Relationship between BGP with glucose and lipids metabolism in elderly men / 中国医师杂志

Objective To study the relationship between serum osteocalcin and parameters of glucose and lipid metabolism in elderly men.Methods The bone metabolism index such as serum osteocalcin was measured by electrochemiluminescence immunoas -say in 206 old male patients , incluiding 69 patients with type 2 diabetes mellitus .The parameters of glucose and lipid metabolism were also measured and the correlation between the parameters and serum BGP were analyzed .Results Serum BGP and beta-CTx concen-trations were significantly lower in patients with type 2 diabetes than those in normal glucose tolerance group [ ( 9.57 ±4.74 )μg/L vs (13.22 ±10.35)μg/L, P <0.05;(0.25 ±0.19)μg/L vs (0.35 ±0.29)μg/L, P <0.05].Compared with the group in low level of BGP, fasting blood glucose and HbA1c were reduced in high-level-BGP group[(5.89 ±2.10)mmol/L vs (5.28 ±1.38)mmol/L, P<0.01;6.30%±1.03% vs 5.98%±0.61%, P <0.01].Triglyceride (TG) was positively correlated with serum BGP ( r =0.146, P =0.032).Stepwise multiple regression analysis showed that TG and HbA 1c were independently associated with serum BGP level(β=1.995, P <0.01;β=-1.483, P <0.05).Conclusions Serum TG and HbA1c are independent factors related to serum BGP in elderly men .

Correlation analyses of serum levels of homocysteine and hypersensitivity C-reactive protein in elderly patients with cerebral infarction / 中国医师杂志

Objective To observe the serum levels of homocysteine (Hcy) and hypersensitivity C-reactive protein(hs-CRP) in elderly patients with cerebral infarction and to investigate their relationship and clinical significance by National Institutes of Health Stroke Scale (NIHSS).Methods The serum levels of Hcy and hs-CRP were by enzymatic cycling method and scattering turbidimetry in the elderly patients ( 116 cases with cerebral infarction and 100 cases of healthy control).Those 116 cases with cerebral infarction were divided into three groups by the degree of NIHSS.The three groups were compared with each other.Results The levels of serum Hcy and hs-CRP in elderly patients with cerebral infarction were significantly higher than that of healthy control group ( t =6.97,P ＜0.01 ; t =14.96,P ＜0.01 ).There has significant difference among those three groups with cerebral infarction by comparing with each other( F =23.49,P ＜0.05; F =28.19,P ＜0.05).A positive correlation was found between Hcy and degree of NIHSS( r=0.54,P ＜0.05),and between hs-CRPand degree of NIHSS( r =0.58,P ＜0.05).Conclusions Serum levels of Hcy and hs-CRP are correlated with the occurrence of cerebral infarction and its severity.There has positive clinical significance to evaluate the effect of cerebral infarction by measuring the serum levels of Hcy and hs-CRP dynamic.

Application of problem-based learning in residency training of general medicine / 中华全科医师杂志

Problem-based learning (PBL) is a student-centered pedagogy in which a subject is approached in the context of realistic problems.We have applied PBL into intemnal medicine of general medicine for up to three years.The results suggest that the PBL method could promote the clinical competencies and self-learning capacities of students.However there is still room for improvement.

The correlation between PTH, Vitamin D and bone mineral density in elderly man with type 2-diabetes / 中国综合临床

Objective To explore the impact of calciotropic hormones,such as parathyroid hormone (PTH)and vitamin D,on bone mineral density(BMD)in the old men with type 2-Diabetes.Methods Sixty elderly men with type 2-Diabetes were submitted to dual-energy X-ray absorptiometry to evaluate the BMD at lumbar spine and hip.Fasting blood samples were collected to evaluate the indexes of bone metablism and blood glucose.PTH and 25-(OH)-Vitamin D3 were measured and analyzed for their correlation with BMD at different sites.Results In all patients,the percentage of osteoporosis and osteopenia accounted for 20.0％ and 53.3％ of the patients according to BMD at lumbar or hip.Compared with the patient group with normal BMD,serum PTH was significantly higher in the patient group with osteopenia or osteoporsis([44.87 ± 10.62]μg/L vs[36.96 ±12.36]μg/L,P ＜ 0.05 ;[50.24 ± 20.32]μg/L vs[36.96 ± 12.36]μg/L,P ＜ 0.05).But there was no difference in 25-(OH)-Vitamin D3 levels between all groups.PTH was correlated negatively with BMD at hip (r =-0.224,P ＜ 0.05),but not significantly correlated with BMD at lumbar(r =-0.187,P ＞ 0.05)Conclusions Serum PTH was correlated negatively with BMD at hip in elderly man with type 2-Diabetes.

Clinical study of the relationship between the level of morning blood pressure surge and hs-CRP in coronary events among old patients / 中国医师杂志

Objective To explore the relationship between the level of morning blood pressure surge (MBPS) and High-sensitivity C-reactive protein( hs-CRP) in acute coronary events among old patients and to evaluate their clinical value. Methods One hundred and twenty - three patients with coronary disease were divided into two groups, each of which was old myocardial infarction(OMI, n = 55) and old myocardial infarction with acute cardiovascular syndrome (OMI + ACS, n =68). The control group includes the patients without coronary disease( n =50). The patients who have infection, malignant tumors, liver and kidney dysfunction, blood diseases, valvular heart diseases, congenital heart diseases, aortic dissection,secondary hypertension were not included. All groups were received 24 hours ambulatory blood pressure monitoring to calculate MBPS and the determination of hs-CRP in serum. Results Compared with each two groups, the levels of MBPS and hs-CRP in OMI group were significantly higher than those of the control group (0. 01 ＜ P ＜0. 05) , and had more significance in the other groups ( P ＜0.01). The levels of MBPS and hs-CRP had positive relationship in coronary events in the elderly ( r =0. 76, P ＜0. 01) . Conclusion The level of MBPS is positively correlated with serum hs-CRP which is one of key risk factors of inflammatory reactions by impairing vessels in body. The two factors both play important roles in the occurrence and the development of coronary events among old patients. They both have important clinical value in recurrent acute coronary events among old patients.

Neuroprotective effects of tanshinone II A on vascular dementia in rats / 中国中药杂志

<p><b>OBJECTIVE</b>To investigate the underlying neuroprotective mechanisms of Tanshinone II A (TSA) on rat cerebral ischemia in vivo.</p><p><b>METHOD</b>Study of TSA on rat cerebral ischemia in vivo: Male SD rats were divided into four groups (sham-operated, ischemic and treated group (lower dose and higher dose). Chronic cerebral ischemmia after permanent bilateral carotid artery ligation was introduced as an in vivo ischemic model. After ischemia impairment, TSA (2, 4 mg x kg(-1) x d(-1)) was administrated by ip for 30 days in treated group. We used Morris water maze to investigate the learning and memory. Levels of malondialdehyde (MDA), activity of superoxide dismetase (SOD) and glutathione peroxidase (GPX) in brain tissue were detected by spectrophotometer. High-performance liquid chromatography (HPLC) with fluorescence detection was applied to measure the contents of glutamate and gamma-aminobutyric acid (GABA) in cortex and hippocampus.</p><p><b>RESULTS</b>TSA can improve learning and memory deficits in vascular dementia. An elevation of SOD and GPX activity and decrease of MDA level were shown in TSA treated group after brain ischemia. Decreased glutamate and gamma-aminobutyric acid induced by chronic brain ischemia were markedly inhibited by TSA pretreatment.</p><p><b>CONCLUSION</b>The neuroprotective effect of TSA are partly due to its functions as follow: anti-free radical injury; regulating the content of glutamate and gamma-aminobutyric acid.</p>

Clinical significance of the levels of D-dimer and hs-CRP in the elderly patients with coronary disease / 中国综合临床

Objective To investigate the clinical significance of the levels of D-dimer and hs-CRP in the elderly patients with coronary disease. Methods One hundred and twenty-two patients with coronary disease were divided into four groups according to their clinical manifestations, there were old myocardial infarction group ( OMI, n =27 ) , stable angina pectoris group ( SAP, n = 29), acute coronary syndromes group ( ACS, n = 32) and old myocardial infarction with acute cardiovascular syndrome group (OMI + ACS,n =34). The control group included the patients without coronary disease (n =30). The patients who had infection, malignant tumors, liver and kidney dysfunction, cerebral infarction, venous embolism in lower extremities and pulmonary embolism were not included, and the patients enrolled should not be on medication of antiplatelet drugs, anticoagulants and antibiotics within the last two weeks. The levels of D-dimer and hs-CRP in all groups were determined by immunoturbidimetric assay and immune scattering assay respectively. Results In each comparison between two groups, the level of D-dimer has no significant difference between the OMI and the SAP ( P > 0. 05 ) , ACS and the OMI + ACS ( P > 0. 05 ) ; but significant difference between the OMI and the control groups ( P < 0. 05) and more significant difference between the other groups were found (P < 0. 01). As for the level of hs-CRP, there was no significant difference between the OMI and the SAP groups (P > 0. 05) or between the ACS and the OMI + ACS groups (P > 0. 05); but significant difference between the other groups (P < 0. 01). the positive relationship between the levels of D-dimer and hs-CRP have in coronary disease in the elderly patients was also found(r = 0. 81 ,P <0.01). Conclusions D-dimer and hs-CRP can be used as the clinical makers to predict the occurrence of the coronary disease in the elderly patients. D-dimer and hs-CRP can be used as the clinical makers to determine the stability of cardiovascular atherosclerotic plaque and the risk of acute cardiovascular syndrome occurrence. They can also be used as the clinical makers to predict the recurrence of the acute cardiovascular syndrome in the patients with old myocardial infarction. However, they can not be used to determine whether the patients with acute cardiovascular syndrome had old myocardial infarction already or not. The levels of D - dimer and hs - CRP are closely related in coronary disease in the elderly patients.

Application of problem-based learning in internal medicine teaching for residency training of general medicine / 中华全科医师杂志

To evaluate the effect of problem-based learning (PBL) in internal medicine teaching for residency training of general medicine.Fifty two residents of general medicine were divided randomly into PBL teaching and traditional teaching groups with 26 in each.The evaluation was conducted in combination of examination scores and questionnaire survey in both groups.In questionnaire survey the residents of PBL group responded positively about the use of PBL in teaching, and rated themselves as having much better competencies in problem solving and self-directed learning.The scores of case analysis examination in PBL group were higher than those in traditional teaching group ( 73.7 ± 4.1 vs.71.1 ± 4.8, P ＜ 0.05 ).The results suggest that the application of PBL has better effect than traditional teaching in residency training of general medicine.

Analysis of relationship between type-2 diabetes mellitus and artery atherosclerosis in elders / 中国综合临床

Objective To investigate the relationship between type-2 diabetes mellitus and artery atherosclerosis(AS) in the elderly. MethodsThe clinical data of 277 elders,who were admitted in hospital between April 2005 and September 2007, were retrospectively analyzed. These elders were divided into four groups: type 2 diabetes with carotid atherosclerosis (CAS) group (group A, n=119), type 2 diabetes without CAS group (group B, n= 30), non-diabetic with CAS group (group C, n=32), non-diabetic without CAS group (group D, n=96). The correlation between carotid artery plaque and related factors were studied. Results① Compared with group C,fasting blood glucose[(7.14±2.49) mmol/L vs. (5.21±0.87) mmol/L], triglycefide [(1.41±0.78) mmol/L vs. (0.95±0.39) mmol/L],left and right common carotid artery IMT [(0.85±0.11) nun vs. (0.79±0.08) mm, (0.85±0.11)mm vs. (0.78±0.09)mm] and PI [(1.37±1.16) vs. (0.50±0.80)] of group A were significantly increased, while high density lipoprotein [(1.29±0.32) mmol/L vs. (1.58±0.45) mmol/L] is significantly decreased(P=0.01). ②Compared with group B, left and right common carotid artery IMT [(0.85±0.11) mm vs. (0.80±0.11)mm,(0.85±0.11)mm vs. (0.80±0.12)mm,PI[(1.37±1.16) vs. (0.00±0.00)]and incidence of stroke 34.5% (41/119) vs. 13.3% (4/30) of group A are significantly increased (P<0.05 or P<0.01). ③Carotid artery plaque was positively correlated with history of diabetes(r=0.051, P<0.01),hypertension(r= 0.169,P<0.01),coronary heart disease (r=0.109,P<0.05),stroke(r=0.136,P<0.05),fatty liver(r= 0.340,P<0.01),FBG(r=0.339,P<0.01),TG(r=0.195,P<0.01),APOB (r=0.152,P<0.05),but negatively correlated with HDL-C (r=-0.143, P<0.05). Conclusion The risk of AS is higher in elderly patients with type 2 diabetes than that of non-diabetes. The incidence of stroke is higher in type 2 diabetes with AS than those of type 2 diabetes without AS. Carotid artery plaque is positively correlated with diabetes, hypertension, history of coronary heart disease, history of stroke, fatty liver, FBG, TG, ApoB, but negatively correlated with HDL-C.

Clinic analysis of bone mineral density and its related factors in elderly men with type 2 diabetes / 中华老年医学杂志

Objective To explore the possible risk factors that influence bone mineral density (BMD) in elderly men with type 2 diabetes. Methods A total of 80 elderly men with type 2 diabetes were included in this study. The BMD of lumbar vertebrae and femur were measured by dual-energy X-ray absorptiometry (DXA). And fasting blood and urine samples were taken to check the biochemical levels of bone metabolism and blood glucose. The correlations between BMD and other related factors were analyzed. Results In this group, the prevalence rates of osteoporosis and osteopenia were 18. 6% and 53.8%, respectively. Body mass and body mass index (BMI) were positively correlated with BMD at all sites (r=0. 202～0. 298, P<0. 05 or P<0. 01). However, age and glycosylated hemoglobin (HbAlc) were negatively correlated with BMD of lumbar and femoral neck (r=-0. 172～-0. 211 ,all P<0. 05). Leptin was not only positively correlated with the BMD of femoral neck and Ward's triangle, but also with body mass, BMI, fasting blood glucose (FBG), total cholesterol and HbAlc (r=0. 219 ～ 0. 509, P<0.05 or P<0.01). Using stepwise regression analysis, body mass was the predictor of BMD at all sites assessed, while the HbAlc and leptin levels could respectively influence BMD at femoral neck and Ward's triangle (r~2= 0. 196 ～ 0. 276, all P< 0. 01). Conclusions It may suggest that differential factors predict the variance of BMD at different sites in elderly men with type 2 diabetes.

Clinical study of the risk factors of old cerebral infarction patient / 中国综合临床

Objective To investigate the related risk factors of old cerebral infarction patient.Methods Tbe related data of 248 old male patients(>65)who weared the 24-h ambulatory blood pressure monitoring at our depanment from September of 2007 to December of 2007 were retrospectively analyzed.They were divided into two groups according to WHO diagnostic criteria for cerebral infarction:cerebral infarction group(n=58)and non-cere-bral infarction group(n=147).The correlation between related risk factors with cerebral infarction were further stud-ied.Results①The result of multiple factor logistic regression analysis(α=0.05,β=0.01 is the selected criteri-on) showed:cerebral Lacunar infarction and the level of blood uric acid had the significant impact on the occurrence of cerebral infarction.To compare with non-cerebral lacunar infarction,the relative risk of cerebral infarction morbili-ty was 7.443 in cerebral lacunar infarction.The level of blood uric acid decreasing l μmol/L,the relative risk of cer-ebral infarction morbility increased 0.994.②Every ingredient of blood pressure deploy independent-samples T test showed that the highest value of systolic blood pressure(167.12±22.08)and the highest value of pulse pressure (88.03±20.81)raised up obviously compared with non-cerebral infarction group.Conclusion In old male,the incidence rate of cerebral infarction is predominantly correlated with cerebral lacunar infarction and the level of blood uric acid,and is closely correlated with the highest value of systolic blood pressure and the higheat value of pulse pressure in all the ingredients of blood pressure.

Correlation between P-selectin and troponin-T in aged people / 中国综合临床

Objective To observe the correlation between P-selectin and troponin-T in aged people.Meth-ods P-selectin and troponin-T were detected in 80 patients,who were divided into two groups according to the level of troponin-T:group A(normal level of tropenin-T)and group B (abnormal level of troponin-T).The relationship of P-selectin and tropenin-T were compared in the two groups.Results P-selectin in group B was increased remark-ably than that in group A(P<0.01).P-selectin had positive correlation with tropenin-T by single factor analysis(r=0.824.P<0.01).Conclusion Cardiac sensitivity and specificity of P-selectin is lower than that of troponin-T,but both P-selectin and troponin-T offer simple and convenient methods of indirect judgment of the degree and prog-nosis of coronary artery disease and myocardial damage.

Low-dose ATRA supplementation abolishes PRM formation in rat liver and ameliorates ethanol-induced liver injury / 华中科技大学学报（医学）（英德文版）

The effects of all-trans-retinoic acid (ATRA) in low doses supplementation on concentrations of polar retinoid metabolites (PRM) and retinoids in the ethanol-fed rat liver, and on hepatocyte injury were investigated. The rat model of alcoholic liver disease (ALD) was induced by intragastric infusion of ethanol, and then the rats were administrated with ATRA in two different doses (150 microg/kg body weight and 1.5 mg/kg body weight) for 4 weeks. Concentrations of retinoids in rat liver and plasma were determined by using HPLC. Liver tissues pathologic changes were observed under the light microscopy and electron microscopy. The serum transaminases concentrations were measured. The results showed that the HPLC analysis of retinoids revealed that retinoids (vitamin A, RA, retinyl palmitate) concentrations in ethanol-fed rat liver and RA concentration in ethanol-fed rat plasma were markedly diminished (P<0.01) after ethanol feeding for 12 weeks. Furthermore, obvious peaks of PRM were formed in livers of ethanol-fed rats. ATRA 150 microg/kg supplementation in ethanol-fed rats for 4 weeks raised RA concentration in both liver and plasma, and also raised vitamin A concentration in liver to control levels, partially restored retinyl palmitate concentration (P<0.05) in liver. ATRA 1.5 mg/kg supplementation raised not only RA concentrations in liver and plasma but also retinyl palmitate concentrations in liver. However, the vitamin A concentration in liver of ATRA-supplemented rats (1.5 mg/kg) was higher than that of controls (P<0.05). The histologic observation of liver tissues indicated that ATRA treatment notably alleviated hepatocellular swelling, steatosis, the swelling of mitochondria and proliferation of smooth endoplasmic reticulum (SER). ATRA treatment greatly decreased levels of serum transaminases as compared with the only ethanol-fed group (P<0.05). It was concluded that low-dose ATRA treatment could restore retinoids concentrations and abolish the PRM formation in liver of ALD rats, and then ameliorate the injury of liver cells.

Interventional effects of alpha D3 on related bone metabolism indexes of children with knee pain at night / 中国组织工程研究

BACKGROUND: It is often seen in clinical practice that children, aged3-15 years, suffer from knee pain of unknown cause at night, which occurs frequently. Most of them can be called "pain of growth".OBJECTIVE: To analyze the related factors of knee pain in adolescents and observe the interventional effect of alpha-D3 (α-D3).DESIGN: Case control analysis, self-control analysis SETTING: Department of Orthopaedics, Jinshan Hospital Affiliated to Shanghai Fudan University PARTICIPANTS: We admitted 22 children outpatients, aged 3 to 15years, who suffered from recurrent attack of knee pain of unknown reasons and received treatment in Jinshan Hospital Affiliated to Shanghai Fudan University from June 1998 to August 2002, servingas group A. Another 20children outpatients of fracture recovered for half a year were recruited simultaneously, serving as Group B (control group).METHODS: Group A adopted the therapy of α- D3 of 0.25 μg taken orally once everyday for successive 7 days then stopped to observe the symptoms for the next three weeks. Four weeks was one therapeutic course.If the pains were still alive or reoccurred, another therapy period was needed until they vanished. The contents of bone gla protein (BGP), blood calcium (Ca2+), blood phosphorus (P3+), blood magnesium (Mg2+), alkaline phosphatase (ALP) and bone mineral density (BMD) of patients were detected between Group A and Group B. GBP index and change of pain in knee at night was observed with α-D3 before therapy and 1,3 and 6months after therapy. After one therapy period, the levels of blood Ca2+, P3+,Mg2+, ALP, BGP, CT, urine and X-ray of knees were detected again, so was BMD after 6 months.MAIN OUTCOME MEASURES: ① Blood Ca2+, P3+, Mg2+, ALP contents of children patients were detected before and after therapy . ② In the Group A, content of BGP was detected before and 1,3 and 6 months after therapy, and BMD before and 6 months after therapy; The above indexes were detected 6 months and one year after bone fracture healing in the control group. ③ Therapeutic effect of α-D3.RESULTS: All the 42 patients entered the stage of result analysis. ① The levels of blood Ca2+, P3+, Mg2+, ALP of patients who suffered pain in knee were all normal before and after therapy . ②BGP content of patients in the control group was significantly lower 1 year after bone fracture healing than 6 months after bone fracture healing [(7.06±0.74), (7.44±1.16)μg/L,P ＜ 0.01]; BGP content of patients in Group A was 15.98 μg/L before therapy , which was significantly higher than that in the control group .BGP content was (12.12±2.2), (10.6±81.31), (7.60±0.95)μg/L , respectively in 1,3 and 6 months after therapy. There was significant difference of BGP content between before and after therapy (P ＜ 0.05). ③ There was no significant difference of BMD of patients between two groups (P ＞ 0.05).④ Symptoms of pain in knee at night improved or disappeared after α-D3therapy, and the therapeutic time was 9 to 83 days.CONCLUSION: Although the knee pain of adolescents and children at night can not reach the diagnostic criterion of rachitis, it is still correlated with the deficiency of bone mineralization, in clinical practice, the BGP determination should be used as a means of monitoring the pain of unknown cause. There is significant effect using vitamin D3 in treatment of knee pain of children at night.

Low-dose ATRA Supplementation Abolishes PRM Formation in Rat Liver and Ameliorates Ethanol-induced Liver Injury / 华中科技大学学报（医学）（英德文版）

The effects of all-trans-retinoic acid (ATRA) in low doses supplementation on concentrations of polar retinoid metabolites (PRM) and retinoids in the ethanol-fed rat liver, and on hepatocyte injury were investigated. The rat model of alcoholic liver disease (ALD) was induced by intragastric infusion of ethanol, and then the rats were administrated with ATRA in two different doses (150 μg/kg body weight and 1.5 mg/kg body weight) for 4 weeks. Concentrations of retinoids in rat liver and plasma were determined by using HPLC. Liver tissues pathologic changes were observed under the light microscopy and electron microscopy. The serum transaminases concentrations were measured. The results showed that the HPLC analysis of retinoids revealed that retinoids (vitamin A,RA, retinyl palmitate) concentrations in ethanol-fed rat liver and RA concentration in ethanol-fed rat plasma were markedly diminished (P＜0.01) after ethanol feeding for 12 weeks. Furthermore, obvious peaks of PRM were formed in livers of ethanol-fed rats. ATRA 150 μg/kg supplementation in ethanol-fed rats for 4 weeks raised RA concentration in both liver and plasma, and also raised vitamin A concentration in liver to control levels, partially restored retinyl palmitate concentration (P＜0.05) in liver. ATRA 1.5 mg/kg supplementation raised not only RA concentrations in liver and plasma but also retinyl palmitate concentrations in liver. However, the vitamin A concentration in liver of ATRA-supplemented rats (1.5 mg/kg) was higher than that of controls (P＜0.05). The histologic observation of liver tissues indicated that ATRA treatment notably alleviated hepatocellular swelling,steatosis, the swelling of mitochondria and proliferation of smooth endoplasmic reticulum (SER).ATRA treatment greatly decreased levels of serum transaminases as compared with the only ethanol-fed group (P＜0.05). It was concluded that low-dose ATRA treatment could restore retinoids concentrations and abolish the PRM formation in liver of ALD rats, and then ameliorate the injury of liver cells.

Relationship between pluse pressure and serum levels of C-protein in elderly patients with HBP / 中国医师杂志

Objective To investigate the relationship between pluse pressure(PP) and serum levels of C-reactive protien(Hs-CRP) in elderly patients with HBP.Methods To measure serum levels of Hs-CRP,total cholesterol(TC),triglyceride(TG),high density lipoprotein-cholesterol( HDL-C),low density lipoprotein-cholesterol(LDL-C) and FBG in 160 patients. Patients were divided into four groups according to the levels of their PP,100mmHg whose serum levels of Hs-CRP were compared.Results Hs-CRP rose with the levels of PP,and were significantly higher in four groups(P