Objective To investigate the effects of Gegenqinlian decoction combined with berberine in the treatment of biguanides resistant type 2 diabetes in elderly patients in glycosylated hemoglobin and homocysteine.Methods 82 elderly patients from March 2015 to March 2016 in our hospital who were diagnosed with type 2 diabetes with biguanides resistant were selected,and randomly divided into two groups,41 cases in each groups.Control group receiced routine treatment,experimental group received more with Gegenqinlian Decoction combined with berberine treatment,and all the patients were treated for two weeks.Levels of FPG,2h PG,serum HbA1c,Hcy,hs-CRP,APN,TNF-α,ICAM-1 and clinical efficacy were compared,and the results were analyzed by statistical software SPSS 19 data analysis.ResultsCompared with before treatment,levels of serum FPG,2h PG,HbA1c,Hcy,hs-CRP,TNF-α and ICAM-1decreased in two groups after the treatment(P<0.05),levels of AFN increased(P<0.05),Compared with the control group,levels of serum FPG,2hPG,HbA1c,Hcy,hs-CRP,TNF-α and ICAM-1 in the experiment group were lower(P<0.05),levels of AFN were higher(P<0.05);The total effective rate of the experimental group was significantly higher than the control group(P<0.05).Conclusion Gegenqinlian decoction combined with berberine can effectively reduce the levels of FPG,2h PG,HbA1c,Hcy,hs-CRP,TNF-α in serum and ICAM-1 levels,increase serum APN level,and good curative effect,worthy of clinical application and promotion.

Objective To explore the outcome and diagnostic methods of umbilical cord winds of the perinatal. Methods Retrospective analysis of 2350 cases of umbilical cord winds in our hospital was conducted. We selected 2400 cases as control. We calculated both the incidence rate of cesarean section, fetal distress and neonatal hypoxic - ischemic encephalopathy. Results Umbilical cord winds accounted for 20.1 percent of the total number of deliveries in the same period. The incidence rate of fetal distress and cesarean section was significantly high. Bsound ultra was 98.9% diagnosis. The electronic fetal care was 99.7% in diagnosis. Color Doppler ultrasound was 100% in diagnosis. Conclusion Umbilical cord winds is a common complication of pregnancy, and decision is also an important factor for delivery mode. Umbilical cord winds will increase obviously in the incidence of fetal distress and perinatal morbidity. The main method for prenatal diagnosis is the color Doppler ultrasound examination, such as B - and E - fetal care. Color Doppler ultrasound technique is the best way for non - invasive is observation of intrauterine blood circulation changes. In helpful for the judge of the progress and outcome of pregnancy, fetal growth and development of the situation.

Objective To evaluate the efficacy of splenectomy plus selective pericardial devascularization under endoscope in the treatment of advanced schistosomiasis patients with portal hypertension and hypersplenism so as to explore the minimally in-vasive and safer surgical treatment. Methods A secure splenectomy was performed with laparoscope and its supporting devices, and at the same time,the ligation of the left gastric vein and the ligation of esophageal vein perforating vertically into the esopha-gus were also performed in 14 advanced schistosomiasis patients with portal hypertension and hypersplenism. Results Among the 14 patients,the splenic artery was separated and clipped before the treatment of splenic pedicle. One patient was of conversion to open laparotomy for the splenic vein rupture bleeding in the separation. There was no death. Conclusion The operation of sple-nectomy plus selective pericardial devascularization under endoscope is effective,truly minimally invasive,and safe in the treat-ment of advanced schistosomiasis patients with portal hypertension and hypersplenism.

Objective To study the effect of liquid extracts from leaves of Canarium pimela Leenh on myo-cardial ischemia-reperfusion injury in rats. Methods The langendorff isolated perfused heart system was applied in this study. Ligating of the left descending anterior for 35 min,followed with 100 min or 50 min reperfusing to set up the cardiac ischemia-reperfusion injury model (I/R). After perfusing the effective pharmacological extracts of leaves of Canarium pimela Leenh(CPL)to the isolated heart,we monitored the cardiac parameters of left ventricu-lar systolic pressure(LVSP),left ventricular end-diastolic pressure(LVEDP)and left ventricular maximal rise/fall of left ventricular pressure(±dp/dtmax)in the following assays with or without 10 min CPL pretreatment. 1. the cardiac parameters,2. the cardiac parameters in 35 min ischemia,followed with 10 min or 50 min reperfusion,3. the incidence of ventricular fibrillation or ventricular tachycardia after 10 min reperfusion,4. the activity of creatine kinase(CK)and lactate dehydrogenase(LDH)in the coronary effluent after 10 min reperfusion,5. pathological analysis in the I/R,CPL and VER group after reperfusion. Results CPL pretreatment improved functions of normal left heart. Furthermore,it significantly reduced LVEDP and +dp/dtmax,the incidence of ventricular fibrillation or ventricular tachycardia,as well as the activities of CK and LDH in coronary effluent induced by ischemia-reperfusion compared with the I/R model. Moreover,CPL pretreatment markedly alleivated the pathological changes of ischemia-reperfusion. Conclusions The liquid extracts of leaves of Canarium pimela Leenh can effectively relieve the myocardial ischemia-reperfusion injury in rats.

ObjectiveTo study the clinical features of the bilateral frontal brain contusion with cerebral hernia center and its treatment strategies. MethodsThe clinical data of 76 patients with cerebral central hernia were restropectively analyzed. ResultsIn 76 patients,there were 53 cases survive,23 cases died.The life and survival quality of these patients were evaluated according to the Karnofsky scale systerm :46 patients underwent surgery,including 35 cases with good recovery,8 cases with long-term coma or unable to look after themselves,3 cases with death;10 cases underwent a expectant treatment,of which,6 cases with good recovery,4 cases with long-term coma or unable to look after themselves.The other 20 cases died of central brain stem failure,with a central hernia when admissioned. ConclusionPatients with bilateral frontal brain contusion were extremely complicated with central hernia,and had a suddenly deteriored condition.Close observation of changes were critical importance.The surgery should be carried out before "diencephalon period",for most recovery well after surgery.Patients with diffuse brain swelling should go under the depressioning surgery as earlier as possible.

Objective To regulate standardized ICD-10 case classification name and coding,and common clinical diagnosis name or expression of mapping rules,to systematically improve the quality of DRGs key data,and to assess the impact of medical diagnostic data quality on DRGs and the indicators based on the DRGs.Methods Extension of the glossaries of clinical diagnosis synonyms or near-synonyms,and establishment of a standardized maintenance procedure of ICD-10 dictionary.Adjustment of the impact extent of DRGs disease makeup on case classification,comparison of the consistency of principal diagnosis classification,and the consistency of DRGs grouping,as well as changes of such indicators as DRGs grouping reduction in variance (RIV) and case mix index (CMI).Results Data of the obstetrics,gynecology and pediatrics disciplines of a maternity and children hospital from 2012 to 2013 (72 005 cases)and 2014 to 2015 (77 705 cases) were chosen for prior-after comparison.The encoding consistency rate was 59.60％ before the improvement,with the improved standardized consistency rate rising to 66.38％afterwards;beforehand the DRGs grouping consistency rate was 69.30％,with the improved standardized consistency rate rising to 88.00％ afterwards;beforehand the cost RIV was 0.515,with the cost RIV rising to 0.576 afterwards;the CMI variations of individual campuses of healthcare institutions appear more reasonable.Conclusions Diagnostic quality control and improvement project can improve the data accuracy of coding.This empowers the RIV and CMI indexes calculated on such basis to better describe the complexity of clinical settings,conducive to establishing a value-oriented prepayment system which is more transparent,fair and reasonable.

Objective To study the relationship between umbilical cord leptin levels and fetal growth as well as neonatal birth weight. Methods One hundred and forty - two neonates selected from February 2009 to June 2013 in Shangqiu First People's Hospital according to the different gestational age and birth weight were divided into 3 groups. Group A included 44 cases(small for gestational age,birth weight below the average weight of the 10th percentile at the same gestational age),23 boy cases,21 girl cases;group B included 56 cases(appropriate for gestational age,birth weight at the average weight of the 10th to 90th percentile at the same gestational age),30 boy cases,26 girl cases;group C included 42 cases(large for gestational age,birth weight above the average weight of the 90th percentile at the same gestational age),22 boy cases,20 girl cases. Neonatal body mass index,birth weight,placenta weight and umbilical lep-tin levels of three groups were compared. Results Neonatal birth weight,neonatal body length,body mass index and the placenta weight leptin levels in group A were significantly lower than those of group B,having statistically significant difference(all P ﹤ 0. 001);Neonatal birth weight,neonatal body length,body mass index and the placenta weight leptin levels in group C were significantly higher than those in group B,with statistically significant difference( all P ﹤0. 001). Neonatal birth weight in the boy group was obviously higher than that of the girl group,and the difference was statistically significant(P ﹤ 0. 001). Neonatal leptin levels in the boy group were significantly lower than that of the girl group,and the difference was statistically significant(P ﹤ 0. 001). There were positive correlations between the umbili-cal cord leptin levels and the neonatal birth weight,neonatal length,neonatal weight index and the placenta weight(r =0. 382,0. 276,0. 358,0. 412,all P ﹤ 0. 01). Conclusions The umbilical cord leptin levels are closely associated with neonatal birth weight and intrauterine growth retardation,and it can be used as one of the important indicators for reflec-ting neonatal birth weight and fetal growth.

Objective To study the value of score for neonatal acute physiology Ⅱ(SNAP]Ⅱ) and its extension version Ⅱ (SNAPPE-Ⅱ) in predicting neonatal necrotizing enterocolitis (NEC) outcome.Methods We explored 73 NEC patients by statistics who were treated in our hospital from January 2002 to January 2012.The patients were divided into two groups:surgery group and non-surgery group,then they were divided into subgroups:alive group and death group.The general information including birth weight,age,clinical manifestations,treatment of patients were collected.Every patient was checked and scored by the methods SNAP-Ⅱ] and SNAPPE-Ⅱ in time.Results The scores (27.0 ± 2.3,26.5 ± 1.8) of surgery group including SNAP-Ⅱ and SNAPPE-Ⅱ were higher than those (14.0 ± 2.1,15.0 ± 2.5) in the non-surgery group(P ＜ 0.01).The scores(31.0 ± 3.2,31.0 ± 3.4) of the death group including SNAP-Ⅱ and SNAPPE-Ⅱ were higher than those(11.0 ± 2.5,10.0 ± 3.6) in the alive group(P ＜ 0.01).According to the area under the curve(AUC) analyzed by the receiver operating characteristic(ROC) curve for measuring the scores of surgery predicting,AUC was 0.726 for SNAP-Ⅱ and 0.732 for SNAPPE-Ⅱ.The value of predicting surgery risk was 20 and 24 respectively.According to the AUC analyzed by the ROC curve for measuring the scores for surgery predicting,AUC was 0.752 for SNAP-Ⅱ and 0.825 for SNAPPE-Ⅱ.The value of predicting mortality risk was 31 and 33 respectively.All P values were less than 0.01 and there were significant differences.Conclusion The two kinds of score for neonatal acute physiology have an important significance in predicting surgery and mortality risk of NEC.

ObjectiveTo evaluate the diagnostic value of multi-slice CT (MSCT) and multi-dimensional reconstructions for congenital pulmonary stenosis (PS) in children.MethodsThe enhanced thin CT images of 33 patients with PS were retrospectively analyzed,the data was transmitted to the workstation for multi-planar reformation ( MPR),volume rendering technique (VRT) and maximum intensity projection (MIP).The CT imaging features of PS were analyzed combining with operation resul ts and Ultrasonic Cardiogram (UCG).ResultsIn 33 cases of PS,there were 17 cases with pulmonary valve stenosis (PVS),10 cases with right ventricular infundibulum stenosis (RVIS),and 6 cases with pulmonary trunk stenosis (PTS).The first two were correctly diagnosed by UCG,5 cases of PVS and Icases of RVIS were correctly diagnosed by MSCTA,the later was correctly diagnosed by UCG and MSCTA.In 14 cases with collateral circulations between aorta and pulmonary artery ( APC ),all were correctly diagnosed by MSCTA,only 3 case was diagnosed by UCG,1 case was misdiagnosed as PDA.UCG can clearly demonstrate the others intra-cardiac deformities,such as ASD,VSD,RVH,PFO,SV,DORV,TECD and TBD,the accuracy rate of MSCTA was 39.4％,and MSCTA can clearly demonstrate the origin,course and diameter of extracardiac vascular abnormalities,such as PDA,RAA,TGA,TAPVD,CoA,PLSV and VLSA,the accuracy rate of UCG was 697％.ConclusionsMSCT and multi-dimensional reconstruction were a kind of non-invasive method,it was a good approach for extra-cardiac vascular malformations and APC in PS.Combining with UCG,it can further be used to improve the diagnostic accuracy of intra-cardiac malformation and supply diagnostic evidence for clinical treatment.

Objective To investigate the clinical value of quality intima-media thicknes (QIMT),quality arterial stiffness(QAS) and XStrain in assessing the ventricular-arterial coupling (VAC) in patients with uremia.Methods Sixty-five patients with uremia and 30 normal subjects were enrolled in this study as the uremic group and control group respectively.Ultrasound examination for the cardiac and carotid artery was performed and some parameters were obtained,such as left ventricular ejection fraction(LVEF),E/e,Tei index,stiffness (β),compliance coefficinet (CC),pulse wave velocity (PWV),intima-media thicknes (IMT),strain,and so on.The sum of left ventricular systolic radial strain and carotid arterial diastolic radial strain was used as a new parameter (VACs) for assessing VAC.The correlation between VACs and VACv,a traditional method to evaluate VAC,was analyzed.The parameters obtained by ultrasonic techniques were compared between two groups.The intra-and inter-observer reliability of XStrain was assessed by intraclass correlation coefficient.The multiple linear regression and ROC curve were used to analyze the independent factor of cardiovascular dysfunction.Results ①The pulse pressure,E/e,Tei index,as well as β,PWV and IMT were larger in uremic group than control group significantly (P ＜0.05).②The function of VAC was decreased in uremic group,and the VACv and VACs were lower than control group significantly (P ＜0.05).③There was strong positive relation between VACs and VACv (r =0.908,P =0.000).The reproducibility of XStrain technique was well.④VACs,β,VACv and PWV could be considered as independent factor of cardiovascular dysfunction and performance of VACs was the largest (standardized coefficient was-0.582).A cutoff value of VACs for assessing cardiovascular dysfunction was less than 23.60,which had both higher sensitivity and specificity (96.4％,81.1％).Conclusions The QIMT,QAS and XStrain can be used to assess cardiovascular structure,function and VAC accurately and globally,which can be consider as an effective method for detecting cardiovascular complication and improving prognosis of uremic patients.