Objective To evaluate the efficacy and safety of acarbose tablets combined with protamine zinc recombinant lai pulp mixing insulin injection in the treatment of elderly patients with type 2 diabetes.Methods 170 elderly patients with type 2 diabetes were randomly divided into the observation group and the control group.85 cases in the observation group were given acarbose tablets combined with protamine zinc recombinant lai pulp mixing insulin injection,85 cases in the control group received aspart 30.The patients were followed up for 12 weeks,the blood glu cose levels,blood glucose fluctuation,glycosylated hemoglobin (HbAlc),the incidence of hypoglycemia and insulin dosage were observed.Results' The level of fasting plasma glucose (FPG) (t =9.92,P ＜ 0.05),2h postprandial blood glucose(2hPG) (t =18.18,P ＜0.05),the mean blood glucose within 4h(t =13.62,P ＜0.05),days of average blood glucose fluctuations (t =14.56,P ＜ 0.05) of observation group dropped significantly compared with that before treatment;HbAlc achieved rate(6.5％)of the observation group and control group were 35.29％,28.23％,re spectively,HbAlc achieved rate (7.0％) of observation group and control group were 57.64％,52.94％,the differences were not statistically significant(all P ＞ 0.05).The dose of insulin was significantly lower in the observation group(20.11 ±3.36) u/d than(35.78 ±4.68) u/d in the control group(t =25.08,P ＜0.01).There were 2 cases of hypoglycemic events and 3 cases in the control group.Conclusion Protamine zinc recombinant insulin lispro injection combined with acarbose has reliable clinical efficacy and safety.

The article gives a brief account of the application of clinical observation to the evaluation of medical students' core competence. It expounds the key points in the assessment about their professional values,attitudes and behavior, emphasizing the application scope, working principle and advantages and disadvantages in the rank evaluation as well as the methods to enhance the effectiveness of evaluation.

Objective To compare the clinical effectiveness among disposable circumcisionsuture device and Shang Ring in treating redundant prepuce and phimosis.Methods The clinical data of 224 cases of circumcisions done by disposable circumcision suture device(n =112)and Shang Ring(n =112)were retrospective1y analyzed. Operation time,intra -operational bleeding and postoperative complications among two techniques were compared. Results Disposable circumcision suture operation and Shang ring circumcision without significant difference in the operation time and intra -operational bleeding.There result was (6.1 ±0.8)min vs (6.5 ±1.7)min and (2.0 ±0.0)mL vs (1.8 ±0.0)mL(P >0.05).The incidence of postoperative complications with incision pain rate was 21.43% vs 50.89%,infection rate was 14.29% vs 6.25%,frenum area incision edema rate was 8.04% vs 25.89%,and the postoperative hematoma and healing time was (8.0 ±1.7)d vs (14.0 ±1.2)d,the differences were statistically significant(P <0.05).Conclusion Each of two techniques has its own advantages and disadvantages.The treatment decision making should be a detailed description to the patients,we propose that school -age children should choose Shang Ring built -in method and the others should use disposable circumcision suture device depending on the situation.

Guided bone regeneration technique (GBR) is regarded as one of the most important methods to increase the bone amount of alveolar ridge, which is often recommended to be applied in the dental implantation surgery. Barrier membrane is utilized in GBR technique to cover the bone defect and create a secluded space, which prevents the connective tissue from growing into the space and facilitates the growth priority of bone tissue. In recent years, along with the emerging of different kinds of barrier membranes and bone grafting materials, the scope of clinical application of this technology is continuously expanded. This article reviews the classification and property of the membranes and the application situation of guided bone regeneration technology in the field of dental implantation.

Purpose To investigate the clinical pathological features, pathological diagnosis and differential diagnosis of the non-Wilms’ renal tumors in children. Methods The clinical pathological data and immunohistochemical findings of 15 cases of non-Wilms’ renal tumors were retrospectively analyzed with review of the relevant literature. Results In 7/15 (46. 67%) cases of cystic nephroma ( CN) , microscopically the variable size of cysts were lined by a single layer flattened, cuboidal epithelia, separated by fi-broblastic stroma;in 4/15 (26. 67%) cases of rhabdoid tumor of kidney (RTK), histological characteristics were rhabdoid cells and cytoplasmic inclusions;in 2/15 (13. 33%) cases of clear cell sarcoma (CCSK), the classical pattern of histology demonstrated nests, cords of ovoid epithelioid or spindled clear cells separated by fibrovascular septa, which had a marked ’ chicken wire’ pattern of small blood vessels;in 1/15 (6. 67%) case of congenital mesoblastic nephroma (CMN), the tumor was mainly composed of spindle cells arranged in fascicular pattern, in which fetal renal tissue was seen;in 1/15 (6. 67%) case of granularity renal cell carcinoma, micro-scopically, the cancer cells with eosinophilic granular cytoplasm arranged in nests, cords and tubular pattern. Conclusions Although non-Wilms’ renal tumors is a small part of all kidney tumor, it is difficult to diagnose and distinguish from other tumors before opera-tion. The pathological diagnosis is the most reliable method for differential diagnosis of non-Wilms’ renal tumor.

Objective To define the correlation between mutation of DNA-LigaseⅣ gene and radiosensitivity.Methods Nasopharyngeal squamous carcinoma cell line (CNE), lung adenocarcinoma cell line (SPC-A1) and breast adenocarcinoma cell line(MCF-7) after irradiation were assessed with specific biological parameters. Polymerase chain reaction, cloning and sequencing techniques were used to determine the sequence of DNA-LigaseⅣ gene in these three cell lines. Then the impact of homologous change and mutation on hydrophicity-hydrophobicity of genic products was analyzed.Results The surviving fractions derived from irradiation were different with more radiosensitivity in the CNE cell line than in the others. In three cell lines, the homology of LigaseⅣ gene were: 99.95%,99.99%,99.98%, respectively. Some mutations including transversion and transition were detected and led to alterations in the hydrophicity-hydrophobicity function of products. Higher radiosensitivity of CNE was associated with amino-acid substitutions: 313aa His→Arg,538aa Gly→Arg,579aa Lys→Arg and 585aa Asn→Ser.Conclusion These results suggest that LigaseⅣp play an important role in the ligation of DNA double strand breaks and certain mutations bring about changes in radiosensitivity.

Objective To observe the enhanced inhibitory effect of adenovirus (Ad)-mediated HCCS1 combined with 5-FU on the growth of LoVo cells, and to explore the molecular mechanisms.Methods RT-PCR and Western blot were used to detect the expression of HCCS1 in LoVo cells infected with Ad HCCS1. CCK-8 assay was applied to observe different inhibitory effects of different treatments on growth of LoVo cells. The apoptotic rates were detected by using flow cytometry. The apoptotic proteins were detected by using Western blot. Results ① The recombinant adenovirus, Ad HCCS1, could trigger the expression of HCCS1 in LoVo cell. ② In comparison with controls (92.23%±3.77%), the cell viability rate of LoVo was only (11.23±4.61 )% on 96 h after the combination treatment of 5-FU and Ad-HCCS1 (P<0. 01). ③ The apoptotic rate was (27.57±1.78)% on 72 h after the combination treatment, which was higher than that in 5-FU treated cells (8.64±0.94)%, Ad-HCCS1 treated cells (13.19±1.32)% and 5-FU Ad treated cells (12.16±1.28)%, (P<0. 01). ④ Cathepsin D was only detected in Ad HCCS1-infected cells. When treated with 5-FU, the procaspase-8 was decreased and the cleaved Bid was increased in cytosol. The lowest level of Bax and the highest level of cytoso C and cleaved caspase-3 were detected in cytosols of 5-FU+Ad HCCS1 treated cells. Conclusion The inhibitory and proapoptotic effects are significantly enhanced in LoVo cells when treated with Ad-HCCS1+5-FU. The key protein of the cross-talk is Bax and these data provided a new strategy to treat colorectal carcinomas.

Objective To evaluate extended vs standard left lateral lobectomy for left lateral lobe hepatolithiasis.Methods A retrospective study was conducted on the clinical data of 110 patients who underwent hepatectomy for hepatolithiasis limited to left lateral lobe of the liver.Results 42 patients received left lateral lobectomy, 68 patients did left hemihepatectomy.There were no marked difference between the two groups in the operation time, introperation or postoperation blood loss, bile leak and bleeding on the hepatic cut surface, liver function and the postoperative hospital stay.The incidence of residual and recurrent stones was 14.3％ and 11.9％ in left lateral lobectimy group and 0％, 0％ in left hemihepatectomy group.Conclusion Left hemihepatectomy for left lateral lobe hepatolithiasis is a safe and effective procedure.

Objective:To evaluate the effects of intermittent change the angle of operating table on the skin in pressure areas of patients in prone position.Methods:A total of 150 hospitalized patients for elective surgical treatment in Yantai Yuhuangding Hospital from January 2019 to June 2019 were selected as subjects. The patients were divided into control group, 15° test group and 30° test group by random number table method, with 50 patients in each group. The control group received routine intraoperative pressure ulcer prevention measures, the 15° test group on the control group, the itinerant nurses adjusted the angle of the operating table according to the left 15°-supine-right 15° every half hour, and the 30° test group on the control group, the itinerant nurses adjusted the angle of the operating table according to the left 30°-supine-right 30° every half hour. The incidence of surgically related pressure ulcers and doctors' satisfaction with the surgical position of the three groups of patients were evaluated.Results:Pressure ulcers occurred in 8 patients of the control group, the incidence of pressure ulcers was 16%. Pressure ulcer occurred in 0 patient of the 15° test group, the incidence of pressure ulcers was 0. Pressure ulcers occurred in 2 cases in the 30° test group, the incidence of pressure ulcers was 4%. The difference was statistically significant ( χ2 value was 10.120, P<0.05). Further comparison showed that the incidence of pressure ulcers was statistically significant between the control group and the 15° test group ( P<0.016 7), while the incidence of pressure ulcers was not statistically significant between the control group and the 30° test group, between the 15° test group and the 30° test group ( P>0.016 7). The results of the postoperative doctors' satisfaction with the surgical body position were (27.880 ± 1.637), (27.520 ± 1.693), (26.920 ± 1.947) points in the control group, the 15° test group and the 30° test group, there was a statistically significant difference among the three groups ( F value was 3.779, P<0.05). Further comparison showed that there was no statistically significant difference in the score of surgical position satisfaction between the control group and the 15° test group, between the 15° test group and the 30° test group ( P>0.05). The satisfaction score of surgeons in the control group was higher than that in the 30° test group, and the difference was statistically significant( P<0.05). Conclusions:Intermittent adjustment of surgical position can reduce the incidence of pressure ulcers and improve the quality of nursing in the operating room without affecting the convenience of the surgeon. The optimal effect was achieved by adjusting the angle of the operating bed according to the left-leaning 15°-supine-right-leaning 15°at an interval of 30 minutes.

To analyze the cause and therapy of hydrops in subcutaneous scalp after repairing skull defect by using silicon-polyester fiber network, a total of 91 patients who were treated with silicon-polyester fiber network to repair skull defect from June 1996 to October 2000 in the Department of Neurosurgery, Nanshan People's Hospital were analyzed retrospectively. And 56 cases of them had hydrops of subcutaneous scalp and treated with suction and pressure dressing, including 11 cases of less than 20 mL hydrop quantity, 27 cases of 20-50 mL, and 18 cases of more than 50 mL. They were observed for 6 weeks averagely after operation and were healed within 4 weeks by simple management. No recurrence of hydrops was found in subcutaneous scalp. It is indicated that silicon-polyester fiber network in repair of skull defect may complicate with hydrops of subcutaneous scalp usually. However, the prognosis will be good by means of drainage, so it can be used as a therapy for skull defect.