Objective To observe hypoglycemic efficacy of continuous glucose monitoring system (CGMS)combined with continuous insulin infusion(CSII)in the elderly diabetic patients aged 60 years and over.Methods A total 0f 100 elderly diabetic patients were randomly divided into two groups.50 were treated with CGMS or self-monitoring blood glucose(SMBG)and CSII.and whose insulin dose was adjusted based on results of monitoring,and the other 50 with SMBG and insulin pump as controls.whose insulin dose was adiusted based on the results of SMBG for three days.After two weeks.all the patients were monitored by CGMS for blood glucose.Results Mean blood level of glucose and mean amplitude of glycemic excursions(MAGE)were significantly lower in CGMS+CSII group than those in controls[(6.6±2.3)mmol/L vs.(7.5±2.1)mmol/L,and(3.9±0.9)mmol/L vs.(5.1±0.6)mmol/L,respectively,P＜0.05 1.Average insulin dose used was significantly lower in CGMS+CSII group than that in controls [(0.64±0.21)U/kg vs.(0.82±0.41)U/kg,P＜0.05],and duration of hypoglycemia was less in the former than that in the latter[(20±3)min vs.(40± 9)min,P＜0.05 ].Conclnsions CGMS combined with CSII can decrease blood glucose.glucose excursions.average dose of insulin and duration of hypoglycemia in the elderly diabetic patients,as well as prevent occurrence of hypoglycemia.

0.05). After lamivudine treatment, the rate of the transform negative of HBV DNA in genotype C was significantly higher than that in genotype B, and the rate of the bounce of HBV DNA in genotype B was higher than that in genotype C (P 0.05). CONCLUSION: There may be a relation between the effect of lamivudine and the genotype of Hepatitis B virus. The effect of the lamivudine treatment may be better in the patients with genotype C.

ObjectiveTo investigate the correlation between glucose excursions and oxidative stress in the elderly type 2 diabetic patients. MethodsFifty five elderly type 2 diabetic patients (32 males and 23 females) were recruited. All the patients were submitted to continuous glucose monitoring system (CGMS) for three days. According to the result of CGMS monitoring ,the patients were divided into two groups: high glucose excursion group (30 cases) and low glucose excursion group (25 cases). In high glucose excursion group, the therapy was adjusted for 4 weeks based on the CGMS monitoring. After the treatments, the specimens of blood were collected again to detect the related indexes. Results(1) There were no differences in age, blood pressure, fasting blood glucose and glycosylated hemoglobin between the two groups (all P>0.05). The stardard deviation of blood glucose was higher, and the maximun and average amplitude of glycemic excursion were significantly lower in high glucose excursion group than in low glucose excursion group (t= 5. 4620,5. 9416,3. 8281, all P<0.05) ;(2) Compared with low glucose excursion group, plasma concentration of 8-iso-PGF2a was obviously higher in high glucose excursion group[(57.56 ± 3.86)ng/L vs.(34. 21±3. 82) ng/L, t= 18. 221, P=0. 0000)] . (3) Stepwise regression analysis showed that the standard deviation of blood glucose was involved in regression model (β= 1. 959, P= 0. 013).ConclusionsIn elderly patients with type 2 diabetes mellitus, glucose excursion is related with oxidation stress, which suggests that the glucose excursion may be the risk factor for oxidation stress.

目的探讨轮椅技能训练的简单化、实用化和规范化。方法将 216例脊髓损伤住院患者按性别、年龄和损伤平面分为4组进行轮椅技能训练,项目包括绕障碍物行走计时、100m竞速、400m竞速、2柱×10折返跑、上下台和上下坡道,将各项目按成绩分为10个级别,制定出不同组别患者应该达到的水平,评定患者的训练效果。结果训练后,患者的100m、400m竞速、2柱×10跑折返、绕障碍计时成绩和上台(坡)的能力明显提高(P<0.01);训练效果明显75人、有效141人。结论轮椅技能训练可使脊髓损伤患者真正达到生活自理、自立,但应根据患者的损伤平面制定规范化的训练方案。

Objective To explore relationship between excursion of blood glucose levels and cognitive performance in diabetic patients over aged 60 years.Methods A total of 108 diabetic patients over aged 60 years were recruited in this study and they wore under continuous blood glucose monitoring system (CGMS) for three days to evaluate excursion of their mean blood glucose (MBG) level and its standard deviation (SD).All the participants accepted cognitive function tests during continuous blood glucose monitoring, including mini mental status examination (MMSE), Montreal cognitive assessment (MOCA) and clock drawing test (CDT).Relationship of the SD of blood glucose level and cognitive performance in the three cognitive tests was assessed.Data were analyzed with CGMS software version 3.0.Results The SD reversely correlated with scores of MMSE (r = - 0.324, P ＜ 0.01 ) and CDT ( r =-0.325, P = 0.001 ), but they did not significantly correlate with MOCA scores (r = -0.212, P =0.081 ).Statistically significant difference was observed between the SD and scores of all three cognitive tests adjusted for glycosylated hemoglobin Alc (HbAlc) level (r = -0.387, -0.046 and -0.292, P =0.029, ＜0.001 and ＜ 0.001, respectively).The SD reversely correlated with scores of MMSE, MOCA and CDT adjusted for MBG (r= -0.314, -0.466 and -0.345, P ＜0.01, respectively).Results of multivariate linear regression analysis showed that the SD reversely correlated to scores of MMSE, MOCA and CDT (β = - 0.378, - 0.224 and - 0.346, all P ＜ 0.05).Conclusions Excursion of blood glucose levels can influence their cognitive performance in diabetic patients over aged 60 years, leading to decrease in their overall cognitive function and activities as its excursion large enough.

Objective To investigate the clinical and pathological features of Guillain-Barré syndrome with treatment-related fluctuations (GBS-TRF).Methods Clinical data were obtained from medical records of patients with GBS-TRF during the period 1999 to 2014 in our Hospital.Sural nerve specimens were collected and summarized retrospectively (two cases).Results Eight of 868 cases with GBS had at least one TRF including three chronic hepatitis B patients.The onset of disease was ranged in age from six to 63 years, averaging 34 years.It is more common in men than in women in a ratio of seven to one.Triggering infections occurred in three patients.The initial symptom included weakness of the lower limbs (five cases) and upper extremities (three cases).Sensory symptom was presented in six patients.Five patients had associated respiratory paralysis.None of them had cranial nerve palsy or autonomic dysfunction.The examination of cerebrospinal fluid showed protein and cell separation.Five patients had two attacks, one had three attacks and two had six attacks.The interval between attacks ranged between 14 days and 46 days (mean 23 days).The striking pathologic finding was the presence of sectional selective nerve fiber degeneration (SNFD) with evidence of demyelination.Conclusions Patients with GBS-TRF show similar onset age, preceding infection, cerebrospinal fluid findings, and electrophysiologic characteristics comparing to patients with GBS,while there are more male patients than female patients.SNFD found in sural nerve biopsy reveals ischemic neuropathy, which predicts that injury of arterioles might play an important role in the pathogenesis of GBS-TRF.

Covered in the paper are the significance of rural doctors′professional development and their professional characteristics,as well as systematic insights on such key factors of professionalism of these doctors,as their professional qualifications,functional positioning,practicing approach,professional guarantee,professional development,social identity,professional stability,and professionalism.Based on such thoughts,the authors recommend on reforms of professional development for rural doctors by stages and levels.

Objective To explore the expression of protease activated receptors (PARs) on human monocytes. Methods Flow cytometry and RT - PCR was used to detect the expressions of PARs on human monocytes that purified by MACS. Results FACS analysis showed that monocytes expressed PAR - 1 , PAR - 3 , PAR - 4, but not PAR - 2.RT - PCR revealed that monocytes expressed PAR - 1 and PAR -3, but not PAR -2 and PAR -4 mRNA. Conclusion PARs is expressed on human monocyte cells,which may facilitate further investigation of the potential functions of PARs on monocytes.

Objective To investigate the clinical and pathological features of Guillain-Barré syndrome with treatment-related fluctuations ( GBS-TRF ).Methods Clinical data were obtained from medical records of patients with GBS-TRF during the period 1999 to 2014 in our Hospital.Sural nerve specimens were collected and summarized retrospectively ( two cases ).Results Eight of 868 cases with GBS had at least one TRF including three chronic hepatitis B patients.The onset of disease was ranged in age from six to 63 years, averaging 34 years.It is more common in men than in women in a ratio of seven:one.Triggering infections occurred in three patients.The initial symptom included weakness of the lower limbs ( five cases ) and upper extremities ( three cases ).Sensory symptom was presented in six patients.Five patients had associated respiratory paralysis.None of them had cranial nerve palsy or autonomic dysfunction.Five patients had two attacks , one had three attacks and two had six attacks.The interval between attacks ranged between 14 days and 46 days ( mean 23 days ).The striking pathologic finding was the presence of sectional selective nerve fiber degeneration ( SNFD ) with evidence of demyelination.Conclusions Patients with GBS-TRF shows similar onset age , preceding infection , cerebrospinal fluid findings, and electrophysiologic characteristics comparing to patients with GBS ,while there are more male patients than female patients.SNFD found in sural nerve biopsy reveals ischemic neuropathy , which predicts that injury of arterioles might play an important role in the pathogenesis of GBS -TRF.

Objective To evaluate the diagnostic value of endoscopic ultrasound guided fine needle aspiration (EUS-FNA) in combination with flow cytometry (FCM) in lymphoma.Methods From January 2011 to December 2011,the cases of suspicious lymphoma with EUS-FNA examination at Shanghai Ruijin Hospital were retrospectively analyzed.The final diagnosis was according to pathological diagnosis of specimen from the surgery and follow up results.The sensitivity,specificity and accuracy of EUS-FNA combined with FCM in lymphoma diagnosis were initially analyzed.Results A total of 14 suspicious lymphoma patients were collected,eight cases were diagnosed as lymphoma by pathological examination of specimen from the surgery or.tissue from aspiration,four cases were non-lymphoma lesions and two cases still had no final diagnosis.The sensitivity and specificity of FCM alone in lymphoma diagnosis were 4/8 and 4/4 respectively.Six cases of lymphoma were detected by EUS-FNA with FCM.The sensitivity,specificity and accuracy of EUS FNA combined with FCM were 6/8,6/6 and 10/12 respectively.Conclusion EUS-FNA combined with FCM has better diagnostic value in lymphoma,especially for gastrointestinal lymphoma and those surrounding deep lesions.