Objective To understand the variation of the motality and death causes for diabetic inpatients in West China Hospital(WCH) during 1996～2004. Methods First,the amount of diabetic inpatients(14670) and died persons (9597)were got each year by computer search system of our hospital from 1996 to 2004,and the case code of died diabetic subjects (842)were obtained.Then,those medical records were investigated and reviewed in details to get useful information.The motality,death causes and its constituent ratio of dead diabetic inpatients were analysed. Data input and analysis were conducted using the tool Epidate3.0,packages SPSS13 and SAS8.0. Results There were totally 14760 inpatients and 842 deaths who were suffered from DM during 1996-2004.The mortality rate was 5.74% and the standardized mortality rate was 5.37%.Tumor was the first cause of deaths (22.3%),followed by infection(15%),fatal cardiovascular events(14.4%),cerebrovascular events(12.3%).Diabetic nephropathy(DN)(6.3%) took the 6th place just after COPD(8%).There were 9269 deaths in the hospital in total(≥15 years old) during 1996-2004 while DM patients contributed 9.08% to them.The proportion of diabetic patients among the total deaths kept increasing every year(χ2=71.9070,P<0.01). Conclusions The mortality proportion of diabetic inpatients among the total deaths in West China Hospital from 1996 to 2004 is increasing every year.It needs to pay more attention to the main death cause of tumor in diabetic patients

Objectives To evaluate the effectiveness of ARB in antihypertensive therapy and judge whether it can also protect cardiovascular. Methods A randomized double-blinded placebo-controlled study was used to survey over ten thousand patients in ARB clinical practices. The primary endpoint was stroke, acute myocardial infarction, heart failure, deadly cardiovascular diseases, total mortal. The results were given comprehensive analysis and statistical processing. Results In LIFE study, ARB was more effective than ?-blockers and ARB had the role of protecting the cardiovascular besides lowering the blood pressure. But the VALUE study showed that ARB was not more effective than Besylate. Conclusion There is no obvious distinction between ARB and the other drugs in reducing the blood pressure.

Objective To investigate the diagnosis and treatment of Mirizzi syndrome.Methods 6 cases of Mirizzi syndrome were analyzed with review of the latest literatures on its diagnosis and treatment.Results None of the 6 cases were definitely diagnosed by ultrasonography and CT.All of them underwent operations,five of them were cured and one died.Conclusions Ultrasonography and CT can give a hand to diagnosis.Definite diagnosis depends on ERCP and PTC.The specific conditions of the patients and the experience of surgeon decide the selection of treatment.Subtotal cholecystectomy and hepaticojejunostomy are the basic choices.

The aim of the study is to investigate chemical constituents of the leaves of Pieris japonica. The isolation and purification of the constituents were performed by various chromatography and spectral analysis. Three new phenolic glucosides, erythro-syringoylglycerol 4-O-β-D-glucoside (1),1-(2-β-D-glucopyranoxyl-4-methoxyl-6-hydroxyphenyl)-3-hydroxyl-1-propanone (3),erythro-1-(4-hydroxyl-3-methoxyphenyl)-2-[4-(3-β-D-glucopyranoxypropyl)-2,6-dimethoxyphenoxy]-1,3-propanediol (4), along with five known phenolic glucosides, syringoylglycerol 8-O-β-D-glucoside (2), magnolenin C (5), syringaresinol mono-β-D-glucoside (6), 3-(4-hydroxyl-3-methyphenyl)-1-propanol-1-O-β-D-glucoside (7) and 3,5-dimethoxyl-4-hydroxybenzyl alcohol 4-O-β-D-glucoside (8) were isolated and identified from the plant leaves. Compounds 1 and 2 inhibited significantly (P<0.01) the proliferation of murine T and B cells at concentration of 1×10-6 mol·L-1, in vitro.

Purpose To study the clinicopathologic feature, classification, benign or malignant histological features and differential diagnosis of extra-adrenal paraganglioma.Methods We performed a retrospective analysis of 21 cases of extra-adrenal (sympathetic and parasympathetic) paraganglioma. Histological, immunohistochemical findings, and follow-up data were reported with review of the relative literatures.Results There were 10 male and 11 female patients aged from 9 to 81 years (mean 46.5 years).Ten tumors occurred in the retroperitoneum, seven in the neck, and one case in the mediastinum, urinary bladder, spermatic cord and kidney, respectively.There were 3 cases of functional and 18 cases of non-functional paragangliomas.Histologically, the tumor was composed of chief cells and sustentacular cells. The chief cells were arranged in nests, alveolAR~-like and stereo-like structures.They were surrounded by sustentacular cells partly or completely.There was one malignant case, in which tumor cells had significant cell atypia and nuclear mitosis, and focal or diffuse necrosis, regional lymph node metastasis and blood vessel involvement were also observed.Immunohistochemical investigations revealed chief cells were intensely positive for neuroendocrine markers such as NSE, CgA, Syn and NF, but negative for CK, EMA and SMA.Sustentacular cells were positive for S-100 protein.The malignant cells were only positive for NSE and weakly positive for CgA.Eighteen cases were followed up.One patient developed to multi-organ metastasis and died.One patient was diagnosed as benign extra-adrenal paraganglioma that recurred and involved adjacent organs after 3 years.Conclusions It is generally considered that malignant potential, local invasiveness and distant metastasis are not correlated with the histological appearances of the extra-adrenal paraganglioma.So,further follow-up will be needed. It is necessary to emphasize the differential diagnoses of extra-adrenal paraganglioma from other pleiomorphic tumors.

Background and purpose:Surgical treatment of breast cancer traditionally has resected including the nipple-areola complex (NAC), because this area had a significant probability of containing occult tumors. The purpose of this study was to investigate the involvement of NAC in breast cancer and evaluate the feasibility of nipple-Areola complex-sparing mastectomy. Methods:168 cases of specimen of NAC collected from breast cancer with 5 mm subareola tissue preserved were sent to pathological examination in order to observe the tumor involvement of nipple, areola, subareola tissue respectively. Results:Tumor involved with nipple, areola and subareola tissue in 3 cases,areola and subareola tissue in 10 cases, and subareola tissue only in 13 cases.The tumors were all located superficially and centrally to the breast in all cases with nipple and areola involvement except sub areola tissue. The factors relative to the involvement of NAC included the location of the primary tumor, alteration of local skin of nipple- areola(?2=9.672,P=0.002), median tumor size(?2=7.141,P=0.008), positive axillary lymph node(?2=6.081,P=0.014) and clinical pathological stage(?2=10.142,P=0.006). Conclusion:If no clinical sign of NAC is found for the patients with tumor distance from areola edge ≥2.5 cm or tumor size≤5 cm, surgery with NAC preservation appears to be safe for the patients with breast cancer.

Objective To investigate the effect of pyrrolidine dithiocarbamate(PDTC) on monocyte chemotactic protein1 (MCP-1) in rejection of cardiac allograft and its mechanisms.Methods Heterotopic cervical heart transplantation was performed by cuff-technique.The SD rat recipients were randomly divided into 3 groups:AR group (Acute rejection,n =12),both the recipients and donors were without any treatment.CsA group(n =12),the recipients were treated with 10 mg/kg cyclosporine A after transplantation.PDTC group(n =12),the recipients were treated with 100 mg/kg PDTC after transplantation.All the cardiac allografts were harvested at different time post transplantation according to requirements.We studied allograft myocardial fibrosis wih the help of Masson stain,immuno-histo-chemistry and western blot also were used to detect the expression of MCP-1.Results The survival time of the cardiac allografts was significantly longer in PDTC group than in acute rejection group and CsA group(P ＜ 0.01),and myocardial fibrosis of cardiac allografts in PDTC group was significantly decreased (P ＜ 0.01).The IOD in PDTC group was markedly lower than in CsA group (P ＜ 0.01).Conclusion As the inhibitor of NF-κB,PDTC can significantly relieve rejection of cardiac allograft by inhibiting the expression of MCp-1.

Objective To observe the preventive efficacy and safety of dexmedetomidine with parecoxib sodium on the patients with postoperative hyperalgesia induced by remifentanil. Methods A total of 100 female patients undergoing elective surgery under general anesthesia were as-signed into four groups according to the table of random number:the control group (group C),the parecoxib sodium group (group P),the dexmedetomidine group (group D)and the parecoxib sodium combined with the dexmedetomidine group (group DP).The vital signs were monitored and the total intravenous anesthesia was performed.All the patients were give intravenous injection of 0.2μg·kg-1 ·min-1 remifentanil and 4-12 mg·kg-1 ·h-1 propofol to maintain the anesthesia.Patients in group P were given 40 mg parecoxib sodium 30 minutes before the end of the operation.Patients in group D were give intravenous injection of 0.6μg·kg-1 ·min-1 dexmedetomidine consistently till 30 min before the end of the operation.Patients in group DP were given 0.6 μg·kg-1 ·min-1 till 30 min before the end of the operation and were given 40 mg parecoxib sodium.The VAS scores were re-corded at 1,2,6,12,24 hours.The cases of agitation,rigors,nausea and vomiting and increasing of analgesics were recorded.Results The postoperative VAS scores in group P,group D and group DP were significantly lower than group C(P <0.05).The postoperative VAS scores in group DP were significantly lower in group P and group D (P<0.05).Cases of agitation and rigors in group D and group DP were less than group C(P <0.05).The increasing of analgesics in group DP was much higher than other groups(P<0.05).Conclusion After induced,patients were given intravenous in-jection of 0.6 μg·kg-1 ·min-1 dexmedetoniding consistently till 30 min before the end of the opera-tion were given 40 mg parecoxib sodium can effectively prevent hyperalgesia after remifentanil anes-thesia without significant increase in revival time and obtain a better sedation.

Objective To investigate the clinical efficacy of Ilizarov bone transport combined with dressing change in the treatment of acute tibial osteomyditis accompanied with massive soft tissue defection.Methods From July 2009 to september 2012, 14 patients with acute tibial osteomyelitis associsted with large-area soft tissue necrosis and defection were treated in Traumatic Orthopaedics Department of the Central Hospital of Binzhou.All cases were Gustillu Ⅲ type open fracture, and Ⅲ C type injury in 11 casas accompanied with vascular injure.Associated with contralateral lower limb in 4 casas.They were 10 male and 4 female,aged from 21 to 45 years old(average age of 35 years old).The duration from injury to surgery ranged from 12-24 days,averaging of 19 days.All cases were treated first with excision of the infected or necrosis bone segment and soft tissue.The wound keep opening, followed by llizarov bone transport combined with dressing change to repair the bone and soft tissue defection.The clinical efficacy was assessed using the Paley's evaluation system at the last follow-up.Results All the patients were followed up for 24 to 36 months (average of 27 months).The bone defection rapaired was from 5 to 1 3 cm(average of 7 cm).The mean duration of distraction was 4 months, range from 2 to 6 months.All cases' gain s.ufficient soft tissue coverage the later period of Ilizarov bone transport.All the fracture and bone defection were cured.Infection were cured in 13 cases, and 1 case converted to chronicle osteomyelitis, and the cure rate was 93％.According to the Paley' s system, the bone union was excellent in 11 cases, good in 2 cases, and fair in 1 Cases, with a good-to-excellent rate was 93％.The functional outcome was excellent in 10 cases,good in 2 cases,and fair in 2 cases,with a good-to-excellent rate of 86％.Conclusion Ilizarov bone transport and dressing change is one reliable and effective treatment of tibial acute infected and soft tissue defection.

Objective:To evaluate the vital signs changes,influence factors in different grades of hy-pertension patients during the treatment of acute pulpitis,in order to obtain the risk prevention measures. Methods:In this study,90 different grades of hypertension patients with acute pulpitis were recruited from February 201 4 to February 201 5 in the Department of Oral Emergency,Peking University School and Hospital of Stomatology.The information about the patients’general health,oral treatment,life signs of change information was collected.Patients were divided into high risk group,middle risk group, and low risk group (30 patients for each group).Results:(1 )Compared with the preoperative,systolic blood pressure (90%),diastolic blood pressure (80%),heart rate increase (1 00%)were increased in the high risk group.The increase rates of the middle risk group and the low risk group were significantly lower than those of the high risk group (P<0.01 ).At the same time,the systolic blood pressure of 1 /4 (26.7%)patients in high risk group increased more than 20 mmHg (1 mmHg=0.1 33 kPa),and the diastolic blood pressure of 2/5 patients in high risk group increased more than 1 0 mmHg,the difference was statistically significant compared with the other two groups (P<0.05).(2)Compared with the pre-operative,the average increase of the maximum peak were increased [systolic blood pressure (1 8.0 ± 1 .5)mmHg,diastolic blood pressure (8.0 ±1 .7)mmHg],the mean of heart rate changes [(7.0 ± 0.3)beats per minute]was also increased in the high risk group,while these two indicators were de-creased in the low risk group and the middle risk group.The electrocardiogram (ECG)was changed in 6 cases during the treatment in the high risk group.No significantly changed were observed in the low risk group and the middle risk group.(3 ) Compared the risk assessment in preoperative with that in postoperative,in the middle risk group,23 cases were evaluated as medium risk in final evaluation,6 as low risk,and 1 as high risk (risk assessment increased);in the high risk group,20 cases were evaluated as high risk,7 as very high risk,and 3 as medium risk (risk assessment decreased).Conclusion:Oral treatment is very safe for patients with hypertension,but the risk factor,target organ damage,and com-plications will also increase the risk of cardiovascular events in elderly patients during the acute pulpitis treatment.Dentist should take some measures to avoid the risks.