Objective To explore the influence of type 2 diabetes mellitus combined with subclinical hypothyroidism on diabetic vascular complications.Methods One hundred and two patients with type 2 diabetes mellitus were selected.The serum free triiodothyronine (FT3),free thyroxine (FT4),thyroid stimulating hormone (TSH),anti-thyroid peroxidase antibody (TPO-Ab),thyroglobulin antibody (TG-Ab) levels were measured by chemiluminescence method.The patients were divided into type 2 diabctes mellitus combined with subclinical hypothyroidism group (47 cases) and type 2 diabetes mellitus with normal thyroid function group (55 cases) according to the thyroid function.The glycated hemoglobin (HbA1c),total cholesterol (TC),low-density lipoprotein cholesterol (LDL-C),triacylglycerol (TG),high-density lipoprotein cholesterol (HDL-C),urea nitrogen,creatinine and albumin levels were measured.The estimated glomerular filtration rate (eGFR) was calculated according to the formula of modification of diet in renal disease (MDRD).The presence of diabetic retinopathy was examined by fundus examination,and the presence of lower limb artery lesions was measured by vascular ultrasound.All indicators were compared between 2 groups.Results There were no statistical differences in age,disease course,HbA1c,body mass index (BMI),TC,TG,HDL-C,LDL-C,incidence of lower limb artery lesions and incidence of diabetic retinopathy between 2 groups (P＞ 0.05).TheeGRF in type 2 diabetes mellitus combined with subclinical hypothyroidism group was significantly lower than that in type 2 diabetes mellitus with normal thyroid function group:(83.74 ± 21.55) ml/(min· 1.73 m2) vs.(115.02 ± 12.29) ml/(min· 1.73 m2),and there was statistical difference (t =4.274,P ＜ 0.01).The incidence of diabetic nephropathy in type 2 diabetes mellitus combined with subclinical hypothyroidism group was significanlty higher than that in type 2 diabetes mellitus with normal thyroid function group:48.9％ (23/47) vs.23.6％(13/55),and there was statistical difference (x2 =7.103,P＜ 0.01).Logistic regression analysis showed that subclinical hypothyroidism was a risk factor for diabetic nephropathy (OR =0.524,95％ CI 0.12-0.93,P ＜ 0.05),but it was not the risk factor for diabetic retinopathy (OR =0.618,95％ CI0.19-2.16,P =0.475) and lower limb artery lesions (OR =0.485,95％ CI 0.32-2.13,P =0.689).Conclusion Subclinical hypothyroidism in patients with type 2 diabetes mellitus has no obvious effect on lower limb arterial complications and diabetic retinopathy,but may increase the risk of diabetic nephropathy.

Objective To investigate the distribution and drug resistance of pathogens for hospital-acquired urinary tract infections between patients in internal medicine wards and in surgical wards .Methods A total of 586 midstream urine samples were collected from patients in the First Municipal Hospital of Qinhuangdao during January 2012 and December 2014.Vitek 2 Compact system was applied in bacteria identification and drug sensitivity tests .Excel and SPSS 11.5 software were applied for data analysis . Results A total of 661 strains were isolated , in which 404 strains were from internal medicine wards and 257 strains were from surgical wards .Escherichia coli (44.6%vs.33.1%) and Enterococcus (23.0%vs. 16.3%) infections were more common in the internal medicine wards (χ2 =8.620 and 4.309, P<0.05), while the occurrence of Pseudomonas aeruginosa infection (4.0%vs.24.5%) was higher in surgical wards (χ2 =63.056, P <0.01).Escherichia coli and Klebsiella pneumonia strains were highly sensitive to piperacillin/tazobactam, cefptetan, amikacin, imipenem, and meropenem, and the sensitivity rates were from 85% to 100.0%.The sensitivity rates of Escherichia coli to ampicillin/sulbactam, levofloxacin and ciprofloxacin were <30%, and strains from surgical wards had lower sensitivity rates to these drug than those isolated from internal medicine wards (χ2 =4.987, 4.575 and 5.359, P<0.05).The sensitivity rates of Klebsiella pneumonia isolated from internal medicine wards to ceftazidime , gentamicin and aztreonam were 68.8%, 60.6% and 69.7%, which were higher than those isolated from surgical wards (36.0%, 32.0%, and 40.0%), and the differences were of statistical significance (χ2 =6.068,4.661 and 5.115, P<0.05).Pseudomonas aeruginosa strains were highly sensitive to piperacillin/tazobactam and amikacin, and the susceptibilities of strains isolated from surgical wards (98.4%and 96.8%) were higher than those isolated from internal medicine wards (75.0% and 81.3%) (χ2 =11.797 and 5.221, P <0.05). Pseudomonas aeruginosa strains isolated from surgical wards were also highly sensitive to cefepime (92.1%), but the sensitive rate of strains from internal medicine wards was only 37.5%, and the difference was of statistical significance (χ2 =24.696, P<0.01).Enterococcus faecium and Enterococcus faecalis were sensitive to tigecycline , vancomycin and linezolid with the sensitivity rates over 95%.Except quinupristin/dalfopristin and tetracycline , the sensitivities of Enterococcus faecalis to other antibiotics were higher than Enterococcus faecium.Susceptibility of Enterococcus faecium from surgical wards (33.3%) to moxifloxacin was lower than those from internal medicine wards (70.8%), and the difference was of statistical significance (χ2 =4.629, P <0.05).Conclusion There are differences in distribution and antimicrobial susceptibility of pathogens isolated from internal medicine wards and from surgical wards .

AIM: To investigate the effects of apelin-13 on proliferation, migration and capillary-like tube formation of a monkey choroid / retinal endothelial cell line, RF/6A, to clarify whether apelin-13 could promote retinal angiogenesis in vitro.METHODS: RF/6A cells in good conditions were administrated with DMSO (the control group), apelin-13 at 0.1μmol/L (low dose group) or apelin-13 at 1μmol/L (high dose group).Cell proliferation, migration and capillary-like tube formation were detected by using the MTT assay, scratch assay and matrigel assay, respectively, at 24h after plating the cells.RESULTS: Cell proliferation was promoted in both low and high dose apelin-13 groups compared to the control cells (P<0.05);the cell migration distance of both apelin-13 groups was significantly greater than that of the control group (P<0.05);and the number of capillary-like tube structures of both apelin-13 groups was significantly larger than that of the control cells (P<0.05).In addition, cell proliferation, migration and tube formation increased as the concentration of apelin-13 increased.CONCLUSION: Apelin-13 could obviously promote the angiogenesis capacity of RF/6A cells, suggesting that apelin-13 was an important pro-angiogenic factor in retinal endothelial cells.

Objective To evaluate the biochemical function of rat nature three-dimensional acellular pancreatic bioscaffold (3D-APB) in promoting cell proliferation and differentiation in vitro.Methods The fresh pancreas from 10 rats were perfused to prepare 3D-APB.The biocompatibility of 3D-APB was eva luated.The experiment was divided into 4 groups based on 4 kinds of three-dimensional media for AR42J culture,including blank control group,ECM group,PLGA group and 3D-APB group.We compared the proliferation and differentiation of AR42J pancreatic acinar cell at 3 days,5 days,7 days and 10 days after seeding among 4 groups.Results The 3D-APB could represent a biocompatible scaffold capable of integrating within host tissue.The proliferation rate of AR42J cells by MTT in 3D-APB was higher,while the apoptosis rate by flow cytometry was lower than those in other 3 media,which were all significantly different (P ＜ 0.05),respectively.The protein expression of PDX-1 and PTF-1 by western blot in 3D-APB group was greatly higher than those in other 3 groups (both P ＜ 0.05).The mRNA expression of PDX-1 and PTF-1 through qRT-PCR was significantly higher than those in other 3 groups (both P ＜ 0.05).Conclusion Compared with the commonly used chemical and natural scaffold at present,3D-APB could promote cell proliferation and differentiation,which was more appropriate for regenerative medicine.

Objective To study the differences of esophageal manometry (M),pH set-up method (P) and X-ray (X) on positioning of the 24-hour esophageal pH catheter and relative factors. Methods Fifty subjects underwent M, then pH catheter was located by P and X. The difference between methods and the relative factors such as body height,lower esophageal sphincter (LES) length etc were analyzed. The difference of less than 2 cm between two methods was accepted. Results The length between the location determined by M,Pand X and nose were (37.9 ±2.9),(40.8 ±4.4) and (40.7 ±5.3) cm, respectively.There was significant difference between P and M as well as between X and M (P＜ 0.01 ). The coincidence rate was 62.0%(31/50) between P and M;84.0%(42/50) between P and X;and 58.0%(29/50) between X and M. Compared with P,M was (2.9 ±3.9) cm nearer to the stomach. Age, body height and LES length were main factors which affect the difference between P and M (P＜ 0.01 or ＜ 0.05),body height and LES length were main factors which affect the difference between X and M (P＜0.05 or ＜0.01). Conclusions Compared with M, the location determined by P is nearer to stomach. The location of X is varied. Body height and LES length are main relative factors.

Abnormalities, Multiple ; diagnosis ; therapy ; Asphyxia ; pathology ; Female ; Humans ; Infant ; Musculoskeletal Abnormalities ; diagnosis ; therapy ; Syndrome ; Thorax ; abnormalities

Objective +o evaluate percutaneous intervetional therapy for portal vein anastomotic occlusion after liver transplantation.Method From July 2005 to July 2013,13 patients (9 male and 4 female; aged 25-65 years) with portal vein occlsion underwent interventional therapy.All patients accepted the imaging examation and 8 patients had typical clinical signs of portal hypertension.Percutaneous hepatic balloon venoplasty and stent placement was performed,trans-catherter urokinase infusion for thrombolysis and embolization for collateral pathways performed if necessary.+echnical success rate,complication rate and clinical symptoms were analyzed.Follow-ups including clinical course,stent patency and potal vein thrombosis which evaluated by imaging were performed.Result +echnical success was achieved in l1of 13 patients (84.6％) and 15 stents were deployed.Seven patients with localized portal vein occulsion accepted balloon dilation and stents deployment,4 patients with long segment cculsion also accept trans-catherter urokinase infusion for thrombolysis and embolization for collateral pathways.Portal vein flow recovered in all 11 patients.Procedure related complication occurred in 2 patient with hemothorax.During the follow-up period of 4-42 months,the clinical signs of portal hypertension were not observed in all patients.Stent stenosis was found in one patient with ultrasound in 23 months,but stent patency was proved by the percutaneous portal angiography.Conclusion Interventional therapy is effective for portal vein occulsion after liver transplantation,comprehensive interventional therapy should be performed in long segment portal vein cculsion.

Objective: Based on nationwide cardiovascular surgery registry database, to analyze the current status and future development of minimally invasive cardiovascular surgery (MICS) in China.
Methods: There were 45 institutions from 19 provinces nationwide involved in Chinese cardiovascular surgery technique registry study. A total of 16480 adult patients with cardiovascular surgery from 2010-09 to 2012-03 were divided into 2 groups, Conventional surgery group, n=14503 and MICS group, n=1977. The basic clinical conditions were analyzed and compared between 2 groups in order to explore the current status and future development of MICS in China.
Results: Compared with Conventional surgery group, the patients in MICS group had the younger age, better and stable pre-operative condition. In MICS group, compared with 4 other common procedures, the patients who received hybrid procedure had obviously shorter cardiopulmonary bypass (CPB) time, aortic occlusion time, ventilator using time, ICU and in-hospital stay time, meanwhile decreased post-operative drainage volume;except for Robotic surgery, it required less red blood cells and plasma at during and post-operative time, all P<0.01. There were 12 (0.6%) in-hospital death in MICS group, the total complication rate was at 4%.
Conclusion: MICS are widely used in China, its short-term safety and efifcacy are conifrmed. Upon cardiovascular disease spectrum changing, the MICS procedures will be adjusted accordingly.

Objective:To investigate the efficacy of tyrosine kinase inhibitors (TKI) in the treatment of metastatic renal cell carcinoma with rhabdoid differentiation(mRCC-R) or sarcomatoid differentiation(mRCC-S)and the survival of the patients.Methods:The clinicopathological and postoperative follow-up data of 5 patients with mRCC-R and 9 with mRCC-S confirmed by pathology from February 2016 to December 2018 in Tianjin Medical University Cancer Hospital were reviewed. There were 3 male and 2 female patients in mRCC-R group, with the average age of (60.2±7.1)years old. The clinic manifestation included back or abdominal pain in 2 cases, loss of appetite and weight in one case and founding during physical examination in 2 cases, with the average maximum diameter was (8.8±4.1)cm. The site of tumor included left kidney in 3 cases and right kidney in 2 cases. Lung metastasis was found in 4 cases. Lung and peritoneum metastasis was found in one case. There were 8 male and 1 female patients in mRCC-S group, with the average age of (58.0±8.0)years old. The clinic manifestation included back or abdominal pain in one case, loss of weight in one case, gross hematuria in one case and founding during physical examination in 6 cases. The average diameter of tumor was (8.9±3.5)cm. The site of tumor included left kidney in 4 cases and right kidney in 5 cases. Postoperative metastasis included lung in 3 cases, bone in one case, retroperitoneal lymph node in one case, brain in one case, lung associated with bone in one case. All of the patients were pathologically diagnosed with renal clear cell carcinoma. After metastasis, 5 cases of mRCC-R and 6 cases of mRCC-S were treated with Sorafenib, 2 cases of mRCC-S were treated with Sunitinib, and 1 case of mRCC-S was treated with Axitinib. The efficacy of TKI for the two specific pathological types and for single pathological type at the early postoperative period (within 3 months) and 3 months later was compared. Meanwhile, subgroup analysis was performed on the efficacy of TKI and survival of patients with same metastatic sites in the two groups.Results:The mean overall survival(OS) of mRCC-R and mRCC-S treated with TKI was (26.5±5.5)months and (20.7±4.7) months( P=0.329), and the mean progression-free survival (PFS) was (21.9±5.5) months and (6.3±2.1)months( P=0.013), respectively. Comparing the efficacy of using TKI in the early postoperative period and after 3 months, the mean OS was (27.5±6.5)months and (16.8±6.1)months ( P=0.619), and the mean PFS was (12.3±3.3)months and (3.3±1.7)months ( P=0.096), respectively. There was only 1 patient with mRCC-R who used TKI within 3 months after surgery, and the result was disease progressed and eventually died, OS was 3 months. Comparing the efficacy of TKI in mRCC-R and mRCC-S with lung metastasis alone, the mean OS was (33.3±2.2) months and (19.5±8.9)months ( P=0.118), and the mean PFS was (27.3±3.1) months and (7.8±4.2) months ( P=0.009), respectively. Patients with liver, bone or brain metastasis only occurred in mRCC-S, so it is unable to identify the efficacy of TKI in the two groups. Conclusions:The efficacy of TKI in the treatment of mRCC-R was better than mRCC-S, and there was statistically significant difference in PFS, especially in patients with lung metastasis alone in the two groups. There was no significant difference in the efficacy between patients with mRCC-R who took TKI in the early postoperative period (within 3 months)and those who took TKI after 3 months.