non-skeletal actions,including immunoregulation,anti-tumor effect,and protecting from central nervous system diseases and metabelie syndrome.

The secondary hyperparathyroidism is one of the complications of chronic renal failure (CRF) and end stage renal failure (ESRD), and becomes more serious with the development of the primary disease. Parathyroid hormone (PTH) is considered as one of the biomarks of the development of renal failure. The purpose of this article will expound the physiological effects of the PTH, the causes and clinical significances of PTH rising in CRF and ESRD patients, the determination of PTH level, and the relationships between the increase of PTH and the polymorphism of CYP2D6, GSTT1,GSTM1.

Objective To evaluate the scales of psychological distress and pain in patients with advanced cancer and the impact of pain on the anxiety and depression.Methods Seventy-four patients with advanced cancer were observed.The hospital anxiety and depression(HAD)scale and the brief pain inventory(BPI)were completed either by patients or under the assistance of the investigator.Results HAD-A(anxiety)and HAD-D(depression)scores were(7.68±4.09)and(7.19±3.38),respectively.Significant correlations were found between pain severity and HAD-A or HAD-D(P＜0.001)by univariate correlation analysis.Furthermore,significant associations were shown between HAD-A and six"pain interference in the patients'functional ability"items(P＜0.001),and between HAD-D and pain interference to"mood"or"relations with other people"(P＜0.01).Conclusions Quantitative analysis of psychological distress have shown that patients with advanced cancer are doubtful cases for both anxiety and depression and need psychological management.Anxiety and depression is not only associated with pain intensity directly,but also with pain interference in the patients'functional ability indirectly.

Objective To investigate the clinical efficacy of acupuncture plus Jisheng Shenqi pills in treating patients with diabetic neurogenic bladder. Method Patients with diabetic neurogenic bladder were allocated, using a random number table, to treatment and control groups. The treatment group received acupuncture plus Jisheng Shenqi pills and the control group, oral administration of Western medicine. Both groups of patients were treated for four weeks as a course. Post-treatment clinical total efficacy rates, pre-treatment and post-treatment postvoid residual urine volumes, and adverse reactions during treatment were compared between the two groups. Result The total efficacy rate was higher in the treatment group (93.8%) than in the control group (68.8%) (P<0.05). The postvoid residual urine volume decreased significantly in both groups of patients after treatment compared with before (P<0.05). Post-treatment postvoid residual urine volume was lower in the treatment group than in the control group (P<0.05). The adverse reaction rate was lower in the treatment group than in the control group (P<0.05). Conclusion Acupuncture plus Jisheng Shenqi pills is remarkably effective in treating patients with diabetic neurogenic bladder. It can effectively decrease postvoid residual urine volume in the patients, has higher safety and is worthy of clinical popularization.

Objective To observe the effect of Tanggankang on the expression of CREB in diabetic-fatty liver rats;To investigate the mechanism of Tanggankang. Methods STZ and feeding high fat forage induced diabetic rats were randomly divided into model group, Huganning group, Tanggankang high dose group, Tanggankang medium dose group, Tanggankang low dose group, 10 rats in each group, with 10 normal rats as control. After 12 weeks of drug intervention, rats were killed, the livers were removed, and the expression of CREB was detected by Western blot. Results Compared with normal group, the level of CREB of model group was significantly decreased (P<0.01). Compared with model group, Tanggankang low, medium and high dose group significantly decreased the level of CREB (P<0.01). Conclusion Tanggankang may play an active role in glucose and lipid metabolism by affecting the expression of CREB.

Objective:To observe the effect of Tangshenning on renal function and LOX-1 mRNA expression in the kidney of early diabetic nephropathy rats model. Methods:Early diabetic nephropathy rats model was made with high fat diet, STZ and unilateral ne-phregtomy. After the 12-week drug intervention, the rats were sacrificed, the kidneys were removed and the mRNA expressions of LOX-1 in the kidney were observed by the method of RT-PCR. Results:Early diabetic nephropathy rats model was successfully made by the triple-modeling method. The mRNA expression of LOX-1 in the kidney was significantly increased, and Tangshenning could low-er the expression of LOX-1 in the kidney in a dose-dependent manner. Conclusion:The abnormal expression of LOX-1 could be one of the mechanisms for diabetic nephropathy. Tangshening has good kidney protective effect through decreasing LOX-1 abnormal expression in the kidneys, which deserves further research.

Objective To study the relevance between blood loss, widespread brain contusion injury and consumptive coagulopathy. Methods One hundred and fifty-three cases with severe brain injury was studied about their coagulation data. Analyzed the relationship between blood loss group according to ≥3000 ml and ＜ 3000 ml and coagulation features, the relationship between widespread brain contusion injury and disorder of coagulation;according to whether with brain contusion injury,kinds of bloods transplant and prognosis were asseseed;according to whether with widespread brain contusion injury in ≥ 3000 ml blood loss group,kinds of bloods transplant and prognosis were assessed. Results Compared with ＜ 3000 ml blood loss patients, ≥ 3000 ml patients' blood coagulation changed obviously, with PT prolonging, Fbg and Plt decreasing, the differences were statistically significant (P ＜ 0.05). Compared with no extensive brain contusion injury patients, in extensive brain contusion injury patients, APTT, PT, TT prolonged, Fbg and Plt decreased,and the difference was statistically significant (P ＜0.05). Extensive brain contusion injury patients with blood loss compared with those without such loss, needed more blood transfusion volume,larger amount of input of fresh frozen plasma Plt volume,the former survival rate was lower [68.29%(28/41)vs. 96.43%(108/112)], the difference between them was statistically significant (P＜ 0.05 ). In 41 patients who had brain widespread contusion ,the cases with extensive blood loss ( ≥ 3000 ml) were compared with those ＜ 3000 ml, and the differences in blood transfusion treatment, fresh frozen plasma, Plt volume,survival rate were statistically significant (P ＜ 0.05). Conclusion When blood loss ≥ 3000 ml after trauma,patients show various degrees of coagulopathy,and when accompanied with extensive brain tissue injury,coagulation disorders are more obvious, and the prognosis is even worse.

Objectives To investigate the surgical technique and some other related problems of simultaneous heptorenal transplantation. Methods Combined liver-kidney transplantation was performed in one patient with huge polycystic liver, bilateral kidney, and another with liver cirrhosis after hepatitis B complicated with hepatic carcinoma and uremia due to chronic nephritis. Donors' organs were infused in situ with UW solution and rapidly harvested. Orthctopic or piggyback liver tranlsplantation was carried out and the kidney was transplanted with conventional method respectively. The patients received an immunosuppression therapy including simulect (CD25 antibody), FK506 or CsA, Mycophenolate mofitil (MMF), and Predinision. Results Both transplanted organs rapidly functioned well after the operation. One patient recovered well but suffered from ALI (acute lung injury) on the 2nd postoperative day and ARDS on the 11th postoporative day. There were no acute rejection or recurrence of the primary diseases in both cases. Conclusions Simultaneous hepatorenal transplantation is one of the treatment methods for end stage liver and kidney diseases. Skillful operative technique, comprehensive perioperative monitoring and appropriate management are all important factors for obtaining a successful result. It requires more shillful techniques than single organ transplantation.

Objective To observe the changes in Bcl-2 protein expression in rat kidney tissue after severe burn with delayed fluid resuscitation in areas of different altitude,and explore the relationship between its expression and cell apoptosis.Methods The experiments were performed at two altitudes(1 517m and 3 848m).A 30% TBSA Ⅲ? scald model was reproduced with 240 male Wistar rats(120 rats for each altitude).Rats were randomly assigned into delayed fluid resuscitation group(DFR,n=50),immediate fluid resuscitation group(IFR,n=60) and normal control group(NC,n=10).Renal tissue samples were harvested at 1,6,12,24,72 and 168 hours after scald,respectively.The cell apoptosis was detected by tissue chips technic and terminal uridin nick end labeling(TUNEL).The expression of Bcl-2 was detected by immunohistochemistry and image analysis.Results In higher altitude,cellular edema,granular degeneration,necrosis and disintegration of renal tubular epithelial cells;dilation and engorgement of renal glomerular capillaries,degeneration and necrosis of endothelial cells,and congestion,edema and inflammatory cell infiltration in renal interstitium were found.The pathological changes were more serious in DFR group than that in IFR group,and they were worse in the rats at 3 848m altitude than that in those rats at 1 517m altitude.The levels of cell apoptosis and Bcl-2 protein expression were higher in DFR group than that in IFR group,and in the rats at 3 848m altitude than that in those rats at 1 517m altitude(P

In this paper, the needs of community care for diabetic patients were studied, and the existing problems were summarized and analyzed. "Four drawbacks" on community care were pointed out, namely, lack of knowledge, insufficient service resources, deficiency of professional nursing staff, and inadequate management. There were also "four lacks" on diabetic patients, namely, lack of confidence, lack of attention, lack of knowledge and lack of compliance. Seven measures of community health care for diabetic patients were pointed out in this paper, which were to enhance the quality of personnel, to strengthen health education, to emphasize on psychological counseling, to enhance behavioral modification, to carry out medical consulting, and to implement the specific medical care and comprehensive intervention.