Objective To observe some current situation in elderly Diabetes Mellitus with ethics in China,and to explore the method to solve the problems.Methods To analyze the problems with ethics.Results To advance some methods for solving the ethical problems associated with doctors and nurses,family and society.Conclusions Only by improving the minds of medical ethics of doctors and nurses,contributing infinite patience,attention and care,offering elderly diabetes mellitus patients much more help and ethical care with their family and society,they can get better clinical diagnosis and treatment,spiritual consolation,life care and economic support.

Objective To analyze the clinical data of patients with penicilliosis marneffei(PSM),summarize clinical characteristics of serosal involvement and provide experience to diagnose and treat serous effusion.Methods We retrospectively analyzed 61 patients with estabolished PSM infection in our hospital from March,2001 to March,2008.Patients were divided into positive groups while presented one or more abnormal serous effusion such as pleural effusion,ascites,pericardial effusion or cerebrospinal fluid.There were ten patients in positive groups finally,including nine male and one female whose ages ranging from 36yr to 67yr[mean(54.2?8.3)yr].Results(1)There were ten cases with pleural effusion,including two cases with pericardial effusion,five cases with ascites and two cases with abnormal cerebrospinal fluid.Ten cases were misdiagnosed as tuberculous pleurisy and accepted anti-tuberculosis treatment,two cases as tuberculous meningitis,two cases as tuberculous pericarditis,five cases as tuberculous peritonitis and five cases as malignant pleural effusion.(2)All patients manifested with fever,anemia,hypodynamia or emaciation,nine cases with cough,eight cases with chest pain,six cases with dyspnea,two cases with alvi profluvium,three cases with bellyache,five cases with necrotic papula,eight cases with subcutaneous abscess,nine cases with lymphadenectasis,nine cases with splenohepatomegalia and seven cases with moist rales.(3)Total white blood cells count increase in nine cases which mainly presented with significantly increase in neutrophil count[(17.6?5.3)?109/L]and ratio(0.841?0.048).Lymphocyte ratio was relatively low(0.976?0.035),but count was normal[(1.59?0.7)?109/L].(4)Human Immunodeficiency Viruses was negative in all patients and the CD4/CD8 ratio was 1.19?0.38.(5)Ratio of A/G was inversion in ten cases.Bilirubin,erythrocyte sedimentation rate and C-reactive protein increase in six cases,ten cases and ten cases respectively.Abnormal renal function appeared in five cases.(6)All cases were defined according to etiology including hemoculture(5 cases),medulloculture(2 cases),sputum culture(1 case),abscess secretion culture(4 cases) and histopathology(4 cases).(7)Imaging check demonstrated parenchymatous abnormality in lung(10 cases),splenohepatomegalia or abdominal para-aortic lymphadenectasis(9 cases)and osteolytic damage(6 cases).(8)The property of serous effusion which appeared cloudy yellow or uprightness was exudate.The cell count especially neutrophil count and protein content increased in it.(9)Anti-eumycete medicine were administered to four cases and achieved improvement.Three cases died of respiratory failure,cardiac failure,hepatic and renal failure.Two patient's condition aggravated and one patient voluntarily leaved hospital without treatment.Conclusion Penicilliosis marneffei often occurs in serous cavity of normal immune function crowd.Clinical characteristics manifest with chronic pyogenic and infected diseases which appear significant increase in neutrophil count.It invades lung,abdominal organ and might be complicated with pleural effusion,ascites and abnomal cerebrospinal fluid.The property of effusion is consistent with inflammatory efflusion which can be totally absorbed under effective anti-fungal treatment.Clinical prognosis relates with general body state.

In present paper, research achievements of post-harvest handling concerning decorticating, boiling, sul-fur-fumigation, drying and sterilizing as well as quality control of Radix Paeoniae Alba were reviewed. Major prob-lems in the post-harvest handling and quality evaluation of Radix Paeoniae Alba were discussed. Strategies for im-provement in post-harvest handling and quality control were proposed, so that the safety and quality consistency can be assured in the medicinal application of Radix Paeoniae Alba.

Objective To explore the influence of the combination therapy of probucol with atorvastatin on levels of serum high sensitivity C-reactive protein (hs-CRP), oxidized low-density lipoproteins (ox-LDL), and marix metallopro? teinase-9 (MMP-9) and resolution of carotid plaque in patients with acute cerebral infarction (ACI). Methods One hun? dred-six patients with acute cerebral infarction who had carotid artery color Doppler ultrasound-confirmed atherosclerot? ic plaques , were included in the present study. The patients were randomly divided into two groups: conventional treat? ment group ( 40 cases) which received atorvastatin (20mg/d) and co-treatment group (40 cases) which received Atorvas? tatin (20mg/d) and Probucol (500mg/d). Levels of hs-CRP, ox-LDL and MMP-9 were detected in all patients before treat? ment and 1, 6 and 12 months after drug therapy. The Intima-media thickness, area and numbers of carotid plaques were evaluated by using Doppler ultrasonography during a 12 months follow-up period. Results ① Serum hs-CRP and MMP-9 levels were significantly decreased at 1, 6 and 12 months after treatment, (conventional treatment group:t =14.662, 23.586, 28.179 and co-treatment group:t =47.023, 50.239, 50.774,P <0.01). The ox-LDL levels was obviously de? creased in the combined treatment group (t =4.592, 5.011, 5.892,P <0.01) but not in conventional treatment group (P > 0.05) at 1, 6 and 12 months after treatment. Serum hs-CRP, ox-LDL and MMP-9 levels were significantly lower in com? bined treatment group than in the conventional treatment group at all time points after treatment (t =7.655, 5.271, 2.492, t =4.927, 3.772, 4.673 andt =16.862, 4.251, 2.045.P <0.01 orP <0.05). ②There were not statistically differences in the IMT, plaque area and plaque numbers between these two groups before treatment (P >0.05). The IMT, plaque area and plaque numbers were significantly smaller in combined treatment group than in conventional treatment group (t =6.117, 3.290, 2.158,P <0.05). Conclusions The combination therapy of probucol with atorvastatin can greatly reduce levels of serunl hs-CRP,ox-LDL and MMP-9, indicating that the combination therapy has a strong anti-oxidant function, thereby reversing and stabilizing the atherosclerosis plaque.

Objective:To observe and compare the clinical effect of single-incision and two-incision posterior chamber phakic intraocularlens implantation in the correction of extreme myopia.Methods:40 cases(80 eyes) of patients with extreme myopia underwent conventional two-incision posterior chamber phakic intraocularlens implantation in our hospital from January 2011 to June 2013 were selected as the control group and 40 cases(80 eyes) underwent single-incision posterior chamber phakic intraocularlens implantation from July 2013 to January 2016 were selected as observation group.The open hole before and after operation,best corrected visual acuity of vision,operation safety,effectiveness index,diopter (column mirror,equivalent ball for eyeglasses),intraocular pressure,ECD,anterior chamber depth and occurrence of complications were compared between two groups.Results:The uncorrected visual acuity (UCVA) of both groups at 6 months after operation were significantly higher than those before operation (P＜0.05),which was significantly higher in the observation group than that of the control group (P＜0.05);The operation safety and effectiveness index of observation group were significantly higher than those of the control group (P＜0.05);The cylinder and spherical equivalent degree of both groups at 6 months after operation were significantly better than those before operation(P＜0.05),which was significantly better in the observation group than that of the control group(P＜0.05).The corneal endothelial cell counts(ECL) of control group after operation was significantly lower than that before operation (P＜0.05),and no significant difference was found in the ECL of observation group before and after operation (P＞0.05).The ECL of observation group after operation was significantly higher than that of the control group (P＜0.05);The incidence rate of complication in observation group was significantly lower than that of the control group (P＜0.05).Conclusion:Compared with two-incision operation,the single-incision posterior chamber phakic intraocularlens implantation had remarkable clinical effect in the correction of extreme myopia with higher security.

Picrotoxin is an anatagninst of gamma-aminobutyric acid, which is an internal inhibition-transmitter in the central nervous system, Picrotoxin exerts a biphasic action on the blood pressure and heart rate in rats and cats in vivo. That is to say, in the initial stage, picrotoxin can lower the blood pressure and heart rate, and then an elevation of these two even above the original level can be observed, up to the present, from the authors limited literature, there has been no report dealing with the problem whether picrotoxin can act on an isolated heart directly.In this study, the heart of a frog was isolated and routine intubation of the heart was done for its perfusion. Physiological polyconduction instrument was inserted through a mechanical transducer to record the heart rale and myocardial contractility. A suspending glass microelectrode coupling with a microamplifier is used to record the action potential of the ventricular myocardium. Real time analysis of all the data was accomplished with a microcomputer. The dosages of picrotoxin used were 1,5, 3.0, 6.0, and 12.0 mg per kilogram of body weight.It was found that picrotcxin can directly act on the isolated frog heart. The results were as follows.1 ) Picrotoxin exerts inhibition on the special conduction system of the heart,and the A-V node and venous sinus are very sensitive. Complete or partial transmission block can be induced.2 ) It can elicit clearly a fall of the heart rate but no biphasic action can berevealed. 3) It can reduce the myocardial contractility, suggesting that the calciuminflow during the functioning period of the action potential is effected. 4 ) It can reduce the amplitude of the action potential but no effect on themaximal depolarization speed is observed, suggesting that picrotoxin islikely to affect the level of resting potential but not the action potentialin the depolarized period.

Objective To investigate current status of use of oral hypoglycemic drugs and insulin among adult patients with type 2 diabetes mellitus (T2DM) in urban community of Beijing.Methods In total,3297 T2DM patients aged more than 20 years from 15 urban communities of Beijing were studied.Their body weight,height,fasting plasma glucose level and glycosylated hemoglobin Alc (HbAlc) were measured.A door-to-door questionnaire survey on use of oral hypoglycemic drugs and insulin was conducted for them.All the T2DM patients surveyed were divided into four groups based on their received intervention.Results ①Of 3279 T2DM patients,454 (13.8％) received lifestyle intervention,971 (29.5％) used only one oral hypoglycemic drug,1179 (35.7％) with combined oral hypoglycemic drugs,and 693(21.0％) with insulin.②There was significant difference in average HbAlc among the four groups of T2DM patients with lifestyle intervention,only one oral hypoglycemic drug,combined oral hypoglycemic drugs,and insulin,with HbAI c of (7.0 ± 1.9) ％,(7.1 ± 1.5) ％,(7.4 ± 1.5 ) ％,and (7.5 ± 1.5 ) ％for them,respectively ( F =15.1,P ＜ 0.01 ).Proportions of the T2DM patients with HbAlc equal to or higher than 7.0％ were 32.2％,39.4％,52.1％ and 59.5％ for the four groups,respectively ( x2 =117.7,P ＜ 0.01 ).③In the T2DM patients with lifestyle intervention,32.2％ (146/454) of them with HbA1 c equal to or higher than 7.0％ were untreated with any oral hypoglycemic drug.In those with only one oral hypoglycemic drug,39.4％ (383/971) of them with HbAlc equal to or higher than 7.0％ were not treated with combined oral hypoglycemic drugs and/or insulin.In those with combined oral hypoglycemic drugs,52.1％ (614/1079) of them with HbAlc equal to or higher than 7.0％ were not received combined insulin treatment.④ Fasting plasma glucose level,treatment strategies,postprandial 2-h blood glucose level and length of the illness were independent risk factors for HbAlc level equal to or higher than 7.0％,with odds ratio (OR) of 1.757,1.256,1.175 and 1.031,respectively.⑤ In 2843 T2DM patients with oral hypoglycemie drugs and/or insulin treatment,1494 (52.6％ ) received biguanides and 693 received (24.4％ )insulin,respectively.Conclusions More than half of adult patients with T2DM do not meet the target of glycemic control of HbAlc less than 7.0％ in urban communities of Beijing,due to not active use of oral hypoglycemic drugs,and not timely adoption of combined use of oral hypoglycemic drugs and insulin therapy.

Objective To study clinical characteristics of type 2 diabetic(T2D)patients with metabolic syndrome(MS)and its components in Beijing urban communities.Methods Totally,3295 T2D patients involved in a combined prospective diabetic management study from 15 urban communities in Beijing were classified as four groups, according to 2004 Chinese Diabetes Society's definition of MS, i. e, isolated T2D, T2D with one component of MS, T2D with two components of MS and T2D with three components of MS. Their clinical characteristics were analyzed. Results ( 1 ) Among 3295 T2D patients, 155 (4. 7% )were isolated T2D, 107 (32.6%) T2D with one component of MS, 1386 (42.1%) T2D with two components of MS and 679 (20.6%) T2D with three components of MS, with an overall 62.7% (2065/3295) of T2D patients complicated with MS. (2) In these T2D patients, the more components of MS they had, the higher body mass index (BMI), waist circumference, waist to hip circumference ratio (WHR),systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting serum levels of insulin and triglyceride (TG) and the lower level of high-density lipoprotein-cholesterol (HDL) were presented (P <0. 01 ). (3) Percentage of isolated T2D in women increased from 49. 0% (76/155) to 61.9% (420/679)of those with three components of MS ( P < 0 01 ), with increasing of components of MS. (4) Multiple logistic regression analysis showed that BMI, history of hypertension, decreased HDL, increased TG,increased blood pressure, all were risk factors for T2D patients complicated with MS. Conclusions Among T2D patients in urban communities of Beijing, 95.3% (3140/3295) of them complicated with one or more components of MS, and 61.9% (420/679) of them complicated with MS. So, community diabetic management must be implemented in an all-round way, including control of blood pressure, blood lipids,body weight and so on, in addition to control of blood sugar.

Objective To investigate the prevalence of dyslipidemia in subjects with type 2 diabetes mellitus in Beijing urban communities.Methods Total 3316 subjects with type 2 diabetes (age 20-80 years) were recruited from 15 urban community health centers in Beijing using a multi-stage random sampling approach.Dyslipidemia was diagnosed according to Chinese Guidelines on Prevention and Treatment of Dyslipidemia in Adults:2007 version.Results Among 3316 diabetic subjects (1329 malesand 1987 females),75.6％ (2506/3316) had dyslipidemia,the prevalence was 72.5％ (964/1329)in men and 77.6％ (1542/1987) in women.The prevalence of hypertriglyceridemia and hypercholesterolemia was 41.9％ (1388/3316) and 48.1％ (1595/3316),respectively.31.5％ (1043/3316) subjects had high levels of low-density lipoprotein cholesterol (LDL-C) and 21.2％ (703/3316) had low high-density lipoprotein cholesterol (HDL-C).Among all subjects with dyslipidemia only 22.9％ (575/2506) took hypolipid agents.The overall blood lipid control rates of triglyceride (TG),total cholesterol (TC),LDL-C and HDL-C in 1393 subjects with dyslipidemia history were 48.0％ (669/1393),17.4％ (242/1393),30.9％ (430/1393) and 75.8％ (1056/1393),respectively.Diabetics with dyslipidemia had higher body mass index,waist circumference,blood pressure,plasma glucose and hemoglobin A1c.The prevalence of dyslipidemia in the overweight and uncontrolled-glucose group were 79.0％ (1678/2125),78.9％ (1756/2227),respectively.Logistic regression analysis showed that gender,age,body mass index and hemoglobin A1c were associated with dyslipidemia.Conclusions The prevalence of dyslipidemia in diabetic subjects in Beijing urban communities is high and less than one quarter patients take hypolipid agents.Age,body mass index and hemoglobin A1c are the risk factors of dyslipidemia in type 2 diabetic patients.

Objective To understand the dominant pathogens of febrile respiratory syndrome (FRS) patients in Gansu province and to establish the Bayes discriminant function in order to identify the patients infected with the dominant pathogens.Methods FRS patients were collected in various sentinel hospitals of Gansu province from 2009 to 2015 and the dominant pathogens were determined by describing the composition of pathogenic profile.Significant clinical variables were selected by stepwise discriminant analysis to establish the Bayes discriminant function.Results In the detection of pathogens for FRS,both influenza virus and rhinovirus showed higher positive rates than those caused by other viruses (13.79％,8.63％),that accounting for 54.38％,13.73％ of total viral positive patients.Most frequently detected bacteria would include Streptococcus pneumoniae,and haemophilus influenza (44.41％,18.07％) that accounting for 66.21％ and 24.55％ among the bacterial positive patients.The original-validated rate of discriminant function,established by 11 clinical variables,was 73.1％,with the cross-validated rate as 70.6％.Conclusion Influenza virus,Rhinovirus,Streptococcus pneumoniae and Haemophilus influenzae were the dominant pathogens of FRS in Gansu province.Results from the Bayes discriminant analysis showed both higher accuracy in the classification of dominant pathogens,and applicative value for FRS.