Two hundred male and 200 female patients with type 2 diabetes mellitus admitted from January 2007 to April 2008 were enrolled in the study. Of them, 267 were diagnosed as non-alcoholic fatty liver disease (NAFLD) by ultrasonography. The measurements included:body mass index (BMI) ,waist-to-hip ratio (WHR) ,fasting blood glucose( FBG), ALT, AST, total bilirubin(TBIL), cholesterol(CHO),triglyceride(TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol ( LDL-C) ,serum creatinine (Cr), supersensitive C-reactive protein (hsCRP) and urine albumin/creatinine. The relationship of above factors with NAFLD was determined. Our data showed that male NAFLD patients were in general younger than female. The BMI ( t = 11. 361, P = 0. 000), waist circumference ( t = 9. 771, P =0. 000), hip circumference (t = 10. 469, P =0. 000) ,TG(t =7. 352, P =0. 000) and hsCRP (t =2. 242,P =0. 026) of NAFLD patients were significantly higher than those without NAFLD. The hsCRP of patients with central obesity was also significantly higher than those without central obesity (t = 0. 266, P = 0. 045 ).BMI and TG were positively correlated with NAFLD. Waist circumference was an independent factor of NAFLD in male patients, same as hip circumference with NAFLD in female patients. In conclusion, gender,central obesity and dyslipidemia may be risk factors for NAFLD in patients with type 2 diabetes mellitus.

Objective To explore the alterations of intestinal mechanical barrier during the nonalcoholic fatty liver disease (NAFLD) progression. Methods To establish NAFLD rats' model,ninety male SD rats were divided into three groups equally: normal-diet group, high-sucrose diet group and high-fat diet group. At the 4th, 8th and 12th week each time point, ten rats were sacrificed in each group. Another twenty SD rats were randomly divided into carbon tetrachloride (CCl4) group and control group. The liver injured model of CCl4 group was induced by CCl4 ; all the rats of these two groups were killed at the 4th week. The degree of liver steatosis was observed through HE staining of liver paraffin sections. The lipopolysaccharide (LPS) level of portal vein blood was measured by limulus test. The occludin expression in intestinal mucosal was detected by immunofluorescent assay,and the fluorescence intensity was scored. The morphology change of intestinal mucosa tight junction was observed through electron microscopy. Results The liver histopathology suggested that NAFLD and liver injured rats' model was successfully established. There was no statistical significance of LPS level between high-sucrose diet group and normal diet group at all the time point (P＞0.05). At the 4th and 12th week, there was no statistical significance of LPS level between high-fat diet group and normal diet group (P＞0.05), while it was significantly higher in high-fat diet group than normal diet group at the 8th week (P＜0. 05). There was no statistical significance of LPS level between CCl4 group and control group (P＞0. 05). At the 8th week, the expression of occludin in normal-diet group, high-sucrose diet group and high-fat diet group was 1.80±0. 42, 1. 50 ± 0. 53 and 1.30±0.67, respectively, the expression was a little bit lower in high-sucrose diet group and high-fat diet group than in normal diet group, the difference was statistical significance (P＜0. 05). At the 12th week, the expression of occludin was significantly lower in high-sucrose diet group and high-fat diet group than normal diet group. The expression of occludin was significantly lower in CCl4 group (0.60±0.16) than in control group (1.80±0. 42) (P＜0. 05). No obvious morphology changes of tight junction was found in high-sucrose diet group, high-fat diet group and CCl4 group at each time point.Conclusion The expression of occludin decreased gradually during the non-alcoholic fatty liver disease progression. So in the NAFLD treatment, besides improving insulin resistance and protecting liver function,the protection of intestinal mucosa barrier as early as possible may slow down the progression of liver injury.

Objective To study the changes of system immune and intestinal immune in the progression of non-alcoholic fatty liver disease due to obesity. Methods Ninty male SD rats were divided into control, high-sucrose and high-fat diet groups. Non-alcoholic fatty liver disease models were established by feeding with high-sucrose diet or high-fat diet and were killed at the 4th,8th and 12th weeks with 10 each for each group. The extent of liver steatosis was observed with HE staining.Portal blood endotoxin level was assessed by limulus test. The percentage of CD4+ and CD8+ cells in peripheral blood mononuclear cells (PBMC) and lymphocytes in Peyer's patches (PP) were calculated by flowcytometry. Results In comparison with control group, the endotoxin level was not elevated from the 4th week to 12th week in high-sucrose diet group, (all P values＞0.05), but was increased in high-fat diet group at the 8th week (P＜0.05). CD4/CD8 ratio in PBMC was higher in high-sucrose and higt-fat diet groups than that in control group at the 4th week (P＜0. 05) ,but was lower than that in control group at the 8th and 12th weeks (P＜0. 05). Whereas the variation of CD4/CD8 ratio in PP was consisted with that in PBMC between the high-sucrose and high-fat diet groups at the 4 th and 8 th weeks, but there was no difference when compared with control group at the 12 th week (P＞0.05).Conclusion Obesity can inhibit systematic immune and intestinal immune. The intestinal immune may be regulated by the liver.

Objective To compare the efficacy in radical cure of H.Pylori (Hp) by different proton pump inhibitor (PPI)-based treatment regimens.Methods One thousand two hundred and three H.Pyloriinfected patients diagnosed by both endoscopic pathology and a rapid urease test were enrolled in this study.Reviewed 13 C-urea breath test at the end of Hp eradication treatment for more than 4 weeks,and retrospective analyzed the different effect of Hp eradication regimens.All patients were given treatment regimens,which including PPI (esomeprazole azole,bella,esomeprazole,pantoprazole omeprazole,2 times/d) plus antimicrobial for 7,10,14 d.According to antimicrobial,patients were divided into A,B,C,D,E group.Patientss in group A(421 cases) were given amoxicillin 1.0 g,2 times/d,clarithromycin 0.5 g,2 times/d;In group B (49cases) were given amoxicillin 1.0 g,2 times/d,levofloxacin 0.2 g,2 times/d;In group C(69 cases) were given amoxicillin 1.0 g,2 times/d,metronidazole 0.4 g,2 times/d;In group D(559 cases) were given clarithromycin 0.5 g/d,2 times/d,levofloxacin 0.2 g,2 times/d and in group E(105 cases) were clarithromycin 0.5 g,2times/d,metronidazole 0.4 g,2 times/d.Bismuth were colloidal bismuth pectin 200 mg,2 times/d.Results The radical cure rate of Hp was 84.04％ (453/539) in the group treated by regimens with Amoxicillin,and significant higher than that of without Amoxicillin (69.12％ (459/664),x2 =36.104,P =0.000),and the radical cure rate of Hp was 14.92％.The Hp radical cure rate of quadruple therapy was 76.85％ (767/998),while triple therapy was 70.73％ (145/205).However,no significant difference between these two regimens was found(x2 =3.476,P =0.062).The Hp radical cure rates of 14-,10-and 7-day course therapies were 84.28％ (134/159),75.79％ (579/764),71.07％ (199/280) respectively,and there was significant different among the three groups (x2 =9.644,P =0.008).There was significant increases trend in the 14-day therapy group comparing to 10-and 7-day regimen groups (x2 =5.399,11.719,P =0.020,0.001 respectively),while no significant difference was shown between the 10-and 7-day therapy groups(x2 =2.398,P =0.121).The radical cure rates were 84.80％ (357/421),81.63％ (40/49),81.16％ (56/69),69.95％ (391/559),64.76％(68/105) respectively in A,B,C,D and E groups,and there was significant difference among the groups (x2 =37.999,P =0.000).Conclusion Radical cure therapy of Hp should be PPI-based.A 14-day triple or quadruple treatment regimen with combination of Amoxicillin and clarithromycin is suggested as a first-line therapy.It is worth to clinically popularize such regimens in the light of the superior efficacy.

Objective To study the clinical value of PgCO_2 measurement on the patients in ICU.Methods PgCO_2 were continuous measured 24 hours by using air-automated tonometry for 50 cases admitted in ICU.The heart rate,blood pressure,MAP,CVP,SpO_2,artery blood gas were measured at the same time.According to acute physiologic and chronic health evaluation(APACH Ⅱ) and MODS mark,the patients were divided into 2 groups,high-risk group and light-risk group.20 cases suffered from malignant tumour without functional failure of the organs were looked on as compared group.The results of measurement of every group were compared.Results Comparing with the three groups,the results of PgCO_2,Pg-aCO_2,Pg-etCO_2 were significantly different,but the Pg-aCO_2 and Pg-etCO_2 were the same.Conclusion PgCO_2 is an effective index for observing the conditional change of the high-risk cases.PgCO_2≥45mmHg,Pg-aCO_2≥15mmHg may be considered as a predictive signal that the patient well appears functional failure or death.Pg-etCO_2 may substitute Pg-aCO_2 as a continuous measurement index.

Objective To investigate the dynamic changes of lymphocyte subsets (lymphocyte count, CD3 +T,CD4 +T,CD8 +T,CD19 +B,CD56 +NK)in children with septic shock.Methods Peripheral blood lymphocyte subsets were analysed in 25 cases with severe septic shock and 24 cases with mild septic shock on day 1 ,3,8,and compared with those of 25 healthy volunteers.Children with severe septic shock were divided in-to survival group and dying group according to the outcome.The detection data were compared.Results In the first day of admission,peripheral blood lymphocyte subsets in children with septic shock decreased significantly compared with the normal children,and there was significant difference in the three groups(P <0.05 ).In the third day of admission,children with mild septic shock had statistical increase of CD4 +T,CD3 +T and lympho-cyte count(P <0.05),and children with severe septic shock had statistical decrease of lymphocyte subsets ex-cept CD56 +NK.In the eighth day of admission,children with mild septic shock had no significant difference in CD4 +T lymphocyte count compared with control group(P >0.05),but children with severe septic shock had statistical increase of CD4 +T,CD3 +T and lymphocyte count(P <0.05).There were 5 cases died who had se-vere septic shock in day 2 to day 5 after admission.The count of lymphocyte subsets were detected significantly lower in dying group than survival group in the third day of admission(P <0.05).Conclusion The continuous low level of lymphocyte subsets indicates bad outcome.The patientˊs condition improved with increase of CD4 +T,CD3 +T,lymphocyte count.CD4 +T is the most sensitive.Dynamic detection of lymphocyte subsets in the pe-ripheral blood of children with septic shock is of great clinical significance in judging the severity of disease and cura-tive effect.

ObjectiveTo evaluate the role of galactomannan (GM) detection in bronchoalveolar lavage fluid (BALF) in the diagnosis of invasive pulmonary aspergillosis (IPA) in elderly patients with lung diseases.MethodsThe elderly patients with lung diseases and suspected of having IPA were enrolled. BALF for culture and GM detection, and serum samples for GM detection were obtained from all participants.According to European Organization for Research and Treatment of Cancer/Mycoses Study Group (EORTC/MSG) with host factors, clinical criteria, mycological evidence and histological or cytopathological evidence, all patients were categorized into the proven, probable,possible and no IPA patients. The IPA patients were considered as IPA group while no IPA was considered as control group. ResultsAmong 76 enrolled elderly patients, 18 cases were diagnosed with IPA (1 proven, 11 probable and 6 possible), the remained 58 patients were as control group.Based on a GM index cutoff value of ≥0. 5, the sensitivity, specificity, positive predictive value and negative predictive value for BALF were 83.3％, 82. 8％, 60.0％ and 94.1％, respectively; these variables in serum were 55.60％ , 91.4 ％, 66.7 ％ and 86.9％ , respectively. Using a GM index cutoff value of ≥1.0, the specificity and positive predictive value of both BALF GM and serum GM reached 100％, but the sensitivity and negative predictive value of BALF GM were higher than serum GM (66.7％ vs. 22.2％, 90.60％ vs. 80.60％, respectively). Receiver operating characteristic curve analysis yielded a sensitivity of 83.4％ and a specificity of 96.6％ at a BALF GM index cutoff value of ≥0.725. ConclusionsGM detection in BALF seems to be a useful tool in the diagnosis of IPA in elderly patients with lung diseases,and could be widely used in future.

Cubic and conductive teaching pattern is based on standardized operation process of microbiological specimens. It uses multi-dimensional teaching methods including tests, question guid-ance, discussion, lectures, measurements and scientific researches to lead the undergraduate students to master the standardized inspection process and to train talents with good gifts and abilities in prac-tical application. The teaching pattern helps the trainees complete training in basic experiment skills, analysis and problem solving skills, scientific thinking and working methods. Then the corresponding practical quantification evaluation criteria has been established according to the standardized inspec-tion process to assess the interns' level of grasping various vocational skills and comprehensive appli-cation in the inspection process. This pattern reflects the teaching philosophy of modern laboratory medicine and can scientifically and objectively assess the talent cultivation quality and teaching quality. Since its implementation, these trainees have improved their overall vocational abilities, and made a good preparation for their practical work after school. Besides, it has enhanced the teaching level of microbiology laboratory practice and has been highly valued by interns. It is hoped that this practical experience will be a useful attempt to promote medical education development of modern laboratory medicine.

Based on the International Federation of Nursing Anesthetists (IFNA) education and training base, our hospital has built a training base for anesthesia specialized nurses in Nanjing from the following aspects: the application for training base of anesthesia specialized nurses, the qualification and examination of students' and teachers' qualification, the settings of training curriculum, the examination contents and methods, and the evaluation of post-training effect. This article summarizes the construction experience of this base, therefore, providing support and standard for the training of anesthesia specialized nurses.

Objective:To investigate associations between glycosylated hemoglobin (HbA1c) levels and nonalcoholic fatty liver disease (NAFLD) in population who underwent periodic heath examination.Methods:A total of 912 subjects were selected from the health examination adults in University of Hong Kong Shenzhen Hospital from June to November 2013,and they were assigned into a NAFLD group,an else hepatic disease group,and a control group.The physical examination results of these subjects were analyzed retrospectively.Results:The prevalence of NAFLD was 29.7％.The related factors such as age,body mass index,and the levels of systolic blood pressure,diastolic blood pressure,total cholesterol,triglyceride,low density lipoprotein cholesterol,fasting glucose,HbA1c and alanine aminotransferase in the NAFLD group were higher than those in the else hepatic disease group and the control group (P＜0.05).Aspartate aminotransferase levels in the NAFLD group were higher than those in the control group (P＜0.05).High density lipoprotein cholesterol levels in the NAFLD group were lower than those in the else hepatic disease group and the control group (P＜0.05).According to the quartile of HbAlc level,these subjects were divided into 4 groups,Q1,Q2,Q3,and Q4,and the prevalence of NAFLD in the Q1,Q2,Q3,and Q4 were 17.5％,21.5％,31％,and 59.4％,respectively.The prevalence of NAFLD increased along with the increase in the level of HbAlc (x2=100.092,P＜0.05).Logistic regression analysis showed that the risk factor for NAFLD was increased in the subjects of Q4 as compared with the subjects of Q1 after adjusting for the related factors including age,gender,body mass index,etc.Conclusion:There is a positive correlation between the prevalence of NAFLD and HbAlc level,and the risk of NAFLD increases with the elevating level of HbA1c.High HbA1c level is an independent risk factor for NAFLD.Thus it should be listed as a routine medical test in the health examination.