[Summary] Poorly controlled hyperglycemia is closely associated with adverse outcomes during pregnancy. As the prevalence of diabetes rapidly increases ,the management of diabetes during pregnancy has been a significant and urgent need in clinical practice. This article reviewed the hot spots in the research field of gestational diabetes mellitus (GDM ) and pregnancy with diabetes mellitus ,including progresses on the risk factors for GDM and the long term effects of diabetes during pregnancy on mothers and offspring. This was followed by a body of evidences on the clinical benefits of improved glycemic control during pregnancy ,current therapeutic strategy using insulin as the golden standard as well as the potential advantage of insulin determir due to its unique pharmacokinetic‐pharmacodynamic (PK‐PD ) profile in this therapeutic area. Finally ,the authors summarized data from clinical trials on the usage of insulin detemir in pregnancy and in particular went over the designs and results of two randomly controlled trials investigating the efficacy and safety of insulin detemir in pregnancy patients with T1DM. Currently available data proved that insulin detemir was effective in improving glycemic control with a good safety profile in diabetic pregnant patients ,which may serve as an ideal choice in the management of diabetes during pregnancy.

Objective To investigate the diagnostic value of adrenal tumors by MRI.Methods The MRI features of adrenal tumors proved pathologically in 26 patients were reviewed,and were comparatively studied with the results of operation and pathology.All patients received pre-and post-contrast MRI scans,the morphology,size,margin,signal intensity and enhancement pattern of the lesion were observed.Results Of 26 adrenal tumors,8 were pheochromocytoma which were encapsulated mass with long T 1 heterogeneous T 2 signal and heterogeneous enhancement,the characteristic manifestations were prominent high signal on T 2WI,heterogeneous signals were showed in haemorrhagia,necrosis,cystic formation.5 cases were metastatic tumors from pulmonary cancers,the shape and signal of tumons were regular or irregular.6 cases were adenomas which were showed as round mass with distinct margin and iso-signal without necrosis and cystic formation.Adenocarcinoma was seen in 4 cases and was manifested as irregular long T 1 heterogeneous T 2 signal and heterogeneous enhancement, the surrounding tissues and blood vessel were involved. Myelolipoma was found in 3 cases and presented as short T 1 and short T 2 signal intensity.Conclusion MRI is valuable in diagnosis and differentiated diagnosis of adrenal tumors, and is important in the delineation of tumor extent and surgical planning.

Objective:To analyze the postoperative recurrentive factors of oral squamous cell carcinoma.Methods: 673 patients of primary oral squamous cell carcinoma were involved. The focus location, growth type, T stage, lymphonodus metastasis, treatment, pathological grading and resection mode of mandible were evaluated to determine the prognosis of patients.Results:The postoperative recurrence rate was relevant to the focus location, growth type, T stage, lymphonodus metastasis and pathological grading, while the treatment and resection mode of mandible had no effects on the recurrence rate. Conclusion: It's of great importance to estimate all kinds of clinicopathologic factors and perform preventive treatments during the clinical work to promote the operative cure rate and survival rate of patients with oral squamous cell carcinoma.

Objective To investigate the clinical features and treatment programs in children with Takayasu arteritis (TA) in order to improve awareness of the disease. Methods A retrospective study of hospi-talized children with TA in our hospital from Jan. 1999 to Dec. 2012 was performed. Results Between the 15 patients with TA, the ratio of male to female was 1∶2. The onset was from 14 months to 15 years old, with average age at (10 ±4) years old. It is according to (the European League against Rheumatism/the Pediatric Rheumatology European Society (EULAR/PRES) criteria for the diagnosis of TA. The most common clinical manifestations are hypertension, which occurred in 13 cases(87%), weak pulse or pulseless in 11 cases (73%), and heart failure in 10 cases (67%). About two-thirds of patients were diagnosed when the onset of heart failure occurred. The most common clinical type was type Ⅱ, which occrred in 9 cases (60%). Antihypertensive drugs, oral steroid and congestive heart failure controlling were the main treatment. Three patients with positive purifiedproteinderivative (PPD) test received anti-TB treatment. Three patients had vascular bypass surgery, one patient had percutaneous transluminal angioplasty. Conclusion TA may be life-threatening and progressive. Many patients are with advanced disease at the time of treatment, so the prognosis is generally poor. Early recognition is necessary to initiate appropriate therapy. The disease should be considered in patients with unexplained arterial hypertension or unexplained inflammatory syndromes without local signs.

The index weight has very significant role in the performance evaluation system for the public hospitals’ financial governance. This paper employed the analytic hierarchy process associated with the Delphi method to determine the index weight based on the previous studies. The index of maximum weight is non-profit (0. 35), fol-lowed closely by financial responsibility(0. 18), asset performance(0. 18), financial performance and risk (0. 18), and the index of minimum weight is society satisfaction ( 0 . 06 ) . The index weight guidance and the practical index system application were also interpreted in order to really play the significant role during the performance evaluation for the public hospitals’ financial governance.

Objective:Total lesion glycolysis (TLG) on PET scans were calculated using custom-designed software, then we analyzed the prognostic utility of PET for patients with locally advanced pancreatic cancer (LAPC) undergoing radiation therapy.Methods: 33 patients with newly diagnosed LAPC who underwent 18F- FDG PET/CT scan for staging before radiation therapy were retrospectively included in this study. Patients were divided into two different groups by the median value of TLG. TLG lower than 55.3 was A group and TLG higher or equal to 55.3 was B group. TLG of tumor tissue were calculated from PET/CT images with the SUV cut-off value of 2.5. We analyzed the relationship between TLG and other clinical factors and prognosis in patients with pancreatic cancer by Kaplan-Meier method and log-rank test.Results: By Log-rank univariate analysis showed that the differences in group A and group B related significantly (r=7.765,P=0.005). And their middle survival time was 15.5 months and 8 months respectively. GTV dose of the patients in two groups and CA19-9 before treatment were also statistically different (x2=7.162, x2=10.476;P=0.05). Multivariate analysis showed that the TLG (P=0.009) were independent risk factors that prevented the long-term survival of the prognosis of patients in this group.Conclusion: The value of CA19-9 and GTV dose before treatment were the risk factors of radiotherapy for patients with locally advanced pancreatic cancer. The parameters of TLG were independent prognostic factors. TLG have a certain clinical value in predicting the prognosis of patients with pancreatic cancer, and can guide clinical diagnosis and treatment planning, and extend the lifespan of patients with pancreatic cancer.

OBJECTIVE: To discuss how to apply pharmacoeconomic evaluation in guiding drug pricing so as to make the drug pricing more scientific and reasonable. METHODS: The problems that pharmacoeconomic evaluation can solve in drug pricing, i. e. the necessity of the application of pharmacoeconomic evaluation were pointed out, and the costs and profits of drugs were evaluated pharmacoeconomically from the perspective of the whole society. RESULTS & CONCLUSION: Pharmacoeconomic evaluation can be utilized to determine the price ranges of new drugs, guide drug pricing and enhance the rationality of drug pricing.

OBJECTIVE: To summarize lessons of the medicine provision and management learned from the anti-Ebola outbreak mission in Sierra Leone executed by Chinese military medical aid team. METHODS: Summarizing the medicine preparing, shipping, storage and management procedure during the whole task period from 16 Sep, 2014 to 21 Mar, 2015. Anlyzing lessons and knowledge we have learned from the mission. RESULTS: According to the local health system situation and currently outbreak characters, the pharmaceutical group of the Chinese military medical aid team have prepared almost all types and dosages of medicines needed for the whole mission. Through feasible transportation pathway including cold chain, medicines were shipped to destination safely. Classified storage, detailed management and sorting system insured the high quality of the medicine distribution. CONCLUSION: The effective provision and scientific management of the pharmaceutical support of military medical aid team have made a good model for the emergency medical aid action abroad. The experiences we have obtained from this mission may be useful for the future performing of similar major overseas task of Chinese military.

Objective To investigate the relationship between the insertion/deletion(I/D) polymorphism of the angiotensin convcer-(ting) enzyme(ACE) gene and congenital heart disease(CHD) and to quest the predisposing gene of congenital heart disease by analyzing the polymorphism of the ACE gene in patients with CHD.Methods Sixty-eight patients with CHD were served as observing group,sixty-four patients without CHD as control group.We drew DNA of leukocyte from blood by the method of saturation phenol and chloroform and we amplified the ACE gene using the DNA polymerase chain reaction technique.The amplification products were employed electrohoresis in 2% sepharose.the polymorphism of the angiotensin converting enzyme gene was analyzed under ultraviolet lump.Results In the obser-(ving) group,the genotype distribution frequency of the ACE was II in 12(17.65%),DD in 32(47.06%) and ID in 24(35.29%),and in the control group,it was II in 20(31.25%),DD in 10(15.63%) and ID in 34(53.12%).Conclusions The study result clarifies that CHD has close correlation to the polymorphism of the angiotensin converting enzyme gene.The relative risk of DD genotype is higher than that of the others,and DD genotype possibly is the predisposing genotype of CHD D allele perhaps is the susceptibility gene of CHD.

Objective:To find out the problems still existing in the teaching reform through the investigation and research of eight-year program graduates of clinical medicine.Methods:In 2017, 118 questionnaires were issued to Batch 2005-2006 graduates of eight-year program in clinical medicine, and 103 valid questionnaires were retrieved. The questionnaire was based on that of the Fuyi Design of the Education Department in Zhongshan Hospital affiliated to Fudan University. The questionnaire was revised on the basis of the pre-survey and the statistical analysis was carried out on the data using Excel 2010.Results:We found that 60.2% of the graduates were satisfied with the training mode of eight-year program, 69.9% of the graduates gave a satisfactory evaluation on the teaching quality in the teaching hospital, and 63.1% of the graduates believed that the curriculum still need partial adjustment.Conclusion:Based on the finding, medical talent training mode is relatively mature in Batch 2005-2006 eight-year program of clinical medicine. The future medical education reform of the eight-year program should be more embodied in innovating the grafting mode of professional medical degree system, strengthening enrollment publicity, adopting diversified enrollment, strictly controlling procedure, carrying out integrated curriculum reform, enhancing clinical teaching design, at the same time further improving teachers' comprehensive quality, and speeding up the construction of clinical teaching staff.