Objective:To analyze the research progress and challenges in electronic health records(EHR) in China by means of literature retrieval of EHR research in China.Methods:" Electronic health record" " Electronic health archive" and " Electronic medical record" were used as search terms, and subject retrieving method was used to retrieve literatures published before December 31 2019 on China National Knowledge Infrastructure(CNKI) database. Such software as SATI, Netdraw, VOSviewer, UCINET and CiteSpace etc. were used for bibliometric analysis and knowledge graphing. These practices could analyze and visualize in an overall perspective the power distsribution, hot spots and evolution trends of EHR study in China.Results:2 146 papers on EHR research were retrieved. The study found that relatively stable groups of core authors on EHR had taken shape in China, and there were not representative authority organizations as of now, while a healthy research ecology was emerging gradually; the current studies were centering on seven hot spots and presented a clear technology-based tendency.Conclusions:Such areas as data security, nation-wide system integration, application performance upgrading mechanism and EHR data industrialization constitute both development opportunities and major challenges as well.

Diabetes mellitus impacts patient survival and quality of life mainly due to its acute and chronic complications.Pancreas transplantation may restore normoglycemia and reduce the complication of insulin-dependent diabetes,thus improving the quality of life and prolonging patient's survival.Although pancreas transplantation requires major surgery and life-long immunosuppression therapy,it currently remains the gold stand for patients with type 1 diabetes mellitus,who do not respond to conventional therapy.Meanwhile,potential of the islet transplantation,insulin-producing cells replacement therapy,and artificial pancreas as the alternative to pancreas transplantation are under investigation.

More and more extrapancreatic actions of incretin-based therapies have been demonstrated and recently case reports have linked glucagon-like peptide-1 (GLP-1) receptor agouist therapy with the improvements in psoriasis.Psoriasis is a common skin disorder characterized by chronic inflammation.Epideminological studies have showed that patients with psoriasis exhibit increased rates of cardiovascular disease,obesity,and type 2 diabetes,owing probably to the enhanced local and (or) systemic inflammation.The observations of anti-inflammatory actions of GLP-1,which exerts direct and indirect actions on immune function,together with the improved psoriasis,offer new insights into the investigation of non-classical anti-inflammatory actions of incretin-based therapeutics and provide a new direction for the research of the novel clinical application of GLP-1.

Amino acids (AA) as substrates of gluconeogenesis could promote endogenous glucose production.Some AA can enhance insulin secretion. Recently,many studies have found that some AA can also activate mammalian target of rapamycin-S6 kinase 1 ( mTOR-S6K1 ) pathway,resulting in maintaining pancreatic β cell function on one hand,and on the other hand,inhibiting insulin signal transduction of insulin-sensitive cells and thus causing insulin resistance.

Objective To observe the cognitional differences between teachers and students concerning teaching objective,curriculum,teaching methods and effect and teaching reform and to pro-vide references for teaching reform. Methods Medical humanistic questionnaire was designed to survey teachers and students. Data were processed by SPSS 18.0 and were analyzed by Chi-square. P value smaller than 0.05 signifies significant differences. Results There were significant differences in cognition of medical humanistic ability,emotion controlling ability,curriculuma provision and teaching methods between teachers and students.12.9% teachers and 41.3% students considered that the opportunity of medical humanistic practice was plenty while 55.7%teachers and 35.3%students thought that the univer-sity attached little importance to medical humanistic teaching. Conclusions Key points of humanistic reform include making clear the teaching objectives,emphasizing practice of medical humanistic teach-ing,improving curriculum and deepening appraisal reform.

Neural stem cells are a study hot spot in neurobiological science and neurosurgery in the near future. The transplantation of neural stem cells already became a new way which be used for treating the injury and degenerative disease in the nervous system, because of the self-renewal and cell differentiation bionomics. However, how to get massive neural stem cells, which can be used in animal experiment and clinical application, has constrainted the development of stem cell technique.This article introduced the harvesting methods of embryonic stem cells, adult neural stem cells and mesenchymal stem cells, in order to lead cellular transplant treatment into clinical treatment plan by a safe and effective mode.

Free fatty acids(FFAs) provide an important energy source and also act as signaling molecules.Medium to long-chain free fatty acids can activate the intracellular signal pathways in the pancreatic ?-cells and play a role in regulating insulin secretion as an extracellular signal molecular via binding to the FFA receptor G protein-coupled receptor 40(GPR40). Furthermore,GPR40 is associated with several biological effects including cell proliferation and antiapoptosis of nerve cells.GPR40 act an important role in the connection of obesity and diabetes or cancers.GPR40 will probably become a novel kind of antidiabetic and anticancer drugs.

As for pediatric patients,antibacterial drugs are the most common prescription drugs.These agents play a significant role in reducing the incidence and mortality of human infections.However,at the same time,some related adverse reactions appeared,such as the impact on intestinal microflora colonization.Intestinal microbial population has great importance in regulating body's metabolism.If early use of antibiotics in life,the composition of the intestinal microbiota will be destroyed,and resulting in obesity.Animal experiments showed that low-dose antibiotics may promote an increase in body weight,and the use of antimicrobial drugs in the early life was more effective than that in late stage.Currently,available human epidemiological investigation indicated that antibacterial drugs had a similar effect in human.Gut flora in early life is essential for the later metabolism of body,but it is susceptible to interference.Using probiotics after the application of antimicrobial drug may be beneficial to improve the balance of intestinal microflora.This may be a new direction to prevent obesity after the early use of antimicrobial drugs.Now,the domestic and foreign reports were combined to elaborate the antibacterial drug metabolism in animals,the influence of body quality on the quality of the human body and the corresponding measures after application of antimicrobial agents.

Objective To compare open reduction and internal fixation (ORIF) and minimally invasive percutaneous plate osteosynthesis (MIPPO) in the operative treatment of complicated proximal humeral fractures.Methods From January 2014 to October 2015,55 complicated proximal humeral fractures were treated at our department.They were 32 men and 23 women,from 21 to 81 years of age (average,51 years).According to Neer classification,34 cases belonged to three-part fractures and 21 ones to four-part fractures,14 of which were complicated with dislocation.Of them,35 received ORIF and 20 underwent MIPPO.The 2 groups were compared in terms of operation time,intraoperative blood loss,incision length and Neer scoring of the shoulder function at the final follow-ups.The 2 groups were compatible without significant differences in preoperative demographic data (P ＞ 0.05).Results The 55 patients were followed up for 6 to 12 months(mean,9 months).The operation time (100.5 ± 10.2 min),intraoperative blood loss (80.0 ± 10.5 mL),and incision length (7.5 ± 3.2 cm) in the MIPPO group were significantly better than those in the ORIF group (120.0±10.1 min,200.5±10.2mL,and10.5±5.3cm,respectively) (P ＜0.05).According to the Neer scoring of the shoulder function at the final follow-ups,the good to excellent rate was 71.4％ (25/35) in the ORIF group and 85.0％ (17/20) in the MIPPO group,showing a significant difference (P ＜ O.05).The incidence of humeral head necrosis was 15 in the ORIF group,significantly higher than that (3) in the MIPPO group (P ＜ 0.05).Conclusion In treatment of complex proximal humeral fractures,compared with ORIF,MIPPO may lead to less damage to local blood supply,less trauma,and quicker functional recovery due to early functional exercise.

Diabetic nephropathy( DN) is one of the main manifestations of diabetic microvascular dis?ease,and it is a major factor in the death of diabetes.At present,the treatment of DN is mainly focused on the control of high blood sugar and high blood pressure.Although angiotensin converting enzyme inhibitors and angio?tensin II receptor antagonists can slow the progression of DN,there were a lot of patients deteriorate to renal fail?ure.The role of vitamin B supplementation in preventing microvascular complications of diabetes has already been a focus of research for some years.In this paper,the role of B vitamins in the pathogenesis of diabetes mellitus and DN,effect of vitamin B supplementation on treatment in DN were discussed.