Objective To investigate the clinical effect and safety of linagliptin combined with insulin aspart 50 in the treatment of hepatogenous diabetes (HD).Methods A total of 57 patients with HD who visited The People's Hospital of Liaoning Province from October 2014 to February 2016 were enrolled and randomly divided into insulin aspart 50 group (group A,28 patients) and linagliptin combined with insulin aspart 50 group (group B,29 patients).The two groups were compared in terms of blood glucose,insulin,C-peptide,glucose disposition index (DI),glycosylated hemoglobin A1c (HbA1c),glucagon,and daily insulin dose at baseline and after 12 weeks of treatment.The adverse events including hypoglycemia were observed.The paired t-test was used for comparison of continuous data within one group,and the independent-samples t test was used for comparison of continuous data between groups;the chi-square test was used for comparison of categorical data between groups.Results After 12 weeks of treatment,both groups had significant reductions in blood glucose at four time points (t =5.357-21.380,all P ＜ 0.05) and significant increases in the insulin level at 30,60,and 120 minutes (t =2.222-6.491,all P ＜0.05).Compared with group A,group B had significantly lower levels of HbA1c and glucagon,daily insulin dose,and blood glucose and insulin levels at 30,60,and 120 minutes (t =3.136-15.096,all P ＜ 0.05),as well as significantly higher DI and levels of C-peptide at four time points (t =2.994-10.813,all P ＜ 0.05).Group A had a significantly higher incidence rate of hypoglycemia than group B (28.6％ vs 3.4％,x2 =5.005,P ＜ 0.05).Conclusion Linagliptin combined with insulin aspart 50 can effectively control blood glucose in patients with HD and has good safety.

Objective To compare the sensitivity and specificity of neutrophil CD64 and C-reactive protein( CRP) in the diagnosis of bacterial infection by Meta-analysis. Methods A computerized literature search of PubMed,Embase and Science Citation Index Expanded was conducted to retrieve studies related to evaluating the diagnosis value both of neutrophil CD64 and CRP in bacterial infectious diseases before January 2015. The methodological quality of each included study was assessed. The method of statistical analysis was dichotomous Meta- analysis using STATA 12. 0 software. Results Ultimately we included a total of 10 studies with 1 057 specimens in neutrophil CD64 group and 1 063 specimens in CRP group. Neutrophil CD64 compared with CRP in the sensitivity,OR=1. 755,95%CI(1. 041,2. 958),P=0. 035,while in the specifici-ty,OR=0. 620,95% CI(0. 442,0. 870),P=0. 006. Conclusion In the diagnosis of bacterial infectious dis-eases,neutrophil CD64 is better than CRP in the sensitivity,but,CRP is better than neutrophil CD64 in the specificity.

OBJECTIVE:To virtually screen potential α-glycosidase inhibitor ingredients from C. mori and F. mori,and to pro-vide reference for finding out new typeα-glycosidase inhibitor ingredient. METHODS:Surflex-Dock module of Sybyl-x 2.0 molecu-lar simulation software was used to perform the docking of small molecule compound,which was from the ingredients of C. mori and F. mori as ligand stated in literatures,with α-glycosidase. Total score of affinity scoring function was equal to 7 as the thresh-old value,to judge potential α-glycosidase inhibitor ingredient in C. mori and F. mori. RESULTS:After 70 small molecule com-pounds docked with α-glycosidase, 10 compounds showed binding activity (Total score≥7.00). Among them, moracin M-3′-O-β-D-glucopyranoside,5,7,2′-trihydroxyflavanone-4′-O-β-D-glucoside,mulberroside A,resveratrol-4,3′-di-O-β-D-gluco-pyranoside and 1,4-dideoxy-1,4-imino-(2-O-β-D-glucopyranosyl)-D-arabinitol had higher binding activity with α-glycosidase(Total score>8.00). CONCLUSIONS:Multi-constituents of C. mori and F. Mori show potential α-glycosidase inhibitory activity. The method is a kind of highly targeted,rapid and efficient approach to discover α-glycosidase inhibitor from traditional Chinese medi-cine.

Objective To effectually record cardiopulmonary resuscitation (CPR) procedure, analyze and compare the CPR performance of all medical and nursing staffs to find out the existed information for the improvement of the quality of CPR and its survival rate. Methods The medical data were collected according to the Utstein Criteria and CPR event was automatically recorded by a digital video-recording system, by which hands-off times within 10 minutes of CPR and times for installation of chest compression machine, establishment of endotracheal intubation and establishment of the venous channel were analyzed. Multiple regression analysis was conducted to analyze the factors affecting CPR effect. Results ① During the period from December 2009 to December 2015, a total of 376 patients with cardiac arrest (CA) was registered, including 248 males and 128 females, with a median age of 68 (53, 78) years. Estimated median time interval from CA to CPR initiation was 5.0 (0.1, 20.0) minutes and there were 189 cases less than or equal to 5 minutes. The acute myocardial infarction (AMI) with 145 cases (38.6%) was the main etiology of CA. Initial shockable rhythm was found in 16 patients (7.0%) out of 230 out-of-hospital cardiac arrest (OHCA) patients, of whom 13 underwent ventricular fibrillation (5.7%), 3 underwent ventricular tachycardia (1.3%). Initial shockable rhythm was found in 47 patients (32.2%) out of 146 in-hospital cardiac arrest (IHCA) patients, of whom 40 underwent ventricular fibrillation (27.4%), and 7 underwent ventricular tachycardia (4.8%). CPR by a mechanical device (Thumper) was performed in 219 patients (58.2%). In 376 patients, 186 patients had return of spontaneous circulation (ROSC, 49.5%), a successful CPR (ROSC ≥ 24 hours) was found in 110 patients (29.3%), 99 patients was hospitalized alive (26.3%) and 40 patients were discharged alive (10.6%). In 146 cases of IHCA, 89 patients had ROSC (61.0%), a successful CPR was found in 63 patients (43.2%), 56 patients were hospitalized alive (38.4%), and 29 patients were discharged alive (19.9%). In 230 patients of OHCA, 89 patients had ROSC (38.7%), 65 patients received pre-hospital CPR (28.3%), a successful CPR was found in 47 patients (20.4%), 43 patients were hospitalized alive (18.7%), and 11 patients were discharged alive (4.8%). There were 37 patients had a successful CPR (69.8%), and 25 patients were discharged alive (47.2%) in 53 patients with ventricular fibrillation. ② There were 77 patients with valid video information for analysis of CPR performance, with 48 patients of OHCA, and 29 patients of IHCA. Delay median time from the patients presence in the resuscitation room to be placed in rescue bed was 22 (0, 33) seconds. Hands-off median times during 10 minutes of CPR was 41 (18, 90) seconds. Thumper installment median times was 43 (31, 69) seconds. Median time for endotracheal intubation was 59 (35, 109) seconds. Median time of venous catheter placement was 112 (70, 165) seconds. It was shown by multivariate regression analysis that there was a significant correlation between estimated time interval from CA to CPR performed, hands-off time and success rate of CPR (t1 = -3.452, t2 = -2.729), rate of discharge alive (t1 = -2.328, t2 = -2.736, all P < 0.05). In 48 OHCA patients, success rate of CPR was significantly correlated with estimated time interval from collapse to CPR performed (t = -2.409, P = 0.021). In 29 IHCA patients, success rate of CPR and rate of discharge alive was significantly correlated with hands-off times (t1 = -3.412, t2 = -2.536, both P < 0.05). Conclusions Survival to hospital discharge following CA is significantly correlated with the time interval from collapse to CPR performed and hands-off times in CPR. Installment and usage of Thumper should be postponed in order to reduce hands-off times during CPR in IHCA.

Objective To investigate the characteristics of growth and angiogenesis of colon cancer xenograft in nude mice with metabolic syndrome induced by high fat diet.Methods Female BALB/C nude mice were fed with high fat diet (45.0％ from fat,HFD group) or common diet (13.8％ from fat,CD group) for 12 weeks (n=15,respectively).Colon cancer cell line SW480 was marked with green fluorescent protein (GFP) and subcutaneous xenograft model was established.The tumor growth was observed by the in vivo imaging system in small animal at the 4th week.By the end of the experiment,serum glucose and lipid level of the two groups were measured,visceral subcutaneous and visceral adipose tissue,liver and xenograft tumor were dissociated and weighted.The differences of proliferating cell nuclear antigen (PCNA) and CD31 expression in the tumors between groups were analyzed.The t-test or x2 test were performed for group comparison.Results Compared with CD group,the body weight,blood serum glucose level,triglyceride and cholesterol level,adipose content of subcutaneous and visceral of the HFD group significantly increased (t=2.91,4.12,4.43,3.92,3.77 and 4.02,all P＜0.05).Averagedaily energy intake of HFD group was significantly higher than that of CD group (t=2.34,P＜0.05).There was no significant difference between the two groups in liver weight (t=1.02,P＞0.05).However,by HE staining lipid vacuoles in the liver tissue was obvious in HFD group.Average bioluminescent index,tumor volume and weight of xenografts of HFD group were remarkably higher than those of CD group (t=8.84,2.48 and 2.86,all P＜0.05).The immunohistochemical staining results indicated that the strong positive rate of PCNA in xenografts of HFD group was 80.00％ and the microvessel density (MVD) was (25.75±0.96)/per high power field,both of which were higher than those of CD group (14.29％ and (13.33±1.53)/per high power field respectively,x2 =12.52,t=13.35,both P＜0.01).Conclusions The colon cancer xenograft in nude mice with metabolic syndrome induced by high fat diet had a high MVD and grew fast.

Endocrine therapy is one of the main treatment for hormone receptor positive breast cancer. In recent years, some of the critical results of clinical studies have been published, triggering a heat discussion. Guidelines and expert consensus have made appropriate updates based on some results. However, the selection and duration of the endocrine therapy for premenopausal women, the judgment of the menstrual conditions, the application of ovarian function suppression and the choice of endocrine drug combining with ovarian function suppress, and monitoring the endometrial thickness and hormone levels during therapy, as well as the endocrine therapy for postmenopausal patients and metastatic cancer are still controversial. Based on the evidence from study and clinical experience, this article will focus and discuss the ten hot issues.
Breast Neoplasms ; Humans

Objective:To explore the early diagnosis and correct treatment of neurogenic pulmonary edema (NPE) and review the literature.Method:Retrospective analysis was performed in six patients diagnosed as NPE who were admitted to the emergency department of Tianjin Third Central Hospital from March 2017 to March 2021.Results:Six patients had acute onset, presenting severe dyspnea and hypoxemia, and obvious wet rales could be heard in both lungs. The white blood cell count (WBC) increased to varying degrees (11-22)×10 9/L, procalcitonin (PCT) was normal, or slightly increased, sputum bacteriological examination was negative, and oxygenation index was < 200 mmHg (1 mmHg≈0.133 kPa). Chest CT mainly showed patchy or patchy exudation. The lesions were of different sizes and were not distributed according to lobes. By reducing intracranial pressure, ventilator assisted breathing, liquid therapy, anti-infection therapy with antibiotics, nutritional support, all six patients were well and discharged, and no one died of NPE. Conclusions:NPE has complex condition, acute onset and rapid development. Early diagnosis and correct treatment can improve the success rate of treatment and prognosis of patients with NPE.

Implementation strategy is a method or technique that enhances the adoption,implementation,and routine practice of evidence-based interventions in real-world healthcare situations,and is an important part of evidence transformation.Implementation mapping provides a practical tool for developing implementation strategies.This review introduces the concept and features and implementation steps of implementation mapping,commonly used theories,frameworks and models,and its application in evidence transformation and featureand application projects,in order to promote the use of implementation mapping in domestic evidence transformation research.

Objective To analyze of the effect of artificial lengthening femoral head replacement in elderly patients with stage Ⅰ of unstable femoral intertrochanteric fracture.Methods 203 patients with stage Ⅰ of unstable femoral intertrochanteric fracture were selected as the research object,and they were taken artificial lengthening femoral head replacement,among which 65caese were male,female in 138 cases.The Harris scoring,SF-36,VAS pain scores on admission,2 weeks after operation,postoperative follow-up limb were counted,and the pain of the affected limb and the hip scores were compared amond 3 time periods.Results All 203 cases of senile patients with follow-up,average operation time was 83.64 minutes,the intraoperative blood loss was 355.41mL.The curative effect was evaluated according to the Harris score,SF-36 and VAS pain scoring criteria,and the Harris scores of the affected limbs at admission,at 2 weeks after the operation and after the follow-up were (28.26 ± 5.50) points,(68.26 ±5.50) points,(93.13 ± 5.31) points,respectively,the differences were statistically significant (t =-71.27,-1 397.55,-46.07,all P ＜ 0.01);The VAS pain scores were (8.19 ± 0.48) points,(3.53 ± 0.71) points,(0.23 ± 0.42) points,respectively,the differences were statistically significant (t =88.06,324.17,60.84,all P ＜ 0.01).The sf-36 scores:physiological [(8.35 ± 1.24) points,(15.23 ± 2.17) points,(19.21 ± 2.12) points],social/family [(7.01 ±1.13) points,(14.12 ± 2.12) points,(19.85 ± 2.24) points],emotional [(4.83 ± 1.01) points,(10.12 ±1.22)points,(14.87 ± 1.32) points],function [(6.35 ± 1.21) points,(13.67 ± 1.87) points,(16.81 ±2.12) points],additional focus [(8.85 ± 1.45) points,(16.38 ± 2.12) points,(20.21 ± 2.42) points],total quality of life [(47.35 ± 4.76) points,(74.69 ± 5.87) points,(89.21 ± 6.12) points],the differences were statistically significant(-39.77,-62.92,-20.21,-44.87,-71.89,-26.79,-45.04,-89.01,-38.25,-45.79,-63.41,-15.29,-45.20,-60.39,-17.54,-52.12,-76.49,-22.58,all P＜0.O1).Conclusion Artificial lengthening femoral head replacement in elderly patients with stage Ⅰ of unstable femoral intertrochanteric fracture has good clinical effect,intraoperative high safety,less postoperative complications,postoperative limb functional recovery is good,and it is worthy of clinical promotion and application.

The quality of public cardiopulmonary resuscitation training plays an important role in improving the survival rate of patients with cardiac arrest. Various forms of training have been carried out all over China, which plays a great role in promoting the work of cardiopulmonary resuscitation. However, there is still a lot of room for improvement in the quality management and effect sustainability of training. This paper reviews the current situation and deficiencies of quality management of public cardiopulmonary resuscitation training, and the role of training quality in enhancing people's self-confidence in learning and rescue, training contents, training methods, quality evaluation indicators, evaluation methods, and quality influencing factors and retraining time requirements, and so on. And it puts forward some practical suggestions on the quality management of public cardiopulmonary resuscitation training in China. Such as it will more emphasize standardized training, deliberate practice, proficient training, National Training, long-term maintenance of knowledge and skills, and using useful tools to improve the quality of cardiopulmonary resuscitation training, etc. In order to improve the training quality management level of the public, so that the trainees can really master cardiopulmonary resuscitation skills, so as to improve the rescue rate and survival rate of patients with cardiac arrest. To promote the sustainable development of people's health.