Objective To determine the associations of visceral adipose tissue area and retinol binding protein 4(RBP4) with bone mineral density (BMD) in the postmenopausal patients with type 2 diabetes mellitus (T2DM).Methods The cross-sectional study involved 69 postmenopausal patients with T2DM (aged 40-73 years) in our hospital,they were divided into 4 groups:group 1:BMI ＜26.0 kg/m2,VAT＜ 155.3 cm2 ; group 2:BMI ＜ 26.0 kg/m2,VAT＞ 155.3 cm2 ; group 3:BMI ＜26.0 kg/m2,VAT＜155.3 cm2;group 4:BMI＜26.0 kg/m2,VAT＞155.3 cm2.The visceral adipose tissue (VAT) area and subcutaneous adipose tissue (SAT) area were obtained by computed tomography(CT) and BMD was measured by dual energy X-ray absorptiometry (DEXA).Results VAT area had negative associanons with lumbar spine BMD (LS-BMD) and greater trochanter BMD (GT-BMD) (r=-0.367,r=-0.301),and with LS-BMD,GT-BMD,femoral neck BMD (FN-BMD) and intertrochanter BMD (IT-BMD) even after adjusting for body mass index(BMI) and SAT (r =-0.433,-0.432,-0.300,-0.297,all P＜0.05).A negative relationship was showed between LNRBP4 and LS-BMD in postmenopausal female patients (all P ＜ 0.05.) The postmenopausal female patients with T2DM were divided into four groups according to the mean values of BMI and VAT area.BMD at any site of group 3(LS-BMD:1.00±0.20,FN-BMD:0.82±0.17,IT-BMD:1.13±0.21,GT-BMD:0.76±0.18) were higher than group 2(0.79±0.14,0.70±0.10,0.95±0.14,0.58±0.11).The multiple regression indicated that the variation of predictors (age,DUR,BMI,VAT,HbA1c,FINS and PMT) explained 51.7％,52.2％,59.8％ and 75.3％ of the variation in LS-BMD.FN-BMD,IT-BMD,GT-BMD among subjects,respectively(all P＜0.01).Conclusions The influence of fat on bone density may depend on its site of VAT or SAT.VAT could be an independent determinant factor of BMDin the postmenopausal female with T2DM.Serum RBP4 may contribute to this effect.

Objective To evaluate the safety and efficaey of oxaliplatin plus capecitabine combined with concurrent radiotherapy in treatment of locally advaneed oesophageal squamous cell cancer (OSCC).Methods Between July 2003 and December 2008, 46 patients with locally advanced OSCC were irradiated with a dose of 60-64 Gy in 30-32 fractions. The target area included the primary tumor, the lymph nodes with short axis ≥ 10 ram, and the lymphatic drainage region. Two cycles of concurrent chemotherapy was given during radiotherapy, with the oxaliplatin of 85 mg/m~2 on d_1, d_(21), d_(41) and capecitabine of 850 mg/m~2 on d_(1-14) and d_(21-35), which was followed by two cycles of adjuvant chemotherapy. Results The complete re-sponse rate was 33% (14/46), and partial response rate was 56% (24/46), thus the response rate was 88%. Three patients (7%) had no response and 2 patients (5%) had progression. Obstruction relief rate was 90% ,and pain in the chest and back disappeared in 100% of patients. The 1-,2- and 3-year local con-trol rates and overall survival rates were 72% ,40%, 34% and 80%, 45%, 40%, respectively. Acute ra-diation-induced esophagitis rate was 100%, of which 19% was ≥ grade 3. Leuoopenia occurred in 65% of paients and 23% was ≥ grade 3. 23% of the patients had reduced hemoglobin, and 10% with ≥ grade 3.Hand and foot syndrome rate was 16%, and 4% was ≥grade 3. Conclusions Oxaliplatin plus capecit-abine combined with concurrent radiotherapy may be an effective and well-tolerated regimen in patients with locally advanced oesophageal cancer.

Objective to analyze the influence obstetric factors of the small for gestational age(SGA)in twins,so as to direct the clinical prenatal supervision in clinic. Methods A retrospective study of the SGA was performed,the general data of 1 514 patients admitted in obstetrics and gyne-cology of Shengjing Hospital during 2001 to 2014 were analyzed by Logistic regression analysis. Results the incidence of the SGA in twins was 10.89%. the protective factors were male fetus,assisted reproductive technology(ARt)and gestational diabetes mellitus(GDM). the risk factors were the female fetus and hypertensive disorders in pregnancy. Conclusion the gender of fetus,assisted reproductive technology(ARt),gestation-al diabetes mellitus(GDM),hypertensive disorder complicating pregnancy are the influential factors of the SGA in twins. We recommend a further pre-pregnancy and pregnancy care which is of significance for the prevention of SGA.

This paper describes the present situation for the lack of sense of life responsibility from health con-sciousness and life responsibilities, and from the school education, social environment, family influence and its own factors four aspects analyze the medical students lack of sense of responsibility at the root of life, and then on this basis put forward the corresponding countermeasures:schools should innovation course, pay attention to the clinical practice, to strengthen the construction of teachers′quality education, deepen the life value;the government should strengthen the administrative intervention; the network, the media should give full play to the guiding function;play a role of family environment influence and change the concept of family education;improve the ability of self-awareness and self-monitoring of frustration education and emotional education.

Objective To study the apoptosis-inducing effect of histamin-indomethacin（his-IN）on Lewis lung cancer cell in mice.Methods The suspension of tumor cells from Lewis lung cancer mice was inoculated into the left axilla of Kunming mice.When the tumor grew to 1 cm in diameter,the mice were divided into 5 groups and received corresponding treatment：3.0 mg/kg indomethacin（IN）group,3.5 mg/kg IN group,3.0 mg/kg his-IN group,3.5 mg/kg his-IN group,and saline control group.Ten days later,the therapeutic effects were evaluated by the tumor inhibitory rate,the apoptotic peak and rate of tumor cells were measured by flow-cytometry（FCM）,and tumor necrosis factor α（TNF-α）level was estimated by radio-immunity method.Results TNF-α level,the tumor inhibitory rate and the apoptosis rate of his-IN group and IN group were significantly higher than those of the control group,and those of 3.5 mg/kg his-IN group was the highest.In the groups of his-IN or IN treatment,an apoptotic peak was found before G0/G1 phase,and the peak in his-IN group appeared earlier than IN group.Conclusion IN and his-IN could resist the growth of the tumor and promote cell apoptosis of Lewis lung cancer in mice.

Objective To observe the effect of Xuefu Zhuyu Decoction combined with metoprolol in the treatment of senile coronary heart disease and angina pectoris and its influence on the level of blood lipid and HCY in plasma.Methods 80 cases of elderly patients with coronary heart disease and angina were randomly divided into the two groups of 40 cases according to the random number table method.The study group was treated with Xuefu Zhuyu Decoction combined with metoprolol,while the control group only used conventional western medicine for treatment,the efficacy and changes of plasma homocysteine (HCY) and serum lipid levels before and after treatment of two groups were compared.Results The effective rate of patients in the study group was 92.5 ％,significantly higher than 65％ of the control group (x2 =4.58,P ＜0.05) ;The plasma HCY of the study group after treatment was (15.8 ±3.7) μmol/L,significantly lower than (26.5 ± 10.3) μmol/L of the control group (t =6.18,P ＜0.05) ;The levels of serum LDL,TC,TG and HDL of the study group after treatment were significantly improved than before treatment (t =9.82,7.66,7.89,6.54,all P ＜ 0.05),and it improved significantly than that of the control group (t =8.35,7.67,7.82,6.33,all P ＜ 0.05).Conclusion Xuefu Zhuyu Decoction combined with metoprolol has a better effect than the pure western medicine in treatment of senile coronary heart disease and angina pectoris,which is worthy of clinical application.

Objective Discuss recovering guidance of effect of coronary heart disease and angina Patients. Methods 120 patients with coronary heart disease and angina were randomly selected for recover self health at home recovering guidance. The process includes data collection, evaluation, action and analyzing the feedback of the home practice in the recovering guidance application within two years when the patient is out of the ward. Results Recover self health at home Recovering Guidance for coronary heart disease and angina patients is effective on preventing and reducing the disease relapse, the neopathy of the brain, kidney,liver and mortality.Conclusions Recover self health at home Recevering Guidance for coronary heart disease and angina patients could help to short patient’s in-ward period, speed in and out ward circulation, relieve his distress and treatment cost of the patients, strengthen the communication between the patient and nurses. It is also a way to improve the comprehensive nursing ability of the nurses.

Sumsimiao's medical morality thoughts attach great importance to the internal life and its quality.It is what the essence of medical humane spirit is,and also what people of the age need.In spite of technology developing in a fantastic speed,modern medicine tends to shrink in humane spirit.Whereupon,it's the medical personnel and whole society's duty to advocate Sumsimiao's thoughts,ponder the function and quality of medicine,and restore the medical humane spirit.

Objective:To analyze the current status of medical students′ humanity education satisfaction rate and present situation of humanity quality and thus provide evidence to better practice of humanity education. Meth-ods:According to the random stratified cluster sampling method, the researchers selected 1146 medical students from Harbin Medical University and then investigated the objects′ humanity education satisfaction rate and general humanity situation. The data was analyzed using χ2 test in SPSS 17. 0. Results:①Satisfaction status of humanity education:the students′satisfaction to teachers′humanity quality, effect of course and library resources were low.② The present situation of humanity quality:80 . 2% of the medical students thought it was necessary to strengthen the medical students′humanity education;18. 1% of the medical students remembered the medical student oath, and there existed significant differences between different specialties;11 . 9% of the medical students could clear connotation of the humanistic concept, and there were significant differences between various grades;24. 4% and 14 . 5% of the medical students couldn′t clear the humanistic attribute of Marxist political theory course and moral course respectively; rural students′ humanity quality was statistically lower than the urban ones. Conclusion:Through optimizing the structure of humanity courses, strengthening the construction of teaching staff and attaching great importance of the library to humanity education effect, so as to improve medical students′ satisfaction of hu-manity education. The government should increase investment in rural education to narrow the gap of basic humani-ty quality education between urban and rural.

Background and purpose:The study hasfound that tumornecrosis factor-related apoptosis inducing ligand (TRAIL) can enhance the cytotoxic effect of chemotherapeutic drugs on tumor cells. The aim of our study was to investigate the effects of the tumor TRAIL and cisplatin combined application on the growth and apoptosis of human ovarian cancer cell lines SKOV3 and OVCAR3, and the possible mechanism.Methods:Under the combined application of cisplatin and TRAIL, MTT method and flow cytometry were used to detect the proliferation and apoptosis of SKOV3 of OVCAR3 cells; the mRNA expression levels of death receptors, DR4 and DR5, were detected by real-time lfuorescent quantitative polymerase chain reaction (RTFQ-PCR). At the same time, the protein expression levels of DR4 and DR5 were detected by Western blot.Results:SKOV3 and OVCAR3 cells were sensitive to TRAIL protein, and with the increasing of TRAIL protein concentration, cell growth inhibitory rate up to 64%. When the
combination application of TRAIL and cisplatin, the inhibition rate of the two cells reached more than 92%, and the two drugs showed high synergistic effect, compared with the single drug group (P<0.05). Flowcytometry analysis indicated that the synergistic killing effect of TRAIL and cisplatin was mainly due to the cell apoptosis. RTFQ-PCR and Western blot detection results showed that the DR4 and DR5 were up-regulated under the combined application of TRAIL and cisplatin.Conclusion:In vitro, TRAIL and cisplatin combined application can signiifcantly inhibit the proliferation of human ovarian cancer cells and induce tumor cell apoptosis. TRAIL can obviously enhance the sensitivity of cisplatin to tumor cells. The mechanism may be related to the increased death receptor DR4 and DR5 expression level.