Objective To analyze the correlations of hepatic function and thyroid function in hyperthyroidism patients with hepatic dysfunction,explore the clinical characteristics in antithyroid drug methimazole related hepatotoxicity and its related factors.Methods A total of 54 patients with hyperthyroidism liver disease(hyperthyroidism liver damage group) and 33 patients with no treatment after initial diagnosis without liver damage hyperthyroidism(hyperthyroidism without liver damage group) were included.The general and clinical data(thyroid and liver function) of the two groups were collected and the related factors to hyperthyroidism with liver dysfunction were analyzed.Twenty-seven patients with antithyroid drug induced liver injury at the same time were also included.They were divided into hepatocellular hepatotoxicity group(7 cases),cholestatic hepatotoxicity group(12 cases) and mixed hepatotoxicity group(8 cases) according to the liver function index,and to compare their general and clinical data（thyroid and liver function）.Results The levels of ALT,AST,alkaline phosphatase(ALP),γ-glutamyl transpeptadase(γ-GT),total bilirubin(TBIL),free triiodomethylamine(FT₃),free thyroid hormone(FT₄) and thyrotrophin receptor antibody(TRAb) before the treatment in patients with hyperthyroidism liver damage group were significantly higher than those in hyperthyroidism without liver damage group（P<0.05）.The levels of ALT,ALP,γ-GT were correlated positively to FT₃,FT₄ and TRAb（P<0.05）.There were statistically significant differences in age,time of application of antithyroid drugs,levels of ALT and ALP among hepatocyte,cholestasis and mixed hepatotoxicity groups（P<0.05）.ConclusionThe severity of thyroid dysfunction may be associated with liver damage in patients with hyperthyroidism.The type of liver damage caused by the antithyroid drug methimidazole maybe related to the age,course of disease and duration of medication in patients.

Objective  To explore the efficacy of home cardiac rehabilitation exercise in patients with coronary heart disease(CHD) after percutaneous coronary intervention(PCI).Methods  According to the order of admission,92 patients with CHD who were received PCI in the third grade hospital and lived in our community were divided into control group(46 cases) and observation group(46 cases).Patients in control group were received conventional treatment after PCI,and patietns in observation group were received home cardiac rehabilitation exercise on basis of those in control group within 3 months.BMI,heart rate,blood pressure,left ventricular end diastolic diameter(LVEDD),left ventricular ejection fraction(LVEF),6 min walking distance and metabolic equivalent (METs) were compared between the two groups.The Seattle angina questionnaire(SAQ) was used to assess quality of life of patietns in the two groups before and after treatment and the results were compared.Results  There were no significant differences of BMI,heart rate,blood pressure,LVEDD,LVEF,6 minutes walking distance,METs and score of every item in SAQ between patient of the two groups before treatment(P＞0.05).BMI,diastolic blood pressure and LVEDD after treatment in patients of observation group were lower than those before treatment,LVEF,6 minutes walking distance,METs and score of every item in SAQ were higher than those before treatment(P＜0.05).LVEDD after treatment in patients of control group was lower than that before treatment,scores of angina stability,treatment satisfaction and disease recognition in SAQ were higher than those before treatment(P＜0.05).Diastolic blood pressure after treatment in patients of observation group was lower than that of control group,LVEF,6 minutes walking distance,METs and score of every item in SAQ were higher than those of control group(P＜0.05).Conclusion  Home cardiac rehabilitation exercise can reduce BMI in patients with CHD after PCI,regulate their blood pressure,improve cardiac function,improve exercise tolerance and quality of life.

Objective  To explore the correlation between fatty liver index(FLI) and insulin resistance(IR) in middle aged and elderly population in China.Methods  A total of 3 592 community population aged over 45 years in Gulou district,Nanjing city were enrolled.The subjects were divided into IR group(1 938 cases) and non-IR group(1 654 cases) according to Homeostatic model assessment of insulin resistance index(HOMA-IR) and divided into FLI＜30 group(2 221 cases),30≤FLI＜60 group(911 cases) and FLI≥60 group(460 cases) based on FLI.General data,biochemical indexes,blood glucose and insulin related indexes of different subgroups were compared.Spearman nonparametric correlation analysis was used to evaluate the correlation between FLI and HOMA-IR,related indicators of islet β cell function.Receiver operating characteristic(ROC) curve was used to analyze the predictive value of FLI for IR.Multivariate logistic regression analysis was conducted to assess the relationship between FLI and IR.Results  The rate of male population,age,blood pressure,blood fat,liver function,plasma glucose and insulin at each time point of OGTT,FLI,homeostatic model assessment of islet β cell function(HOMA-β),ΔI0-30/ΔG0-30 and HOMA-IR of IR group were higher than those of non-IR group,while serum creatinine and Matsuda ISI were lower than those of non-IR group(P＜0.001).The differences of blood pressure,biochemical indexes,plasma glucose and insulin related indexes among different FLI subgroups were statistically significant(P＜0.001).Spearman nonparametric correlation analysis results showed that FLI was positively correlated with HOMA-IR(P＜0.001) and negatively correlated with Matsuda ISI(P<0.001).ROC curve analysis results showed that AUC of IR based on FLI was 0.670(95% CI 0.653-0.688).Multivariate logistic regression analysis results showed that FLI was one of the risk factors for IR and could increase the risk of IR by 1.021 times(P<0.001).Conclusion  FLI is correlated with IR and can be a simple and practical index for evaluating IR in middle-aged and elderly population in China．

Objective To explore the predictive value of QT interval after correction（QTc） prolongation in electrocardiogram for delayed neuropsychiatric sequelae(DNS) in patients with carbon monoxide(CO) poisoning.Methods Clinical data of 223 patients with CO poisoning were retrospectively analyzed,the patients were divided into DNS group(31 cases) and non-DNS group(202 cases).Univariate and multivariate logistics regression analysis were used to determine independent risk factors for DNS occurrence,the predictive value of QTc detecting time for DNS was evaluated by ROC curve.Results DNS occurred in 31 cases(13.3%) of the 233 patients with CO poisoning.Univariate logistic regression analysis showed that the Glasgow coma score(GCS)<9 points,transient loss of consciousness,CO exposure to prolonged hospital admission and QTc prolongation were associated with DNS(P<0.05).Multivariate logistic regression analysis showed that the GCS score<9 points,CO exposure to admission time>6h and QTc prolongation were independent risk factors for DNS deveplement(P<0.05).ROC curve analysis showed that QTc detection within CO exposure<2h,2~4h,4~6h had high predictive value for DNS development,and with the best predicted value of within 6 hours of CO exposure.Conclusion QTc prolongation within 6h of CO exposure is a new index for predicting DNS occurrence in patients with CO poisoning.

Objective To study the secretion of serum cholecystokinin(CCK) and ghrelin at different times after oral glucose administration in patients with type 2 diabetes（T2DM).Methods The 82 patients with T2DM were selected as T2DM group,34 healthy subjects who underwent physical examination during the same period were selected as control group.General clinical data of both groups were collected,blood glucose levels at different times after fasting and oral glucose administration were measured and compared between the two groups.Pearson correlation analysis was used to investigate the correlation of serum CCK,ghrelin with blood glucose,insulin.Results The blood glucose levels in the T2DM group were higher than those in the control group at 0,30,60,120 and 180min after oral glucose administration.The insulin and C-peptide levels were lower than those of the control group at 30,60 and 120min after oral glucose administration,the CCK level was lower than those of the control group at 60 and 120min after glucose administration.The levels of ghrelin was lower than that of the control group at 0,30,60 and 120min after oral glucose administration（P<0.05）.Pearson correlation analysis found a negative correlation between serum ghrelin level and BMI（r=-0.282，P=0.047）.Conclusion The secretion of CCK and ghrelin in T2DM patients is lower than the normal population after oral glucose administration,the peak of CCK secretion is significantly delayed,and the fasting serum ghrelin is negatively correlated with BMI.

Objective To explore the predictive value of platelet microRNA(miR)-223 and miR-21 on clopidogrel resistance after percutaneous coronary intervention(PCI) in patients with coronary heart disease(CHD).Methods According to platelet inhibition rate,119 patients with CHD undergoing PCI were divided into normal clopidogrel response(normal group,67 cases) and clopidogrel resistance group(resistance group,52 cases).Levels of platelet miR-23 and miR-21 were compared between the two groups.Multivariate logistic regression analysis was used to assess the influencing factors of clopidogrel resistance.Pearson correlation analysis was used to evaluate correlation between levels of platelet miR-223 and miR-21 with platelet inhibition rate.Receiver operating characteristic(ROC) curve was used to evaluate the predictive value of platelet miR-223 and miR-21 for clopidogrel resistance.Results Levels of platelet miR-223 and miR-21 in resistance group were higher than those in normal group(P<0.05).Results of multivariate logistic regression analysis showed that increased levels of platelet miR-223 and miR-21 were independent risk factors for clopidogrel resistance after PCI in patients with CHD(P<0.05).Results of Pearson correlation analysis showed that levels of platelet miR-223 and miR-21 were negatively correlated with platelet inhibition rate in patients with CHD undergoing PCI(P<0.05).Area under ROC curve(AUC) of platelet miR-223 and miR-21 predicting clopidogrel resistance after PCI in patients with CHD were 0.69(95%CI 0.53~0.78),0.64(95%CI 0.51~0.69) respectively,and AUC of platelet miR-223 combined with miR-21 was 0.85(95%CI 0.77~0.94).ConclusionLevels of platelet miR-223 and miR-21 in patients with CHD who develop clopidogrel resistance after PCI increase,and they are negatively correlated with platelet inhibition rate,which can be used to predict the risk of clopidogrel resistance.

Objective To investigate the characteristics of major adverse cardiovascular events(MACE) and the risk of all-cause mortality in patients with diabetes mellitus and sepsis within 30 days of hospitalization.Methods A total of 720 patients with sepsis were enrolled.According to whether or not with diabetes mellitus,the patients were divided into diabetic group（n=252） and non-diabetic group（n=468）.The occurrence of MACE and all-cause mortality as well as the characteristics of MACE occurred on the 1st to 15th day(D₁₅) and the 16th to 30th day(D₃₀) were compared between the two groups.Results The incidence of MACE in the diabetic group was 36.5%,which was higher than that in non-diabetic group(22.2%，P<0.05),but there was no statistical difference in the incidence of acute cerebrovascular accidents between the two groups（P＞0.05）.The incidence of all-cause death in patients with diabetes was 25.0%,which was higher than that in non-diabetic group（15.6%，P<0.05).The incidences of ACS,acute heart failure,severe arrhythmia and cardiogenic death in D₁₅ of the two groups were respectively higher than those of D₃₀ in the same groups(P<0.05),but there was no statistical difference in the incidence of acute cerebrovascular accidents between D₁₅ and D₃₀ in both two groups（P＞0.05）.Multivariate logistic regression analysis showed that diabetes was an independent predictor of MACE(P<0.05).Conclusion In patients with diabetes mellitus and sepsis,the incidence of MACE and all-cause death during the 30day hospital stay increases significantly.Effective control of blood glucose may reduce MACE and all-cause mortality in sepsis patients with diabetes mellitus.

Objective To analyze the distribution and drug resistance of mycobacterium tuberculosis(MTB) and non-tuberculosis mycobacteriu(NTM) among AIDS patients with positive results of mycobacterium culture in Shanghai public health clinical center from 2006 to 2015.Methods From January 2006 to December 2015,the patients who were admitted to our hospital with clinical symptoms and positive results of mycobacterium culture were collected.The general data such as age and gender,the results of subsequent drug resistance test and NTM typing results were collected and analyzed.Results In 816 cases with mycobacterium,679 cases were male and 137 cases were female.The median age was 40 years.There were 364 patients(44.6%) infected with MTB and 377 patients(46.2%) with NTM.There were 275 cases with MTB infection and drug resistance test data.The drug resistance rates to streptomycin and isoniazid were 24.0%(66 cases) respectively,the drup resistance rate to ethambutol was 17.1%(47 cases),and the drug resistance rate to rifampicin was 16.7%( 46 cases);42 cases(15.3%) were multi-drug resistant tuberculosis.There were 124 patients with NTM infection and drug resistance test data.The resistance rate to isoniazid was 91.1%(113 cases),and the resistance rate to streptomycin was 83.9%(104 cases).The drug resistance rate to rifampicin was 47.6%(59 cases),and the drug resistance rate to ethambutol was 38.7%(48 cases).A total of 102 NTM typing data were collected,including 33 cases(32.3%) of mycobacterium avium,29 cases(28.4%) of mycobacterium Gordon and 25 cases(24.5%) of mycobacterium Kansas.Conclusion For AIDS patients with mycobacterium infection,the proportion of NTM is significantly higher than that of the general population without HIV infection,so it is necessary to adjust the regimen according to the results of drug sensitivity test.

Objective To explore the correlation between brachial artery blood flow velocity measured by color Doppler flow imaging (CDFI) and maturation of autologous arteriovenous fistula (AVF).Methods Clinical data of 141 patients who underwent end to side cephalic radial anastomosis was collected from December 2015 to August 2018 in our hospital.A comparative study of CDFI results before and after AVF was performed.Results Among 141 patients,116 AVF cases achieved maturation successfully（mature group）and 25 cases did not achieve maturation（immature group）.The prevalence of diabetes mellitus and the proportion of diabetic nephropathy as primary diseases in immature group were higher than those in mature group(P＜0.05).The diameter of cephalic vein in mature group was higher than that in immature group before operation.At 8 weeks after operation,the diameter of fistula anastomosis,diameter of brachial artery,max blood flow velocity of brachial artery and flow velocity change of brachial artery in mature group ware all higher than those in immature group(P＜0.05).Conclusion The diameter of brachial artery,max blood flow velocity of brachial artery and flow velocity change of brachial artery are measured early after operation can forecast the maturity of internal fistula and find the immature internal fistula early.

Objective To explore the effects of interleukin(IL)-13 on SPDEF expression in human bronchial epithelial cells and role of SPDEF in airway mucus hypersecretion of asthma.Methods Normal human bronchial epithelial(NHBE) cells were divided into control group,IL-13 group and IL-13+SPDEF siRNA group.After 28 days of the culture,NHBE cells were collected and total RNA was extracted.Real time polymerase chain reaction was used to detect the expression levels of SPDEF,MUC5AC and MUC5B mRNA in NHBE cells.Numbers and immunofluorescence intensity of MUC5AC positive cells were identified by flow cytometry.Eexpression levels of mucin MUC5AC and MUC5B were detected by immunefluorescence staining.Results Expression levels of SPDEF and MUC5AC mRNA,numbers and immunofluorescence intensity of MUC5AC positive cells in IL-13 group were significantly higher than those in control group(P<0.001),while expression level of MUC5B mRNA was significantly lower than that in control group(P<0.05).The expression levels of SPDEF and MUC5AC mRNA,numbers and immunofluorescence intensity of MUC5AC positive cells in IL-13+SPDEF siRNA group were significantly lower than those in IL-13 group(P<0.001).Expression llevel of MUC5B mRNA in IL-13+SPDEF siRNA group was lower than that in control group(P<0.05).The expression level of MUC5AC in NHBE cells in IL-13 group was significantly higher than those in control group and IL-13+SPDEF siRNA group,while the expression level of MUC5B was lower than that in control group.Conclusion IL-13 may promote the hyperexpression of mucin MUC5AC by inducing the up regulation of SPDEF in human bronchial epithelial cells,leading to airway mucus hypersecretion of asthma.

Objective To observe the effect of carvedilol combined with Tanshinone ⅡA sulfonate sodium on ventricular remodeling and energe metabolism in patients with chronic heart failure(CHF).Methods A total of 226 patients with CHF were randomly divided into control group(114 cases) and observation group(112 cases).Patients in the two groups received conventional anti-heart failure drugs and carvedilol.Patients in observation group were added sodium tanshinone ⅡA sulfonate on basis of above treatment.After 8 weeks of treatment,cardiac function[left ventricular end diastolic dimension(LVEDd),left ventricular endsystolic dimension(LVESd),left ventricular ejection fraction(LVEF)],ventricular remodeling indexes[left ventricular posterior wall thickness(LVPWT),left ventricular fraction shortening(LVFS),inter ventricular spetal end systolic thickness(IVSS),left ventricular mass index(LVMI)],energe metabolism indexes[circumferential end systolic wall stress(cESS),myocardial energy expenditure(MEE)],myocardial enzyme profile[creatine kinase(CK),creatine kinase isoenzyme(CK-MB),lactate dehydrogenase(LDH)] and hemorheology indexes[pulmonary capillary wedge pressure(PCWP),cardiac index(CI),stroke volume(SV)] were compared between the two groups.Results LVEDd,LVESd,LVPWT,IVSS,LVMI,cESS,MEE,CK,CK-MB,LDH,CI,SV and PCWPC after treatment were all significantly lower than those before treatment in the two groups,while LVEF and LVFS were significantly higher than those before treatment in the two groups（P<0.05）.After treatment,LVEDd,LVESd,LVPWT,IVSS,LVMI,cESS,MEE,CK,CK-MB,LDH,CI,SV and PCWPC in observation group were all significantly lower than those in control group,while LVEF and LVFS were significantly higher than those in control group（P<0.001 or P<0.05）.Conclusion Carvedilol combined with Tanshinone ⅡA sulfonate sodium can improve myocardial enzyme profile and hemorheology,suppress ventricular remodeling and energe metabolism,so as to improve cardiac function in patients with CHF.

Objective  To evaluate the relationship between thyroid stimulating hormone(TSH) level and insulin resistance(IR) in obese non-diabetic patients.Methods  Obese non-diabetic patients who were treated in the clinic of endocrinology department in people’s hospital of Fufeng county from August 2016 to May 2018 were selected as subjects.The clinical data,laboratory results and thyroid morphological and functional evaluation results were collected.The relationship of TSH level and insulin resistance index(HOMA-IR) were computed using multivariate linear regression analysis.Results  TSH level was positively correlated with HOMA-IR(r=0.24,P=0.028),serum insulin(r=0.23,P=0.037)and triglyceride(r=0.30,P=0.006)in the overall cohort,while negatively correlated with serum high density lipoprotein cholesterol(r=-0.25,P=0.002).HOMA-IR was positively correlated with triglyceride(r=0.25,P=0.026),ALT(r=0.37,P=0.001)and amplification of glutamyl transpeptidase(r=0.32,P=0.003).The results of multivariate linear regression analysis showed that TSH(β=0.620,95%CI 0.482-0.758,P=0.015)and BMI(β=0.147,95%CI 0.111-0.184,P=0.034)were significantly correlated with HOMA-IR.Conclusion  TSH is associated with insulin resistance in obese non-diabetic patients,suggesting that the screening of thyroid function is important for obese non-diabetic patients.

Objective To explore the clinical characteristics of patients with pre-hypertension accompanied by increased hemoglobin(Hb) level and effect of high-salt diet on their long-term prognosis.Methods A total of 421 patients with pre-hypertension were divided into group A(Hb≤138g/L,217 cases) and group B(Hb>138g/L,204 cases) according to baseline median Hb level dichotomies.Clinical data and prognosis of the two groups were compared.At the same time,patients in group B were divided into high salt group(117 cases) and normal salt group(87 cases) according to the salt intake.Clinical data and prognosis of the two groups were compared.Cox regression analysis was used to assess risk factors for developing hypertension and MACCE during follow-up in group B patients.Results Proportions of patients with single coronary artery lesion,Gensini score and number of diseased coronary arterys in group A were lower than those in group B,while proportion of patients with no coronary artery lesion was higher than those in group B(P＜0.05).During follow-up,proportions of patients with hypertension and MACCE in group B were higher than those in group A(P＜0.05).Kaplan-Meier curve analysis showed that incidences of hypertension and MACCE in patients of goup B were higher than those of group A(P＜0.05).Cox regression analysis showed that both high salt diet and diabetes history were independent risk factors for hypertension and MACCE during follow-up in group B(P＜0.05).Proportions of patients with MACCE in high salt group was higher than those in normal salt group(P＜0.05).Kaplan-Meier curve analysis showed that incidence of hypertension and MACCE in high salt group were higher than those in normal salt group(P＜0.05).Conclusion Coronary lesions in patients with pre-hypertension accompanied by increased Hb level is serious Incidence rates of hypertension and MACCE during follow-up are high,and high salt diet can furtherly lead to the occurrence of hypertension and MACCE.

Objective To investigate the situation of vitamin D level in Chaoyang district of Beijing in recent two years,and explore the influencing factors of vitamin D deficiency and the correlation with blood lipid.Methods A cross sectional study was conducted to include 3905 subjects who underwent physical examination at Beijing first integrated traditional Chinese and western medicine hospital.Venous blood was taken to test 25-hydroxy-vitamin D[25(OH)D] and blood biochemical indexes.Multiple linear regression analysis was used to evaluate the correlation between 25(OH)D and blood lipid.Results The average serum 25(OH)D level of all subjects was(16.22±6.95) ng/ml,deficiency serious was found in 636 cases (16.29 %),deficiency was found in 2372 cases(60.74%),insufficiency was found in 713 cases(18.26%),plenty was found in 184 cases(4.71%).Subjects with different 25(OH)D levels had statistically significant differences in gender,age,weight,BMI,waist circumference,waist to hip ratio,systolic blood pressure,diastolic blood pressure,fasting plasma glucose(FPG),uric acid(UA),creatinine(Cr),total cholesterol(TC),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C) and low-density lipoprotein cholesterol(LDL-C)(P<0.05).There were statistically significant differences in 25(OH)D levels among subjects of different gender(P=0.010),different BMI and gender(P=0.030) and physical examination in different season(P<0.001).Age distribution of subjects with different 25(OH)D levels was statistically significant(P＜0.001).The results of multiple linear regression analysis showed that 25(OH)D level was negatively correlated with TC(r=-0.35,P=0.016),TG(r=-0.28,P=0.046),LDL-C(r=-0.33,P=0.022),waist circumference(r=-0.30,P=0.035),waist to hip ratio(r=-0.30,P=0.032),and positively correlated with HDL-C(r=0.27,P=0.049).Conclusion Vitamin D deficiency in Chaoyang district of Beijing is common and should be paid attention.Vitamin D deficiency is associated with age,gender,seasonal variation，waist circumference,waist to hip ratio,BMI and blood lipid.

Objective To explore the efficacy and safety of radiofrequency catheter ablation for ventricular arrhythmias originated from the right ventricular outflow tract(RVOT-VAs)and its influencing factors.Methods According to the success of a single operation or not,256 patients with RVOT-VAs undergoing radiofrequency catheter ablation were divided into successful single operation group(196 cases)and unsuccessful single operation group(60 cases),then general data and operational data of them were compared.Binary logistic regression analysis was performed to evaluate factors that affect the efficacy and safety of operation.Results In 256 patients,immediate success rate,single operation success rate and recurrence rate were 88.3%,76.6% and 13.2% respectively.Proportion of patients combined with hypertension and organic heart disease,QRS waves with various forms,surgical complications and pericardial tamponade in successful single operation group were lower than those in unsuccessful single operation group（P<0.05）.Results of binary logistic regression analysis showed that combining organic heart disease,lack of experience for operators and target site of catheter ablation locating in free wall were independent risk factors for failure of single operation（P<0.05）.Persistent ventricular tachycardial and target site of catheter ablation locating in free wall were independent risk factors for immediate failure of the first operation（P<0.05）.Combining organic heart disease,lack of experience for operators,target site of catheter ablation locating in free wall and QRS waves with various forms were independent risk factors for recurrence after the first operation（P<0.05）.Advanced age and lack of experience for operators were independent risk factors for complications during the first operation（P<0.05）.Conclusion There is high success rate and safety of radiofrequency catheter ablation treating RVOT-VAs.Combining organic heart disease,target site of catheter ablation locating in free wall and the operator’s experience are important factors which affect the efficacy and safety.

Objective To explore the effect of Suramin on Cyclosporine A(CsA)-induced nephrotoxicity in rats and the relevant mechanism.Methods Forty male SD rats were randomly divided into control group,CsA group,CsA+Suramin(low dose) group and CsA+Suramin(high dose)group,with 10 rats in each group.After 5 weeks of administration,24h urine protein,α₁-microglobulin(MG),β₂-MG,N-acetyl-β-D-glucosaminidase(NAG),serum creatinine(SCr),blood urea nitrogen(BUN),uric acid(UA) and cystatin C（Cys C） in 4 groups were detected.The values of creatinine clearance(Ccr) were calculated.Masson trichrome staining was performed to estimate the degree of interstitial fibrosis.The expression of transform growth factor（TGF）-β₁，collagen-Ⅰand fibronectin were determined qualitatively by immunohistochemistry.The corresponding values of average optical density(AOD) of the above indicators were determined.Results The levels of α₁-MG,β₂-MG,NAG,BUN,UA and Cys C in CsA group were higher than those in control group,while the level of Ccr was lower than that in control group（P<0.05）.The levels of α₁-MG,β₂-MG,NAG,BUN,UA and Cys C in CsA+Suramin(low dose) group and CsA+Suramin(high dose)group were lower than that in CsA group,the level of Ccr was higher than that in CsA group（P<0.05）.The degree of interstitial fibrosis and the AOD of TGF-β₁，collagen-Ⅰ，fibronectin in CsA group were higher than those in control group,while the above indicators in CsA+Suramin(low dose) group and CsA+Suramin(high dose)group were lower than those in CsA group（P<0.05）.ConclusionSuramin may probably antagonize the nephrotoxicity induced by CsA.Down regulated expression of TGF-β₁ may probably associated with the mechanism of interstitial fibrosis.

Objective To investigate the situation of vitamin D level in Chaoyang district of Beijing in recent two years,and explore the influencing factors of vitamin D deficiency and the correlation with blood lipid.Methods A cross sectional study was conducted to include 3905 subjects who underwent physical examination at Beijing first integrated traditional Chinese and western medicine hospital.Venous blood was taken to test 25-hydroxy-vitamin D[25(OH)D] and blood biochemical indexes.Multiple linear regression analysis was used to evaluate the correlation between 25(OH)D and blood lipid.Results The average serum 25(OH)D level of all subjects was(16.22±6.95) ng/ml,deficiency serious was found in 636 cases (16.29 %),deficiency was found in 2372 cases(60.74%),insufficiency was found in 713 cases(18.26%),plenty was found in 184 cases(4.71%).Subjects with different 25(OH)D levels had statistically significant differences in gender,age,weight,BMI,waist circumference,waist to hip ratio,systolic blood pressure,diastolic blood pressure,fasting plasma glucose(FPG),uric acid(UA),creatinine(Cr),total cholesterol(TC),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C) and low-density lipoprotein cholesterol(LDL-C)(P<0.05).There were statistically significant differences in 25(OH)D levels among subjects of different gender(P=0.010),different BMI and gender(P=0.030) and physical examination in different season(P<0.001).Age distribution of subjects with different 25(OH)D levels was statistically significant(P＜0.001).The results of multiple linear regression analysis showed that 25(OH)D level was negatively correlated with TC(r=-0.35,P=0.016),TG(r=-0.28,P=0.046),LDL-C(r=-0.33,P=0.022),waist circumference(r=-0.30,P=0.035),waist to hip ratio(r=-0.30,P=0.032),and positively correlated with HDL-C(r=0.27,P=0.049).Conclusion Vitamin D deficiency in Chaoyang district of Beijing is common and should be paid attention.Vitamin D deficiency is associated with age,gender,seasonal variation，waist circumference,waist to hip ratio,BMI and blood lipid.

Objective To analyze the correlations of hepatic function and thyroid function in hyperthyroidism patients with hepatic dysfunction,explore the clinical characteristics in antithyroid drug methimazole related hepatotoxicity and its related factors.Methods A total of 54 patients with hyperthyroidism liver disease(hyperthyroidism liver damage group) and 33 patients with no treatment after initial diagnosis without liver damage hyperthyroidism(hyperthyroidism without liver damage group) were included.The general and clinical data(thyroid and liver function) of the two groups were collected and the related factors to hyperthyroidism with liver dysfunction were analyzed.Twenty-seven patients with antithyroid drug induced liver injury at the same time were also included.They were divided into hepatocellular hepatotoxicity group(7 cases),cholestatic hepatotoxicity group(12 cases) and mixed hepatotoxicity group(8 cases) according to the liver function index,and to compare their general and clinical data（thyroid and liver function）.Results The levels of ALT,AST,alkaline phosphatase(ALP),γ-glutamyl transpeptadase(γ-GT),total bilirubin(TBIL),free triiodomethylamine(FT₃),free thyroid hormone(FT₄) and thyrotrophin receptor antibody(TRAb) before the treatment in patients with hyperthyroidism liver damage group were significantly higher than those in hyperthyroidism without liver damage group（P<0.05）.The levels of ALT,ALP,γ-GT were correlated positively to FT₃,FT₄ and TRAb（P<0.05）.There were statistically significant differences in age,time of application of antithyroid drugs,levels of ALT and ALP among hepatocyte,cholestasis and mixed hepatotoxicity groups（P<0.05）.ConclusionThe severity of thyroid dysfunction may be associated with liver damage in patients with hyperthyroidism.The type of liver damage caused by the antithyroid drug methimidazole maybe related to the age,course of disease and duration of medication in patients.

Objective To analyze the value of inflammatory factors combined with Ranson scores in predicting the severity of acute pancreatitis(AP) and guiding clinical treatment.Methods According to the 2012 Atlanta standard,150 AP patients were divided into mild group (n=50),moderate group(n=50) and severe group(n=50).Serum inflammatory factors [interleukin(IL)-6,procalcitonin (PCT),C-reactive protein(CRP),IL-8,IL-10] levels,Ranson scores in 3 groups were compared and the mortality rate of each group was counted.Draw the receiver operating characteristics (ROC) curve.The area under the ROC(AUC) of each index was calculated and and the value of each index to assess organ failure and mortality rate was compared.Results PCT,IL-6 and CRP increased gradually at 12h,24h,48h in the three groups,and PCT,IL-6 and CRP increased gradually with the severity of the disease(P<0.05).The IL-10 levels in the three groups were higher at 24h than those at 12h,but the IL-10 levels were lower at 48h than those at 24h(P<0.05).The Ranson scores of the light,moderate and severe groups showed an increasing trend with the increase of the severity of the disease(P<0.05).The mortality rate of severe group was higher than that of mild group(0) and moderate group(2.0%，P<0.05).Among the serum inflammatory factors,the AUCs of IL-6 to evaluate organ failure and mortality rate were larger than that of PCT and CRP.The AUC of CRP to evalute pancreatic necrosis was larger than that of PCT and IL-6.The AUCs of Ranson scores to evaluate organ failure and fatality rate were larger than that of PCT,IL-6 and CRP.The AUCs of PCT+IL-6+CRP+Ranson scores to evaluate organ failure,pancreatic necrosis and fatality rate were larger than those of Ranson score and any serum inflammatory factor.Conclusion IL-6 has higher predictive value for organ failure and mortality rate in AP patients,and CRP has higher predicitvie value for pancreatic necrosis.The combination of PCT,IL-6,CRP and Ranson scores can further improve the predictive ability of organ failure,pancreatic necrosis and mortality rate,which provides a reference for the selection of clinical treatment strategies.

Objective To analyze the distribution and drug resistance of mycobacterium tuberculosis(MTB) and non-tuberculosis mycobacteriu(NTM) among AIDS patients with positive results of mycobacterium culture in Shanghai public health clinical center from 2006 to 2015.Methods From January 2006 to December 2015,the patients who were admitted to our hospital with clinical symptoms and positive results of mycobacterium culture were collected.The general data such as age and gender,the results of subsequent drug resistance test and NTM typing results were collected and analyzed.Results In 816 cases with mycobacterium,679 cases were male and 137 cases were female.The median age was 40 years.There were 364 patients(44.6%) infected with MTB and 377 patients(46.2%) with NTM.There were 275 cases with MTB infection and drug resistance test data.The drug resistance rates to streptomycin and isoniazid were 24.0%(66 cases) respectively,the drup resistance rate to ethambutol was 17.1%(47 cases),and the drug resistance rate to rifampicin was 16.7%( 46 cases);42 cases(15.3%) were multi-drug resistant tuberculosis.There were 124 patients with NTM infection and drug resistance test data.The resistance rate to isoniazid was 91.1%(113 cases),and the resistance rate to streptomycin was 83.9%(104 cases).The drug resistance rate to rifampicin was 47.6%(59 cases),and the drug resistance rate to ethambutol was 38.7%(48 cases).A total of 102 NTM typing data were collected,including 33 cases(32.3%) of mycobacterium avium,29 cases(28.4%) of mycobacterium Gordon and 25 cases(24.5%) of mycobacterium Kansas.Conclusion For AIDS patients with mycobacterium infection,the proportion of NTM is significantly higher than that of the general population without HIV infection,so it is necessary to adjust the regimen according to the results of drug sensitivity test.

Objective To investigate the characteristics of major adverse cardiovascular events(MACE) and the risk of all-cause mortality in patients with diabetes mellitus and sepsis within 30 days of hospitalization.Methods A total of 720 patients with sepsis were enrolled.According to whether or not with diabetes mellitus,the patients were divided into diabetic group（n=252） and non-diabetic group（n=468）.The occurrence of MACE and all-cause mortality as well as the characteristics of MACE occurred on the 1st to 15th day(D₁₅) and the 16th to 30th day(D₃₀) were compared between the two groups.Results The incidence of MACE in the diabetic group was 36.5%,which was higher than that in non-diabetic group(22.2%，P<0.05),but there was no statistical difference in the incidence of acute cerebrovascular accidents between the two groups（P＞0.05）.The incidence of all-cause death in patients with diabetes was 25.0%,which was higher than that in non-diabetic group（15.6%，P<0.05).The incidences of ACS,acute heart failure,severe arrhythmia and cardiogenic death in D₁₅ of the two groups were respectively higher than those of D₃₀ in the same groups(P<0.05),but there was no statistical difference in the incidence of acute cerebrovascular accidents between D₁₅ and D₃₀ in both two groups（P＞0.05）.Multivariate logistic regression analysis showed that diabetes was an independent predictor of MACE(P<0.05).Conclusion In patients with diabetes mellitus and sepsis,the incidence of MACE and all-cause death during the 30day hospital stay increases significantly.Effective control of blood glucose may reduce MACE and all-cause mortality in sepsis patients with diabetes mellitus.

Objective To explore the clinical characteristics of patients with pre-hypertension accompanied by increased hemoglobin(Hb) level and effect of high-salt diet on their long-term prognosis.Methods A total of 421 patients with pre-hypertension were divided into group A(Hb≤138g/L,217 cases) and group B(Hb>138g/L,204 cases) according to baseline median Hb level dichotomies.Clinical data and prognosis of the two groups were compared.At the same time,patients in group B were divided into high salt group(117 cases) and normal salt group(87 cases) according to the salt intake.Clinical data and prognosis of the two groups were compared.Cox regression analysis was used to assess risk factors for developing hypertension and MACCE during follow-up in group B patients.Results Proportions of patients with single coronary artery lesion,Gensini score and number of diseased coronary arterys in group A were lower than those in group B,while proportion of patients with no coronary artery lesion was higher than those in group B(P＜0.05).During follow-up,proportions of patients with hypertension and MACCE in group B were higher than those in group A(P＜0.05).Kaplan-Meier curve analysis showed that incidences of hypertension and MACCE in patients of goup B were higher than those of group A(P＜0.05).Cox regression analysis showed that both high salt diet and diabetes history were independent risk factors for hypertension and MACCE during follow-up in group B(P＜0.05).Proportions of patients with MACCE in high salt group was higher than those in normal salt group(P＜0.05).Kaplan-Meier curve analysis showed that incidence of hypertension and MACCE in high salt group were higher than those in normal salt group(P＜0.05).Conclusion Coronary lesions in patients with pre-hypertension accompanied by increased Hb level is serious Incidence rates of hypertension and MACCE during follow-up are high,and high salt diet can furtherly lead to the occurrence of hypertension and MACCE.

Objective To investigate the current situation of clinical and imaging remission in patients with axial spondyloarthritis(axSpA) and analyze relevant impacted factors.Methods According to past treatment programs,ankylosing spondylitis disease activity scores based on C-reactive protein(CRP)(ASDAScrp)and Spondyloarthritis Research Consortium of Canada(SPARCC) scores,233 patientswith axSpA were divided into different groups respectively.Clinical data of each group were compared.Risk factors for clinical and imaging remission were analyzed by multivariate logistic regression analysis.Results Rate of clinical remission was 25.3% in patients with axSpA.Rate of imaging nonremission in clinical standard group(32.2%) was lower than that in clinical nonstandard group(56.3%,P<0.05).CRP in clinical standard group was lower than that in clinical nonstandard group,and ratio of patients receiving anti-tumor necrosis factor（TNF）-α treatment was higher than that in clinical non-standard group(P<0.05).ASDAScrp in imaging remission group was lower than that in imaging non-remission group,and ratio of patients receiving anti-TNF-α treatment was higher than that in imaging non-remission group(P<0.05).Rate of clinical standard and imaging remission in non-standard treatment group were lower than those in anti-TNF-α treatment group(P<0.05).Results of multivariate logistic regression analysis showed that CRP rise was risk factor for clinical non-remission in axSpA(P<0.001),while ASDAScrp rise was risk factor for imaging non-remission(P<0.05).Anti-TNF-α treatment was protective factor for both clinical and imaging remission(P<0.05).Conclusion Rate of clinical remission in axSpA is still low.CRP and ASDAScrp rise are risk factors for clinical and imaging non-remission in axSpA respectively,while anti-TNF-α treatment can promote clinical and imaging remission.

Objective To explore the correlation between level of nine vitamins and metastasis of lung adenocarcinoma.Methods Clinical data of 201 patients with lung adenocarcinoma in our hospital from January 2016 to August 2018 were analyzed retrospectively.They were divided into metastasis group(132 cases) and non-metastasis group(69 cases) according to tumor metastasis or not.The 132 patients in metastasis group were divided into oligo-metastasis group(73 cases) and multiple-metastatic group(59 cases) according to number of tumor metastatic organs and metastatic lesions.Levels of serum nine vitamins were measured and compared between each group.Results There were no significant differences of age and composition ratio of sex,smoking history,family history,regular exercise,daily sunshine time,fruit intake and diet balance between non-metastasis group and metastasis group(P>0.05).Levels of serum vitamins in patients of non-metastasis group and metastasis group were mainly deficient,such as vitamin A,vitamin B₂,vitamin C and vitamin D deficiency.Overdose of serum vitamins were relatively rare.There were no significant differences of levels of serum vitamin A,B₁,B₂,B₆,B₉,B₁₂,C,D and E between non-metastasis group and metastasis group(P>0.05).Level of serum vitamin D in multiple metastasis group was lower than that in oligo-metastasis group(P＜0.05).While there were no significant differences of levels of serum vitamin A,B₁,B₂,B₆,B₉,B₁₂,C and E between multiple-metastasis group and oligo-metastasis group(P>0.05).Conclusion Vitamin D may play a role in inhibition of metastasis of lung adenocarcinoma.   

Objective To explore the predictive value of platelet microRNA(miR)-223 and miR-21 on clopidogrel resistance after percutaneous coronary intervention(PCI) in patients with coronary heart disease(CHD).Methods According to platelet inhibition rate,119 patients with CHD undergoing PCI were divided into normal clopidogrel response(normal group,67 cases) and clopidogrel resistance group(resistance group,52 cases).Levels of platelet miR-23 and miR-21 were compared between the two groups.Multivariate logistic regression analysis was used to assess the influencing factors of clopidogrel resistance.Pearson correlation analysis was used to evaluate correlation between levels of platelet miR-223 and miR-21 with platelet inhibition rate.Receiver operating characteristic(ROC) curve was used to evaluate the predictive value of platelet miR-223 and miR-21 for clopidogrel resistance.Results Levels of platelet miR-223 and miR-21 in resistance group were higher than those in normal group(P<0.05).Results of multivariate logistic regression analysis showed that increased levels of platelet miR-223 and miR-21 were independent risk factors for clopidogrel resistance after PCI in patients with CHD(P<0.05).Results of Pearson correlation analysis showed that levels of platelet miR-223 and miR-21 were negatively correlated with platelet inhibition rate in patients with CHD undergoing PCI(P<0.05).Area under ROC curve(AUC) of platelet miR-223 and miR-21 predicting clopidogrel resistance after PCI in patients with CHD were 0.69(95%CI 0.53~0.78),0.64(95%CI 0.51~0.69) respectively,and AUC of platelet miR-223 combined with miR-21 was 0.85(95%CI 0.77~0.94).ConclusionLevels of platelet miR-223 and miR-21 in patients with CHD who develop clopidogrel resistance after PCI increase,and they are negatively correlated with platelet inhibition rate,which can be used to predict the risk of clopidogrel resistance.

Objective To explore the effects of interleukin(IL)-13 on SPDEF expression in human bronchial epithelial cells and role of SPDEF in airway mucus hypersecretion of asthma.Methods Normal human bronchial epithelial(NHBE) cells were divided into control group,IL-13 group and IL-13+SPDEF siRNA group.After 28 days of the culture,NHBE cells were collected and total RNA was extracted.Real time polymerase chain reaction was used to detect the expression levels of SPDEF,MUC5AC and MUC5B mRNA in NHBE cells.Numbers and immunofluorescence intensity of MUC5AC positive cells were identified by flow cytometry.Eexpression levels of mucin MUC5AC and MUC5B were detected by immunefluorescence staining.Results Expression levels of SPDEF and MUC5AC mRNA,numbers and immunofluorescence intensity of MUC5AC positive cells in IL-13 group were significantly higher than those in control group(P<0.001),while expression level of MUC5B mRNA was significantly lower than that in control group(P<0.05).The expression levels of SPDEF and MUC5AC mRNA,numbers and immunofluorescence intensity of MUC5AC positive cells in IL-13+SPDEF siRNA group were significantly lower than those in IL-13 group(P<0.001).Expression llevel of MUC5B mRNA in IL-13+SPDEF siRNA group was lower than that in control group(P<0.05).The expression level of MUC5AC in NHBE cells in IL-13 group was significantly higher than those in control group and IL-13+SPDEF siRNA group,while the expression level of MUC5B was lower than that in control group.Conclusion IL-13 may promote the hyperexpression of mucin MUC5AC by inducing the up regulation of SPDEF in human bronchial epithelial cells,leading to airway mucus hypersecretion of asthma.

Objective To explore the effects of hemodialysis and peritoneal dialysis on microinflammation of chronic renal failure（CRF）uremic patients and its relationship with cardiovascular disease.Methods A total of 120 CRF uremic patients treated in our hospital were divided into hemodialysis group(60 cases) and peritonealdialysis group(60 cases) according to the type of dialysis.After 6 months of treatment,the levels of C reactive protein(CRP)，tumor necrosis factor(TNF)-α，interleukin(IL)-1β，IL-6 btween the two groups were compared.Patients in the two groups were divided into the group with and without chronic heart failure(CHF) according to the presence or absence of combined with CHF,the levels of TNF-α、IL-1β，IL-6 in each group were compared.Results There were no significant differences in the levels of CRP,TNF-α,IL-1β，IL-6 between the two groups before treatment(P>0.05).After treatment,the levels of TNF-α,IL-1β，IL-6 in both groups were significantly reduced than the same group before treatment(P<0.05),the levels of TNF-α,IL-1β，IL-6 in the peritoneal dialysis group were lower than those in the hemodialysis group(P<0.05).In patients with CHF,the levels of TNF-α,IL-1β，IL-6 in patients of the group with heart failure were significantly higher than those in the same group of the group without heart failure(P<0.05).Conclusion Both hemodialysis and peritoneal dialysis can reduce the level of TNF-α,IL-1β，IL-6 in CRF uremic patients,and peritoneal dialysis is better.Microinflammation is correlated with cardiovascular disease.

Objective To explore the correlation between brachial artery blood flow velocity measured by color Doppler flow imaging (CDFI) and maturation of autologous arteriovenous fistula (AVF).Methods Clinical data of 141 patients who underwent end to side cephalic radial anastomosis was collected from December 2015 to August 2018 in our hospital.A comparative study of CDFI results before and after AVF was performed.Results Among 141 patients,116 AVF cases achieved maturation successfully（mature group）and 25 cases did not achieve maturation（immature group）.The prevalence of diabetes mellitus and the proportion of diabetic nephropathy as primary diseases in immature group were higher than those in mature group(P＜0.05).The diameter of cephalic vein in mature group was higher than that in immature group before operation.At 8 weeks after operation,the diameter of fistula anastomosis,diameter of brachial artery,max blood flow velocity of brachial artery and flow velocity change of brachial artery in mature group ware all higher than those in immature group(P＜0.05).Conclusion The diameter of brachial artery,max blood flow velocity of brachial artery and flow velocity change of brachial artery are measured early after operation can forecast the maturity of internal fistula and find the immature internal fistula early.

Objective To explore the short-term variation and related factors of serum calcium and phosphorus after parathyroidectomy(PTX) in patients with secondary hyperparathyroidism (SHPT).Methods A total of 18 patients treated with PTX for intractable SHPT in our hospital were analyzed retrospectively.Baseline data and serum intact parathyroid hormone(iPTH),serum alkaline phosphatase(ALP),serum calcium and phosphorus of all patients on the first，the third and the seventh day after PTX were collected and compared.The calcium requirements in a week after PTX were collected.Pearson and Spearman correlation analysis were used to analyze the correlation among preoperative serum iPTH,serum calcium,serum phosphorus,serum ALP and calcium requirements in a week after the operation.Results Serum iPTH and phosphorus of all patients on the first，the third and the seventh day after PTX were significantly decreased than those before PTX(P＜0.05).Serum ALP on the first day after PTX was significantly decreased than that before PTX(P＜0.05).Serum calcium on the seventh day after PTX was significantly decreased than that before PTX(P＜0.05).Serum iPTH level before PTX was positively correlated with serum ALP level before PTX(r=0.773,P＜0.001).Calcium requirements in a week after PTX were positively correlated with serum iPTH level(r=0.855,P＜0.001) and ALP level(r=0.925,P＜0.001)before PTX.Conclusion PTX is a safe and effective treatment for intractable SHPT，which can quickly correct the metabolic disorder of serum calcium and phosphorus in short time.

Objective To explore the effect of different ischemic time on benefit of interventional thrombus aspiration(TA) in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods A total of 198 patients with STEMI who received percutaneous coronary intervention(PCI) were concluded.The 109 patients receiving TA were selected as TA group,and 89 patients who did not reveive TA were selected as control group.Patients were divided into early PCI group[total myocardial ischemia time(TTT)≤4h,72 cases) and non-early PCI group(TTT>4h,126 cases) according to TTT.Epicardial coronary flow was evaluated by myocardial infarction thrombolysis(TIMI) blood flow grading.The effect of TA and TTT on PCI prognosis in patients with STEMI was analyzed.Results The proportion of patients with TIMI blood flow grading 0 in TA group before PCI was higher than that in control group(P＜0.05).The proportion of patients receiving TA in early PCI group was higher than that in nonearly PCI group,while the proportion of patients who occurred major adverse cardiovascular events(MACE) was lower than that in nonearly PCI group(P＜0.05).There was a negative correlation between TA treatment and MACE in patients with STEMI(P＜0.001),while TTT was positively correlated with all-cause death and MACE after PCI(P＜0.001).Logistic regression analysis showed that TTT>4h significantly increased the risk of MACE,and TA treatment reduced the risk of MACE for all STEMI patients(P＜0.05).For the patients in TA group,TTT>4h increased the risk of death and all-cause MACE(P＜0.05).Conclusion For STEMI patients receiving TA treatment during PCI,TTT>4h increases the risk of death and all-cause MACE.

Objective To explore the changes of thyroid stimulating hormone(TSH) and thyroid hormone(TH) levels in type 2 diabetic patients with different body mass index(BMI) and waist circumference(WC) and the influence of obesity on TSH and TH.Methods A total of 275 hospitalized patients with type 2 diabetes were collected.They were divided into the normal group(18.5kg/m²≤BMI<24kg/m²，88 cases),overweight group(24kg/m²≤BMI<28kg/m²，90 cases) and obesity group(BMI≥28kg/m²，97cases) according to BMI.The blood lipid levels and thyroid function among these three groups were compared.Then,them were divided into M1 group（male WC<85cm）,M2 group（male WC≥85cm）,F1 group（female WC<80cm）,F2 group(female WC≥80cm) according to gender and WC.Make a comparison among the above indexes among these groups.Spearman correlation analysis was used to analyze correlation and multiple linear stepwise regression was used for influence factor analysis.Results Compared with the normal group,TSH levels in the overweight group and obesity group were significantly increased(P<0.05).TSH level in F2 group was obviously higher than those in F1 group and M2 group,and free thyroxine（FT₄） level was lower than that in M2 group(P<0.05).The results of correlation analysis showed that BMI of type 2 diabetic patients was positively correlated with TSH(r=0.25,P<0.05),TC was negatively related with FT₃(r=-0.39,P<0.05),and BMI and WC were negatively related with FT₄(r=-0.31,r=-0.29,P<0.05).The results of multiple linear stepwise regression showed that BMI was an independent correlative factor for TSH,and WC was an independent correlative factor for FT4(P<0.05).Conclusion The TSH level of obese patients with type 2 diabetes is increased,and FT4 is decreased，which are more obvious in female patients with abdominal obesity than those in males.

Objective To observe the therapeutic effect of β-glucan on immunoglobulin A(IgA) nephritis rat model and its effect on Th1/Th2 drift.Methods Forty-two rats were selected to establish IgA nephritis model,which were divided into model group,low dose group,medium dose group and high dose group,and 12 unmodeled rats were set as control group.The urinary erythrocyte count and 24 hour urinary protein content were compared.The histopathological changes of kidney were observed.IgA immunofluorescence precipitation in kidney tissues,Th1/Th2 in rat spleen,the levels of gamma interferon (IFN-γ) and interleukin-4 (IL-4) in serum and kidney tissues of rats were detected.IFN-γ/IL-4 were calculated and compared.Results (1)Comparisons of urinary erythrocyte count and 24 hour urinary protein levels of rats in 5 groups showed that model group>low dose group>medium dose group>high dose group>control group (P<0.05).(2)In model group,glomerular enlargement,cystic wall adhesion,mesangial matrix proliferation and vacuole like changes of renal tubular epithelial cells were observed.The above structures were normal in control group and alleviated in each dose group with doseindependence.(3)There was no IgA immunofluorescence precipitation in the glomerular mesangial area of the control group,but there was strong IgA green fluorescence precipitation in the model group,which was weakened in each dose group with dose independence.(4)Comparison of Th1/Th2 in spleen tissue of rats in 5 groups showed that model groupP<0.05).(5)Comparison of the levels of IL-4 in serum and kidney tissues of rats in 5 groups showed that,model group>low dose group>medium dose group>high dose group>control group（P＜0.05）.Comparison of serum IFN-γ levels and IFN-γ/IL-4 showed that,model groupP＜0.05）.Conclusion β-glucan can significantly improve the condition of hematuria,urinary protein and IgA precipitation in rats with IgA nephritis,and alleviate renal injury,which may be related to regulating the shift of Th1/Th2 balance to Th1.

Objective To explore predictive value of serum microRNA(miR)-20a and autophagy related gene 7(ATG7) on major adverse cardiovascular event(MACE) in patients with acute ST-segment elevation myocardial infarction(STEMI) after percutaneous coronary intervention(PCI).Methods According to in-hospital prognosis,233 patients with newly diagnosed acute STEMI undergoing PCI were divided into MACE group(64 cases) and non-MACE group(169 cases).Serum amino terminal pro-brain natriuretic peptide(NT-proBNP),type Ⅲ procollagen amino terminal peptide(PⅢNP),ATG7 and miR-20a levels were compared and to analyze their correlation.Results Age,NT-proBNP,PⅢNP,ATG7 levels and ratio of patients with Killip cardiac function grade Ⅳ in MACE group were higher than those in non-MACE group,while serum miR-20a level was lower than that in non-MACE group(P<0.05).Multivariate logistic regression analysis showed that elevated age,Killip cardiac function grade Ⅳ,NT-proBNP,PⅢNP and ATG7 levels were independent risk factors for in-hospital MACE after PCI in patients with acute STEMI,and elevated serum miR-20a level was an independent protective factor for it（P<0.05).Pearson correlation analysis showed that serum miR-20a was negatively correlated with ATG7,NT-proBNP and PⅢNP(P<0.05)，while serum ATG7 was positively correlated with NT-proBNP and PⅢNP（P<0.05).Receiver operating characteristic(ROC) curve analysis showed that value of serum miR-20a combined with ATG7 predicted in-hospital MACE in patients with acute STEMI after PCI was higher than serum miR-20a and ATG7.Conclusion Serum miR-20a and ATG7 are closely related with NT-proBNP and PⅢNP and are independent predictive factors of in-hospital MACE in patients with acute STEMI after PCI.

Objective To observe the efficacy and safety of different doses of recombinant tissue plasminogen activator(rt-PA) intravenous thrombolysis in the treatment of senile acute cerebral infarction(≥80 years old).Methods Seventy-eight patients with acute cerebral infarction were treated with intravenous thrombolysis using rt-PA，and were divided into low-dose group(0.6mg/kg，40 cases) and standard group(0.9mg/kg，38 cases) according to the drug dose.There were 39 cases in the non-thrombolytic group.Clinical efficacy,National Institutes of Health Stroke scale (NIHSS),modified Rankin Scale(mRS),incidence of intracranial hemorrhageand mortality of the three groups were compared.Results There was no significant difference in total effective rate between low-dose group and standard dose group (P>0.05),and were both higher than that in the non-thrombolytic group(P<0.05).There was no significant difference in NIHSS scores between low-dose group and standard dose group on 1d,7d,15d and 30d after treatment (P>0.05),and were significantly lower than those of the non-thrombolytic group (P<0.05).There was no significant difference in mRS scores between low-dose group and standard dose group(P>0.05),and were significantly lower than that of non-thrombolytic group(P<0.05).The intracranial hemorrhage rate in low-dose group was significantly lower than that in standard dose group(P<0.05).The intracranial hemorrhage rates in low-dose group and standard dose group were higher than that in non-thrombolytic group(P<0.05).There was no significant difference in the mortality between low-dose group and standard dose group(P>0.05)，and were significantly lower than that in non-thrombolytic group(P<0.05).Conclusion Venous thrombolysis is safe and effective in the treatment of senile acute cerebral infarction.Small dose of rt-PA can reduce the risk of bleeding and reduce the neurological deficit.

Objective To evaluate the value of erythrocyte sedimentation rate(ESR)/C reactive protein(CRP) ratio combined with procalcitonin(PCT) in the differential diagnosis of systemic lupus erythematosus(SLE) activity and bacterial infection.Methods A total of 167 patients with SLE were divided into active group(SLE active patients,64 cases) and infection group(SLE patients with bacterial infection,103 cases).Levels of ESR,CRP,ESR/CRP ratio and PCT were compared between the two groups.Value of above indexes in differential diagnosis of SLE activity and bacterial infection was evaluated by receiver operating characteristic(ROC) curve.Results CRP and PCT in patients of active group were lower than those of infection group,while ESR and ESR/CRP ratio were higher than those of infection group(P<0.05).Sensitivity of PCT combined with ESR/CRP ratio in differential diagnosis of SLE activity and bacterial infection was higher than that of PCT,CRP,ESR/CRP ratio and PCT combined with CRP(P<0.05),while there were no significant differences among specificity of above 5 indexes（P>0.05）.Area under ROC curve(AUC) for differential diagnosis of SLE activity and bacterial infection by PCT combined with ESR/CRP ratio was higher than that of CRP,ESR,PCT,ESR/CRP ratio and PCT combined with CRP(P<0.05),and Youden index(YI) of CRP,ESR,PCT,ESR/CRP ratio was 0.36,0.23,0.40 and 0.54 respectively,whose corresponding values were 22.02mg/L,39mm/h,1.69ng/ml and 11.75 respectively.Conclusion Levels of PCT and CRP increase in SLE patients with bacterial infection.ESR/CRP ratio can be used as a new index to identify SLE activity and bacterial infection,and ESR/CRP ratio<11.75 indicates a high possibility of bacterial infection.PCT combined with ESR/CRP ratio can improve the differential diagnosis value of SLE activity and bacterial infection.

Objective To evaluate the effect of sustained low-efficiency diafiltration(SLEDF) on intestinal mucosal barrier dysfunction and immune dysfunction in patients with severe acute pancreatitis（SAP）.Methods Fifty-one patients with SAP were randomly divided into continuous veno-venous hemofiltration(CVVH) group with 25 patients and SLEDF group with 26 patients,CVVH and SLEDF were treated separately on the basis of routine treatment.Prognosis,recovery time for blood and urine amylase,blood D-lactic acid,endotoxin(ET),diamine oxidase(DAO),CD3⁺,CD4⁺,CD8⁺ T lymphocyte levels,CD4⁺/CD8⁺ T lymphocyte ratio before and on the 2nd,4th,8th,14th day after treatment,complications related to blood purification were collected and compared in the two groups.Results There were no significant differences between the two groups in the mortality rate and the recovery time of blood and urine amylase,there were no significant differences in blood D-lactic acid,ET,DAO,CD3⁺,CD4⁺,CD8⁺ T lymphocyte levels,CD4⁺/CD8⁺T lymphocyte ratio between the two groups before and on the 2nd,4th,8th,14th day after treatment（P>0.05）.The levels of D-lactic acid,ET and DAO in both groups were lower on the 2nd,4th,8th,14th day after treatment,the levels on the 8th and 14th day were lower than those on the 4th day（P＜0.05）.CD3⁺,CD4⁺ T lymphocyte levels,CD4⁺/CD8⁺ T lymphocyte ratio in the two groups on the 4th,8th,14th day were higher than those in the same group before treatment,the levels on the 8th and 14th day were higher than those on the 4th day（P＜0.05）.CD8⁺ T lymphocyte level in the two groups on the 4th,8th day were lower than those in the same group before treatment,the levels on  the 8th and 14th day were lower than those on the 4th day（P＜0.05）.Conclusion SLEDF and CVVH could improve intestinal mucosal barrier dysfunction and immune dysfunction in SAP patients.SLEDF is worth popularizing in clinic because of convenient operation and low medical cost.

Objective To explore the effect of inhibiting intracellular SIRT6 gene expression in H9C2 cardiomyocytes by RNA interference technology on cell injure induced by anoxia/reoxygenation(A/R) and its mechanism.Methods H9C2 cardiomyocytes were randomly divided into control(Con) group,A/R group,negative control(NC) group and SIRT6-shRNA plasmid treated group(shRNA group).Survival rate,apoptotic rate,Caspase-3 activity,expression levels of SIRT6,nuclear factor(NF)-κBp65,I-κBα and interleukin(IL)-6 and tumor necrosis factor(TNF)-α in culture medium of H9C2 cardiomyocytes in four groups were assessed and compared.Results Compared with Con group,survival rate of H9C2 cardiomyocytes and the expression level of I-κBα protein in cytoplasm decreased significantly in A/R group,apoptotic rate of H9C2 cardiomyocytes,expression levels of SIRT6 mRNA and protein,NF-κBp65 protein in nucleus,IL-6,TNF-α in culture medium and Caspase-3 activity increased significantly in A/R group（P<0.05）.Compared with A/R group,survival rate of H9C2 cardiomyocytes,expression levels of SIRT6 mRNA and protein and I-κBα protein in cytoplasm decreased significantly in shRNA group,while apoptotic rate of H9C2 cardiomyocytes,expression levels of NF-κBp65 protein in nucleus,IL-6,TNF-α in culture medium and Caspase-3 activity increased significantly in shRNA group（P<0.05）.Conclusion Inhibition of intracellular SIRT6 gene expression in H9C2 cardiomyocytes can promote the secretion of inflammatory cytokines,activate NF-κB signaling pathway,induce cell apoptosis and aggravate cardiomyocytes injury induced by A/R.