Objective To observe the renal expression of cyclooxygenase-2(COX-2) in diabetic nephropathy rats and the effects of Losartan as angiotensin II type 1(AT1) receptor antagonist.Methods Twenty-eight diabetic Sprague-Dawley(SD) rats induced with intraperitoneal injection of streptozotocin were randomly divided into two groups: diabetic rats without therapy(group D,n=14) and diabetic rats treated with Losartan(group L,n=14).Twenty SD rats were used as the control(group N).The urine and blood samples in 24h were collected after the treatment with Losartan for 10 weeks.The rats were killed and the renal expression of COX-2 was determined with immunohistochemistry.Results Expression of COX-2 in the nephridial tissue and the concentration of urinary thromboxane B_2(TXB_2) in group D were significantly higher than those in group N(P

Objective To explore effects of fosinopril and losartan on renal Klotho expression and oxidative stress in spontaneously hypertensive rats (SHR) and the mechanisms underlying the protection against renal damage. Methods Fifteen male SHRs (22 weeks old) were randomly divided into 3 groups (n=5 in each group): a SHR group, a fosinopril group ［10 mg/(kg?d)］, and a losartan group ［50 mg/(kg?d)］. Age-matched Wistar-Kyoto (WKY) rats were chosen for a control group. Eight weeks later, tail arterial pressure, 24 hours urinary protein (Upro)，urinary N-acetyl-β-D-glucosaminidase (NAGase) were measured. Renal pathological changes were examined under light microscopy by HE staining. The renal mRNA and protein expression of Klotho were determined by RT-PCR, immunohistochemical staining or Western blot. The levels of total antioxidant capacity (TAOC), malondialdehyde (MDA), Cu/Zn superoxide dismutase (Cu/Zn-SOD), Mn superoxide dismutase (Mn-SOD), catalase (CAT), and glutathione peroxidase (GSH-Px) were determined.Results The typical pathological characteristics of hypertensive renal damage were observed in the kidney of the SHR group．Compared with the SHR group, the systolic pressure, Upro, and urinary NAGase, the content of MDA and renal pathological damage was reduced while the renal Klotho expression and activities of TAOC, Cu/Zn-SOD, CAT, and GSH-Px were increased (P<0.05 or P<0.01) in the fosinopril or losartan group. There was no significant difference in renal Mn-SOD level among the 4 groups (P>0.05). Conclusion Fosinopril and losartan can exert protection against hypertensive renal damage through upregulating Klotho expression as well as reducing oxidative stress.

We carried out a new unit-based method in the teaching process of epidemiology for improving undergraduate prevention-oriented medical students' comprehensive ability. The new method integrated heuristic teaching and case teaching, and focused reform on the system of teaching and assessment. The results showed new teaching method can significantly improve students' capacity of analysis and oral expression, and contributes to the comprehensive ability.

Extracorporeal membrane oxygenation(ECMO) is a kind of extra life support technique that can support cardiac and pulmonary function in a relatively long time.With the application of nitric oxide,pulmonary surfactant and high frequency ventilation,the use of ECMO in neonatal respiratory failure decreased.Although received these treatment,there are some newborn with respiratory failure still required ECMO at last.On this paper,the application of ECMO in neonatal respiratory failure from foreign medical institute was introduced,and compared with the domestic situation,in order to improve the application of ECMO in neonatal respiratory failure.

Objective To evaluate the effects of dexmedetomidine combined with subanesthetic dose of ketamine on the emergence agitation in the patients undergoing thoracotomy.Methods Eighty ASA physical status Ⅱ or Ⅲ patients,aged 55-75 yr,weighing 50-75 kg,scheduled for elective esophageal cancer resection,were randomly divided into 4 groups (n =20 each) using a random number table:normal saline group (NS group),dexmedetomidine group (group D),subanesthetic dose of ketamine group (group K),and dexmedetomidine combined with ketamine group (group DK).In DK and K groups,ketamine 0.5 mg/kg was injected intravenously (within 1 min) at 10 min before the end of the operation.In DK and D groups,dexmedetomidine 0.5 μg/kg was infused intravenously over 10 min starting from 10 min before the end of operation.In group NS,the equal volume of normal saline was infused intravenously over 10 min starting from l0 min before the end of operation.The emergence time,extubation time,duration of ICU stay,occurrence and degree of agitation,and development of cardiovascular events and hypoxemia within 24 h after operation were recorded.Ramsay sedation scores were recorded before induction of anesthesia (T1),immediately after completion of administration at the end of surgery (T2),and at 0,5,10 and 30 min after extubation (T3-6).Results There was no significant difference in the emergence time,extubation time,and duration of ICU stay between the four groups.Compared with group NS,Ramsay sedation scores were significantly increased at T3-6,the incidence and degree of agitation were decreased,and the incidence of cardiovascular events and hyoxemia was decreased in D,K and DK groups.Compared with D or K group,Ramsay sedation scores were significantly increased at T3-6,the incidence and degree of agitation were decreased,and the incidence of cardiovascular events and hyoxemia was decreased in group DK.Conclusion Dexmedetomidine combined with subanesthetic dose of ketamine can prevent the emergence agitation in the patients undergoing thoracotomy,which provides better efficacy than either alone.

Objective To investigate the effect of high glucose and losartan on cell proliferation and cyelooxygenase-2 (COX2) expression in normal human mesangial cells (NHMCs), and to examine the effect of losartan on COX2 and transforming growth factor-betal (TGF-β1) expression in a model of diabetic nephropathy (DN). Methods NHMCs were cultured in vitro in high glucose media with or without losartan. NHMCs proliferation and COX2 expression were determined by WST-1, Western blot,and RT-PCR. The rat model of DN was produced by injections of streptozocin (STZ). After the treatment with losartan for 4 weeks, glomerular hypertrophy, urinary thromboxane B2(TXB2) and 24 h urinary pro-tein counts were measured,and COX2 and TGF-β1 expressions were investigated using immunohistochem-ical techniques and RT-PCR. Results Losartan dose-dependently inhibited the proliferation of NHMCs in response to high glucose. Losartan also decreased COX2 expression in NHMCs at high or low glucose concentrations. In vivo experiments found kidney weight/body weight (KW/BW), urinary TXB2 and 24 hurinary protein counts increased significantly in the DN group. Losartan reduced KW/BW, urinary TXB2,and 24 h urinary protein counts and significantly suppressed the over-expression of COX2 and TGF-β1.Conclusion Losartan reduces COX2 expression in NHMCs, especially at high glucose concentrations.Losartan could suppress the expression of COX2 and TGF-β1 in the kidney of DN rats and attenuate the renal lesions caused by DN.

Objective To investigate the clinical features of sepsis caused by gram negative or positive pathogens and funguses in preterm infants.Methods The clinical data of 140 premature infants with sepsis admitted to preterm neonatal intensive care unit of Bayi Children's Hospital from October 2008 to June 2011 were collected and analyzed retrospectively.The clinical features of sepsis caused by different types of pathogens in preterm infants were compared by SPSS 18.0 software.Comparison of measurement data was conducted by one way ANOVA,and comparison between groups was performed by LSD method.Rates among groups were compared by Chi-square test or Fisher's exact test.Results Of 140 preterm infants with sepsis,70 cases were caused by gramnegative bacteria,36 by gram positive bacteria,and 34 by funguses.The top three gram negative sepsis pathogens were Klebsiella pneumonia (55.7 ％,n =39),Escherichia coli (20.0 ％,n =14) and Acinetobacter baumannii (12.9％,n =9).The top three gram positive sepsis pathogens were Staphylococcus epidermidis (36.1％, n =13), Staphylococcus hominis (22.2％, n =8) and Staphylococcus haemolyticus (19.4％,n=7).The top four fungus sepsis pathogens were Candida parapsilosis (44.1％,n=15),Candida albicans (23.5％,n=8),Candida famata (8.8％,n=3)and Cryptococcus laurentii (8.8％,n=3).There were no significant differences in delivery mode,fetal distress, asphyxia, fetal growth restriction, meconium-stained amniotic fluid, maternal infection,hypertensive disorder complicating pregnancy,gestational diabetes mellitus,peripherally inserted central venous catheter,mechanical ventilation before infection,cortical hormon（e） (e)xposure,intraventricular hemorrhage, periventricular leukomalacia, peripheral blood immature-to-total neutrophil ratio,recovery time of platelet,the time of infection onset,fever and hypothermia among the three groups (P＞0.05).While there were differences in gestational age [(30.4 ± 2.3) weeks,(31.0±2.4) weeks and (29.5±1.8) weeks,F=4.317,P=0.015],birth weight [(1512.5±406.0) g,(1563.8±485.4) g and (1328.8±303.2) g,F=3.190,P=0.044],premature rupture of membranes rate [24.3％ (17/70),16.7％ (6/36) and 44.1％ (15/34),X2 =7.241,P=0.034],rate of surgery during neonatal period [12.9％ (9/70),38.9％ (14/36) and 11.8％ (4/34),X2 =10.430,P=0.005],the incidence of lowperfusion [64.3％ (45/70),30.6％ (11/36) and 50.0％ (17/34),X2 =10.922,P=0.004],rate of frequent apnea [67.1％ (47/70),36.1％ (13/36) and 55.9％ (19/34),X2=9.341,P=0.009],incidence of low white blood cell [21.4％ (15/70),8.3％ (3/36) and 32.4％ (11/34),X2=6.267,P=0.042],thrombocytopenia rate [64.3％ (45/70),16.7％ (6/36)and 67.6％ (23/34),X2 =25.576,P=0.000],white blood cell count [(19.9± 17.8) × 109/L,(19.9±14.3) ×109/L and (12.0±8.1)×109/L,F=3.553,P=0.031],platelet count [(159.1±169.1) ×109/L,(311.8±179.7) ×109/L and (121.4±123.4) ×109/L,F=14.140,P=0.000],C-reactive protein [(76.8±70.1) mg/L,(16.6±27.2) mg/L and (31.8±27.5) mg/L,F=17.248,P=0.000],incidence of central nervous system infections [1.4％ (1/70),2.8％ (1/36) and 11.8％(4/34),X2 =5.066,P=0.043],retinopathy rate of premature infants [38.6％ (27/70),50.0％(18/36) and 67.7％ (23/34),X2 =8.780,P=0.012],bronchopulmonary dysplasia rate [8.6％ (6/70),11.1％ (4/36) and 26.5％ (9/34),X2=5.837,P=0.044] and mortality [11.4％ (8/70),0.0％ (0/36) and 2.9％ (1/34),X2 =5.361,P =0.042] among the three groups.Conclusions There are significant differences among sepsis caused by different types of pathogens in risk factors (gestational age,birth weight,premature rupture of membranes and neonatal surgical procedures),clinical manifestations,infection indexes and prognosis in preterm infants.Sepsis caused by gram negative bacilli liked to present shock with obvious increasing of C-reactive protein; and the prognosis is the worst.Central nervous system infection is more common in fungal infection; and the rates of retinopathy of prematurity and bronchopulmonary dysplasia are higher.Sepsis caused by gram positive cocci have mild clinical manifestations and infection indexes variations and better prognosis.

Objective To summarize the characteristics of treatment and outcomes of extremely low birth weight infants (ELBWI).Methods The clinical data of 81 cases of ELBWI admitted to Bayi Children's Hospital Affiliated to General Hospital of Beijing Military Command from October 1st.2008 to August 31st.2011 were retrospectively analyzed.The survival rate and mortality of ELBWI with different gestational age and birth weight were compared with Chi-square test.Results Of 81 ELBWI,43 were male and 38 were female; the mean gestational age at birth was (28.4 ±2.1) weeks; the average birth weight was (903.5 ± 95.4) g.Complications of them included respiratory distress syndrome (68/81,84.0％),patent ductus arteriosus (47/81,58.0％),retinopathy of prematurity (41/81,50.6％),intraventricular hemorrhage (23/81,28.4％),bronchopulmonary dysplasia (17/81,21.0％),sepsis (15/81,18.5％),periventricular leukomalacia (2/81,2.5％) and necrotizing enterocolitis (1/81,1.2％).Among 81 infants,96.3％ (n =78)received oxygen inhalation with the average time was 19.1 d (median 11 d,0-121 d) ; 70.4％ (n=57)received pulmonary surfactant; 27.2％ (n =22) received nasal continuous positive airway pressure;34.6％ (n =28) received normal frequency mechanicalfrequency ventilation.All 47 ELBWI with patent ductus arteriosus received ibuprofen treatment,among which 6 cases received arterial canal ligation after failure of ibuprofen treatment.20 out of 41 cases of retinopathy of prematurity received laser surgery.Total parenteral nutrition was required in 74 infants(91.4％),the average age of beginning enteral feeding was 5.2 d (median 6 d,0-17 d)and achieved full gastrointestinal feeding time was 31 d (median 28 d,7-65 d).The survival rate of ELBWI with gestational age of ≤26,-28 and ＞28 weeks was 25.0％ (4/16),72.0％ (18/25) and 77.5％ (31/40),respectively; the corresponding mortality was 12.5％ (2/16),8.0％ (2/25) and 2.5％ (1/40),respectively.The survival rate of ELBWI with birth weight ≤800,-900 and ＞900 g was 33.3％ (4/12),58.3％ (14/24) and 77.8％ (35/45),respectively; and corresponding mortality of them was 16.7％ (2/12),8.3％ (2/24) and 2.2％ (1/45),respectively.Conclusions The outcome of ELBWI is closely related to gestational age and birth weight.Professional and sophisticated treatment might improve the survival rate and general outcome of ELBWI.

Objective To determine the incidence and risk factors of retinopathy of prematurity (ROP) in preterm infants.Methods Fundus examinations were performed by RetCam Ⅱ ophthalmoscopy on 2185 premature infants (birth weight ≤ 2000 g or gestational age≤34 weeks)admitted into the neonatal intensive care unit of Beijing Bayi Children's Hospital from January 1st 2009 to December 31st 2010.According to the results,all infants were divided into ROP group and nonRO P group.Two-sample t test and Logistic regression analysis were used to investigate the risk factors of ROP.Results Among 2185 premature infants,287 (13.1 ％) cases were diagnosed with RO P.According to International Classification of RO P,34 cases (11.9 ％) were in zone Ⅰ,147 cases (51.2％) in zone Ⅱ,and 106 cases(36.9％) in zone Ⅲ.And there were 117 cases (40.8％) with stage 1 lesion,142 cases (49.5％) with stage 2 lesion,28 cases (9.7％) with stage 3 lesion,and no stage 4 or 5 lesion was identified.Thirty-six cases (12.5 ％) were accompanied by additional diseases.Logistic analysis showed that small gestational age (OR=0.859,95％CI:0.770-0.958,P=0.006),low birth weight (OR=0.729,95％CI:0.6340.838,P=0.000),long duration of oxygen supplement (OR=2.221,95％CI:1.904-2.592,P=0.000),assistant ventilation (OR=3.104,95％CI:2.0964.956,P=0.000),apnea (OR=1.767,95％CI:1.103 2.831,P=0.018) and=anemia (OR=2.242,95％CI:1.641-3.604,P=0.000) were independent risk factors of ROP.Conclusions The incidence of ROP in premature infants is high.Small gestational age and low birth weight,long duration of oxygen supplement,assistant ventilation,apnea and anemia are risk factors of ROP.Preventive measures should be taken against these factors.

Objective To investigate the situation of oxygen supplement and the incidence and clinical characteristics of long-term oxygen inhalation newborns in neonatal intensive care unit(NICU).Methods The records of oxygen supplement and the related clinical data of 12 155 neonates admitted in our NICU from Oct 2009 to May 2011 were collected and retrospectively analyzed.The results were compared with the data from a survey on 19 hospitals in China which reported by other authors.Results In 12 155 newborns,4 951 were full term,7 204 were preterm.One hundred and two patients (0.84％,102/12 155 ) accepted oxygen for more than 28 days.Among them,88 were preterm,14 were full term,with the average gestational age (31.16 ±3.70) weeks,the average birth weight (1.60 ±0.68) kg and the mean oxygen supplement period (40.60 ± 12.25) d.Finally,98 were cured or improved,4 died.The incidence of bronchopulmonary dysplasia (BPD) in 7 204 preterm infants was 1.22％ ( 88/7 204) according to the standard of continuous oxygen supply more than 28 days after birth.The incidence of BPD in preterm infants less than 32 weeks was 4.92％ (68/1 381 ) according to the standard of continuous oxygen supply more than 28 days after birth,while the rate was only 2.10％ (29/1 381 ) according to the standard of continuous oxygen supply more than 36 weeks postmenstrual age.The rates of BPD according to the two different standards were significantly different ( x2 =16.251,P ＜0.001 ).There were significant differences in the rate of supply oxygen( x2 =119.99) and supply oxygen time( F =109.27 ) among different gestational age groups in overall the 5 499 neonates ( P ＜0.001 ),but no significant differences in the average time of oxygen supply and mechanical ventilation among different gestational age groups in infants with long-term oxygen dependence ( P ＞ 0.05 ).There were significant differences in rates of pulmonary surfactant therapy,heart failure,retinopathy of prematurity,congenital heart disease,other congenital malformation and mortality among different gestational age groups in long-term oxygen dependence infants (x2 =8.789,13.538,23.176,7.778,8.842,8.246,P ＜ 0.05 ).As compared with the data from 19 hospitals,the corrected rate of long-term oxygen supplement in preterm infants in our hospital was obviously lower[0.99％ (71/7204) vsl.54％ (190/12 351),P ＜0.001].Conclusion Theincidence of BPD in our NICU is low.Lower gestational age,immature lung and secondary lung injury may be the mainly cause of neonatal long-term oxygen dependence,but some factors such as congenital heart disease,congenital malformations should be considered in more mature infants.The most appropriate standard for BPD still remains to be discussed.