The elderly patients with diabetes often have a high prevalence of hypertension.Meanwhile,hypertension is a major vascular risk factor in this population.The benefit of proper management of hypertension in elderly patients with diabetes has been well recognized.According to the IDF Global Guideline for Managing Old People with Type 2 Diabetes,lifestyle interventions are recommended to form the first step in managing hypertension in elderly patients with diabetes.Pharmacological therapy should be initiated in addition to lifestyle interventions after 6 weeks during which non-pharmacological therapy has failed to achieve blood pressure targets.ACE-inhibitors are the first choice for initial medication,especially in the presence of diabetic nephropathy.ARBs can be used in people who cannot tolerate ACE-inhibitors.Diuretics or calcium channel blockers can be used as the first add-on therapy to ACE-inhibitors or ARBs if they fail to achieve target blood pressure.β-blockers should be considered for combination therapy in people with tachycardia or coronary artery disease.The generally recommended blood pressure target for older people with diabetes should be less than 140/90 mmHg(1 mmHg=0.133 kPa).

Objective To analyze the feasibility, safety, and technique of laparoscopic myomectomy in patients with large hysteromyoma. Methods A total of 82 hysteromyoma patients with the uterus larger than 14-week gestational size were treated by laparoscopic myomectomy. The outcome of the operation were compared with that in 182 hysteromyoma cases with the uterus smaller than 14-week gestational size. Results In the 82 patients with the uterus larger than 14-week gestational size, 77 were treated successfully by laparoscopy, in which pneumoperitoneum was used in 68 cases and gasless laparoscopy in the other 9. One of the cases converted to open surgery, and small abdominal incision was made in 4 patients. Compared with the patients with the uterus smaller than 14-week gestational size, the 77 patients who had been successfully by laparoscopy had longer operation time [(157.6?89.7) min vs (35.3?26.2) min, t=16.926, P=0.000] and more blood loss [(218.0?108.2)ml vs (108.5?67.5)ml,t=9.904,P=0.000]. Conclusions Myomectomy can be performed under a laparoscope for patients with the uterus larger than 14-week gestational size. Highly skilled technique is important for the surgery.!Gasless laparoscopy is applicable to myomectomy for patients with the uterus smaller than 16-week gestational size.

Compared with proinflammatory processes in the development of type 2 diabetes,our knowledge on anti-inflammatory cytokines is rather limited.Anti-inflammatory cytokines such as adiponectin,interleukin 1 receptor antagonist(IL-1RA),transforming growth factor-β1 (TGF-β1),growth differentiation factor-15 (GDF-15),omentin,and secreted frizzled-related protein 5 (SFRP5) are strongly associated with increased risk of type 2 diabetes:Adiponectin and omentin levels decreased before type 2 diabetes,in contrast,concentrations of IL-1RA,TGF-β1,GDF-15 are increased.Change of SFRP5 levels in impaired glucose tolerance and type 2 diabetes remains controversial.This paper will summarize and recommend studies that investigated associations between circulating levels of anti-inflammatory cytokines and type 2 diabetes.

Regulatory T cells (Tregs) possess the function of immune suppression and achieve immunosuppression by the approach of expressing cytotoxic T lymphocyte-associated antigen,perforin-particle enzyme mediated cytotoxic effect,and secretion of cytokines such as IL-10,TGF-β,et al.The antibodies,vaccines and chemical drugs can be applied for targeting FOXP3 + CD25 + CD4 + Tregs,depleting Tregs in peripheral blood and tumor tissues of patients of various forms of cancers.The function of immune suppression can be decreased and antitumor curative effects by immunotherapy can be enhanced.

Objective: To study the protective effects of tetrahydropalmatine (THP) against ischemia－reperfusion induced hippocamp lesion in rats. 　MethodS: A model of ischemia-reperfusion induced brain lesion was set up by ligation of common carotid arteria in rats, and the protective effects of THP was observed.　Results: It was found that, with administration of THP, the activities of superoxide dismutase (SOD), glutathione peroxidase (GSHPx) and Na+, K+-ATPase as well as Ca2＋－ATPase were increased (P＜0.05, respectively), while malondialehyde (MDA) was decreased to 42.5% (P＜0.01) during brain ischemia－reperfusion.　Conclusion:The results suggested that THP can protect the rat against ischemia－reperfusion induced brain lesion.

Objective:To investigate the effect of JAK2 V617F gene mutation status and burden on BCR-ABL-negative myeloproliferative neoplasms (MPN).Methods:Clinical data of 199 patients with MPN in Cangzhou Central Hospital in Hebei Province from September 2015 to January 2020 were retrospectively analyzed, and the correlations of JAK2 V617F gene mutation burden with clinicopathological features and prognostic score of MPN patients were analyzed.Results:Of the 199 BCR-ABL-negative MPN patients, 138 patients (69.4%) were positive for JAK2 V617F mutation; of these patients, 64 (88.9%) of 72 patients with polycythemia vera (PV) were mutation-positive, 54 (53.5%) of 101 patients with essential thrombocytosis (ET) were positive, 20 (80.0%) of 25 patients with myelofibrosis (MF) were mutation-positive, and 1 patient with hypereosinophilic syndrome (HES) was mutation-positive. About 55.1% (76/138) of patients had a high JAK2 V617F mutation burden. The mutation burden in PV group was the highest, MF was the second, and ET was the lowest; the mutation burdens in these three groups were (73.9±18.3)%, (59.9±25.2)% and (25.0±16.5)%, respectively. Mutation burden was positively correlated with the white blood cell counts of patients with PV, ET and MF ( r values were 0.626, 0.675 and 0.796, all P < 0.01). JAK2 V617F mutation burden was positively correlated with the prognostic scores of patients with PV and ET ( r values were 0.296 and 0.404, both P < 0.05). Conclusion:The JAK2 V617F mutation burden of BCR-ABL-negative MPN patients is related to clinicopathological factors, and the prognosis of patients with high JAK2 V617F mutation burden is poor.

Objective To construct the prokaryotic expression vector of human procalcitonin(PCT) and obtain the highly purified recombinant PCT protein.Methods PCT primers were designed based on the sequence of PCT gene from NCBI,and PCT gene was amplified by PCR.Then,the recombinant vector PCT/pET-22b(+) was constructed and transferred into E.coli BL21 to induce the expression of recombinant PCT protein.Last,the recombinant PCT protein was purified by the nickel column affinity chromatography and identified by Western blot and the colloidal gold method,respectively.Results The results of agarose gel electrophoresis showed that the product of PCR amplification was about 350 bp.The homology comparison analysis revealed that the PCT gene fragment(348 bp) was successfully inserted into pTG19-T vector,and that no any base mutation was found.When the recombinant plasmid of PCT/pET-22b(+) was digested with BamH Ⅰ and HindⅢ,two pieces of about 350 bp and 5 500 bp were obtained.SDS-PAGE showed that the recombinant PCT protein with about 14 000 of Mr was existed in soluble form,and was easily obtained by the nickel column affinity chromatography.Moreover,western blot and the colloidal gold method demonstrated that the recombinant PCT protein was successfully expressed and contained histidine label(His-tag).Conclusion The recombinant vector PCT/pET-22b(+) is successfully constructed by the recombinant DNA technology,and the recombinant PCT fusion protein is successfully obtained by the nickel column affinity chromatography.

Objective: To monitor the content of bisphenol S ( BPS ) in vegetables and fruits in Henan Province and evaluate the dietary exposure risk of the population, so as to provide the basis for formulating relevant food safety standards. Methods: From 2018 to 2019, 276 samples of vegetables and fruits produced and sold in Henan Province were collected. BPS was determined by isotope dilution ultra performance liquid chromatography triple quadrupole tandem mass spectrometry ( UPLC-MS/MS ) , and the dietary exposure was calculated according to the dietary structure and average body weight of local residents. The risk index of BPS was calculated according to the daily tolerable intake ( TDI ) of bisphenol A ( BPA ). Results: The BPS contents in vegetables and fruits were 0.006-12.600 µg/kg and 0.006-9.380 µg/kg, the medians were 0.053 µg/kg and 0.023 µg/kg, the detection rates were 78.43% and 62.60%, respectively.The detection rate and content of BPS in vegetables were higher than those in fruits ( P<0.05 ). The maximum exposure of BPS from vegetables and fruits was 5.37×10-2 µg/ ( kgbw·d ), and the exposure risk index was 1.07 × 10-3, which was acceptable. Conclusions BPS was detected from vegetables and fruits in Henan Province. The detection rate and content of BPS in vegetables were higher than those in fruits. The health risk of BPS exposed by vegetables and fruits is small.

Objective To know the prevalence of iodine deficiency disorders(IDD) and the implementation of control measures against the disorders in high-risk areas of Hainan province. Methods Typical sampling principle was used. Eight townships with lower coverage rate of iodized salt were chosen in IDD high-risk counties of Hainan. New cretinism cases were screened among children aged 10 years and under. Intelligence quotient (IQ)value, urinary iodine (UI) concentration and thyroid gland size (by palpation and B ultrasonic) were investigated in children aged 8 to 10 years and questionnaire was also carried out among students from grade 5 in elementary school. Edible salt and urine of women of childbearing age were collected to detect iodine levels, respectively,questionnaire was also carried out among the women of childbearing age. The UI was determined by As3-Ce4+ catalytic spectrophotometer, the salt iodine level was determined using self-quantitative kit. IQ values were measured by the Combined Raven Test in China (CRT-C2). Results Seventy-two townships were investigated in three consecutive years, 7937 children aged 8 to 10 years, 1797 women of childbearing age and 4128 students of grade 5 were included in the survey. One child was diagnosed as suspected new cretinism case. The coverage rate of iodized salt was increased from 44.6%(629/1411) in 2007 to 92.1%(1688/1832) in 2009. The goiter rate was dropped from 5.9% (269/4548), 6.0% (274/4548) in 2007 to 1.6% (24/1461), 0.1% (2/1461) in 2009 bypalpation, and by B-ultrasound, respectively, in children aged 8 to 10 years. The median urinary iodine(MUI) was found to be increased from 97.4 μg/L in 2007 to 165.0 μg/L in 2009, and the percentage of UI less than 50.0 μg/L, and 100.0 μg/L were dropped from 21.4%(973/4548), 51.2%(2329/4548) in 2007 to 7.5 %(110/1461), 23.4%(342/1461) in 2009, respectively. The MUI of women of childbearing age was found to be elevated from 73.7 μg/L in 2007 to 126.1 μg/L in 2009, and the value was also increased from 55.7 μg/L to 121.5 μg/L in pregnant women, but these values were still lower than 150.0 μg/L The pass rate of the questionnaire of IDD controlling among the students of grade 5 and the women of childbearing age was raised from 29.8% (446/1495) ,24.1% (179/742) in 2007 to 65.8%(732/1112), 72.1%(264/366) in 2009, respectively. The mean IQ of children was 90.4±16.0, and the percentage of IQ value less than 69 was 12.6% (1000/7937). Conclusions The diseased state of IDD has improved in the high-risk counties of disorders in Hainan province, but the pregnant women are still iodine deficient. Iodine supplimentation should be promoted among pregnant women.

Objective To investigate the diagnosis and surgical management of ureteral obstruction after renal transplantation.Method A respective study was performed on 15 cases of ureteral obstruction who received renal allografts.All of the cases were confirmed,including 5 cases of stenosis of ureterovesical junction,4 cases of stenosis of distal ureter,2 cases of blood clot blockage,2 cases of edema due to perforation of distal ureter,1 case of ureteral calculi,and 1 case of extrinsic compression of hematoma.All 14 patients underwent open surgical management to reestablish ureter with D-J catheter as stent for 12-16 weeks.One patient was subjected to percutaneous nephrostomy followed by percutaneous ureteroscopy,the obstructed site was identified at ureterovesical junction and antegrade balloon dilation and D-J stent in ureter were performed subsequently.Result Fifteen patients were diagnosed as ureteral obstruction by colour Doppler ultrasound and MRU.All of the patients were resolved the obstructions after surgical managements and the renal function got improved.No reobstruction occured during one year follow-up period.Conclusion Colour Doppler ultrasound and MRU can definitely be used to diagnose ureteral obstruction after renal transplantation.Early diagnosis and surgical management are very important.Open surgical management of the obstructed ureter is an effective method.Antigrade balloon dilation is a therapeutic approach to treat ureteral obstruction.