ObjectiveTo investigate whether the good control of fasting plasma glucose(FPG) has any effects on bone turnover rate in type2 diabetes mellitus (DM).MethodsA series of markers,such as bone specific alkaline phosphatase (BAP),deoxypyridinoline (DPD),were assessed before and after glycemic control for more than 18 days in 43 poorly controlled type 2 DM patients with initial hemoglobin A1c over 8%.ResultsBy either oral hypoglycemic agent or insulin administration,or both, ideal control of FPG resulted in a reduction in the secretion of urinary calcium(Ca),phosphate(Pi) and magnesium(Mg),and an increase in serum Ca and Pi without obvious changes in serum Mg.The marker for bone resorption,urinary DPD and the marker for bone formation,BAP in serum were reduced significantly before and after the management.The results indicated that the decreases both in DPD and in BAP were not only correlated well with each other,but with the improvement in glycemic indices as well.ConclusionGood control of hyperglycemia in poorly controlled type 2 DM may have the high bone turnover rate back to normal and protect type 2 DM patients from bone loss.

Objective] To conclude the teacher Qiu's clinical experience and academic points on diagnosing and treating pregnancy with myasthenia gravis(MG). [Method] By reviewing relevant literature of traditional Chinese medicine, studying in clinic with teacher and tidying medical records, systematic mining and constructing teacher Qiu's clinical experience and academic points on etiology and pathogenesis, syndrome differentiation, medication thinking, drug characteristics, the taboo of drugs and combining traditional Chinese and western medicines treatment of pregnancy with myasthenia gravis(MG).[Results]Teacher Qiu thinks, pregnancy with MG involving spleen and kidney deficiency is the pathological process of pregnancy and physio-logical process of MG; Clinical syndrome differentiations can be divided into three types like temper deficiency, spleen and kidney deficiency, qi and Yin deficiency; establish the therapeutic rules of nourishing qi to invigorate spleen, tonifying the spleen and kidney and tonifying qi and yin. Respectively adding and subtracting Buzhong Yiqi Decoction with Taishan Panshi San, Buzhong Yiqi Decoction with aconitum lizhong pill and Taishan Panshi San, Buzhong Yiqi Decoction with sengmai san and Taishan Panshi San for syndrome differentiation treating the disease, nourishing qi to invigorate spleen and fetal irritability are the main treatments of the disease. Buzhong Yiqi Decoction and Taishan Panshi San are the basic prescriptions. Large dose of the astragalus membranaceus, atractylodes macrocephala koidz, Codonopsis pilosula,epimedium gradiflorum morr to tonify kidney strengthening spleen and supporting Qi in the prescription, combining traditional Chinese medicine with western medicine can reduce the use of western medicine and reduce the adverse reaction of western medicine. [Conclusion]The teacher Qiu's experience of syndrome differentiation and treatment on pregnancy complicating myasthenia gravis is rich, efficacy is got and has less side effect. It states that Chinese medicine treatment of pregnancy with MG has certain advantages and is worth being popularized and inheriting.

Objective] To sum up Qiu Changlin's clinical experience and academic views of treatment of multiple sclerosis remission stage. [Methods] Through the way of reviewing the related literature of traditional Chinese medicine, clinical practice with teacher, arranging medical records, systematically arranging Qiu Changlin's clinical experience and academic perspective in the aspects of etiology and pathogenesis, syndrome differentiation ,treatment ideas, drug integration of TCM and western medicine. [Results] Qiu Changlin believes that the MS remission stage is of deficiency syndrome or deficiency complicated with excess syndrome. The main pathogenesis is insufficiency of kidney yin and kidney yang, deficiency of governor vessel. The subject is wind and phlegm attacking into collateral, stagnation of phlegm and blood stasis. Put forward that the treatment based on the differentiation between the main syndrome and minor syndrome. In clinic, divided the main syndrome into three types, like insufficiency of kidney yin, insufficiency of kidney yang, insufficiency of kidney essence. Establish the therapeutic principles like nourishing yin and kidney, warming yang and nourishing kidney, the complementing of yin and yang, dispelling wind and dredging collaterals. The kidney yin deficiency type can modify Six Ingredient Rehmannia pill, Zhibaidihuang pill, Zuogui pill, Dabuyin pill, Huqian pill. The kidney yang deficiency type can modify Jingui Shenqi pill, Yougui pill. The kidney essence deficiency type can modify Dihuangyinzi. Regard that nourishing kidney and governing vessel to the fundamental treatment, ants going into collaterals to dispel the blood stasis and wind for treatment of the symptoms, and believe that nourishing kidney and extinguish wind should always run through the whole treatment process. When treatment based on the main syndrome, we should emphasize personalized features that can reflect the characteristics of this disease, in order to improve the clinical curative effect. [Conclusion] Qiu Changlin has rich clinical experience in the treatment of MS remission stage;patients are satisfactory to the curative effect and have fewer side effects. It's fully explained that TCM has certain advantages in the treatment of MS remission stage, and is worth popularizing inheritance.

Objective To investigate the pressures from night shifts among nurses from pediatrics department and find the countermeasures.Methods A self-designed questionnaire was used to investigate the pressures from night shifts among 112 nurses from pediatrics department as well as the reasons.Results 110 of the nurses(98.2%) assumed that the pressures from night shifts was intensive.The main reasons for the pressures came out of heavy workload,shortage of staff and stuff and the unsettled balance between job and family.Conclusion Such measures as reasonable distributions of nurses,abound supply of stuff and reduced working links may be effective for the alleviation of the pressures on nurses at night shifts,motivated activeness in them and then the enhancement of nursing quality.

Objective To observe the influence of Ginkgo laminae on serum lipid, serum level of homocysteine (HCY) and carotid intima-media thickness (IMT) of patients in recovery phase of cerebral infarction. Methods 100 patients in recovery phase of cerebral infarction were randomly divided into treatment group and control group, with 50 cases in each group. The control group were given aspirin enteric coated tablets 0.1g qn po., atorvastatin calcium capsule 20mg qn po.; the treatment group on the basis of the control group were added Ginkgo laminae, 1 tablet per time, three times daily. The blood liqid and HCY levels pre-treatment and 1, 3 and 6 months post-treatment and IMT value pre-treatment and 6 months post-treatment were collected. Results The triglyceride level had no significantly change in two groups. The high density lipoprotein cholesterol 3, 6 months post-treatment in treatment group was significantly higher than control group(P<0.05). The cholesterol and low density lipoprotein cholesterin 1 ,3, 6 months post-treatment in two groups significantly decreased compared with pre-treatment(P<0.05), while there was no significant difference between two groups at each time point. The cholesterol in treatment group had a smooth decreasing, while it had an increasing trend in control group 3 months post-treatment. The HCY 3 months post-treatment in treatment group was significantly lower than pre-treatment and control group 1, 3 and 6 months post-treatment (P<0.05). The IMT 6 months post-treatment in treatment group was significantly lower than control gorup(P<0.05). Conclusion Ginkgo laminae combined with atorvastatin for reducing lipid, which could raise high density lipoprotein cholesterol and reduce cholesterol smoothly and lower IMT, with the effective protection on vessel. The blood homocysteine level decreases after taking Ginkgo laminae for three months, which also could improve impaired endothelial function induced by high level of HCY and slow down the process of atherosclerotic plaque.

Objective To investigate the relationship between neck circumference and metabolic syndrome(MS) and its components in type 2 diabetes Methods A total of 272 subjects with type 2 diabetes were recruited.According to the diagnostic criteria of MS,all subjects were divided into MS group and non-MS group.According to neck circumference tertile,all subjects were respectively divided into male and female of three groups to analyze the relationship between neck circumference and MS and its components.Male:Q1＜38.8 cm,Q2=(38.8-41.3) cm,Q3≥41.4 cm;female:Q1＜34.0 cm,Q2=34.0-36.3 cm,Q3≥36.4 cm.The optimal cut-off points of neck circumference were used to determine the MS by ROC curve.Results (1) Compared with non-MS group,subjects in MS group had significantly higher neck circumference((38.3±3.2)cm vs.(36.1±3.7) cm),waist circumference((94.1±8.4) cm vs.(82.7±10.8) cm),waist-hip ratio(0.93±0.06 vs.0.88± 0.08),body mass index ((26.2 ± 2.9) kg/m2 vs.(23.9 ± 3.5) kg/m2),fasting plasma glucose(9.0(6.7-11.5) mmol/L vs.7.7(5.9-10.2) mmol/L),systolic pressure(140(130-150) mmHg vs.130 (120-130) mmHg),diastolic pressure (80 (80-90) mmHg vs.80 (75-85) mmHg),triglycerides (1.9(1.4-2.8) mmol/L vs.1.2 (0.9-1.5) mmol/L),low-density lipoprotein cholesterol (LDL-C) ((3.3 ± 1.0)mmol/L vs.(3.0±0.9) mmol/L) and blood uric acid((322.7±90.1) mmol/L vs.(270.3±82.3) mmol/L),and the differences were significant(t or Z=-4.843,-8.622,-5.157,-5.592,-2.729,-5.723,-3.847,-6.856,-2.123,-4.545;P＜0.05).While the level of total cholesterol((2.7±2.8) mmol/L vs.(4.9±1.3)mmol/L) and high-density lipoprotein cholesterol (HDL-C) (1.0 (0.8-1.2) mmol/L vs.1.2 (1.1-1.5)mmol/L) were decreased,and the differences were significant (t or Z =-2.269,-7.068;P ＜ 0.05).(2)Compared with those with lowest tertiles(Q1 ＜38.8 cm) of neck circumference,male subjects with highest tertile (Q3≥41.4 cm) had higher level of waist circumference((97.8±8.6) cm vs.(89.9±8.5) cm),waist-hip rati (0.96±0.07 vs.0.93±0.06),body mass index((27.4±2.1) kg/m2 vs.(23.8±2.3) kg/m2),blood uric acid ((374.0±85.6) mmol/L vs.(305.8±73.6) mmol/L),and the differences were significant(P＜0.05).While age((52.1±10.7) years vs.(60.4±11.8) years) andHDL-C((1.0±0.3) mmol/Lvs.(1.2±0.5) mmol/L) were decreased,and the differences were significant (P＜0.05).Female subjects with higher tertile (Q3 ≥ 36.4 cm) had significantly higher level of waist circumference ((96.8 ± 10.1) cm vs.(79.5 ± 8.5) cm),waist-hip ratio(0.94±0.07 vs.0.86±0.06),body mass index((28.5±3.1) kg/m2 vs.(21.9±2.2) kg/m2),blood uric acid((295.2±94.3) mmol/L vs.(244.6±62.3) mmol/L),the frequency of MS(83.3％(40/48)vs.21.7％(10/46)) than with lower tertile(Q1＜34.0 cm).(3) Logistic regression analysis showed that neck circumference (β =0.187,P ＜ 0.001) was an independent risk factor of MS (y =0.187x-6.613).(4) The optimal cut-off points of neck circumference to MS were 40.1 cm (AUC =0.682,P=＞0.008) in male,and 35.3cm (AUC =0.766,P＜ 0.001) in female.Conclusion Neck circumference increases when type 2 diabetes patients with MS.Neck circumference is an independent risk factor for MS,which can be used as an indicator to evaluate MS.

ObjectiveTo investigate influence on adults'visual function and fluid intelligence with N-back working memory training based on Gabor signal.MethodsControlling group including 13 adults had no training,training group including 14 adults received an eight-days training,half an hour a day.The stimulus was N-back training which has on improved Gabor signal with adjustable spatial frequency and contrast sensitivity.The contrast sensitivity and fluid intelligence were record using OPTEC 6500 and Raven's Standard Progressive Matrices before and after training,then the data was analyzed and processed by SPSS.ResultsContrast sensitivity:there was a siguificant different of the contrast sensitivity between pretest and posttest ( ( 1.93 ± 0.17 ) log,( 1.76 ±0.20 ) log) in training group ( t =-4.579,P =0.001 ).Fluid intelligence:there was a significant different of fluid intelligence between pretest and posttest( ( 129.9 ± 9.0 ) scores,( 113.7 4-16.0 ) scores ) in training group ( t =-4.373,P =0.001 ),and superior to controlling group,which also had a statistical significance (F =1.353,P =0.004).ConclusionThe method of N-back working memory training based on Gabor signal not only enhances working memory and fluid intelligence,but also improves the visual function effectively,and more various effect is acquired comparing to traditional training method.

Objective To assess the significance of urethral sphincter electromyography (US-EMG) and external anal sphincter electromyography (EAS-EMG) for the diagnosis of multiple system atrophy (MSA).Methods US-EMG and EAS-EMG were performed in 9 patients who were diagnosed as MSA.Duration,motor unit action potentials amplitude,polyphasicity,as well as recruited pattern and amplitude during powerful contraction were recorded and analyzed.Results Among 9 patients who were diagnosed as MSA,7 cases showed neural injury by both US-EMG and EAS-EMG.There was significant difference of electromyographic findings between US-EMG group and EAS-EMG group (average volatility (μV):1063.44 ±499.92 vs 634.89 ±265.07; polyphasic wave:0(0,20％ ) vs 57％ (28％,63％ ) ; t =2.567,P=0.033;t =2.833,P=0.012).Conclusions Although US-EMG may be difficult to perform,US-EMG may have the same specificity as EAS-EMG for the diagnosis of MSA,especially for the diagnosis of MSA patients only with urination disorders,who are involved in Onuf neclear according to some of the abnormal indexes.

Objective To evaluate the clinical,neuroimaging and electrophysiology features of 62 patients with multiple system atrophy(MSA).Methods Sixty-two cases with diagnosis of probable MSA were recruited in a retrospective studied.Clinical,neuroimage and external anal sphincter electromyography (EAS-EMG)data was retrospectively analyzed.Results In 62 cases(44 male and 18 female),the onset age was between 37 and 76.Among them,29 cases(46.8 % )were MSA-A,with orthostatie hypotension as the main clinical manifestation;24 cases(38.7 % )were MSA-C,with cerebellar ataxia ag the main chnical manifestation;9 cases(14.5 % )were MSA-P,with extrapyramidal symptoms as the main clinical manifestation.MRI showed that main lesion of MSA-A was in the cerebellum:that of MSA-C was in the cerebellum,pons and medulla;and that of MSA-P was in the putamen.Fifty-one cases did EAS-EMG and 46 cases showed neurogenie impairments.Nineteen cases were initially misdiagnosed with other diseases.Conclusions MSA is easy to be omitted or misdiagnosed at early stage.The diagnostie rate of MSA can be increased by the combination of clinical expressions,neuroimage,EAS-EMG and other necessary examinations.

Preliminary exploration on subject librarian mechanism and service is carried out in college and university libraries in Chi-na. The paper introduces actual needs, implementation modes, service contents and forms of subject librarian service in Library of China Medical University;hopefully the good experience would provide reference to other medical colleges and universities.