Type 2 Diabetes is the consequence of the disturbances of both α- and β-cell secretions.Glucagon-like peptide-1 ( GLP-1 ),which regulates the function of alpha and beta cells,has led to the emergence of a new class of oral anti-diabetic drugs.DPP-4 inhibitors,which increase the concentration of GLP-1 and consequently improve HbAlC,have become a choice for patients in different stages of diabetes.

The adenosine triphosphate-binding cassette subfamily member 4 (ABCB4) gene encodes multidrug resistance rotein 3 (MDR3),which is expressed on the cannalicular membranes of hepatocytes and translocates major phospholipids from the inner to the outer leaflet.Phospholipids are the major carrier and solvent of cholesterol,and in combination with bile salts form mixed micelles.Defects in ABCB4 function cause a low phospholipid content in bile,resulting in cholesterol supersaturation and crystal formation.Low phospholipid-associated cholelithiasis (LPAC) is characterized by the association of ABCB4 mutations and a low biliary phospholipid concentration,resulting in symptomatic gallstones starting before age 40 years,a high serum gamma glutamyl transferase (γ-GT) activity,intrahepatic microlithiasis,and recurrent biliary symptoms despite cholecystectomy.LPAC is an autosomal recessive condition caused by a rare single-gene mutation,commonly occurring in ABCB4,and can include homozygous and heterozygous point mutations in introns,coding exons,and 5 UTR regions.

Objective To investigate the causes of failure of manually rotating fetal head technology and its delivery outcomes.Methods One hundred and Ninety-eight cases with persistent occipito transverse position or persistent occipitoposterior position admitted to our hospital form January 2008 to December 2010 were enrolled as our subjects.According to the result of manually rotating fetal head technology,these patients were divided into the success group (126 cases) and the failure group (72 cases).The information related to delivery was recorded.Results The proportion of fetal weight ≥ 3500 g in the failure group was 76.4％ (55/72),higher than that of the success group(31.7％ (40/126)),and there has statistic significant difference (x2 =30.177,P =0.001).The proportion of uterine inertia in the failure group(58.3％ (42/72)) was higher than that of the success group(38.1％ (48/126)),and there has statistic significant difference (x2 =7.569,P =0.006).The proportion of critical or low-grade narrow birth canal in the failure group(38.9％ (28/72)) was significantly higher than that of the success group (23.8％ (30/126)),and there has statistic significant difference (x2 =5.030,P =0.002).The proportion of the improper time for manually rotating fetal head (opening of cervix was less than 6 cm,and fetal head was above ischial spine and opening of cervix was 8-10 cm,fetal head reach to more than 2 cm lower of ischial spine) in the failure group was 61.1％ (44/72),which was significantly higher than that of the success group (38.9 ％ (49/126)),and there has statistic significant difference (x2 =9.084,P =0.003).The proportion of maternal and neonatal complications (postpartum hemorrhage,puerperal morbidity,fetal distress,neonatal asphyxia) in the failure group were significantly higher than those of the success group (x2 =9.586,P =0.002 ; x2 =9.334,P =0.002 ; x2 =5.910,P =0.015 ; x2 =5.240,P =0.022).The proportion of cesarean section in the failure group(72.2％ (52/72)) was significantly higher than that of the success group(34.1％ (43/126)),and there has statistic significant difference(x2 =26.641,P =0.001).Conclusion The manually rotating fetal head technology can transform from dystocia to normal delivery and decrease the rate of cesarean section.It is necessary to prevent and deal with the failure causes of manually rotating fetal head technology.And it must be cautious to perform the follow-up correction and trial production after the failure of previous correction.

Objective To study the clinical application of 3-dimensional arterial spin labeling technology (3D-ASL) in brain tumors.Methods Twenty patients with the pathological diagnosis of brain tumors were selected in this study,with low grade glioma in 4 cases,the high grade glioma in 2 cases,lymphoma in 1 case,metastatic tumor in 7 cases,meningioma in 6 cases.All patients were appLIed preoperative 3D-ASL and dynamic contrast-enhanced perfusion magnetic sensitive (DSC) MR imaging line two methods,to analyze the value of 3D-ASL in brain tumors.Results 3D-ASL examination lesions in patients with brain tumors might be displayed in high or low perfusion; 3D-ASL and DSC were obtained from tumor tissue blood supply,the local relative cerebral blood flow (rCBF),there was no significant difference (P ＞ 0.05).The high grade glioma in 3D-ASL image showed a high perfusion,rCBF was 3.0 ± 1.3; Low grade gliomas showed low perfusion,rCBF was 0.6 ± 0.2,the rCBF between the high-and low-grade gliomas was significantly different (P ＜ 0.01).Metastatic tumor 3D-ASL showed ring high perfusion,central necrosis and edema area of low perfusion.Lymphoma 3D-ASL showed slightly higher perfusion.Meningioma showed high perfusion,and highest rCBF,3.5 ± 1.9.Conclusions 3D-ASL in the diagnosis of brain tumors,has high repeatability,non-invasive,without contrast agent.3D-ASL can be further developed into the brain blood flow dynamics of conventional evaluation methods,and can be used for brain tumors level assessment,has broad application prospects.

This paper started from the relevant concepts of nursing students'professional values , discussed the core value of nursing profession and nursing students occupational choice , which are included in the nursing students'professional values .Based on the current status , the author proposed some suggestions: emphasizing on curriculum and teaching content reform , strengthening the guiding role of the teachers;cultivating professional val-ues in practice; improving evaluation system; implementing sectional training plan , etc.In addition, the values education in nursing students should make efforts at national , hospital and school levels .

Recently,alveolar recruitment maneuver is one of effective management of mechanically ventilated patients with acute respiratory distress syndrome.Recruitment maneuvers are widely used in clinical practice to open the lung and prevent lung injury by derecruitment,improving the compliance,increasing PaO2,increasing the PaO2/FiO2 ratio,and reducing the pulmonary shunt fraction,although the evidence is still discussed.This review discussed recruitment maneuvers in pediatric patients with acute respiratory distress syndrome.

Objective:To improve the hospital degree of attention to SPECT quality control. Methods: To introduction the basic principle and test methods of the Brightview produced by Philips company, and to analyze some common troubles.Results: According to understanding the working principle, parameter testing, maintenance and troubleshooting, to master quality control method.Conclusion: The quality control of the SPECT is the demand of UM workers. To master the test methods, improve the quality of medical imaging, minimize unnecessary exposure and serve the patients better.

0.05),an effective mA seconds in the experimental group(296.74?19.15)mAs,than in the control group 350 mAs was reduced about 15.4%(P

Objective To understand the sanitary quality of ground water in countryside of Tongzhou District, Beijing, and to provide basic data for water improvment in countryside in future. Methods The water sampls collected from wells by stratified sampling method in every township of Tongzhou District, Beijing were analyzed. Results The sanitarg quality of source water samples from every township showed significant differences. The completely-qualified rate of source water was 100% in Maqiao, 0% in Xuxinzhuang, Langfu, Gantang. 13 indexes among 26 determined sanitary indexes including ammonia nitrogen, turbidity, total iron, and manganese exceeded the related standards. The concentrations of total hardness, arsenic, fluoride nitrite exceeded the related standards. Regional differences in contaminative degree were noticed. Conclusion The ground water in countryside of Tongzhou District was contaminated in different degree, and show regional differences in water quality, which needed to be improved urgently.

Internship is an important stage in which medical students utilize and develop their aca-demic theory to inform clinical practice. In this stage, practical teaching combining the theoretical study with clinical practice to refine interns' clinical skills is the only way to train qualified clinicians. The teach-ing during orthopaedic internship is facing the following problems, such as complex anatomy and difficult learning curve associated with orthopaedic clinical practice. In addition, interns face the employment pres-sure, and the clinical practice time may be occupied by job hunting or preparation for postgraduate entrance examination. For teachers, since clinical doctors are tired of clinical work and scientific research, they can-not devote more time and energy to teaching. In this study, the author summarizes the problems of orthopedic practice teaching in recent years and presents a series of solutions, such as standardizing clinical thinking, improving the students' clinical participation, standardizing teaching assessment and so on, which have improved the teaching quality of orthopedic clinical practice.