Objective To explore the correlation between left ventricular hypertrophy (LVH) and dynamic parameters of blood pressure as well as blood pressure variation in patients with essential hypertension (EH). Methods From January to September, 2013, 581 patients with EH were divided into hypertrophy group (n=161) and non-hypertrophy group (n=420) according to the left ventricular mass index (LV-MI). The clinical data, biochemical indexes and dynamic parameters of blood pressure were compared, and the multiple factors regression was used to analyze the risk factors of LVH. Results The incidence of LVH was higher in women than in men (χ2=4.836, P=0.03), the level of blood uric acid was higher in the hypertrophy group than in the non-hypertrophy group (t=-11.540, P<0.001). The clinic systolic blood pressure was higher in the non-hypertrophy group (t=-3.805, P<0.001). There was significantly difference in 24-hour systolic blood pres-sure load, systolic blood pressure drops at night and average systolic blood pressure between two groups (t>2.770, P<0.05). Multi-factor Lo-gistic regression analysis showed that gender (OR=1.674, P=0.044) and 24-hour systolic blood pressure load (OR=1.021, P=0.003) associat-ed with LVH. Conclusion The occurrence of LVH in patients with EH was closely related to the 24-hour systolic blood pressure load, and was higher in women than in men.

Objective To explore the relationship between brachial ankle pulse wave velocity (BaPWV) change and carotid artery plaque formation in middle-aged and elderly patients with essential hypertension(EH).Methods A cross sectional study was conducted in 409 patients who were admitted in Hypertension Department in our hospital from January to September 2013.Their age ranged from 35 to 75 years,with mean aged(53.2±15.0) years.Parallel carotid artery ultrasound and BaPWV examination were performed in all patients.According to whether carotid plaques were present,patients were divided into two groups:carotid plaque group and control group.And carotid plaque group was sub-grouped into normal BaPWV group (BaPWV ＜ 1400cm/s) and increased BaPWV group(BaPWV≥1400 cm/s) according to BaPWV levels.The detection rate of carotid plaque was compared between normal BaPWV group and increased BaPWV group.The correlation between BaPWV and carotid plaques was analyzed by multivariate logistic regression analysis.Results Compared with the control group,carotid plaque group showed the prevalence of carotid plaques was increased along with the increases of age(t=11.0,P=11.0),systolic blood pressure (t=3.87,P=3.87),diastolic blood pressure(t=3.70,P=0.00),pulse pressure(t=6.13,P 6.13),total cholesterol levels(t=2.57,P=0.01).The detection rate of carotid plaque was higher in increased BaPWV group than in normal BaPWV group [62.6％(159/254) vs.43.2％(67/155),x2=14.61,P=0.00].After adjusting for age,blood pressure and other cardiovascular risk factors,the multivariate logistic regression analysis showed that increased BaPWV was an independent risk factor for carotid plaques(OR=2.06,P=0.05),and age,smoking,systolic pressure,diastolic pressure,pulse pressure,total cholesterol,low-density lipoprotein cholesterol,triglyceride levels were positively correlated with carotid plaques.Conclusions BaPWV is one of the independent impact factors for carotid plaques,which plays an important role in early diagnosis and screening for subclinical vascular lesions.

OBJECTIVE:To investigate the role of clinical pharmacists in the therapy for patient with multiple pulmonary in-fection after renal transplantation. METHODS:Clinical pharmacists participated in drug therapy for a patient with multiple pulmo-nary infection after renal transplantation,and assisted physicians to formulate primary therapy plan:ganciclovir 250 mg,ivgtt,q12 h+ Cefoperazone sodium and sulbactam sodium 3 g,ivgtt,bid+ methylprednisolone 80 mg,ivgtt,qd+ Compound sulfamethoxazole tablet,2 piece,po,qd+Ciclosporin soft capsule 75 mg,po,q12 h+Sodium bicarbonate tablet 1 g,po,qd+Nifedipine controlled release tablet 30 mg,po,qd+Famotidine tablet 20 mg,po,bid. The dose of ganciclovir was adjusted twice because of complica-tion cytomegaloviral pneumonia;the dose of ganciclovir was adjusted twice because of complication pneumocystis pneumonia. Pre-vention and disposal of ADR,patient education were also conducted. RESULTS:Physicians adopted the suggestion of clinical phar-macists;the pulmonary infection had been controlled,and the patient was discharged from hospital. CONCLUSIONS:Clinical pharmacists identify the breakthrough point to promote rational drug use,indicating the value of pharmaceutical care in the clinical treatment.

Objective To explore the types and drug resistance of pathogens in patients with type Ⅰ incision surgical site infection in orthopedics department.Methods Patients with type Ⅰ incision surgical site infection in orthopedics department at Peking University Third Hospital from January 2005 to December 2013 were retrospectively collected.Clinical characteristics of patients,distribution and drug resistance of pathogens were analyzed.Results A total of 58.2 thousands patients with type Ⅰ incision surgical site were hospitalized from January 2005 to December 2013 in orthopedics department,and among them 442 patients had infection in the type Ⅰ incision surgical site.The infection rate was 0.8％.Infection was mainly observed in elderly patients.The most common diseases were lumbar canal stenosis (21.7％),cervical spondylosis (20.6％) and lumbar intervertebral disc herniation (14.0％).A total of 453 pathogenic strains were detected,of which 52.9％ were gram-positive bacteria,45.5％ were gramnegative bacteria and 1.6 ％ were fungi.The common pathogens were Staphylococcus aureus (25.2 ％),Staphylococcus epidermidis (14.1 ％),Escherichia coli (11.5 ％),Enterobacter cloacae (7.3 ％),Pseudomonas aeruginosa (6.2 ％) and Acinetobacter baumannii (6.0 ％).The percentage of Meticillinresistant Staphylococcus aureus (MRSA) was 23.7％ and the percentage of Meticillin-resistant Staphylococcus epidermidis (MRSE) was 43.8％.Vancomycin or linezolid-resistant Staphylococcus aureus or Staphylococcus epidermidis were not detected.Proportion of extended-spectrum beta-lactamases (ESBL) producing strains in Escherichia coli was 53.8％,and proportion of ESBL-producing strains in Klebesiella pneumonia was 50.0％.The resistance rates to impenem and meropenem of the three different species in Enterobacteriaceae,including Escherichia coli,Enterobacter cloacae and Klebsiella pneumonia,were 0.Resistance rates of Pseudomonas aeruginosa to cefoperazone-sulbactam,piperacillin-tazobactam were less than 10 ％.Resistance rate of Acinetobacter baumannii to minocyline was 11.1％ and resistance rates of it to other drugs were more than 20％.Conclusions The rate of type Ⅰ incision surgical site infection in orthopedics department is low.Gram-positive and gram-negative bacteria each account for half of the pathogens.The proportion of resistant pathogens is high and empirical treatment is needed to cover these pathogens.

[Summary] The relationship between the state of cognition and hypertension in 155 type 2 diabetic patients was studied.The results showed that significant difference in the state of cognition was found in patients with or without hypertension,so as to those with poorly or well controlled hypertension (P＜0.05).Systolic blood pressure,pulse pressure,mean arterial blood pressure,and duration of hypertension were negatively correlated with multiple cognitive domains,suggesting that proper control of blood pressure may have a protective effect on cognitive function in type 2 diabetic patients.

To study the effect of Tibetan medicine Zuotai on the activity, protein and mRNA expression of CYP1A2 and NAT2, three different doses (1.2, 3.8 and 12 mg x kg(-1)) of Zuotai were administrated orally to rats once a day or once daily for twelve days, separately. Rats were administrated orally caffeine (CF) on the second day after Zuotai administration, and the urine concentration of CF metabolite 5-acetylamino-6-formylamino-3-methyl-uracil (AFMU), 1-methyluric acid (1U), 1-methylxanthine (1X), 1, 7-dimethylxanthine (17U) at 5 h after study drug administration was determined by RP-HPLC. The activity of CYP1A2 and NAT2 was evaluated by the ratio of metabolites (AFMU+1X+1U)/17U and the ratio of AFMU/(AFMU+1X+1U), respectively. The protein and mRNA expression of CYP1A2 and NAT2 were determined by ELISA and RT-PCR method, respectively. After single administration of Zuotai 3.8 mg x kg(-1) and repeated administration of Zuotai 3.8 and 12 mg x kg(-1), the activity of CYP1A2 and NAT2 decreased significantly compared with control group and there was no significant difference between other dose group and control group. The protein expression of CYP1A2 was significant lower than that in control group after repeated administration of Zuotai 12 mg x kg(-1), and the mRNA expression of CYP1A2 decreased significantly compared with that of control group after single administration of Zuotai 3.8 mg x kg(-1) and repeated admistration of Zuotai 12 mg x kg(-1), separately. The protein expression of NAT2 decreased significantly compared with that of control group after single and repeated administration of Zuotai 3.8 mg x kg(-1), respectively, and the mRNA expression of CYP1A2 decreased significantly compared with control group after single administration of Zuotai 3.8 mg x kg(-1). This study found that Tibetan medicine Zuotai had significant effect on the activity, protein and mRNA expression of CYP1A2 and NAT2.

Objective:Peritoneal free cancer cells can negatively impact disease progression and patient outcomes in gastric cancer.This study aimed to investigate the feasibility of using golden-angle radial sampling dynamic contrast-enhanced magnetic resonance imaging(GRASP DCE-MRI)to predict the presence of peritoneal free cancer cells in gastric cancer patients.Methods:All enrolled patients were consecutively divided into analysis and validation groups.Preoperative magnetic resonance imaging(MRI)scans and perfusion were performed in patients with gastric cancer undergoing surgery,and peritoneal lavage specimens were collected for examination.Based on the peritoneal lavage cytology(PLC)results,patients were divided into negative and positive lavage fluid groups.The data collected included clinical and MR information.A nomogram prediction model was constructed to predict the positive rate of peritoneal lavage fluid,and the validity of the model was verified based on data from the verification group.Results:There was no statistical difference between the proportion of PLC-positive cases predicted by GRASP DCE-MR and the actual PLC test.MR tumor stage,tumor thickness,and perfusion parameter Tofts-Ketty model volume transfer constant(Ktrans)were independent predictors of positive peritoneal lavage fluid.The nomogram model featured a concordance index(C-index)of 0.785 and 0.742 for the modeling and validation groups,respectively.Conclusions:GRASP DCE-MR could effectively predict peritoneal free cancer cells in gastric cancer patients.The nomogram model constructed using these predictors may help clinicians to better predict the risk of peritoneal free cancer cells being present in gastric cancer patients.

Objective:To study the clinical risk factors for osteoporotic fracture (OF) risk prediction in patients with type 2 diabetes mellitus (T2DM) using adjusted fracture risk assessment tool (FRAX) .Methods:A cross-sectional study of 429 patients with T2DM who were hospitalized in the Department of Endocrinology and Geriatrics of the Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University from Sep. 2019 to Sep. 2020 was conducted. Participants were divided into OF low-risk group and OF high-risk group. Participant characteristics (age, gender, height, weight, waist, blood pressure, history of drug treatment, serum glucose, glycosylated hemoglobin, total cholesterol, low-density lipoprotein cholesterol (LDL-C) , high-density lipoprotein cholesterol (HDL-C) , triglyceride, serum uric acid, alkaline phosphatase, and thyroid stimulating hormone levels, urine protein/creatinine ratio, urea, creatinine and TPOAB) and dual energy x-ray absorptiometry results were obtained and analyzed. Logistic regression model was used to investigate the relationship between the OF risk of T2DM assessed by adjusted FRAX and clinical risk factors.Results:Patients in the OF high-risk group accounted for 9.09% of the subjects. After adjustment for other variables, the duration of diabetes was still positively associated with significantly elevated risk of OF assessed by adjusted FRAX ( OR 7.660, 95% CI 1.661-35.334, P=0.009) , whereas the blood uric acid was negatively associated with significantly elevated risk of OF assessed by adjusted FRAX ( OR 0.345, 95 % CI 0.128-0.928, P=0.035) .Likewise, LDL-C levels decreased the odds of the risk of OF assessed by adjusted FRAX ( OR 0.316, 95 % CI 0.114-0.881, P=0.028) . There was no significant relationship between alkaline phosphatase ( OR 1.902, 95 % CI 0.904-4.004, P=0.090) as well as total cholesterol ( OR 0.297, 95% CI 0.056~1.560, P=0.151) levels and the elevated risk of OF assessed by adjusted FRAX. Conclusion:Diabetes duration could be a risk factor for OF risk prediction in patients with T2DM using adjusted FRAX, and serum uric acid and LDL-C could be protective factors for OF risk prediction in patients with T2DM using adjusted FRAX.

Objective To evaluate the association between preoperative serum thyroglobulin concentration and aggressive behavior of papillary thyroid cancer(PTC).Methods A total of 334 PTC patients diagnosed by surgical pathology treated in our hospital from Jan.2013 to Dec.2017 were retrospectively reviewed.Patients were divided into two groups according to Tg levels and clinicopathological characteristics between the two groups were compared.Binary logistic regression analysis was conducted to evaluate the factors influencing extrathyroidal extension and lymph node metastasis of PTC.Results High level of preoperative serum Tg was signifcantly associated with old age,multifocality,larger maximum tumor size,more frequent extrathyroidal extension,lymph node metastasis,and advanced T and TNM stage(P＜0.05).Maximum tumor diameter ＞2 cm(P=0.031) and preoperative serum Tg level ＞17.21 ng/ml(P=0.028) were independent risk factors for extrathyroidal extension.Maximum tumor diameter ＞2 cm(P=0.007) and preoperative serum Tg levels ＞25.40 ng/ml (P=0.016) were independent risk factors for lymph node metastasis,whereas female was a significant protective predictive factor(P＜0.001).Conclusion Preoperative serum Tg levels may serve as an independent risk marker for extrathyroidal extension and lymph node metastasis of PTC,and partly contributes to predict aggressive behavior of PTC.

Objective:To explore the association of hemoglobin(HGB) levels with bone mineral density(BMD) and osteoporosis in patients with type 2 diabetes mellitus(T2DM).Methods:A cross-sectional study was conducted in 364 patients with T2DM who were hospitalized in the Department of Endocrinology and Geriatrics of the Affiliated Huaian No. 1 People′s Hospital of Nanjing Medical University from September 2019 to September 2020. Participants were stratified into tertiles(lower, middle, and upper) according to femoral BMD determined by dual-energy X-ray absorptiometry. Demographic characteristics, medical history, chronic diabetes complications, and comorbid conditions were compared among the 3 groups. The association between hemoglobin levels and BMD/osteoporosis was examined using multivariable logistic regression analyses. Interaction and stratified analyses were conducted according to age, body mass index(BMI), duration of diabetes, estimated glomerular filtration rate(eGFR), glycosylated hemoglobin(HbA 1C), total cholesterol(TC), triglycerides(TG), high-density lipoprotein-cholesterol(HDL-C), low-density lipoprotein-cholesterol(LDL-C) and uric acid(UA). Results:After adjusting for age, BMI, and duration of diabetes, there were no significant differences observed in the association between hemoglobin levels and BMD or osteoporosis among postmenopausal women with T2DM(all P>0.05). After adjusting for age, BMI, duration of diabetes, and eGFR, men aged≥50 years with hemoglobin≥130 g/L showed a positive association between hemoglobin level and femoral neck BMD compared to those with hemoglobin<130 g/L( β=0.057, 95% CI 0.014-0.100, P=0.011). However, no significant associations were observed between hemoglobin level and BMDs at the total hip or lumbar spine(L1-L4), nor the risk of osteoporosis(all P>0.05). Stratified analyses revealed no significant differences in the subgroups classified based on age, BMI, diabetes duration, eGFR, HbA 1C, TC, TG, HDL-C, LDL-C, and UA(all interaction P>0.05). Conclusion:In males aged 50 and above with T2DM, elevated hemoglobin levels may be a protective factor for femoral neck bone density.