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.

Sepsis is a complex systemic inflammatory response syndrome caused by invasion of a varie-ty of pathogenic bacteria. The disease spectrum includes sepsis, severe sepsis, septic shock and multiple organ failure. Mitochondria are referred to as “power plants”, providing energy for viscera to maintain normal func-tion. Immune disorders,the activation and release of a series of inflammatory factors,anomalies of intracellular signal transmission and oxidative stress in sepsis can induce mitochondrial dysfunction. Recent research suggests that mitochondrial autophagy also plays a certain role in mitochondrial dysfunction. This article reviews the mechanism of mitochondrial functional damage during the pathogenesis of sepsis.

Objective: To analyze the level of resilience and its influencing factors in the young and middle-aged patients with type 2 diabetes mellitus ( T2DM ), so as to provide reference for optimizing mental interventions for the patients. Methods: The young and middle-aged patients with T2DM from September 2019 to September 2020 in Hangzhou First People's Hospital, affiliated to the Medical School of Zhejiang University, were selected as the subjects, the general information questionnaire, Perceived Social Support Scale ( PSSS ) , Conner-Davidson Resilience Scale ( CD-RISC ), Diabetes Distress Scale (DDS) and Diabetes Management Self-efficacy Scale ( DMSES ) were used to investigate, the multivariate linear regression model was used to analyze the influencing factors for resilience in young and middle-aged patients with T2DM. Results: A total of 250 questionnaires were distributed and 238 valid questionnaires were recovered. The effective recovery rate was 95.20%. Among 238 patients, 142 cases ( 59.66% ) were males and 96 cases ( 40.34% ) were females; 168 cases ( 70.59% ) were 45-59 years old. The CD-RISC score was 70.49±12.81, PSSS score was 63.70±10.90, DDS score was 2.14±0.87, and DMSES score was 130.22±38.49. The results of multivariate regression analysis indicated that educational level, average monthly family income, fasting blood glucose, self-efficacy, social support and diabetes distress were the influencing factors for resilience of young and middle-aged patients with T2DM ( P<0.05 ). Conclusion The level of mental resilience in young and middle-aged patients with T2DM is mainly related to the level of education, monthly family income, blood glucose control, diabetes distress, self-efficacy and social support.

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.

A novel electrochemical method based on dehydroabietylamine schiff base( DBS) and multi-walled carbon nano-tubes( MWCNTs) composite modified glassy carbon electrode was presented for determination of Pb2+. The electrochemical behaviors of Pb2+on the modifled electrode were investigated by cyclic voltammetry ( CV) and differential pulse anodic stripping voltammetry ( DPASV ) . The results showed that under the optimized conditions including 0 . 2 mol/L NaAc-HAc used as supporting buffer ( pH 5 . 5 ) , -1 . 1 V of accumulating potential, 250 s of accumulating time, the oxidation peak current was proportional to Pb2+concentration in the range between 1 × 10-8 mol/L and 1 × 10-6 mol/L with the linear regression equation as I(μA)= 6. 6173c(μmol/L)+0. 2597(R=0. 9971) and the detection limit as 5. 0×10-9 mol/L (S/N=3). The proposed sensor was successfully employed to determine Pb2+ in real samples with satisfactory results. In addition, this method showed the advantages of simple operation, short assay time, good accuracy, satisfactory efficiency and good selectivity for determination of low concentration lead in water samples.

Objective To observe the effects of Toxoplasma lysate antigen(TLA)on growth inhibition and tumor angiogenesis in mice B16 melanoma.Methods Twenty mice bearing B16 melanoma were established by subcutaneous inoculating with B16 cells and were randomly divided into the treatment group and the control group 0.1 ml TLA was administered once every two days for the treatment group starting on the seventh day after inoculation.and an equivalent volume of sterile saline was administered similarly in the control group.The mice were sacrificed on 21 th day after the tumor cells was injected.The anti-tumor effects of TLA were observed by measuring the size and weight of tumor.The microvessel density(MVD)and expression of vascdar endotheilial growth factor(VEGF)were observed by immunohistochemical method.Results TLA Can markedly inhibit the B16 melamoa growth in mice.The volume and weight of the tumors in the experimental group were significantly decreased compared with the control group(P＜0.05),and the turnout inhibitory rate was 49.6%.The MVD of experimental group and control was(44.4000±4.7888)and(31.9000±2.6012)respectively,and with a significant difference between two groups(P＜0.05).The VEGF in the treatment group were significantly lower than those in the control group(P＜0.05).Conclusion TLA can inhibit the growth of the B16 melanoma in mice.suggesting that the anti-tumor effect induced by TLA via a possible antianigionesis mechanism.

Described in the paper is the reform made at public hospitals in Zhejiang province,with analysis of its problems and causes. Based on such,the authors proposed the following actions:to accelerate the reform of public hospitals centering on health promotion, and encourage such hospitals to shoulder the health care responsibility on behalf of the government; to proceed with hierarchical medical system and contract-based service focusing on capacity building of general practitioners; to attract private capital into building the healthcare system; and to motivate non-governmental organizations to cater to diversified healthcare needs of the people.

Based on large sample of clinical epidemiology survey,we discussed the etiology and pathogenesis of type-2 diabetes.On the basis of Internal Classic ofHuang Di,and discussions of both ancient and modern doctors,we believed that:type 2 diabetes is just like Jueyin disease of Treatise on Febrile Disease,characterizing by adverse-rising of Qi,cold mingling with heat and deficiency mingling with access.The diseased location is spleen,and closely related with liver and lung.The pathogenesis is the failure transportation and transformation of spleen,floating of deficient five visceral essence,and turbid dampness flowing down to form yin fire syndrome.The reason for failure transportation and transformation of spleen includes depression of lung,adverse flow of liver-qi,dampness accumulation in the middle and deficiency of kidney Qi.

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.

Objective To understand the status of resistance to multiple insecticides and the frequencies of kdr mutations in Culex pipiens pallens from north?central Anhui Province. Methods From July to September,2014,the C. pipiens pallens mosquito larvae were collected in Huaibei,Bengbu and Chuzhou cities of the north?central Anhui Province and reared to adults. The female adult mosquitoes at 3-5 days post emergence were tested for susceptibility to the four insecticides,namely 0.05%deltamethrin,5%malathion,0.1%bendiocarb and 4%DDT,by using the standard WHO resistance tube bioassay. The detec?tion of the point mutations of the kdr gene at codon 1014 was conducted by PCR and DNA sequencing in the deltamethrin?resis?tant and?susceptible mosquitoes. Results High levels of resistance to all the four insecticides were found in all the three tested populations,although mosquito mortality varied among populations and test insecticides. Among the test insecticides,DDT showed lowest mortality with no significant difference(F=1.027,P>0.05)in all test populations,whereas significantly differ?ent mortalities were observed among populations for the remained three insecticides tested(deltamethrin,malathion,and ben?diocarb)(F = 23.823,33.955,128.841;all P < 0.01). Two types of non?synonymous kdr mutation at codon position 1014 (L1014F and L1014S)were observed. A positive correlation between L1014F mutation frequencies and deltamethrin resistance levels were detected in the three mosquito populations(r2=0.718,P<0.01). Conclusions The observed high levels of resis?tance to multiple?insecticides coupled with the occurrence of medium to high kdr frequencies in populations of C. pipiens pallens could profoundly affect the mosquito vector control programme in China. The local health departments need to strengthen vector dynamic monitoring and implement rational resistance management strategies.