Objective To investigate the risk factors of albuminuria in type 2 diabetes nephropathy patients. Methods 870 hospitalized patients with type 2 diabetes mellitus were included in the study. The patients were divided into normal buminuria group (n = 634) and persistent albuminuria group (n = 236) according to the 24h urinary albumin excretion. Diabetic chronic complication and related biochemical indicators were analyzed. Independent risk factors associated with diabetic nephropathy were analyzed. Results The differences in duration of diabetes, age, SBP, DBP, Hb, HbA1C, UA, TG, CHOL-C, HDL-C, diabetic retinopathy (DR), cardiovascular and cerebrovascular disease were statistically significant between two groups (P < 0.01). Regression analysis showed that independent risk factors of albuminuria of DN included duration of diabetes, SBP, Hb, UA, TG and DR. Conclusions Such risk factors of duration of diabetes, SBP, UA, TG, Hb and DR may be associated with the occurrence and severity of albuminuria of DN.

Objective To investigate the possible association between vascular endothelial growth factor (VEGF), endostatin (ES) and type 2 diabetic nephropathy. Methods The level of serum VEGF and ES were measured by ELISA in eighty type 2 diabetic patients including thirty subjects without diabetic nephropathy , twenty with microalbuminuria and thirty with macroalbuminuria, and the correlation was analyzed. Results The level of serum VEGF and ES in patients with macroalbuminuria were both significantly higher than that of patients with and without microalbuminuria (P < 0.05). The level of serum VEGF and ES in patients with microalbuminuria were significantly higher than that of patients without diabetic nephropathy (P<0.05). Both VEGF and ES level were positively correlated with the level of microalbuminuria (mAlb) (r=0.226, P<0.01; r=0.491, P<0.01), and negatively correlated with the level of estimated glomerular filtration rate (eGFR) (r=-0.237, P<0.05;r=-0.620, P<0.01). There was a significantly positive correlation between VEGF and ES in patients with microalbuminuria and macroalbuminuria (r1=0.633, P1<0.01; r2=0.532, P2<0.05). However, there was no correlation between VEGF and ES in patients without diabetic nephropathy (r3=0.175, P3>0.05). Conclusion The levels of VEGF and ES in type 2 diabetic nephropathy had varying degree of increasing in different diabetic nephropathy stage , and closely related to mAlb and eGFR. Disequilibrium of VEGF and ES may speed up the progression of diabetic nephropathy.

Objective To explore the effects of beraprost sodium (BPS) on angiotensin Ⅱ(AngⅡ)-induced podocyte apoptosis and the relationship between BPS and peroxisome proliferator activated receptor δ(PPARδ). Methods Differentiated mouse podocytes were exposed to AngⅡ, further treated with BPS (or GSK0660) for 24 h. Podocyte apoptosis was detected by flow cytometry and AnnexinV-FITC staining. Bax , Bcl-2 and PPARδ mRNA were assessed by RT-PCR. Results AngⅡ promoted podocyte apoptosis and Bax mRNA expression significantly, down-regulated Bcl-2 and inhibited PPARδ mRNA (P < 0.05). Conversely, treatment with BPS reduced AngⅡ-induced podocyte apoptosis and Bax mRNA expression and promoted Bcl-s expression significantly resulting in an increase of PPARδ mRNA expression (P < 0.05). With the inhibition of PPARδ, podocyte apoptosis and Bax mRNA expression increased while Bcl-2 mRNA expression reduced. Conclusion BPS can effectively reduce AngⅡ-induced podocyte apoptosis , which is associated with the activation of PPARδand regulation of Bcl-2/Bax mRNA expression.

Objective: To evaluate the feasibility,the safety and the effect of early postoperative enteral nutrition in patients with esophageal cancer.Methods: On the first postoperative day,40 patients were randomly divided into two groups.One group was given isocaloric total parenteral nutrition through central vein(TPN group) and the other group was fed with enteral nutrition through nasoenteric tubes or jejunostomy tubes which were inserted during the operation(EEN group).All variables were measured before operation and on postoperative day 1 and 8.Blood was drawn at different time points to assess albumin,prealbumin and transferrin.Immune response was determined by immunoglobins,total lymphocytes,T-lymphocyte subsets and NK cells. Inflammatory response were determined by C-reactive protein,IL-6 and TNF-?.Morbidity,mortality and length of hospital stay were also evaluated. Results: Tolerance of enteral nutrition was excellent.Neither mortality nor serious morbidity occurred in all patients during the period of study.After the study,the levels of serum prealbumin,total lymphocytes,CD3,CD4 and CD4/CD8 ratio in the EEN group were significantly higher than the levels in the TPN group.The concentrations of IL-6 and the length of hospital stay in the EEN group were significantly lower than in the TPN group.Conclusion: Early postoperative enteral nutrition in patients with esophageal cancer is safe,and also has the benefit effects of enhancing the body status of nutrition and immune function,and reducing the inflammatory response and the length of hospital stay.

Objective:To analyze the clinical features, treatment and prognosis of asymptomatic patients with retinoblastoma.Methods:A retrospective series of case study. Eight asymptomatic patients (11 eyes) with the diagnosis of retinoblastoma by screening enrolled in Department of Ophthalmology of The Eye-ENT Hospital of Fudan University from January 2006 to March 2019 were included. There were 6 males and 3 females ranging from 2 days to 20 months, with a median age of 6 months. Five patients were unilateral retinoblastoma while 3 patients were bilateral. Based on the International Classification of Intraocular Retinoblastoma, 4 eyes were stage A, 3 eyes were stage B and 4 eyes were stage C. One patient had family history. Four patients were evaluated the Rb1 mutation. Routine ophthalmic examinations and ultra-wide field fundus imaging were performed on the 16 parents and 3 siblings of the 8 patients. Systemic intravenous chemotherapy was performed using the Carboplatin, Vincristine, Etoposide protocol, intra-arterial chemotherapy using Carboplatin and Melphalan, and local treatment involved cryotherapy and transpupillary thermotherapy. The mean follow-up time is 47.25 months.Results:None of the 8 children had any ocular symptoms. Six patients received intravenous chemotherapy (5-6 times), 1 patient received intra-arterial chemotherapy (3 times), and 1 patient just received local treatment. Among the 11 eyes, 9 eyes were treated with local cryotherapy and 8 eyes were treated with transpupillary thermotherapy. During the follow-up period, 2 patients had new tumor, and the average time was 6.3 months after the last chemotherapy. At the last follow-up, the tumor disappeared in 11 eyes, remained stable in 11 eyes. The eye protection rate was 100% (8/8) for patients without eyeball excision. The best corrected visual acuity was 0.1 for 3 eyes and 1.0 for 5 eyes. Three eyes were not found. One heterozygous mutation of Rb1 gene [1c.35_69del (p.T12fs)] was identified in 1 patient, and the other 3 patients were not detected. One had bilateral bulbar tuberculosis of the 16 parents, 1 had bilateral RB of the 3 siblings. They were the mother and brother of a child with bilateral RB.Conclusions:Fundus screening is helpful for the detection of early RB. The eye protection rate is high and the long-term vision prognosis is good after systemic or topical chemical drugs (IVC, IAC) and ocular topical treatment (cryopreservation and transpupillary thermotherapy).

The technique of liquisolid compress is a new technique developed in 1990s, which was considered to be the most promising technique to improve the dissolution of water-insoluble drugs. In this article, tanshinone II(A) and the extracts of the ester-solubility fractions were chosen as the model drugs to evaluate the effects of the liquisolid technique for enhancement of dissolution properties of tanshinone II(A). Several liquisolid tablets (LS) formulations containing different dosage of drugs and various liquid vehicle were pre-pared and for all the formulations, microcrystalline cellulose and silica were chosen as the carrier and coating materials to evaluate their flow properties, such as angle of repose, Carr's compressibility index and Hausner's ratio. The interaction between drug and excipients in prepared LS compacts were studied by differential scanning calorimetry(DSC) and X-ray powder diffraction (XRPD). The dissolution curves of tanshinone II(A) from liquisolid compacts were investigated to determine the technique's effect in improving the dissolution of tanshinone II(A) and its impacting factors. According to the results, the dissolution increased with the rise in the dissolution of the liquid-phase solvent. The R-value and drug dosage can significantly affect the drug release, but with less impact on active fractions. This indicated that liquisolid technique is a promising alternative for improvement of dissolution property of water-soluble drugs, and can make a synergistic effect with other ester-soluble constituents and bettern improve the release of tanshinone II(A). Therefore, the technique of liquisolid compress will have a better development prospect in traditional Chinese medicines.
Calorimetry, Differential Scanning ; Diterpenes, Abietane ; chemistry ; Solubility ; X-Ray Diffraction

Objective To apply 3C3R model in problem design of PBL for pediatrics teaching.Methods The 3C3R model comprises two classes of components:core components and processing components.Core components of the model are 3C,which are content,context and connection while processing components are 3R,which are researching,reasoning and reflecting.3C3R model was used in the problem design for the PBL case of ‘ Why the mouth of Baobao became purple when he was crying?' Totally 76 eight-year program medical students and 7 tutors were enrolled as teaching object.The anonymous questionnaires from the students were collected for assessment of PBL teaching.Results The percentage of students with scores ≥4 for content in PLB problem design was 90.8％,for context was 80.3％,for connection was 64.5％,for researching was 81.6％,for reasoning was 69.7％ and for reflecting was 40.8％.The percentage of tutors with scores ≥4 for content in PLB problem design was 100％,for context was 71.4％,for connection was 28.6％,for researching was 71.4％,for reasoning was100％,for reflecting was57.1％.Both students and tutors held a positive attitude towards the component of content,context,researching and reasoning in problem design model.But the components of connection and reflection needed to be improved.Conclusion The 3C3R model is helpful for problem design of PBL in pediatric teaching.

Objective To compare the RIFLE and AKIN diagnosis criteria for acute kidney injury ( AKI) in patients undergoing cardiac surgery. Methods Patients undergoing cardiac surgery from January 2004 to June 2007 were retrospectively evaluated. RIFLE and AKIN criteria were employed for the diagnosis and staging of AKI which occurred 7 d after cardiac surgery. The diagnosis sensitivity and precision for prediction of hospital mortality were compared between these two criteria. Results One thousand and fifty-six patients were included in this study. There was no significant difference between the prevalence of AKI after cardiac surgery diagnosed by RIFLE criteria and that diagnosed by AKIN criteria (29.55% vs 31.06%, P>0.05). There was no significant difference between the total hospital mortality and the hospital mortality of each stage of AKI diagnosed by RIFLE criteria and those diagnosed by AKIN criteria ( P > 0. 05). Logistic regression analysis suggested that the relative risk of hospital mortality for AKI was similar between patients diagnosed by AKIN criteria and those diagnosed by RIFLE criteria. The area under the ROC curve for hospital mortality was 0. 856 for RIFLE and 0.865 for AKIN in all patients (P<0.001). Conclusion Compared to RIFLE criteria, AKIN criteria do not improve the sensitivity of diagnosis and predictive ability of hospital mortality of AKI after cardiac surgery.

Objective To investigate the incidence, risk factors and outcome of acute kidney injury (AKI) following cardiac surgeries. Methods Clinical data of 1056 patients undergoing open heart surgery in Renji Hospital from January 2004 to June 2007 were retrospectively analyzed. Univariate and multivariate analyses were used to evaluate possible pre-,intra-, and post-operative parameters associated with AKI according to AKI Network (AKIN). Results Of the 1056 patients, 328 (31.06%) developed AKI. In-hospital mortality was 4.07% in all discharges while 11.59% in AKI patients (P<0.01). Multivariate logistic regression analysis revealed that increased age (OR=1.40), pre-operative hyperurieemia (OR=1.97), pre-operative left ventricular insufficiency (OR=2.53), combined surgery (OR=2.79), prolonged operation time (OR=1.43), post-operative circulation volume insufficiency (OR=11.08) were risk factors of AKI. Conclusions AKI is a common complication and associated with increased mortality following cardiac surgery. Increased age, pre-operative hyperuricemia, pre-operative left ventricular insufficiency, combined surgery, prolonged operation time, post-operative circulation volume insufficiency are useful in stratifying risk factors for the development of AKI.

We have evaluated the plague epidemic situation in the Three Rivers Source Region,Qinghai Province in recent 20 years to provide the basis for revising the plague prevention countermeasures.We have analyzed the time distribution and the plague epidemic situation between animals and human beings during twenty years in the Three Rivers Source Region,Qinghai Province by describing epidemiology.The animal plague in the natural source of Marmot plague was extremely serious in the Three Rivers Source Region during the past 20 years.It mainly distributes in Yushu State and Tanggula County,Germu City and the serious season ran through the whole period of marmot camp ground activities and the peak was between June and August.Human plague epidemic took place between May and October each year and reached its peak between July and September.The peak covered about 41.67％ at most.It mainly endemic distributes in Nangqian and Xinghai Country.During the past 20 years,we have totally found 14 human plague epidemics in the Three Rivers Source Region,among which 48 cases took place and there were deaths of 17 cases.The fatality rate was 35.42％.The lung type was the majority among 48 cases,which startde with the glandular type.During the past 20 years the plague epidemic has been active and the animal plague epidemic broke out continuously in the Three Rivers Source Region,Qinghai Province.The variety of animals and insects infected the plague epidemic was increasing.The human plague epidemics is most serious with high fatality rate,but it is on the decline as a whole.