Objective To investigate the clinical value of urinaryα1-acid glycoprotein (AAG)in the early diagnosis of diabetic nephropathy(DN).Methods 266 cases of diabetic patients in Drum Tower Hospital Affiliated to Medical School of Nanjing University from May 2013 to October 2014 were recruited,and patients were divided into four groups based on the urine al-bumin/creatinine (ACR)levels,as follows:non-diabetic nephropathy group (Non-DN)152 cases,low urinary albumin/cre-atinine group (LUA)49 cases,high urinary albumin/creatinine group (HUA)32 cases,and very high urinary albumin/cre-atinine group (VHUA)33 cases.63 cases of healthy subjects (NC group)and 66 cases of fracture patients (stress group) were recruited as control group.The urinary AAG and other biochemical indicators were measured for all subjects.Results The level of urinary AAG in DN group was significantly higher than that in stress group,Non-DN group and NC group (t=7.951,7.985,8.021,P <0.05),and gradually increased from LUA,HUA to VHUA group (P <0.05).The urinary AAG level was positively correlated with UA,Cr,CRP and ACR (r=0.169,0.286,0.373,0.606,P <0.01).Stepwise logistic re-gression analysis showed that the urinary AAG was the independent risk factor of DN (P <0.05).Conclusion The level of urinary AAG has good application value in the early diagnosis and monitoring progression of DN.

Objective:To compare the concordance between subjective experience and clinician-rated in different treatment phrase of elderly patients with depressive disorder,and to explore the relevant factors.Methods:Sixty-nine consecutive elderly patiems with depressive disorder diagnosed with International Classification of Diseases-10 criteria were included.The Visual Scale for Depression(VSD) were used to evaluate subjective experience of depression,while the Hamilton Depression Scale (HAMD),Hamilton Anxiety Scale (HAMA),Minimum Mental State Examination (MMSE) were used by clinician to evaluate depression symptom,anxiety symptom and cognition at baseline,2-,4-and 52-week of the treatment respectively.Results:Compared with baseline,VSD scores were increased at 2 weeks and 4 weeks [(2.7 ± 1.6),(5.3 ± 2.0) vs.(7.0 ± 1.8),P ＜ 0.001],HAMD scores were decreased at 2 weeks and 4 weeks [(36 ± 11),(17 ±9) vs.(9 ±8),P ＜0.001],HAMA scores were decreased at 2 weeks and 4 weeks [(27 ± 10),(14 ±8) vs.(7 ±6),P ＜0.001].No significant differences were found between 4 weeks and 52 weeks.There was no correlation between VSD and HAMD scores at baseline and 2 weeks.There were significant correlations among scores of VSD and HAMD(r =-0.31,-0.74,Ps ＜ 0.05),HAMA (r =-0.36,-0.76,Ps ＜ 0.05) at 4 weeks and 52 weeks.Using logistic regression analysis,the concordance between VSD and HAMD related with the factors of HAMD,higher scores of anxiety/somatization factor were associated with lower concordance (OR =0.87),and higher scores of weight factor (OR =1.86),diurnal variation factor (OR =2.00),hopelessness factor (OR =1.13) were associated with higher concordance.Conclusion:Compared with acute depression phase,concordance between subjective experience and clinician-rated for depression may be higher at depression remission phase in elderly patients with depression,which suggests that characteristics of depression symptom may have a certain impact on the self-awareness for depression experience.

Objective To study the iodine nutritional status and the thyroid function of pregnant women during different periods,and provide scientific basis for iodine supplementation.Methods Totally 728 pregnant women who visited the obstetric outpatient of Nanjing Drum Tower Hospital for routine prenatal care from December 2014 to August 2016 were recruited in this study,and at the same time 182 non-pregnant women were recruited as control group.The thyroid stimulating hormone (TSH) and free thyroxine (FT4) were measured by Roche 601.The urinary iodine level was measured by SR-I-100 kit.Results The median urinary iodine of 728 pregnant women was 168.24 g/L,and the median urinary iodine of those women in the T1,T2 and T3 period were 186.31,162.65 and 148.76 g/L,respectively.The TSH at T1 period was lower than T2 and T3 period (t=3.429,3.135,P＜0.05).The FT4 at T1 period was higher than T2 and T3 period (t=5.251,5.965,P＜ 0.05).The prevalence rate of thyroid disease in normal urinary iodine group was lower than that in low urinary iodine group and high urinary iodine group (x2 =4.139,4.131,P＜0.05).Conclusion There was no iodine deficiency among those pregnant women groups,but only 34.75 ％ individuals reached the appropriate iodine nutritional level,and the ratio of iodine insufficient increased with the extension of pregnancy.The whole prevalence rate of thyroid disease in abnormal urinary iodine pregnant women was obviously higher than that in normal.It is necessary to improve the pregnant women's knowledge of iodine nutrition,moreover it is suggested that urinary iodine monitoring and thyroid function should be conducted in pregnant women.

Objective To explore the molecular mechanisms of carbapenem-resistant Klebsiella pneumoniae.Methods Carba NP confirmatory test were used to detect carbapenemases.Carbapenemase genes,ESBL genes and plasmid-mediated AmpC genes were amplified by polymerase chain reaction (PCR).The genetic correlation analysis was carried out by using multiple sequence type (MLST).Results 42 out of the 50 carbapenem-resistant Klebsiella pneumoniae strains were KPC-2-positive strains,1 strain was positive for NDM-1,the other 7 strains were not detected for any carbapenemase genes.The percentages of KPC-2-positive Klebsiella pneumoniae with the bla CTX-M,bla SHV,bla TEM,bla DHA were 21.5 ％,42.9 ％,69.1％ and 4.8％ respectively.The results of MLST showed that 37 out of 42 KPC-2 positive strains were ST11.Conclusion The production of KPC-2 is the main mechanism of Klebsiella pneumoniae resistance to carbapenem and there is an outbreak of ST11 KPC-2 Klebsiella pneumoniae in this hospital.

Objective To determine the purity,composition and antitumor activities of polysaccharide AHP-12 from abalone harslet.Methods Its purity was checked by HPLC with TSK-GEL G4000PWXL column and agarose gel electrophoresis;Molecular weight was determined by gel filtration chromatography;Sulfate content was identified by gelatine nephelometry and aminohexose content by chromatometry;Gas chromatograph was applied to determine monosaccharide composition;Antitumor activities were investigated by MTT method.Results AHP-12 from abalone harslet was a homogeneous polysaccharide both measured by molecular weight and electric property;The molecular weight was about 3?105;It was contained sulfate 13.07% and aminohexose 4.98%;AHP-12 was composed of rhamnose,fucose and galactose(the ratio in mole is 1∶2.2∶1.7);the activity determined by MTT method showed it could hamper the growth of HeLa cell.Conclusion AHP-12 was extracted and purified from abalone harslet.It was a homogeneous polysaccharide,which contained sulfate and aminopolysaccharide,and with weak antitumor activities in vitro.

Objective To evaluate the value of reducing radiation dose with decreased size of ECG-pulsing windows and influence on image quality in dual-source CT coronary angiography. Methods 120 patients with stable heart rate(HR) were divided into four groups according to HR and the rang of ECG-pulsing windows in dual-source CT coronary angiography: HR ＜ 70 bpm and 61% ～ 77% R-R interval of ECG-pulsing windows, HR ＜ 70 bpm and 25% ～ 80% R-R interval of ECG-pulsing windows,HR ＞ 80 bpm and 31% ～47% R-R interval of ECG-pulsing windows, and HR ＞ 80 bpm and 25% ～ 80%R-R interval of ECG-pulsing windows was employed, respectively. The radiation dose parameters were recorded and image quality scores were performed. The image quality and radiation dose between two slow HR groups and between two fast HR groups were compared respectively. Result The effective doses were (7.06 ± 2. 13 ), ( 11.34 ± 3.65 ), ( 6. 67 ± 1.97 ) and ( 9. 92 ± 3. 15 ) mSy for four groups, respectively.The effective dose was decreased by 37.74% for slow HR and by 32. 76% for fast HR using narrow ECG-pulsing windows. There was no difference on image quality between two slow HR groups and two fast HR grouvs. Concluslons The proper application of narrow ECG-pulsing windows can reduce radiation exposure significantly to stable slow or fast HR patients in dual-source CT coronary angiography withont sacrificing the image quality.

Objective To conduct a meta-analysis to evaluate the outcomes of donation after cardiac death (DCD) compared with donation after brain death (DBD) liver transplantatior.Methods The MELDINE (1950-2011),EMBASE,and Cochrane Library databases were searched.All original single institution studies reporting outcomes of comparing donation after DCD and DBD liver transplantation were considered.A meta-analysis of complication incidence and patients/grafts survival after liver transplantation was conducted.Odds ratios (OR) and 95 ％ confidence intervals (CI) based on random effects models were calculated.Results Thirteen studies,all retrospective cohort studies,involving 5867 DCD and 619 DBD recipients,were included.DCD recipients had a 2.5 times increased odds of biliary complications (95 ％ CI =2.0～3.12),an 11.24 times increased odds of ischemic cholangiopathy (IC) (95 ％ CI =5.58 ～ 22.64 ),and a 2.12 times increased odds of primary nonfunction (PNF).DCD recipients also experienced lower odds of 1-year patient survival (OR =0.78,95 ％ CI=0.59～1.02),83.8 ％,87.2 ％,separately,and 1-year graft survival (OR=0.55,95％ CI=0.45～0.68),72.2 ％ and 82.4 ％,separately.Three-year patient survival was present in 81.5 ％ of DCD vs 78.9 ％ of DBD,which has no significant difference.The 3-year graft survival was lower inDCD than that in DBD (OR =0.73,95 ％ CI =0.56～0.94),69.5 ％ and 73.6％,separately.Conclusion DCD liver transplantation is associated with higher risks of biliary complications.But regarding the comparable general outcomes with DBD transplantation,DCD could be a source of liver.

Objective To investigate the effect of parecoxib on cardiac function after acute myocardial infarction (AMI) in rats. Methods Twenty-four adult male SD rats, weighing 230-250 g, were randomly divided into 3 groups ( n = 8 each): group Ⅰ sham operation (group S), group Ⅱ AMI and group Ⅲ parecoxib (group P). Myocardial infarction was induced by ligation of left anterior descending branch (LAD) of coronary artery in group Ⅱ and Ⅲ . In group S, LAD and cervical sympathetic trunk were exposed but not ligated and transected.Group P received intrperitoneal parecoxib 8 mg/kg once a day for 3 days 24 h after ligation of LAD, while group AMI received normal saline instead. At 4th day after ligation LAD, the left ventricular systolic pressure ( LVSP),left ventricular end-diastolic pressure (LVEDP) and ± dp/dtmax were measured and recorded. Blood samples were taken from common carotid artery to determine the plasma concentrations of TXA2 and PGI2 and PGI2/TXA2 was calculated. Then the animals were sacrificed and hearts removed. Myocardial infarct size of left venicle was calculated. Results Compared with group S, LVSP, ± dp/dtmax, plasma concentrations of PGI2 and PGI2/TXA2 were significantly decreased, while LVEDP and plasma concentrations of TXA2 increased in group AMI and P( P ＜0.05). Compared with group AMI, LVSP, ± dp/dtmax, plasma concentrations of PGI2 and PGI2/TXA2 were significantly decreased, while LVEDP and plasma concentrations of TXA2 increased in group P ( P ＜ 0.05). There was no significant difference in myocardial infarct size between group AMI and P (P ＞ 0.05). Conclusion Parecoxib can improve cardiac function after AMI in rats and the mechanism is related to regulation of the balance of PGI2/TXA2.

Objective To explore the feasibility and secure cold storage time of human arteries during sequentially cold-cryopreservation by observing the cellular metabolic activity and structure after cold storage and cryopreservation. Methods Human iliac and splenic arteries were stored for 72 h, 1 week, 2 weeks, 3 weeks and 4 weeks in UW solution at 4 ℃. After the cold storage procedure, half of the vascular allografts were examined by NBT dye method, electron and light microscope. The other vascular allografts continued to be stored by - 80 ℃ cryopreservation procedure for 4 weeks, and then the vascular allografts were examined by NBT dye method, electron and light microscope. Results There was no statistically significant difference in NBT dyeing time between the groups stored in UW solution within 2 weeks and fresh group at 4 ℃ (P ＞ 0. 05). After - 80 ℃ cryopreservation, there was also no statistically significant difference in NBT dyeing time between the groups stored by UW solution within 1 week and fresh group at 4 ℃ (P＞0. 05). Along with the extension of cold storage time, the destruction of ultrastructure was aggravated. When vascular allograft was stored over 2 weeks at 4 ℃, the destruction was more obvious. As the cold storage time prolonged, the ultrastructural destruction of vascular allografts was aggravated, especially those stored over 1 week. Conclusion The optimal time limit for arteries stored at 4 ℃ in UW solution was 2 weeks. Cryopreservation at - 80 ℃ kept the arteries satisfactory metabolic activity and organizational structure. The arteries stored within 1 week at 4 ℃ in UW solution, which restored at - 80 ℃ , could maintain satisfactory metabolic activity and organizational structure.

Aim To study the transport of geniposide and geniposide in Zhizi Bopi Decoction in MDCK cell membrane model. Methods The safety concentration of geniposide and Zhizi Bopi Decoction in MDCK cells were determined by MTT assay. Then the MDCK cell membrane model was used to investigate the transport of drugs. Firstly, the effects of time, drug concentra-tion, P-gp inhibitor and EDTA on the absorption and transport of geniposide were studied systematically. Secondly, the differences were compared between the transport of the same concentration of geniposide as single compound and that in Zhizi Bopi Decoction in MDCK cell model. The drug concentration was deter-mined by high performance liquid chromatography ( HPLC) to calculate the apparent permeability coeffi-cient (Papp). Results Geniposide transport in MDCK cell monolayer was time and concentration dependent. P-gp inhibitors had no significant effect on its transport and the transport of geniposide was enhanced by ED-TA. The absorption Papp of different concentrations of geniposide in Zhizi Bopi Decoction were ( 8. 96 ± 0. 35 ) × 10 -7 cm · s-1 , ( 8. 95 ± 0. 38 ) × 10 -7 cm · s-1 and (9. 16 ± 0. 30) × 10 -7 cm·s-1, significantly higher than the absorption Papp of geniposide as single compound(5. 85 ± 0. 44) × 10 -7 cm·s-1, (6. 88 ± 0. 38) × 10 -7 cm·s-1 and (6. 31 ± 0. 19) × 10 -7 cm ·s-1 ( P<0. 05 ) . Conclusion The transport of ge-niposide in MDCK cell membrane model is passive transport and is not affected by P-gp. Geniposide may transport via the paracellular route. The Zhizi Bopi De-coction can increase the absorption of geniposide.