subgroup but ANGPTL4 levels have no significant differences after treatment ,and UAlb/Cr decreased [(27.20 ± 3.54 ) vs (26.60 ± 3.48 )ng/ml ,P > 0.05 ;(99.70 ± 12.80 ) vs (122.40 ± 13.10 )mg/24 h ,P < 0.05]. HbA1 c ,FIns ,UAlb/Cr were the independent related factors influencing ANGPTL4 of CKD patients. Conclusion Serum ANGPTL4 has a lower level in CKD patients. PGZ is effective in treating CKD. This role is associated with the increase of serum ANGPTL4.

Objective To investigate the clinical and pdysomnographic characteristics and related factors of obstructive sleep apnea hypopnea syndrome (OSAHS) in elderly patients. Methods The 163 elderly patients with OSAHS confirmed by polysomnography were classified into obesity group and non-obesity group according to body mass index (BMI). All cases were grouped into mild,moderate and severe groups according to the apnea hypopnea index (AHI) and night SaO2. The 190non-elderly OSAHS patients were as control group at the same time. The clinical and polysomnographic characteristics were recorded and analyzed. Results (1)The proportion of obesity in OSAHS patients was 79. 1%, there was significant difference between the elderly-obesity group and non-elderly-obesity group (70.3% vs. 83.6%, P＜0.05). (2)The proportions of moderate and severe OSAHS patients were lower in elderly group than in non-elderly group. There were significant differences in AHI, the lowest arterial O2 saturation (LSaO2) and % TRT SaO2 ＜90% between the two groups (all P＜0.05). (3)The sleep architecture disturbance was significantly severer in elderly group than in non-elderly group. The percentages of non-rapid eye movementsleep (NREM sleep)stage Ⅲ-Ⅳ sleep were significantly decreased, and the arousal was significantly increased. (4) The syndrome of OSAHS in elderly group was untypical and the clinical complication was increased.Conclusions The elderly OSAHS patients are less severe than non-elderly group, but the elderly patients have worse sleep architecture disturbance and more complications such as hypertension and other cardiovascular diseases.

Objectives To clarify the differential diagnostic value for iron deficiency anemia (IDA)and anemia of chronic disease(ACD)with analysis method of multiple parameters.Methods The serum concentrations of iron parameters (SI,TIBC,TF,SF and sTfR),inflammatory index(IL-1,IL-6,TNF-β),CRP and hepcidin were detected in patients with IDA and ACD by biochemical method and ELISA respectively.Results In the differential diagnosis of IDA versus ACD,the SF (98.6 versus 6.0,P=0)and sTfR/logSF[(13.1-±-4.4) versus (27.6 ± 16.5),P=0.002] had clinical value for the differential diagnosis.Inflammatory factors level was increased in two groups,only the difference in CRP between IDA and ACD showed a statistical significance.The hepcidin had the clinical value in differential diagnosis for single disease diagnosis of IDA and ACD and for differential diagnosis between IDA and ACD [(144.6 ±-1.9) versus (86.5-±-3.1),P＜ 0.05].Correlation analysis showed that the sTfR/logSF had a significantly negative correlation with SI(P=0.002),a significantly positive correlation with TIBC and TRF,and no significant correlation with inflammatory factors.The hepcidin had significantly positive correlation with IL-6 and TNF-β,and a significantly negative correlation with SI.The positive correlation was observed between sTfR/logSF and Hepcidin(r=0.376,P=0.005).Conclusions Analysis method of multiple parameters could make a differential diagnosis of ACD in the elderly.

BACKGROUND: Studies have shown that after bone marrow stem cell transplantation, there are juvenile cells with the episode of myocardial cells around the infarct areas, which was recognized as deriving from bone marrow stem cells.OBJECTIVE: To explore the homing situation of bone marrow stem cells by autologous mobilization around the infarct areas aftar myocardial infarction.DESIGN, TIME AND SETTING: The cytological in vitro study was performed at the China-Japan Clinical Pathology Center, Daliar Medical University from February 2005 to April 2006.MATERIALS: A total of 30 myocardial samples from the autopsy at the Department of Pathology and Forensic Medicine, Dalian Medical University between 2000 and 2005. Fifteen normal samples dyed from the mechanical injuries or craniocerebral injury,without abnormity following autopsy. Fifteen samples in the myocardial infarction group suffered from coronary atherosclerosis and coronary tube stenosis, and died within 10 days after myocardial infarction.METHODS: The autopsy was performed within 48 hours after the death and the tissues were obtained from antedor wall, lateral wall and posterior wall of the left ventricle, and made into tissue sections. We checked the expression of CD34, CD133 and transforming growth factor-β, in the normal area, infarct area and around the infarct area by immunohistochemistry.MAIN OUTCOME MEASURES: The expression of CD34, CD133 and transforming growth factor-β in different areas and the relationship between them.RESULTS: The positive expression of CD34 in infarct area was significantly stronger than that around the infarct area and in normal area (P < 0.01). The positive expression of transforming growth factor-β in infarct area was significantly stronger than that around the infarct area (P < 0.01), and the expression of transforming growth factor-β showed negative reactJon in normal area. The expression of CD34, CD133 and transforming growth factor-β, in infarct areas and around the infarct area was closely related (P < 0.01).CONCLUSION: There are the homing of bone marrow hemopoietic stem cells in infarct area and around the infarct ares after myocardial infarction. The increase in transforming growth factor-β in infarct area provides the possibility for the differentiation of the homing stem cells, the following angiogenesis and the regeneration of cardiomyocytes.

OBJECTIVE To investigate the pathogenic causes of community acquired pneumonia(CAP) in the elderly and to guide experience antibiotic therapy.METHODS An etiological study was performed on 204 elder patients with CAP in the Cadres Medical Department of Beijing Shijitan Hospital from May 2005 to Apr 2008.The count scores were by CURB-65 scoring system.RESULTS Pathogens were identified in 204 patients: there were Mycoplasma pneumoniae(42,20.6%),Streptococcus pneumoniae(30,14.7%),Haemophilus influenzae(24,11.8%),Chlamydia pneumoniae(17,8.3%),Klebsiella pneumoniae(14,6.9%),Escherichia coli(7,3.4%),Pseudomonas aeruginosa(5,2.5%),Staphylococcus aureus(4,2.0%),Legionella pneumophila(2,1.0%),and Acinetobacter baumannii(1,0.5%).The score,by CURB-65 scoring system,of mixed infected patients was higher than single infections.CONCLUSIONS Atypical pathogens have important role in elderly CAP,the most common pathogenare Gram-negative bacilli,S.aureusand fungi.Mixed infection couldn′t be ignored.