Objective To detect and analyze the insulin resistance and islet beta cell function under different glucose metabolic state in the elderly.Methods 30 cases with impaired fasting glucose (IFG),impaired glucose tolerance (IGT),IFG plus IGT,diabetes mellitus (DM) and normal glucose tolerance (NGT) respectively were selected.The HOMA model was adopted for assessing insulin resistance and islet beta cell function.Results Insulin resistance index (HOMA-IR) was higher in IFG group (1.16±0.03) than in NGT group (0.87±0.03) (P＜0.05).The HOMA-IR was higher in IFG and IGF groups than in NGT group (both P＜0.05).The insulin secretion index (HOMA-IS) was lower in DM (3.95±0.06) than in NGT (5.15±0.05),IGT (5.13±0.03) and IFG (4.56 ± 0.07) groups (all P＜0.05).There was no significant difference in the HOMA-IS between IGT and NGT groups.Conclusions The IFG patients mainly present the defect in insulin secretion,and the IGT patients mainly present insulin resistance.With the deterioration of glucose metabolism,insulin resistance increases and islet beta cell function decays gradually.

“The guideline for the diagnosis and management of thyroid diseases during pregnancy and postpartum in China” written by Chinese Society of Endocrinology and Chinese Society of Perinatal Medicine is now formally published.This guideline was written following the principles of “based on the national conditions,evidencebased medicine,being innovative and realistic,and resource sharing”.It is modeled on the guideline issued by American Thyroid Association in 2011,joining the research of domestic scholars and combining with the actual situation of domestic clinical work and maternal and child health.This guideline contains 11 chapters,taking question terms and recommendation terms in the model,and a total of 68 problem terms and 57 recommendation terms.This paper deeply discusses the problems about the diagnosis and treatment of subclinical hypothyroidism during pregnancy,as well as the importance of establishing gestation-specific TSH reference interval.

OBJECTIVE:To explore the effects of tirofiban with different medication timing on blood flow and complications in patients with acute myocardial infarction after percutaneous coronary intervention(PCI). METHODS:214 cases of acute ST-seg-ment elevation myocardial infarction were divided into late stage group(n=98)and early stage group(n=116)based on the order of admission. Te latter was given intravenous injection of tirofiban after PCI;the former was given intravenous injection of tirofi-ban before entered emergency room [1-2 h before PCI]. The injection-balloon dilation time was compared between 2 groups. The coronary TIMI flow situation,cardiac function and microcirculatory perfusion index before and after operation,and complications during hospitalization were also compared. RESULTS:Intravenous injection of tirofiban to balloon dilation time were 3-40 min in early stage group,and 30-65 min in late stage group,with statistical significance (t=8.94,P=0.00);during angiography,the number of patients with IRA prorsal blood flow rate to reach 2 and 3 grade was 16 cases(13.8% and 20 cases(17.2%)in early stage group,which were higher than in late stage group [7 cases (7.1%),9 cases (9.2%)],with statistical significance (P<0.05). After PCI,occluded artery of 2 groups opened up,there were 2 cases of no-reflow in early stage group and 6 cases of no-re-flow;there was no statistical significance in 3 grade blood flow of TIMI between 2 groups(χ2=1.21,P>0.05). The amount of 4 and 8 h creatine kinase MB,and postoperative 24 h LVEF of 2 groups were similar after operation,without statistical significance (P>0.05);ST segment of early stage group drop value was (1.93 ± 0.57) mm,which was significantly higher than that of late stage group(1.07±0.29)mm,with statistical significance(P<0.05);the incidence of cardiac adverse events and bleeding compli-cation were 3.45%and 7.76%in early stage group,and 4.08%and 5.10%in late-stage group,without statistical significance(P<0.05). CONCLUSIONS:Different medication timing has no significant effect on the safety of tirofiban,but clinical outcomes and angiographic results are consistent. However,early treatment can improve IRA prorsal blood flow rate before PCI,which is the good medication timing of tirofiban.

Objective: This study was to evaluate the effects of inhalation of nitric oxide combined with intravenous phenylephrine on the arterial hypoxemia and tissues acidosis in patient with tetralogy of Fallot. Method: The 34 pa tients were randomly divided into Ⅰ(n=17) and Ⅱ(n=17) groups. In both groups, when the patient's SpO_2 was less than 80%, the intervention began. In Ⅰ group,a bolus dose(1?g/kg) of phenylephrine was given intermittently, until the SpO_2 was large than 90% or blood pressure increased to 120%, of baseline. In Ⅱ group, inhalation of 20 ppm NC was combined with intermittent bolus of phenylephrine 1?g/kg. Result: The value of SpO_2, MAP and BE had no sig nificant differences between two groups at pre-treatment. In Ⅱ group, SpO_2 was higher, meanwhile MAP, the negative value of BE,the total dose of phenylephrine used were lower than those in Ⅰ group after treatment (P

hypothyroidism is a common subclinical disease in endocrinology. Its diagnosis is based on an elevated serum TSH but normal FT 4 levels. The adverse outcome of subclinical hypothyroidism is progressing to overt hypothyroidism with an increased risk for atherosclerosis and myocardial infarction . Two factors may affect the development of overt hypothyroidism: the levels of serum TSH and thyroid autoantibodies and both factors have additional effects on the outcome. The benefits of treatment with T 4for preventing the development of overt hypothyroidism is not yet certain; subclinical hypothyroidism is a strong indicator of risk for atherosclerosis and myocardial infarction, just like other known major risk fators such as hypercholestrolemia, hypertension, smoking and diabetes (odds ratio for aortic atherosclerosis 1.9; odds ratio for myocardial infarction 3.1). The treatment with T 4 for the patients could reduce the levels of serum cholesterol. The effects of subclinical hypothyroidism in pregnant women on the IQ of their children have been widely focused. According to the results from a published epidemiological study, the normal reference values of TSH, thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TgAb) detected by immunochemiluminesence assay (ICMA) method and the cut-off values of TPOAb and TgAb associated with thyroid diseases have been proposed.

Recently, more and more attention have been paid to the impact of maternal thyroid hormones on neuropsychologic development of offspring. In the first 20 weeks of gestation, neuropsychologic development of the fetus is mostly dependent on thyroxine from the mother. Limited epidemiological data showed that full-scale WISC IQs averaged 7 points lower among children born to mothers with undiagnosed thyroid deficiency during pregnancy, in comparison with control children. The main cause of subclinical maternal hypothyroidism is autoimmune thyroiditis. Data from basic studies have confirmed the impacts of maternal thyroid hormones on the neurodevelopmental outcomes of offspring. In a Chinese female population, the positive rate of thyroid autoantibodies was 11.0%, and the prevalence of postpartum thyroiditis was 11.9%. Hence, it is necessary to set up a screening schedule for subclinical hypothyroidism and autoimmne thyroiditis in pregnant women, which is of great value for the health of both women and children.

Objective To analyze the clinical characteristics and curative effects of myoclonic epilepsy in children. Methods 35 cases were used to retrospectively study to analyze the medical history、clinical features and treatments.Results 7 patients(20%) had a family history of epilepsy while 11 cases(31.4%) had a history of febrile convulsion.The first onset was about at the age of 8.0?2.4. The first onset of myoclonic seizure and generalized tonic-clonic seizure would be put off and the diagnostic time would be delayed by 3.4 years.EEG induced by sleep and/or flash could raise the epileptic detectable rate.6 children had a tendency to be aggravated during the treatment.2 cases died of severe myoclonic epilepsy.28 patients(80%) were treated only by sodium vedproate and the effects were satisfying.Conclusion It is easily wrongly diagnosed and treated. Taking small dose of sodium vedproate drugs,the patients have better treatment effects.The children with severe myoclonic epilepsy have poor prognosis and high death rate.

In the complex interpersonal relationships,due to its specificities,the physician-patient relationship has drawn great attention from clinical doctors,patients and medical experts.The physician-patient communication is a skill.A harmonious physician-patient relationship can only be constructed by both the doctors and patients sharing their good faith and sincerity during their communication process.

This paper introduces the concept, characteristics and applications of fault tolerant technique, which can ensure high availability of network server.

Objective:To evaluate the present development and service offering of community health service(CHS) institutions in Chongqing City,to find the main problems at present,and provide the solving proposal.Methods:All the CHS institutions in 35 counties of Chongqing were surveyed;the CHS institutions of main city zone were investigated by stratified random sampling,and their principals were interviewed.Results:The new health service system of two levels have been established,but there are still several problems.The total number of CHS institutions is inadequate.Foundational construction of CHS station is not good.It's widespread that CHS institutions support their medicine sevice with drugs-income and their public heath sevice with medicine-income.The public health sevice is weakened.For the dual referral system,it's easy to refer up and hard to refer down.Conclusion:At present government should increse finance aid,improve management and monitor mechanism,strengthen the foundation construction,and further consummate the training system of personnel,and a GIS System should be built to help improve the Dual Referral System.