Objective To explore the clinical characteristics and prognostic factors in patients with Parkinson's disease (PD) and excessive daytime sleepiness (EDS) and to identify whether EDS could influence the sleep architecture and sleep apnea-related parameters.Methods A total of 130 PD patients were eligible and enrolled in the study.By the Epworth sleepiness scale (ESS),patients were divided into the EDS group (ESS ≥ 10) with 61 patients and the non-EDS group (ESS ＜ 10) with 69 patients.All underwent a video-polysomnography (PSG).Clinical characteristics were mainly evaluated by the unified Parkinson's disease rating scale (UPDRS) and the Hoehn-Yahr(H-Y) stage.while other related scales were applied for evaluating depression,cognitive function,quality of sleep and quality of life.Results A total of 61 patients (46.92％) were diagnosed as EDS (ESS≥ 10).Compared to the non-EDS group,the EDS group had significantly higher score of HAMD,UPDRS Ⅰ and UPDRS Ⅱ,and significantly lower score of MoCA and PDQ (all P ＜ 0.05).Non-conditional logistic regression analysis showed that the scores of HAMD and UPDRS Ⅰ were the main prognostic factors for EDS.Significantly decreased sleep latency (SL) was found in the EDS group by PSG (P =0.008).The score of ESS was showed to be correlated with the scores of HAMD,MoCA,UPDRS Ⅰ,UPDRS Ⅱ,PDQ and SL.Conclusions PD patients with EDS have more severe depression and cognitive dysfunction and worse quality of life.Sleep structure is altered in those patients with decreased sleep latency.Mental status is closely associated with EDS,but not sleep apnea.

Objective To investigate the correlation of diabetes duration and coronary arterial pathological changes by coronary angiography in patients with coronary heart disease and type 2 diabetes mellitus.Methods 206 patients with coronary heart disease admitted into the hospital were divided into 4 groups:no diabetes(n=62),the duration of diabetes ≤5 years(n=41),>5～≤10 years(n=38)and >10～≤20 years(n=45).The interventional therapy history and type 1 diabetes mellitus were excluded.The pathologic changes of coronary artery evaluated by coronary angiography and the results among different groups were analyzed with the diabetes duration.Results There was no significant differences in the pathological changes of coronary artery between the group of no diabetes and the groups of ≤5 years duration and >5～≤10 years duration.However,the group of >10～≤20 years duration showed more serious pathologic changes of coronary artery than other groups including the multi-branch lesion,diffuse lesion and obstruct lesion(P<0.01).Conclusion Following the process of the diabetes,the coronary lesions in patients with type 2 diabetes mellitus tend to be more widespread and severe.

Objective\ To study the early diagnosis and treatment of the fracture of posterior medial tubercle of the talus (PMTT).Methods\ Five cases of PMTT fractures had been definitely diagnosed by CT scan. Subtalar joint were involved in three cases, open reduction and internal fixation (ORIF) had been adopted in 2;and 1 had been treated conservatively because of the refusal to surgery by the patient. Plaster cast fixation and excision of fragment was done respectively in one case. Results\ Four out of five cases had been correctly diagnosed and one had been misdiagnosed in the first visit.The mean follow up was 24 months. Non union combined with tenderness and numbness of the sole of the foot was found in the misdiagnosed case after 6 months. Excision of the fragment was carried out for this case and a satisfactory result had been achieved. Three of the other four cases was treated operatively with a good result and one were treated conservatively with a poor result. Conclusion\ The PMTT fractures are rarely seen and often misdiagnosed. Early diagnosis and correct treatment is important to eliminate the nonunion or tarsal tunnel syndrome.

Objective To investigate the feasibility of laparoscopic repair for ingunal hernia after peritoneal dialysis. Methods Laparoscopic repair of inguinal hernia was conducted in 26 patients with chronic renal insufficiency who had received peritoneal dialysis for a long time. For indirect inguinal hernia, a piece of mesh was placed in the abdominal cavity and the internal ring was sutured and ligated under laparoscope. For direct inguinal hernia, the hernia sac was high suspended and then the mesh onlay was placed under laparoscope. Results The laparoscopy was successfully performed in all the 26 patients, without conversions to open surgery. No postoperative hematoma of scrotum or refractory neuralgia was observed. Follow-up examinations for 6~12 months (mean, 9 months) showed no recurrence. Conclusions Laparoscopic herniorrhaphy for inguinal hernia after peritoneal dialysis is feasible, effective, and safe.

Objective To investigate the changes of buffy coat components after 25Gy 137Cs-irradiation.Methods Lymphocyte proliferation was detected by MTT,the fluorescent intensity of neutrophils was measured as phagocytotic rate by flow cytometry,O2-release was determined by cytochrome C reduction,and cytokine production pre-and post-irradiation was detected by ELISA.Results 25Gy is adequate to inactivate T cells.The percentages of phagocytosis of E.coli before and after irradiation were of no significant difference.The release of O2-increased significantly and monocytes maintained the ability to produce cytokines after irradiation.Conclusion Radiation does affect the components of buffy coat,and neutrophils isolated should be transfused as early as possible.

Objective To stuey effects of coloprotectomy under colonoscopy combined with laparoscope on exfoliated tumor cells in abdominal cavity.Methods 42 cases of colorectal cancer proved by pathologic histology were devided into two groups randomly: Laparoscope Group(laparoscopic surgery) and Combined Group(colonoscopy combined with laparoscope surgery).Operation time,the positive rate of exfoliated tumor cells in abdominal cavity after and before operation,the positive rate of residual tumor cells in resection of operation specimen and postoperative complications between 2 groups were compared.Results Operation time of the Combined Group was shorter than that of the Laparoscope Group [(160.5?12.6) min vs.(201.2?18.4) min,t=-8.363,P=0.000].The positive rate of exfoliated cells in abdominal cavity before operation had no significant difference between the 2 groups[9.5%(2/21) vs.19.0%(4/21),?2=0.194,P=0.659],but the postoperative positive rate of exfoliated cells in the Combined Group was significantly lower than that in the Laparoscope Group[14.3%(3/21) vs.42.9%(9/21),?2=4.200,P=0.040].There were no residual tumor cells in resection of operation specimen of 2 groups.No infection of incisional wound and lung occurred.A follow-up for 6-24 months in the Laparoscope Group showed abdominal metastasis in 1 case.Conclusions Coloprotectomy for colorectal cancer under colonoscopy combined with laparoscope can decrease exfoliated tumor cells in abdominal cavity and shorten operation time.

Objective To explore the clinical significance of urine trace albumin in early diagnosis of diabetic nephropathy(DN). Methods A total of 35 patients with DN in DN group,32 patients with type 2 diabetes mellitus (DM)in DM group and 36 people accepted physical examination in control group.The urine trace albumin,blood urea nitrogen,serum creatinine were detected and compared.Results Urine trace albumin level in DN group was significant higher than those of DM group and control group,the differences were statistical significant(P <0.05),blood urea nitrogen and serum creatinine levels were slightly higher than those of DM group and control group,but there were no statistical significant differences (P >0.05).The urine trace albumin,blood urea ni-trogen and serum creatinine between DM group and control group had no statistical significant differences (P >0.05).Conclusion Urine trace albumin could be used as an early diagnostic index for early diagnosis of DN.

Objective: To determine the relationship among perceived stigma, mental health and unsafe sexual behaviors of people living with HIV/AIDS. Methods: Cross-sectional research was used to interview people living with HIV/AIDS (PLWHA) from April 2012 to March 2013 in Changsha, China. The questionnaires included General Questionnaire, Sexual Behavior Questionnaire, Patient Health Questionnaire Depression Scale (PHQ-9), General Anxiety Disorder Scale (GAD-7) and Psychometric Assessment of the HIV Stigma Scale. hTe results were statistically analyzed with SPSS18.0. Results: hTe total score of perceived stigma and its 4 dimensions were positively correlated with anxiety and depression. The total score of perceived stigma and its dimensions were associated with disclosure, but no signiifcantly correlated with other sexual behaviors. Hierarchical regression showed perceived stigma had an effect on anxiety. Conclusion: hTe stigma perceived by PLWHA is above the average level. Perceived stigma has an effect on mental health, especially anxiety, but no effect on unsafe sexual behaviors.

Objective:To explore the cause and treatment of hemorrhage in laparoscopic cholecystectomy(LC).Methods:The clinical data of 112 cases of LC were analyzed to summarize the causes and treatment of hemorrhage.Results:The causes of hemorrhage in LC included subjective and objective elements.All of them were successfully hemostatic in different ways including reclamping,coagulation,suturing,packing hemostasis and suspension of falciform ligament of liver.Conclusion:Hemorrhage is the serious and most common complication in LC,but it can be avoided through an immediate and effective process.

Objective To explore the distribution of temperament types and its related influencing factors of school-age twins.Method Childhood temperament were evaluated by standardized Middle Childhood Temperament Questionnaire (MCTQ) in a total of 125 pairs of 8 to 12 years old twins,and temperament related factors were measured by FACES Ⅱ-CV.Results The majority of temperament types of school-age twins were easy and intermediate-low.Easy,intermediate-low,difficult,intermediate-high and start-to-warm up took a percent of 41.6％,38.0％,11.2％,6.4％ and 2.8％,respectively.The heritability of temperament types was 0.454.The distribution of temperament types were influenced by the family cohesion,parenting rearing style,zygotic,age,father's occupation,mother's educational level and the method of delivery.Conclusion The temperament types of school-age twins were both influenced by genetic and environmental factors.