Objective To analyze the pressure source and effect of comprehensive intervention in type 2 diabetes mellitus patients. Methods 200 diabetes patients were randomized into the observation group and the control group with 100 cases in each group. Comprehensive intervention was introduced into the observation group and the control group underwent routine treatment. The pressure source was investigated after intervention by questionnaires and the results were compared. Results Fearing of serious complications bocame the most common cause of pressure. The scores of Self-rating Depression Scale(SDS)and Self-rating Anxiety Scale(SAS)were lower and the biochemical index was also better in the observation group than those in the control group as well as those before intervention in the observation group(P＜0.05).Conclusion The depression, anxiety status and biochemical index in patients with type 2 diabetes mellitus were effectively controled by corresponding and comprehensive intervention measures according to the sequence order of pressure source.

Objective To investigate the level and correlation between Thioredoxin (Trx) and Thioredoxin interacting protein (Txnip) in aqueous humor of cortical cataract patients with type 2 diabetes.Methods The Txnip and Trx levels were determined by Elisa in aqueous humor of 60 cataract patients with type 2 diabetes,which were divided into group A (control group,HbA1c ＜5.5％),group B (5.5％ ≤HbA1c ＜6.5％) and group C (HbA1c＞6.5％),and each group contains 20 patients.Results The level of Txnip in group B was higher than that in group A,while that in group C was the highest,there were statistical differences (all P ＜ 0.05).Compared with group A,the level of Trx in group B was increased,while that in group C was the lowest,there were statistical differences (all P ＜ 0.05).The level of Trx was positive correlated with Txnip in group A (r =0.810,P =0.000),but negative correlated with Txnip in group C (r =-0.809,P =0.000) and degree of cataract in group C (r =-0.727,P =0.001).Logistic regression analysis revealed that Txnip and HbAl c were risk factors of cortical cataract.Conclusion Trx and Txnip may play an important role in the development of diabetic cataract.

Objective To contrastively analyze the performance of two kinds of blood cell separators for apheresis platelets . Methods 80 blood donors were selected from 4 234 healthy apheresis platelet donors and their data before and after apheresis platelets were respectively collected by using two kinds of different blood cell separators Trima and Amicus .The product quality during the collection process ,residual WBC and RBC count ,acquisition time ,collection efficiency ,scrapping situation and safety were performed the comparative analysis between the two kinds of blood cell separator .Results In the case of the difference of the basic parameters before apheresis platelet having no statistical significance ,the two kinds of blood cell separator had no differences in the aspects of product quality ,processing blood amount and the use amount of anticoagulants(P>0 .05);but there were statisti‐cal differences in the aspects of acquisition time ,collection efficiency and pipeline residual blood amount (P<0 .05) .Conclusion Two kinds of blood cell separators have their own advantages and disadvantages during the use process ,so the blood cell separator should be selected according to the physical quality and their own characteristics of blood donors .

Objective To explore the effect of particulate matter (PM) 2.5 on the expression of pigment epithelium-derived factor (PEDF) protein in bronchial epithelial cells (BEAS-2B). Methods Human BEAS-2B were subcultivated, followed by low, medium and high concentrations of PM2.5 (25μg/ml, 50μg/ml, 100μg/ml) stimulation for 24 hours. The expression of PEDF protein in supernatant was ana-lyzed by enzyme-linked immunosorbent assay (ELISA), and the expression in BEAS-2B cells was detected by Western blotting. Results Compared with the control group, the expression of PEDF protein in supernatant and BEAS-2B cells induced by PM2.5 (25 μg/ml) in-creased, but no significance was found (t=-0.730, t=-1.840, P>0.05), and the expression induced by PM2.5 with the concentrations of 50μg/ml and 100μg/ml significantly increased (t>5.798, P<0.05). Conclusion PM2.5 with the concentrations of 50μg/ml and 100μg/ml could increase the expression of PEDF protein in a concentration-dependent manner both in supernatant and BEAS-2B cells.

Objective The purpose of this sturdy was to conduct a meta-analysis of published randomised controlled trials(RCT) comparing the clinical outcomes of radiofrequency ablation(RFA) versus surgery alone(SA) in all patients with cardiac surgery.Methods PubMed, Embase, the Cochrane Controlled Trials Register databases, CNKI, CBM disc and VIP datebases were searched, and study eligibility and conducted data abstraction were determined independently and in duplicate.Literature searches from database establishment to November 2014.The heterogeneity and data were analyzed by the software of Rev Man 5.2.Results Of 564 studies identified, 8 studies met eligibility criteria, and included a total of 591 patients.In efficacy, The number of patients in sinus rhythm(SR) was signifcantly improved in RFA group compared to SA group at discharge(OR =10.59;95％ CI: 3.81-29.45).This effect on SR remained at all follow-up periods until ＞ 1 year.In safety, there was no significant difference in the incidence of hospital mortality(OR =1.17;95％ CI: 0.41-3.35) and mortality rate in follow up period(OR =0.77;95％ CI: 0.35-1.69) between RFA group and SA group.Similar results were shown in the incidence of permanent pacemaker(OR =0.65;95 ％ CI: 0.28-1.52;P =0.32) , thromboembolic events (OR =1.61;95 ％ CI: 0.54-4.84;P =0.40), postoperative re-intervention for bleeding (OR =0.45;95 ％ CI: 0.12-1.70;P =0.24).Conclusion The results of the current randomized trials demonstrates that concomitant surgical radiofrequency ablation and cardiac surgery is safe and effective at restoring sinus rhythm.

Objective To summarize 500 cases of surgical experience in restoration of adult congenital heart disease ( ACHD) treatment and early postoperative.Methods During January 2012 to December 2014 in Fuwai Hospital, 500 cases of ACHD treated by operation were chosen to collect the clinical data .We divided the groups according to whether the case was a complex malformation and whether the case had an ICU retention time is more than the 5 days.Results The average age was 35, the average weight was 59 kg.The operation average cardiopulmonary bypass(CPB) time was 102min.The average ICU treatment time was 2 days, the average duration of mechanical ventilation was 23 hours, 3 early deaths occurred.The complex malformation group had younger age and less weight than the simple malformation group , the complex malformation group had longer time of cardiopulmonary bypass time, aortic cross clamping time, mechanical ventilation time and ICU treatment time, had higher rate of complication and blood transfusion peri-operative period than the simple malformation group.(P<0.05) The group of ICU retention time less than 5 days had higher rate of the male proportion, had younger age and less weigh, had longer time of cardiopulmonary bypass time , mechanical ventilation time and ICU treatment time , had higher rate of complication and blood transfusion peri-operative period than the control group(P <0.01).Conclusion Although ACHD patients have long medical history and complicated pathological and physiological changes , when they get proper surgical operation and periopera-tive treatment, they should obtain satisfied effect.Professional medical team or organization service for the ACHD patient is very important and urgent to build.

OBJECTIVETo analyze the reason and treatment of the complications of 61 cases of extracorporeal membrane oxygenation (ECMO) in order to improve survival rate of ECMO treatment.

METHODSECMO records from January 2007 to December 2014 in Shanghai Chest Hospital were investigated retrospectively focusing on complications. There were included 43 male and 18 female patients, age 3 to 66 years. Indications for ECMO included post-operative low cardiac output, viral myocarditis, bridge to heart transplantation, acute respiratory distress syndrome and myocardial infarction. There were 49 cases of veno-arterial ECMO and 12 cases of veno-venous ECMO.

RESULTSECMO duration was 2 to 61 days. Among 43 patients, 37 patients weaned from ECMO successfully and 28 survived to discharge. Various complications occurred to 56 patients, including oxygenator plasma leakage(4 case times), circuit emboli (7), hemolysis (4), bleeding (34), infection (8), acute kidney injury (35), lower limb ischemia (8) and neurologic complications (6). There were 49 cases times of complications in survivors, while 61 cases times in death group. Bleeding (10 time cases) and acute kidney injury (33 time cases) happened in the death group. Progresses in ECMO technique had influences on complications in some parts. For instance, incidence of lower limb ischemia was 6/7 in cutdown cannulating group, but reduced to 2/42(4.8%) when semi-open technique was applied.

CONCLUSIONSComplications in ECMO are relative to patients' outcome intimately. Appropriate prevention and treatment of complication play a major role in the success of ECMO support. The incidences of certain complications reduce significantly due to progresses of equipment and medical experiences.

Acute Disease ; Acute Kidney Injury ; etiology ; Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; China ; Extracorporeal Membrane Oxygenation ; adverse effects ; Female ; Heart Transplantation ; Hemorrhage ; etiology ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; Myocarditis ; virology ; Respiratory Distress Syndrome, Adult ; Retrospective Studies ; Treatment Outcome ; Young Adult

Objective:To understand the clinical and laboratory characteristics of primary Epstein-Barr virus (EBV) infection in children.Methods:Totally 210 cases with primary EBV infection from September 2016 to March 2017 in Department of Infectious Diseases, Children′s Hospital of Fudan University in Shanghai were retrospectively collected. The clinical information (fever, rash, etc), and laboratory data such as liver function, EBV test (serological test, polymerase chain reaction (PCR)-DNA) were analyzed.Results:The age of children with primary EBV infection was (4.2±2.4) years. Numbers of patients with fever, tonsil and/or pharynx exudation, cervical lymphadenopathy, eyelid edema and rash were 187 (89.0%), 130 (61.9%), 204 (97.1%), 95 (45.2%) and 21 (10.0%), respectively. A total of 120 cases (57.1%) presented with typical triplets of infectious mononucleosis. Absolute lymphocyte count ≥5.0×10 9/L was found in 177 cases (84.3%), and abnormal lymphocyte ratio≥0.10 was found in 184 cases (87.6%). Elevated transaminase level was found in 96 cases (45.6%), and 72 cases were followed until transaminase level back to normal, in whom 97.2% (70/72) patient returned to normal within six weeks. Epstein-Barr viral capsid antigen (EBV-VCA)-IgM was positive in 192 cases (91.4%). EBV-VCA-IgG and Epstein-Barr viral early antigen (EBV-EA)-IgG positive were presented in 182 cases (86.7%) and 62 cases (29.5%), respectively. Epstein-Barr viral nuclear antigen (EBV-NA)-IgG was negative in all cases. EBV DNA test was carried in 199 cases, of which 122 cases (61.3%) were positive. Conclusions:Pediatric primary EBV infection mainly occurs in preschoolers. Most patients are presented with enlarged cervical lymph nodes, fever, and positive EBV serological markers. Transient transaminase elevation is observed in some cases.

Objective:To study the improvement of medical service quality in a public hospital by integrating Kano and quality function deployment(QFD)technology, so as to provide reference for the improvement of service quality in hospitals.Methods:The Kano questionnaire of patients′ needs was designed, the attributes of patients′ needs were identified, and the importance of patients′ needs was calculated and determined. Then, using the house of quality technology in QFD, the patient needs were transformed into corresponding medical service quality assurance elements, and the improvement priority of each assurance element was determined through calculation.Results:The six quality assurance elements most expected to be improved by patients in the hospital were to improve medical level, strengthen service management, improve supervision and review mechanism, standardize complaint process, ensure drug safety and guidance, and track treatment effect.Conclusions:The integrated Kano-QFD technology can provide an effective methodological reference for improving the quality of medical service.

Objective:To investigate the effect of alogliptin on bone loss in ovariectomized(OVX)mice.Methods:For animal experiments, thirty 8-week-old C57BL/6J female mice were divided into Sham group, OVX group, and OVX+ alogliptin group. OVX+ alogliptin group were administered with alogliptin in a dosage of 20 mg·kg -1·d -1 by gavage, Sham and OVX groups with equivalent saline. After 12 weeks intervention, serum bone anabolism indicators were detected, and Micro CT and HE staining were used to observe and analyze the bone trabecular structure of femur and tibia in mice. For in vitro experiments, bone marrow mesenchymal stem cells(BMSCs)were incubated with 100 μmol/L alogliptin for osteoblast differentiation. Alkaline phosphatase(ALP)and alizarin red S staining were used to determine the ALP activity and mineralization after osteogenic induction and culture. Real-time fluorescence quantitative PCR and Western blot were used to detect mRNA and protein expressions of osteoblast related genes. Results:Alogliptin intervention improved the biochemical indexes of bone anabolism and protected against bone microstructure deterioration to alleviate bone loss in OVX mice. Alogliptin stimulated osteoblast differentiation and elevated expression levels of Runt-related transcription factor 2(Runx2), ALP, osteocalcin, and osterix in in vitro experiments. Conclusion:Alogliptin can alleviate bone loss in OVX mice.