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 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 efficacy and safety of crizotinib in patients with advanced anaplastic lymphoma kinase (ALK)-positive non-small cell lung cancer (NSCLC),and focuse on analysis of its prognostic factors.Methods Fifty patients with advanced (stage m B-Ⅳ) ALK-positive NSCLC confirmed by cytology or histology in Peking Union Medical Collage Hospital from January 2013 to September 2016 were collected.The relevant clinical imformation and treatment protocols were recorded.The efficacy and safety of crizotinib were followed up,and its prognostic factors were analyzed.Results At the end of follow-up,the median progression free survival (PFS) of progressed patients (n =24) was 9.6 months (95％ CI:8.3-10.9 months),of which five patients died.The median follow-up time of non-progressed patients (n =26) was 10.7 months.The most common adverse event was abnormal liver function (48.0％,24/50).In the single factor analysis of Kaplan-Meier,younger or equal to 40 years old patients had a longer PFS (P =0.017),and the COX regression analysis (Enter method) also had statistical significance differences (HR =6.1,95％ CI:1.4-27.5,P =0.018).However,gender (HR =0.8,95％ CI:0.2-2.6,P =0.697),smoking history (HR =1.5,95％ CI:0.4-5.6,P =0.524),pathology (HR =1.1,95％ CI:0.3-4.2,P =0.922),tumor stage (HR =1.7,95％ CI:0.4-8.4,P =0.502),epidermal growth factor receptor (EGFR) mutant type (HR =0.4,95％ CI:0.4-4.3,P =0.461),EGFR unknown (HR =1.3,95％ CI:0.3-6.1,P =0.727),Eastern Cooperative Oncology Group Performance Status (ECOG) PS score (HR =2.0,95％ CI:0.6-6.8,P =0.290),the status of previous treatment (HR =0.6,95％ CI:0.2-1.8,P =0.385) and brain metastasis (HR=0.7,95％CI:0.1-3.2,P=0.628) were not associated with disease progression Conclusion Crizotinib has good efficacy and is safe and well-tolerated to advanced ALK-positive NSCLC patients,and age is the independent prognostic factor.

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.

Nowadays, lung cancer is the malignant tumor of the highest morbidity and mortality over the world, and non-small cell lung cancer (NSCLC) makes up about 80%. hTere is a great many NSCLC patients have been in advanced stage when diagnosed. As a result, people pay more attention to curing advanced NSCLC. hTe standard treatment to advanced NSCLC is platinum-based combined chemotherapy. However, chemotherapy drugs usually have limited effects on improving the survival of the patients. hTen exploring new therapies is extremely urgent to us. Now, molecular targeted therapy has been the most promising research area for the treatment of NSCLC with researches going deep into pathogenesis and biological behavior of lung cancer. Epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) have achieved a great suc-cess in the treatment of advanced NSCLC. hTeir representatives are erlotinib and geiftinib. hTe two drugs have been widely used to treat advanced NSCLCs worldwide, especially for the patients with EGFR activating mutations. However, atfer a period of treatment (median time is 6 to 12 months), most patients will develop drug resistance to EGFR-TKIs. Intense research in these NSCLCs has identiifed two major mechanisms of resistance to TKIs:primary and acquired resistances. hTe research about resistance mechanism of NSCLC to EGFR-TKIs is a hot one because of their excellent effects on improving overall and progression-free survival. hTe aim of this article was to summarize the development of the resistance mechanisms.

Background and objective Small cell lung cancer (SCLC) is the most malignant neuroendocrine tu-mor and sensitive to chemotherapy and radiotherapy. However, most patients who receive ifrst-line chemotherapy will relapse within one to two years. Once recurrent, it indicates poor prognosis. Currently, the standard ifrst-line chemotherapy regimen of extensive-stage SCLC is platinum combined etoposide regimen while the standard second-line chemotherapy regimen is open to debate. hTe aim of this study is to analysis the prognostic factors of second-line chemotherapy in extensive-stage SCLC and to compare the differences of objective response rate, side effects and survival among different second-line chemotherapy regimens. Methods 181 patients who were diagnosed as extensive-stage SCLC and received second-line chemotherapy were collected.χ2 test was used to analysis the differences of enumeration data and between different groups. Kaplan-Meier method was used to calculate the overall survival (OS) and progression-free survival (PFS). Univariate analysis and Cox regression analysis were used to detect the prognostic factors. Objective response rate was evaluated by RECIST criteria and side effects were evaluated by WHO criteria. Results hTe patients who received second-line chemotherapy can be divided into 6 groups, namly group A (CE/EP regimen) 27 cases, group B (regimens containing TPT) 44 cases, group C (regimens containing CPT-11) 33 cases, group D (regimens containing TAX/DXL) 20 cases, group E (regimens containing IFO) 28 cases and group F (other regimens) 29 cases. hTe median OS in second-line chemotherapy as 7.0 months and was relevant with smoking his-tory (P=0.004), ECOG PS (P<0.001), liver metastasis (P=0.019) and bone metastasis (P=0.028) independently. hTe median PFS in second-line chemotherapy as 3.0 months and was relevant with smoking history (P=0.034), ECOG PS (P=0.011) and bone metastasis (P=0.005). hTe response rate among six regimens was signiifcantly different (P=0.017);hTere was not statistical signiifcance between each group. As to side effects, the incidence of gastrointestinal reaction in group C was higher than any other group. hTe differences of OS and PFS between six regimens in second-line therapy were not statistically differ-ent (P=0.914, P=0.293). Conclusion hTe most signiifcant prognostic factor of extensive-stage small cell lung cancer patients who received second-line chemotherapy was ECOG PS. hTe most optimal second-line chemotherapy regimen with deifnite curatice effect was controversial.

Background and objective At present, surgery is advocated for stage IIIa non-small cell lung cancer (NSCLC), and the survival of them is determined by many factors. hTe aim of this study is to analyze the inlfuencing factors of prognosis for stage IIIa surgical patients. Methods Between March 2002 and October 2012, 151 surgical cases that have postoperative pathological ifnding of stage IIIa NSCLC with completed followed-up data were received in the Peking Union Medical College Hospital. According to different N stages, 151 patients were divided into T4N0/T3-4N1M0 and T1-3N2M0 stages. Kaplan-Meier survival method was used to calculate the overall survival (OS) and progression-free survival (PFS), and to proceed univariate analysis of survival. Cox regression analysis was used to conduct multivariate analysis. A p-value less than 0.05 was evaluated as statistically signiifcant. Results 151 stage IIIa NSCLC patients had 43 stage T4N0/T3-4N1M0 cases and 108 stage T1-3N2M0 cases. hTe median OS and PFS of the whole group were 38.9 and 12.9 months respectively. hTe median OS of stage T4N0/T3-4N1M0 and T1-3N2M0 were 48.7 and 38.9 months. hTe median PFS of them were 14.9 and 19.8 months respectively. hTere were no signiifcant differences of OS and PFS between two groups. Univariate and multivari-ate analysis indicated that postoperative chemotherapy had a signiifcant inlfuence on OS of the surgical patients with stage IIIa NSCLC (P=0.001), and family history of tumor had a signiifcant inlfuence on PFS (P<0.05). hTe maximum diameter of tumor had a signiifcant inlfuence on PFS only in univariate analysis. Conclusion For stage IIIa NSCLC, postoperative chemotherapy can increase OS and PFS, but postoperative radiotherapy have no beneift on them.

Background and objective Nowadays, comprehensive treatment, including surgery, chemotherapy and radiotherapy is advocated for stage III non-small cell lung cancer (NSCLC). However, many researchers have questioned the effectiveness of surgery. The aim of this study is to evaluate the effect of surgery for stage III NSCLC. Methods Between March 2002 and October 2012, 310 cases that have completed followed-up data with stage III NSCLC were received in the Peking Union Medical College Hospital. They were divided into surgical and non-surgical groups according to whether received surgery when diagnosed. In TNM staging, stage III NSCLC includes stage IIIa and IIIb, and stage IIIa NSCLC can be grouped into stage T4N0/T3-4N1M0 and T1-3N2M0 according to different N stages. Analyzed the enumeration data by Chi-Square test. Kaplan-Meier survival method was used to calculate the overall survival (OS) and progression-free survival (PFS), and to draw the survival curves. AP value less than 0.05 was evaluated as statistically significant. Results Three hundred and ten stage III NSCLC patients include surgical group 189 cases and non-surgical group 121 cases. One hundred and eighty-eight stage IIIa NSCLC patients include surgical group 152 cases and non-surgical group 36 cases. In stage IIIa, stage T4N0/T3-4N1M0 had 57 patients with 44 surgical and 13 non-surgical patients, and stage T1-3N2M0 had 131 patients with 108 surgical and 23 non-surgical patients. Thirty-seven out of 121 stage IIIb NSCLC patients received surgery. They had 22 stage T4N2M0 cases and 15 stage T1-4N3M0 cases. The patient whose performance status was 0 and staging was stage IIIa was more inclined to undergo surgery. For stage IIIa NSCLC patients, the median OS of surgical and non-surgical groups were 38.9 and 21.8 months, and the median PFS of them were 19.2 and 11.9 months respectively. The difference of OS between the two groups was significant (P=0.041), but the PFS of them had no significant difference (P=0.209). For stage T4N0/T3-4N1M0 which belongs to stage IIIa, the median OS of surgical and non-surgical groups were 48.7 and 20.1 months, and the median PFS of them were 14.6 and 10.5 months respectively. There were no significant differences of OS and PFS between the two groups (P>0.05). For stage T1-3N2M0 which also belongs to stage IIIa, the median OS of surgical and non-surgical groups were 38.9 and 30.8 months, and the median PFS of them were 19.8 and 12.7 months respectively. There were also no significant differences of OS and PFS between the two groups (P>0.05). The maximum diameter of tumor and auxillary chemotherapy had significant influences on OS and PFS of stage IIIa-N2 NSCLC patients, while the histology of tumor only influenced the OS of them (P<0.05). Conclusion The patient whose performance status is 0 and staging is stage IIIa is more inclined to undergo surgery. Surgery can prolong OS of patients with stage IIIa, especially for stage T4N0/T3-4N1M0. However, it has no benefit on PFS. The maximum diameter of tumor and auxillary chemotherapy have significant influences on OS and PFS of stage IIIa-N2 NSCLC patients, while the histology of tumor only influence the OS of them.

Background and objective Small cell lung cancer (SCLC) is the most malignant neuroendocrine tumor but highly sensitive to chemotherapy and radiotherapy. At present, the standard ifrst-line chemotherapy regimen of extensive-stage SCLC is platinum combined etoposide regimen. However, most patients who receive ifrst-line chemotherapy will relapse within one to two years. Once recurrent, it indicates poor prognosis. In this study, we analyzed the survival among all extensive-stage SCLC and patients who received ifrst-line chemotherapy and determined prognostic factors. Methods Total of 394 patients who were diagnosed as extensive-stage small cell lung cancer from February 2001to December 2011hospitalized in Peking Union Medical College Hospital were collected. Kaplan-Meier method was used to calculate the overall survival (OS) and progression-free survival (PFS). Univariate analysis and Cox regression analysis were used to detect the inlfuence factors of survival. Results hTe median OS of all extensive-stage small cell lung cancer was14.8 months;1-year, 2-year and 5-year survival rates were 58.9%, 27.2%and 7.8%, respectively. According to the results of univariate and Cox multivariate analysis, OS of extensive-stage SCLC was closely associated with age (P=0.006), ECOG PS (P=0.021), liver metastasis (P<0.001), bone metastasis (P<0.001) and chemotherapy (P<0.001). hTe mortality risk of patients who didn’t receive chemotherapy was 4.919 times higher than that who received;the mortality risk of patients without liver, bone metastasis was reduced by approximately 50 percent. hTe ifrst-line chemotherapy was mainly EP (DDP+VP-16) or CE (CBP+VP-16) regimens (accounting for 82.8%) with 4-6 cycles. hTe median OS and PFS in ifrst-line chemotherapy were15.1months and 7.5 months, respectively. hTe result of Cox regression analysis indicated that OS in ifrst-line chemotherapy was remarkably related to smoking history (P=0.041), liver metastasis (P<0.001), bone metastasis (P<0.001), chemotherapy cycle number (P<0.001);PFS was relevant with smoking history (P=0.003), liver metastasis (P=0.001), bone metastasis (P<0.001), chemotherapy cycle number (P<0.001). hToracic radiotherapy was not an independent inlfuence factor of OS and PFS in extensive-stage small cell lung cancer. Con-clusion hTe patients who were younger than 60-year old, with good KPS, absence of liver and bone metastasis had better prognosis. Patients should receive chemotherapy with ifrst-line standard regimen (CE/EP regimen). It was beneifcial to sur-vival if the effect of ifrst-line chemotherapy was SD or PR-CR and the proper chemotherapy cycle number was 4-6 cycles. hTe role of thoracic radiotherapy in extensive-stage small cell lung cancer needed to be investigated further.

Objective To discuss the correlation between the nurse′s humanistic care quality and the core competence of the low seniority nurses.Methods A total of 262 low seniority (work ≤3 years)registered nurses were selected from our hospital and completed the general information scale,nurse′s humanistic care quality scale and nurse′s core competence scale.Results The total score of humanistic caring quality of nurses was (1 1 0.41 ±1 1 .1 1 ).The total score of nurse′s core ability was (1 49.1 6 ±31 .08).Their total score and attributes were in the positive correlation (r =0.1 22-0.393,P <0.05).Conclusions Nurse′s humanistic care quality has the obvious correlation with the nurse′s core competence.When the hospital managers build up the humanistic care quality in the low seniority of nurses,it should carry on the care education,clear the care practicing and the standard of manage,improve the total level of the nurse′s humanistic care quality,training and develop the nurse′s core competence constantly in order to promote the total level nursing work.