Objective To investigate the efficacies of laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery in the treatment of patients with different body mass indexes (BMI) and type 2 diabetes mellitus.Methods The clinical data of 40 patients with type 2 diabetes mellitus who underwent LRYGB surgery at the Shengjing Hospital of China Medical University from January 2013 to December 2013 were retrospectively analyzed.According to different BMI,8 patients with BMI ＜ 27.5 kg/m2 were allocated into group 1,14 patients with BMI≥27.5 kg/m2 and ＜32.5 kg/m2 in group 2 and 18 patients with BMI≥32.5 kg/m2 in group 3.Forty patients were followed up via telephone interview and food habits questionnaire by weight loss file managers of Shengjing Hospital and the fourth Affiliated Hospital of China Medical University.All the patients received the reexamination of blood test and data collection at postoperative year 1.The preoperative and postoperative 1-year fasting plasma glucose,glycosylated hemoglobin (HbA1 c),BMI and C-peptide were collected and detected.The fasting plasma glucose ＜ 7.00 mmol/L and HbA1 c ＜ 7.00％ were used as a standard of complete remission.Count data and comparison of rates were analyzed using the chi-square test.Measurement data with normal distribution were presented as x ± s and analyzed by the t test.Skew distribution data were described as M (range) and analyzed by the Wilcoxon rank sum test.Repeated measurement data were analyzed by the repeated measures ANOVA.Results Forty patients received successful LRYGB surgery without perioperative complications,and were followed up for 1 year at the Shengjing Hospital (23 patients),the fourth Affiliated Hospital (8 patients) and other hospitals (9 patients).Of the 40 patients,85.0％ (34/40) of patients had no postoperative long-term obvious malnutrition,anastomotic stenosis,ion disorders and digestive tract dynamic obstacles,15.0％ (6/40) of patients were not adapted to the change of life habits such as frequent nausea and vomiting.Five patients with different degrees of frequent vomiting,abdominal pain and night heartburn within postoperative 1 month had the remission of synptoms after symptomatic treatment.One patient in group 2 had a symptom of hypertonic coma due to intake of oral high-sugar drinks at postoperative 1 week and then was cured by hospitalization.The fasting plasma glucose,HbA1c and BMI in group 1 from preoperation to postoperation were decreased from 11.07 mmol/L (range,6.00-17.00 mmol/L) to 7.18 mmol/L (range,6.00-15.00 mmol/L),from 8.85％ (range,6.00％-11.00％) to 6.35％ (range,6.00％-9.00％) and from 26.0 kg/m2 (range,22.0-27.0 kg/m2) to 22.2 kg/m2 (range,20.0-25.0 kg/m2),with significant differences (F =2.413,3.256,6.750,P ＜ 0.05).C-peptide from preoperation to postoperation was decreased from 1.20 nmol/L (range,1.00-3.00 nmol/L) to 1.07 nmol/L (range,1.00-2.00 nmol/L),with no significant difference (F =1.678,P ＞ 0.05).The remission rate of diabetes in group 1 was 3/8.The fasting plasma glucose and HbA1c in group 2 from preoperation to postoperation were decreased respectively from 10.73 mmol/L (range,7.00-19.00 mmol/L) to 5.89 mmol/L (range,5.00-9.00 mmol/L) and from 8.00％ (range,6.00％-15.00％) to 5.85％ (range,5.00％-8.00％).The BMI from preoperation to postoperation was decreased from 31.0 kg/m2 (range,29.0-32.0 kg/m2) to 25.5 kg/m2 (range,21.0-29.0 kg/m2),with significant differences in the above 3 indexes (F =5.449,4.008,-3.296,P ＜ 0.05).C-peptide from preoperation to postoperation was decreased from 1.53 nmol/L (range,1.00-5.00 nmol/L) to 1.52 nmol/L (range,1.00-6.00 nmol/L),with no significant difference (F =-0.251,P ＞ 0.05).The remission rate of diabetes in group 2 was 10/14.The fasting plasma glucose,HbA1c and BMI in group 3 from preoperation to postoperation were decreased from 9.44 mmol/L (range,5.00-16.00 mmol/L) to 6.65 mmol/L (range,4.00-15.00 mmol/L),from 7.90％ (range,6.00％-11.00％) to 6.45％ (range,5.00％-9.00％) and from 36.9 kg/m2 (range,33.0-47.0 kg/m2) to 27.7 kg/m2 (range,23.0-34.0 kg/m2),with significant differences (F =-3.027,-3.410,-3.724,P ＜ 0.05).C-peptide from preoperation to postoperation was decreased from 2.91 nmol/L (range,0.00-9.00 nmol/L) to 2.13 nmol/L (range,0.00-6.00 nmol/L),with no significant difference (F =-3.724,P ＞ 0.05).The remission rate of diabetes in group 3 was 14/18.There was no significant difference in the remission rate of diabetes of 3 groups (x2 =4.460,P ＞ 0.05).There were significant differences in the changing trends of fasting plasma glucose and BMI among the 3 groups (F =3.200,22.500,P ＜ 0.05).There were no significant differences in the changing trends of HbA1c and C-peptide among the 3 groups (F =0.720,1.640,P ＞ 0.05).Conclusion LRYGB surgery is feasible for the treatment of type 2 diabetes mellitus with effectively decreasing fasting glucose,and should be performed on patients with BMI ≥ 27.5 kg/m2 instead of patients with BMI ＜ 27.5 kg/m2 according to a correlation of blood glucose control and preoperative BMI.

Objective To estimate the sensitivity of malignant cells from ascites of gastric cancer to anticancer agents by in vitro sensitivity test, and to study its value in individualized intraperitoneal chemotherapy. Methods Forty-seven cases of gastric cancers with malignant ascites were selected. The gastric cancer cells were isolated from the ascites of 19 patients with gastric cancers, and in vitro sensitivity tests to carboplatin, taxol, fluorouracil, cisplatin, adriamycin, hydroxycamptothecine, methotrexate, mitomycin and dacarbazine were performed by ATP bioluminescence assay. One of the most sensitive drugs was applied to intraperitoneal chemotherapy. The rates of the patients with complete remission of ascites and with disappearance of intraperitoneal cancer cells in the sensitivity test group were compared to those of 28 patients in control group who all were treated with intraperitoneal cisplatin. Results In sensitivity test group, the sensitive cases to carboplatin, taxol, fluorouracil, cisplatin, adriamycin, hydroxycamptothecine, and mitomycin were 7,6,6,6,5,5 and 5 respectively. No case was sensitive to methotrexate or dacarbazine. The rates of patients with complete remmission of ascites and the rates of patients with disappearance of intraperitoneal cancer cells in the sensitivity test group were significantly higher than those in cisplatin control group(68.4% vs. 32.1%, P

AIM: To investigate the genetic and epigenetic alterations of p14~ ARF gene and mutation status of p53 gene in human primary colorectal carcinomas and to analyze the relationship between the two gene changes and the role of abrogation of the p14~ ARF -p53 pathway in colorectal carcinogenesis. METHODS: The homozygous deletions, mutations, methylation of 5′ CpG islands, mRNA expression of p14~ ARF gene and mutations of p53 gene were assessed by PCR, direct sequencing, methylation-specific PCR, and RT-PCR in the tumorous and matched adjacent normal colorectal tissues from 56 patients with colorectal carcinoma. RESULTS: ① p14~ ARF alterations were detected in 27% (15/56) of colorectal carcinoma tissues studied, of which 1 case showed homozygous deletion, 14 cases showed 5′ CpG island methylation, and no mutation was found in any tumor. ②15 colorectal carcinomas with p14~ ARF alterations indicated lack of (13 cases) or at low level of expression (2 cases) of p14~ ARF mRNA, while expression of the p14~ ARF transcript was detected in the remaining 41 colorectal carcinomas and any matched adjacent normal colorectal tissues. ③ The mutations of p53 gene were detected in 48% (27/56) of colorectal carcinomas investigated. ④ Of these 56 cases, 12 had p14~ ARF alterations alone, 24 had p53 mutations alone, 3 had both p53 mutations and p14~ ARF methylation, and 17 had neither. 70% (39/56) of the samples had either or both abnormalities of the two genes, and p14~ ARF hypermethylation was related to wildtype p53 (P

Objective Structured Clinical Examination(OSCE)is a popular and objective clinical examination mode in recent years.Teaching Section of Internal Medicine of the First Clinical College of Harbin Medical University adopts the OSCE assessment approach in the internship phase exam of the clinical overseas students to check the study effect in internal medicine internship and objectively and scientifically evaluates their overall quality through multimedia technology,standardized patient,multi-functional simulation man and other means.

Scientific and rigorous management system is the prerequisite for specialists to standardize training.In order to cultivate and promote the actual clinical ability,the First Clinical College of Harbin Medical University establish a scientific,reasonable,standard and strict evaluation system in specialist training - the Mini-CEX.This system was employed to test on completion of a course and meet the current medical development of specialist training and evaluation mode.

Objectives To identify the mainstream studies and their development trends in health management research, and enable domestic scholars and institutions in their decision making to select strategic research fields and their discipline development on health management. Methods Co-citation cluster analysis of high-frequency citations, combined with co-word cluster analysis of high-frequency of MeSH terms were used to discover research focuses. This was followed by statistical analysis of the content of each cluster, and demonstration of the research trends through citation and subject strategic diagrams. Results Eight hot sub-fields have been identified both before and after 2002, which include both cross and separate topics. Conclusion With a multi-disciplinary characteristic, health management has not yet developed into a mature and stable research field; Health management involves the whole management process of healthcare services; Mental health management, chronic disease management and its primary health care service are all constant hotspots of studies. Health literacy is an area deserving greater attention in health management; Health management should interact with health insurance,making it part of the medical insurance system.

Comprehensively improving the quality of postgraduate education is the main theme of reform and development of postgraduate education. A series of effective measures was taken in the First Affiliated Hospital of Harbin Medical University according to the various aspects of postgraduate education, implementing the whole quality control, enhancing the quality of postgraduate education, in order to accommodate the new situation of postgraduate education.

Objective To investigate the effect of 17β-estradiol on insulin resistance and the expression of insulin receptor-α in skeletal muscle of ovariectomized rats with insulin resistance induced by high fructose.Methods Forty-eight mature female Sprague-Dawley (SD) rats were randomly divided into four groups: the normal control group (NC, n= 12) rats were fed with the normal diet for 8 weeks; the model group (M, n= 12)rats were ovariectomized and fed with the high fructose diet for 8 weeks, meanwhile the physiological-dose of 17βestradiol (30 μg · kg-1 · d-1 ) was injected subcutaneously every day; the vehicle control group (VC, n= 12) rats were ovariectomized and fed with the high fructose diet for eight weeks, meanwhile equivalent alcohol was injected subcutaneously every day. Systolic blood pressure (SBP), fasting blood sugar (FBS), and fasting serum insulin (FSI) were measured and insulin sensitivity index (ISI) was calculated. The expressions of mRNA and protein of insulin receptor-α in quadriceps femoris were measured by RT-PCR and Western-blot. Results Compared with the normal control group, SBP (P<0.05), FBS (P<0.05) and FSI (P<0.01) were increased significantly while ISI was decreased significantly (P < 0. 05) in the model group. The expressions of mRNA and protein of insulin receptor-α and phosphorylated Akt were decreased significantly in quadriceps femoris in the model group (P<0.05), compared with the normal control group. However, these effects were reversed by 17β-estradiol in the 17βestradiol replacement group. Conclusions 17β-Estradiol inhibits insulin resistance, and up-regulates the expression of insulin receptor-α and the level of phosphorylated Akt in ovariectomized rats with insulin resistance induced by high fructose diet.

Objective To analyze the histopathology of patients with atypical squamous cells of undetermined significance (ASCUS),and provide evidence for further classification and clinical treatment of ASCUS.Methods The histopathology of cervical biopsy specimens from 249 patients with ASCUS diagnosed by liquid-based cervical cytology examination was analyzed retrospectively. Results Among the 249 ASCUS patients, the proportion of patients with inflammation was 34.14% (85/249), morphological change by human papillomaviral infection was 19.28%(48/249), CIN I was 32.53%(81/249),CIN II was 8.84%(22/249),CIN III was 3.21%(8/249), infiltrating squamous cell carcinoma was 1.20%(3/249),and endometrioid adenocarcinoma was 0.80%(2/249) . Conclusion It is very important to to further definitude the diagnosis of ASCUS, because a certain proportion of cervical cancer and precancerous leisions woud be confirmed.

Objective To provide reference for improving the performance of public health by establishing performance evaluation framework of public health in rural areas of China.Methods The performance evaluation framework of public health in rural areas is established by literature research,theoretical derivation and Delphi method.The results of expert consultation are tested by W test of Kendall coordination coefficient and chi-square test.Results The performance evaluation framework of public health in rural areas contains four conceptual modules,ten performance goals and twenty-eight performance evaluation indexes.The positive coefficient of experts is 0.889.The average values of authoritative grade of experts are between 0.681～0.715.The Kendall W uniformity coefficients of the necessity,sensitivity and maneuverability of the indexes are respectively 0.167,0.209 and 0.185.The P values are less than 0.01.Conclusion The performance evaluation framework of public health in rural areas has certain application value.It is necessary to pay attention to scientific nature and applicability in developing performance evaluation of public health in rural areas.