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.

The therapeutic effects of dermatological preparations for external use are not only dependent on its peculiar pharmacological action of the basis but also closely related to many factors, such as drug concentrations, types of preparation, excipients etc. On the basis of extensively reading the relevant literatures and of author's practical experiences, the above affected faetors were discussed preliminarily.

Objective To assess the safety and effectiveness of prenatal multiple and single course glucocorticoids treatment on preterm birth infants. Method Seven researches on the treatment of preterm birth infants with glucocorticids were meta analyzed. Results Multiple courses of glucocorticoids treatment before labor may lower the incidence of patent ductus arteriosus (PDA) of preterm babies (OR=0.51,95% CI 0.49~0.54),and so did the respiratory distress syndrome (RDS), (OR=0.72,95% CI 0.49~1.07).But it may increase the septicemia of preterm infants (OR=1.62, 95%CI 1.07~2.44),and could not decrease the morbidity and mortality of intracranial hemorrhage (ICH)(OR=0.65, 95% CI 0.37~1.15)? necrosis enterocolonitis (NEC)(OR=1.30, 95% CI 0.79~2.12)and chronic lung disease (CLD)(OR=0.94,95%IC 0.59~1.49)? It cound not decrease the use of pulmonary surfactant after the birth of preterm infants. (OR=0.86,95% CI 0.48~1.55). Conclusions It suggests that multiple courses treatment with glucocorticoids is not safer and more effective than single course before labor.

Objective To discuss the role of p38MAPK signal pathway in the process of TWEAK inducing rheumatoid arthritis(RA) fibroblast-like synoviocyte(FLS) to synthesize MMP-9 and look for a new target for RA treatment. Methods RA FLS were primarily cultured and stimulated with TWEAK. Western blot was used to detect the expression of p-p38MAPK and p65 in RA FLS. FLS were pretreated by SB203580 or not. ELISA was used to detect the concentration of MMP-9 in cell-cultured fluid. The mRNA expression of MMP-9 was measured by RT-PCR. Results TWEAK( 100 ng/ml) can make p38MAPK phosphorylated and increased the expression of p65 protein in the cell nucleus. SB203580 can partially inhibit the expression of MMP-9 and MMP-9 mRNA produced by RA FLS which is induced by TWEAK. Conclusion TWEAK induced RA FLS to synthesize MMP-9, in that process, the p38MAPK signal trausduction pathway was in active state, and induced the expression of NF-κB.

Objective To study the reasons and prophylaxes of conversion to laparotomy during gy-necological laparoscopic surgery. Method Clinical records of 36 cases of conversion to laparotomy out of 1143 cases of gynecological laparescopic surgery were analyzed retrospectively. Results The rate of conver-sion to laparotomy was 3.15%. The reasons of conversion to laparotomy were abdominopelvic cavity adhesion in 23 cases, technical difficulty and complication in 8 cases, malignant tumor in 3 cases, accounting for 63.89%, 22.22%, 8.33%, respectively. The rate of conversion to hparotomy in patients with a history of laparotomy was significantly higher than that without a history of laparotomy. The rate of conversion to laparoto-my in early stage of developing laparoscopic surgery was significantly higher than that in other stages. Con-clusions Abdominopelvic cavity adhesion is the primary reason of conversion to laparotomy during gyneco-logical laparoscopic surgery. Careful evaluation before surgery and improving ability of performance can de-crease the rate of conversion to laparotomy.

Objective To study the effects of vaginal estrogen application on blood flow of the lower urinary tract in post-menopausal women. Methods Arterial blood flow frequency spectrum, peak systolic blood flow, end-diastolic blood flow velocity and resistance index of the peri-urethra and neck of the urinary bladder, as well as changes in their genitourinary system, were measured with color Doppler ultrasound imaging in post-menopausal women before and three months after their use of premarin ointment containing natural estrogen per vagina. Results Three months after treatment with estrogen-premarin ointment per vagina in post-menopausal women, their peak systolic blood flow velocity of the peri-urethra arteries increased to 13.23 cm/s from 11.94 cm/s before treatment, end-diastolic blood flow velocity increased to 3.92 cm/s from 1.91 cm/s and resistance index decreased to 2. 79 from 3. 84 (P <0. 01 ). And, their peak systolic blood flow velocity of the arteries of the neck of the urinary bladder increased to 17.09 cm/s from 12. 77 cm/s before treatment, end-diastolic blood flow velocity increased to 2. 83 cm/s from 1.31 cm/s and resistant index decreased to 2. 78 from 3.78 (P<0.01). It indicated that local vasodilatation and decrease dresistance of the lower urinary tract made blood flow of the arteries of the peri-urethra and neck of the urinary bladder increase, urinary frequency and nocturia occurrence decrease, and sexual satisfaction improve.Conclusions Blood flow, symptoms of the lower urinary tract and their quality of life can be improved in post-menopausal women after treatment with natural estrogen-premarin ointment per vagina.

Objective To analyze the pressure source and effect of comprehensive intervention in type 2 diabetes mellitus patients. Methods 200 diabetes patients were randomized into the observation group and the control group with 100 cases in each group. Comprehensive intervention was introduced into the observation group and the control group underwent routine treatment. The pressure source was investigated after intervention by questionnaires and the results were compared. Results Fearing of serious complications bocame the most common cause of pressure. The scores of Self-rating Depression Scale(SDS)and Self-rating Anxiety Scale(SAS)were lower and the biochemical index was also better in the observation group than those in the control group as well as those before intervention in the observation group(P＜0.05).Conclusion The depression, anxiety status and biochemical index in patients with type 2 diabetes mellitus were effectively controled by corresponding and comprehensive intervention measures according to the sequence order of pressure source.

Objective To investigate the effectiveness of system approach to management on prenatal health care in floating population. Methods The prenatal care was managed through establishing "Contact handbook on the health of pregnant women in Shanghai" for 505 lying-in women from the floating population of Minhang District. The condition of antenatal health care, the outcome of gestation and related factors were investigated and the results were compared to those reported in literatures. Results After system approach to management, the rate of having 1 - 3 antenatal examinations accounted for 32.1% ( 162/505 ), that of 4 - 8 examinations accounted for 43.0% ( 217/505 ), that ≥ 9 examinations accounted for 15.6% (79/505), which were higher than that reported by Zhuang Chanjuan (P = 0.001 ). Among 458 responders 185 (40.4% ) thought the cost for prenatal examination was "high" or "too high". Among 293 responders, 211 (72.0%) did not establish the contact handbook due to "not knowing the handbook" or "not clear about the process". The frequency of antenatal examination was associated with education levels of the lying-in women ( P =0.000) , whether their husbands being native Shanghainese or not ( P =0.002)and establishing contact handbood ( P = 0.002). Conclusions System approach to management promotes the utilization of antenatal health care for floating population, establishing contact handbook is a workable method to promote the utilization.

Objective To study the serum small dense low density lipoprotein-cholesterol (sdLDL-C)concentration in patients with clinical and sub-clinical primary hypothyroidism,and to explore the clinical significance of serum sdLDL-C determination in pa-tients with hypothyroidism.Methods 60 patients with clinical hypothyroidism(clinical hypothyroidism group),96 cases with sub-clinical hypothyroidism(sub-clinical hypothyroidism group)and 132 normal subjects (normal group)were enrolled in the study. FT3,FT4,thyroid stimulating hormone (TSH),TG,TC,HDL-C,LDL-C,apolipoprotein AⅠ(ApoAⅠ),apolipoprotein B (ApoB), and sdLDL-C concentrations were measured.Analysis of Variance,Kruskal-Wallis H test and Spearman rank correlation analysis were used for statistical analysis.Results The concentration of sdLDL-C in sub-clinical hypothyroidism group was significantly higher than that in normal group (t=5.78,P <0.01),the concentration of sdLDL-C in clinical hypothyroidism group was signifi-cantly higher than that in sub-clinical hypothyroidism group(t=-2.88,P <0.01)and in normal group (t=6.68,P <0.01).There was statistically significant difference among groups (F =37.66,P <0.01).Correlation analysis showed that sdLDL-C in primary hypothyroidism patients was positively correlated with LgTSH (r =0.203,P =0.011 ),and negatively correlated with FT4 (r =-0.169,P =0.035).Conclusion The high concentration of sdLDL-C is a manifestation of dyslipidemia in primary hypothyroidism patients,and an important risk factor for atherosclerosis in primary hypothyroidism patients.