Objective:To study the efficacy and safety of saxagliptin or pioglitazone combined with metformin in the newly diag-nosed patients with type 2 diabetes mellitus(T2DM) with inadequate glycemic control by metformin alone. Methods:Totally 82 newly diagnosed T2DM patients with inadequately control by metfomin monotherapy for 12 weeks were randomly divided into two groups, sax-agliptin group ( saxagliptin combined with metforminc) and pioglitazone group ( pioglitazone combined with metformin) . The blood glu-cose control, homeostatic model assessment of insulin resistance index ( HOMA-IR) , body weight change and adverse reactions were assessed before and after the treatment for 12 weeks. Results:After the 12-week treatment,the level of fasting plasma glucose ( FPG) , two-hour postprandial plasma glucose (2hPG) and glyeosylated hemoglobin(HbA1c) in both groups were significantly decreased. Compared with the pioglitazone group,the level of 2hPG and HbAlc was lower while the level of FPG was higher in the saxagliptin group (P<0. 05). Compared with the saxagliptin group,the level of fasting plasma insulin(FINS) was significantly decreased and HOMA-IR was significantly improved in the pioglitazone group. The body mass index ( BMI) of the patients was increased in the pioglitazone group(P<0. 05) and showed no change in the saxagliptin group(P>0. 05). There was no statistical difference in the adverse reac-tions between the two groups(P>0. 05). Conclusion:The combination of saxagliptin or pioglitazone with metformin in the treatment of newly diagnosed patients with type 2 diabetes can improve glycemic control with low incidence of hypoglycemia and adverse reactions. Saxagliptin is more suitable for the patients with heart diseases or old patients.

Flood damage is one of the ordinary natural calamities. The areas of middle and down of the Yangtze River and its south are the endemic area of schistosomiasis. As the flood damage,it causes property loss,and harm public and people health severely even. This paper aims at the status of catastrophic flood damage again in the Yangtze River basin ,analyzes the impact of schistosomiasis transmission by it,and indicates that at present,the process of schistosomiasis control in China is marching from transmission control to transmission interruption and elimination,but the frequent flooding exacerbates Oncomelania hupen?sis snail breeding area and schistosomiasis source spreading,which may influence,in a certain extent,the realization of the goal of schistosomiasis control in China. We should timely assess and monitor the impact and risk of schistosomiasis transmission by flood damage,and give the early warning and adopt emergency handling measures in time. This paper also proposes the disas?ter prevention measures according to flood damage stages(the early,middle,later,and post?flood)and the occurrence and de?velopment of damage and endemic situation,so as to control the risk and damage of the disease transmission in a high limit,to consolidate the current achievements of schistosomiasis prevention and control and guarantee the realization of the goal of schisto?somiasis interruption and elimination in China on the schedule.

Objective To discuss the mechanism about exercise preconditioning (EP) protected myocardium by means of regulate NLRP3 inflammasome signal pathways on exhausted exercise rats. Methods The male Sprague-Dawley (SD) rats were randomly divided into four groups: normal control group (C group), no EP on exhausted exercise group (EE group), 3dEP + EE group, and 3wEP + EE group, with 12 rats in each group. In C group and EE group, the rats had not done exercise, while EE group took an exhausted swimming exercise with 3% heavy weight on tail at the end of 3 weeks; 3dEP + EE group and 3wEP + EE group exercised according to the standard of swimming for 60 minutes every day (swam 15 minutes, took a rest for 5 minutes, repeated 3 times), 6 days in a week, and were trained for 3 days and 3 weeks respectively, and took an exhausted swimming exercise on the last day. A light microscope and electron microscope were used to observe the myocardial histopathology and ultrastructure change, and enzyme linked immunosorbent assay (ELISA) was used to detect the levels of serum interleukin (IL-1β, IL-18, IL-6), hypersensitive C-reactive protein (hs-CRP), MB isoenzyme of creatine kinase (CK-MB), and brain natriuretic peptide (BNP). The protein expressions of NLRP3 and caspase-1 were detected by Western Blot. The correlations among all the parameters were analyzed by Pearson correlation analysis. Results Under the light microscope and electron microscope, the myocardial fiber morphological structure was normal, neatly, and no interstitial edema, muscle membrane damage or myocardial cell swellen was found in C group. In EE group, heart tissues were stained obviously uneven, a large number of myocardial fibers were fractured and messed, interstitial fibers were hyperplasiaed and edema moderately, much of myocardial cells were edema and necrosis, inflammatory cells were infiltrated, the number of average infiltration inflammatory cells was highest, mitochondria were edema seriously, part of the crest and a small number of membrane were blended together, fuzzy and crest were fractured, sarcomere were disordered; 3dEP + EE group and 3wEP + EE group heart tissues injuries were obviously alleviated, among the three groups, and the best results were in 3wEP + EE group. Compared with C group, the serum contents of IL-1β, IL-18, IL-6, hs-CRP, CK-MB, BNP and heart tissues protein expressions of NLRP3 and caspase-1 in EE group were significantly increased [IL-1β (μg/L): 18.77±1.28 vs. 12.00±1.55, IL-18 (μg/L): 236.79±15.73 vs. 150.74±7.09, IL-6 (μg/L): 59.31±9.17 vs. 34.65±2.89, hs-CRP (mg/L): 469.37±137.73 vs. 107.15±14.22, CK-MB (U/L): 15.57±0.91 vs. 7.40±0.40, BNP (ng/L): 532.08±63.44 vs. 386.96±34.77, NLRP3 protein (gray value): 0.66±0.07 vs. 0.16±0.06, caspase-1 protein (gray value): 0.96±0.08 vs. 0.48±0.06, all P < 0.01]. Compared with EE group, the above indicators in 3dEP + EE group and 3wEP + EE group were remarkably decreased, each index in 3wEP + EE group was lower than that in 3dEP + EE group except BNP [IL-1β (μg/L): 14.26±1.42 vs. 16.57±1.81, IL-18 (μg/L): 168.49±7.05 vs. 191.92±14.16, IL-6 (μg/L): 32.62±3.81 vs. 45.61±6.20, hs-CRP (mg/L): 207.06±41.68 vs. 339.56±89.65, CK-MB (U/L): 9.97±1.08 vs. 13.10±0.78, NLRP3 protein (gray value): 0.33±0.07 vs. 0.48±0.06, caspase-1 protein (gray value): 0.65±0.06 vs. 0.79±0.02, all P < 0.01; BNP (ng/L): 432.53±32.03 vs. 478.46±44.79, P > 0.05]. A positive correlation was shown among IL-1β, IL-18, IL-6, hs-CRP, BNP, CK-MB, NLRP3, and caspase-1 (all P < 0.01). Conclusions EP can reduce inflammatory reaction by regulating the NLRP3 inflammatory signal pathways, and protect the myocardial injury. The protection of the heart by long-term EP is more obvious than that of short-term EP.

In order to acquire the information on the changes and improvement after the implementation of National Schistosomiasis Control and Prevention Regulation, a survey was performed. The awareness of schistosomiasis and the regulation, stool management and other related contents were carried out in the rural areas of Jiangsu, Anhui, Jiangxi, Hubei, Hunan, Sichuan and Yunan provinces. The results showed 98.9% of the residents knew about schistosomiasis, 89. 8% knew the regulation, 95. 1% supported the management of drinking water and lavatory, 45.3% used tap water as their ordinary drinking water supply, but there were 47.6% still drank well water, 51.1% used water closet and 40.0% used simple toilet. The work on improving water and sanitary conditions in mountain areas was left behind that in lake areas. It is indicated that there is still a lot we must do to promote the propaganda of the regulation.

Objective To compare the clinical effect of the primary total hip replacement (THR)and the secondary THR after failed internal fixation in elderly patients with displaced femoral neck fracture,so as to investigate the optimal treatment for displaced femoral neck fractures in elderly patients.Methods From January 2006 to December 2012,22 patients treated with a secondary THR after failed internal fixation were chosen as the observation group and 30 patients treated with a primary THR were chosen as the control group,the operation time,blood loss,postoperative Harris scores for hip joint and health-related quality of life (~ index score) were observed and analyzed in two groups.Results Both of the groups were followed up successfully and each of the groups had 1 patient died.There were no joint infection,re-operations and any other complications in both groups.The operation time in observation group was longer than that in control group [(114.82 ±32.13) min vs.(90.63 ± 16.24) min],blood loss was more than that in control group [(551.73 ± 241.62) ml vs.(314.46:± 156.72) ml],there was significant difference (P ＜ 0.05).But the Harris score and KPS index score between two groups had no significant differences (P ＞ 0.05).Conclusion The primary THR in elderly patients with displaced femoral neck fracture has lower risk in operation tocompare with the secondary THR after failed internal fixation,but the two ways are similar in the hip joint function recovery and improve patients quality of life.

Objective To evaluate the effectives of high-frequency oscillatory ventilation (HFOV)in the treatment of severe NRDS.Methods The severe NRDS who failed to response to conventional mechanical ventilation (CMV) were changed to HFOV treatment.Ventilator parameters and blood gas analysis were compared before and after treatment.Results Among thirty patients,19 cases were significantly improved and 11 cases were failed,the success rate was 63％.Nineteen patients with HFOV,the main ventilator parameters and blood gas results such as FiO2 ( 0 h:0.87 ± 0.09 vs 3 h:0.67 ± 0.10,6 h:0.54 ±0.08,12h:0.44 ±0.08),MAP[0 h:(14.47 ±1.17) mbar vs 3 h:(13.79 ± 1.03) mbar,6 h:(13.26 ±1.05) mbar,12 h:( 12.37 ±0.83) mbar],f[0 h:(7.26 ±0.56) Hz vs 3 h:(7.89 ±0.57) Hz,6 h:(8.42±0.51 ) Hz,12 h:(9.26 ±0.45) Hz] and PaCO2 [0 h:(9.69 ±0.86) kPa vs 3 h:(6.00 ±0.55) kPa,6 h:(5.62 ± 1.03)kPa,12 h:(5.47 ±0.55)kPa] were decreased while pH(0 h:7.21 ±0.06 vs 3 h:7.35 ±0.07,6 h:7.39 ±0.07,12 h:7.40 ±0.06) and PaO2[0 h:(5.46 ±0.82)kPa vs 3 h:(7.92 ± 1.13)kPa,6 h:(9.25 ± 0.99)kPa,12 h:(9.20 ± 0.96)kPa] were significantly increased compared with before treatment ( P ＜ 0.05).Conclusions The patients of severe NRDS who failed to response to CMV were treated with HFOV,some patients received a significant effect with HFOV treatment.

Objective To evaluate the effect of schistosomiasis control in Gongan County,Hubei Province by longitudinal ob-servations so as to provide the evidence for formulating the schistosomiasis control strategy in lake and marshland regions. Meth-ods The schistosomiasis epidemic data in Gongan County from 2000-2013 were collected by the retrospective research method, and analyzed about the changing tendency of human and cattle infection rates,and Oncomelania hupensis snail situation. Re-sults The tendency of schistosomiasis epidemic situation was descended from 2000 to 2013. The human infection rate declined from 12.62%in 2000 to 0.69%in 2013. The decline scope of human infection rate was 24.1%in the first stage,64.4%in the sec-ond stage,and 73.0%in the third stage. Eight acute schistosomiasis cases were reported in the first stage,15 cases in the second stage,and none in the third stage. The cattle infection rate declined from 6.50%in 2000 to 0.30%in 2013. The rise scope of cattle infection rate was 74.2%in the first stage,but the decline scope was 75.0%in the second stage and 87.6%in the third stage. All the cattle were disposal at the end of 2013. The infection rate of snails,area with infected snails,and average density of living snails in the first stage increased by 18.1%,46.0%and 7.6%,respectively. The 3 indexes above-mentioned in the second stage de-creased by 76.8%,97.8%and 37.9%,respectively. In the third stage,the infection rate of snails and area with infected snails de-creased by both 100%,but the average density of living snails increased by 2.7%. The infected snails were found from 2000 to 2011,but none in 2012 and 2013. The infection rate of snails and area with infected snails dropped yearly,the infection rate of snails declined from 0.0007% in 2000 to 0.0002% in 2011,and the area with infected snails declined from 267.8 hm2 in 2000 to 6.37 hm2 in 2011. Conclusions After the implementation of the integrated schistosomiasis prevention and control strategy with the emphasis on infectious source control,the human and cattle schistosome infection rates decline significantly. Hereafter,it is necessary to prevent the schistosomiasis epidemic outbreak or rebound.

Objective To study the pathogenesis, clinical symptoms, surgical treatment and preventive measures of esophagogastric-arterial fistula following resection for carcinoma of the esophagus and cardia. Methods The clinical data of 18 patients with esophagogastric-arterial fistula were retrospective analyzed. Results There were 14 patients of esophageal carcinoma and 4 patients of cardiac carcinoma.7 patients had supra-aortic esophagogastric anastomosis(2 near the apex of pleura) and 11 had anastomosis under the aortic arch. Fatal hemorrhage occurred postoperatively from 11 to 93 days. The interval between hemorrhage and death varied from being instant to 18 days.All patients died. Conclusion The surgical treatment provide an opportunity for those patients. Successful management is possible if early diagnosis is made and prompt surgical management is undertaken. Preventive measures of peptic ulcer and esophageal fistula can decrease occurrence of this complication.

Objective To analyze the schistosomiasis endemic situation and understand its transmission trend in Jiangling County from 2004 to 2013 so as to improving the schistosomiasis control. Methods The relevant data of schistosomiasis were collected and analyzed statistically in Jiangling county from 2004-2013. Results The human prevalence of schistosomiasis was decreased from 10.22%in 2004 to 0.63%in 2013 with the descend rate of 93.84% and the notable descend rate was 76.92%from 2009-2013. The cattle infection rate was decreased yearly from 7.59%in 2004 to 0 in 2013. The appearance rate of frames with living Oncomelaniahupensissnails and the infection rate of snails reduce by 17.53%and 100%respectively. Conclusions Af?ter 10?year control the endemic situation of schistosomiasis in Jiangling County decreases and is at a low level. However the risk factors of transmission still exist. Therefore the comprehensive control measures still should be enhanced continuously.

ObjectiveTo detect mRNA and protein expression of steroidogenic factor-1 ( SF-1 ) and DAX-1 in human adrenocortical tumors and normal adrenal cortex,and to investigate the effect of SF-1 and DAX-1 on the steroidogenesis and development of adrenocortical tumors.Methods Total RNA and protein was extracted from angiotensin Ⅱ unresponsive aldoterone-producing adenomas ( A Ⅱ -U-APA,n =12 ),angiotensin Ⅱ responsive aldoterone-producing adenomas ( AⅡ -R-APA,n =5 ),cortisol-producing adenomas ( CPA,n =10 ),adrenal nonfunctional adenomas ( NFA,n =10 ),aldosterone-producing carcinoma ( APC,n =2 ) and normal adrenal cortex ( NAC,n =8).To analyze gene expression of SF-1,DAX-1,ACTH receptor(ACTHR),and β-actin by real-time quantitative PCR in different tissues.The protein expression of SF-1,DAX-1,and β-actin in the same tissues by Western blot.To study the relationship of ACTHR,SF-1,and DAX-1 with clinical data in adrenocortical tumors.ResultsThe expression of SF-1,DAX-1 mRNA and protein was different in NAC,AⅡ -U-APA,A Ⅱ -R- APA,APC,CPA,and NFA tissues [ relative expression of SF-1 mRNA:24.58±2.45,23.89±3.17,21.59±3.00,(38.75,44.16),14.17±2.80,and 36.38±3.50; DAX-1 mRNA:0.57±0.06,0.37±0.05,0.43±0.05,( 1.52,1.21 ),0.39 ±0.04,and 0.83 ±0.08 ; SF-1 protein:0.76 ±0.11,0.76 ±0.10,0.73 ±0.07,(1.24,1.40),0.55±0.04,and0.98±0.10; DAX-1 protein:0.65±0.14,0.39±0.13,0.43±0.14,(1.18,1.02),0.56±0.04,and 1.03±0.13 ; all P＜0.05 or P＜0.01 ].There was negative correlation by higher SF-1/DAX-1 ratio and tumor size in AⅡ -U-APA tissues.The mRNA and protein expression of SF-1 was lower in CPA and there was the positive correlation with tumor size.Conclusion SF-1 and DAX-1 might play a key role in the development of the adrenocortical tumorigenesis and steroidogenic tissues.