From September to October 2018, a questionnaire survey was conducted on the status of diabetes management, basic equipment allocation, complication screening and follow-up, basic drug supply and health education among 136 grassroots institutions in Nanjing. Doctors in the 136 grassroots institutions who had received diabetes specialist training accounted for 18.2% (358/1 968) of total general practitioners. The management rate of diabetes patients was 98.67% (196 352/199 000) , and the standard management rate was 88.63%(174 024/196 352).The screening and follow-up rates of diabetic complications were 89.0%(121/136) and 61.2%(74/121) for glycosylated hemoglobin; 64.7%(88/136), 58.0%(51/88) for urine microalbumin;51.5% (70/136), 62.9%(44/70) for diabetic foot; 44.9%(61/136), 42.6%(26/61) carotid ultrasonography; 32.4%(44/136) and 59.1%(26/44) for fundus examination; 17.6%(24/136) and 33.3%(8/24) for ankle brachial index. The rates of screening for glycosylated hemoglobin, urinary microalbumin, diabetic foot, carotid B ultrasound, fundus and ankle brachial index in urban areas were significantly higher than those in the suburbs (both P<0.05). The diabetes health education was regularly conducted in 92.0%(126/136) of grassroots institutions. At present, the grassroots institutions in Nanjing have established health archives for most diabetic patients and conducted health education regularly, but the professional training and the screening of diabetic complications need to be strengthened.

OBJECTIVE: To explore the value of interferon-inducible protein 10 (IP-10) in the auxiliary diagnosis of tuberculosis and the judgment of the severity of disease. METHODS: From February, 2013 to February, 2017, a total of 193 patients with TB admitted in our hospital and 84 healthy control subjects were recruited consecutively. The peripheral blood plasma levels of interferon-γ (IFN-γ) and IP-10 were detected using liquid phase chip (Luminex) technique. According to the number of lung fields affected by TB, the patients were divided into group A (with lesions in 1-2 lung fields), group B (3-4 lung fields) and group C (5-6 lung fields), The expressions of IFN-γ and IP-10 in 3 groups were compared. RESULTS: The plasma levels of IP-10 were significantly higher in TB patients than in the control subjects ( < 0.05), but IFN-γ levels were comparable between the two groups ( > 0.05). Among the TB patients, plasma IP-10 levels was the highest in group C ( < 0.05), and IFN-γ levels did not differ significantly among the 3 groups ( > 0.05). CONCLUSIONS Plasma IP-10 has a certain reference value in the auxiliary diagnosis of active tuberculosis and the judgment of the severity of the disease.
Antigens, Bacterial ; Biomarkers ; blood ; Chemokine CXCL10 ; blood ; Humans ; Tuberculosis, Pulmonary ; blood ; diagnosis

AIM: To investigate the effects of astragalus injection combined with puerarin injection on endo-plasmic reticulum stress through PERK pathway in diabetic nephropathy mice .METHODS: Male KKAy mice were ran-domly divided into model group ( injected with normal saline ) and treatment group ( injected with astragalus and puerarin ) . The male C57BL/6J mice served as normal group .The mice were sacrificed 4 weeks after treatments for observing morpho-logical changes under electron microscope .The renal tissues were collected to determine the expression of protein kinase R-like endoplasmic reticulum kinase ( PERK ) , eukaryotic initiation factor 2α( eIF2α) and glucose-regulated protein 78 (GRP78) at mRNA and protein levels by real-time PCR and Western blot.RESULTS: Under electron microscope, the renal tubular epithelial cells in model group and treatment group showed the swelling of the nucleus , endoplasmic reticulum and mitochondria .The results of real-time PCR and Western blot showed that the expression of PERK , eIF2αand GRP78 at mRNA and protein levels in model group was higher than that in normal group (P<0.05), while that in treatment group was lower than that in model group .CONCLUSION: Astragalus injection combined with puerarin injection reduces the mRNA and protein expression of PERK , eIF2αand GRP78, thus inhibiting the endoplasmic reticulum stress in type 2 dia-betic mice to protect the kidney function .

Gut microbiota(GM)consists of a complex community of microorganism species that live in the digestive tracts of animals including humans. Dysbiosis is believed to involve in the development of some diseases. Recently dysbiosis in the patients with Alzheimer′s disease(AD)and AD rat models was reported. GM may influence the pathogenesis and development of AD in several ways. Some neurotoxic substances produced by GM can invade into the brain via circulation and impair the neural functions. These sub?stances include ammonia,cyanobacteria-producedβ-N-methylamino-L-alanine,saxitoxin,anatoxin-αand amyloid. The decrease in brain-derived neurotrophic factor(BDNF)in hippocampus and cerebral cortex induced by dysbiosis contributes to the cognitive dys?function. Dysbiosis related endotoxin can induce inflammation,which is one important risk factor for obesity,insulin resistance(IR) and type 2 diabetes mellitus(TIDM). AD and diabetes have good correlation and similarity. Probiotics,prebiotics and Chinese herbal medicines can rebuild GM and have been reported to ameliorate the memory loss of AD patients or model rats. However ,whether and how their preventative and therapeutic effects on AD mediated by GM are worthy of further investigation.

Objective To explore the value of the variation of clinical pulmonary infection score (CPIS) and serum procalcitonin (PCT) in diagnosis and treatment evaluation in patients suffering from active pulmonary tuberculosis with complication of ventilator-associated pneumonia (VAP).Methods A retrospective analysis was carried out in 58 VAP patients from June 1,2009 to December 30,2014 in the respiratory intensive care unit.According to the patient suffering from tuberculosis or not,patients were divided into two groups.The PCT and CPIS score changes were observed in the two groups of patients with intra-tracheal intubation 1,3 and 7 days after VAP onset.Comparisons of CPIS and PCT scores were carried out between two groups at different intervals after VAP onset.Data were statistically processed by SPSS 19.0.Count data were tested by x2,and measurement data were expressed by mean ± standard deviation (x-±s).The comparison within the groups was made by t test,whereas the comparison between the groups was by means of repeated measure analysis of variance and Bonferroni test;Pearson linear correlation analysis was used,and P ＜ 0.05 was considered statistically significant.Results At the same observation interval in two groups of patients with VAP,there was no significant difference in the serum levels of PCT and CPIS score (P ＞ 0.05);there were significant differences in PCT and CPIS scores between VAP occurred at the first day,the third day and at time of intra-tracheal intubation in two groups (P ＜ 0.05).However,comparison of PCT and CPIS scores at the seventh day,the differences were not statistically significant (P ＞ 0.05).In addition,at the 7 days the correlation coefficient between PCT and survival patients' mechanical ventilation,days in ICU and total length of hospital stay were 0.92,0.83,and 0.71,respectively,yet the 7-day CPIS score correlation coefficients were 0.83,0.74 and 0.70,(both P ＜ 0.05).Conclusions Early monitoring of serum PCT and CIPS score of pulmonary tuberculosis patients can judge the incidence of VAP,and the variations of PCT and CIPS score can predict the severity and prognosis of the disease as well.

OBJECTIVETo investigate the distribution and drug-resistance of bacteria in the lower respiratory tract in patients with tuberculosis and severe pneumonia receiving invasive mechanical ventilation.

METHODSThe clinical data, lower respiratory tract infection pathogens and bacterial drug sensitivity were analyzed in 208 patients receiving invasive mechanical ventilation for tuberculosis and severe pneumonia.

RESULTSA total of 355 pathogenic microbial strains were obtained from the patients, among which 281 (79.2%) strains were Gram-negative bacteria, 62 (17.5%) were fungi, and 12 (3.4%) were Gram-positive bacteria. Mixed infections were found in 68 cases (19.2%). The sensitivity rates of meropenem, imipenem and amikacin were over 60% for Gram-negative bacteria, and those of teicoplanin, vancomycin, and fusidic acid were 100% for Gram-positive bacteria.

CONCLUSIONThe main pathogenic bacteria are Gram-negative bacteria, fungi and Gram-positive bacteria in the lower respiratory tract of patients with tuberculosis and severe pneumonia receiving mechanical ventilation. Meropenem, imipenem and amikacin are effective antibiotics for lower respiratory tract infections, and multi-drug resistance is frequent in these patients, which urges appropriate use of the antibiotics.

Anti-Bacterial Agents ; pharmacology ; Drug Resistance, Bacterial ; Gram-Negative Bacteria ; isolation & purification ; Gram-Positive Bacteria ; isolation & purification ; Humans ; Microbial Sensitivity Tests ; Pneumonia, Bacterial ; microbiology ; Respiration, Artificial ; Respiratory Tract Infections ; microbiology ; Tuberculosis ; microbiology

Objective To explore a rapid bacterial identifying method based on the 16S rRNA gene sequence analysis technology to provide the scientific basis for the diagnosis and treatment of unknown pathogenic bacteria.Methods The pure colonies were iso-lated and cultured directly from a clinical patient′s sputum sample.The colony as a template for PCR amplification with universal primers to amplify 16S rRNA gene fragments of unknown bacteria.The product of PCR was sequenced directly,then the sequence result was compared by using the BLAST of NCBI and the pathogen was identified based on the sequence homology.Results 1 strain of unknown pathogen was identified as ochrobactrum by this test and confirmed by ABI bacterial rapid identification sys-tem.Conclusion This study simplifies the isolation and identification procedures of unknown pathogen from the clinical samples and establishes a simple method for the rapid identification of pathogens by using 16S rRNA gene amplification.

Objective To explore the expression and clinical significance of EphA2 and E-eadherin in colorectal carcinoma.Methods The expression of EphA2 and E-eadherin in 67 cases of eoloreetal carcinoma and 28 cases of normal large intestine tissues were determined by immunohistochemieal method(S-P method),and their relationship to elinicopathological characteristics were analyzed.Results The positive expression of EphA2 and negative expression of E-cadherin in colorectul carcinoma tissues were significantly higher than those in normal intestine tissues(P<0.01).F111e positive expression of EphA2 and negative expression of E-eadherin were positively correlated with tumor histological grade,invasive depth and lymph node metastasis(P<0.01 orP<0.05),but not correlated with tumor～ross type(P> O.05).The expression of EphA2 was negatively related with E-cadherin.Conclusions The abnormal expression of EphA2 and E-cadherin may be together involved in the development and progression of eolorectal carcinoma,It may be a good marker for monitoring the malignant degree and the prognosis of colorectal carcinoma by combining E-eadherin and EphA2.

Objective To discuss the influence of parturition balloon on the labor course of primi-paras. Methods We divided 160 primiparas into the observation group and the control group with 80 cases in each group.We gave the observation group parturition balloon intervention with the help of midwife. Nursing measures in the control group were the same as those of the observation group except for the appli-cation of parturition balloon. We observed and compared the psychological status,pain;labor course,dehvery manner and postpartum hemorrhage between the two groups. Results The patients in the observation group got alleviation of psychological condition and pain.The rate of caesarean operation rate,postpartum hemorrhage and time cost of labor course were shortened,which were statistically different from those of the control group(P < 0.01 ). Conclusions Nursing intervention with parturition balloon for primiparas could alleviate pain of the patients, shorten time cost of labor course,improve rate of natural parturition and de-crease caesarean operation rate.It is a service model for delivery worthy of application.

Objective To study the level of serum high-sensitive C-reactive protein and HbA1c in diabetes patients with blood stasis syndrome,and to investigate the relationship among them.Methods 58 cases of diabetes patients with blood stasis syndrome and 65 cases without blood stasis syndrome were observed.The level of FPG,hsCRP,HbA1c,24 h UAER,TC,TG,HDL-C and LDL-C were estimated.Results The level of FPG,LDL-C,TG,HbA1c,hsCRP of diabetes with blood stasis syndrome were higher than the control group(P 0.05).In patients with blood stasis syndrome,the hsCRP was positively correlated to HbA1c,24 h UAER,BMI,LDL-C,TC,TG,but the multifactor regression analysis indicated that hsCRP was only correlated to the HbA1c independently.Conclusions The long-term hyperglycemia and inflammatory may be one of the reasons for the formation of blood stasis syndrome of diabetes patients,hsCRP and HbA1c may be new evidences for diagnosis of diabetes patients with blood stasis syndrome.