Objective To explore the early screening of f type 2 diabetes in communities.Methods 1058 residents were selected during community health service for health examination and the health documents were established .he type 2 diabetes pa-tients were screened.According to the risk factors for type 2 diabetes, the screening was done to find out the suspicious patients and high risk individuals, whom received selective intervention.The health records of 982 community residents before the intervention were used for comparisons.The difference inthe indicators such as awareness rate, treatment rate, disability rate and mortality rate of diabetes patients before intervention were compared with those after intervention .Results 76 cases of type 2 diabetes without symp-toms were screened out after intervention and 81 cases before intervention.The awareness rate and treatment rate after intervention were 96.05% and90.79%, significantly higher than 74.07% and67.90%.After treatment, the disability rate was 6.58%, signifi-cantly lower than 19.75%before intervention (p<0.05).Conclusion The model such as“screening-intervention-follow-up-treatment” is the key strategy for three-level prevention of diabetes .It has the important social value to curb the prevalence of diabe-tes, reduce the burden on families or society and improve the quality of life of patients .

ObjectiveTo evaluate the feasibility of using dexmedetomidine (Dex) as supplement to stellate ganglion block (SGB) in the treatment of trigcminal post-herpetic neuralgia in elderly patients.MethodsForty-five ASA Ⅱ patients with trigeminal post-herpetic neuralgia aged 65-85 yr weighing 45-85 kg undergoing stellate ganglion block were randomly divided into 3 groups ( n =15 each): group SGB; group Dex 0.4 and 0.6 μg/kg +SGB (groups DS1 and DS2).SGB was performed on the affected side with 0.5％ ropivacaine 8-10 ml.Dex 0.4 and 0.6 μg/kg in normal saline were infused iv over 15 min before SGB in groups DS1 and DS2 respectively.The onset time and duration of block were recorded.Bradycardia,hypotension and respiratory depression were also recorded.The intensity of pain was assessed with VAS scores (0=no pain,10 =worst pain) before and at 1,2,4,8 weeks after SGB.VAS score ≤3 was defined as satisfactory analgesia.The rate of satisfactory analgesia was calculated.ResultsThere was no significant difference in the incidence of bradycardia,hypotension and respiratory depression among the 3 groups.The duration of block was significantly longer and the rate of satisfactory analgesia at 2,4,8 weeks after SGB was significantly higher in groups DS1 and DS2 than in group SGB.There was no significant difference in the onset time,duration of block and the rate of satisfactory analgesia between groups DS1 and DS2.ConclusionSGB with Dex has better therapeutic effect than SGB in elderly patients with trigeminal post-herpetic neuralgia.

Sixty gynecological patients undergoing laparoscopic surgery during October 2010 to June 2011were randomly divided into 2 groups:laryngeal mask airway proseal ( PLMA group,n =30 ) and laryngeal mask airway classic (CLMA group,n =30).Laryngeal mask was inserted after induction.The heart rate (HR),mean arterial pressure (MAP),airway sealing pressure,the average time of placement,the pulmonary satisfaction and complications were recorded.There was no significant difference in heart rate and MAP between the two groups(P＞0.05).The airway sealing pressure [ (26 ±6) cm H2O ( 1cm H2O =0.098 kPa) vs.(16±5) cm H2O],the average time of placement [(36±5) vs.(24±6) s)] and the excellent lung ventilation(90％ vs.73％ ) in the PLMA group were more significantly increased than those in the CLMA group(P ＜0.05).PLMA can assure good airway sealing and is more suitable for gynecological patients undergoing laparoscopic surgery.

Objective:To investigate the relationship between T/N take-up value and the clinic feature of breast cancer, and explore the predictive ability of T/N take-up value for breast cancer prognosis.Methods:Breast cancer patients treated at Zhongshan Hospital, Fudan University and undergoing BSGI examination before surgery from Jan 2014 to Nov 2018 were collected. The relationship between T/N take-up value and the clinical features of breast cancer and DFS was analyzed.Results:A total of 419 breast cancer patients were collected. The median follow-up time after operation was 34 months. At the end of the follow-up, 43 cases relapsed and 376 cases did not. The average T/N values of CC position and MLO position before surgery were 2.74 and 2.58. The T/N value of CC is related to tumor stage (χ 2=22.077, P<0.05), lymph node metastasis ( Z=2.138, P<0.05) and degree of invasion ( Z=3.371, P<0.05). The T/N value of MLO is related to tumor stage (χ 2=23.091, P<0.05), lymph node metastasis ( Z=2.531, P<0.05) and degree of invasion ( Z=2.99, P<0.05). The best cut-off values of CC position and MLO position calculated by ROC curve are 2.59 and 2.97. Univariate analysis showed that tumor staging ( HR: 2.039, 95% CI: 1.404-2.962, P=0.001), T/N value at CC position ( HR: 4.349, 95% CI: 2.141-8.883, P<0.001) and T/N value at MLO position ( HR: 2.767, 95% CI: 1.520-5.039, P<0.001) is an independent risk factor for the prognosis of breast cancer. Multivariate COX regression analysis showed that tumor stage ( HR: 1.959, 95% CI: 1.302-2.946, P=0.001) and T/N value at MLO position ( HR: 3.498, 95% CI: 1.531-7.992, P=0.003) are independent risk factor of breast cancer prognosis. Conclusion:The BSGI T/N value has a certain correlation with breast cancer DFS.

Objective To evaluate the myocardial protective effect of dexmedetomidine in the pediatric patients undergoing total correction of tetralogy of Fallot.Methods Forty ASA physical status Ⅱ] or Ⅲ pediatric patients of both sexes,aged 9 months-5 yr,weighing 7-21 kg,scheduled for elective total correction of tetralogy of Fallot under cardiopulmonary bypass,were randomly divided into 2 groups (n =20 each):control group (C group) and dexmedetomidine group (D group).Anesthesia was induced with iv injection of midazolam,sufentanil,etomidate and rocuronium.The patients were endotracheally intubated and mechanically ventilated.After intubation,dexmedetomidine was infused intravenously at 0.6 μg· kg-1 · h-1 until the end of operation in group D,while the equal volume normal saline was given instead of dexmedetomidine in group C.Venous blood samples were obtained before operation,at the end of operation and at 24 h after operation for determination of plasma TNF-α and IL-6 concentrations.The occurence of anoxic spells was recorded.Results The concentrations of plasma TNF-α and IL-6 were significantly lower at the end of operation and 24 h after operation in group D than in group C(P ＜0.05).The incidence of anoxic spells was 0 in group D,however it was 20％ in group C.Conclusion For the pediatric patients undergoing total correction of tetralogy of Fallot under cardiopulmonary bypass,dexmedetomidine infused at 0.6 μg· kg-1 · h-1 during operation can exert myocardial protective effect with clinical significance.

Objective To compare HC video-laryngoscope with Macintosh laryngoscope for tracheal intubation.Methods Sixty ASA Ⅰ or Ⅱ patients of both sexes,aged 18-64 yr,with body mass index 19-27 kg/m2,Mallampati grade Ⅰ-Ⅱ,undergoing elective surgery,were randomly divided into 2 groups (n =30 each):HC video-laryngoscope group (group H) and Macintosh laryngoscope (group M).After induction of anesthesia,the patients underwent orotracheal intubation assisted by HC video-laryngoscope in group H,and by Macintosh laryngoscope in group M.The glottic exposure time,intubation time,Cormack-Lehane grade,the number of pressing the cricoid and intubation-related complications were recorded.Results The rate of satisfactory glottic exposure was significantly higher and the number of pressing the cricoid was smaller in group H than in group M (P ＜ 0.05).There was no significant difference in the glottic exposure time,intubation time and incidence of intubation-related complications between the two groups (P ＞ 0.05).Conclusion The efficacy of tracheal intubation guided by HC video-laryngoscope is better than that guided by Macintosh laryngoscope.

Objective To discuss the changes of neutrophil gelatinase-associated lipocalin (NGAL) in patients with primary nephrotic syndrome (PNS)and the correlation with renal pathological type,renal tubulointerstitial lesions and the clinical indicators.Methods Forty patients with PNS were divided into acute kidney injury (AKI) group and non-AKI group according to whether renal tubular necrosis (ATN) occurred in renal pathology.Moreover,on the basis of pathological type they were divided into minimal change disease (MCD) group,mesangial proliferative glomerulonephritis (MsPGN) group,focal segmental glomerulosclerosis (FSGS) group,membrane proliferative glomerulonephritis (MPGN) group and membranous nephropathy (MN) group.Twenty healthy subjects and normal kidney tissues which came from 20 patients with renal tumor nephrectomy and were distant from the tumor sites were the control groups.Enzyme-linked immunosorbent assay (ELISA) was applied to detect the serum and urine level of NGAL,and immunohistochemical staining was used to observe the expression of NGAL in the renal tissue.Results (1)The serum and urine level of NGAL and the expression of NGAL in the renal tissue in the PNS complicated with AKI group were significantly higher than that in the PNS without AKI group and in the control group(P ＜ 0.05).(2)The serum and urine level of NGAL and the expression of NGAL in the renal tissue were enhanced in MPGN group and FSGS group than that in the other three groups(P ＜ 0.05).(3) Before developing to severe tubulointerstitial lesions,with the aggravation of tubulointerstitial damage,the serum and urine level of NGAL and the expression of NGAL in the renal tissue were increased.But when renal tubular interstitial lesions developed to severe disease,serum level of NGAL and the expression of NGAL in the renal tissue were decreased(P ＜ 0.05).(4)The serum and urine level of NGAL and the expression of NGAL in the renal tissue were positively correlated with serum creatinine(r values were 0.198,0.352,0.146 respectively,P values were 0.048,0.000,0.028 respectively),were positively correlated with blood urea nitrogen(r values were 0.199,0.278,0.325 respectively,P values were 0.043,0.000,0.019 respectively),were negatively correlated with serum albumin(r values were-0.384,-0.318,-0.259 respectively,P values were 0.028,0.024,0.020 respectively) and were negatively correlated with urine osmotic pressure(r values were-0.250,-0.256,-0.277 respectively,P values were 0.012,0.027,0.002 respectively).Conclusion NGAL is a sensitive biological parameter for predicting AKI in the patients with PNS,and it can be used to evaluate the degree of tubulointerstitial lesions and renal function to a certain extent.

Objective To evaluate the effects of blood-lipid report's reformat on outpatients' behavior and knowledge of dyslipidemia therapy.Methods The blood-lipid report was reformatted by adding three tables from the Chinese Guideline on the Prevention and Treatment of Adult Dyslipidemia on its back.The same questionnaire was used twice to evaluate the patients' behavior and knowledge of dyslipidemia therapy before and after reformat.Results Before and after reformat,the rates of correct deterination of their own risk stratification were 26.0％ ( 112/430 ) and 26.3％ ( 115/438 ) respectively.The awareness rates of Different LDL-C goals among different persons wcre 37.0％ (159/430) and 35.8％ (157/438).Only 0.7％ (2/306) and 1.0％ (3/299) of patients knew their blood lipid goals (P =0.557).When the report showed normal blood lipid levels,the percentages of taking lipid-lowering drug were 47.6％ ( 230/483 ) and 46.6％ ( 216/464 ),20.5％ ( 99/483 ) and 19.0％ ( 88/464 ) of patients questioned the prescription.Non-medication rates were 31.9％ ( 154/483 ) and 34.5％ ( 160/464 ) respectively before and after reformat ( P ＞ 0.05 ).For patients requiting lipid-lowering drug therapy by the guideline,treatment rate improved significantly in the low-risk group (13.3％ vs.75.0％,P =0.002).Treatment rate slightly increased in the high-risk and very high-risk groups after reformat (54.0％ vs.56.8％,62.4％ vs.69.0％,P ＞ 0.05 ).Rates of achieving lipid goal showed no change [ 41.5％ ( 102/ 245 ) vs.44.5％ ( 114/256 ),P ＞ 0.05 ] after reformat,especially among the very high-risk patients [17.9％(12/68) vs.21.6％(11/52),P＞0.05].Conclusions The blood-lipid report reformat did not improve the patient behaviors and knowledge of the prevention and treatment of dyslipidemia because of poor treatment rate and medication compliance.The combination of patient education and thorough blood-lipid report reformat may help to increase the attainment rate of dyslipidemia therapy.

Objective To investigate the role of silent mating type information regulation 2 homologue 1(SIRT1) in renal ischemia-reperfusion(IR) injury and its effect on NF-κBp65-peroxisome proliferator-activated receptor gamma coactivator 1 alpha (PGC-1α) signal pathway in mice.Methods Seventy-two healthy C57BL/6 male mice were randomly divided into four groups:control group(n=18),sham-operated group(n=18),IR group(n=18),resveratrol group(n=18).Bilateral renal pedicle were clamped for 45 min was adopted to establish the model of acute ischemic renal injury,to give 2％ dimethyl sulfoxide or resveratrol by intraperitoneal injection for 7 days before modeling.Determination techniques included routine biochemical methods for the the levels of Scr and BUN,spectrophotometry for the level of superoxide dismutase (SOD),HE staining for the histological changes as well as immunohistochemical method and Western blotting for the expressions of SIRT1,NF-κBp65 and PGC-1α,respectively.Results Compared with that in control and sham-operated groups,the levels of serum Scr and BUN were higher and SOD levels in renal tissues were lower at 12 h and 24 h after operation in IR groups(P ＜ 0.05).HE staining revealed evident pathological lesions including necrosis of renal tubular epithelial cells in IR group.Compared with that in IR group,resveratrol attenuated the above-mentioned changes.Western blotting revealed the up-regulated SIRT1 expression and the activated NF-κB signal pathway,the up-regulated p65 expression and the down-regulated PGC-1αexpression subsequent to IR(P ＜ 0.05).Both Western blotting and immunohistochemistry showed that the expressions of SIRT1 and PGC-1α in resveratrol group were up-regulated compared to that in IRgroup(P ＜ 0.05),while the NF-κBp65 expression in resveratrol group was down-regulated(P ＜ 0.05).Conclusions In mouse model of renal ischemia-reperfusion injury,the activation of SIRT1 can inhibit the NF-κBp65 expression and accordingly up-regulated PGC-1α level,contributing to inhibiting inflammatory reactions and attenuating oxidative stress-induced injury in the protection of the kidneys.

This article reviewed the measures taken by the hospital against a catastrophic fire hazard and exploration in its response and work organization of nursing care of the wounded.Proposed in this paper are development of such five systems as the pre-plan,exercises,personnel,quality control and incentives,which are expected to improve the nursing capacity of the hospital in emergency rescue,for sustainable development of nursing emergency rescue work.