Objective To evaluate the effect of hyperuricemia on vascular complications of type 2 diabetes and analysis of the possible mechanism. Methods 586 cases with T2DM were divided into two groups: normal serum uric acid (n=397) and hyperuricemia (n=189).The morbidity of macrovascular and microvascular complications and the serum levels of CRP,TNF,IL-1,IL-2,IL-6,IL-8 and PAI-1 were detected. Results (1)Hyperuricemia group showed higher BMI, blood pressure, TG,TC,LDL,WHR ratio and lower serum HDL-C than the group with normal uric acid (all P<0.05).(2)Group with hyperuricemia showed higher morbidities of macrovascular and microvascular complications than the group with normal uric acid (all P<0.05).(3) Group with hyperuricemia had higher levels of CRP,TNF,IL-6,IL-8,PAI-1 (all P<0.05). Conclusions (1) Hyperuricemia is associated with obesity and dyslipidemia.(2) Hyperuricemia may cause atherosclerosis by inflammation of vascular endothelium, resulting macrovascular and microvascular complications.

Objective To estimate the diagnostic value of dual-energy CT in gouty arthritis.Methods English and Chinese litera-tures publicated before May 2014 were searched in PubMed,Embase,Cochrane and Wanfang database.Available literatures were selected according to the inclusion and exclusion criterias.Sensitivity,specificity with 95% confidence interval (95% CI)was pooled with bivariate random-effects model.Hierarchical weighted symmetric summary receiver-operating curve (HSROC)was also used in estimating.Meta-regression and sensitivity analysis were used to explore the potential sources of heterogeneity.Results Nine studies were included in the analysis.The pooled sensitivity,specificity and 95% CI were 92%(84-96%)and 88%(83-92%)respectively, area under the HSROC curve was 0.91 (0.88-0.93).There was substantial heterogeneity between studies(I 2 =85%).Conclusion Dual-energy CT is accuracy in diagnosing gouty arthritis.The sources of heterogeneity was not been explored.

Objective To investigate clinical effect of reattribution-cognitive-pharmacy model (RCPM) in the treatment for irritable bowel syndrome(IBS). Methods 125 subjects with diarrhea predominant irritable bowel syndrome (IBS-D) were divided into two groups randomly. 62 patients in group A were treated with 10 ～ 20 mg of paroxetine without any other medication or psychological interview and 63 patients in group B received RCPM with interviewing once a week for 6 sessions and took 10 ～ 20 mg of paroxetine in the same way as group A after a week. The effect was evaluated at the end of 4 weeks and 12 weeks by a questionnaire. Results At the end of 4 weeks,29 patients in group A reported a reduction in abdominal pain,and 28 reported a reduction in stool frequency ,and 12 patients stopped taking paroxetine because of worrying about those side effect . In group B 48 reported a reduction in abdominal pain ,and 42 reported a reduction in stool frequency ,and 3 patients stopped taking paroxetine. At the end of 12 weeks,36 patients in group A reported a reduction in abdominal pain ,and 30 reported a reduction in stool frequency,and 14 patients stopped taking paroxetine because of worry about those side effect. In group B,54 cases reported a reduction in abdominal pain,and 45 reported a reduction in stool frequency,and 5 patients stopped taking paroxetine because of no obvious improvement. Conclusion RCPM can alleviate the abdominal pain and bowl movement frequency of IBS-D,and it seems better than paroxetine treatment alone. RCPM can improve compliance of paroxetine in patients with IBS-D.

Objective To investigate the efficacy of combination of reattribution cognitive psychotherapy and low-dose antidepressants in the treatment of ulcerative colitis (UC) complicated with functional symptoms , and to explore the psychosomatic digestive disease pattern that incorporated psychosocial variables into clinical thinking and practice .Methods From March 2016 to April 2017 ,sixty patients with UC who met the admission criteria were randomly divided into control group and observation group with 30 patients in each group .Both groups were treated with oral mesalazine ,and the observation group was further treated with reattribution cognitive psychotherapy and antidepressants . Clinical symptoms ,self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were applied to assess the efficacy at the time of enrollment and four weeks after treatment in both groups .Chi square test or t test was performed for statistical analysis .Results Among the 60 patients ,47 (78 .3％ ) met four syndromes of diagnostic criteria for phychosomatic research , and there was no statistically significant difference in the case number of each syndrome between the two groups (P> 0 .05) .After four weeks treatment ,the total effective rates of observation group and control group was 93 .3％ (28/30 ) and 53 .3％ (16/30) ,respectively ,and the difference was statistically significant (χ2 = 22 .667 ,P< 0 .05) . Before and four weeks after treatment , the SAS scores of observation group were 54 .50 ± 6 .70 and 41 .07 ± 3 .72 ,respectively ,and the difference was statistically significant (t=9 .595 ,P= 0 .005) .The SAS scores of control group were 54 .30 ± 6 .06 and 51 .90 ± 7 .92 ,respectively ,and the difference was not statistically significant (P=0 .195) .Before and four weeks after treatment ,the SDS scores of observation group were 50 .63 ± 6 .29 and 34 .40 ± 4 .58 ,respectively ,and the difference was statistically significant (t=11 .426 ,P=0 .025) .The SDS scores of control group were 50 .03 ± 6 .02 and 43 .47 ± 6 .81 ,respectively , and the difference was not statistically significant ( P= 0 .307 ) . Conclusions Psychosomatic model can significantly improve the functional symptoms complicated with UC .It is meaningful to incorporate psychosocial variables into clinical thinking and practice in psychosomatic digestive disease pattern .

Objective: To explore the clinical features, the serotype distribution and drug resistance of the isolates in patient with invasive pneumococcal disease (IPD). Methods: By retrieving the laboratory information system in 18 children′s hospitals from 2012 to 2017, the children with IPD were enrolled. Streptococcus pneumoniae (Spn) must be isolated from the sterile sites (blood, cerebrospinal fluid, hydrothorax and joint effusion etc.). The clinical characteristics, serotype, drug resistance, treatment and prognosis were reviewed and analyzed. According to the telephone follow up results, the patients were divided into death group and recovered group. The index as an independent risk factor of mortality was demonstrated by multivariate logistic regression analysis. Results: There were 1 138 children with IPD, including 684 male and 454 female. The proportion of male to female was 1.5∶1. The age ranged from one day to 16 years. The median age was 1 year 3 month. The majority was under 5 years of age (89.3%, n= 1 016), especially under 2 years of age (61.9%, n=704). In all cases, 88.2% (n=1 004) were community acquired infection. The infections included meningitis (n=446, 39.2%), pneumonia with bacteremia (n=339, 29.8%), and bacteremia without focus (n=232, 20.4%). Underlying diseases were found in 242 cases (21.3%). Co-infections were determined in 62 cases (5.4%) with mycoplasma, 27 cases (2.4%) with adenovirus and 34 cases with influenza virus (3.0%). The penicillin insensitivity (PNSP) rates in meningitis and non-meningitis isolates were 69.5% (276/397) and 35.9% (221/615), respectively. There were 81 strains serotyped, in which 93.8% (76/81) were covered by 13-valent protein-polysaccharide conjugate vaccine (PCV13). In the 965 patients who were followed up by phone call, 156 cases (16.2%) were confirmed dead. The independent risk factors for the death were under 2 years of age (OR=2.143, 95%CI 1.284-3.577, P=0.004), meningitis (OR=3.066, 95%CI 1.852-5.074, P<0.01), underlying disease (OR=4.801, 95%CI 2.953-7.804, P<0.01), septic shock(OR=3.542, 95%CI 1.829-6.859, P<0.01), disseminated intravascular coagulation (DIC) (OR=4.150, 95%CI 1.468-11.733, P=0.007), multiple organ failure (OR=12.693, 95%CI 6.623-24.325, P<0.01) and complications of central nervous system (OR=1.975, 95%CI 1.144-3.410, P=0.015). Conclusions Most children with IPD were under 5 years of age, having underlying diseases and acquired the infection in community. The independent risk factors for death were under two years old, meningitis, underlying diseases and multiple organ failure. The problem of drug resistance was severe. The universal immunization of PCV13 would be effective to prevent IPD in Chinese children.