Objective To investigate the risk factors of type 2 diabetes mellitus(T2DM) in patients with nonalcoholic fatty liver disease (NAFLD) and correlations with carotid atherosclerosis.Methods The clinical data of 51 cases of N AFLD with T2DM (NAFLD with T2DM group),43 cases of NAFLD(NAFLD group) and 45 healthy objects (control group) were collected.The clinical biochemical features,carotid intima-media thickness (IMT) were observed.Results The BMI and smoking rate in NAFLD with T2DM group and NAFLD group were significandy higher than those in control group [(27.25 ±3.16),(26.31 ± 2.63) kg/m2 vs.(23.12 ±3.44) kg/m2,43.1％(22/51),37.2％(16/43) vs.13.3％(6/45)](P＜0.05).The ratio of family history of T2DM in NAFLD with T2DM group was significantly higher than that in NAFLD group and control group[66.7％(34/51)vs.32.6％(14/43),8.9％(4/45)](P ＜ 0.05).Compared with control group,the level of total cholesterol (TC),trigalloyl glycerol (TG),low density lipoprotein cholesterol (LDL-C),alanine transaminase(ALT),aspartic transaminase(AST),IMT in NAFLD with T2DM group and NAFLD group were significantly higher [(5.39 ± 0.85),(5.12 ± 0.77) mmol/L vs.(4.11 ± 0.64) mmol/L,(2.77 ± 1.11),(2.32 + 1.04) mmol/L vs.(1.21 ± 0.52) mmol/L,(2.98 ±0.93),(2.76 +0.78) mmol/L vs.(2.15 ±0.57) mtmol/L,(48.4 ± 18.9),(43.3 ± 16.5) U/L vs.(21.4 ± 13.6) U/L,(46.2 ± 16.7),(42.1 ± 17.5) U/L vs.(20.5 ± 12.6) U/L,(1.95 ±0.93),(1.26±0.51) mmvs.(0.71 ±0.22) mm](P＜ 0.05),while the level of high density lipoprotein cholesterol (HDL-C) was significantly lower [(1.01 ± 0.35),(1.13 + 0.22) mmol/L vs.(1.31 ± 0.26) mmol/L] (P ＜ 0.05).The level of above mentioned index,there were no significant difference between NAFLD with T2DM group and NAFLD group (P ＞ 0.05).The level of fasting blood glucose (FBG),2-hour postprandial blood glucose (2 h PBG),glycosylated hemoglobin (HbA1c),fasting insulin (FINS),2-hour postprandial insulin (2 h PINS) and insulin resistance index of HOMA (HOMA-IR) in NAFLD with T2DM group were significantly higher than those in NAFLD group and control group [(8.15 ± 1.48) mmol/L vs.(5.10 ± 1.32),(5.62 ± 0.88) mmol/L,(13.67 ± 1.59) mmol/L vs.(7.31 ± 1.25),(8.64± 1.35) mmol/L,(7.03 ±0.84)％ vs.(5.16 ±0.72)％,(5.53 ±0.61)％,(13.32 ±4.55) mU/L vs.(6.06 ±3.11),(9.13 ±4.37) mU/L,(106.37 ±21.45) mU/L vs.(33.21 ± 18.87),(46.34 ± 16.39) mU/L,3.88 + 2.14 vs.1.13 ± 0.36,2.23 ± 1.15] (P ＜ 0.05).Carotid IMT,the incidence of carotid plaque and Crouse scores of plaque in NAFLD with T2DM group were significandy higher than those in NAFLD group [(1.95 ±0.93) mm vs.(1.26 ±0.51) mm,64.7％(33/51) vs.30.2％(13/43),(3.11 ±0.57) nn vs.(1.35 ± 0.49) mm] (P ＜ 0.05).The regression analysis showed that family history of T2DM,FBG,2 h PBG,FINS,2 h PINS were independently associated with T2DM.Conclusions Family history of T2DM,FBG,2 h PBG,FINS,2 h PINS are the main risk factors for the onset of T2DM in NAFLD.The risk of carotid atherosclerosis is increased in patients of NAFLD with T2DM.

There were some problems in the seven-year pediatric clinical Teaching of Learning on the job in the past.It is insufficient that the teaching mode and teaching form raised the clinical diathesis and competence of medical students.Aimed at these problems,countermeasures are proposed from the following aspects.First of all,let the students learn how to be on good behaviour.Using"students'simulation diagnose and treatment method" enables the students to assimilate the knowledge learned by themselves,use the evidence based medicine(EBM)to give directions to paediatric clinical practice,so as to make the clinical medicine change from the experience type to the science type.

Objective To learn the change of causes sequences, the pattern and dynamic trend of causes of death for the inhabitants in Jiaxing from 2009 to 2014, and to provide a major reference for health decisions and disease control and prevention. Method This study was based on chronic disease surveillance information management data in Zhejiang province from 2009 to 2014. ICD-10 criteria and method was used to classify the causes of death. To evaluate health status of those residents, the relative health indicators such as mortality rate, constituent ratio, PYLL, AYLL, PYLL‰were used. Results The average mortality rate of residents was 691.92/100 000 of Jiaxing from 2009 to 2014, with male 760.73/100 000 and female 624.64/100 000 (the average mortality rate of male was significantly higher than that of female, χ2=455.52, P<0.01). The top five causes of death of local residents were malignant neoplasm, respiratory system diseases, cerebrovascular diseases, injury and poisoning, heart diseases, which accounted for 87.95%of all deaths. The mortality caused by malignant neoplasm was 189.53/100 000, which accounted for 31.90% of five main death causes (the rate of male was significantly higher than that of female, χ2=3767.70, P<0.01). The PYLL of malignant neoplasm were 38 368 years, which was the main reason. The AYLL of injury and poisoning were 9.58 years. Conclusion The average mortality rate of residents has been declining across the Jiaxing, but the mortality rate of malignant neoplasm is increasing year by year. The data suggested that malignant neoplasm, cardiovascular disease, unintentional falls, motor vehicle traffic accidents and pneumonia are major factors affecting the health of the population.

Objective To discuss the quality of life in the postoperative patients with aortic valve replacement (AVR) and related influencing factors .Methods The changes of preoperative and postoperative survival quality in 102 cases of AVR surgery were assessed by using the SF‐36 scale ,and the Logistic regression was used to analyze the impact of age ,effective valve orifice area and prosthetic valve on the quality of life .Results Five patients died during follow‐up .The relative baseline survey after postopera‐tive 1 year showed that the quality of life of patients was significantly improved ,the Logistic regression analysis revealed that a lar‐ger effective orifice area(EOA) and biological valve replacement could have higher health scale scores ,and showed a positive corre‐lation .Conclusion The quality of life in the postoperative patients with AVR is affected by the valve type and EOA of prosthetic valve .

Objective To study the supporting role of traditional Chinese medicine GanFuAn in the treatment of high-risk state of liver cancer by color Doppler ultrasound.Methods Based on a number of joint detection of tumor markers,85 patients of liver cancer were selected from patients with chronic hepatitis B.Among these 85patients,50 patients were selected in a treatment group and treated with Chinese herbal preparation GanFuAn,with ultrasound and tumor markers serving as joint monitoring; while the other 35 patients were selected in a control group and treated with conventional treatment.Results In the treatment group,the liver tumor markers or liver tumor continually diminished.5 cases showed tumor disappear.38 cases showed effective results,while 7 cases showed no effects.The total incidence rate of liver cancer was 14％;while in the control group,none case showed tumor disappear.20 cases showed effects and 15 cases showed none effects.The cumulative incidence rate of liver cancer induced by chronic hepatitis was 43％,with all the cases have been confirmed by pathology.Conclusion Color doppler ultrasound was an intuitive,non-invasive dynamic method to monitor liver tumor's growth and decline.

Objective To evaluate volume doubling time (VDT) and net mass doubling time of tumor (nMDT) of pulmonary pure ground glass nodules (PGGN) of different pathological types and to investigate whether VDT and nMDT can help to differentiate invasive pulmonary adenocarcinomas from minimally invasive adenocarcinomas and preinvasive lesions.Methods Fifty-one pathologically confirmed pGGNs in 46 patients were retrospectively evaluated,in whom at least two HRCT scans were obtained preoperatively (median scan times,3 times;range,2-6 times) with 1-month or longer follow-up interval (median follow-up interval,251 days;range,30-1 552 days).According to the rechecked results of the postoperative pathological section,51 pGGNs were divided into two groups:group A,invasive adenocarcinoma (IAC),30 pGGNs (58.8％);group B,21 pGGNs (41.2％),including 8 minimally invasive adenocarcinoma (MIA),7 adenocarcinomas in situ (AIS) and 6 atypical adenomatous hyperplasia (AAH).The volume,cumulative percentage of volume growth and VDTs of pGGNs were automatically acquired by Lung VCAR (advantage windows 4.6,GE HealthCare).Subsequently,the mass,cumulative percentage of mass growth and nMDTs of pGGNs were calculated.The count data and measurement data between two groups were compared using Fisher exact probability and Mann-Whitney U test,respectively.A pairwise comparision were performed by using Wilcoxon signed-rank test.Subsequently,the receiver operating characteristic (ROC) curve was used to determine the optimal cut-off values of VDT and nMDT for the differential diagnosis of IAC and MIA/AIS/AAH,and calculated the area under the curve (AUC).Results The median VDT and nMDT of 51 pGGNs were 1 854.11 days (range,165.22—+∞ days) and 1 138.45 days (range,95.92—+ ∞ days),respectively.The median nMDT was shorter than the median VDT,and the difference was significant (Z=-2.444,P=-0.O15).The median VDTs of IAC and MIA/AIS/AAH were 847.07 days (165.22—+∞ days) and 4 460.09 days (691.14—+∞ days),respectively.The median nMDTs of IAC,MIA/AIS/AAH were 769.93 days (95.92—+∞ days) and 3814.77 days (611.56—+∞ days),respectively.The median VDT and nMDT of IAC were significantly shorter than those of MIA/AIS/AAH (Z=-3.443,-3.860,P＜ 0.01,respectively).Differentiating IAC from MIA/AIS/AAH,the optimal cutoff value of VDT was 2095.86 days (sensitivity,71.4％;specificity,80.0％),the optimal cutoff value of nMDT was 1 169.77 days (sensitivity,81.0％;specificity,76.7％).Conclusions In pulmonary pGGNs,IAC showed significantly shorter VDT and nMDT than MIA/AIS/AAH.When VDT is shorter than 2 095.86 days or nMDT is shorter than 1 169.77 days,IAC is suggested.

Background and purpose:Tumor suppressor gene P53 has long been studied in tumors, including breast cancer. More studies focused on the relationship between P53 and prognosis of breast cancer and found that P53 overexpression suggested a bad prognosis. However, the effect of P53 on early stage postmenopausal patients with ER-positive breast cancer has not been clariifed yet. This study was to investigate the role of P53 plays in aromatase inhibitor (AI) resistance among early stage postmenopausal patients with ER-positive breast cancer patients. Methods:A total number of 293 operable breast cancer patients who received surgical treatment during Jul. 2000 to Jul. 2006 in Fudan University Shanghai Cancer Center were enrolled into this study. All patients received AI treatment. The SPSS 12.0 software was used to estimate the survival rate. Univariate and multivariate analysis were also performed via above software. Results:The median follow-up time is 72 months (6-140 months). The 5 year disease free survival (DFS) of P53 positive and negative were 78%and 89%. The results showed that P53 overexpression (HR=1.729, 95%CI:1.038-2.880, P=0.035), pathological stage (HR=2.270, 95%CI:1.399-3.681, P=0.001);histological grade (HR=2.328, 95%CI:1.312-4.133, P=0.004); age (HR=1.988, 95%CI:1.511-2.617, P<0.005) were still the independent risk factors of recurrence and metastasis in breast cancer patients treated with AI. Conclusion:P53 overexpression correlated strongly with AI resistance in early stage postmenopausal patients with ER-positive breast cancer patients who were treated with AI and conifrmed the relevance of previously described prognostic factors. It is reasonable to take P53 expression into account when we evaluate the risk of breast cancer patients and decide the anti-cancer treatment strategy.

Objective To investigate the role of the hypothalamus, medullary visceral zone (MVZ)and vagus in cerebral hemorrhage (CH) in multiple organ dysfunction syndrome (MODS) rat model.To reveal the possible regulatory mechanism of the hypothalamus-MVZ-vagus pathway in CMODS.Methods 80 Wistar rats were randomly divided into sham-operative group (n = 10), subdiaphragmatic vagotomy group (SDV, n = 10), CH group (n = 20), CH + SDV group (n = 20) and CH + vagus stimulation group (CH +SIV, n = 20).Rat CH model was made by stereotaxis injection of collagenase in caudate nucleus.Its endotoxin in serum was evaluated with a test kit.The expression of FOS in the hypothalamus and CHAT in the MVZ in the rats were examined using immunohistochemistry methods.Results Abnormality of hepatic and renal function, myocardium enzyme in CH + SDV group, CH + SIV group and CH group were more severe than those in sham-operative group and SDV group; CH + SDV group more severe than CH group.CH +SIV group were much milder than CH group.The serum endotoxin level (EU/ml) in CH group,compared with the sham-operated group, were significantly different (1.03 ± 0.25 and 0.18 ± 0.03respectively, t = 10.61, P <0.01).The expression of FOS in hypothalamus of CH + SDV group (9.3 ±2.6) were significantly higher than those in sham-operative group (2.5 ± 0.4, t = 8.17, P < 0.01) and SDV group (2.9 ±0.5, t =7.64, P <0.01), but significantly lower than those in CH group (48.6 ± 18.1,t =6.80, P<0.01); was higher in CH +SIV group than those in CH group (74.3 ±6.3 and 48.6 ± 18.1,t=4.23, P <0.01).The expression of CHAT in MVZ in CH + SDV group (138.5 ± 11.8) was significantly higher than those in sham-operative group (108.2 ±9.5, t =5.39, P <0.01) and SDV group (110.7 ±9.9, t =4.83, P <0.01), but significantly lower than those in CH group (164.4 ± 12.4, t =3.53, P <0.01); was higher in CH + SIV group than in CH group (189.4 ± 15.0 and 164.4 ± 12.4, t =3.14, P < 0.05).Conclusion Hypothalamus may be related to the nerve immunity adjustment in MODS after cerebral hemorrhage.The hypothalamus-MVZ-vagus pathway may be distinctive in CMODS.Vagus nerve may be a Bi-directional Channel of the rats following cerebral hemorrhage and MODS.

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Objective To investigate the effects and mechanisms of carbon monoxide-releasing molecule-2 (CORM-2) on LPS induced barrier injure of Caco-2 cells.Methods The model of Caco-2 monolayer cells damage induced by LPS was established by using 50 μg/ml LPS for 24 hours.After preconditioning with different concentrations (10 μmol/L,50 μmol/L,and 100 μ mol/L) of CORM-2 for 1 hour,the cultured well-grown Caco-2 monolayer cells were stimulated with 50 μ g/ml lipopolysaccharides (LPS) for 24 hour.The 100 μmol/L CORM-2 was put into 37℃ and 5％ CO2 incubator for 18 hours until the CO has been fully released,and it became an inactive CORM-2(iCORM-2).The cultured Caco-2 monolayer cells were divided into six groups:the control group,the LPS group,the LC1(10 μmol /L CORM-2 preconditioning) group,the LC2(50 μmol/L CORM-2 preconditioning) group,the LC3(100 μmol/L CORM-2 preconditioning) group,and the LC4 (iCORM-2 preconditioning) group.The apoptosis rates of different groups of Caco-2 monolayer cells were detected using flow cytometry.Cytokines (TNF-α,IL-1β and HMGB-1) levels of different groups were detected using ELISA kits.The levels of tight junction proteins (occludin ZO-1,claudin-1 and claudin-4) of every group were detected using Western blotting with specific antibodies.The structural changes of tight junction proteins were visualized by immunofluorescence technique.Results Compared with control group,cell apoptosis rate and release of inflammatory cytokines such as TNF-α,IL-1β and HMGB-1 in LPS group were significantly higher,and the levels of tight junction proteins were apparently decreased (P＜0.05) in LPS group.Compared with LPS group,cell apoptosis rate and release of inflammatory cytokines such as TNF-α,IL-1β and HMGB-1 decreased,and the levels of tight junction proteins were attenuated obviously,P＜0.05,in CORM-2 preconditioning groups.And the higher the concentration of CORM-2,the more obvious the protective effects.Conclusions This study demonstrates that CORM-2,as one of exogenous CO-releasing molecules,has the capacity to protect the barrier damage of LPS-stimulated Caco-2 monolayer cells in a concentration dependent manner.The higher the concentration of CORM-2 was,the stronger the protective effects were.The protective effects of CORM-2 include reducing Caco-2 monolayer cells apoptosis rate,inhibiting inflammatory cytokines production and release,and restoring distribution and levels of tight junction proteins.