Objective:To observe therapeutic effects of blood glucose control by using acarbose in combination with different insulin.Method:58 patients were randomly divided into two groups treated with either insulin glargine (Lan- tus;Aventis) or human NPH insulin (Novolin;NovoNordisk).Subcutaneous injection of insulin before sleep and oral acar- bose were carried out for the treatment,which lasted three weeks.The degree of blood control,the amount of insulin used, and the cases of hypoglycemia for both groups were observed at the end of the experiments.Result:The fasting blood glu- cose showed its normal and stable result,and the average blood glucose values at different time slots per day in the group treated with insulin glarglne were lower than those in the group treated with human NPH insulin.The maximum difference of blood glucose values occurred after dinner while no significant variance appeared after breakfast and after lunch.Conclu- sion:The therapeutic effects are quite efficient and stable in controlling 24-hour blood glucose in type 2 diabetes by using acarbose in combination with either insulin glargine or human NPH insulin (Novolin;NovoNordisk).In addition,the oc- currence rates of hypoglycemia with both methods are low whereas the therapeutic effects for the first group are superior to those for the latter group.

Objective To investigate the relationship between thyroid hormones and Lp(a) the pituitary-thyroid axis in elder patients with congestive heart failure(CHF). Methods 50 normal controls and 158 elder patients with CHF who had not thyroid gland illness were involved in this study. Levels of FT 3, FT 4, TSH and Lp(a) in serum were measured. Patients were divided into two groups according to the course of chronic heart failure: patients with the course of CHF

13.1mmol/L were treated by 2 weeks short-term intensive insulin treatment. FBS, Fasting blood insulin(FINS), glycosylated hemoglobin A1c (HbA1c), 2 hours postprandial blood sugar(PBS 2), Homa ? and Homa IR were measured and compared between pre-treatment and post-treatment. Results After 2 weeks short-term intensive insulin treatment, the excellent control of FBS, PBS 2 in 23 out of 27 patients were achieved respectively in (5.6?2.3)days and (8.5?3.5)days. Homa ? significantly increased, and HbA1c and Homa IR decreased comared with pre-treatment. Conclusions The excellent glycemia control and improvement of ?-cell function can be induced by short-term intensive insulin treatment in newly diagnosed type 2 diabetic patients with severe hyperglycemia.

Objective To explore the influence of expert patient progratmne on self-efficacy and serf-management of patients with permanent colostomy. Methods 46 patients with permanent colostomy were participated in expert patient programme .All patients' self-efficacy and self-management were inves-tigated with questionnaire before and after training. Results The score of serf-efficacy and self-manage-ment was increased after participating in the expert patient programme. Conclusions Taking part in ex-pert patient programme may improve self-efficacy and self-management of patients with permanent colosto-my effectively.

Objective To discuss the clinical outcomes of old fracture-dislocation of proximal interphalangeal joint treated with a self-made distraction external fixator which consists of 3 pins and rubbers.Methods From March 2005 to August 2011,8 cases of old fracture-dislocation of proximal interphalangeal joint treated with a pins-rubber distraction external fixator were retrospectively reviewed.There were 6 males and 2 females,aged from 17 to 58 years,averaged 23.2 years.The middle finger was involved in 5 cases and ring finger was involved in 3 cases.The right hand was affected in six patients,and the left hand was affectd in two patients.The mechanism of injury was sports injury in 6 cases,traffic injuries in 1,and sprain in 1.All of the cases were closed injury.The mean time from injury to surgery was 58 d (range,45-90 d).According to Schenck classification of the proximal interphalangeal joint fracture-dislocation,there were 4 cases of type Ⅰ,3 of type Ⅱ,I of type Ⅲ.Based on the Michigan Hand Outcomes Questionnaire (MHQ) for subjective hand function score,the average preoperative score was 56; the range of motion of proximal interphalangeal joint was 0°.Grip strength was 60％-80％ of the contralateral hand.Results The follow-up lasted 6-51 months,with a mean period of 20.5 months.Solid bone healing was eventually achieved in all patients.The average healing period was 3 months (range,2-5 months).The mean normalized MHQ score was 88 (range,84-92).Grip strength was 85％-100％ of the contralateral hand.Extension of proximal interphalangeal joint was -10°-0° (average,-5°).Flexion angle was 75°-100° (average,89.4°).Postoperative complications included slight joint space narrowing (2 cases),joint incongruity (＜ 1 mm) (2 cases) and fusiform arthrocele (2 cases).No infection,pin loosening,and pin breakage was encounted.Conclusion A pins-rubber distraction external fixator is a minimally invasive,reliable and effective treatment for old fracture-dislocation of proximal interphalangeal joint.

Objective To explore an objective and standard approach for accurately evaluating peristomal skin lesions and providing comprehensive and professional nursing guidance.Methods Images of peristomal skin were taken by a cell phone camera and then evaluated by medical image processing and analyzing software combined with the condition option.The computer automatically calculates and provides professional nursing advice for patients developing peristomal skin lesions based on ostomy skin assesssment score system and ostomy skin nursing guideline for peristoma skin care.Advice from two ostomy nursing professionals were compared with that from the medical image analyzing software in two different cell phones.Results Results were analyzed by Kendall coordination coefficient W test to analyze the level of coordination among the experts and medical image analyzing system.There was agreement among study groups (W=0.902,P＜0.05) with respect to DET score.Conclusions Application of medical image analyzing software for standard nursing and treatment of peristomal skin lesions provides standardized assessment and professional advice,reduces artificial distinctions and absence of nursing advices,and effectively improves nursing of peristomal skin.

Objective To study the clinicopathological and immunohistochemical features, histogenesis and biological behavior of solid pseudopapillary tumor of the pancreas ( SPT ). Methods Routine HE and immunohistochemical ( SP) methods were used in 20 cases of SPT. Results There were 18 females and 2 males, age ranging from 13 to 48 years with mean age of 25. 3 years. Abdominal pain and palpable mass were among the main complains. Seventeen cases were followed-up from 9 to 120 monthes. Fourteen cases were alive. Tumors were encapsulated, mixed with solid and cystic tissues. Histological features were psudopapillary structure with a fibrovascular core. Immunohistogically, the tumors were positive for a-1-AT ( 17 cases) , vimentin ( 14 cases) , synaptophysin ( 10 cases) , CgA (5 cases) ,CK and insulin (2 cases) ,glucagon and S-100 (1 case) ,PR (14 cases) , ER (1 case) ,pS2 (6 cases) , but all were negative for CEA and gastrin. Conclusion SPT is of low-graded malignancy and a distinct clinicopathologic entity in young female patients with both exocrine as well as endocrine differentiation. The tumor is closely related with sex hormone receptors.

Objective To detect the modification levels of H2AKll9 ubiquitination (H2AK119ub) and H2BK120ub,and to analyze the relationship between the levels of H2AK119ub,H2BK120ub and arsenic exposure.Methods A cross-sectional study was conducted in typical areas of drinking water type of endemic arsenicosis in Shanxi and Jilin provinces.Totally 281 residents who had drank local water for more 10 years were enrolled in this study,these participants were divided into control group (water arsenic content ＜ 0.01 mg/L),low arsenic exposure group (water arsenic content ranged 0.01-0.05 mg/L),medium arsenic exposure group (water arsenic content ranged ＞ 0.05-0.10 mg/L) and high arsenic exposure group (water arsenic content ＞ 0.10 mg/L).Among them,including 60 subjects in control group (20 males and 40 females),61 subjects in low arsenic exposure group (27 males and 34 females),50 subjects in medium arsenic exposure group (17 males and 33 females),and 110 subjects in high arsenic exposure group (40 males and 70 females).Drinking water and urine samples were collected and the arsenic content was detected by the method of atomic fluorescence spectrometry.After extracting leukocytes histone from the peripheral venous blood that collected from the subjects,the levels of H2AK119ub and H2BK120ub were detected by dot blotting.The levels of water arsenic,urinary arsenic,water arsenic accumulative intake,H2AK119ub and H2BK120ub were expressed as medium and quartile [M (P25,P75)].Results Age,body mass index (BMI),gender,smoking and alcohol drinking between control group and water arsenic exposure groups had no statistical differences (x2 =3.780,3.572,1.938,4.937,6.025,all P ＞ 0.05).Compared the contents of water arsenic [0.005 (0.003,0.006),0.024 (0.017,0.037),0.076 (0.057,0.084),0.150 (0.124,0.185) mg/L],the contents of urinary arsenic [0.011 (0.006,0.017),0.018 (0.004,0.072),0.061 (0.032,0.124),0.134 (0.069,0.223) mg/L],the water arsenic accumulative intake [0.342 (0.248,0.477),1.641 (1.012,2.324),5.273 (3.690,7.036),7.716 (5.608,12.053) mg] among the control,low,medium and high arsenic exposure groups,the differences were statistically significant (Hc =256.041,88.615,218.610,all P ＜ 0.01).Compared the levels of H2AK119ub [1.231 (0.856,1.817),1.244 (0.792,1.884),1.376 (0.743,1.981),1.390 (0.906,2.045)],H2BK120ub [0.350 (0.186,0.589),0.363 (0.152,0.678),0.428 (0.134,0.788),0.276 (0.146,0.453)] in human peripheral blood leukocytes among control,low,medium and high arsenic exposuregroups,the differences were not statistically significant (Hc =2.130,4.330,all P ＞ 0.05).There were no correlations between H2AK119ub and water arsenic content,water arsenic accumulative intake (r =0.104,-0.008,all P ＞ 0.05);there was a positive correlation between H2AK119ub and urinary arsenic content (r =0.166,P ＜ 0.05).There were negative correlations between H2BK120ub and water arsenic content,water arsenic accumulative intake (r =-0.183,-0.159,all P ＜ 0.05);there was no correlation between H2BK120ub and urinary arsenic content (r =-0.101,P ＞ 0.05).There was a negative correlation between H2AK119ub and H2BK120ub (r =-0.127,P ＜ 0.05).Conclusion External exposure to arsenic may change the levels of H2BK120ub in human peripheral blood leukocytes.

Objective To investigate the relationship between single nucleotide polymorphism(SNP)of the peroxisome proliferator activated receptor γ (PPARγ) gene Rs1801282 and brick-tea type fluorosis. Methods From 2012 to 2013, this cross-sectional study was performed in 16 endemic fluorosis areas of brick-tea type in Inner Mongolia Autonomous Region,Qinghai and Xinjiang Uygur Autonomous Region of China,to select adults>18 years old as subjects, who were diagnosed as skeletal fluorosis by X-ray. All of the subjects filled in demography survey questionnaire; the survey contents included general characteristic s, and average daily brick tea intake. Drinking tea samples and urine samples of each subject were collected, and fluoride content of urine and brick-tea was determined via the ion selective electrode method (WS/T 89-2006). X-ray scintigraphy was used to diagnose skeletal fluorosis, according to the "Diagnostic Criteria of Endemic Skeletal Fluorosis" (WS/T 192-2007); the subjects were divided into skeletal fluorosis group (case group) and non-skeletal fluorosis group (control group). To collect venous blood 5 ml, whole blood DNA was extracted, and polymorphism at Rs1801282 of PPARγ was detected by MassARRAY time-of-flight mass spectrometry, to calculate odds ratio (OR) and 95% confidence interval (CI). Results There were 1 414 people included in this study,including 347 in case group and 1 067 in control group. By the Hardy-Weinberg balance test, the PPARγ gene Rs1801282 genotype was representative in case group, control group and each nationality (P > 0.05). The difference of PPARγ gene Rs1801282 genotype in case group and control group was not statistically significant (OR was 0.991, 95%CI: 0.704 - 1.395, the adjusted OR was 1.026, 95%CI: 0.707-1.489).The difference of PPARγ gene Rs1801282 genotype(CC,CG+GG)in case group and control group in different nationality was not statistically significant (Tibetan: OR was 1.400, 95%CI: 0.576 - 3.404, the adjusted OR was 1.258, 95%CI: 0.474 - 3.340; Kazak: OR was 0.898, 95%CI:0.516 -1.562,the adjusted OR was 0.936,95%CI:0.532 -1.648;Mongolia: OR was 1.148,95%CI:0.508-2.594, the adjusted OR was 1.644, 95%CI: 0.683 - 3.956; Han: OR was 1.058, 95%CI: 0.451 - 2.482, the adjusted OR was 0.959, 95%CI: 0.388 - 2.371; Russian: OR was 0.000, 95%CI: 0.000 - 0.000, the adjusted OR was 0.000, 95% CI: 0.000 - 0.000) with binary Logistic regression analysis. Conclusion We have found no association between SNP of PPARγ gene Rs1801282 and skeletal fluorosis of brick-tea type fluorosis in China.

Objective To study the urinary arsenic safety guideline value of a population for evaluating the arsenic exposure level in a certain population and providing evidence for the implementation of prevention and control measures in endemic arsenicosis area.Methods According to the data from the national high-arsenic drinking water sources screening in endemic arsenicosis area of drinking water type and quality supervision and inspection for water-improving project to decrease arsenic from 2005 to 2014,census data on arsenic poisoning in endemic arsenicosis area,data on surveillance of endemic arsenicosis,10 722 people with detailed personal information,complete water arsenic exposure data and accurate urinary arsenic detection data were selected to be the research objects.The relationship between urinary arsenic and water arsenic was analyzed based on the surveillance data of 4 501 people from 2013 to 2014.The safety guidance value of urinary arsenic was determined based on the geometric mean value of urinary arsenic in people exposed to water arsenic in the range of (0.050 ± 0.005) mg/L,and verified using the data of 6 221 people from 2005 to 2012.Every time,a random sample of 2 000 people was taken as the verification sample,the sensitivity and specificity of the index for determining whether water arsenic exposure exceeded the standard were determined by area under the ROC curve (AUC),and a total of 10 sample tests was performed.Results When the water arsenic concentration was less than 0.01 mg/L,the correlation coefficient of water arsenic concentration with urinary arsenic concentration was 0.097 (P ＜ 0.01);when the water arsenic concentration was more than 0.01 mg/L and less than 0.05 mg/L,the correlation coefficient of arsenic concentration with water arsenic concentration was 0.456 (P ＜ 0.01);when the water arsenic concentration was more than 0.05 mg/L,the correlation coefficient of water arsenic concentration with urinary arsenic concentration was 0.630 (P ＜ 0.01).With increase of water arsenic concentration,the concentration of urinary arsenic increased significantly,and the difference was statistically significant (x2 =2 337.956,P ＜ 0.01).When water arsenic concentration was in the range of (0.050 ± 0.005) mg/L,the urinary arsenic geometric mean was 0.032 mg/L.AUC analysis of 10 random samples of 2 000 people showed that the geometric mean of urinary arsenic was 0.032 mg/L in the population,which can accurately distinguish whether the water arsenic level exceeded 0.05 mg/L,and the AUC value was higher than 0.94.And the sensitivity and specificity were achieved 0.898 and 0.844.Conclusions The geometric mean of urinary arsenic is 0.032 mg/L,which can be used as a safety guideline value for urinary arsenic in the population.When the geometric mean of urinary arsenic exceeds this value,the population may be exposed to high arsenic.