We summarized the researches of syndrome differentiation for type 2 diabetes mellitus (T2DM) in this article. According to the constitution feature of obesity and non-obesity and analysis of researches of different medical scholars, we put forward that the easy-suffering constitutions were the basis of the evolution and development of syndromes of T2DM, and the different inducements were the conditions of that courses. The persons whose constitutions were of qi-deficiency of spleen and kidney and excessive stomach often appeared a obese physique, and the people whose constitutions were of yin-deficiency of both the liver and kidney usually showed a non-obese shape. Affected chronically by the inducements, the evolution and development of the syndromes had its own rules respectively corresponding to the different constitutions as the diseases go on. Therefore, to integrate the constitution, disease stage and pathological change with specific zang-fu organs can better grasp its rules of syndrome differentiation.

OBJECTIVE:To observe the effectiveness and safety of liraglutide combined with insulin and glipizide in the treat-ment of subclinical hypothyroidism(SCH)complicated with type 2 diabetes in the elderly patients. METHODS:Totally 82 elderly patients with SCH complicated with type 2 diabetes were selected from our hospital during Dec. 2013-Dec. 2015,and then divided into trial group(40 cases)and control group(42 cases)according to random number table. Control group was given Insulin in-jection+Glipizide tablets. Trial group was additionally given Liraglutide injection 0.6 mg,sc,qd,on the basis of control group. Treatment courses of 2 groups lasted for 12 weeks. The levels of blood glucose [fasting glucose,postprandial 1 h and 2 h glucose,mean of daily differences(MODD),mean amplitude of glycemic excursions(MAGE)],glycosylated hemoglo-bin,body weight,total cholesterol,blood pressure [systolic blood pressure(SBP),diastolic blood pressure(DBP)],thyroid stimulating hormone(TSH)and homeostasis model assessment(HOMA-B)were observed in 2 groups before and after treat-ment. The occurrence of ADR was recorded. RESULTS:Totally 4 patients of control group withdrew from the study,and no one withdrew from the study in trial group. Before treatment,there was no statistical significance in the levels of blood glu-cose,glycosylated hemoglobin,body weight,total cholesterol,blood pressure,TSH and HOMA-B (P>0.05). After treat-ment,body weight and total cholesterol level of trial groups were significantly decreased and lower than those of control group,with statistical significance (P<0.05). The levels of blood glucose,glycosylated hemoglobin,blood pressure (SBP, DBP)and TSH in 2 groups were decreased significantly,while HOMA-B levels were increased significantly,and trial group was significantly better than control group,with statistical significance(P<0.05). There was no statistical significance in the incidence of ADR between trial group (12.5%) and control group (19.0%)(P>0.05). CONCLUSIONS:Liraglutide com-bined with insulin and glipizide for elderly patients with SCH complicated with type 2 diabetes can effectively reduce blood glucose level,keep blood glucose stable,control the increase of body weight and improve islet B cell function with good safety.

Objective To analyze the clinical presentation and maternal-neonatal outcome of HELLP syndrome.Methods 32 cases with HELLP syndrome from January 2003 to January 2009 were analyzed retrospectively.Results The incidence of HELLP syndrome in preeclampsia was 3.7%.Complete HELLP were 17 cases,partial HELLP were 15 cases.Two pregnant women died(one case of intracranial hemorrhage,one case of acute left cardiac failure),the mortality was 6.3%.Five newborns died,the mortality was 15.6%.The main materal complications were DIC(8 cases),placental abruption(2 cases),intracranial hemorrhage(2 cases).The main perinatal complications were preterm labor(20 cases),newborn asphysia(17 cases),SGA(15 cases).Conclusion HELLP syndrome is one of the most serious obstetric complications,early diagnosis,early therapy,controlling hypertension and termination of pregnancy in time are most important for treatment.

Objective: To construct the recombinant vaccinia virus of mutant N-ras/61 gene and enhance the immunogenecity of mutant N-ras／61 protein produced by the recombinant vaccinia virus. Methods: N-ras／61 gene was inserted into P1108 and transfected into CV-1 cell infected with vaccinia virus by Cell FECTIN. PCR and Western blot were used to identify the recombinants. Results: We get recombinant vaccinia virus rV-N-ras/61 by PCR and tk- selecting. The expression of N-ras gene was detected by Western blot. Conclusion: This study is a test for studing effective vaccine of mutant N-ras/61 gene. The efficacy in vivo of the N-ras／61 vaccine in immunotherapy is under investgation.

Objective To investigate the effects of deletion of adenosine A2A receptors on peripheral leukocytes on cerebral white matter lesions induced by chronic cerebral hypoperfusion.Methods Twenty-four wild type(WT) male mice were given a ? irradiation of 12.5Gy,followed by receiving bone marrow cells tail vein from female A2A receptor knocked out(KO) mice via tail vein,were assigned as KO→WT group,while those received bone marrow cells from WT female mice were assigned as WT→WT group(n=20).The efficiency of reconstitution of bone marrow cells in recipient mice was assessed 7 weeks after transplantation by PCR and immunofluorescent technique.Then,the recipient mice were subjected to bilateral common carotid artery stenosis with internal diameter of 0.18mm by external banding using microcoils at 8 weeks after transplantation.On 7d,14d and 30d after the surgery,corpus callosum,fiber bundles of Caudoputamen and optic tract were harvested from the cerebral white matter,and stained with Kluver-Barrera staining for observing the changes in nerve fibers,and with GFAP and CD11b immunohistochemistry staining for observing the proliferation of microglia and astrocytes.Results At 7 weeks after successful transplantation,the genotype of sex chromosome in peripheral leukocytes of the male recipient mice was changed into female pattern.The expression rate of A2A receptor was 9.73%?2.05% in KO→WT group and 93.82%?11.24% in WT→WT group,with significant difference between the two groups(P

Objective To observe behavioral characteristics and pathologic changes of chronic cerebral hypoperfusion in mice. MethodsTotally 62 adult C57BL/6 mice were subjected to either sham-operation (n=31) or bilateral common carotid artery stenosis using external microcoils with an inner diameter of 0.18 mm(n=31). At 30 d after the stenosis, the animals of the 2 groups (8 mice for each group) underwent behavioral test of 8-arm radial maze. In 7, 14 and 30 d, the rest mice were sacrificed for their brain tissue samples which were examined with Kluver-Barrera staining and immunohistochemical assay for markers of microglia and astroglia, glial fibrillary acidic protein (GFAP) and CD11b. In 14 d after the model establishment, Evans blue dye extravasation test was performed for the blood-brain barrier function. ResultsThe model group made significantly more errors than sham-operated group in 8-arm radial maze test at 30 d after the surgery. White matter lesions occurred and the proliferation of activated microglia and astroglia were observed in white matter in model mice after 14 and 30 d bilateral common carotid artery stenosis. The disruption of blood-brain barrier function of model mice was indicated in the evans blue extravasation test at 14 d after bilateral common carotid artery stenosis. ConclusionCognitive impairment, white matter lesions and glial activation are successfully induced after bilateral common carotid artery stenosis in mice model of chronic cerebral hypoperfusion.

Objective To investigate the effect of adenosine A2A receptor deficiency on the ischemic neuronal injury and its potential mechanism.Methods Transient(2 h)cerebral ischemia was induced by the middle cerebral artery occlusion(MCAO)in mice.Adenosine A2A receptor knockout(A2ARKO)mice and their wild-type littermates(A2ARWT)were divided into 2-hour cerebral ischemia group,cerebral ischemia with 22-hour reperfusion group and cerebral ischemia with 46-hour reperfusion group.Cerebral infarction volume was measured by image analysis of brain sections stained with cresyl violet(CV).Brain water content was evaluated with the dry-wet weighing method.The expression of calbindin D-28k(CB)and aquaporin-4(AQP4)in ischemic brain was determined with immunohistochemical methods.Results The cerebral infarction volumes in 2-hour cerebral ischemia group,cerebral ischemia with 22-hour reperfusion group and cerebral ischemia with 46-hour reperfusion group of A2ARKO mice were lesser than those in the corresponding groups of A2ARWT mice.Compared with A2ARWT mice,A2ARKO mice had more CB,lesser AQP4 expressions and lesser brain water contents.Conclusion Adenosine A2A receptor deficiency exerts the protection against ischemic brain injury both in the acute phase and reperfusion phase,and attenuates brain edema caused by cerebral ischemia,which may be due to the inhibition of intracellular calcium overload and AQP4 expression.

Objective To investigate the distribution of vancomycin-resistant genes and virulence genes in vancomycin-resistant Enterococcus (VRE) isolates from intensive care unit (ICU).Methods A total of 180 anal swabs were collected from patients in ICU in Tianjin Medical University General Hospital during September 2012 and May 2013.VRE strains were screened by ChromID agar method.Vitek 2 Compact system was used in drug sensitivity test,and the sensitivities to vancomycin and teicoplanin were further determined using Kirby-Bauer disk diffusion method.Vancomycin resistant genes vanA,vanB,vanC1 and virulence genes esp,hyl were detected by polymerase chain reaction(PCR).Results Nineteen strains of vancomycin resistant Enterococcusfaecium were isolated from 180 anal swabs.All 19 VRE isolates were resistant to both vancomycin and teicoplanin,while they were susceptible to linezolid and tigecycline.All VRE isolates carried vanA and esp genes,and hyl gene was positive in 10 isolates.Conclusions VRE isolates from ICU are highly resistant to commonly used antibacterial agents,and most isolates carry vancomycin-resistant genes and virulence genes.Linezolid and tigecycline may be recommended for VRE infection in ICU.

Objective To study the protective effect of fluvastatin,one of the HMG-CoA reductase inhibitors (statins),against oxygen radical-induced oxidative damages in human aortic endothelial cell,and the role of Bcl-2 in this protection.Methods Human aortic endothelial cells with or without Bcl-2 siRNA transfection were subjected to 1-100 nM of fluvastatin and 100 la hydrogen peroxide for 24 hours.Bcl-2 mRNA and protein expression were measured by Taqman quantitative PCR and Western blotting.Cell apoptosis was measured by normal and fluorescent microscopy and Cell Death Detection ELISA.Results In the Bcl-2-expressed cells,fluvastatin significantly reversed hydrogen peroxide-induced microscopic apoptosis and apoptotic DNA fragmentation,which were accompanied by a markedly upregulation of Bcl-2 expression by fluvastatin.However,the endothelial protection by fluvastatin was completely lost in Bcl-2 siRNA transfected cells.Conclusion Fluvastatin protects human endothelial cells against oxygen radical-induced cell apoptosis in vitro,and this protection seemed to be mediated in a Bcl-2 dependent pathway.(J Geriatr Cardil 12008;5:33-38)

Medical care on the battlefield is the core and basis of echelons of care.This review summarizes the background and characteristics of medical care units on the battlefield from the birth and growth of mobile army surgical hospitals before being replaced by forward surgical teams and combat support hospitals, since the United States Armed Forces began to lead the world military revolution during and after the World WarⅡ.Quick adaptation to the combat envi-ronment and the combat modes is the main reason that medical care units on the battlefield are adjusted continuously.This paper may provide some ideas for the development of our medical care units on the battlefield in the future.