[Summary] Sodium glucose cotransporter 2 (SGLT2) inhibitors have been developed as a new antidiabetic agent .The antihyperglycemic effect of SGLT 2 inhibitors is independent of insulin secretion and insulin action .SGLT2 inhibitors improve IS and islet βcell function with the possible mechanisms of reducing glucotoxicity ,weight loss and increasing GLP‐1 response .

Objective:Based on the unreasonable structure,fragmentization and insufficient resources of medical and health service system in China,the literature review was conducted on the analysis of integrated medical and health service system.Methods:It sorted out and analyzed the existing related literature in the academic field.Results:The integrated health system was developed by their elements and methods,which lacked the evaluation and analysis on the responsibility among different stake holders and effects after the integration.Conclusion:Further research should be developed into the implementation of dual referral based on integrated health system;the responsibility relationship among different stakeholders in the integration progress,the integration and optimization of medical and health service system under the background of Internet+,etc.

Objective To know the effect of low level exposure of toluene on conditioned place preference (CPP) in rats. Methods 60 SD rats were randomly divided into 6 groups, 10 in each. 4 groups were treated respectively with toluene by inspiration of 328.6, 1 026.8mg/m3, OB-impaired+toluene 328.6 mg/m3, OB-impaired+1 026.8 mg/m3 in a closed chambers for 4 weeks (5 days/week, 6 hours/day) and 2 groups were taken as the control, OB-impaired control, blank control. The addiction and the generating electricity of the OB were examined by CCP chamber and the system of PowerLab. Results Compared with the blank group, in the toluene 328.6 and 1 026.8 mg/m3 groups the time in the light chamber was longer (P

Background Phacoemulsification for hard nuclear cataract is easy to cause corneal edema and posterior capsular rupture.Researches determined that soft-shell technique phacoemulsification can effectively reduce corneal edema,but the risk of posterior capsular rupture during the surgery is still existed.Whether intra-capsular bag soft-shell technique can protect the posterior capsular of lens from rupture is still unclear.Objective This study was to observe the effect of intra-capsular bag soft-shell technique phacoemulsification on hard nuclear cataract.Methods A prospective cohort study was designed.One hundred and sixty-eight eyes of 160 patients with age-related cataract and Ⅳ-Ⅴ grade of nucleus were enrolled in Affiliated Second Hospital of Zhengzhou University from November 2013 to May 2015 under the approval of Ethic Commission and informed consent of the patients.The eyes were randomized into the intra-capsular soft-shell technique group and conventional soft-shell technique group with the matched age,gender and nuclear hardness in a manner of randomized block design.A 3.0 mm incision of cataract phacoemulsification with soft-shell technique in capsular bag was performed on 80 eyes of 78 patients in the intracapsular soft-shell technique group,and conventional soft-shell technique phacoemulsification was performed on 88 eyes of 82 patients in the conventional soft-shell technique group.Intraoperative records including the cumulative dissipated energy,effective phacoemulsification time and posterior capsular changes were recorded during the surgery.Postoperative follow-up indexes included corneal edema,endothelial cell density,BCVA and intraocular pressure changes.Results The mean cumulative dissipated energy and operation duration were (20.13 ± 8.34) ％ and (14.28-±2.17) minutes in the intra-capsular soft-shell technique group,and those in the conventional soft-shell technique group were (19.67±5.24)％ and (15.36±3.49) minutes,showing significant differences between them (t =0.216,P =0.376;t =0.403,P-=0.518).Posterior capsular rupture occurred in 1 eye in the intra-capsular softshell technique group and 7 eyes in the conventional soft-shell technique group.The percentages of eyes with BCVA ≥ 0.5 were 78％,83％ and 92％ in postoperative 1 day,1 week and 1 month in the intra-capsular soft-shell technique group,and those in the conventional soft-shell technique group were 56％,71％ and 89％,with a significant increase in postoperative 1 day,1 week in the intra-capsular soft-shell technique group (x2 =5.130,P =0.027;x2 =4.361,P =0.032).The corneal endothelial cell loss rates were 6.97％ and 7.19％ in the intra-capsular soft-shell technique group and conventional soft-shell technique group respectively in postoperative 3 months,with no significant difference between them (P＞0.05).The intraocular pressure was (20.16±4.23) mmHg (1 mmHg =0.133 kPa) in postoperative 1 day in the intra-capsular soft-shell technique group,which was significantly higher than (17.38± 5.21) mmHg in the conventional soft-shell technique group (t =1.241,P =0.037).Conclusions Intra-capsular bag soft-shell technique phacoemulsification for hard nuclear cataract can decrease the intraoperative and postoperative complications and quicken the visual recovery after surgery.

Objective To investigate the status of structural empowerment,job stress and burnout,and to explore the relationship aunong them.Methods The questionnaires of CWEQ-Ⅱ,job stressors and MBI were used to investigate 350 nurses working at tertiary-level hospitals.Results The average score of CWEQ-Ⅱ was (2.23±0.59),the score of EE of MBI was (29.75±13.94),PA was (27.40±11.21),both of them showed a high level of exhaustion,DP was (8.07±5.82),which showed a middle level of exhaustion.The findings showed that workload and time pressure were the most frequently encountered job stressor among staff nurses,the score was (3.23±0.95).There was a significant correlation among structural empowerment,job stressors and the level of burnout.Hierarchical regression analysis and structural equation modeling showed that structural empowerment had significant influence on every factor of job stressors and burnout,job stressors had significant influence on the every factors of burnout.Conciusins It is suggested to pay attention to the main job stressors,and take proper interventions to enhance nurses' structural empowerment to prevent burnout,and thereby to raise the quality of care.

Purpose To investigate the clinical and morphological features as well as immunophenotype of pleomorphic lobular carcino-ma ( PLC) . Methods Seven cases of PLC were retrieved from 34 cases of invasive lobular carcinoma. The clinical data, histologic features, immunohistochemical findings were analyzed. Results The mean age of the patients was 56. 6 years, with a range of 47 to 74 years. PLC might be nodular mass in general macroscopy. Histologically, PLC retained classical or non-classical single cells, but exhibited a greater degree of cellular atypia and pleomorphism and a higher mitotic rate than classic invasive lobular carcinoma ( ILC) . PLC was accompanied by ductal carcinoma in situ ( DCIS) and pleomorphic lobular carcinoma in situ ( PLCIS) . Immunohistochemistry and HER-2 FISH were detected. PLC showed E-cadherin negative (7/7) and p120 cytoplasmic positive (7/7), ER (5/7), PR (5/7), and HER-2 (7/7) mostly negative. 5 cases were characterized by triple negative breast cancer, two of which are basal-like pheno-type. Some cases could be observed nerve invasion (3/7) and axillary lymph node metastasis (4/7). Conclusion PLC is a very rare subtype of invasive lobular carcinoma. In some cases there are nerve invasion and lymph node metastasis. The diagnosis of PLC de-pends on the pathological morphological and immunohistochemical markers.

To study the transport mechanisms of drugs for transplacental treatment of fetal tachyarrhythmia, MDCKII-BCRP and MDCKII cell models was used. MDCKII-BCRP and MDCKII cell monolayer model was used to investigate the bi-direction transport of sotalol, propranolol, propafenone, procainamide and flecainide. Drug concentrations were measured by HPLC-UV or chemiluminescence. The apparent permeability coefficient (P(app)), efflux rate (R(E)) and net efflux rate (R(net)) were calculated. Drugs with R(net) greater than 1.5 were further investigated using cellular accumulation experiments with or without a BCRP inhibitor. The R(net) of sotalol, propranolol, propafenone and procainamide were less than 1.5, while R(net) of flecainide with concentrations of 20 and 5 μmol x L(-1) were 1.6 and 1.9, respectively. The results showed that the transport of flecainide on MDCKII-BCRP cell monolayer could be mediated by BCRP; and the affinity increased when the concentration of flecainide decreased. Cellular accumulation experiments further suggested that accumulation of flecainide in MDCKII-BCRP cells was significantly lower than that in MDCKII cells in a concentration-dependent manner. BCRP inhibitor quercetin (50 μmol x L(-1)) significantly increased the accumulation of flecainide in MDCKII-BCRP cells (P < 0.05). Our preliminary data showed that flecainide but not sotalol, propranolol, propafenone or procainamide can be a substrate of BCRP. Thus the effect of flecainide may be affected by the BCRP in the maternal placental trophoblast membrane layer when treating fetal tachyarrhythmia.

Objective To study the effect of the treatment of epiglottis cyst by Nd:YAG laser combined with clamp under electronic laryngoscope. Methods Under superficial anesthesia, ninety cases of epiglottis cyst complicated with a series of pharyngeal clinical symptoms which were treated by Nd:YAG laser combined with clamp guided under electronic laryngoscope. Results Eight patients were not reexamined, and the rest 82 patients were followed up after one month, the body sensation and laryngeal obstruction disappeared or relieved signiifcantly. After further conifrmation by laryngoscope, the cysts of 79 cases were disappeared, and 3 cases were considered residual, the cysts was clamped out and treated by biopsy forceps Laser, further checked after 2 months by laryngoscope, the cysts disappeared! 100%recovered. Conclusion Treatment of epiglottis cyst by Nd:YAG laser combined with clamp under electronic laryngoscope has many advantages such as clear vision, accurate positioning, less hemorrhage, less postoperative complications, less recurrence rate and less pain. Treatment is effective and worthy of clinical promotion.

ObjectiveTo design a weight-bearing pressure casting system for transtibial prostheses to make the total surface bearing socket and to control the stump and bearing during the casting process.MethodsThe weight-bearing pressure casting system was designed. 6 cases weared the socket by this method and traditional patellar tendon bearing socket by hand casting. Socket interface pressure was compared, and the effect of casting was assessed.ResultsCompared with patellar tendon bearing socket, the socket pressure in the socked by this method was distributed more equally throughout the transtibial residual limb during the casting process, and completed the stumps compression and stump-end pressure control.ConclusionWeight-bearing pressure casting system can make the total surface bearing socket, and improve the fit of the socket.

10.3969/j.issn.2095-4344.2013.24.011