ObjectiveTo observe the effect of insulin detemir combined with acarbose in treatment of patients with type 2 diabetes (T2DM).Methods32 T2DM patients whose blood glucose control was poor receiving twice daily isophane protamine biosynthetic human insulin( Novolin 30R) combined or not combined with oral hypoglycemic drugs,were switched to receive insulin detemir injection once daily and oral acarbose three times daily for 12 weeks.By self-contrasted method,observed blood glucose before and after three meals,before sleeping,glycated hemoglobin ( HbA1c),change of body mass index( BMI),incidence of hypoglycemia,compliance and satisfaction of patients (by questionnaire) before and after treatment.ResultsAfter treatment,the blood glucose before and after three meals,before sleeping and HbA1 c declined sigmifieatly ( t =11.212,14.997,10.863,17.950,11.108,14.034,12.422,22.764,all P ＜0.01 )compared to state before treatment.The rate of hypoglycemia in the day was 3.1％,without nocturnal symptoms of hypoglycemia.BMI had certain declining,but there was no statistical significance (P ＞ 0.05).The compliance and satisfaction of patients were in a higher rate (x2 =10.255,9.143,all P ＜ 0.01 ).ConclusionInsulin detemir combined with acarbose could effectively control the blood glucose,incidence of hypoglycemia,without increasing body mass,achieve good compliance and satisfaction of patients.

The article introduces the current situation of higher medical education of Taiwan Province and makes some brief comments and analyses by analyzing its advantages and disadvantages as well as the effectuation condition of higher education reforming measures.

Objective To investigate the characteristics of high-risk cholecystolithiasis and summarize the experience of laparoscopic chol-ecystectomy for this disease.Methods A retrospective analysis was performed on the clinical data of 1 15 patients with high-risk cholecys-tolithiasis who underwent laparoscopic cholecystectomy in our hospital from October 2008 to March 2012.Results Of the 1 15 patients,47 had stones filling the gallbladder as well as atrophy of the gallbladder and porcelain gallbladder,42 had acute suppurative and gangrenous cholecystitis,20 had stone incarceration in the gallbladder neck,3 had cystic duct stones,2 had cholecystoduodenal fistula,and 1 had Mi-rizzi syndrome;all patients were cured and discharged.Conclusion For patients with high-risk cholecystolithiasis,laparoscopic cholecys-tectomy is feasible,given active preoperative preparation,strengthened perioperative management,and accurate,standard,and skilled sur-gical operation.

Objective To study the regulatory effect of ethanol extract of glossy privet fruit and its monomer tyrosol on the adhesion and migration of human epidermal melanocytes.Methods Epidermal melanocytes were isolated from human foreskin,and subjected to a primary culture.Mter 3-5 passages,the melanocytes were treated with various concentrations of ethanol extract of glossy privet fruit (0.0375-0.6 mg/ml)and tyrosol (0.125-2 mmol/L) for 24-72 hours.The XTT colorimetric assay was carried out to evaluate the proliferation of melanocytes,fibronectin (FN)-coated culture plates were used to evaluate the adhesion activity of melanocytes,and Transwell assay was conducted to assess the migration activity of melanocytes.Confocal laser microscopy was utilized to observe the structure and distribution of actin cytoskeleton in melanocytes,and cellular fluorescence intensity was determined by a semi-quantitative analysis.Statistical analysis was carried out by using unpaired t test.Results The adhesion activity of melanocytes to FN was significantly enhanced by the ethanol extract of 0.0375-0.6 mg/ml from glossy privet fruit (P ＜ 0.05 or 0.01),and by tyrosol of 0.5-2 mmol/L (P ＜ 0.05 or 0.01).As XTT assay showed,neither the ethanol extract of 0.15 mg/ml nor tyrosol of 2 mmol/L had cytotoxicity or promotive effect on cell proliferation.Hence,0.15 mg/ml and 2 mmol/L were determined as the working concentrations of ethanol extract and tyrosol respectively.The number of cells migrating through micropore membranes per high-power field (× 200) was 43.7 and 51.0 in melanocytes treated with the ethanol extract of 0.15 mg/ml and tyrosol of 2 mmol/L,respectively,significantly higher than that in untreated melanocytes (20.3,both P ＜ 0.01).Compared with untreated melanocytes,those treated with the ethanol extract of 0.15 mg/ml and those with tyrosol of 2 mmol/L showed higher intracellular fluorescence intensity (P ＜ 0.01) and more stress fiber bundles which congregated inside the cell membrane and around the nuclei.Conclusions The ethanol extract of glossy privet fruit and its monomer tyrosol can promote the adhesion and migration of human melanocytes in vitro,likely by promoting the congregation of actin cytoskeleton in melanocytes.

Objective To evaluate the effect of tacalcitol on the proliferation,adhesion,migration and c-kit mRNA expression of cultured human epidermal melanocytes.Methods Cultured epidermal melanocytes from the prepuce of adolescent males were treated with various concentrations of tacalcitol.Then,cell proliferation was evaluated by tetrazolium salt (XTT) assay after 24,48 and 72 hours of treatment,adhesive activity by using fibronectin-coated culture plates after 72 hours,migratory activity by Transwell assay using a microporous membrane after 24 hours,and the c-kit mRNA expression was semiquantitatively analyzed by reverse transcription PCR after 72 hours of treatment.Statistical analysis was done by repeated-measure analysis of variance and completely random design analysis of variance.Results As repeated-measure analysis of variance showed,tacalcitol of 10-10,10-9,10-8,10-7 and 10-6 mol/L significantly promoted the proliferation of melanocytes (F =9.47,P ＜ 0.01),with significant differences in the promoting effect among various durations of treatment with different concentrations of tacalcitol (F =14.44,P ＜ 0.01),and with significant interaction effect between drug concentration and treatment duration (F =2.47,P ＜ 0.01).The highest proliferation level was observed in melanocytes treated with tacalcitol of 10-s mol/Lfor 72 hours.There was a significant increase in the adhesion rate of human epidermal melanocytes to fibronectin after treatment with tacalcitol of 10-8-10-7 mol/L for 72 hours (both P ＜ 0.01),number of melanocytes migrating through micropore membranes per high-power field (× 200) after treatment with tacalcitol of 10-9-10-8 mol/L for 24 hours (both P ＜ 0.01),and in the c-kit mRNA expression in melanocytes treated with tacalcitol of 10-9-10-7mol/L for 72 hours (all P ＜ 0.01).Conclusion Tacalcitol can promote melanocytes to proliferate,migrate,express c-kit mRNA,and adhere to fibronectin.

Objective To explore the correlation between serum hs-CRP and β-cell finction in patients with gestational diabetes mellitus(GDM).Methods The levels of hs-CRP in 60 patients with GDM(GDM group)and 30pregnant women with normal glucose tolerance(NGT group)were detected.Insulin resistance was assessed by the homeostasismodel insulin resistance index(HOMA-IR),Insulin secretion by the homeostasis β-cell funetiOn index(HOMA-β).Results The levels of hs-CRP and HOMA-IR were higher in GDM group than in NGT group.There was significant difference between two groups(P＜0.01);HOMA-β was lower in GDM group than in NGT group,there was significant difference between two groups(P＜0.05).The level of hs-CRP was correlated with age,pre-pregnant bodymass-index(BMI),screening BMI,fasting blood glucose(FBG),fasting insulin(Fins),and HOMA-IR(r=0.222,0.649、0.862、0.923、0.935、0.941,P＜0.05 or P＜0.01),but was inversely related with HOMA-β(r=-0.872,P＜0.01).Multiple stepwise regression analysis indicated that HOMA-IR and HOMA-β was the most important effect factors of hs-CRP.Conclusion The level of hs-CRP increased in women with GDM.which was related to insulin resistance(IR)and insulin secretion,and it maybe participate in the pathogenesis of GDM.

Objective To investigate the relationship between the single nucleotide polymorphisms (SNPs) of TLR9 gene and the occurrence of condyloma acuminatum (CA). Methods Peripheral venous blood was obtained from 63 patients with CA and 23 normal human controls with informed consent. DNA was extracted from the blood samples and subjected to the amplification of TLR9 gene by PCR followed by sequence analysis. Results There were 4 SNPs, i.e., SNP1, SNP2, SNP3 and SNP4 at positions 1174, 1635, 1269 and 1724 of the TLR9 gene, respectively. Of these SNPs, SNP1 was located in intron 1, SNP2, SNP3 and SNP4 in exon 2. The registration number is rs352139 for SNP1, rs352140 for SNP2 in NCBI database. SNP3 and SNP4 were newly discovered positions. The frequency at SNP1 position was 0.690 and 0.609 for allele A in the patients and controls, respectively, 0.309 and 0.391 for allele G, respectively (both P > 0.05). No significant difference was observed between the patients and controls in the frequency of allele A or allele G at position SNP2 (0.302 vs. 0.698, 0.369 vs. 0.630, both P > 0.05). There were 4 haplotypes at the SNP1 and SNP2 positions, including AA, AG, GA and GG, with no significant difference in the frequency between the patients and controls (all P> 0.05). Conclusions There are 4 SNPs including SNP1, SNP2, SNP3 and SNP4 in the TLR9 gene in Guangdong Han population. SNP1 and SNP2 appear unrelated to the liability to CA.

Objective To analyze the dynamic evolution of brain MRI in patients with mitochondrial myopathy,encephalopathy,lactic acidosis,and stroke-like episodes (MELAS) syndrome.Methods A retrospective study was performed on 58 MELAS cases with pathologically and (or) molecularly confirmed diagnosis.MRI were repeated within 60 days after the onset of stroke-like episodes (SLE) and the evolution changes of cerebral lesions were accessed.Brain atrophy index (BAI) was calculated in the remission stage from 31 patients with MELAS,and the correlation between BAI,age and disease duration was analyzed.Results The proportion of lesions expansion,migration and shrink within 30 days after the onset of SLE was 64.1％ (25/39),10.2％ (4/39),17.9％ (7/39),respectively,and 13％ (3/23),21.7％ (5/23),56.5％ (13/23),between 30-60 days after the onset of SLE respectively.In the recovery stage of SLE,the BAI in 31 patients with MELAS was 15.2％ ±2.8％.The correlation coefficient between BAI and the age,total disease course and duration of encephalopathy was 0.329 (P =0.043),0.405 (P =0.012) and 0.649 (P =0.000).Conclusions Brain atrophy in the studied MELAS patients gradually develops and strokelike lesions shrink with progression of the disease.However,the migration of lesions is persistent.

Objective To study the clinical characteristics and risk factors of cow's milk protein allergy(CMPA)in infants less than 3 months old in Guangxi District.Methods From July 1 ,2012,to December 30,2014,infants less than 3 months old suspected of CMPA visiting the pediatric outpatient depart-ment of Maternal and Children Hospital of Guangxi Zhuang Autonomous Region were recruited,which included initial diagnosis and being transported from peripheral hospitals.Observation scale was formulated, attending physician screened patients and their senior made a definite diagnosis.All the infants underwent diagnostic algorithms and were followed up constantly.Results A total of 137 cases were divided into aller-gy group(n =51 )and control group(n =86).Two groups shared some common symptoms such as diarrhea, constipation,bloody stool,stomachache,gastroesophageal reflux(GER),indigestion,anorexia,feeding diffi-culties.Between the allergy group and control group the parameters such as feeding patterns (including breast feeding,mix feeding,formula feeding),improper deeding of food supplement,long-term use of antibiotics in neonatal period and parental atopy showed no significant differences(P ﹥0.05).The parameters in neonatal period including GER [20 cases (39.2%)vs.7 cases (8.1 %)],intake of cow's milk formula [51 cases (100%)vs.71 cases (82.6%)],feeding intolerance (including GER)[17 cases (33.3%)vs.1 1 cases (12.8%)],gut infection[8 cases(15.7%)vs.4 cases(4.7%)],transfusion of blood or/and bloody prod-ucts[12 cases(23.5%)vs.1 1 cases(12.8%)]showed statistically significant differences between the aller-gy group and control group(χ2 =19.538,P =0.000;χ2 =9.989,P =0.002;χ2 =8.308,P =0.004;χ2 =4.691 ,P =0.030;χ2 =5.198,P =0.023 ).Conclusion Symptoms of CMPA in infants no more than 3 months old involve mainly digestive system such as diarrhea,bloody stool,GER.Intake of cow milk formula in neonatal period play an important role in triggering CMPA.

[Abstract ] Objective Pelvic radiation disease(PRD) is multiple injuries in more than one organ resulted by pelvic radio-therapy.Patients have the symptoms of frequent feces and fecal incontinence after the resection of small bowel lesion .Sugeries on PRD patients were mainly distal ileum and ilieocecal valve resections , while the most susceptible part of pelvic radiation injury is rectum . However , little research has been done concerning PRD patients′anorectal functions .This study was mainly to evaluate the anorectal function of cervical cancer patients with PRD in order to provide evidence for the therapy and prognosis of PRD . Methods Cervical cancer patients with PRD in need of small bowel resection who hospitalized in our department from January 2014 to January 2015 were collected as patient group , while people from outpatient physical exam group were selected as control group according to the exclusion criteria of hypertension , diabetes, constipation and unrelaxed pelvic floor syndrome .PDR group and control group were matched according to age.All subjects underwent colonoscopy and anorectal manometry .Rectal radiation injury was estimated on the basis of colonoscopy results.Anorectal manometry results of PRD group and control group were analysised statistically . Results PRD group and control group both included 20 women without stenosis or obstruction in rectum .Significant difference was found between PRD group and con-trol group in anal resting pressure (47.23 ±9.08 mmHg vs 58.25 ±9.24 mmHg, P<0.05), anal maximum squeezing pressure (47.23 ±9.08 mmHg vs 58.25 ±9.24 mmHg, P<0.01), anal distension pressure (23.30 ±12.49 mmHg vs 39.10 ±9.99 mmHg, P<0.01), rectal defecation pressure(22.85 ±16,69 mmHg vs 50.90 ±9.14 mmHg, P<0.01) and maximum tolerated rectal volume (112.85 ±51.34 mL vs 173.50 ±48.15 mL, P<0.01).There was no significant difference between the two groups as to the lenghth of functional sphincters(P=0.313),rectum initial threshold(P=0.416) and rectal defecation threshold(P=0.161). Conclusion Ionization radiation that injures PRD patients′internal anal sphincters and external anal sphincters also reduces maximum tolerated rec -tal volumes preoperatively .It′s necessary to assess the muscles and nerve functions of anorectum before intestinal surgery in order to make a proper operation plan which will improve PRD patients′life quality.