Objective To analyse the risk factors relating to diabetic peripheral neuropathy(DPN).Methods 214 type 2 DM cases were investigated and the factors relating to DPN were analysed including age 、diabetic duration 、fasting blood glucose(FBG) 、post blood glucose(PBG)、 HbA_1c、blood pressure(BP)、 urinary albumin excretory rate(UAER)and lipid.Results Logistic regresstion analysis showed that UAER and FBG were relatively independent risk factors.Conclusion In many risk factors UAER and FBG are the most important factors of all in developling DPN.

Objective To investigate the methods of diagnosis and treatment for delayed infection after hip arthroplasty. Methods From March 1998 to April 2004, 11 patients with delayed infection after hip arthroplasty were analyzed retrospectively. There were 4 males and 7 females with average of 66 years, ranging from 49 to 81 years. The interval between infection and primary hip arthroplasty varied from 9 to 96 months(mean 25.5 months). Pain is the most common symptom in all patients with an infected hip arthroplasty. Abnormal ESR was observed in 9 cases. The increase of CRP was found in 8 patients, and fistula occurred in 5 patients. Radiography findings, such as loosening, osteolysis, and endosteal scalloping, are present on 10 patients. One-stage exchange arthroplasty was performed in 8 patients, among whom 7 prostheses with antibiotic-impregnated cement and one with plain cement for fixation were chosen. Two-stage exchange arthroplasty was performed in 3 patients. After thorough irrigation and debridement of the infected joint and the removal of the femoral and acetabular components, a temporary spacer with irrigation device and antibiotic-loaded beads or a bulb were inserted between the first and second stage. The interval was a minimum of 4 weeks. During the delayed reconstruction, the final prostheses were fixed with antibiotic-loaded cement after the infection was eliminated. Results All 11 patients were followed up for a period of 8 to 72 months. Fracture of femoral shaft happened during the debridement in one patient. None of recurrent infection was found during the average 29.3 months follow-up. Conclusion No test is 100 percent specific; therefore, the diagnosis of infection relies on the patients' history, and the physical examination findings, and the lab test combined with results of imaging study, etiology as well as pathology. The key to success is that the treatment must be tailored to the patients' status.

The paper introduces the definition of smart phone,operating mobile communication network and hidden danger about safety,and definition and advantages of SSL VPN,states the application of SSL VPN technology in the direct network report of epidemic situation information of infectious diseases combining with SSL VPN technology and remote connection,analyzes the work principle and specific operation process,achieves safety login to the China Information System for Disease Prevention and Control with smart phones,and completes normal business data processing.

BACKGROUND:Brain natriuretic peptide, an important serum marker for diagnosis of cardiovascular diseases, is crucial for risk factor analysis of cardiovascular diseases.
OBJECTIVE: To analyze the relationship between brain natriuretic peptide and hemodynamic parameters before and after coronary artery bypass grafting.
METHODS:Thirty patients with coronary heart disease undergoing coronary artery bypass grafting were selected, including 13 patients with left ventricular ejection fraction≥ 50% (normal heart function) and 17 patients with left ventricular ejection fraction < 50% (cardiac insufficiency). Levels of plasma brain natriuretic peptides were detected at 1 day before transplantation, 7 hours, 1, 3, 5, 7 days after transplantation, and then the correlation between plasma brain natriuretic peptide levels and hemodynamic parameters was analyzed before and after coronary artery bypass grafting.
RESULTS AND CONCLUSION: Preoperative and postoperative levels of plasma brain natriuretic peptides were significantly lower in the patients with left ventricular ejection fraction≥ 50% than those with left ventricular ejection fraction < 50%; while in each group, the level of brain natriuretic peptides was remarkably increased after coronary artery bypass grafting (P < 0.05 orP< 0.001). Preoperative brain natriuretic peptide levels were positively correlated with New York Heart Association classification grading, left atrial diameter and left ventricular diameter (r=0.61;r=0.34;r=0.67), but negatively correlated with echocardiographic left ventricular ejection fraction and cardiac output (r=-0.75;r=-0.70). The postoperative peak level of brain natriuretic peptides was positively correlated with New York Heart Association classification grading, echocardiographic left ventricular end diastolic diameter and pulmonary artery pressure (r=0.72;r=0.70;r=0.45). These findings indicate that the plasma level of brain natriuretic peptides before coronary artery bypass grafting shows a good correlation with left ventricular ejection fraction and left ventricular end diastolic diameter, which accurately reflect the state of cardiac function before coronary artery bypass grafting.

Objective To investigate the relationship between Trp64Arg mutation in β3-adrenerglc receptor (β3-AR) gene and the incidence of metabolic syndrome (MS). Methods A seven-year follow-up study was conducted in 386 simple obese subjects and 175 normal weight subjects in whom geno-typing of Trp64Arg mutation in β3-AR gene was examined in 2000. Results There were no differences between a Trp64Trp homozygote group and a Trp64Arg heterozygote group of whether obese or normal weight subjects with respect to adiposity, blood pressure, lipid profile, fasting blood glucose and fasting insulin in the baseline. The results of follow-up indicated that the incidence of MS in the Trp64Arg heterozygote group was higher than that in the Trp64Trp homozygote group of obese males (54. 76% vs 40. 85% ,P <0. 05) but not in the group of obese females. The incidences of MS both in the Trp64Trp homozygote group and Trp64Arg heterozygote group were higher in obese males than in obese females (40. 85% vs 18. 27% and 54. 76% vs 21.28% ,all P <0. 01 ) . No significant differences were found in incidences of MS both in the Trp64Trp homozygote group and Trp64Arg heterozygote group of normal weight subjects whether the comparison was made between males and females respectively or between males and females. The overall incidence of MS in the obese subjects were significantly increased than that in the normal weight subjects whether there was genevariant or not(31.30% vs 6. 03% and 42. 75% vs 12. 73%, all P <0. 01 ). Logistic analysis showed thatβ3-AR gene variant was associated with increased incidence of MS in males. Conclusion β3-AR gene Trp64Arg mutation is an independent risk factor for the incidence of MS in males.Conclusion β3-AR gene Trp64Arg mutation is an independent risk factor for the incidence of MS in males.

BACKGROUND: It has been recently found that endothelial progenitor cells (EPCs) can promote injured endothelial healing. There is a supposition that in-stent restenosis possibly correlates with the number and/or activity of EPCs.OBJECTIVE: To comparatively observe the number and activity of circulating EPCs in patients with and without coronary in-stent restenosis, and to verify the above-mentioned supposition.DESIGN, TIME AND SETTING: This study, a comparative observation, was performed at the Department of Internal Medicine, Beijing Shijitan Hospital, Department of Internal Medicine, First Hospital, Peking University, and Department of Physiology and Pathophysiology, Peking University Health Science Center between March 2005 and May 2007.PARTICIPANTS: According to the coronary angiography, 15 patients were recruited into the restenosis group and 17patients with patent stents were selected into the control group.METHODS: Total peripheral mononuclear cells were isolated from blood of patients with restenosis or control subjects by Ficoll density-gradient centrifugation. These cells were plated on dishes coated with human fibronection. After 7 days in culture, the nature of adherent cells was confirmed by direct fluorescent staining with the use of 1,1'-dioctadecyl-3,3,3',3'-tetramethylindocarbocyanide percholate-labelled acetylated low-dencity lipoprotein and fluorescein isothiocyanate-labeled ulex europaeus agglutinin-Ⅰ under a laser scanning confocal microscope. Cells demonstrating double-positive fluorescence were identified as differentiating EPCs.MAIN OUTCOME MEASURES: After 7 days of culture, EPCs were counted under an inverted microscope. Proliferation of EPCs was determined using the MTT colorimetric assay. Migration of EPCs was assayed using the scratch assay qualitatively. EPCs adhesion was performed by replating cells on fibronectin-coated dishes and then counting the adherent cells.RESULTS: The number of EPCs was significantly reduced in patients with in-stent restenosis compared with that in the control group (P = 0.001). The proliferative activities were impaired in the in-stent restenosis group than in the control group(P < 0.05). In addition, the migrative activities were also impaired in the in-stent restenosis group, but no significant difference in adherent activities existed between the two groups (P > 0.05).CONCLUSION: The number and functional activities of proliferation and migration of EPCs were decreased in patients with in-stent restenosis, which may be related to the number and/or activities of EPCs.

Objective To evaluate the results and complications of hip arthroplasty performed as a salvage procedure after the failed treatment of intertrochanteric hip fractures in elderly patients. Methods Between 2004 and 2009,10 patients were treated with hip arthroplasty after the failed treatment of intertrochanteric fracture.There were six females and four males,at mean age of 75.7 years ( range,68-84 years).The initial treatment of fractures included dynamic hip screw (DHS) fixation in three cases,dynamic condyle screw (DCS) fixation in one,proximal femur fixation with reconstruction interlocking nail in three and conservative treatment without internal fixation in three.The failed procedures included avascular necrosis in four cases,cephalic implant cutting in three,nonunion in two and malunion associated with osteoarthritis in one.Joint hip replacement was performed except for pre-operative infection.Harris score at follow-up was recorded and prosthesis position was evaluated by imaging. Results Six patients were treated with total hip arthroplasty with a cemented cup (three patients) and an uncemented cup ( three patients) and four with a bipolar hemiarthroplasty.A long-stem implant was used in 5 of the 10 hips.The average duration of follow-up was 4.6 years (2-7 years).The mean duration of surgery was 128 minutes and mean blood loss was 764 ml.The mean Harris hip score increased from 37 preoperatively to 85 postoperatively.The functional results were satisfactory.One 84-year-old patient with the implant intact died 2 years postoperatively from a brain hemorrhage. Conclusions Hip arthroplasty is an effective salvage procedure after the failed treatment of intertrochanteric fractures in elderly patient.Most patients have better pain relief and functional improvements in spite of technical difficulties than primary arthroplasty.In the meantime,attention should be paid to patients with poor bone quality,bone loss,or articular cartilage damage.

Objective To investigate the effects of short hairpin RNA (shRNA) expression plasmid targeting vascular endothelial growth factor-C (VEGF-C) on the proliferation and invasion of HepG2 cells. Methods The VEGF-C shRNA plasmid vector labeled with green fluorescent protein was constructed and stably transfected into HepG2 cells. The transfected cells were sorted by G418 and visualized by fluorescent microscope and assayed by flow cytometry. Expression of VEGF-C in transfected cells was determined by RT-PCR and Western blot. The inhibition rates of the cell proliferation and invasion were determined by MTT assay and reconstituted basement membrane invasion assay, respectively. Results VEGF-C shRNA effectively downregulated VEGF-C mRNA and protein expression in HepG2 cells, and it also effectively inhibited the proliferation of HepG2 cells in a time-dependent manner. The invasion capacity of HepG2 cells was inhibited by VEGF-C shRNA, and the inhibition rate was 51.54%. Conclusions VEGF-C plays an important role in tumor proliferation, invasion and metastasis. RNA interfering technology that targets VEGF-C may serve as a potential therapeutic intervention in the treatment of human hepatic cancer.

Objective To summarize the perioperative characters of femoral neck fractures in patients aged at over 80 years by analyzing the surgical treatment procedures. Methods A retrospective study was done on data of patients with femoral neck fractures treated surgically from June 2000 and June 2008. There were 25 males and 36 females, at average age of 83.4 years (80-94 years). Of all, there were 53 patients with fresh fractures including six with type Garden Ⅰ or Ⅱ fractures and 47 with type Garden Ⅲ or Ⅳ fractures, eight with old fractures ( all type Garden Ⅳ). Fifty-one patients (84%) were accompanied with preexisted internal medical or neurological diseases. Six patients with type Garden Ⅰ or Ⅱ fractures were treated with cannulated screw fixation (CSF). Among 55 patients with type Garden Ⅲ or Ⅳ fractures inclu-ding 47 fresh fractures and 8 old ones, 53 patients were treated by hip hemiarthroplasty (HHA) but the other two by cemented total hip arthroplasty (THA) because of preexisting hip osteoarthritis. Results The average operation duration and blood loss were 51 minutes and 50 ml in CSF group, 81 minutes and 180 ml in HHA group, 105 minutes and 350 ml in THA group. Fifteen patients (25%) had postoperative com-plications, mostly hypotension, cardiac insufficiency and atrial fibrillation, accounting for 12%. Postoperative hemoglobin was decreased by 11.9%, 17.1% and 18. 1% on average respectively in CSF group, HHA group and THA group, and postoperative albumin decreased by 10.8%, 18. 1% and 20.2% on average respectively in CSF group, HHA group and THA group. There were 17 patients (28%) with hemoglobin below 100 g/L and four (7%) with albumin below 30 g/L after operation. Conclusions The patients aged ≥80 years with femoral neck fractures are usually accompanied with preexisted internal medical or neurological diseases and have high risk in operation. Adequate preoperative preparation and active prevention and treatment of perioperative complications are important for successful operation and good postoperative results.

Objective: To observe the effect of applying electro-acupuncture to the governor vessel on the expression of proteins in the MAPK/ERK1/2 signaling pathway. Methods: Sixty-four female C57BL/6 mice were randomly divided into a sham group, a spinal cord injured (SCI) group, an acupuncture (AP) group and an electro-acupuncture (EA) group. An SCI model was induced in all of the rats except those in the sham group. The sham and SCI groups were not given any special treatment, while the AP and EA groups were treated with conventional or electro-acupuncture applied to the Dazhui (DU14) and Mingmen (DU4) acupoints in the governor vessel beginning on the day following the operation. The electrical stimulation was in dense-disperse waves at 2/100Hz frequency and 0.2mA intensity, lasted for 15 minutes daily, 5 days a week for 4 weeks . The expression of myelin basic protein (MBP), the phosphorylation of extracellular signal-regulated kinase (ERK)1/2 and the phosphorylation of protein kinase B (Akt) in the injured volume were determined using immunofluorescence and western blotting on the 3rd, 7th, 14th and 28th days after the modeling. Results: Compared with the SCI group, p-ERK1/2 expression was greatly enhanced in the EA group on the 3rd, 14th and 28th days. It was also significantly enhanced in the AP group by the 28th day. Compared with the AP group, the average p-ERK1/2 expression in the EA group was significantly enhanced on the 3rd and 14th days. Compared with the SCI group, the average p-Akt of the EA group was significantly enhanced on the 14th and 28th days. The average p-Akt of the AP group had decreased significantly on the 3rd day. Compared with the SCI group, the average expression of MBP in the EA group was enhanced significantly on the 3rd, 7th and 14th days and the AP group′s average was significantly greater on the 3rd and 7th days. Conclusion Electro-acupuncture can promote the expression of MBP, the phosphorylation of ERK1/2 and the phosphorylation of Akt after spinal cord injury.