Objective To study the association between renal dysfunction and platelet parameters in elderly patients with early heart failure (HF).Methods 637 patients (350 old-aged and 287 middle-aged) with hypertension,CHD,T2DM admitted to our hospital from January 2013 to December 2014 served as a disease group and 464 subjects (229 old-aged and 235 middle-aged) selected from the 973 Aging Project in September 2007-June 2008 served as a healthy group.Their eGFR and platelets (PLT) were calculated,their plateletcrit (PCT) and mean platelet volume (MPV) were measured.Association between platelet parameters and renal dysfunction was analyzed by binary logistic regression analysis.Results The MPV and PCT were significantly lower in the old-aged disease group than in the old aged healthy group (9.78± 1.45 vs 10.66±0.78,P＜0.01;19.79 ± 6.21 vs 21.82 ± 6.04,P＜0.01).The PLT and PCT were closely associated with the eGFR in two groups (P＜0.05,P＜0.01).Binary logistic regression analysis indicated that the median and high PLT in disease group and the median PLT in healthy group were independently associated with renal dysfunction (OR=0.560,95％CI:0.315-0.996;OR=0.480,95％CI:0.262-0.879;OR=0.483,95％CI:0.249-0.936,P＜0.05).Conclusion Attention should be paid to the effect of PLT and their functional activity on renal function in treatment of early HF patients because aging-induced change of PLT and their functional activity are associated with renal dysfunction.

Objective: To develop 5-FU multiple emulsion entrapped into thermo-sensitive gel (5-FU-DEG) and detect the ab-sorption and transportation in Caco-2 cell monolayer model. Methods:The 5-FU multiple emulsion was prepared by a two-step emulsif-ying method. Poloxamer 407 (P407) was used as the thermo-sensitive material and sodium alginate (SA) was used as the bioadhesive material for the preparation of 5-FU-DEG. Caco-2 cell monolayer model was used to investigate the transportation and absorption of 5-FU. Results:5-FU-DEG gelled at the ambient temperature and turned into liquid below 10℃ The apparent permeability coefficient (Papp) of 5-FU-DEG was 1.47 ±0.11 ×10 -5(cm·s-1), which was about 6 times higher than that of 5-FU water solution(2.39 ± 0.21 ×10 -6 cm·s-1)(P<0.01). The cellular uptake rate of 5-FU-DEG was (17.1 ±0.24) %, which was 3.9 times greater than that of 5-FU water solution (4. 41 ± 0. 23%)(P<0. 01). Conclusion:5-FU-DEG can efficiently enhance the transportation and ab-sorption of drug in rectal site by using micro-emulsion technology combined with thermo-sensitive technology, which can be an effective rectal delivery system for 5-FU to treat rectal cancer.

Objective:To compare and study coronary artery lesions characteristics of patients with non -ST -seg‐ment elevation acute myocardial infarction (NSTEMI) .Methods :A total of 66 patients diagnosed as acute NSTEMI were enrolled as NSTEMI group ,meanwhile 74 patients with unstable angina pectoris (UAP) were regarded as UAP group and 76 patients with acute ST -segment elevation myocardial infarction (STEMI ) were regarded as STEMI group .All patients received coronary angiography (CAG) and optical coherence tomography (OCT) examination . Coronary artery lesions characteristics were compared among three groups .Results:Pairwise comparison showed , that occlusion lesion (33.3% ) and serious stenosis (70% ~94% ) lesion (34.8% ) in NSTEMI group were signifi‐cantly more than those of UAP group (14.9% ,8.1% ) respectively;the occlusion lesion and serious stenosis lesion of STEMI group were no significant difference compared with those of STEMI group , P>0.05 all;type C lesion 43.9% of NSTEMI group was significantly more than that of UAP group (27.0% ) and of STEMI group (31.6% ) respectively ( P<0.05 all);vulnerable plaque of NSTEMI group (56.1% ) was significantly more than that of UAP group (23.0% ,P<0.01) ,but was no significant difference compared with STEMI group (56.6% ,P> 0.05). Conclusion :Serious stenosis lesion ,type C lesion and vulnerable plaque of NSTEMI group are significantly more than those of UAP group ;in NSTEMI group , type C lesion is significantly more than ,and occlusion lesion occlusion le‐sion significantly less than that of STEMI group .

Objective To explore CT and MRI imaging in the application of newly diagnosed esophageal cancer staging.Methods 200 patients with newly diagnosed esophageal cancer were selected as the research object, who voluntarily accepted the chest CT and MRI examination.Newly diagnosed esophageal cancer pathological results and CT,MRI features were observed.Spiral CT,MRI for T staging of esophageal cancer and N staging diagnosis were compared.Results In 200 patients,including 160 cases of squamous cell carcinoma,30 cases of adenocarcinoma, 10 cases of other types,T1 ,T2 ,T3 and T4 clinical staging period were respectively 19 cases,47 cases,81 cases and 53 cases,while N0 and N1 period were 65 cases and 135 cases respectively.The lesion diameter was 10 -22 (16.5 ± 4.6)mm.CT and MRI showed irregular thickening of the esophageal wall,CT showed equal or slightly lower density, T1 WI was MRI or low signal,T2 WI showed a slightly higher signal.Enhanced scanning,a substantial part of lesion enhancement,while the dead part had no enhancement.In T1 ,T2 of the diagnosis of esophageal carcinoma,MRI had higher diagnostic sensitivity and accuracy compared with CT,and the difference was statistically significant (χ2 =4.32,3.89,all P <0.05).In T3 ,T4 of the diagnosis of esophageal carcinoma,there were no statistical significance of MRI and CT of the diagnostic sensitivity,specificity and accuracy rate difference (P >0.05).By using the joint appli-cation of the two methods,the diagnostic sensitivity and accuracy were significantly higher than that used alone,the difference was statistically significant (χ2 =4.12,3.98,all P <0.05).In the diagnosis of N0 and N1 in esophageal cancer,MRI had a higher sensitivity,there were statistically significant difference compared with CT (χ2 =4.54, 4.23,all P <0.05).The two methods had no significant difference in N0 and N1 phase specific diagnosis of esophage-al cancer and the correct rate (P >0.05).The combined application of MRI and CT significantly improved the diag-nostic sensitivity and accuracy.Compared with the single application,the difference was statistically significant (χ2 =4.32,4.54,all P <0.05).Conclusion MRI is more sensitive to diagnosis T1 ,T2 stage and N0 ,N1 stage in esopha-geal carcinoma.Combined application of MRI and CT can improve the diagnostic sensitivity and accuracy.

The paper analyzes the overall evolutionary context of the situations of anti-diabetic drug patent applicants at home and abroad and conducts comparative analysis of the main patent applicants,etc.by making use of the patent analysis method and combining pharmaceutical knowledge.Relevant research results can be taken as the references for domestic pharmaceutical enterprises to make patent strategies and evaluate competitors.

Background Fungal keratitis has poor prognosis and high blinding rate,so it is vital to identify the risk factors that affect the treating outcome and prognosis of fungal keratitis.Objective This study was to evaluate the clinical outcome of fungal keratitis and identify the affecting factors.Methods This was a series cases-observational study.A total of 267 eyes of 267 patients with fungal keratitis were included in Henan Eye Institute during January 2013 to January 2014.Eye examinations were performed including slit-lamp microscope examination,corneal smears,confocal microscopy,fungal culture and identification.Combined anti-fungal drugs were topically used in all eyes for the initial treatment then the treating regimen were selected based on the susceptibility testing.corneal lesion resection combined with conjunctival flap transplantation,lamellar corneal transplantation or penetrating corneal transplantation was performed respectively on the patients with poor curative effect after drug treatment.The clinical prognosis of the patients was graded and the affecting factors for clinical outcome were evaluated.This study protocol complied with Helsinki Declaration and was approved by Ethic Committee of Henan Eye Hospital.Written informed consent was obtained from patients or guardians.Results One hundred and eighty-five eyes were cured by anti-fungal eye drops with the effective rate of 69.29％,and the inflammation was controlled in 60 eyes who received combination procedure of anti-fungal drugs with different surgeries,while 22 eyes lost visual function because of refractory glaucoma and final evisceration.The total clinical effective rate was 91.76％.Aspergillus and Fusarium spp.appeared to be the most common pathogenic fungi by drug sensitivity test.The keratitis caused by Aspergillus had lowest cure rate among different fungi (x2 =11.350,P =0.002) and the most poor clinical prognosis (H=31.285,P =0.013).The medication curative rate was 71.8％ in the patients with positive culture outcome,which was higher than 62.5％ in the patients with negative culture outcome (x2=8.75,P＜0.01).A significant difference was found in the medication curative rate and prognosis between the patients with ≥ 2 kinds of sensitive anti-fungal drugs and the patients with ＜2 kinds of sensitive anti-fungal drugs (77.5％ versus 52.3％,x2 =9.63,P＜0.01;H=24.281,P =0.021).Size of infiltration area,with or without hypopyon,number of sensitive drugs,and pathogenic fungi were significantly correlated with clinical outcome (all at P ＜ 0.05).Conclusions In vitro susceptibility testing can guide clinical drug treatment of fungal keratitis.Infiltration area ＞ 16 mm2,hypopyon ＞2 mm,resistance to those drugs in vitro and infection of Fusarium.spp or Aspergillus.spp are predictors of a poor outcome.

Objective: To study the effect of cytochrome P-450 4F2 (CYP4F2, rs2108622) gene polymorphisms in patients with warfarin for initial doses in 7 days.
Methods: A total of 271 patients treated by warfarin were studied. The CYP4F2 gene polymorphisms were assessed by real-time PCR, the average initial warfarin doses in 7 days and the time of international normalized ratio (INR) ifrst arrived to therapeutic range were recorded. The differences of initial warfarin doses and the time of INR ifrst arrived to therapeutic range among CYP4F2 gene polymorphisms of CC, CT and TT genotypes were analyzed by statistical method.
Results: The average initial warfarin doses among CYP4F2 polymorphisms of TT and CT/TT were higher than CC, P<0.05. The times of INR first arrived to therapeutic range in TT genotype was higher than CC genotype, P<0.05. With adjusted gender, age, body height and weight, CYP2C9 and VKORC1 polymorphisms, conditions of disease and medication, the effect of CYP4F2 gene polymorphisms on initial warfarin doses in 7 days were still with the statistic meaning (regression coefifcient=0.21, P=0.003).
Conclusion: CYP4F2 polymorphisms inlfuenced the initial warfarin doses in 7 days in relevant patients.

Objective To observe the effect of Allicin on renal tissue fibrosis in chronic renal failure (CRF) and to study the protective mechanism of Allicin on CRF rats. Methods The CRF rat models were established by intragastric administration of adenine solution (250 mg/kg) for 21 days. After successful modeling, 80 model rats were randomly divided into the normal control group, the model group and the allicin low, medium and high dose groups using a random number table method (n=20). Allicin low-, medium-, and high-dose groups were intragastrically administered with 2.5, 5, and 10 mg/ml of allicin respectively. The model group and normal control group were given an equal volume of normal saline, and were administered at 2 ml/kg body weight of the rats, with once a day continuous administration for 28 d. Two hours after the last dose, the kidney mass was measured and the kidney index was calculated. The pathological changes of renal tissue was observed by HE staining; the serum BUN, SCr, uric acid, and 24-hour urinary protein levels were measured by a biochemical analyzer; the levels of CRP, IL-6 and TNF-α in serum and the levels of ollagen type Ⅳ(CⅣ), type Ⅲ procollagen (PCⅢ), laminin (LN), Fibronectin (FN) in plasma were by ELISA; the expression of collagen type Ⅰ (Col Ⅰ), plasminogen activator inhibitor-1 (PAI-1) and MMP-1 were observed by mmunohistochemical staining. Results Compared with model group, the bodyweight of rats in allicin medium, high dose groups were increased and kidney index decreased (P＜0.05 or P＜0.01), kidney histopathology scores decreased (P＜0.01). Compared with model group, the level of BUN (14.51 ± 2.76 mmol/L, 11.48 ± 2.43 mmol/L vs. 24.07 ± 3.82 mmol/L), SCr (116.28 ± 27.35 μmol/L, 106.57 ± 24.18 μmol/L vs. 134.89 ± 35.02 μmol/L), Uric acid (83.34 ± 16.42 mmol/L, 77.86 ± 13.97 mmol/L vs. 114.76 ± 16.53 mmol/L), 24 h urinary protein (152.79 ± 48.43 mg, 137.03 ± 42.61 mg vs. 177.94 ± 96.47 mg), CRP (8.79 ± 1.84 mg/L, 7.51 ± 1.69 mg/L vs. 11.64 ± 1.95 mg/L), TNF-α (184.37 ± 24.15 ng/L, 126.82 ± 12.96 ng/L vs. 255.87 ± 31.93 ng/L) in the allicin medium and high dose groups were significantly decreased (P＜0.05 or P＜0.01); the levels of C-Ⅳ (40.26 ± 7.12 ng/ml, 23.79 ± 4.25 ng/ml vs. 67.53 ± 8.39 ng/ml), PC-Ⅲ (32.03 ± 5.89 ng/ml, 24.31 ± 5.84 ng/ml vs. 54.20 ± 7.08 ng/ml), LN (99.05 ± 38.17 ng/ml, 83.42 ± 28.83 ng/ml vs. 117.83 ± 35.76 ng/ml) in plasma in the allicin medium and high dose groups were significantly decreased and the level of FN (98.58 ± 21.43 mg/L, 125.96 ± 25.12 mg/L vs. 66.72 ± 13.09 mg/L) in plasma in the allicin medium and high dose groups were significantly increased (P＜0.05 or P＜0.01); the expression of Col Ⅰ (0.17 ± 0.03, 0.09 ± 0.03 vs. 0.27 ± 0.05), PAI-1 (0.20 ± 0.05, 0.16 ± 0.04 vs. 0.31 ± 0.08) were down-regulated and the expression of MMP-1 (0.10 ± 0.03, 0.22 ± 0.05 vs. 0.04 ± 0.02) were up-regulated (P＜0.05 or P＜0.01). Conclusion Allicin has protective effects on CRF rats by inhibiting the renal tissue fibrosis and alleviating inflammation.

Objective:To study effect of rehabilitation training self-efficacy and training compliance of stage nursing intervention Based on the Compliance Curve for hemiplegia patients with Cerebral Infarction.Methods:Totally 116 stroke patients with hemiplegia from July 2017 to June 2018 were Divided into observation groups (January 2018 to June 2018) 60 cases, control group (July 2017 to December 2017) 56 cases. The control group given including health education, psychological intervention, basic nursing, rehabilitation training, complications prevention, follow-up management etc received routine nursing interventions. The observation group combined nursing intervention based on the compliance curve. After 6 months of follow-up, the rehabilitation self-efficacy, rehabilitation training compliance, and rehabilitation effects were compared between two groups.Results:The observation group physical exercise self-efficacy, coping self-efficacy, self-efficacy rehabilitation (SER) in rehabilitation self-efficacy scale was (35.36 ± 4.45), (51.24 ± 6.42), (86.60 ± 9.20) points, which was significantly higher than that control group (30.45 ± 4.56), (42.45 ± 6.34), (72.90 ± 8.45) points, and the difference was statistically significant ( t values were 5.658, 7.145, 8.028, P<0.05 or 0.01) ; The 6-24 week rehabilitation training compliance index curve was a flat line, Physical exercise, exercise effect monitoring, active seeking advice, and rehabilitation training total compliance index were (74.26 ± 8.20), (68.36±7.20), (61.45±7.21), (70.26±8.54) points, which was significantly higher than that of the control group (67.06±7.12), (6.12±7.34), (56.12±6.45), (63.23±7.36) points, and the difference was statistically significant ( t values were 4.845, 5.882, 4.030, 4.556, P<0.05) ; Fugl-Meyer Assessment Scale (FMA), Berg Balance Scale (BBS), Barethl index score were (22.32 ± 4.12), (32.72 ± 5.36), (72.45 ± 8.21) points, which were significantly higher than that in the control group (18.45±3.26), (26.45±4.42), (60.65±7.42) points, and the difference was statistically significant ( t values were 5.370, 6.586, 7.801, P<0.05). Conclusion:Staged nursing intervention based on the compliance curve help to promote the development of rehabilitation self-efficacy, and enhance rehabilitation training compliance behavior, then improve rehabilitation training effect.

Objective:To investigate the changes of podocyte circadian rhythm in the high-glucose environment and diabetic nephropathy (DN) mouse model and the protective effect of melatonin on podocyte injury in DN.Methods:Primary podocytes were cultured in vitro and divided into 3 groups: control group, high glucose (30 mmol/L) group and high glucose (30 mmol/L) treated with melatonin (0.1 mmol/L or 0.5 mmol/L) group. The podocytes were collected every 4 hours for 24 hours, synchronized with dexamethasone (100 nmol/L) for 2 hours, which was recorded as zeitgeber time 0 point. Male C57BL/6J mice aged 6-8 weeks and weighing about 20 g were randomly (randomized block) assigned to three groups: control group, DN (high-fat diet+streptozotocin 120 mg/kg intravenously injected) group, and DN (high-fat diet+streptozotocin 120 mg/kg intravenously) treated with melatonin (20 mg/kg intragastric treatment) group (melatonin group). Real-time quantitative PCR was used to detect the mRNA levels of rhythm genes in podocytes. Western blotting was used to detect the protein expression levels of circadian clock genes (Clock and Bmal1), podocyte marker proteins (Nephrin, Synaptopodin, WT1, and Desmin) and autophagy-related proteins (Beclin1, LC3Ⅱ/Ⅰ and P62). Immunofluorescence staining was used to detect the protein expression level of WT1, and immunohistochemistry was used to analyze the protein expression levels of P62 and cleaved-caspase-3 in renal tissues of mice. The pathological changes of renal glomerulus were observed under electron microscope. Results:(1) Dexamethasone reseted the expression and rhythmic oscillation of circadian clock genes in podocytes. The circadian rhythmic oscillations of Clock and Ck1e mRNA in the high glucose group were flattened compared to the control group, and the circadian rhythmic oscillations in Clock and Ck1e mRNA expression were partial recovery in high glucose treated with melatonin group (all P<0.05). (2) Compared with the control group, the protein expression levels of Nephrin, Synaptopodin and WT1 were lower while Desmin was higher in the high glucose group (all P<0.05). The protein expression levels of Nephrin, Synaptopodin and WT1 were higher and the protein expression level of Desmin was lower in the high glucose treated with melatonin (0.5 mmol/L) group compared with the high glucose group (all P<0.05). (3) The invivo experimental results showed that compared with the DN group, melatonin group had higher protein expression levels of glomerular Nephrin and WT1, and lower urinary albumin/creatinine ratio, width of foot process and thickness of glomerular basement membrane (all P<0.05). The protein expression levels of Beclin1 and LC3Ⅱ/Ⅰ in the DN group were lower than those in the control group, and the protein expression level of P62 was higher than that in the control group (all P<0.05). Compared with the DN group, the protein expression levels of Beclin1 and LC3Ⅱ/Ⅰ in the melatonin group were significantly higher, and the protein expression level of P62 was lower (all P<0.05). Conclusions:Melatonin can partially restore the circadian rhythm of clock genes in high-glucose environment, improve autophagy and alleviate injury in podocytes.