BACKGROUND: Chitosan/poly (3-hydroxybutyrate) (PHB) copolymer has been paid close attention for special biological source of Chitosan and PHB. However, there has been no proper method for them to polymerize effectively.OBJECTIVE: To prepare chitosan/PHB graft copolymer in a homogeneous medium, using a gentle initiator.DESIGN, TIME and SETTING: This study, a single-sample experiment, was performed at the Research Center of Chemistry, Xi'an University of Architecture and Technology, Xi'an, Shaanxi Province, China from August 2007 to October 2007.MATERIALS: Chitosan: DD=100%, Mη=123000, Kyoto, Japan. PHB was purchased from Aldrich chemicals and the molecular weight was 10000.METHODS: Chitosan was grafted with poly (3-hydroxybutyrate) (PHB) in acetic acid/dimethyl sulfoxide system, and benzoyl peroxide (BPO) was used as initiator. The reaction temperature was 85℃ and the reaction continued for 5 hours with nitrogen protection. Grafting reaction and the chemical structure of the copolymer were confirmed by infrared analysis, NMR and elemental analysis. The crystal form and thermal stability of copolymer were characterized with wide-angel X-ray diffraction (WAXD) and thermogravimetric/differential thermal analysis balance, respectively.MAIN OUTCOME MEASURES: The chemical structure of copolymer, crystal form as well as thermal stability.RESULTS: Grafting reaction was confirmed by infrared analysis, NMR and elemental analysis. Wide angle X-ray diffraction and thermogravimetric analysis indicated that graft copolymer was different from chitosan and PHB in crystalline morphology, and had a good thermal stability.CONCLUSION: Using BPO as initiator, chitosan/PHB grafting copolymer is prepared and it has a steady property.

Objective To evaluate the relationship between serum albumin(Alb) level and short-term prognosis in patients with acute cerebral stroke.Methods The serum Alb level was examined at admission and once in two weeks during hospitalization in 242 patients with acute cerebral stroke.The mortality,incidence of complication and rate of disease improvement were compared between lower serum Alb level group (Alb

Objective:To investigate the effect of intensive hypoglycemic therapy on the frequency of recurrent periodontitis in the patients with type 2 diabetes mellitus. Methods: Totally 40 patients with type 2 diabetes mellitus and recurrent periodontal disease were randomly divided into group A and group B. Group A was treated with the periodontal basic therapy combined with the convention-al hypoglycemic therapy. Group B was treated with the periodontal basic therapy combined with the intensive hypoglycemic therapy. Af-ter 6-month treatment,the change of the probing depth of the periodontal pocket, sulcus bleeding index, incidence frequency, recovery course, body mass index, fasting blood glucose, glycosylated hemoglobin and serum C-reactive protein levels were measured before and after treatment. Results:After the treatment, the indices were improved in group A except body mass index and fasting blood glucose (P<0. 05), and in group B, the indices were improved except body mass index (P<0. 05), and the probing depth of the periodontal pocket, sulcus bleeding index, incidence frequency, body mass index, serum C-reactive protein levels, glycosylated hemoglobin and fasting blood glucose of the patients in group B were all better than those in group A (P<0. 05). Conclusion:Periodontal basic thera-py combined with intensive hypoglycemic therapy can effectively improve the periodontal health of diabetic patients, shorten the recov-ery treatment of periodontal disease, reduce the incidence frequency, and reduce blood glucose as well.

Purpose To evaluate renal function recovery state with color Doppler ultrasound before and after ultrasonic pneumatic ballistic lithotripsy under percutaneous nephrolithotomy. Materials and Methods 79 patients with 81 kidneys with upper urinary tract stones underwent ultrasonic pneumatic ballistic lithotripsy under percutaneous nephrolithotomy, renal parenchymal thickness, renal collecting system separation degree and renal arterial resistance index (RI) were measured with color Doppler ultrasound before and after the operation, subjects were divided into renal dysfunction group (both preoperative and postoperative GFR <20 ml/min, the difference <20 ml/min), renal function significantly improved group (postoperative GFR greater than preoperative, the difference>20 ml/min), renal function significantly impaired group (postoperative GFR less than preoperative GFR, the difference>20 ml/min) and no significant improvement group (both preoperative and postoperative GFR were >20 ml/min, the difference <20 ml/min) according to the preoperative and postoperative glomerular filtration rate (GFR) difference. Renal parenchymal thickness, renal collecting system separation degree and renal artery RI of each group were compared, and their correlation with GFR was analyzed. Results Statistically significant differences (F=129.750, 110.953, 45.411, 18.530, 18.904, 12.565, 27.291, 24.263; P<0.05) were detected in all the four groups between preoperative and postoperative renal parenchymal thickness, renal collecting system separation degree, interlobar renal artery (IRA) and main renal artery (MRA) RI. There was a significant positive correlation (r=0.916, P<0.05) between renal parenchymal thickness and pre-and post-lithotripsy GFR, and a significant negative correlation (r=-0.886,-0.903,-0.923;P<0.05) between renal collecting system separation degree, IRA and MRA RI with pre-and post-lithotripsy GFR. The sensitivity and specificity were 93.4%and 97.3%, respectively when taking renal parenchymal thickness<0.32 cm, renal collecting system separation degree >4.27 cm, IRA RI and MRA RI>0.8 as diagnostic standard for kidney dysfunction; and the sensitivity and specificity were 87.4% and 85.7%respectively when taking IRA RI<0.72 as diagnostic standard for renal function improvement. Conclusion Renal parenchymal thickness <0.32 cm, renal collecting system separation degree >4.27 cm, IRA and MRA RI >0.8, and IRA RI <0.72 can be regarded as clinical reference standard for renal function prognosis of kidney dysfunction and hypo-functional before conducting ultrasonic pneumatic ballistic lithotripsy under percutaneous nephrolithotomy.

BACKGROUND:Studies have confirmed that the nano-hydroxyapatite/chitosan/alginate composite materials have a certain flexibility and strength and possess a bioactivity similar to human bone.
OBJECTIVE:To explore the effect of the nano-hydroxyapatite/chitosan/alginate composite materials on the repair of rabbit mandible defects.
METHODS:Bilateral mandibular defect models of 10 mm × 5 mm × 5 mm were made in 18 healthy New Zealand white rabbits. Then, the rabbits were divided into two groups:experimental group was implanted with nano-hydroxyapatite/chitosan/alginate composite material, and control group was implanted with hydroxyapatite/chitosan composite. At 4, 8 and 12 weeks after implantation, cone-beam CT was applied to observe implant degradation, cal us growth and bone connection in the defect area;new bone formation was observed by hematoxylin-eosin staining.
RESULTS AND CONCLUSION:The gray values of the bone density in the experimental group and control group gradual y increased with time, and there were remarkably significant differences between the two groups at different time points (P<0.01). At the same time point, the experimental group was superior to the control group in gross observation, cone-beam CT observation, gray value of CT and histological observation (P<0.05). At 4-8 weeks after implantation, the implant materials in the two groups were gradual y degraded with a blurred junction between the defect and bone tissue, and a smal amount of new bone formed tightly integrated to the recipient bone tissue, in which the experimental group was more significant. And during 8 to 12 weeks, the degradation of implanted materials in the two groups was basical y complete, and the implant began to merge with the recipient bone tissue, with further generation of new bone tissue and gradual repair of bone defect area, in which, the experimental group was more obvious. Results show that the nano-hydroxyapatite/chitosan/alginate can repair bone defects effectively, and promote the new bone formation.

Objective To explore the method to relieve fingertip pain in monitoring fingertip blood glucose.Methods A total of 130 newly admitted patients with type 2 diabetes received glucose monitoring 6 times daily at different time points.Blood sampling was taken from different sites including the central and top of middle finger pulp,central and side of ring finger pulp,top of middle finger with pressing the acupoint of Hegu at the same time or pressing acupoint of Hegu for 1 minute before blood taking.Pain degree was assessed by numeric rating scale after blood glucose taking.Pain scores were compared among the different methods.Results There were significant differences in pain scores between different methods (x2 =164.83,P＜0.05).Pain score was higher in sampling blood on the side of ring finger pulp,while the proportion of subjects with mild pain after pressing Hegu was increased significantly.There were significant differences in pain scores between subjects with versus without pressing Hegu (all P＜0.05).Pain degree was reduced more significantly by pressing Hegu for 1 minute before blood taking than pressing Hegu at the same time of sampling blood,and the former had a higher proportion of subjects with only mild pain than the latter (x2 =10.44,P＜0.01).There were no significant differences in pain scores between the other methods (all P＞ 0.05).Conclusions Pressing Hegu can effectively reduce fingertip pain in fingertip blood glucose monitoring,and pressing Hegu for 1 minute before blood taking is more effective.

Objective To study the prognostic value of procalcitonin(PCT) and C?reactive protein ( CRP ) in critically ill patients with ventilator?associated pneumonia ( VAP )?Methods A single?center prospective observational study was conducted?A total of 67 cases patients with VAP admitted into intensive care unit(ICU) from November 2013 to October 2015 were enrolled and grouped as survivors(43 cases) and non?survivors(24 cases)?Blood samples for PCT and CRP were collected on the day of the pneumonia diagnosis,and the 4th and 8th day after the diagnosis?Results There were 24 cases(35?8 %) died among the 28 days after the pneumonia diagnosis?There was no significant difference between the survivor and non?survivor groups in terms of PCT on the day of the pneumonia diagnosis( P>0?05) ,or CRP on the day of the pneumonia diagnosis, and the 4th and 8th day after the diagnosis ( P>0?05)?But the PCT values on the 4th and 8th day were significantly higher in the non?survivor group than the survivor group(4 d:0?4(0?3,1?1) μg/L vs?4?7(2?3, 10?8) μg/L,P<0?05;8 d:0?2(0?1,1?7) μg/L vs?3?9(3?2,14?8) μg/L,P<0?05)?PCT levels decreased significantly from the day of the pneumonia diagnosis(0?7(0?4,4?2) μg/L) to the 8th day after the diagnosis (0?2(0?1,1?7) μg/L,P<0?05) in the survivor group?The PCT level above 1 μg/L on the 4th day after the diagnosis was the strongest predictor of mortality,with an odds ratio of 23?Conclusion PCT is found to be a more important prognostic marker compared to CRP in terms of predicting mortality in critically ill patients with VAP?The PCT level on the 4th day after the diagnosis is the strongest predictor of mortality in VAP.

Objective:To investigate the association of Subclinical Carotid AtheroSclerosis (SCAS) and prediabetes or Diabetes Mellitus (DM)in the healthy people.Methods:From September 2018 to June 2019, participants who underwent physical examination in the Health Management Center of Beijing Tiantan Hospitial were enrolled consecutively. The baseline characters were collected prospectively. Carotid Ultrasound was evaluated by radiologists according to the standard operating protocol. Univariable analysis and multivariable logistic analysis were used to estimate the association of prediabetes or DM with SCAS.Results:Totally 401 participants were eligible and enrolled. The mean age was (52.2±10.4) years and 43.7% (252/401) of them were females. The prevalence of DM and SCAS were 16.4% (66/401) and 48.9% (196/401) respectively. In the univariate analysis, elder age (≥60 years old) ( OR=5.93, 95% CI: 3.86-9.09, P<0.001), hypertension ( OR=2.76, 95% CI: 1.84-4.15, P<0.01), prediabetes( OR=1.67, 95% CI: 1.08-2.58, P<0.05) and DM ( OR=3.60, 95% CI: 1.97-6.58, P<0.01), cigarettes smoking ( OR=2.64, 95% CI: 1.82-3.81, P<0.001), lower HDLlevel<1.04 mmol/L ( OR=1.58, 95% CI: 1.04-2.42, P<0.001) and hyperhomocysteinemia (≥15 μmol/L)( OR=1.69, 95% CI: 1.17-4.04, P<0.01) were associated with higher prevalence of SCAS. On the contrary, female sex ( OR=0.53, 95% CI: 0.39-0.74, P<0.001) was associated with lower prevalence of SCAS. In the multivariable logistic analysis, elder age(≥60 years old) ( OR=6.04, 95% CI: 3.13-11.7, P<0.01), hypertension ( OR=2.14, 95% CI: 1.13-3.87, P<0.05), cigarettes smoking ( OR=2.19, 95% CI: 1.21-3.98, P<0.05) and DM ( OR=2.32, 95% CI: 1.16-4.67, P<0.05) were associated with SCAS independently. The association between prediabetes and SCAS was not statistically significant. Conclusions:DM is independently associated with SCAS in neurological healthy people, while prediabetes tended to increase the risk of SCAS.

Objective To study cost-effectiveness of primary cerebral infarction patients. Methods The neural function of primary cerebral infarction patients was studied by the National Institutes of Health Stroke Scale (NIHSS) with rank test and multiple regression analysis. Results After treatment in hospitals of different grades, no obvious difference was detected in the NIHSS score, but difference was found in therapy cost and therapy time; the NIHSS score and therapy time of primary cerebral infarction patients in different attack positions were obviously different, but therapy cost had no significant statistical difference. The NIHSS score of primary cerebral infarction patients with different treatments was obviously different, but therapy cost and therapy time was not. Conclusions Patients are advised to choose grade hospitals in nearby cities for treatment. Clinician are expected to choose low-cost treatment plan to relieve patients' economic burden.

Objective To investigate the feasibility,safety and clinical efficacy of three-port laparoscopic sleeve gastrectomy (TLSG).Methods The retrospective cross-sectional study was conducted.The clinical data of 104 obese patients who were admitted to the Beijing Friendship Hospital of Capital Medical University between September 2016 and March 2017 were collected.TLSG was performed to all the 104 patients by the same surgical team.The surgical situations,conversion situations (port-site increased or conversion to open surgery),operation time,volume of intraoperative blood loss,surgery-related complications,duration of postoperative hospital stay and follow-up situations were observed.Patients were followed up by Wechat,telephone interview and inpatient examination once at month 3,6,9 and 12 postoperatively and once every year after 1 year postoperatively up to April 2017.Follow-up included weight-loss efficacy and postoperative long-term complications.Measurement data with normal distribution were represented as x±s or average (range).Results All the 104 patients underwent successful TLSG,without port-site increased or conversion to open surgery.Operation time and volume of intraoperative blood loss were (121±25)minutes and (9±6)mL,respectively.There was no severe intraoperative collateral damage.All the 104 patients with complications were cured by symptomatic treatment,including 1 with port-site infection,1 with peritoneal effusions causing secondary infection,3 with improper eating-induced acute delayed gastric emptying,6 with fat liquefaction around port-site and 9 with delay healing of port-site.There was no occurrence of severe complications,such as gastrointestinal bleeding,intra-abdominal bleeding and gastrostoma.Duration of postoperative hospital stay was (2.4±0.8)days.Eighty-two patients were followed up for 3 months (range,3-6 months),including 59 with 3-month follow-up,23 with 6-month follow-up and 22 with under 3-month follow-up.During the follow-up,there was no port-site hernia.Excess weight loss (EWL) was 37％± 11％ in 59 patients with 3-month follow-up and 45％± 13％ in 23 patients with 6-month follow-up.Of 59 patients with 3-month follow-up,14 patients with diabetes mellitus stopped taking antidiabetic drugs,10 of 14 patients had complete remission (CR) of hemoglobin Alc (HbAlc) and 4 of 14 patients had partial remission (PR) of HbAlc.Of 23 patients with 6-month follow-up,6 patients with diabetes mellitus had CR of HbAlc.Of 18 patients with obstructive sleep apnea hypopnea syndrome (OSAHS),4 had 3-month follow-up,including 3 with CR and 1 was improved to mild OSAHS.Other 14 patients were not evaluated due to inadequate follow-up time.Conclusion TLSG for obese patients with specific indications cannot increase operation time and risk,meanwhile,it can reduce port-site,with a good cosmetic effect.