435 patients with type 2 diabetes were divided into 2 groups according to their fatty liver,then the relations between fatty liver and various parameters in two groups were observed and analyzed by statistical methods.Body mass index,HbA_1c and triglyceride were the risk factors for fatty liver.The prevalences of metabolic syndrome,hypertension and coronary heart disease in fatty liver group were significantly higher than those in the control group.

Objective To discuss the effect and the method of treatment of anti-cardiolipin antibody (ACA),ANA and ENA on abnormal delivery women,and their relationship with abnormal delivery.Methods The concentrations of plasman ACA,ANA,ENA and the times of abortion in abnormal delivery for 193 cases of abnormal delivery women and 100 cases of normal pregnancy were quarnlitatively detected and satistically analyzed.The 81 ACA positive patients were treated orally with aspirin,25 ACA and ANA/ENA positive patients were treated with aspirin combined with prednisone,and 3 ANA/ENA positive patients with prednisone treatment oral.Results The number of ACA and ANA positive patients was closely related to the types of abmormal delivery. The ANA and ENA positive patients was related to the times of abortion. There was no difference in the outcome of treatment between both therapies of aspirine and aspirine combined with prednisone in abnormal delivery women.Conclusions ACA is an important factor in causing abnormal delivery. No matter what ANA and ENA are in ACA positive patients,their can be treated with aspirin alone.

This article reports the development of hyperosmolar hypernatremic hyperchloremic coma and acute renal failure in a male diabetic patient after recovery from hyperosmolar hypergly-cemic nonketonic coma, of which the cause is fluid retention in excess of urinary output due to the obstruction of lower urethra by diabetic neurogenic urinary bladder and hyper-plasia of prostate gland.By our experience each old diabetic man should be examined to confirm if he has neuro-genic urinary bladder and/or hyperplasia of prostate gland. Care should be taken to keep the balance of fluid intake and output provided that both of these conditions are present. The acute obstructive nephropathy can quickly ameliorate with release of the obstruction.

Objective To study the clinical characteristics of Gitelman′s syndrome, and the differentiation of Gitelman′s syndrome from Bartter′s syndrome. Methods Clinical data of 2 patients diagnosed as Gitelman′s syndrome were retrospectively analysed. Results The symptoms of both patients appeared at adult age, their main manifestation included hypokalaemic alkalosis, hyperreninemia and juxtaglomerular apparatus hyperplasia with normal blood pressure, hypocalciuria and hypomagnesemia, then the diagnosis of Gitelman′s syndrome was established. Potassium and magnesium supplementation ameliorated one patient′s symptom. Another patient treated with indomethacin, serum potassium was recovered to normal level. Conclusion Gitelman′s syndrome and Bartter′s syndrome appear to be similar in the pathogenesis, clinical manifestation and prognosis, but still show some differences, Gitelman′s syndrome should be carefully differentiated from Bartter′s syndrome.

Objective To observe the effect of the Western massage combined with muscle energy technique on masticatory muscle disorders. Methods 58 patients with masticatory muscle disorders were randomly divided into control group (n=29) and observation group (n=29). The control group accepted ultrashort wave therapy, while the observation group accepted the Western massage and muscle energy technique. They were assessed with Visual Analogue Scale (VAS) of pain and Friction index of the temporomandibular joint (TMJ) before and 4 weeks after treatment. Results The scores of VAS and Friction index of the TMJ decreased in both groups (P<0.001), and decreased more in the observation group than in the control group (P<0.001). Conclusion The combination of Western massage and muscle energy technique is advanced for masticatory muscle disorders.

Objective:To evaluate the role of extracellular signal-regulated kinase 1/2 (ERK1/2)/cyclic adenosine monophosphate response element-binding protein (CREB)/brain-derived neurotrophic factor (BDNF) signaling pathway in dexmedetomidine-induced inhibition of propofol-caused apoptosis in isolated hippocampal neurons of fetal rats.Methods:Pregnant Sprague-Dawley rats at 16 days of gestation were sacrificed, and the fetal rats were taken out, and hippocampal neurons of fetal rats were obtained and primarily cultured in vitro for 7 days.The neurons were divided into 9 groups ( n=12 each) using a random number table method: control group (group C), fat emulsion group (group I), dimethyl sulfoxide (DMSO) group, dexmedetomidine group (group D), propofol group (group P), propofol plus dexmedetomidine group (group PD), PD98059 plus propofol plus dexmedetomidine group (group PDP), MH89 plus propofol plus dexmedetomidine group (group HDP), and KG501 plus propofol plus dexmedetomidine group (group KDP). Group C received no treatment.In group I, 20% fat emulsion was added, and the neurons were incubated for 30 min, and 0.25% DMSO was added in group DMSO, and the neurons were incubated for 30 min.Dexmedetomidine at a final concentration of 10 μmol/L was added, and the neurons were incubated for 30 min in group D. Propofol at a final concentration of 100 μmol/L was added, and the neurons were incubated for 3 h in group P. In group PD, dexmedetomidine at a final concentration of 10 μmol/L was added, the neurons were incubated for 30 min, propofol at a final concentration of 100 μmol/L was added, and the neurons were incubated for 3 h. In PDP, HDP and KDP groups, 25 μmol PD98059 (p-ERK1/2 inhibitor), 10 μmol H89 (p-CREB inhibitor) and 25 μmol KG501 (CREB inhibitor) were added, respectively, the neurons were incubated for 30 min, dexmedetomidine at a final concentration of 10 μmol/L was added, the neurons were incubated for 30 min, and propofol at a final concentration of 100 μmol/L was added, and the neurons were incubated for 3 h. The cell ultrastructure was observed with the transmission electron microscope, the apoptosis in neurons was detected by flow cytometry, the expression of ERK1/2, CREB and BDNF mRNA was detected by quantitative real-time polymerase chain reaction, and the expression of p-ERK1/2, CREB, p-CREB, BDNF and cleaved caspase-3 was detected by Western blot. Results:Compared with group C, the apoptosis rate was significantly increased, the expression of p-ERK1/2 and p-CREB was down-regulated, and the expression of cleaved caspase-3 was up-regulated in P, PD, PDP, HDP and KDP groups, and the expression of BDNF was significantly down-regulated in P, PDP, HDP and KDP groups ( P<0.05). Compared with group P, the apoptosis rate was significantly decreased, the expression of p-ERK1/2, p-CREB and BDNF was up-regulated, and the expression of cleaved caspase-3 was down-regulated in group PD ( P<0.05). Compared with group PD, the apoptosis rate was significantly increased, the expression of p-ERK1/2, p-CREB and BDNF was down-regulated, and the expression of cleaved caspase-3 was up-regulated in PDP, HDP and KDP groups ( P<0.05). Conclusion:The ERK1/2/CREB/BDNF signaling pathway is involved in dexmedetomidine-induced inhibition of propofol-caused apoptosis in isolated hippocampal neurons of fetal rats.

Objective:To evaluate modified Lanza score (MLS) of gastric mucosa for predicting the prognosis of geriatric patients with sepsis.Methods:Data of 50 patients with sepsis, who were over 60 years old and underwent gastroscopy for suspected gastrointestinal bleeding in the Department of Geriatric Critical Care Medicine of Guangdong Provincial People's Hospital from January 2019 to April 2022, were retrospectively analyzed. Patients were divided into the death group ( n=32) and the survival group ( n=18) according to their regression within 28 days after gastroscopy. Their gastric mucosa was scored by using MLS system, and the mortality of patients with MLS≥1 was calculated, then the patients were further divided into 2 groups, MLS=0-2 ( n=23, less than 2 regions of lesions ) and MLS=3-5 ( n=27, two or more regions of lesions). The relationship between MLS and acute physiology and chronic health status evaluation (APACHE) Ⅱ score, risk factor of death and mortality in each group were compared. The correlation between MLS and mortality was analyzed. The influence of geriatric sepsis risk factors affecting the prognosis of patients within 28 days were analyzed by using logistic regression. Results:Among the 50 geriatric patients with sepsis, those with gastric mucosal lesions, i.e., MLS ≥1, accounted for 68.00% (34/50), including 84.38% (27/32) patients with MLS≥1 in the death group, which was significantly higher than the 38.89% (7/18) patients with MLS≥1 in the survival group ( χ 2=10.593, P<0.001). Patients with MLS=3-5 had significantly higher APACHE Ⅱ scores (26.09±6.47 VS 18.57±7.66, t=3.527, P=0.001) and higher mortality [85.19% (23/27) VS 39.13% (9/23), χ 2=11.434, P=0.001] compared with MLS=0-2. Correlation analysis showed a significant correlation between MLS and mortality ( r=0.886, P=0.019). Multivariate logistic regression analysis showed that MLS=4-5 was an independent risk factor for death in geriatric patients with sepsis ( OR=17.055, 95% CI: 1.387-209.744, P=0.027). Conclusion:MLS presents high sensitivity in predicting 28-day outcomes for geriatric patients with sepsis. Two or more than 2 regions of gastric mucosal lesions can significantly increase the risk of death in geriatric patients with sepsis.