[Objective] To emphasize the importance of early prevention and treatment, this article discusses on the theory and application of preventive treatment of disease from traditional Chinese medicine in prevention and treatment of carotid atherosclerosis in patients with diabetes. [Methods] With de-tailed research into related study of risk factors affecting carotid atherosclerosis in type 2 diabetic patients from recent years, comprehensive summary of tra-ditional risk factors and risk factors of the latest findings were demonstrated. The prevention and treatment of carotid atherosclerosis in type 2 diabetes mel itus was discussed in two aspects by theory of“preventive treatment of disease. [Result] In diabetic patients without carotid atherosclerosis, early and timely intervention can prevent the occurrence and development of the diabetes vascular lesions; In diabetic patients with carotid atherosclerosis, active treatment can reduce the incidence of stroke, myocardial infarction and other critical care. [Conclusion] In patients with type 2 diabetes, risk factors affect-ing carotid atherosclerosis should be control ed and intervened early, which can effectively reduce the occurrence and development of the diabetes vascular lesions to improve the quality of life, but early diagnosis technology and indicators need to be further researched.

Objective To investigate the role of interleukin-6(IL-6), interleukin-8(IL-8) and tumor necrosis factor-?(TNF-?) in the pathogenesis of secondary syphilis, and their relationship with RPR titers and clinical manifestations in secondary syphilis. Methods The serum IL-6, IL-8 and TNF-? were tested by ELISA. RPR titers of the patients were determined simultaneously. Histopathology was performed if skin lesions were present. Results Thirty three cases of secondary syphilis were studied. The average levels of serum IL-6, IL-8 and TNF-? were 78.7?82.5 pg/mL, 171.9?117.9 pg/mL and 115.7?67.9 pg/mL, respectively, in syphilis group, which were significantly higher in comparison with those in controls (P

Objective To investigate the clinicopathological relation between the TNF-? and IgA nephropathy. Methods TNF-? levels in serum, urine and renal tissues of 50 patients with IgA nephropathy were measured, and 10 patients with minimal change nephrotic syndrome(MCNS) and 10 healthy subjects served as negative control group. Results The serum and urine levels of TNF-? in the patients with IgA nephropathy were significantly higher than those in the patients with MCNS and healthy subjects, and had a significant positive correlation with the degree of proteinuria and renal demage. TNF-? expression was mainly localized in the cytoplasm of the proximal renal tubular epithelial cells, and the interstitium with more monocyte-macrophages infiltration. Conclusion TNF-? took part in the onset of hematuria and proteinuria, was correlated with the degree of renal damage, and played an important role in the aggravation of IgA nephropathy.

According to the related requirements of medical technology clinical application management, the specific implementation approaches of surgery physicians surgery permission management were made, including establishing surgery classification project directory library, developing surgery classification management system and the surgery permission declared, and audit program, and investigating to determine the steps of surgery permission owned by surgery physicians currently, and finding problems and solution measures in implementation surgery permission management. To prevent surgical risk, improve the quality of operation, and evaluate surgical doctors scientifically, it provides management experience and references.

Objective:To develop an total knee arthroplasty(TKA) enhanced recovery after surgery information management system based on "cloud + terminal" data-drivene technology, which can be used in the perioperative interaction between doctors and patients and rehabilitation management of TKA, and evaluate its implementation effect.Methods:The clinical data of 96 patients with unilateral TKA from Qilu Hospital Shandong University were analyzed retrospectively. Forty eight patients in the control group from February to August, 2018 were treated with traditional management. From February to August, 2019, 48 patients in the research group adopted the accelerated rehabilitation information management system based on data-driven technology, which can automatically match, interact and push the information between medical and patient.Results:The Self-rating Anxiety Scale(SAS) score of the intervention group on hospitalization day was 41.52±4.65, which was better than that of the control group (52.60±4.84). The difference between the two groups was statistically significant ( F value was 11.446, P<0.05). The scores of Hospital for Special Surgery(HSS), Visual Analogue Scale(VAS) and SAS in the intervention group 3 days after operation were 56.31±5.81, 2.79±0.68, 38.69±3.81, which were better than those of the control group (51.31±5.20, 4.31±0.78, 46.02±3.86). The difference between the two groups was statistically significant ( F value was 4.44, 10.19, 9.37, all P<0.05); the HSS, VAS, and SAS scores of the intervention group one week after operation were 71.35±3.59, 1.98± 0.67, 36.81±4.03, better than the control group (67.15±3.67, 2.60±0.87, 39.48±4.04), the difference between the two groups was statistically significant ( F value was 5.683, 3.951, 3.237, all P<0.05); the postoperative hospital stay in the intervention group was (3.98±0.84) days, which was less than (6.00±0.80) days in the control group, the difference was statistically significant ( F value was 146.286, P<0.05); The patients′ satisfaction score in the intervention group during medical treatment was 97.46±1.73, which was higher than the control group (94.35±2.04), the difference was statistically significant ( F value was 64.911, P<0.05). Conclusions:TKA enhanced recovery management system based on "cloud + terminal" data-drivene can improve the management level of TKA patients, reduce the length of stay and improve satisfaction of patients.

Objective To evaluate the value of nuchal translucency (NT) thickness in the fetal chromosome abnormality screening. Methods 11 086 pregnant women received NT measurement in 11 ~ 13+6 weeks at Hainan general hospital from January 2010 to December 2014 were selected in the study. The NT thickness was measured according to guidelines from Fetal Medicine Foundation. 122 fetuses (NT≥2.5 mm) were recruited to accept karyotype analysis. Results 11 086 pregnant women received NT measurement in 11 ~13+6 weeks, in which 122 cases′ NT are more than or equal to 2.5 mm, with a positive rate of 1.10%. 122 cases of fetal NT thickening are between 2.5 to 12.0 mm, with the average degree at (4.5 ± 2.1)mm. 122 invasive prenatal diagnostic specimens chromosome karyotype analysis results showed chromosomal abnormalities in 21 cases (abnormal rate of 17.2%), the abnormal chromosome number in 17 cases and abnormal structure in 4 cases. The top 3 are trisomy 21 (12 cases, 57.1%), chromosome pericentric inversion (3 cases, 14.3%), and trisomy 18 (2 cases, 9.5%). Fetal chromosomal abnormalities resulting from different childbirth age, the sex of the fetus, NT thickness showed significant statistical difference (P < 0.05). The concrete manifestation is that fetal chromosomal anomaly detection rate in childbirth by women more than 35 years old age are higher than other age. Female fetal chromosomal anomaly detection rate is higher than the male , and NT thickness of 5mm of fetal chromosomal abnormality rate is significantly higher than the thickness of NT group at 2.5mm~ and 3.5mm~. Fetal NT thickening of NT measurements was in significant positive correlation with fetal chromosome abnormal rate (χ2=15.533, P < 0.001). Logistic regression analysis found that with a higher NT thickness , risk of fetal chromosomal abnormalities would be significantly higher , and thickening of NT could be an independent predictor of fetal chromosome abnormalities. Conclusion In early pregnancy, ultrasound examination of fetal ultrasound screening of NT thickness can be used as an important index of fetal chromosomal abnormality , and interventional diagnosis of prenatal NT thickness increase could pose increased risk of fetal chromosomal abnormalities.

Objective To evaluate the effect of integrated service platform of extensional care based on the combined internet and extensional care model in the orthopedics nurse care. Methods Two hundred and eighty six hospitalized patients in the orthopedic department were randomly divided into two groups including experimental group (144 cases) and control group (142 cases) according to the random number table method. Patients in the control group received extensional care by traditional telephone follow-up, patients in the experimental group received extensional care by using the integrated service platform combing internet and extensional care. All the patients were evaluated using the self-made extensional care satisfaction questionnaire and Short Form 36 Questionnaire. Results The extensional care satisfaction scores of experimental group using internet plus extended care mode were respectively ( 74.4 ± 5.3) points and (76.2 ± 8.1) points at the time points of 3 months and 6 months after discharge from hospital;The extensional care satisfaction scores of control group were respectively (69.4±9.9) points and (70.1±12.2) points at the time points of 3 months and 6 months after discharge from hospital;The two groups had statistically comparative difference (t=7.40, 6.37, P<0.01). There was a statistically significant improvement of extensional care satisfaction and physical function score and role-physical score and social function score in the experimental group compared with the control group both at the time points of 3 months and 6 months after discharge from hospital. There was a statistically significant improvement of vitality score and role-emotion score in the experimental group compared with the control group both at the time points of 1 month and 3 months after discharge from hospital (t=2.366-8.211, P<0.05). Conclusions The effect of integrated service platform of extensional care based on the combined internet and extensional care model is better than traditional telephone follow-up, patients′satisfaction is higher. This new mode of service platform could greatly deepen the connotation of quality nursing, intensify the effect of extensional care, and reduce the working strength of nurse who did extensional care as while.

Objective To investigate the anti-inflammatory activity of the main active ingredients in the dried stem bark of Daphne giraldii Nitsche.Methods Severialchemical compounds like vladinol D, pinoresinol, daphneticin, daphnoretin, daphnetin, giraloid A and giraldoid B were isolated from the stem barks. The CCK-8 experiemnts were analyzed for the cytotoxicity study. The cells were divided into the control group, the model group and the treatment group according to random number table method. The control group and the model group were added with 50μl culture medium. Moreover, treatment group was added with different concentrations (50.00, 25.00, 12.50, 6.25, 3.12μg/ml) of the solutions of giraloid A, giraldoid B and daphneticin. Then, RAW264.7 cells were treated with 50μl LPS (4μg/ml) for 24 h in the model group and treatment group. Griess reagent was used to determine the amount of NO release, and the secretion of TNF-α was detected by ELISA kit.Results Cytotoxicity test indicated that giraldoid A (50.00μg/ml), giraldoid B (50.00μg/ml) and daphneticin (50.00μg/ml) showed noobvious cytotoxicity. Giraldoid B (12.50, 25.00, 50.00μg/ml) could inhibit the production of NO (271.86% ± 20.92%, 256.48% ± 20.92%, 199.31% ± 15.16%vs.358.62% ± 28.64%) and  TNF-α (647.87% ±115.79%, 618.42% ± 87.52%, 588.33% ± 87.94%vs. 1035.06% ± 58.29%) in RAW264.7 induced by LPS compared with the model group. Giraldoid A (25, 50μg/ml) could inhibit the production of NO (234.99% ± 34.28%, 167.36% ± 25.76% vs.358.62%±28.64%) and TNF-α (691.76% ± 60.37%, 534.01% ± 41.60% vs. 1035.06% ± 58.29%) in RAW264.7 induced by LPS compared with the model group. Daphneticin (12.5, 25, 50μg/ml) could inhibit the production of NO (283.89% ± 36.69%, 243.08% ± 48.19%, 225.92% ± 33.67% vs.358.62% ± 28.64%) and TNF-α (713.77% ± 121.96%, 670.62% ± 18.70% vs. 1035.06% ± 58.29%) in RAW264.7 induced by LPS compared with the model group.Conclusions Giraldoid A, giraldoid B and daphneticin exhi bited anti-inflammatory effect through inhibiting the release of NO and the production of TNF-α in RAW264.7 induced by LPS.

Objective To evaluate clinical features,insulin sensitivity and β-cell function of pregnant women with different glucose tolerance status,so as to identify the possible risk factors for adverse pregnancy outcomes in women with gestational diabetes mellitus (GDM).Methods We retrospectively analyzed the clinical data of 360 pregnant women with positive results of 50 g glucose challenge test who received antenatal care and admitted for delivery in the period from January 2009 to June 2012 in Peking Union Medical College Hospital.According to the result of 100 g oral glucose tolerance test (OGTT),the 360 women were divided into GDM group (n =83),impaired glucose tolerance (IGT) group (n =75),and normal glucose tolerance (NGT) group (n =202).The blood glucose level in all those women was controlled in normal range for gestational period.We compared the general clinical data,biochemical indexes,insulin resistance index,insulin sensitivity index,function index of islet β-cell,first-and second-phase insulin secretion,insulin secretion-sensitivity index as well as the pregnancy outcomes of the 3 groups,analyzing the possible risk factors for adverse pregnancy outcomes in women with GDM.Results Compared with the NGT group,the pregnant women in GDM group were older [(33.1 ± 3.7) years vs.(31.7 ± 3.4) years,P =0.008],had higher systolic blood pressure [(115.8 ± 9.7) mmHg vs.(111.4 ± 13.5) mmHg (1 mmHg =0.133 kPa),P =0.031] and diastolic blood pressure in first trimester [(75.4 ±9.0) mmHg vs.(71.8 ±8.8) mmHg,P =0.010],higher positive rate of family history of diabetes in first-degree relatives (37.3％ vs.22.3％,P =0.012),positive rate of insulin therapy (10.8％ vs.0％,P =0.001),serum triglyceride level [(2.8 ±0.9) mmol/L vs.(2.3 ±0.9) mmol/L,P =0.001],free fatty acid level [(486.7 ± 137.6) μmol/L vs.(438.1 ± 140.7) μmol/L,P =0.033],and C-reactive protein level [(5.7 ± 4.3) mg/L vs.(3.6 ± 3.0) mg/L,P =0.001].The GDM group had a larger pre-pregnancy body mass index [(22.6 ± 2.9) kg/m2] than that in IGT group [(21.3 ± 2.7) kg/m2] (P =0.049) and NGT group [(21.2 ±2.8) kg/m2] (P =0.003).In the order from NGT to IGT to GDM group,the hemoglobin A1c [(5.2 ± 0.3) ％ vs.(5.3 ± 0.3) ％ vs.(5.4 ± 0.3) ％,P =0.001,P =0.007],the areas under curve of glucose [(20.4±2.0) mmol · h/L vs.(22.9 ± 1.5) mmol · h/L vs.(26.9 ±2.1) mmol · h/L,both P=0.001] and the areas under curve of insulin [(1.7 ±0.9) × 103 pmol · h/L vs.(2.1 ± 1.1) × 103 pmol · h/L vs.(2.7±1.3) ×103 pmol · h/L,P=0.001,P=0.007] increased gradually,while insulin sensitivity index (88.1 ± 52.1 vs.80.0 ± 30.6 vs.50.0 ± 24.1,P =0.001,P =0.014) and insulin secretion-sensitivity index (134 507.0 ± 43 291.0 vs.102 542.0 ± 15 291.0 vs.77 582.0 ± 20 764.0,both P =0.001) decreased gradually.The insulin resistance index in the GDM group (3.3 ± 2.2) was significantly higher than that in IGT (2.2 ± 1.0) and NGT groups (3.0 ± 1.1) (both P =0.001).The function of β-cell,first-and second-phase insulin secretion were not significantly different among the 3 groups.Compared with the NGT group,pregnant women with GDM had shorter gestational age [(38.8 ± 1.1) weeks vs.(39.4 ± 1.1) weeks,P=0.004] and higher incidence of adverse pregnancy outcomes (44.6％ vs.21.8％,P =0.001).Seven risk factors predicting adverse pregnancy outcomes in women with GDM were identified,including pre-pregnancy body mass index (P=0.017),0-,1-,and 2-hour blood glucose in 100 g OGTT (P=0.036,P=0.009,P=0.004),3-hour insulin (P =0.014),and hemoglobin A1 c (P =0.002) and C-reactive protein (P =0.005) in second trimester,among which 1-hour blood glucose displayed the highest coefficient (OR =2.767).Conclusions Pregnant women with GDM have elevated blood pressure,dyslipidemia and increased inflammatory cytokine C-reactive protein.Women with GDM and IGT both show insulin resistance and β-cell dysfunction,and these impairments are more severe in women with GDM.Higher pre-pregnancy body mass index and blood glucose levels during pregnancy are associated with adverse pregnancy outcomes in women with GDM.

Purpose To investigate the role of PTEN in podocyte injury in patients with diabetic nephropathy ( DN) . Methods Uri-nary samples from 30 patients with DN and 10 healthy volunteers were collected to detect the level of PCX by ELISA. Renal biopsies were reviewed to observe the morphological changes. All patients with DN were divided into three groups by glomerular lesion. The ex-pression of p-Akt and PTEN in glomeruli was detected by immunohistochemistry. Results The levels of PCX in the urine were signifi-cantly higher in patients with DN compared with those in healthy volunteers, and gradually increased along with glomerular lesion aggra-vating. The expression of p-Akt and PTEN increased in patients with DN compared with healthy volunteers. Although the expression of p-Akt and PTEN decreased with the aggravation of glomerular lesion, they were still higher than that in volunteers. There were obvious-ly positive correlation between the level of PCX and 24-h urinary protein and negative correlation between the level of PCX and the ex-pression level of p-Akt and PTEN. Conclusion PTEN down-regulation may be associated with podocyte injury in DN, which may be associated with the phosphorylation of Akt.