Objective To investigate the changes of plasma fibrinolytic activity and D dimer level in the primary hypertension of the elderly.Methods ELISA was applied to measure blood and urine D dimer.Chromophore substrate method was used to detect PL,Plg,t PA and PAI 1.Results The levels of PAI 1,D dimer and Plg were obviously higher in the elderly primary hypertension and hypertentive kidney disease than those in the control group,while t PA and PL activity were lower than in the control group.Conclusion The changes of PLA and D dimer play an important role in hypertension and hypertentive renal disease of the elderly,on which the early diagnosis can be based.

Objective To investigate the clinical manifestations and laboratory findings of patients with the late onset systemic lupus erythematosus(LOSLE) and the elderly onset SLE. Methods Forty one patients with SLE onset beyond the age of 50 years(including 20 patients SLE onset beyond the age of 60 years) were identified and compared with 41 patients who had SLE onset before the age of 50 (General SLE). Patients in the group of general SLE were selected by 1 to 1 individual matching according to sex, course of diseases, date of admission. The presenting clinical features, laboratory findings, incidence rate of complication, efficacy of glucocorticoid and the prognosis of patients in two groups of LOSLE and general SLE were compared and analyzed. In addition, 20 cases of elderly onset SLE were also compared and analyzed. Results There were significant differences in symptoms between groups of LOSLE and General SLE. The LOSLE group had less occurrence of rash (39 0% vs 73 2%, P

Objective To investigate effects of high fat-salt diet on change of growth and development,body fat distribution insulin sensitivity and associated metabolic indexes for juvenile rats. Methods 50 grams of male,female SD juvenile rats (3 weeks,just weaned) were randomly divided into 3 groups,12-14 animals in each group,were given routine diet (NC) and high fat diet (FC) and high fat-salt diet (FSC) .Then the body weight,,body length,abdominal circumference,blood pressure,visceral fat weight,plasma lipids were measured 4 weeks later,at the same time oral glucose tolerance test and insulin release test were performed. Results In the FSC group,body weight,abdominal circumference,blood pressure,visceral fat,plasma glucose and insulin level significantly increased than the NC group,plasma lipid disorders increased and significant insulin resistance occurred. Conclusion High fat and high salt could successfully induced obesity,hypertension,dyslipidemia and impaired glucose tolerance.

BACKGROUND:There is evidence that internal fixation through an anterior or posterior approach for treatment of severe kyphotic deformity in spinal tuberculosis exhibits good curative effects. However, few prospective, long-term fol ow-up case control studies are reported. OBJECTIVE:To investigate the efficacy and safety of cobalt al oy pedicle screw implantation for treatment of severe kyphotic deformity in spinal tuberculosis. METHODS/DESIGN:This is a prospective, single-center, self-control, open-label trial, which wil be performed at the Affiliated Hospital of Hebei University, China. Eighty-four patients with severe kyphotic deformity in spinal tuberculosis wil be included according to the diagnosis criteria. Among 52 patients with tuberculosis of the thoracic spine, 28 wil undergo surgery through a posterior approach, and 24 through an anterior approach. According to the Frankel Grade classification, grade C, D and E spinal cord function wil be assessed in 8, 31 and 13 patients, respectively. Surgery through a posterior and anterior approach wil be respectively performed in half of 32 patients with tuberculosis of the lumbar spine. Grade C, D and E spinal cord function wil be assessed in 7, 14 and 11 patients, respectively. The primary outcome measure of this study wil be the Cobb angle at the thoracic spine segments before and 2 years after surgery, which wil be used to evaluate the angle of the spine curvature at the thoracic segments. The secondary outcome measures wil be X-ray scan or MRI findings before and 2 years after surgery, which wil be used to evaluate vertebral fusion after internal fixation;and Frankel Grade before and 2 years after surgery, which wil be used to evaluate recovery of spinal cord function after injury. Other outcome measures wil include multiple logistic regression analysis results of the factors that influence patient's curative effects and the incidence of adverse events 2 years after surgery. The trial protocol has been approved by the Ethics Committee, Affiliated Hospital of Hebei University, China and wil be performed in strict accordance with the Declaration of Helsinki, formulated by the World Medical Association. Signed informed consent regarding the trial protocol wil be obtained from each participant. DISCUSSION:This study is to validate that cobalt al oy pedicle screw implantation shows precise curative effects in the treatment of severe kyphotic deformity in spinal tuberculosis and to analyze through what approach, posterior or anterior, internal fixation wil be more beneficial to surgery performance. The outcomes of this study wil provide objective long-term fol ow-up evidence for internal fixation treatment of severe kyphotic deformity in spinal tuberculosis in the clinic.

Objective To explore the clinical features of late-onset neuromyelitis optica spectrum disorders (LON?MOSD). Methods A retrospective analysis was performed to evaluate 61 patients with LONMOSD admitted to our hospital from January 2010 to May 2015. Results (1) The median age at onset was 57 (53, 63) years, male/female was 1∶3.7. Thirty-two patients (52.5%) had transverse myelitis (TM) and 16 patients (26.2%) had optic neuritis (ON) at the disease onset. Fifty-one patients (83.6%) experienced recurrent attacks. Forty patients (65.6%) showed abnormal brain magnetic resonance imag?ing (MRI). Spinal cord MRI showed more frequently present in thoracic regions (39.3%). (2) There were no significant differ?ences in clinical features between AQP-4 seropositive and seronegative groups. (3) By Spearman analysis, it was obvious that EDSS scores at acute phase and remission were positively correlated to AQP-4 antibody levels (rs=0.389, P<0.01;rs=0.380, P<0.01). But there was no correlation between the mean segments of spinal cord and relapse rates with AQP-4 anti?body levels (rs=0.146, P>0.05;rs=0.096, P>0.05). Conclusion LONMOSD patients are more prone to present with TM at onset and have more lesions in thoracic spinal cord and brain. The AQP-4 antibody titres can indicate the severity of disease in acute phase.

Objective To screen the prevalence of celiac disease with serologic markers in the central Chinese population,specifically in patients with chronic diarrhea-predominant irritable bowel syndrome (D-IBS).Methods A total of 282 adult patients with D-IBS were selected based on ROME Ⅲ criteria with 296 age and sex matched consecutive healthy individuals as controls.A gluten-free diet (GFD) was advised in subjects positive for IgA/IgG anti-htTG/DGP antibodies and the serologic antibodies were retested after the GFD.Results Among the 578 study subjects,five D-IBS patients (5/282,1.77％) and two healthy controls (2/296,0.68％) were positive for anti-htTG/DGP antibodies.Among the seven positive cases,one was lost to follow-up and only four were evaluated during GFD therapy for an average of 5.2 months with clinical and/or serological manifestations improved.Conclusions The prevalence of celiac disease may not be uncommon in China.Compared with the healthy population,patients with D-IBS tend to be affected more.Thus,it is significantly important to conduct routine screening for celiac disease in patients with D-IBS.

Objective To investigate the dynamic changes of interleukin-1 receptor-associated kinases (IRAK-4) in hypoxic neurons and explore their role in regulation of inflammatory reaction. Methods The B35 cells exposed to hypoxia of 3% O2,5% CO2 and 92% N2 were cultured for 1,3,6, 12,24,48,72 and 96 hours respectively. Then, mRNA and protein expressions of IRAK-4 were detected by RT-PCR and Western blot, the expression of IRAK-4 in the cells were observed by laser scanning con-focal microscope (LSCM), and the concentration of IL-6 was measured by ELISA method. Results After hypoxia, the mRNA and protein expressions of IRAK-4 were increased at one hour, reached the peak at six hours (P<0.05), kept at a high level at 12 hours (P<0.05) , but decreased gradually to the normal oxygen level at 24 hours (P < 0.05) and to below the normal oxygen level at 48 hours (P < 0.05). Immunofluorescence results showed that the fluorescence intensity of IRAK-4 was gradually increased with time. The changes of IL-6 in the supernatant were positively correlated with protein expression of IRAK-4 (r =0.84, P < 0.05 ). Conclusions Hypoxia can increase the expression of IRAK-4 at transcription and translation levels in a certain period of time, which may participate in down-stream inflammatory reaction and lead to increase of IL-6 expression.

OBJECTIVE To investigate the clinical features and risks factors of nosocomial bacterial infection in patients with systemic lupus erythematosus(SLE).METHODS Five hundred and ninety-seven patients with SLE were classed into two groups,the group of nosocomial bacterial infection and the control group according to the results of bacteriological examinations.A comparison was performed between the two groups.RESULTS According to the infection sites,36% occurred in the respiratory tract and lungs,29.0% in the urinary tract,19.9% in the blood system and 15.1% in other tissues and organs.From them,75.8% onsets of nosocomial bacterial infection were chronic or insidious.The pathogens of nosocomial bacterial infection were mostly opportunistic,45.6% were G-bacilli,40.9% G+cocci and 13.9% were other bacteria.The eight major risk factors included lung disease,the more than 3 damaged organs or systems,plasma albumin under 30 g/L,long application of large dose glucocorticoid(GC),treatment of super-dose GC,therapeutic alliance of GC and cytotoxic immunosuppressant usage,use of broad-spectrum antibiotics before hospitalization and the time in hospital over 3 weeks.CONCLUSIONS The respiratory tract and lungs are the commonest site of nosocomial bacterial infection in patients with SLE.Most of the pathogens may be opportunistic of G-bacilli and G+cocci.The clinical features are untypical.It may decrease the incidence of the nosocomial bacterial infection to diminish by decreasing dose and the course of GC treatment after the patient's condition improved,select prudently application of super-dose GC,therapeutic alliance of GC and cytotoxic immunosuppressants,cautiously use of broad-spectrum antibiotics and shorten the duration of hospitalization.

Objective To evaluate the effects of a traditional Chinese medicine Rubia cordifolia L.aqueous extract (RCAE) on body weight, fat mass and parameters of glucose and lipid metabolism in high fat diet (HFD)-induced obese rats and its mechanism.Methods pGL3-Enhancer-PPARγ2 (625 bp)-Luc plasmid, a luciferase reportergene expression plasmid containing PPARγ2 promoter was constructed and stably transfected 3T3-L1 preadipocytes were established.PPARγ2 promoter`s activities in these cells were detected after administration with different concentration (0.1 mg/L~1 000 mg/L) of RCAE or with 100 mg/L RCAE for different action time.PPARγ2 mRNA expression in human adipocytes were detected after administration with 100 mg/L RCAE.Meanwhile, HFD-induced obese rats were administrated with low or high dose RCAE to investigate the effects of RCAE on serum glucose, lipid and insulin levels, body weight, visceral fat mass and so on.Results 10 mg/L RCAE could increase luciferase expression in 3T3-L1 cells to 1.43 folds of that in control group (P<0.01) and it reached 3.24 folds of that in control group when the concentration of RCAE was 1000 mg/L (P<0.01).With the administration with 100 mg/L RCAE, the luciferase activity of 3T3-L1 cells peaked at 28 h where it was 2.72 folds of that in control group (P<0.01), and the expression of PPARγ2 mRNA in human adipocytes increased to 2.27 folds of that in control group (P<0.01).Compared with HFD group, low dose RCAE significantly reduced the fasting insulin level, HOMA-IR and visceral fat mass (P<0.05).Conclusions Low dose RCAE significantly reduces the visceral fat mass and ameliorates insulin resistance in HFD-induced obese rats.The potential mechanism may be explained by the stimulation of PPARγ2 promoter activities and the increased expression of PPARγ2 gene.

We reported a case of hypophysitis caused by a programmed death-1 ( PD-1) inhibitor. The patient was a 59-year-old female with metastatic malignant melanoma who participated in the phaseⅡclinical trial of a PD-1 inhibitor toripalimab. More than five months after the administration of toripalimab,she experienced fatigue, depression, nausea, and anorexia. Laboratory examinations showed mild hyponatremia, secondary adrenal insufficiency, and secondary hypothyroidism. MRI revealed the enlargement of her pituitary with obvious enhancement. The patient was diagnosed as hypophysitis caused by the PD-1 inhibitor and was given replacement therapy with physiological doses of corticosteroid and levothyroxine sodium. Her symptoms were then improved. MRI revealed that her pituitary size returned to normal after 8 weeks of treatment and remained stable during every 3-month follow-up. This case reminds us of the possibility of hypophysitis when patients suffere from fatigue and anorexia during the process of PD-1 inhibitor treatment. Correct diagnosis, proper therapy, and regular follow-up are important to ensure the patients' safety, and to improve their prognosis.