Objective To study the relation between kidney function impairment and respiratory tract infections(RTI) in the elderly.Methods Two hundred and twenty-four patients above 65 years old were divided into five groups according to stages of chronic renal disease and estimated glomerular filtration rate (e GFR):(A group,n =65):≥90 ml/(min · 1.73 m2),(B group,n =55):60-89 ml/(min · 1.73 m2),(C group,n =27):30-59 ml/(min · 1.73 m2),(D group,n =28):15-29 ml/(min · 1.73 m2) and(E group,n =49):＜ 15 ml/(min · 1.73 m2).Taking A group as the control baseline.Logistic regression was employed to analyze the relationship between kidney function and RTL Results Compare with A group(10.8％,7/65),the incidences of RTI in three groups(C group,D group and E group were 63.0％ (17/27),85.7％ (24/28) and 100％ (49/49) respectively.The incidence in these groups was higher than that in A group(x2 =26.95,49.46 and 89.00 respectively,P ＜ 0.05).We identified the risk factors with RTI were smoking (Waldx2 =17.66,P ＜ 0.01),respiratory underlying diseases(Waldx2 =14.38,P ＜0.01),invasive operation history(Waldx2 =4.50,P ＜ 0.05),diabetes (Waldx2 =3.86,P ＜ 0.05),stay in hospital for above 2 weeks (Waldx2 =18.18,P ＜ 0.01),Gender(Waldx2 =4.12,P ＜ 0.05),eGFR (Waldx2 =13.57,P ＜ 0.01).After adjusting for other risk factors of RTI,Logistic regression analysis showed that the risk of RTI still increased with the decrease of eGFR (eGFR≥90 ml/(min · 1.73 m2):(Waldx2 =0.053,P ＞0.05);60-89 ml/(min · 1.73 m2):(Waldx2 =0.046,P＞0.05) ;30-59 ml/(minl · 1.73 m2):(Waldx2 =7.61,P＜0.05),15-29 ml/(min · 1.73 m2):(Waldx2 =4.38,P＜0.05); ＜15 ml/(min · 1.73 m2):(Waldx2 =13.57,P＜0.01)).Conclusion Kidney function impairment in patients above 65 years old is an independent risk factor for RTI.

Objective To investigate the effects of aerobic exercise training on oxidative stress and ultrastructure of pancreas tissue in diabetic rats and the mechanism of protective effects of aerobic exercise training on pancreatic mitochondria in diabetic rats.Methods Thirty Sprague-Dawley rats were randomly divided into three groups:a normal control group,a diabetic model group and an exercise diabetic group,with 10 rats in each group.Type 2 diabetic rat models were established by intra-abdominal injection of streptozotocin (STZ).The success rate of establishing diabetic rat models was 85.7％.The normal control group and diabetic model group were not given exercise training.Exercise group was trained with 8 weeks of swimming of medium strength,eg.60 min/time,5 d/week. After training for 8 weeks, the activities of superoxide dismutase(SOD), glutathion peroxidase (GPX),nitric oxide synthase (NOS) and the contents of malondialdehyde (MDA) and nitric oxide (NO) in pancreatic mitochondria were observed respectively.The ultrastructures of pancreas tissue in rats were observed under electron microscope.Results After swimming training for 8 weeks,the activities of SOD and GPx in pancreatic mitochondria in exercise diabetic group elevated more obviously than those in diabetic model group ( P ＜ 0.05 ),while the activity of NOS and the contents of MDA and NO reduced obviously (P ＜ 0.05 ).Compared with diabetic model group,the ultrastructures of pancreas tissue in exercise diabetic group improved,and the histomorphology was similar to normal control group.Conclusions Aerobic exercise training can provide protective effects on pancreas in diabetic rats,and can enhance antioxidation ability to eliminate free radicals,improve the ultrastructures of pancreas tissue.

ObjectiveTo explore the prognosis and relationship between soluble differentiation antigen of cluster designation 14 (sCD14) and the injury severity score (ISS) of casualties with multiple injuries.Methods A total of 86 casualties with multiple injuries were enrolled from October 2009 to March 2010,and the severity of trauma of casualties were assessed in ISS score within the first 24 hours after accident,and the patients were divided into survival and non-survival groups as per the outcomes in 28 days after accident. Another 20 healthy subjects served as control group. In multiple injuries group,sCD14 concentrations were detected and APACHE Ⅱ scores were calculated on the 1st,3rd,5th and 7th days after accident.The related coefficient between sCD14 and ISS was calculated and then the values of sCD14 in predicting prognosis were analyzed by ROC curve. ResultsCompared with control group, sCD14 concentrations were obviously higher in casualties of multiple injuries group at all observation intervals ( P ＜0.01). Compared with survival group, casualties of non-survival group had more higher sCD14 concentrations and APACHE Ⅱ scores ( P ＜ 0.05 ).The sCD14 concentration was correlated with ISS and the related coefficient was 0.469 ( P ＜ 0.01 ). ROC curve analysis suggested sCD14 had values in predicting prognosis of casualties with multiple injuries and area under ROC curve was 0.820.Conclusions The concentration of sCD14 is correlated with ISS and can be used for predicting the prognosis of casualties with multiple injuries.

Mesenchymal stem cells (MSCs) are multipotent stem cells existing in multi-organs and can differentiate into several kinds of somatic cells. Recently it has been found that MSCs, under defined conditions in vivo or in vitro, can be induced to trans-differentiate into islet-like cells, which can secrete a small amount of insulin and lower blood glucose levels in diabetic mice. Thus, two major obstacles of islet transplantation, the insufficience of donor islets and immunologic rejection, might be solved simultaneously with this technique. This finding provides a new insight into treatment for diabetes.

Objective To investigate the effect of common diseases by the Charlson weighted index of comorbidities(WIC) in predicting 1-year survival rate of older patients with rectum cancer.Methods Retrospective analyzed 160 patients with rectum cancer who were admitted in general surgery of Beijing Chaoyang Hospital Affiliated to Capital Medical University from Jun.2011 to May 2012.The patients were divided into two groups according to 1-year survival status:survival group (n =123) and death group (n =37).The data were recorded including age,gender,cancer diagnosis,underlying diseases,operation mode (laparoscopic or open) The WIC and the Acute physiology and chronic health Ⅱ (APACHE Ⅱ) score were calculated.Logistic regression analysis was used to determine the independent predictors for 1-year survival rate.Receiver operating characteristics(ROC) curve was used to evaluate the value of WIC in predicting 1-year survival rate.Results Of the 160 patients,123 cases survived,37 cases died at 1 year after treatment.WIC score and APACHE score in death group were (2.2 ± 1.3) and (11.5 ± 5.1),higher than those of survival group (1.3 ± 1.2,9.5 ± 4.3 ;P =0.021,0.014).Multivariate Logistic regression analysis indicated that age,mode of operation,WIC score and APACHE score were related to the 1-year survival status of patients with rectal cancer(OR(95％ CI):1.053 (1.018-1.178,1.021 (1.011-1.906),1.786 (1.203-2.235),1.019 (1.004-1.628).ROC curve area of forecasting of death of the WIC score,APACHE Ⅱ score and the combination of the two are 0.731,0.828,0.959.Conclusion The WIC scoring system can be a good evaluation method for 1-year survival rate in old patients with rectum cancer.

Objective:To observe the clinical efficacy of acupoint massage plus moxibustion in treating refractory insomnia.
Methods:Sixty patients with refractory insomnia were randomized into two groups, 30 in each group. The treatment group was intervened by acupoint massage on the face and head plus moxibustion at Yongquan (KI 1);the control group was intervened only by the same acupoint massage. For both groups, the treatment was given once a day, and the therapeutic efficacy was evaluated after 4-week treatment.
Results:The total effective rate was 93.3%in the treatment group versus 80.0%in the control group, and the difference was statistically significant (P<0.05).
Conclusion:Acupoint massage plus moxibustion can produce a better efficacy than acupoint massage alone in treating refractory insomnia.

Objective The study is to investigate the effects of skin protectant carried out among the patients with incontinence,analyze the risk factors and protective factors of the occurrence of incontinence-associated dermatitis,and provide effective preventive measures for clinic.Methods From May 2013 to January 2014,174 cases of high-risk patients with incontinence from care units of intensive care unit,neurology intensive care unit,neurosurgery intensive care unit,and emergency intensive care unit of a top three hospital of Nantong were divided into three groups and provided with preventive interventions of skin protectant.Group A used ostomy skin care powder,group B used tannic acid ointment,and group C used Comfeel skin protective film.The incidence rate and time to onset of incontinence-associated dermatitis were compared,and then the relevant factors which might cause the occurrence of incontinence-associated dermatitis underwent Logistic regression analysis.Results 32 cases (18.4％) of patients after application of skin protectants occurred incontinence-associated dermatitis.The incidence rate of IAD in the three experiment groups (group A,group B and group C) were 30.4％,10.3％ and 15.0％.The incidence rate of IAD was the lowest in group B,followed by group C and group A.There was a significant difference among the three groups.In the comparison pair match,the differences of incidence rate between group A and group B,group A and group C were statistically significant,but the incidence rate of group B and group C was statistically insignificant.Mean time to onset of incontinence-associated dermatitis was (7.00± 3.91) days.The occurrence time of IAD among the three groups was not statistically significant.Conclusions In the process of incontinence care,it should be given as early as possible to clean the peri-anal skin and apply skin protectant with better preventive effects.

With the economic growth and better standards of living,the prevalence of non-alcoholic fatty liver disease (NAFLD) is expected to increase dramatically worldwide.NAFLD is a common chronic inflammation disease.NF-κB is a transcription factor that plays crucial roles in inflammation,immunity,cell proliferation and apoptosis.It can facilitate the occurrence and development of NAFLD,and the underlying mechanisms are related to insulin resistance,oxidative stress,alteration of intestinal flora,activation ofrenin angiotensin system,etc.

By using the famous American pedagogical and psychological scientist Gagne,Robert's opinion about the component and organization of study diathesis mentioned in his book named Principle of Teaching Design, the author analyzes the construction of diathesis of Chinese students : the innate diathesis , the acquired diathesis and the naturally developed diathesis. Based on the knowledge and ability that high quality medical talents should have in the future, the article prefer the thought and methods to cultivate high quality medical talents by complying with the modern psychological theory.