Objective:To study the efficacy and safety of saxagliptin or pioglitazone combined with metformin in the newly diag-nosed patients with type 2 diabetes mellitus(T2DM) with inadequate glycemic control by metformin alone. Methods:Totally 82 newly diagnosed T2DM patients with inadequately control by metfomin monotherapy for 12 weeks were randomly divided into two groups, sax-agliptin group ( saxagliptin combined with metforminc) and pioglitazone group ( pioglitazone combined with metformin) . The blood glu-cose control, homeostatic model assessment of insulin resistance index ( HOMA-IR) , body weight change and adverse reactions were assessed before and after the treatment for 12 weeks. Results:After the 12-week treatment,the level of fasting plasma glucose ( FPG) , two-hour postprandial plasma glucose (2hPG) and glyeosylated hemoglobin(HbA1c) in both groups were significantly decreased. Compared with the pioglitazone group,the level of 2hPG and HbAlc was lower while the level of FPG was higher in the saxagliptin group (P<0. 05). Compared with the saxagliptin group,the level of fasting plasma insulin(FINS) was significantly decreased and HOMA-IR was significantly improved in the pioglitazone group. The body mass index ( BMI) of the patients was increased in the pioglitazone group(P<0. 05) and showed no change in the saxagliptin group(P>0. 05). There was no statistical difference in the adverse reac-tions between the two groups(P>0. 05). Conclusion:The combination of saxagliptin or pioglitazone with metformin in the treatment of newly diagnosed patients with type 2 diabetes can improve glycemic control with low incidence of hypoglycemia and adverse reactions. Saxagliptin is more suitable for the patients with heart diseases or old patients.

Objective:To explore the effect of integrated treatment of Chinese and western medicine on muhiple organ dysfunction syndrome (MODS).Methods:129 cases of MODS were treated by syndrome differentiation of TCM with the“four syndrome and four methods”based on the routine western medicine treatment from 1997 to 2003,and their therapeutic effects were evaluated. Results:Of the 129 cases,75 were cured and 54 died,the mortality being 41.9%.After treatment of TCM,the state of illness of the patients were ameliorated,the level of blood endotoxin decreased and the clinical syndrome improved.Conclusion:Integrated with western medicine,the“four syndrome and four methods”has obvious therapeutic effect.

Objective To discuss the feature of the ultrasonic image and the clinical value of this test way.Methods six Cases of hypoplastie cartilage from 30 thousand fetus were detected.Results Shortened and widened long bone in four limbs,betl shape in chest,enlarged head and inflated abdomen are the main features of the ultrasonic image.Conclusion Ultrasound is superior to other methods in diagnosing fetus'hypoplastic cartilage.

Objective To explore the effects of lithium on expressions of cyclin-dependent kinase 5 (CDK5) and protein phosphatase 2A (PP2A) in the brains of chronic aluminum exposure rats so as to further understand the mechanism of lithium's inhibition on tau phosphorylation. Methods We divided 12 chronic aluminum chloride exposure rats into treatment group and non-treatment group (6 rats in each). Treatment group was given lithium chloride (200 mg/kg?d) via gastric perfusion daily for 6 weeks,while the non-treatment group sodium chloride at the same dosage and the normal group (6 non-aluminum exposure rats of the same month old) without intervention. Six weeks later,all the rats received Morris water maze test for learning memory function; CDK5 and PP2A expressions and phosphorylated tau protein level in rat hippocampus were determined by Western blotting. Results Compared with normal group,non-treatment of chronic aluminum exposure group showed higher phosphorylated tau protein level and CDK5 expression in the brain (P0.05). Conclusion Lithium may reduce tau phosphorylation and neurofibrillary tangle formation by inhibiting the expression of CDK5.

Objective To investigate the life quality (QoL) of end stage renal disease patients. Methods KDQOL-SFTM1.2 scale was used to assess the life quality of end-stage renal disease patients who received maintenance hemodialysis or Newly diagnosed but not yet received renal replacement therapy more than three months in the First Affiliated Hospital of Kunming Medical University or the Yunnan Kidney Disease Hospital from March 2011 to July 2012. Results (1) The QoL of maintenance hemodialysis group was significantly higher than not yet started renal replacement therapy group in the Physical functioning (PF),Role physical (RP),Body pain (BP) fields, the difference was statistically significant ( <0.05) . (2) The QoL of maintenance hemodialysis group was significantly higher than not yet started renal replacement therapy group in the Symptom/problem list (SPL), Sleep fields,but lower than not yet started renal replacement therapy group in the Effects of Kidney disease (EKD), Work status (WS) fields,the difference was statistically significant (<0.05) . Conclusion The life quality of maintenance hemodialysis patients is higher than newly diagnosed but not yet started renal replacement therapy patients in some aspects.

Objective To obtain the most effective preventive management for corticosteroid-induced osteoporosis by the evidence-based medicine approach.Methods We attempted to find the current best evidence for the prevention of corticosteroid-induced osteoporosis by searching ACP Journal Club(1991-Sep.2005),USA Agency for Healthcare and Research evidence report,Cochrane Library(Issue3,2005)and MEDLINE(1990-Sep.2005),and further critically appraised the available evidence.Results We found that VitD or its analogues with calcium and bisphosphonates could improve bone mineral density significantly.But the effects on reducing the development of fracture were not concluded.Conclusion VitD or its analogues with calcium can be the preferential method as prevention for corticosteroid-induced osteoporosis,while bisphosphonates may be an alternative way.

Traditional Chinese medicine (TCM) is a great knowledge base that has been developed through thousands of years and has been accumulated a wealth of experience in diagnosis and treatment.TCM has advanced concepts,but lag behind the use of modern technology and means.With the progress of modern science and technology,the combination of TCM theory and moderm science and technology promotes the development of TCM engineering.TCM has been a breakthrough in diagnostic techniques and clinical treatment,especially modern TCM instruments.At present,diagnostic instruments of TCM mainly depend on pulse and tongue device,and gradually develop to four diagnostic comprehensive analysis platform.Therapeutic instruments of TCM include electroacupuncture device,meridian instrument,laser treatment device and magnetic therapy instrument.This article focuses on the current status,problems and trend on TCM diagnostic and therapeutic instruments,which mainly include diagnostic instruments,clinical treatment instruments,Chinese medical instruments.

Objective To evaluate the clinical application of susceptibility-weighted imaging(SWI) in the early diagnosis of massive cerebral infarction with hemorrhage and analysis of collateral circulation.Methods Fifty patients with massive cerebral infarction underwent MRI (T1WI,T2WI,DWI,MRA and SWI) scan in acute stage and decubation respectively in Hanrison International Peace Hospital from January 2012 to January 2014.Analysis T1WI,T2WI,DWI,MRA and SWI differences in the delection of cerebral infarction with hemorrhage and analysis of Collateral circulation.Record the magnetic resonance angiography hemorrhagic transformation and display the ischemic area of collateral circulation in the detection of cerebral infarction remodeling differences.Results (1)SWI detected out 18 cases of cerebral infarction with hemorrhage (36％),including 14 cases of hemorrhagic infarction(HI) type(28％),4 cases of parenchymal hemorrhage(PH) type 8％).MRI detected 11 cases of cerebral infarction with hemorrhage (22％),including 7 cases of HI type 14％),4 cases of PH type (8％).SWI detected 106 focuses,the detection rate was 100％,MRI detected only 26,and the detection rate was 32.51％,and the missing mainly for micro hemorrhage.There was statistical significance between the groups(x2 =21.045,P＜0.05).(2) SWI can display the condition of micrangium in the area of cerebral infarction clearly.The number of micrangium decreased or disappeared in acute stage,but the micrangium increased in decubation.The ratio of capillary vessels increased to 66％.MRA detected 82％ of criminal vessel in patients with cerebral infarction.Conclusion SWI is more sensitive than conventional MR in the early diagnosis of massive cerebral infarction with hemorrhage.MRA combined with SWI could not only detect the criminal vessel of cerebral infarction area,but also monitor the reconstruction of collateral circulation in the infarction region,and there will be extremely valuable to the treatment massive cerebral infarction and evaluation of prognosis.

Objective To explore the effect of butylphthalide on the prognosis of massive cerebral infarction patients.Methods We studied 92 massive cerebral infarction patients hospitalized in the Neurology department of harrison international peace hospital from February 2011 to December 2013 as the researchers.According to the treatment of patients,patients were randomly divided into control group (n=46)and treatment group(n=46),control group was given edaravone.Treatment group was given butylphthalide capsule and edaravone.Two groups were all given 2 weeks treatment continuously.Improvement of symptoms is evaluated by the National Institute of Health stroke scale (NIHSS).The effect of butylphthalide on collateral circulation in ischemic infarction area was evaluated by the standards of collateral vessels grading of susceptibility-weighted imaging(SWI)imaging sequence. Results The symptoms and signs of two groups were improved in a certain extent,but the improvement of patients in treatment group was significantly greater than control group,the difference was statistically significant (P<0.05 ).Degree of NIHSS of treatment group was lower than control group,the difference was also statistically significant (P<0.05).The SWI collateral vessels grading of the two groups were all improved,and the cases of treatment group was higher than control group,the difference was statistically significant (P <0.05 ).The two groups have no obvious adverse reaction.Conclusion Butylphthalide have good effect on massive cerebral infarction.It can effectively improve the nerve function defect,and promote the reconstruction of collateral circulation in ischemic infarction area.

Objective To research the reliability and validity of the N-QOL Chinese version system.Methods A total of 260 nocturia patients were surveyed by the Chinese version of N-QOL and the reliability and validity of the Chinese version of N-QOL were assessed.Results Cronbach's α of the total questionnaire and two dimensions were 0.899,0.672 and 0.799,respectively.The split-half reliability was 0.828 and re-test reliability was 0.796.The correlation coefficients of scores of the items with its subordinate dimensionality were 0.595～0.854,and those with the total scores were 0.578～0.754.Two common factors were found through exploratory factor analysis,which explained the percent of 57.20％ rotation sums of squared loadings.Conclusions The reliability and validity of the Chinese version of N-QOL were good,so it could be used to evaluate the life quality of nocturia patients.