BACKGROUND: Most of the literatures only reported that there is a great difference between diabetics who have a high 24-hour urinary albumin excretion rate and those without renal damage, but there is no obvious difference between cases of microalbuminuria and those without renal damage.OBJECTIVE: To probe into the relationship between diabetic nephropathy and osteoporosis.DESIGN: A case-control study.SETTING: Department of Endocrinology, West China Hospital of Sichuan University.PARTICIPANTS: According to the diagnostic standard set by the American Diabetes Association in 1997 (fasting blood glucose ≥ 7 mmol/L,postprandial blood glucose ≥ 11.1 mmol/L), 96 diabetic patients were selected, including 56 males ＜ 60 years old and 40 females who had not entered the menopausal period, excluding the influence of age and osteoporosis caused by menopause. The average age of the subjects was (48.7±10.5)years, their duration were from one month to twenty-one years with the aver age of (7.85±2.56) years, and their general information had no significant differences.METHODS: According to the urine albumine excretion rate and renal function, the patients were divided into four groups: normal albuminuria group (n=48), microalbuminuria group (n=28), macroalbuminuria group (n=15), renal failure group (n=5). The bone mineral densities of lumbar spines (L2-4), femoral neck, Ward's triangle and trochanter were detected with Dual energy X-ray absorptiometry, and then the fasting blood glucose,2-hour postprandial blood glucose, glycosylated hemoglobin A, alkaline phosphatase, calcium, phosphorus, blood urea nitrogen, creatinine and urine albumine excretion rate were compared between the patients with and without osteoporosis.MAIN OUTCOME MEASURES: The fasting blood glucose, 2-hour postprandial blood glucose, glycosylated hemoglobin A, alkaline phosphatase, calcium, phosphorus, blood urea nitrogen, creatinine and urine albumine excretion rate, as well as the bone mineral density, were observed in all the patients.RESULTS: The L2-3 bone mineral density in the macroalbuminuria group was significantly different from that in the microalbuminuria group (P ＜ 0.05). The proximal femur bone mineral density in the microalbuminuria group was significantly different from that in the normal albuminuria group (P ＜ 0.05). The bone mineral densities of proximal femur and lumbar spine in the renal failure group were significantly decreased as compared with those in the other groups (P ＜ 0.01). The disease course,glycosylated hemoglobin A, alkaline phosphatase and body mass index were significantly different between the patients with and without osteoporosis (P ＜ 0.05).CONCLUSION: The incidence rate of osteoporosis is increased with the aggravation of nephropathy, and diabetic nephropathy may be closely correlated with the decrease of bone mineral density and the occurrence of osteoporosis.

0.05). The most prominent symptoms were speech retardation and social dysfunction.Conclusion:Early detection of autism in children is a great task in the near future.

A comprehensive analysis was carried out about the influencing factors of medication safety in the elderly with multiple chronic diseases,who lived in the community and stayed at their own homes.Applicable and simple preventive countermeasures should be established to ensure the medication safety outside medical agency.We should promote extending service of hospitals,cooperate with community and nursing facility in order to increase life quality of the elderly,and supply reference for professional continuous service model including rapid aging,empty nest with advanced age,disability and dementia and elderly people with chronic diseases.

Objective To investigate the fatigue experience of the community-dwelling frail elderly to establish the conceptual model.Methods Grounded theory was adopted.With MAXQDA v10.4.15.1for 3 levels coding,the conceptual model of fatigue experience of community-dwelling frail elderly people was structured through constant comparison and in-depth analysis.Results Multi-response,selfmanagement,safe and belonging,hitting rock bottom,accepting and transferring formed the conceptual model.Conclusions Based on the conceptual model,nurses should pay more attention to concern about the fatigue experience of community-dwelling frail elderly people,and probe different assessment methods to enrich comprehensive geriatric assessment (CGA),then improve the community health service level and the quality of elderly people's life.

Objective To explore the opportunities and challenges which COC (continuity of care) has been facing,some strategies were proposed and improved continuously during the process of deepening medical reform in public hospital,and at the same time to supply reference for government to make relative policy.Methods By SWOT-analysis,the strengths,weaknesses,opportunities as well as threats of COC in medical reform were analyzed comprehensively.Results Depending on national relevant policies,supportive measures,the cooperation from multidisciplinary team was improved.Along with strategies of strengthening advantages,weakening disadvantages,meeting challenges and facing up to threat.COC had be approved and consented initially.Conclusions Public hospitals should demonstrate their various resources and make full use of their advantages,then guide and solid grass-roots in the new healthcare system which integrate medical,rehabilitation and elderly nursing out of the hospital.It must benefit the hospital,specialized subject,family and society.

OBJECTIVETo observe the effects of respiratory support with high frequency jet ventilation (HFJV) in severely burned patients with inhalation injury during early postburn stage.

METHODSTwenty severely burned patients with TBSA of 79.6 +/- 29.3% and inhalation injury were enrolled in the study. Nineteen cases received tracheostomy after admission and only one received nasal intubation. All the patients underwent HFJV to correct hypoxia. The changes in blood gas analysis, respiratory rate and pulse were recorded before and 11 days after the ventilation.

RESULTSTracheostomy was performed on 2.7 +/- 2.4 postburn days (PBDs), and HFJV was given during 4.4 +/- 2.9 PBDs. PaO(2) was evidently higher during 1 - 3 days after HFJV than that before the ventilation (P < 0.01) and remained at high level for 1 week after HFJV. There was no change in PaCO(2), respiratory rate and pulse during the ventilation.

CONCLUSIONHFJV was beneficial in improving oxygenation and without any obvious side effects during the early management of severely burned patients with inhalation injury. This might be an optimal respiratory support pattern.

Adult ; Blood Gas Analysis ; Burns ; complications ; surgery ; High-Frequency Jet Ventilation ; Humans ; Middle Aged ; Smoke Inhalation Injury ; etiology ; surgery ; therapy ; Tracheostomy

The study aimed to analyze the efficacy and safety of rituximab in the treatment of 23 cases of lupus nephritis and explore the prospect of half-dose rituximab in lupus nephritis treatment. Twenty-three patients with lupus nephritis hospitalized in the Department of Rheumatology and Immunology at the First Medical Center of the PLA General Hospital from May 2013 to December 2021 were selected. Eighteen patients received rituximab 375 mg/m 2 on the first and 14th days, 5 patients received 500 mg of rituximab on the first and 14th days, and rituximab was used as needed 6 months later. Methylprednisolone (80-120 mg) was given together with rituximab. Afterward, 1 mg/kg prednisone was used for 4 weeks, which was progressively tapered to maintenance doses or discontinued. B lymphocyte level, renal function, 24-h urine protein level, and systemic lupus erythematosus (SLE) disease activity index 2000 (SLEDAI2K) score before and after treatment were recorded. The efficacy and adverse reactions were analyzed. The results showed that 11 patients suffered from renal insufficiency [creatinine (162.7±58.6) μmol/L ] at baseline, while the creatinine level of 9 patients returned to normal 12 months after the treatment [ (66.3±10.1)μmol/L ]. Normal renal function of the other 12 patients was maintained during treatment. After 12 months, the 24-h urine protein level decreased from 4.00 (2.00,6.80) g in the baseline period to 0.10 (0.08,0.40) g. SLEDAI2K score decreased from 22 (18,26) in the baseline period to 3 (0,6) 12 months after the treatment. The B lymphocyte level reached 0.00 (0.00,0.01)% at 3 months. Of 23 patients, 13 patients achieved complete remission, and 7 patients achieved partial remission after 6 months of rituximab treatment. Five patients experienced adverse reactions related to rituximab, including 1 case of transfusion reaction, 1 case of perioral herpes with pulmonary infection, and 3 cases of decreased IgG levels. Therefore, rituximab regimen used in this study can be an effective treatment strategy for lupus nephritis.

Objective:To construct a eukaryotic expression vector for bacteriophage D29 LysinB/Holin fusion protein and study its bactericidal efficacy against Mycobacterium tuberculosis ( Mtb) in a cell infection model. Methods:A recombinant plasmid pET32a-LysinB was constructed and induced to express LysinB. The polyclonal antibody against LysinB was prepared after the purification of LysinB. A recombinant plasmid pcDNA3.1(+ )-LysinB/Holin was constructed and transfected into mononuclear macrophages RAW264.7. After the expression of the prepared polyclonal antibody was identified, a cell infection model was established and the bactericidal efficacy of LysinB/Holin fusion protein was measured by acid-fast staining and colony counting.Results:The polyclonal antibody against LysinB was successfully prepared. The recombinant plasmid pcDNA3.1(+ )-LysinB/Holin could effectively express LysinB/Holin fusion protein in eukaryotic cells without inducing significant cytotoxicity. LysinB/Holin fusion protein was effective in killing Mtb in cells. Conclusions:The recombinant plasmid pcDNA3.1(+ )-LysinB/Holin has a better killing effect on intracellular Mtb without inducing obvious cytotoxicity against eukaryotic cells, showing a potential in the treatment of tuberculosis.

【Objective】 To explore the molecular hereditary and frequency of Jk(a-b-) in blood donors in Yichang. 【Methods】 A total of 49 999 samples from Yichang Red Cross Central Blood Station were screened for Jk(a-b-) by urea hemolysis test(2 mol /L). The phenotypes of JK (a-b -) probands and their families were confirmed by monoclonal anti-Jk^a and anti-Jk^b, and the whole exon of SLC14A1 gene was sequenced. 【Results】 The frequency of Jk(a-b-) in Yichang blood donors was 0.004% (2/49 999), and the exon sequencing of SLC14A1 gene confirmed that both two probands were JK^*02N.01 caused by c. 342-1G>A homozygous mutation.Besides, JK^*01W.01 allele was observed in the pedigree analysis, and weak expression of Jk^a was found in 4 out of 11 family members. 【Conclusion】 The frequency of JK (a-b -) in Yichang blood donors is similar to those in Shanghai 0.004%(2/48 400), and both caused by JK ^* 02N.01 allele with high frequency in Southeast Asia. The epidemiological survey of JK ^* 01w.01 allele frequency should be further performed.

Objective:To explore the efficacy and safety of Rivaroxaban in preventing catheter related thrombosis (CRT) in patients with breast cancer who are undergoing central venous catheter chemotherapy, and provide basis for making standardized prevention and treatment strategies.Methods:In this research, a prospective cohort study was adopted, and breast cancer patients who received central venous catheter chemotherapy in Sanhuan Cancer Hospital during September 2020 to March 2022 were selected as a treatment group to take the rivaroxaban anticoagulation therapy with 10 mg.po.qd for one month. The control group got no preventive anticoagulation therapy. Vascular ultrasound examination was taken to confirm the occurrence of CRT, and a chi-square test was done for comparison the disparity between the groups. Logistic regression was applied to analyze the univariate and multivariate factors for the formation of CRT.Results:In the research, a total of 235 patients were selected, and there were a total of 19 035 days of catheterization with 81 days of catheterization on average. While in the control group, the incidence of CRT was 28.0% (33/118), the incidence of CRT in the treatment group was 20.5% (24/117), the difference was no significant ( P=0.183). Subgroup analysis results showed that the peripherally inserted central catheter (PICC) was performed in 165 cases with the CRT incidence of 18.2% (30/165) and thrombosis was mostly seen around axillary vein, accounting for 63.3%. Subclavian vein catheterization was performed in 63 cases with the CRT incidence of 39.7% (25/63), and thrombosis was mostly seen around subclavian vein, accounting for 88.0% (22/25). Implantable venous access port was implanted in 7 cases around subclavian vein and internal jugular vein with the CRT incidence of 28.6% (2/7). The patients who developed CRT within 30 days after catheterization accounted for 54.4% (31/57), 22.8% (13/57) in a period during 30 days and 60 days) and 22.8% (13/57) in a period during 60 days and 180 days). The diagnosed CRT patients had been treated with rivaroxaban 15 mg.bid.po for 3 months. During the 3 months, 100.0% of the thrombosis waned, 71.9% (41/57) of the thrombosis waned within 30 days, 19.3% (11/57) in a period during 30 and 60days and 8.8% (5/57) in a period during 60 days and 90 days. Univariate and multivariate analysis indicated that the risk of CRT in subclavian vein catheterization was higher than that in PICC, respectively ( OR=2.898, 95% CI:1.386-6.056 P=0.005), and the type of catheterization was an independent factor for the formation of thrombosis. Safety analysis result showed that in the prevention of CRT, rivaroxaban treatment did not induce drug-related bleeding, liver function damage, bone marrow suppression or any other side effects. While CRT diagnosed patients were treated with anticoagulation, they kept the central venous catheter, and the infusion was smooth. These patients all finished the anti-tumor treatment as planned, and no abnormalities like new thrombosis or pulmonary embolism were observed. Conclusions:In the mid-term analysis, the proportion of Rivaroxaban in preventing anticoagulant CRT decreases, but it don't reach statistical significance. The sample size should be further increased for observation. Rivaroxaban is proved effective and very safe in the treatment of CRT, and does not affect the concurrent chemotherapy. Medical personnel should carry out the policy of "early prevention, early detection and early treatment" for CRT so as to improve the patients' quality of life.