ADVANCE trial demonstrated that stable intensive glucose control could improve prognosis and the target HbA1c should be 6.5%.While ACCORD and VADT trials suggested aggressive glucose lowering in diabetics at high cardiovascular risk is potentially harmful,tight glucose control yields no significant effect on long duration,poorly controlled patients with complications.DCCT and UKPDS research confirmed benefits of early intensive glucose control could persist due to legacy effect.Steno-2 research showed patients benefit greatly from comprehensive control of risk factors.In sum,early intensive control of risk factors and individualized treatment in diabetics are mainstream therapy.

Objective To investigate the effects of continuous infusion of moderate dose tranexamic acid and ulinastatin on fibrinolysis during orthotopic liver transplantation (OLT).Methods Thirty ASA Ⅲ or Ⅳ patients aged 34-63 yr with a body mass index of 17-37 kg/m2 and end-stage liver disease score 6-34,undergoing OLT,were randomly assigned to one of 3 groups ( n =10 each):group control (group C) ; group tranexamic acid (group T) and group ulinastatin (group U).The patients received continuous infusion of normal saline at 10 ml/h in group C or ulinastatin at 100 000 U/h in group U immediately after tracheal intubation until 120 min after portal vein was declamped,while in group T the patients received a loading dose of tranexamic acid 1 g followed by continuous infusion at 10 mg· kg-1 ·h- 1.Prothrombin time (PT),activated partial thromboplastin time (APTT),international normalized ratio ( INR),fibrinogen (Fg),D-dimers (D-D) and fibrin degradation product (FDP) were measured before induction of anesthesia (baseline),at 120 min after skin incision,30 min after clamping of portal vein (anhepatic phase),30 and 120 min after declamping (neohepatic phase) and at the end of operation.The amount of blood loss and transfusion were recorded.The patients were followed up after operation for hepatic artery and portal vein thrombosis in groups U and T.Results There were no significant differences in PT,APTT,Fg,INR and amount of blood loss and transfusion among the 3 groups.The plasma D-D concentration and percentage of patients with plasma FDP ＞ 20μg/ml were significantly lower in group T than in group C.There were no significant differences in plasma D-D concentration and percentage of patients with plasma FDP ＞ 20 μg/ml between groups U and C.No hepatic artery and portal vein thrombosis was detected after operation in groups T and U.Conclusion Continuous infusion of moderate dose tranexamic acid can inhibit fibrinolysis during OLT,but can not reduce the amount of blood loss.Continuous infusion of ulinastatin ( 100 000 U/h) has no significant effect on fibrinolysis during OLT.

By analyzing the status quo of moral construction of current Chinese medical students,the authors make an in-depth analysis and accurate grasp of human nature,establish a scientific concept of morality education,and clarify the objective which aims to develop students into real "socialized individuals" with mental health,personal integrity and all-round development.Four moral methods including vertical process,horizontal extension,virtual network and class building are created to promote the ideological and moral construction for medical students.

OBJECTIVE To study commonly encountered pathogenic bacteria leading to lung infection and their drug sensitivity. METHODS In the period of Jan 2003 to Feb 2005,the pathogenic species and drug sensitivity of 233 positive samples isolated from 496 phlegm samples were analyzed.RESULTS Totally 234 strains of pathogenic bacteria were(isolated) from 233 phlegm samples.It had been found that 132 strains of Gram-negative bacilli,(accounted) for(56.4%);57 strains of Gram-positive cocci,accounted for 24.4 %;41 strains of fungi,accounted for 17.5%;and 4 strains of Gram-positive bacilli,accounted for 1.7%.The pathogens of the highest infective rate were:(Pseudomonas) aeruginosa(15.4%),Candida albicans(11.6 %),Enterobacter cloacae(6.0%),Klebsiella(pneumoniae)(5.6%),Escherichia coli(5.1%),Staphylococcus aureus(4.3 %),Streptococus pyogenes((4.3%)),Acinetobacter baumannii(3.6%),and C.tropicalis(3.6 %).Results of drug sensitivity indicated that drugs selected sensitive to Gram-negative bacilli were:imipenem(75.4%),piperacillin/tazobactam(38.9%),(ciprofloxacin)(37.3%),gentamicin(37.3%),and amikacin(36.5%).Drugs sensitive to Gram-positive cocci were:vancomycin(75%),rifampin(55%),and erythromycin(35%).CONCLUSIONS The commonly encountered pathogens of lung infection in our hospital are: P.aeruginosia,C.albicans,E.cloacae,K.pneumoniae,E.coli,S.aureus,and S.pyogenes.Infective rate of Candida is increasing evidently.Antibiotic resistance of bacteria(becomes) severe,drugs applied became less and less.Clinic should(actively) develop phlegm cultivation and drug sensitivity test,applying antibiotics reasonably,reducing production of bacteria resistant to drugs.

Objective　 To investigate aetiology of alopecia seborrhoeica. Methods　Immunocytochemical localization of androqenic receptor(AR) was performed in the skin with baldness, and serum Fe,Cu,Zn,SOD and MDA detected, together with an interrogation. Results　 Expression of androgenic receptor in alopecia was higher than that in normal controls.There was no correlation between the positive expression of AR and familial history. No expression of AR was found in about 35 % of the patrents.More than two factors involved in the pathogenesis of alopecia seborrhoeia.. Conclusion 　Alopecia seborrhoeica is a disease entity related to multple pathogenic factors.

As a stable marker to reflect the average level of blood glucose,HbA1c is very important in glycaemic control evaluation.However,more and more data from evidence based medicine demonstrated that blood glucose fluctuation can also contribute to diabetic complication and prognosis which can not be neglected.Multiple capillary glucose measurements and continuous glucose monitoring are major methods to detect glucose fluctuation.Apart from insulin,various oral anti-diabetic drugs can reduce postprandial glucose excursion.Representative drugs include ?-glycosidase inhibitors,glinides and short-acting sulfonylureas,each have their own way of acting. Abstract:Summ ary:As a stab le m arker to reflect the average level of b lood glucose,HbA1c is very important in glycaem ic control evaluation.However,more and more data from evidence based m ed ic ine demonstrated that b lood glucose fluctuation can also contribute to d iabetic comp lication and prognosis wh ich can not be neglected.Mu ltip le cap illary glucose m easurem ents and continuous glucose mon itoring are m ajorm ethods to detect glucose fluctuation.Apart from insu lin,various oral anti-d iabetic drugs can reduce postprand ial glucose excursion.Representative drugs inc lude?-glycosidase inh ib itors,glin ides and short-acting su lfonylureas,each have the ir own way of acting.

[Objective]To evaluate the method and curative effect of posterior internal fixation and bone grafting fusion for atlantoaxial fracture or dislocation.[Method]Posterior internal fixation and bone grafting fusion were made on 26 patients with atlantoaxial fracture or dislocation in condition of tracheal intubation anesthesia.Occipitocervieal fixation(Aixs) and bone grafting fusion were performed on patients with fracture of vertebral lamina-arch.Vertebral lamina splint fixation (Apofix) was performed on patients without fracture of vertebral lamina-arch and decompression of vertebral canal.[Result]Followed up for 5 to 60 months(averaged,16.8 months),the vertebral artery and spinal cord injury were not occurred and clinical symptom was relieved in all patients.X ray examination showed screws in vertebral articular process and occipital condyle were normotopic without laxation and fragmentation.The bone grafting transformed into osseous fusion after 3 months.[Conclusion]Aixs fixation and bone grafting fusion and Apofix fixation are effective methods for atlantoaxial fracture or dislocation.

Objective To prepare complex material—hydroxyapatite/silicone rubber (HA/SR) used in filling parenchyma and to measure and analyse its mechanical properties, looking for proper proportion of material. Methods The complex material was mixed based on different proportion (the HA/SR mass ratio of 23%, 33.3% and 41%), and its respective properties were tested according to national standard and performed statistical analysis. Results With the increasing proportion of hydroxyapatite in complex material, the rigidity of complex material enhanced gradually, but the mechanical property decreased. Conclusion If the HA/SR mass ratio was 23% to 33.3%, the mechanical properties of complex material are equal to that of pure SR. If the HA/SR mass ratio was over 41%, the mechanical properties of complex material decrease so that the complex material can not be used in filling.

Objective To construct an eukaryotic expression vector carrying human glutathione-S-transferase(GST)A1gene and to provide study materials for toxicology and pharmacogenetic.Methods The GST A1cDNA was amplified and separated from human liver total RNAs by RT-PCR approach and recombined with eukaryotic expression vector pcDNA3.The recombined plasmid pcDNA3-hGSTA1was verified using PCR,restriction analysis and sequencing determination.Results Human GST A1gene was recombined correctly with pcDNA3,compared with Genbank,in code152T→C,amino acid Met→Thr.Conclusion The eukaryotic expression vector pcDNA3-hGSTA1was constructed for research on toxicology and pharmacogenetics.

Objective To investigate drug-resistance and the genotypes of extended-spectrum ? lactamases (ESBLs) producers in Beijing Tiantan Hospital and Beijing Chaoyang Hospital. Methods Standard agar dilution method, transconjugation test, isoelectric focusing, DNA sequencing were preformed in 52 clinical isolates of Escherichia coli and Klebsiella pneumoniae. Results ESBLs producers were resistant to many antibiotics. DNA sequencing of amplicons of 52 strains revealed that ESBLs-encoded genes were CTX-M-14, 22,24 and SHV-2,12,respectively. Conclusions We should pay great attention to detect ESBLs producers and investigate their genotypes, so that we could prevent regional prevalence of ESBLs producers and utilize antibiotics reasonably.