Objective To investigate the association between serum Klotho and oxidative stress in metabolically healthy obese individuals. Methods 180 physicalexamination subjects were investigated. They were devided into 3 groups:60 cases of normal weight and metabolic normality,60 cases of metabolically healthy but obese( MHO) ,60 cases of obesity with metabolic syndrome. Fasting blood glucose(FBG),2 h blood glucose(2 hBG),triglyceride ( TG) ,high densitylipoprotein cholesterol( HDL-C) , systolic blood pressure, diastolic blood pressure,body height, body weight,waist circumference,body mass index( BMI) were recorded. Malondialdehyde( MDA) ,superoxide dis-mutase( SOD) ,total antioxidation capacity( TAOC) ,Klotho were detected by ELISA. The difference of clinical pa-rameters,metabolic parameters,oxidative stress and Klotho among these three groups was compared by the methods of covariance analysis. Regression analysis and pearson correlation were used to evaluate the relationship of Klotho with oxidative stress. Results Compared with the control group, TAOC, SOD, Klotho were decreased significantly while MDA elevated significantly in both MHO group and obesity with metabolic syndrome group(P<0. 05). Com-pared with MHO group, TAOC, Klotho were significantly lower in obesity with metabolic syndrome ( P<0. 05 ) . Klotho protein was significantly positively associated with SOD, TAOC, negatively associated with waist circumfer-ence,BMI,FBG,2 hBG(r= -0. 182,-0. 225,-0. 221,-0. 202,-0. 188,P<0. 05). SOD,TAOC were deter-minants for Klotho. Conclusion The balancebetween oxidative and antioxidative system is disturbed in subjects with MHO. Klotho protein may maintain the normal metabolism of thebody by regulating the oxidative stress.

Twenty-two cases of infantile muscular torticollis were treated with such Tuina manipulations as pushing, kneading, grasping and wrenching with the following result: 18 cases got recovery, 3 cases got marked effect and 1 case got no effect. The whole effective rate was 95.4%.

Objective To explore application of case management for hypertension in the elderly.Methods In total, 106 elderly patients with hypertension treated at outpatient and inpatient departments of the First Affiliated Hospital of Xian Jiaotong University were recruited during January to October 2007, and divided randomly into two groups, one with conventional management and the other with case management.Patients with conventional treatment accepted routine diagnostic and therapeutic procedures and were followed-up passively, and patients with case management accepted integrated therapy and active interview provided by a team with a cardiovascular specialist as core, were followed-up actively and their medical records were kept in files. Percentage of the patients with blood pressure lowered to meet criteria of effectiveness and their improvement in depression and anxiety status and quality of life were evaluated two years after management for the two groups. Results Percentage of patients with their blood pressure lowered to meet effective criteria increased significantly in both of the groups, from 32. 8% to 67.5% in patients with conventional management and from 33.7% to 83.4% in those with case management ( P = 0. 007 ),respectively. Scores of self-rating anxiety scale ( SAS) and self-rating depression scale (SDS) decreased in patients of the both groups, from 57 ± 10 and 56 ± 11 before management to 40 ±9 and 48 ± 10 after it,respectively in patients of conventional management ( P = 0. 032 ), and from 56 ± 10 and 57 ± 10 before management to 35 ±9 and 40 ± 9 after it ( P = 0. 008 ), respectively in those with case management; and scores of quality of life improved in patients of the two group, from 65 ± 13 before management to 85 ± 14 after it in those with conventional management, and from 64 ± 13 before management to 98 ± 14 after it in those with case management ( P = 0.017 ), respectively. Conclusions Case management is better for chronic diseases and recommended in management for the elderly with hypertension, which can improve their targets of blood pressure lowering, decrease their scores of SAS and SDS and improve their quality of life,with an integrated, in-depth, continuous management.

Objective To observe the effects of salmeterol/fluticasone on the bone metabolism and bone density of the patients with moderate COPD and whether the effects is relate with inhaled corticosteroid course. Methods Sixty pa-tients with COPD were divided into 2 groups by random digit table. Patients in experimental group (n=30) were given conven-tional therapy with salmeterol/fluticasone one inhale(bid) for continuously 12 months while patients in control group (N=30) were given conventional therapy without any glucocorticoid.The bone mineral density (BMD) of the femoral triangle in all patients were measured by DXA before therapy, 3 months and 12 months after therapy. At the same time, biochemical indi-cators that are correlated with bone metabolism include bone gla protein (BGP) and alkaline phosphatase (ALP) were mea-sured by radioimmunoassay. Results The BMD, BGP and ALP of patients in experimental group and in control group be-fore therapy, 3 month and 12 month after therapy were compared. There is no significant difference (P>0.05) between these two groups before therapy and after 3 month but significant difference was shown after 9 months (P<0.05). Conclusion Short period inhaling salmeterol/fluticasone in patients with COPD is safe. But long-term inhaling salmeterol/fluticason may lead to decline of the bone density in patients with COPD.

Objective To compare and analyze the effect of laparoscopic surgery and open toperation of rectal can﹣cer in middle or lower positions. Methods 128 patients with middle or lower rectal cancer were randomly divided into observation group and control group, 64 cases in each one, Laparoscopic surgery for observation group and con﹣trol group using traditional open surgery. Operative time, blood loss, ambulation time, length of stay, postoperative complications, anus-preserving, the recurrence during follow-up were compared between the two groups. Results Blood loss, ambulation time, length of hospital stay, the observation group were significantly less than the control group (P< 0.05), operation time between the two groups have no obvious differences (P> 0.05). Nine patients in control group with complications, the rate was 14.1 %; postoperative complication were observed in 2 cases, the rate was 3.1 %; complication rate in observation group was significantly lower than the control group (P< 0.05). Anus-preserving rate was significantly higher in the observation group (P<0.05);followed up for 8-47 months with an av﹣erage follow-up (23.1 ± 6.4) months, relapse rates of the two groups have no significant difference (P> 0.05). Con﹣clusions Compared with open operation,laparoscopic surgery is safe and effective, can reduce the surgical trauma and complications, shorten hospitalization time, improve the anus-preserving rate, worth clinical promotion.

Objective To study the genome dynamics of Y. pestis and look for the relationship between its genome microevolution and niche adaption.Methods The DNA microarray combined with PCR was used to perform comparative genomic analysis of natural populations of Y.pestis.Results It was revealed that considerable genome dynamics of Y. pestis were the result of gene acquisition and loss in genome. We established a genomotyping system to group homologous isolates of Y. pestis, drew an outline of parallel microevolution of the Y. pestis genome, and established the link between the bacterial niche adaptation and genome microevolution.Conclusion The transmission, colonization and expansion of Y. pestis in natural foci are the results of its parallel, directional and gradual adaptation to the complex interactions among the environment, the hosts, and the pathogen itself.

Objective To develop a whole-genome DNA microarray based on the genomic sequences of Y. pestis CO92 and 91001 and its use in comparative genomic analysis. Methods A total number of 4 005 genes of Y. pestis were amplified by PCR and printed onto glass slides in duplicate. Fluorescently labeled probes were prepared by marking genomic DNAs with random hexamers and Klenow. Labeled DNAs were hybridized with the microarrays by the method of two-fluorescence comparative hybridization. Three sets of two-fluorescence hybridizations were performed to examine the absence/presence of each gene. Results The results agreed with those derived from the in silico genomic comparison. Conclusion The results demonstrate that the microarry can be a useful tool for comparative genomic analysis of Y. pestis.

Objective To identify and compare the genome differences among live plague vaccines prepared with different strains of the bacillus. Methods The whole-genome DNA microarray of Yersinia pestis was used as a tool to perform genomic comparison among live plague vaccines prepared with 19 different strains. Results Dozens of deletions and/or increased copies of the genomic fragments were identified in the studied vaccines of different strains. Conclusion The revealed genomic differences among the vaccines from different origins account for the variability of the immunogenic and protective potency of live plague vaccines. The whole-genome DNA microarray was also provesd to be an ideal tool for the pre-evaluation of a vaccine strain.

Objective To identify the DNA tag sequences with the purpose of rapid and specific characterization of Y. pestis. Methods DNA microarray hybridization combined with PCR was used to perform genomic comparison between strains of Y. pestis and Y. pseudotuberculosis in order to screen and identify Y. pestis-specific genes. Results Twenty eight signature genes of Y. pestis were discovered. Three pairs of Y. pestis-specific primers were designed according to tag genes and proved to amplify the specific sequences of the target bacterium, showing no cross-reaction with the closely related Y. pseudotuberculosis and a large collection of genomic DNAs from other organisms. Conclusion DNA tag sequence is an ideal target for the rapid detection and identification of Y. pestis by PCR method.

Objective To compare the effects of labor epidural analgesia initiated in latent phase and active phase on parturients and neonates. Methods One hundred twenty nulliparous women at full term (single, head presentation, ASA Ⅰ or Ⅱ ) were randomly divided into 3 groups (n=40 each):control group(group C) ; PCEA initiated in latent phase group (cervical dilatation 0.5-3.0 cm) (group L) and PCEA initiated in active phase group (cervical dilatation＞3.0 cm) (group A). Epidural catheter was placed through L2,3 interspace. 0.1% ropivacaine with fentanyl 2 μg/ml was used for PCEA. A test dose of 5 ml was followed by a loading dose of 10 ml. PCEA device was programmed to allow a bolus of 6 ml with a 30 min lockout interval. The intensity of pain was measured with VAS (0=no pain, 10=worst pain) before analgesia, at 5, 10, 15 and 30 min after beginning of PCEA and cervical dilatation of 7-8 cm and 10 cm. Degree of motor block was assessed by lower extremity muscle strength (modified Bromage scale,0=no motor block, 3=inability to flex ankle joints).Plasma cortisol in maternal venous blood obtained before analgesia and at delivery of fetus and in umbilical cord blood and plasma ropivacaine concentrations in umbilical core blood were determined.The length of every stage, duration of analgesia,delivery mode, the amount of oxytocin used, maternal satisfaction, Apgar scores of the neonates and adverse effects were recorded. Results PCEA initiated in latent phase or active phase significantly reduced VAS score, the plasma cortisol level at delivery, the duration of 1st stage of labor, and the rate of cesarean section and increased the use of oxytocin in L and A groups as compared with group C, but there was no significant difference in the above variables between L and A groups. The duration of analgesia was shorter in group A than in group L. Conclusions Labor epidural analgesia initiated in latent phase or active phase can decrease the rate of cesarean section but does not prolong the duration of labor and is safe for the newborn.