Based on the result of oral 75 g glucose tolerance test (OGTT),55 pregnant women during the second trimester (gestational age 24-28 weeks) were selected and divided into gestational diabetes mellitus (GDM)group (n =25) and normal glucose tolerance (NGT) group (n =30).Women with GDM were older than those in NGT group.Blood glucose and insulin levels during the OGTT,incremental area under the glucose curve (AUCGLU) and insulin curve (AUCINs) during the OGTT,and basic insulin secretion index (HOMA-β) in the GDM group were higher compared with those in NGT group (P＜0.05).However,in GDM group,insulin sensitivity index (ISI-Matsuda),dynamic insulin secretion index(Stumvoll 1-and 2-phase insulin secretion indices),and insulin secretion-sensitivity index (ISSI)were lowered (all P＜ 0.05),so was AUCINS/AUCGLU (P ＜ 0.01),as compared with those in NGT group.Blood glucagon levels during OGTF and incremental area under the glucagon curve (AUCGL) showed no significant differences between 2 groups (P ＞ 0.05).Multiple linear regression analysis showed that ISI-Matsuda,ISSI,HOMA-β,Stumvoll 1-and 2-phase insulin secretion indices accounted partially for the change of plasma glucose and ISI-Matsuda was the most important one among them.The function of islet α-cell seems to be normal while the function of β-cell is impaired in the patients with GDM,and failure of insulin secretion to overcome insulin resistance is the main reason for GDM.

To elaborate the the main thoughts and treatment experience of dampness in Medical Origin and Insights, written by Zhang Yuansu. Dampness-resolving drugs and prescriptions were comprehensively and carefully summarized and analyzed. Strengthening spleen and stomach was viewed as guideline, and Rhizoma Atractylodis Macrocephalae as well as its brilliant combinations, was taken as preferred drug to resolve dampness, with the help of brilliant combinations. Emphasis was laid on the treatment according to patterns, positions and characters of diseases. Medical Origin and Insights, essence collector of Zhang’s thoughts, has enriched and developed basic traditional Chinese medicine theories and practices. Thus, it showed guiding significance on dampness treatments.

Objective To investigate treatment effect of the type of foot drop in patients with lumbar disc herniation.Methods Clinical data of 34 patients with foot drop in lumbar disc herniation who were treated in Spinal Surgery Department of Shunyi District Hospital of Beijing from January 2006 to December 2013 were retrospective analyzed,all patients were treated by operation.After 24 months of follow-up,the effect was observed,the prognosis and related factors were analyzed.Results Two years after operation,the recovery of the patients was excellent in 4 cases and good in 19 cases,common and poor in 11 cases,and the excellent and good rate was up to 67.6%(23/34).Analysis results showed that after 3 to 24 months after surgery,the anterior tibial muscle strength grades(grade 0-5) corresponding score were 28 points preoperatively,59 points at 3 months after surgery,69 points at 6 months after surgery,92 points 1 year after surgery,reached 95 points 2 years after surgery.Muscle strength score of patients with an increasing trend,especially after 3 months to 12 months after the operation.Conclusion The drop occurred should be operated as soon as possible,recommendations for open surgery,complete decompression,avoid injury.Three months to 1 years after operation is the key period of recovery.

Objective To investigate the short segment(less than 2 segments)of lumbar posterior open surgery in the application of iodophor rinse operation field for the prevention of wound infection effect.Methods One hundred and sixty-four cases patients who underwent all lumbar posterior short segment(less than 2 segments)decompression and fusion in Shunyi District Hospital of Beijing from January 2012 to December 2015 were selected as study objects,and were randomly divided into two groups according to random number table method,including 87 cases of single application of physiological saline(saline group)and 77 cases with diluted iodophor rinse liquid during the operation(diluted iodophor group).The incidence of infection in patients with different irrigation patterns during 3 months after the operation was followed up,and the results were analyzed by Fisher exact probability method.Results The infection rate of saline group was 8.05％(7/87),1.30％(1/77)of iodophor group,there was significant difference between two groups(P=0.04).Conclusion The application of iodophor rinse operation field for the prevention of wound infection has obvious effect on lumbar posterior open surgery.

Objective To explore the efficacy and toxicities of S-1 in the maintenance treatment of advanced esophageal cancer. Methods A total of 52 advanced esophageal cancer patients who benefited from the first-line treatment were randomly divided into experimental group (26 cases received S-1 orally as maintenance treatment) and control group (26 cases received placebo orally) by means of coin toss. After treatment, the efficacy and toxicities of the two groups were observed comparatively. Results The overall response rates (ORR) in experimental group and control group were 84.6% (22/26) and 76.9% (20/26), respectively, and there was significant difference between the two groups (χ2=3.885, P=0.049). The median progression free survival (PFS) time of experimental group was 14.4 months, and that of control group was 12.5 months (χ2= 3.885, P= 0.049). The main adverse reactions of the two groups were grade 1-2, and grade 4 adverse reactions did not appear in all patients. Conclusion S-1 is effective and well-tolerated in the maintenance treatment of advanced esophageal cancer.

Objective To investigate the Effects of thyroxine on the level of serum homocysteine and urinary albumin excretion rate in elderly patients with early diabetic nephropathy and subclinical hypothyroidism.Methods Seventy-five patients with early diabetic nephropathy and subclinical hypothyroidism were randomly divided into levothyroxine treatment group and conventional treatment group.Urinary albumin excretion rate (UAER),serum levels of homocysteine,creatinine,and lipids were measured at both pre-and post-treatment of 48 weeks.Results After treatment,serum total cholesterol,low density lipoprotein-cholesterol,triglyceride,thyrotropin,homocysteine,UAER,and serum creatinine in the levothyroxine treatment group were significantly lower than those in the conventional treatment group [(-0.52 ± 0.12 vs 0.31 ± 0.40) mmol/L,(-0.33 ± 0.22 vs 0.24 ± 0.36) mmol/L,(-0.16±0.18 vs0.19±0.29)mmol/L,(-4.4 ± 1.2 vs 1.2 ±0.8)mIU/L,(-1.4 ±2.0 vs0.9± 1.0)mmol/L,(-13 ± 13 vs 10 ± 7) pg/ml,(-2 ± 2 vs 3 ± 2) μmoL/L,respectively,all P＜0.01].Conclusions Treatment with levothyroxine could significantly improve serum lipid profiles and reduce homocysteine,UAER,and creatinine,and exert a protective effect on the kidney in the elderly patients with early diabetic nephropathy and subclinical hypothyroidism.

Objective To investigate the characteristics and relevant factors of overweight and obesity in adults of the Shandong coastal area in 2009,as well as to estimate the epidemiological trends by comparing with results found in 2004.Methods A random and stratified cluster sampling of adults aged 20 years or older was conducted,and 5060 inhabitants in the cities of Qingdao,Yantai,Weihai,Rizhao,and Dongying were included.Results The standardized prevalence rates of overweight,obesity,and abdominal obesity were 33.5％,16.1％,and 40.0％respectively in 2009,with respective increase of 0.6％ (P＜0.05),2.9％ (P＜0.01),and 6.8％ (P＜0.05)compared with those in 2004; the rates for male were 37.9％,17.1％,and 44.6％ respectively in 2009,with increase of 3.7％ (P＜0.01),3.7％ (P＜0.0l),and 10.2％ (P＜0.01) respectively compared with those in 2004 ;the prevalence of abdominal obesity for female was 38.6％,with an increase of 6.6％ (P＜0.01) compared with that in 2004.The prevalence of obesity increased consistently with age,reached a peak within 50-69 years old.There was a trend of developing obesity in younger,males,while obesity became more common in postmenopausal women.In contrast with the findings in 2004,the average age,body mass index,waist circumference,triglyceride,total cholesterol,uric acid,and blood glucose levels increased significantly (P＜0.01) in 2009.Logistic regression analysis showed that aging,dyslipidemia,hypertension,hyperglycemia,hyperuricemia were positively related with obesity,and smoking was negatively related with it.Consumption of meat was related to male obesity,while carbohydrate consumption was related to female obesity.Conclusions A remarkable increase in the prevalence of obesity was found in 2009 compared with 2004,especially for the young and middle-aged men and postmenopausal women.Aging,hypertension,hyperglycemia,hyperuricemia,dyslipidaemia,and incorrect components of diet contributed to obesity.Although smoking is a negative factor for body weight,it is not suggested.

Objective To study the change of miR-146a in the development and progression of papillary thyroid carcinoma(PTC).Methods Real-time fluorescence quantitative polymerase chain reaction was used to detect the change of miR-146a in tumor tissues of 43 cases of PTC and 36 cases of nodular goiter,also in peripheral blood of 32 cases of PTC and 23 cases of nodular goiter.The correlation of miR-146a change and the clinicopathological parameters of patients with PTC was analyzed.Results ① The relative content of miR-146a in the 43 patients with PTC and 36 patients with nodular goiter was 0.0280 ± 0.0131 and 0.0212 ± 0.0111 respectively.The difference had statistical significance (P ＜ 0.05).miR-146a in PTC tissues was significantly correlated to clinicopathological parameters such as lymph node metastasis,tumor stage (P ＜ 0.05),and it was unrelated to age or tumor size(P ＞0.05).② The relative content of miR-146a in peripheral blood of 32 patients with PTC and 23 patients with nodular goiter was 0.0891 ±0.0419 and 0.0922 ±0.0456 respectively.The difference had no statistical significance(P ＞ 0.05).There was no significant correlation between miR-146a in peripheral blood of patients with PTC and age,tumor stage,lymph node metastasis,or tumor size of patients (P ＞ 0.05).Conclusions MiR-146a expression is upregulated in patients with PTC,and there is a significant correlation between miR-146a content and clinicopathological parameters such as lymph node metastasis,tumor stage,especially in advanced stage.It suggests that miR-146a may play a role in carcinogenesis and development of PTC.

Objective:To discuss the effect of pharmacist intervention on the use of antimicrobial agents in the clinical pathway of community-acquired pneumonia ( CAP) in our hospital to standardize the rational medication and promote the rational use of antimicro-bial agents. Methods:Totally 100 bacterial CAP patients in 2013 ( before the intervention) and 2014 ( after the intervention) in the pneumology department were studied. The antibacterial drug cost, total hospitalization cost, use intensity of antimicrobial drugs, hospi-talization time, therapeutic effects and so on in the two groups were observed during the treatment. Results: There were significant differences between the two groups in antibacterial drug cost, total hospitalization cost, use intensity of antimicrobial drugs, hospitaliza-tion time and so on, whereas there was no significant difference in the curative effect. Conclusion:After the pharmacist intervention, the application of antibiotics is more rational, the antibiotics use density and per capita cost are reduced, the hospitalization day is shortened and the value of pharmacists is also improved.

Objective To analyze and summarize the experiences in diagnosis and treatment of patients with severe traumatic brain injury (sTBI) so as to increase the cure rate and survival rate. Methods A retrospective study was made on the diagnoses and treatment of 4 462 cases of sTBI inclu-ding 3 298 males (73.9%) and 1 164 females (26.1%). The most frequent cause for injury was traffic accident, accounting for 35.5% (1 583/4 462). Closed bead injury ocurred in 3 654 cases (81.9%) and open head injury in 808 (18.1%). The most commen clinical manifestations included unconscious-ness, changes of pupils and life signs. Of all, 1 158 cases (26.0%) were found with combined injury and 1 356 (30.4%) with complications. Treatment measures included first aid, surgery or conventional treatment. Emphasis was put on the treatment of secondary insults. Results Surgery was performed in 3 023 cases (67.7%) including craniotomy for hematoma clearance in 856 cases and hematoma clearance plus decompression in 2 167, with mortality rate of 17.9%. Conventional treatment was carried out in 1 439 cases (32.3%), with mortality rate of 23.7%. There were 2 462 eases (55.2%) with fair recov-ery, 508 (11.4%) with mild disability, 339 (7.6%) with severe disability, 272 (6.1%) under vege-tative state and 881 (19.7%) deaths on discharge according to the Glasgow Outcome Scale. Conelu-sions Active diagnoses and treatment, strict medication rules and prevention and treatment of secondary insults may be key to higher eure rate as well as lower morbidity and mortality of sTBI.