Objective:To evaluate the clinical efficacy and safety of repaglinide and gliclazide in the treatment of elderly type 2 di-abetes mellitus (T2DM). Methods:A total of 225 T2DM patients with the age over 60 were enrolled and randomly divided into repa-glinide group (n=112) and gliclazide group (n=113). The repaglinide group was given repaglinide 0. 5~2 mg, po, tid, while the gliclazide group was given gliclazide modified release tablets 30~120 mg, po, qd,both with the treatment course of 12 weeks. The level of FPG, 2h PG, HbAlC, TC and TG and the side effects were observed and the clinical efficacy was compared between the two groups. Results:The level of FPG, 2h PG, HbAlc and TC in the two groups showed significant decrease after the treatment (P<0. 01 or P<0. 05), and the level of 2h PG was decreased more significantly in the repaglinide group (P<0. 05). There were no significant differ-ences in the total effective rate (91. 8% vs 86. 2%), hypoglycemia incidence (4. 5% vs 8. 2%) and ADR incidence (6. 4% vs 10. 1%) in the two groups (P>0. 05). Conclusion:Both repaglinide and gliclazide show safe and reliable efficacy in the treatment of elderly T2DM.

Objective To investigate characteristics of deceleration capacity (DC) and Tp-e/QT value in different age groups of patients with diabetic autonomic neuropathy, and to analyze their influencing factors. Methods A total of 487 subjects were enrolled in this study, and divided into three groups:patients with diabetic autonomic neuropathy (DM+CAN group,n=287), normal glucose tolerance patients with diabetic autonomic neuropathy (CAN group,n=130) and healthy controls (NC group,n=150).Then the DM+CAN group were further divided into three subgroups according to age tertiles:the lowest tertile group (35.0~47.2 years old,n=91),the middle tertile group (47.3~59.6 years old,n=116)and the highest tertile group (59.7~72.0 years old,n=80).All subjects were underwent 24-hour dynamic electrocardiogram recordings.DC and Tp-e/QT values were calculated,and then the correlation between DC and Tp-e/QT with other indicators was analyzed. Results The levels of WC,SBP,BMI,FPG,HbA1c,FIns and HOMA-IR were higher in DM+CAN group than in CAN group and in NC group (P<0.05 or P<0.01).DC increased and Tp-e/QT decreased from DM+CAN group,CAN group to NC group,and the pairwise comparisons were statistically significant (P<0.05 or P<0.01).DM duration,WC,FPG,FIns,HbA1c,HOMA-IR,hypertension and CHD ratio were higher in the highest tertile group and middle tertile group than in the lowest tertile group (P<0.05 or P<0.01).DM duration and FIns were higher in the highest tertile group than in middle tertile group (P<0.05 or P<0.01).RHR and AHR were lower in the highest tertile group than in the lowest tertile group (P<0.05),and there were no statistical significant difference between the middle tertile group and the lowest tertile group (P>0.05).DC increased [(2.90±0.47) vs (4.22±0.41) vs (4.97±0.35) ms],and the Tp-e/QT decreased [(0.23±0.05) vs (0.18±0.03) vs (0.12±0.02)] from the highest tertile group to the lowest tertile group,(P<0.05 or P<0.01),and the pairwise comparisons were statistically significant (P<0.05 or P<0.01).Multiple stepwise regression analysis showed that age,DM duration,WC,FPG,HbA1c,complicated with hypertension and coronary heart disease (CHD) were risk factors for DC and Tp-e/QT values (P<0.05). Conclusion Together with the increased age,DC level is reduced and Tp-e/QT value increased in patients with diabetic autonomic neuropathy.Dynamic electrocardiogram should be considered in patients with advanced age,long DM duration,high level of WC,FPG,HbA1c,and complicated with hypertension and CHD,in order to prevent the occurrence of cardiovascular events effectively.

BACKGROUND:Clinicaly, patients with constipation often have depression and depression is often associated with symptoms of constipation, but the mechanisms remain unclear. OBJECTIVE:To observe the relation between constipation and depression by establishing animal models. METHODS:A total of 60 specific-pathogen-free rats were divided randomly into three groups: normal group, chronic stress-induced depression model group and slow transit constipation model group. Slow transit constipation model was created by giving the solution of compound diphenoxlate 8 mg/kg daily, for 120 consecutive days. On day 100, chronic stress model rats were subjected to successive unforeseen stimulus for 21 days. Rats in the normal group were regularly housed. Fecal number, dry weight of feces and body weight were recorded once a week. After successful model establishment, fecal number, dry weight of feces, time of first dark stools defecation, sucrose preference, open-field behavior score and forced swim time were detected in each group, and statisticaly analyzed. RESULTS AND CONCLUSION:Fecal number was less in the chronic stress-induced depression model group than in the normal group (P = 0.00), and time of first dark stools defecation was longer (P = 0.00). Fecal number was more in the chronic stress-induced depression model group than in the slow transit constipation model group (P = 0.00), but time of first dark stools defecation was shorter (P = 0.00). No significant difference in fluid consumption, sucrose preference, horizontal and vertical scores of open-field test, and forced swim time was detected between slow transit constipation model group and normal group (P > 0.05). However, above indexes were higher in the slow transit constipation model group than in the chronic stress-induced depression model group (P < 0.01). Results verified that constipation was observed in chronic stress-induced rat model, but depression was not observed in slow transit constipation rat model, suggesting that depression can induce constipation, but constipation does not necessarily lead to depression.

Objective To study the relationship between serum hepatitis B virus covalently closed circle DNA (HBV cccDNA) as well as liver function and liver tissue pathological changes in children with chronic hepatitis B.Methods One hundred and twenty-four HBV-DNA positive children with hepatitis B were enrolled.Among 124 patients,65 cases were HBV carriers,59 cases were chronic hepatitis (mild in 31 cases,moderate in 18 cases and severe in 10 cases).HBV cccDNA in serum and liver function were detected,46 of which underwent liver biopsy and liver tissue inflammation and fibrosis grading classification was made.Results In moderate and severe cases,positive rates of serum HBV cccDNA (77.8％,100％) were higher than those of the HBV carriers and mild cases (32.3％,54.8％) (x2 =25.429,P ＜ 0.01),indicating more severe illness in children,detection rate of serum HBV cccDNA was higher.ALT,AST,and TBIL were higher in serum HBV cccDNA positive group than those of negative group[(95.6 ± 18.2) U/L vs (52.5 ± 17.7) U/L,(88.8 ±20.3) U/L vs (48.4 ±21.4) U/L,(68.4 ±24.6) μmol/L vs (28.3 ± 23.9) μmol/L](t =15.572,10.750,17.067,P ＜ 0.01).Serum HBV cccDNA and liver inflammatory activity and fibrosis showed no significant correlationship.Conclusion Serum HBV cccDNA is a sensitive indicator of viral replication,the more severe the disease situation,the peripheral HBV cccDNA detection rate is higher.But it is not entirely consistent with liver inflammation and fibrosis,so it can not completely reflect the degree of liver damage.

The systematic approaches of metabonomics are similar to the essential attribution in concept of the wholism for traditional Chinese medicine (TCM) theories. The metabonomics had been progressively utilized to study the TCM theories, such as "ZHENG" (synelromes), or the systematic mechanism of Chinese materia medica (CMM) and its formulae by animal models, and toxicology in recent years. These studies almost focused on the responeses of endogenous metabonome to biological stimuli or genetic manipulation (pharmacodynamics and toxicology) by TCM theory of "ZHENG", while less involved the precess of formulae itself and its dynamic changes (pharmacokinetics) by TCM theory of "FANG". The "treatment by differentiating syndrome" and "Correspondence of FANG-ZHANG" is the quintessence of TCM theories. Consequently, in this idea, the application of PK-PD methods based on metabonomics and "FANG-ZHENG correspondence" to investigating the compatibility of the formulae in TCM theory is discussed in this paper.

Objective To determine the levels of anti-Toxoplasma gondii antibody (ATAb) and antisperm antibody (AsAb) in serum samples and interferon-?(IFN-?) in supernatants of peripheral blood cell culture in females with infertility, and to analyze their correlation. Methods ELISA was applied to determine and compare the ATAb and AsAb in serum samples of 182 women with infertility and those of 94 women with normal pregnant history. The level of IFN-? in supernatants of peripheral blood cell culture was also measured and compared by ELISA. Results The positive rates of serum ATAb and AsAb in the cases of infertility were 15.38% and 18.13% respectively, which were significantly higher than those of women with normal pregnant history( 6.38% and 5.32%). The supernatant IFN-? level in infertile women was significantly higher than that of women with normal pregnant history (0.970?0.493) ?g/L vs (0.531?0.274) ?g/L(P

Objective: To investigate the mechanism of Glytan lowering portal pressure induced by biliary liver fibrosis. Methods: SD male rats, 240-260g weight around, were randomly divided into sham-operation group, model group, propranolol group, Glytan high-dose, middle-dose and low-dose group according to the weight. Portal hypertension was induced by common bile duct ligation in rats. After two and four weeks, measured the portal pressure(PP) of each group, observed the histological changes of liver by HE staining, tested liver function and the concentration of endothelin-1 in systemic circulation and mesenteric circulation radioimmnuoassay. Results: After two and four weeks, portal pressure of model group rats increased significantly. Both Glytan and propranolol can decrease PP after two and four weeks, and the pressure-relief effect was similar between the two drugs. HE staining showed that Glytan can significantly inhibit the formation of collagen, promote the recovery of liver tissue structure; liver function indicated a significant decrease in serum AST, ALT, TBIL and Na+ concentration. In addition, Glytan decreased the concentration of endothelin -1 in systemic circulation, increased it in mesenteric circulation after two weeks. Conclusion: Glytan decrease PP by improving liver function and microcirculation, inhibiting collagen formation and water-sodium retention after long-term therapy, ameliorating hyperdynamic circulation at the early stage.

Objective To survey the current situation of teaching for general practitioners (GPs) in community health centers of Shanghai.Methods A questionnaire survey on the teaching situation was conducted among 742 GP mentors who attended a municipal training workshop during July to October 2012 in Shanghai.The items of the survey included general background,previous teaching experience and self-evaluation on teaching ability.Results Among 742 GP mentors receiving the survey,the average age was (37 ± 6) years old.49.8％ (366/734) of mentors expressed their willingness of teaching,and the main reason was that it may upgrade themselves,while learning from teaching (58.6％,419/715).Heavy work load,lack of teaching time (31.8％,378/1 187) and teaching experience (30.7％,364/1 187) were the main obstacles for teaching.Among 106 GP mentors who had teaching experience in community health center previously,79.2％ (80/101) made teaching plans,but only 8.9％ (9/102) often prepared syllabus.Teaching plans were made mainly according to the work needs in community health care (54.2％,52/96),the situation and demands students (29.1％,28/96) or requirement of syllabus (17.7％,17/96).The problems included lack of teaching experience (50.5 ％,50/99) and time (42.4％,42/99),monotonous instructional modality (24.1％,25/104),and weak operability of the syllabus (21.2％).The self-reported results showed that 14.4％ were not able to develop a teaching program and to execute,18.3％ were not able to use a variety of teaching methods,31.2％ were not able to engage in teaching for 1.5 days per week.Logistic regression analysis showed that mentors with higher education background (OR =2.027,P ＜ 0.05),community teaching experience (OR =3.069,P ＜ 0.05),higher self assessment of general personal quality and communication ability (OR =2.488,P ＜ 0.05),higher teaching ability (OR =2.399,P ＜ 0.05) and strong training wishes (OR =11.382,P ＜ 0.05) were more willing to engage in the teaching work.Conclusions Heavy work load,insufficiency of teaching capacity and experience are main problems for GP mentors in Shanghai community health centers.Educational theory and methods should be focus on teacher training so as to improve teaching abilities.

Objective To investigate the clinical significance of NaviCam magnetic-controlled capsule endoscopy (NMCE) system in the examination of upper gastrointestinal tract.Methods A total of 39 healthy volunteers were enrolled in the present study.NMCE system was used to examine upper gastrointestinal tract.The safety,gastric preparation,visualization and comfort of the subjects were evaluated.Results Visualization of the Z-line,gastric cardia,fundus,body,angulus,antrum and pylorus was subjectively assessed as more than 75％ mucosa in 19 (48.71％),37 (94.87％),25 (64.10％),30 (76.92％),39 (100.00％),39 (100.00％),and 39 (100.00％),respectively.The observation time was 1.5,3.0,8.0,17.0,3.0,3.0,5.0 min respectively.The capsule was driven into duodenum positively in 25 (64.10％).Seven subjects went into small bowel without control.The one-time visualization efficacy was 97.43％ (38/39).Only one subject felt foreign body sensation.All subjects extracted the capsule within 7 days.Conclusion Our study provides a preliminary assessment of the NMCE on its feasibility and safety.It is comfortable with no chance of cross-infection.NMCE system is a useful tool for upper GI examination and will have a good future.

Objective To explore the role of CD4+CD25+CD127low/-regulatory T cells (Tregs) in the pathogenesis of psoriasis vulgaris(PV). Methods Flow cytometry analysis was used to detect the amount of Tregs in peripheral blood and ELISA to test the levels of IL-10 and TGF-β1 in blood serum; the suppressive function of Tregs on autologous CD4+CD25-T cells was determined by MTT method. Results No significant difference was found in the proportion of Tregs in PV patients and healthy controls(P>0.05). There was a diminished suppression of Tregs from patients on autologous CD4+CD25- responder T cell proliferation in PV patients when compared with that in controls (P < 0.01). The serum level of IL-10 in patients was lower than that in controls (P < 0.01) while that of TGF-β1 in PV patients was significantly higher than that in controls(P < 0.01). Conclusion Abnormal function of Tregs and low secretion of IL-10 in PV patients might be related to the pathogenesis of psoriasis.