Volume 95  ·  Issue 44  ·  2015

Diabetes is a chronic disease that seriously endangers human health. Its rapidly rising prevalence and various serious complications bring a heavy burden to families and society. At the same time, diabetes also has accompanying phenomena with many diseases.

The process of modernization is accompanied by the increasing pressure of work and life, and the sleep pattern is changing. The number of sleep disorders is gradually increasing, which has become a common social problem. The association between sleep status and metabolic abnormalities is attracting academic attention. Sleep disorders are associated with diabetes and complications. Studies have found that 52.0% ~77.4% of patients with diabetes have poor sleep quality, far exceeding 34.1% of non-diabetic patients^[1]。 Sleep quality is closely related to the occurrence of diabetes, the control of metabolic abnormalities in diabetic patients, and the occurrence of diabetic complications. Prospective studies have found that sleep disorders are independent risk factors for the development of diabetes, and sleep disorders also affect blood sugar control in diabetics.

The prevalence of non-alcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus (T2DM) have both increased significantly in recent years. Epidemiological studies show that the prevalence of diabetes in China is 11.6%, and the prevalence of pre-diabetes is as high as 50.1%^[1]； The prevalence of NAFLD was 20.9% in mainland China^[2]And 42% in Hong Kong, China^[3]。 T2DM and NAFLD are closely related and influence each other. This article will sort out the relationship between epidemiology, pathogenesis and clinical management strategies, and provide ideas for formulating comprehensive intervention strategies in clinical practice.

Since 2009, public hospitals at all levels in China have carried out different forms of cooperative medical services, and it has continued to increase year by year. Public hospitals have gained many successful experiences in the process of cooperative medical construction and management, but also have many confusions and sharp problems. Where to go next in cooperative medical care and how to develop healthily are worth studying and thinking.

To explore the effects of metformin on left ventricular remodeling in patients with primary hypertension and type 2 diabetes mellitus, and to investigate the effects of hypertension duration and duration of drug administration on metformin's cardiac action.

The clinical and echocardiographic data of 176 patients with primary hypertension and type 2 diabetes mellitus who were admitted to department of cardiology from January to December 2012 were retrospectively analyzed. The follow-up period was 6 to 24 months (the median follow-up time was 11 months). The patients were classified into two groups according to the usage of metformin: metformin group (n=84) and control group (n=92). The clinical data and echocardiography findings were evaluated both at baseline and follow-up. Subgroup analyses were used to assess the effects of hypertension duration and duration of drug medication on metfomin's action.

At baseline, there was no significant difference in interventricular septum depth (IVSD), left ventricular posterior wall depth (LVPWD), and left ventricular mass index (LVMI) between the two groups. At the follow-up period, IVSD (P=0.001), LVPWD (P=0.04) and LVMI (P=0.01) were lower in metformin group. Multiple linear regression indicated that metformin had significant influence on LVPWD (P=0.02) and LVMI (P=0.04). At the follow-up period, LVMI was lower in two metformin subgroups. Additionally, LVMI was lower in the group which the patients took metformin for more than one year than that in control group (P=0.04). For patients whose hypertension duration was not shorter than 5 years, IVSD (P=0.01) and LVMI (P=0.02) were lower in metformin group at the follow-up period, compared with control group.

Metformin may attenuate hypertrophy of left ventricular in patients with primary hypertension and type 2 diabetes mellitus. In patients with longer hypertension duration and longer duration of metformin use, metformin may show more obvious effects.

To investigate the clinical features of non-alcoholic fatty liver disease (NAFLD) and its relationship with serum C-peptide levels in patients with latent autoimmune diabetes in adults (LADA).

A total of 155 patients with LADA who had no drinking history and were hospitalized in department of endocrinology and metabolism from January 2007 to June 2009 were divided into two groups, including patients with LADA but without NAFLD and patients with both LADA and NAFLD, according to Chinese medical association's guidelines of NAFLD and hepatic ultrasound result. Their clinical data and results of laboratory examinations were collected and analyzed, including medications, blood pressure, weight, height, waist circumference, hip circumference, fasting plasma glucose, 2 h postprandial plasma glucose, fasting C-peptide, 2 h postprandial C-peptide, hemoglobin A1c, renal function, liver function, blood lipid and C-reactive protein. The clinical features between two groups were compared and the relationship between serum C-peptide and NAFLD were also analyzed.

Compared to the patients with LADA but without NAFLD, patients with both LADA and NAFLD had higher alanine aminotransferase (ALT), aspartate aminotransferase (AST) and gamma-glutamyl transferase (γ-GT) (allP<0.01), but the serum total bilirubin (TBI) and direct bilirubin (DBI) level had no significant inter-group difference (P>0.05). The patients with both LADA and NAFLD had higher fasting C-peptide [0.62(0.33-0.93) vs 0.17(0.05-0.50) nmol/L,P<0.001], 2 h postprandial C-peptide [1.57(0.78-1.88) vs 0.42(0.06-1.01) nmol/L,P<0.001] and more severe insulin resistance [0.8(1.0-2.5) vs 0.6(0.2-1.3),P<0.001]. Logistic regression analysis showed that there was a significant association between fasting C-peptide and the presence of NAFLD after controlling other confounding factors in patients with LADA.

The patients with both LADA and NAFLD had more severe metabolic disorders and insulin resistance. Serum fasting C peptide was independently associated with the presence of NAFLD in patients with LADA.

To investigate the characteristic of dynamic glucose level in obstructive sleep apnea-hypopnea syndrome (OSAHS) patients with newly diagnosed type 2 diabetes mellitus (T2DM) and to evaluate the effect of continuous positive airway pressure (CPAP) treatment on the glucose level.

A total of 65 cases of patients with T2DM who were newly diagnosed by oral glucose tolerance test (OGTT) were enrolled from April 2014 to April 2015 in Gansu Provincial Hospital, and divided into simple T2DM group (n=30) and OSAHS with T2DM group (n=35) according to aponea-hypopnea index (AHI) which was monitored by polysomnography (PSG). Their general clinical data were collected, and glucose level of different periods was monitored by continuous glucose moitoring system (CGMS). Changes of glucose level were compared between two groups before and after CPAP treatment.

Age, gender proportion, BMI, smoking and drinking history, glycosylated hemoglobin (HbA1c) and blood lipid profile had no significantly difference between two groups. Longer neck circumstance and higher waist-hip ration (WHR), higher systolic blood pressure and diastolic blood pressure, higher fasting plasma glucose (FPG)[(9.4±3.2) vs (7.3±2.1)mmol/L, P=0.028]and fasting insulin (FINS)[(19.2±8.7) vs (11.1±4.7)mU/L, P=0.044]level, more serious homeostasis model assessment insulin resistance (HOMA-IR) were found in OSAHS patients with T2DM when compared to patients in simple T2DM group. The average dynamic glucose level of 24 hours, daytime, nocturnal and sleep time in OSAHS with T2DM group were higher than that in the simple T2DM group (all P<0.05). The alarming times when the average dynamic glucose level of nocturnal time was more than 0.1 mmol·L^-1·min^-1 in T2DM with OSAHS was more than that in control group (P=0.001). After treatment of CPAP, the level of AHI[(5.9±3.6) vs (56.7±11.4) times/h, P<0.001], average dynamic glucose level of 24 hours, day, nocturnal and sleep time were obviously decreased (allP<0.05); lowest saturation oxygen(LSpO₂) was significantly increased[(92.3±3.7)% vs (81.5±20.2)%, P<0.001]; the alarming times and HOMA-IR were obviously decreased (P=0.019, 0.043). According to multiple linear regression analysis, the AHI(β=0.736, P<0.001) in OSAHS with T2DM group was positively related to the average dynamic glucose level during sleep time, but the LSpO₂(β=-0.889, P<0.001) was negatively correlated.

OSAHS patients with newly diagnosed T2DM have higher glucose level than that in simple T2DM patients, and CPAP therapy can obviously decrease the glucose level in newly diagnosed T2DM patients with OSAHS. AHI and LSpO₂ may influence the average dynamic glucose level during sleep time.

To evaluate the perioperative complications and effectiveness of carotid endarterectomy (CEA) with diabetes mellitus (DM).

A total of 148 patients with carotid stenosis undergone CEA from December 2010 to December 2013 were collected and analyzed retrospectively. The patients were distributed into DM group (n=83) and the control group (n=65) according to the comorbidities. Age, gender, risk factors, stenosis degree, cerebral ischemic symptom, shunt in operation, perioperative complications and restenosis after one year in the two groups were analyzed and compared .

There were no statistical difference between the two groups in terms of the general characteristic, clinical ischemic symptoms, concomitant disease, operative time, the amount of bleeding, the ratio of shunt(P>0.05). The rates of perioperative complications observed in DM group, including postoperative infection, neck hematoma, cranial nerves injured, acute cardiac infarction, stroke, hyperperfusion syndrome, all-cause mortality and one year restenosis after operation were 7.2%, 12.0%, 10.8%, 3.6%, 6.0%, 9.6%, 2.4% and 9.6% respectively. The complication rates observed in the control group, on the other hand were 3.1%, 9.2%, 4.6%, 1.5%, 4.6%, 7.7%, 1.5% and 3.1% respectively. There were no significant statistical difference between the two groups(χ²=0.551, 0.300, 1.898, 0.069, 0, 0.172, 0.138, 1.559, P>0.05).

CEA may be safe and effective in diabetic patients suffering from carotid stenosis, on the condition that the blood glucoses of the patients are controlled well, and the cardio cerebral vascular system is carefully assessed and intervened before the operation.

To investigate the incidences of clinical relevant bleeding events and risk factors in elderly patients with acute pulmonary thromboembolism (PTE).

Between January of 2009 and December of 2013, a total of 539 initially diagnosed PTE patients were recruited in our study in Beijing Chao Yang hospital. Basic clinical characteristics, medical history, imaging results, laboratory tests, therapy and outcomes (including mortality, recurrence and incidences of bleeding events) were collected during 3 months' follow-up. All the patients were divided into two groups according to age (≤65 years and>65 years ), and these parameters were compared between the two groups.

Compared with younger patients (≤65 years old), older patients(>65 years) had higher incidences of total bleeding, clinical relevant non-major bleeding (20.2% vs 13.4%,P=0.038; 16.7% vs 10.5%, P=0.043). The incidence of gastrointestinal bleeding of the elderly was also higher than that of younger patients (6.0% vs 1.4%, P=0.005) and majority of bleeding events were within 1 month after initial treatment. For the elderly, chronic liver diseases (P=0.001, OR=9.229), ischemic stroke (P=0.001, OR=6.323) and anemia (P=0.014, OR=3.774) were independent risk factors for major bleeding, and malignancy (P<0.001,OR=3.140) was independent risk factor for clinical relevant non-major bleeding. The independent risk factors for gastrointestinal bleeding were diabetes mellitus (P=0.012, OR=3.711) and anemia (P<0.001,OR=5.863).

The older PTE patients had higher incidences of total bleeding and clinical relevant non-major bleeding. Gastrointestinal bleeding of the elderly was also higher than that of younger patients and mainly occurred within 1 month after initial treatment. Complications can increase the risk of bleeding in older PTE patients.

To investigate the efficacy of different regimens in previously untreated follicular lymphoma (FL) patients with bone marrow involvement.

Clinical data of 38 previously untreated FL patients with bone marrow involvement visited Institute of Hematology and Blood Disease Hospital, Chinese Academy of Medical Sciences during the period from January 2002 to December 2013 were analyzed retrospectively, in order to compare the efficacy and survival status of different regimens.

The median age of onset was 43 years (19-74 years). The number of patients in low, intermediate and high risk group according to the follicular lymphoma international prognostic index (FLIPI) was 11 (28.9%), 11 (28.9%), and 16 (42.1%) respectively.And 36 of the 38 patients received combined chemotherapies. The overall response rate (ORR), complete remission (CR) rate, and partial remission (PR) rate were 100%, 66.7%, and 33.3%, respectively.A total of 31 patients (86.1%) used rituximab, in whom the 3-year overall survival (OS) was significantly higher than that in those who had not used rituximab (94.4% vs 80.0%, P=0.012), but the difference between 3-year progression-free survival (PFS) rate had no statistical significance (P=0.305). In the rituximab group, 16 patients had received RCHOP (rituximab, cyclophosphamide, epirubicin, vincristine, prednisone), 9 patients had received RFC (rituximab, fludarabine, cyclophosphamide), 6 young patients with high invasion and high tumor burden had received R-HyperCVAD (rituximab , cyclophosphamide, epirubicin, vincristine, dexamethasone). In the RFC/R-HyperCVAD group, the 3-year PFS was significantly higher than that in the RCHOP group (92.3% vs 48.9%, P=0.036), but the 3-year OS rate had no statistically significant difference (P=0.190). Compared with the RCHOP group, the 3-year PFS was significantly higher in the RFC group (100% vs 48.9%, P=0.029), but the 3-year OS rate had no statistically significant difference (100% vs 85.7%, P=0.285). Of the 36 patients who had received combined chemotherapy, 13 had received rituximab for maintenance treatment, whose 3-year PFS (92.3% vs 58.7%, P=0.025) and OS (100% vs 80.0%, P=0.040) were significantly higher than those not receiving maintenance treatment.

FL patients with bone marrow involvement may tend to have an onset at young age and intermediate to high FLIPI scores. These patients may benefit from rituximab combined with intensive chemotherapy. Rituximab as maintenance treatment may further improve the survival of these patients.

To assess the exercise capacity of three kinds of pulmonary artery hypertension using cardiopulmonary exercise testing (CPET).

In the Center for Pulmonary Vascular Disease Diagnosis and Treatment of Fuwai Hospital, idiopathic pulmonary artery hypertension (IPAH), congenital heart disease associated pulmonary artery hypertension (CHD-PAH), connective tissue disease associated pulmonary artery hypertension (CTD-PAH) were enrolled into this study from December 2012 to May 2013. CPET was performed in all patients, and clinical features, routine tests results, N-terminal B-type natriuretic peptide (NT-proBNP), Six-minutes-walk distance (6MWD) were all collected.

Thirty-two patients with IPAH, 38 patients with CHD-PAH, 25 patients with CTD-PAH were enrolled. For IPAH, CHD-PAH, and CTD-PAH patients, the peak oxygen uptake via body weight (VO₂max/kg) was (12.3±2.3), (14.9±4.0), and (11.1±2.5) ml·min^-1·kg^-1, respectively. The peak VO₂/kg was significantly different within these three groups (P<0.001), and was significantly higher in CHD-PAH patients compared with the other two groups (P=0.003, P<0.001). The peak VO₂/heart rate (HR) was (5.8±1.4), (6.4±1.8), (5.3±1.7) ml·beat^-1·min^-1 in the above three groups and was significantly different within these three groups (P=0.034). The peak VO₂/HR was significantly increased in CHD-PAH patients than CTD-PAD patients (P=0.012). The peak HR was (136.1±21.4), (140.8±19.9), (124.5±21.6) beat/min respectively and was significantly lower in CTD-PAD patients than CHD-PAH patients (P=0.009). The 6MWD was significantly decreased in CTD-PAD patients compared with CHD-PAH and IPAH patients (P=0.006, 0.010). Nt-proBNP was significantly decreased in CTD-PAD patients compared with CHD-PAH patients (P=0.012). In Pearson and partial correlation analysis, the peak VO₂/kg was significantly correlated with peak VO₂/HR, peak HR, 6MWD, Nt-proBNP, left ventricular end-diastolic diameter, right ventricular end-diastolic diameter (r=0.477, 0.518, 0.387, 0.465,-0.350, 0.349,-0.259).

CPET parameters can objectively evaluate exercise capacity and cardiopulmonary function of the patients with pulmonary hypertension.

To investigate the correlation of the extra-vascular lung water index (EVLWI) and the pulmonary vascular permeability index (PVPI) with disease severity and their prognostic value in patients with acute respiratory distress syndrome (ARDS).

A total of 44 patients with ARDS from October 2012 to June 2014 admitted in the Second Affiliated Hospital of Wenzhou Medical University were recruited in this study. According to the severity, patients were divided into three groups (Mild group, Moderate group and Severe group); the acute physiology and chronic health evaluation system Ⅱ score (APACHE Ⅱ), the lung injury score (LIS), the pulse contour curve continuous cardiac output (PiCCO) and other clinical indicators were respectively monitored in the period of 24, 48, 72 hrs after admission; then the correlation of EVLWI, PVPI and oxygenation index (OI) among groups were analyzed; According to the prognosis, patients were divided into the survival group and the death group, both given the univariate and multivariate Logistic regression analysis; EVLWI, PVPI, APACHE Ⅱ score, LIS and lactic acid were admitted into the receiver operating characteristic (ROC) curve analysis, and the prognosis was evaluated respectively.

With the increase of disease severity, LIS and lactic acid gradually increased, the difference was significant among the three groups of Mild, Moderate and Severe (P<0.05). And the APACHE Ⅱ score also increased gradually with the severity, but the difference was statistically significant only between the Mild group and the Severe group (P<0.01). And likewise, mild, moderate, severe ARDS patients had 1, 6, 9 cases of death, respectively. The 28-day mortality rate increased gradually after admission, with a significant difference between the Mild group and the Severe group (P<0.05). When all the 44 patients of three severities (during the 24 hrs period and during the 72 hrs period) were compared, the OI gradually decreased with the increase of severity of ARDS, while EVLWI and PVPI ascended, and differences between any two groups were statistically significant (P<0.05). In addition, there was a significant negative correlation between EVLWI and OI or between PVPI and OI (r=-0.666,-0.763, all P<0.01), and a significant positive correlation between EVLWI and PVPI, the APACHE Ⅱ score or LIS (r=0.929, 0.895, 0.661, all P<0.01). Besides, OI was a predictive protection factor of ARDS, whereas lactic acid, EVLWI and PVPI were risk factors. Multivariate Logistic regression analysis showed that EVLWI and lactic acid were risk factors for ARDS death (allP<0.05). ROC curve analysis results suggested EVLWI and lactic acid were risk factors, (odd ratio (OR)> 1, and 95%CI: 1.071-5.201, 5.201-99.852, all P<0.05).

EVLWI, PVPI were positively correlated with the severity of ARDS illness; EVLWI can be used as an independent risk factor for forecasting ARDS death, jointing EVLWI with PVPI could improve the accuracy of ARDS death forecasting.

To investigate the application and security of plasmapheresis combined with hemofiltration in the treatment of severe liver disease in middle and late pregnancy.

Clinical data of 29 patients of middle and late pregnancy with severe liver disease from March 2009 to November 2013 in the Third Affiliated Hospital of Sun Yat-sen University was analyzed retrospectively. According to the therapeutic schedule, patients were divided into control group (n=16, 18-29 years old, median age of 24 years old) and treatment group (n=13, 21-28 years old, median age of 25 years old). The informed consents of all patients were obtained and the ethical committee approval was received. The control group was given the treatment of resisting infection, protecting liver, reducing jaundice, supplying albumin and globulin, infusing blood coagulation and so on. The treatment group was given plasmapheresis and hemofiltration on the basis of the above-mentioned treatment. The differences of major clinical indicators such as MELD scores, APACHEⅡ scores, total bilirubin (TB), albumin (ALB), prothrombin time activity (PTA) , fasting blood glucose (FPG), serum creatinine (Scr) of peripheral venous blood and arterial lactic acid (Lac) in patients of two groups were observed 6 hours before and 1, 3, 5 days after the treatment. The major clinical indicators in patients of two groups were compared by t test and the clinical efficient were compared by χ ² test.

There were no statistical differences of the clinical indicators between the two groups 6 hours before the treatment (all P>0.05). The MELD scores, APACHEⅡ scores, TB, ALB, PTA, FPG, Scr, Lac were (25±6) scores, (22±5) scores, (197±69) μmol/L, (30±7) g/L, (55±24)%, (5.7±2.4) mmol/L, (111±42) μmol/L, (2.3±0.6) mmol/L in treatment group 1 day after treatment, and were (33±8) scores, (30±7) scores, (299±113) μmol/L, (24±6) g/L, (33±11)%, (3.7±1.7) mmol/L, (165±82) μmol/L, (4.4±1.5) mmol/L in control group, which improved significantly in the treated group compared to those in the control group. There was also significant improvement in those posttreatment d3, and 5 lab findings in the treatment group (P<0.05). The effective rate was higher in the treatment group (92%, 12/13) than the control group (56%, 9/16) (χ²=4.215, P<0.05). Kaplan-Meier analysis showed the combined treatment could significantly improve the 42 d survival rate in postpartum patients with liver function failure. One patient had transitional hypotension after plasma infusion and hemofiltration in the treatment group, but the blood pressure returned to normal 1 h after small dose of vasoconstrictor.

The therapeutic effect of plasmapheresis combined with hemofiltration on the treatment of severe liver disease in middle and late pregnancy is safe and effective, and it could improve the clinical outcomes and survival rate.

To investigate the clinical and high-resolution computed tomography (HRCT) features of the welder's pneumoconiosis.

A total of 10 patients diagnosed by bronchoscopy and pathology from January 2010 to January 2015 in Nanjing Drum Tower Hospital were recruited in this study, and the clinical manifestations, pulmonary function tests, pathology and HRCT data were collected and analyzed retrospectively.

Ten patients all had welder's occupational history for 5-30 years, with the main clinical manifestations of cough, sputum production, chest tightness and other symptoms. And the ratio of forced expiratory volume in one second and forced vital capacity (FEV₁/FVC) of 4 patients was lower than 75.0% in the pulmonary function tests. Transbronchial lung biopsy specimen showed numerous hemosiderin-laden macrophages within the alveolar space, associated with positive iron staining. In welder's pneumoconiosis, small centrilobular nodules (10 cases) were frequently seen on HRCT in bilateral lung fields, with branching linear structures or the tree buds like shadows in 7 cases; 3 patients also showed areas of ground-glass attenuation. And the patients were misdiagnosed as tuberculosis (1/10), interstitial pneumonia (3/10), allergic alveolitis (1/10), diffuse lung disease (2/10), and vasculitis (1/10).

Clinical manifestations of welder's pneumoconiosis are not specific; small centrilobular nodules are frequently seen on HRCT, with linear opacities or tree bud-like shadows.

To analyze the serum level of procalcitonin (PCT) in urinary tract infection (UTI) patients with urinary obstruction or bacteremia, and to investigate the value of PCT in diagnosing UTI.

A total of 102 patients with UTI hospitalized from January to December 2013 in the Second Hospital of Tianjin Medical University were categorized into obstructed UTI (n=60) and non-obstructed UTI (n=42), whose serum PCT concentrations were compared. Blood cultures were implemented in 44 patients, including 13 with positive findings (bacteremia) and 31 with negative findings (non-bacteremia). Serum PCT levels were also compared between the bacteremia and non-bacteremia groups. Receiver operating characteristic (ROC) curves were constructed to illustrate the performance of PCT in diagnosing urinary obstruction and bacteremia.

The median serum concentration of PCT in the obstructed UTI group(1.71 (0.10-53.20) mg/L)was higher than that in the non-obstructed UTI group(0.21 (0.10-10.00) mg/L, P<0.001); the serum concentration of PCT in the bacteremia group(2.73 (0.10-41.60) mg/L)was higher than that in the non-bacteremia group(0.42 (0.10-53.20) mg/L,P=0.030). The area under ROC curve of PCT in diagnosing urinary obstruction and bacteremia was 0.80 (95%CI 0.71-0.89) and 0.71 (95%CI 0.53-0.88). The maximum negative predictive value (NPV) was 0.90 and 0.87, respectively, when the serum concentrations of PCT diagnosing bacteremia and urinary obstruction was 0.51 mg/L and 0.35 mg/L.

PCT may be of some value in diagnosing UTI with urinary obstruction or bacteremia.

To explore the factors affecting the residual stones after percutaneous nephrolithotomy (PCNL) in patients with renal calculus.

A retrospective analysis was performed for 1 200 patients who were affected by renal calculus and treated with PCNL between Jan 2008 and May 2014 in People's Hospital of Anyang City. Among those patients, 16 were diagnosed as bilateral renal stone and had two successive operations. The size, location and number of stones, previous history of surgery, the degree of hydronephrosis, urinary infection were included in the univariate analysis. Significant factors in univariate analysis were included in the multivariate analysis to determine factors affecting stone residual.

A total of 385 cases developed stone residual after surgery. The overall residual rate was 31.7%. In univariate analysis, renal pelvis combined with caliceal calculus (P=0.006), stone size larger than 4 cm (P=0.005), stone number more than 4 (P=0.002), the amount of bleeding more than 200 ml (P=0.025), operation time longer than 120 minutes (P=0.028) were associated with an increased rate of stone residual. When subjected to the Cox multivariate analysis, the independent risk factors for residual stones were renal pelvis combined with caliceal calculus (P=0.049), stone size larger than 4 cm (P=0.038) and stone number more than 4 (P=0.018).

Factors affecting the incidence of residual stones after PCNL are the size, location and number of stones. Larger size stone and the presence of renal pelvis combined with caliceal calculus are significantly associated with residual stones. Nevertheless, stone number less than 4 indicates an increased stone clearance rate.

To confirm the existence of purkinje fibers in rabbit outflow tract tissue and explore the role of Hyperpolarization-Activated Cyclic Nucleotide-Gated Channel 4 (HCN4) protein in idiopathic ventricular tachycardia.

A total of ten New Zealand white rabbits were randomly selected to observe whether there were pukinje fibers in outflow tract by the methods of HE staining and immunohistochemical detection of midsize neurofilament (NF-M). Forty rabbits were randomly divided into four groups: normal control group (SO), ventricular tachycardia group (VT), ventricular tachycardia+ esmolol intervention group (VT+ ESM) and ventricular tachycardia+ ivabradine intervention group (VT+ IVA). Immunohistochemistry was used to detect the expression of HCN4 protein in ventricular outflow tract; the required output voltage amplitude was recorded when ventricular tachycardia was induced; the times and duration of spontaneous ventricular tachycardia when stimulation stopped were also recorded for each group.

(1)Purkinje fibers existed in the myocardial tissue of rabbit outflow tract. (2)HCN4 protein expression significantly increased in VT group compared with SO group (left ventricular: 97.6±16.7 vs 29.0±8.0, P<0.01; right ventricular: 92.7±12.3 vs 26.0±10.8,P<0.01), the expression of HCN4 protein obviously reduced in VT+ IVA group compared with VT group (left ventricular: 32.0±9.4 vs 97.6±16.7,P<0.01; right ventricular: 30.8±12.4 vs 92.7±12.3,P<0.01). (3)The output voltage amplitude required to induce the desired ventricular tachycardia in VT+ ESM group and VT+ IVA group were higher than the VT group, under the same high frequency stimulation (P<0.01); the times and duration of spontaneous ventricular tachycardia in VT+ ESM group and VT+ IVA group significantly reduced when the stimulation stopped, compared with the VT group (bothP<0.01).

(1)Purkinje fibers exist in ventricular outflow tract, which may be the histological origin of the ventricular tachycardia. (2)HCN4 protein is up-regulated in ventricular outflow tract when ventricular tachycardia occurs. (3)Esmolol and ivabradine can prevent and reduce the occurrence of ventricular tachycardia, and as the specific inhibitor of the HCN channel, the effect of ivabradine is more obvious.

To evaluate the clinical safety and efficacy of percutaneous transluminal atherectomy for in-stent restenosis (ISR) in patients with low extremity peripheral arterial diseases (PAD).

PubMed, Elsevier, EBSCO, Spring databases and Cochrane Library were searched for relevant articles. Based on the different mechanisms of atherectomy, the patients were divided into mechanic atherectomy group and laser atherectomy group. The safety end points included the rate of distal embolism and severe arterial wall injuries. And the efficacy end points included primary patency rate and freedom from target vessel revascularization (TVR-free) 6 months and 12 months after surgery.

A total of 9 studies and 620 patients (published between 2006 and 2014) were accepted. The rate of distal embolism was 4.2% (95% confidence interval (CI): 1.7%-6.7%), while that of severe arterial wall injuries was 1.9% (95%CI: 0.9%-3.0%), respectively. Laser atherectomy was responsible for more distal embolism (6.8%) compared to mechanic atherectomy (2.0%), which was significantly different (Q=21.66, P=0.010). At 6-month follow-up, primary patency rate and rate of TVR-free were 63.0% (95%CI: 55.5%-70.6%) and 80.4% (95%CI: 70.5%-90.3%), while at 12-month follow-up were 43.5% (95%CI: 32.2%-54.9%) and 58.0% (95%CI: 52.1%-63.9%), respectively. The free-TVR rate at 6 months follow-up in mechanical atherectomy group was 77.9%, and was inferior to that in laser atherectomy group (80.8%, Q=13.49, P=0.009). Published bias was discovered at the analysis of 12-month TVR-free rate by means of Begg Test (P=0.039). Meta analysis concerned about the 3 randomized controlled trials demonstrated that there was no significant improvement using atherectomy for ISR comparing to standard balloon at 6-month TVR-free rate (OR=1.34, 95%CI: 0.86-2.07, P=0.196).

To treat ISR lesion in lower extremities, laser atherectomy has a lower free-TVR rate in the middle term follow-up.A higher rate of distal embolism is noted though. On balance, percutaneous transluminal atherectomy demonstrates no significant improvement compared to plain balloon angioplasty for ISR lesions.

To develop a quick quantitative detecting method for luteinizing hormone(LH) based on superparamagnetic particles labeled immunochromatography technology.

Magnetic particles were catalyzed by EDC/NHS, LH monoclonal antibody were coupled with magnetic particles, another antibody were coated with the NC membrane, established a quantitative detecting method combined sandwish assay format with immunochromatography. The performance of this method was evaluated by linear range, precision, accuracy, specificity and stability. Detecting the serum sample that were tested by chemiluminescence immunoassay(CLIA) which was high credibility to verify the reliability.

The reaction time of LH antibody coupled magnetic particles, LH and LH antibody coated in nitrocellulose membrane was 20 min; the coefficient of variation (CV) values for low, median, high were 8%-12%, the bias was less than 10%, recovery rate was 90%-120%, the minimum detection limit was 0.63 mIU/ml, no obvious cross reaction with human chorionic gonadotropin(HCG), thyroid stimulating hormone(TSH), follicle-stimulating hormone(FSH). Test results of clinical sample had good correlation with CLIA(R²=0.96, P<0.05).

The superparamagnetic particles labeled immuno-chromatography method is simple and rapid, and is expected to become a direction in the development for point-of-care test(POCT) quantitative detection of microcompnents in biological sample.

Essential thrombocythemia (ET) is a BCR-ABL1 gene-negative myeloproliferative neoplasm (MPN) that can transform into polycythemia vera (PV) and acute leukemia. The JAK2 gene mutation discovered in 2005 is the characteristic molecular marker of ET at present, and its incidence rate can reach 50% ~60%^[1,2]。 The thrombopoietin receptor gene MPL W515L/K, which was discovered since then, also has a 5% ~10% incidence rate in ET. Nevertheless, nearly 1/3 of ET patients do not have the above two gene mutations. At the end of 2013, Klampfl et al.^[3]Through whole exon sequencing, it was found that calreticulin (CALR) has a high incidence and certain clinical characteristics in MPN, especially in ET with negative mutation of JAK2 gene, which provides a new direction for us to understand and treat this class of subtypes^[3,4]。 This paper reviews the structure and function of CALR, its relationship with ET and possible pathogenic mechanisms.