The purpose of this study was to investigate the role of miR-4281 in immune thrombocytopenic purpura(ITP)and its underlying mechanism.Differentially expressed miRNAs in ITP were searched by using GEO database.Newly diagnosed ITP patients,treatment-effective ITP patients and healthy subjects were collected.Venous blood was obtained and peripheral blood mononuclear cells(PBMCs)and CD4+T cells were separated.Real-time quantitative PCR was used to detect the expression of miR-4281 and other factors in cells.Flow cytometry was conducted to analyze the rate of CD4+CD25+FOXP3+Tregs and Th17 cells.Pearson correlation coefficient method was used to test the relationship between miR-4281 expression level and various factors.Bioinformatics analysis revealed an abnormal expression of miR-4281 in ITP.Compared with healthy subjects and treatment-effective ITP patients,the expression level of miR-4281 in newly diagnosed ITP was decreased.The expression level of miR-4281 in PBMCs of ITP patients was positively correlated with Tregs content and Treg/Th17,while negatively correlated with Th17 cell content.miR-4281 can promote the differentiation of Tregs cells and inhibit the differentiation of Th17.Furthermore,the expression level of miR-4281 is positively correlated with the expression level of FOXP3.Taken together,the expression level of miR-4281 is reduced in ITP.This decrease can inhibit the expression of FOXP3,cause Treg/Th17 immune imbalance,and promote the progression of ITP.

ZHANG Zhongjing's Zhenwutang is a classic formula for warming Yang and excreting water. It is composed of Aconiti Lateralis Radix Praeparata， Poria， Atractylodis Macrocephalae Rhizoma， Paeoniae Radix Alba， and Zingiberis Rhizoma Recens. Physicians of later generations have inherited and developed this formula by detailed recording and application. This paper adopted bibliometrics method to analyze Zhenwutang in terms of history， indications， dosage， drug processing， usage， and modification. The results showed that Zhenwutang was most widely used in Ming and Qing dynasties. Many physicians have inherited ZHANG Zhongjing's theory regarding the application of Zhenwutang in disease treatment， and a few physicians have used it to treat diphtheria and water-related diseases. Some physicians modified this formula to treat maculae， intermittent dysentery， jaundice and so on. Zhenwutang was mainly used to treat diseases of the circulatory system， respiratory system and urinary system in modern clinical practice. The processing of herbal medicines in this formula was clear. Specifically， the raw material of Aconiti Lateralis Radix Praeparata needed to be processed and peeled， while those of Poria， Atractylodis Macrocephalae Rhizoma， Paeoniae Radix Alba， and Zingiberis Rhizoma Recens can be used directly. Although being different， most of the dosages were consistent with those in Treatise on Febrile Diseases. According to the textual research， it is suggested that the reference dosage of this prescription in clinical practice is 41.25 g for Poria， Paeoniae Radix Alba， and Zingiberis Rhizoma Recens， respectively， 27.5 g for Atractylodes macrocephala， and 15 g for Aconiti Lateralis Radix Praeparata. The medicinal materials should be decocted in 1 600 mL water to reach a volume of 600 mL. After removal of the residues， the decoction should be taken warm with 140 mL each time， three times a day. The textual research of Zhenwutang is expected to provide a theoretical reference for the clinical application and formulation of Zhenwutang.

Objective To analyze the effects of different supplements on anemia related indexes in rural children. Methods A stratified method was adopted, and six villages (towns) in and around Qinghai Province were selected as intervention sits for the present study. A total of 304 children from 2 to 6 years old at each intervention site meeting the inclusion criteria were screened and divided into three groups (A, B, and C), who were intervened for 3 months. Serum vitamin A, vitamin D and hemoglobin levels were measured before and after the intervention. Results The hemoglobin level of 304 children before intervention was (118.65±16.07) g /L, and the prevalence of anemia was 9.54%. The vitamin A value, vitamin D value and hemoglobin value were increased after three months of the intervention. The changes of vitamin A value, vitamin D value and hemoglobin value in rural children in group C were significantly higher than those in groups A and B. The increase in vitamin A value in rural children aged 3 years was significantly higher than that in other age groups, and the increase in hemoglobin in rural children of 1 year old was significantly higher than that in other age groups. The increase in vitamin A value of rural children of other ethnic groups (mainly Tibetans) was significantly higher than that of Han and Hui nationalities, and the increase of hemoglobin value in Hui rural children was significantly higher than that in Han and other ethnic groups. Conclusion Vitamin A combined with iron dextran tablets was effective in preventing anemia in rural children.

Objective To evaluate the clinical value of the regional wall motion in patients with suspected coronary artery disease by real-time three-dimensional echocardiography (RT-3DE) and two-dimensional speckle tracking imaging (2D-STI). Methods A total of 143 hospitaized patients with suspected coronary artery disease and normal wall motion de?tected by two-dimensional echocardiography (2DE) were enrolled and devided into group A (coronary stenosis ≥75%) 73 cases and group B (coronary stenosis<75%) that include 70 cases according to coronary angiography results. Left ventricu?lar segmental ejection fraction (sEF) was measured by RT-3DE and peak systolic longitudial strain (SL) was measured by 2D-STI. ROC curves of the two measurements were generated and compared. Differences in sEF and SL between group A and group B were respectively analyzed. Results (1)Both sEF of RT-3DE and SL of 2D-STI in group A were significantly low?er than those in group B (P<0.05);(2)sEF was positively correlated with SL(r=0.689,P<0.05);(3)Compared with SL, sEF had larger area under ROC curve in some segments of left ventricle where both parameters are abnormal for the diagnosis of the coronary stenosis ≥75% (0.922 vs 0.874). Conclusion Regional wall motion of left ventricular can be measured by both RT-3DE and 2D-STI which can be both used to estimate the extend of stenosis of coronary artery. And RT-3DE is su?perior over 2D-STI.

Objective To investigate the relationship between plasma Chemerin and diabetic nephropathy of type 2 diabetes mellitus (T2DM).Methods Totally 195 T2DM patients and 65 healthy controls were enrolled in this study.The T2DM patients were further divivded into three subgroups:normal albuminuria group (n =65),microalbuminuria group (n =65),and clinical albuminuria group (n =65).The plasma Chemerin level was determined by enzyme-linked immunosorbent assay (ELISA).Results The serum Chemerin level was (150.20 ±21.99) μg/L in diabetic patients,which was significantly higher than that in healthy controls (62.13 ± 18.90) μg/L) (P ＜0.01).Inside the T2DM group,the plasma Chemerin level was [(143.63 ± 22.33) μg/L] in the microalbuminuria group and [(173.21 ± 23.91) μg/L] in the clinical albuminuria group (P ＜ 0.001),and both were significantly higher than that in the normal albuminuria group [(100.35 ±20.11) μg/L] (both P ＜0.01).Multivariate regression analysis showed that the plasma Chemerin level was independently associated with glycosylated hemoglobin (β =0.216,P =0.038),total cholesterol (β =1.867,P =0.048),high-sensitivity c-reactive protein (β =12.330,P ＜ 0.001),and urine albumin (β =37.184,P ＜0.001) in T2DM patients.Conclusion Plasema Chemerin level increases in T2DM patients and therefore can be a reliable indicator for detecting early type 2 diabetic nephropathy.

Impaired eady phase insulin secretion is an important reason for leading to postprandial hyperglycemia.Nateglinide is a rapid-acting insulin secretagogue,which reduces postprandial blood glucose of type 2diabetic patient by restoring early phase insulin secretion.The efficacy and safety have been fully verified by clinical administration and it is more widely used to treat type 2 diabetic patients.Both sulfonylureas and glinides were named insulin secretagogue agents and regarded as alternative first-line drugs in the 2010 Chinese Guideline for treatment of type 2 diabetes.AACE/ACE Consensus statement claimed that glinides would be one of the important choices after metformin.In order to further guide the clinical application of nateglinide,16 national specialists in the field of endocrinology and metabolism of China discussed,drafted,and edited this consensus.The current consensus combined clinical evidences at home and abroad.systematically reviewed and summarized tlle results of these studies about nateglinide.It will provide guiding recommendations and reference concerning how to reasonably and effectively use nateglinide in the clinical practice.

Objective To develop a diabetes risk score (DRS)to predict the risk of development of incident diabetes in male senile people in Beijing. Methods DRS was developed basing on a test group including a cohort of 1 370 individuals aged 48-87 years without diabetes at baseline, followed for 10 years by Logistic regression and validated on a value group including a cohort of 340 individuals aged 43-88 years without diabetes at baseline. Results The model with the highest area under the ROC curve ( AUC ) included age, hypertension,history of hyperglycemia, body mass index, fasting plasma glucose, triglycerides, and high-density lipoproteincholesterol (HDL-C). DRS was developed basing on this model with a range from 0 to 12 and an optimal cut-off of 4. AUC were respectively 0. 726 ( 95% CI0. 692-0. 759 ) and 0. 765 ( 95% CI0. 691-0. 839 ) in test group and validation group. The sum score value ≥4 had sensitivity of 65.3% and 68. 1%, specificity of 70. 0% and 64.8%, positive predictive value of 37.0% and 23.2%, negative predictive value of 88.2% and 94. 1%.Conclusion The DRS, derived from clinical information combined with plasma glucose and lipids, is an effective tool to predict incident diabetes.

Objectives To improve the diagnostic and therapeutic ability of ectopic ACTH syndrome by analysing its clinical features.Methods Sixteen cases of ectopic ACTH syndrome diagnosed in Chinese PLA General Hospital from 2000 to 2009 were analyzed retrospectively.Results ( 1 ) The main causes of ectopic ACTH syndrome were lung tumor and thymic carcinoid;(2) Abnormal glucose metabolism, hypertension, hypokalemia and edema of both lower limbs were the most common clinical symptoms;(3) Laboratory examination showed a significant increase of serum cortisol, adrenocorticotropic hormone(ACTH) and 24 h urinary free cortisol (24hUFC) together with severe hypokalemia and alkalosis;(4) High dose dexamethasone suppressing test, corticotrophin-releasing hormone(CRH) stimulating test and petrosal sinus sampling were the most meaningful diagnostic methods;(5) Most of the primary lesions might be detected with chest film and CT;(6) Resection of the primary lesion was the treatment of first choice.Conclusion The diagnosis of ectopic ACTH syndrome is very hard.Resection of the primary lesion is the best treatment.

inal event.

Objective To investigate the outcome and related risk factors of integrated intensive intervention in participants with impaired glucose regulation (IGR) after two years by the criteria of American Diabetes Association 2003. Methods The subjects who remained to be IGR at the end of first year following 75 g oral glucose tolerance test were randomly assigned to either a routine care control group or to an intensive integrated intervention group. The control group received general dietary and exercise advice at baseline and was followed up. In addition to dietary control and exercise advice, mefformin or acarbose were administrated in the intervention group. The latter group was also advised to take antihypertensive agents, lipid-regulating agents if necessary, as well as aspirin. Results The proportion of patients who fulfilled the assigned goals of blood glucose, blood pressure, body mass index or triglycerides was significantly higher in the intensive group than those in the control group. None in the intensive group developed overt diabetes mellitus, while 8 (9.3%) in the control group did. The proportion of patients who reverted to normal glucose tolerance (NGT) was slightly higher in the intensive group than in the control group (29.5% vs 22.1%, P>0.05). Logistic analysis showed that increase of waist circumference and systolic blood pressure was positively while the improvement of islet β-cell function was negatively correlated with the development of diabetes mellitus. Conclusions The intensive integrated intervention could significantly decrease the conversion rate of IGR to diabetes mellitus, and increase the chance of reversion to NGT. The increase of waist circumference or systolic blood pressure, the deterioration of islet β-ccll function were the influencing factors of the conversion of IGR to diabetes mellitus.