Objective To observe the efficacy of atorvastatin and irbesartan in the treatment of early diabetic nephropathy and the influence on serum cystatin C and adiponectin,thus to improve clinical outcomes.Methods 80 patients with early diabetic nephropathy met the inclusion criteria were randomly divided into observation group (40 cases)and control group(40 cases).All patients were given conventional diabetes comprehensive intervention, the control group then was given irbesartan 150mg/d,qd,the observation group was given atorvastatin on the basis of control group,20mg/d,qd,both two groups were treated for 12 weeks.The FBG,HbA1c,renal function indication (Scr,BUN,UAER),lipid parameters indication(TC,TG),cystatin C,adiponectin were detected.DBP,SBP were detected by 24h ambulatory blood pressure.Results The DBP,SBP,Scr,BUN,UAER,TC,TG,cystatin C,adiponec-tin of the observation group after treatment were lower than before treatment(P <0.05 or P <0.01).The BUN,TC, TG of the control group had no significant changes before and after treatment (P >0.05).The DBP,SBP,Scr,BUN, UAER,TC,TG,cystatin C,adiponectin of the observation group after treatment were lower than the control group (P <0.05 or P <0.01).Conclusion Atorvastatin combined with irbesartan can effectively control blood pressure, has overall improvement in glucose and lipid metabolism,effectively reduce adiponectin,inhibit glomerular dysfunc-tion,improve kidney function,it is a good method for prevention and treatment of early diabetic nephropathy.

Objective To observe the effects of subarachnoid block on plasma nitric oxide level of the pregnancy induced hypertension patients Methods Twenty female patients ASA class I ,scheduled for elective gynecological surgery served as non pregnancy group, 20 normal late stage gravidas as pregnancy group,and 20 severe pregnancy induced hypertension(PIH) gravidas as PIH group The intravenohs blood samples were taken immediately before subarachnoid block and 10 min following subarachnoid block(before incision),to quantify the plasma concentration of nitric oxide by measuring the metabolic production of nitric oxide:nitrite and nitrate Results Immediately before subarachnoid block,the plasma nitric oxide level decreased significantly in non pregnancy group and PIH group compared with that in pregnancy group (P

AIM: To evaluate the effect of GYY4137, a novel hydrogen sulfide (H2S) donor, on cytosolic lipid decomposition in mouse primary steatosis hepatocytes.METHODS: Oleic acid (OA) was used to induce hepatic steatosis model in vitro.The C57BL/6 mouse primary hepatocytes isolated and cultured by 2-step in situ perfusion were divided into 4 groups: the cells in control group were incubated with normal medium for 54 h;the cells in model group were incubated with OA at 1.2 mmol/L for 48 h followed by serum-free phenol red-free RPMI-1640 for 6 h;the cells in H2S group or DL-propar-gylglycine (PAG;an inhibitor of cystathione γ-lysase, inhibiting H2S synthesis) group were incubated with OA at 1.2 mmol/L for 48 h followed by serum-free phenol red-free RPMI-1640 which contained 1 mmol/L GYY4137 or 200 μmol/L PAG for 6 h.The glycerin release and the protein expression of hormone-sensitive lipase (HSL) in the cells were mea-sured.RESULTS: Compared with model group, the glycerin release and the protein expression of phosphorylated HSL (p-HSL) in H2S group decreased significantly, while those increased significantly in PAG group.CONCLUSION: In steatosis hepatocytes, exogenous H2S possibly decreases cytosolic lipid decomposition by decreasing the protein level of p-HSL.

PURPOSE: The aim of this study was to evaluate the effects of perioperative psychological and music interventions in elderly patients undergoing elective surgery on anxiety, post-operative pain, and changes in heart rate variability (HRV) to ascertain if perioperative psychological and music interventions can affect overall anxiety levels. MATERIALS AND METHODS: Fourty elderly patients undergoing elective surgery were randomized to two groups; one group received psychological and music intervention, and the other was the control. The intervention group underwent psychological intervention and listening to music for 30 min before surgery. RESULTS: The mean change in HRV as determined by low frequency (LF) power measurements. After the intervention, the ratio of mean LF to high frequency (HF) power decreased significantly in the intervention group compared to before the intervention (p<0.05). In the control group, mean LF measurements and the ratio of LF:HF did not change significantly. In the intervention group, mean HF power was significantly higher after the procedure than before (p<0.01). Moreover, the mean self-rating anxiety score of the intervention group decreased after the procedure compared to before (p<0.05). The mean visual analogue score of the intervention group 6 hours after surgery was significantly lower than that of the control group (p<0.01). CONCLUSION: Perioperative psychological and music interventions can reduce anxiety and postoperative pain in elderly patients.
Aged ; Aged, 80 and over ; Anesthesia, Spinal/*methods/*psychology ; Anxiety/*therapy ; Female ; Heart Rate/*physiology ; Humans ; Male ; Music Therapy/*methods ; Pain, Postoperative/*therapy ; Relaxation Therapy/methods

Objective To investigate the clinical value of contrast-enhanced ultrasonography (CEUS)in evaluating renal cortical perfusion in elderly diabetic patients.Methods A retrospective cross-sectional study was conducted.A total of 70 diabetic patients with chronic renal insufficiency stage 1 to 5 were enrolled.The glomerular filtration rate (GFR)was estimated according to the creatinine level.Based on GFR,patients were divided into a mild-to-moderate chronic kidney disease (CKD)group(n=42,CKD stage 1 to 3)and a severe CKD group(n=28,CKD stage 4 to 5).All patients underwent CEUS for the assessment of renal perfusion and renal dynamic imaging for the assessment of GFR.QLAB analysis software was used to obtain the time-intensity curve(TIC)and related parameters including area under the curve(AUC),the ascending slope(A),the derived peak intensity(DP1) and the time to peak (TTP).The differences in renal perfusion parameters were compared between the two groups.Pearson correlation test was used to assess the correlation between the quantitative parameters of renal cortical perfusion and GFR.Results There was no significant difference in age,gender,history of hypertension,basal blood glucose level,systolic or diastolic blood pressure between the two groups (all P ＞ 0.05).CEUS findings revealed high renal cortical blood perfusion in the mild-to-moderate group.There were significant differences in quantitative perfusion parameters including AUC,DPI,A and TTP between the two groups.Pearson correlation test indicated that TTP and A were significantly correlated with GFR in both groups(r =-0.456 and-0.693,0.432 and-0.529,all P＜0.05),while AUC and DPI had no correlation with GFR(r =-0.003 and -0.057,0.066 and-0.081,all P ＞0.05).Conclusions Diabetic patients with mild-to-moderate CKD have high renal cortical blood perfusion.CEUS findings can indirectly reflect renal function.The perfusion parameters A and TTP have good correlations with GFR.CEUS can be used as a safe and effective method to evaluate renal function,especially in patients with severe renal insufficiency,but more studies are needed to verify the results.

Objective: To investigate the clinical outcome of distraction osteogenesis in the treatment of pediatric maxillofacial fractures. Methods: From November 2017 to November 2018, 6 cases of maxillofacial fractures were treated, including 3 cases of maxillary fracture and 3 cases of mandibular fracture. All of them were associated with facial asymmetry of different severity, disordered occlusion and displacement of fracture segments. The distraction osteogenesis device was used to fix the fracture during the operation. The distraction was initiated after 1 day latency period, and proceeded at approximately 0.5 mm each time, twice a day, until the normal occlusal relationship was achieved. Distractor was maintained for 1 month after distraction, and then removed. The degree of fracture healing, the mouth opening and the occlusal status at the fracture site were evaluated during follow-up, and the corresponding curative effect was observed and evaluated. Results: All fractures were healed well, without infection, dislocation, or pseudo-joint formation after 1 month. The distraction duration is 15-20 days and the distraction distance is 15-20 mm. At the end, the occlusal relationship was normal, and the mouth opening was not limited. The follow-up period was from 1 month to 1 year. The maxillofacial appearance of the children was normal, and the maxillofacial development was not significantly affected. Conclusions Distraction osteogenesis is an effective and controllable method for child maxillofacial fracture. It can be used as a supplement to the conventional treatment of maxillary and mandibular fracture in children.

Objective: To evaluate the characteristics of renal cortical blood perfusion assessed by contrast-enhanced ultrasound (CEUS) in elderly patients with renal artery stenosis (RAS) and its relationship with renal function. Methods: Ninety-three elderly patients diagnosed with RAS, who were admitted in Beijing Hospital during June 2017 and December 2018, were retrospectively enrolled. According to the degree of RAS, 186 renal arteries were divided into normal renal artery group (n=79), mild RAS group (30% to 49%, n=59), moderate RAS group (50% to 70%, n=33), and severe RAS group (70% to 99%, n=15). Renal cortical blood perfusion and renal glomerular filtration rate (GFR) were measured by CEUS and radionuclide renal dynamic imaging. According to the renal GFR, 186 kidneys were divided into normal renal function group (GFR≥35 ml/min, n=42) and mild renal insufficiency group (35 ml/min>GFR≥25 ml/min, n=51), moderate renal insufficiency group (25 ml/min>GFR≥15 ml/min, n=75) and severe renal insufficiency group (GFR<15 ml/min, n=18). The renal cortical blood perfusion time-intensity curve (TIC) and related parameters were analyzed, including the area under the curve (AUC), the slope of the ascending branch (A), the peak intensity (PI), the peak time (TTP) and the mean transit time (MTT), the kidneys of different RAS groups and patients with different renal function groups were analyzed. Pearson correlation analysis was used to evaluate the correlation between renal cortical blood perfusion parameters and renal GFR. Results: (1) Renal cortical blood perfusion and GFR: CEUS showed that parameter A of TIC was significantly reduced, while TTP was prolonged in the mild renal artery stenosis group compared with the normal renal artery group (both P<0.05), GFP was similar between the two groups. Cortical perfusion parameters, such as AUC, A, PI and GFR were significantly lower, while TTP and MTT were significantly prolonged in the moderate and severe renal artery stenosis group than in the normal and mild stenosis groups (all P<0.05). Compared with the moderate stenosis group, AUC, A, PI and GFR were significantly lower while TTP, MTT were significantly prolonged in the severe renal artery stenosis group (all P<0.05). (2) TIC showed that the renal perfusion parameters, AUC, PI and A were significantly lower, while TTP was significantly longer in the mild renal dysfunction group than in the normal renal function group (all P<0.001). The changes aggravated in proportion with renal dysfunction. (3) Correlation between perfusion parameters and GFR: Pearson correlation analysis showed that the AUC (r=0.774, P<0.05), A (r=0.815, P<0.05) and PI (r=0.772, P<0.05) were positively correlated with GFR; serum creatinine level (r=-0.841, P<0.05), renal function grading (r=-0.731, P<0.05), TTP (r=-0.803, P<0.05) and MTT (r=-0.741, P<0.05) were negative correlated with GFR. The degree of stenosis was negatively correlated with GFR (r=-0.427, P<0.05). Conclusion Cortical perfusion parameters differ significantly among patients with various degree of RAS and renal dysfunction. The renal cortical blood perfusion parameters are correlated with renal GFR.

Objective To explore the characteristics of renal cortical perfusion with contrastenhanced ultrasound (CEU)in elderly mice.Methods Randomly selected 12 healthy C57BL/6J young mice(aged 1-2 months)and 12 healthy elderly mice(aged 18-20 months)were assigned respectively into the control group and the experimental group.All mice were examined by color Doppler ultrasound and CEU.Renal morphology and hemodynamics were assessed with conventional ultrasound and CEU was used to assess renal microvascular perfusion,analyzing the time-intensity curve(TIC) and related parameters,including slope rate of ascending curve (A),area under curve (AUC),peak intensity (PI),and time to peak (TTP).Results Conventional ultrasound showed similar blood flow dynamics in the renal hilum artery,the renal segmental artery and the renal interlobar artery between the young and elderly mice groups(all P ＞0.05).Moreover,CEU showed slower ascendance of TIC in the elderly mice group(P ＜ 0.05).Furthermore,the elderly mice were associated with significantly decreased A (0.74 ± 0.06 vs.0.89 ± 0.12,P ＜ 0.05) and increased AUC (1420.08± 208.30)dB · s vs.(1261.41± 34.65)dB/s(P＜0.05),delayed TTP(7.75 ±0.88)s vs.(6.93± 0.44) s (P ＜ 0.05),and similar PI (P ＞ 0.05),compared with those in the young mice group.Conclusions Qualitative analysis of CEU is capable of detecting renal perfusion differences between young and elderly nice,which might lay a basis for further study.

Objective:To observe the effect of the cortical blood perfusion parameter of wash-in area under curve (iAUC) with contrast-enhanced ultrasound(CEUS) on the effect of short-term outcomes of stent implantation in patients with severe renal artery stenosis (RAS).Methods:Retrospective analysis was performed on 82 patients with unilateral severe RAS who received stent implantation in Beijing Hospital from October 2017 to December 2019. According to the baseline iAUC before CEUS, all patients were divided into the poorly-perfused group (iAUC<850.0 dB×s) (37 cases) and the well-perfused group (iAUC≥850.0 dB×s) (45 cases). Baseline and perioperative clinical-imaging data were analyzed between the two groups. Followed up for 10-12 (11.5±1.7) months, Kaplan-Meier survival curves and Log-rank test were used to analyze the rate of adverse cardiac and renal vascular events and hypertension control rates.Results:Compared with the well-perfused group, the poorly-perfused group showed a longer course of hypertension, more diabetic patients, higher systolic blood pressure, diastolic blood pressure, 24 h average systolic blood pressure, and 24 h average diastolic blood pressure, lower glomerular filtration rate, and severe renal artery stenosis. Besides, the iAUC, wash-out AUC and the peak intensity were lower, the average transit time was longer, and the hypoglycemic treatment rate was higher (all P<0.05). Kaplan-Meier survival curve and Log-rank test analysis showed that the occurrence of cardio-renal vascular events ( HR=0.361, 95% CI=0.144-0.907, P=0.012) and renal function deterioration rate ( HR=0.286, 95% CI=0.090-0.914, P=0.035) in the well-perfused group were significantly lower than those in the poorly-perfused group. The blood pressure results demonstrated that the effective rate of hypertension treatment in the well-perfused group was significantly higher than that in the poorly-perfused group (93.3% vs 59.5%, P<0.001), but the improvement rate of hypertension (60.0% vs 43.2%) and cure rate (28.9% vs 16.2%) were not statistically significant between the two groups(all P>0.05). Conclusions:Severe RAS patients with decreased baseline iAUC often have diabetes, longer duration of hypertension, significantly reduced glomerular filtration rate and more severe RAS, short-term outcomes are worse with stent implantation.

Objective:To explore the potential role of nucleotide-binding oligomerization domain-like receptor protein 3 (NLRP3)/GATA-binding protein 4 (GATA-4)/vascular endothelial growth factor (VEGF) signal pathway in neovascular age-related macular degeneration (nAMD).Methods:We applied the TRANSFAC Public database to search the human and mouse VEGF promoters and upstream transcription factors, analyzed the transcription factors that may influence the transcriptional activity of VEGF. The RAW264.7 cells were divided into control group and lipopolysaccharide (LPS) stimulated group (LPS group). Real time fluorescence quantitative polymerase chain reaction (qRT-PCR) was used to detect the activation of NLRP3 inflammasome, and the mRNA levels of GATA-4 and VEGFA. Thus, we applied the specific small molecular NLRP3 inhibitor MCC950 pretreated RAW264.7 cells (LPS+ MCC950 group), and detected the gene expression of NLRP3, Caspase-1, interleukin 1β( IL-1β), GATA-4 and VEGFA.Results:There were multiple GATA transcription factor binding sites upstream of human and mouse VEGF promoters. Compared with the control group, mRNA expression of NLRP3, Caspase-1, IL-1β, GATA-4 and VEGFA in LPS group were increased (all P<0.05). Compared with LPS group, mRNA expression of NLRP3, Caspase-1, IL-1β, GATA-4 and VEGFA in LPS+ MCC950 group were significantly decreased (all P<0.05). Conclusions:NLRP3/GATA-4/VEGF signal pathway may play a significant role in the pathologic processes of nAMD.