[Summary] The concept for the pathogenesis of diabetes is now changing from previousinsulinocentric model andinsulin/glucagon bihormonal model to a recentglucagonocentric model.Glucagon excess rather than insulin deficiency may play a more important role in mediating the glucose derangement during insulin insufficiency.Antagonizing glucagon signaling pathway may become a potential therapeutic modality in diabetes.

Type 1 diabetes includes two categories:autoimmune (type 1A) and idiopathic (type 1B)diabetes.Fulminant type 1 diabetes is a recently discovered subtype of type 1 diabetes with extremely rapid progression of hyperglycemia and ketoacidosis.The prevalence of fulminant type 1 diabetes among acute-onset type 1 diabetic patients is around 15%-20%.Class Ⅱ HLA genotype and virus infection may contribute to its development.The near-normal HbA_(1C) level despite a very high plasma glucose concentration in patients with ketoacidosis is the clue to diagnosis of fulminant type 1 diabetes.Treatment must be started immediately and aggressively when the diagnosis of fulminant type 1 diabetes is made or strongly suspected.

β cell failure is one of the important components in the pathogenesis of type 2 diabetes.Protecting and reversing β cell function is a critical part in diabetes treatments.It has been recently discovered that rather than apoptosis,β cell dedifferentiation into an endocrine progenitor-like stage is the main mechanism of β cell failure,which is closely related with the loss of FoxO1 on β cells.Some of these dedifferentiated β cells even have the potency to convert into α-cells.These great discoveries expand our understanding for the β cell exhaustion during the progression of hyperglycemia.It is worthwhile to reconsider our current treatment strategy for type 2 diabetes,especially during the beginning period,to protect rather than stimulate β cells.It also paves the way to develop a brand-new class of hypoglycemic agent to re-differentiate the already dedifferentiated β cells back into insulinsecreting cells.

Non-operative treatment in 105 cases of acute traumatic intracranial hematomas confirmed by CT scan is reported. Results were satisfactory except in 6 cases in which operation was performed because of the worsening of their conditions. In this paper, the indication, method, and advantages of non-operative treatment are also discussed. We believe that the change of state of consciousness, size of hematoma, degree of shift of midline structures and cerebral contusion, and type of hematoma are decisive factors in making the choice of operative or non-operative treatment.

Vitamin D and parathyroid hormone (PTH) are two classical hormones modulating calcium and phosphorus homeostasis.The rapid development of modern endocrinology has greatly expanded our understanding of these two hormones.The extra-skeleton effects of vitamin D/PTH are well documented,novel findings regarding to the embryonic and adult parathyroid development,and the changing clinical patterns in certain parathyroid-related disorders have been discovered.

Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar status (HSS) are severe acute diabetic complications. This article mainly discusses the definition, mortality rate, pathophysiology, precipitating factors, main clinical manifestations, laboratory findings and principles of treatment in DKA and HHS.

Objective To evaluate the role of genetic factors in the pathogenesis of vitiligo. Methods A questionnaire survey was performed to collect clinical data on 1005 cases of vitiligo in Beijing Hospital from September 1997 to March 2009. Data analysis was carried out by SPSS 13.0 software. Results There were 206 (20.5%) patients with positive family history among the 1005 cases of vitiligo. The mean age at onset was younger and bilateral vitiligo lesions were more frequently observed in patients with positive family history than those without (24.45 ± 15.87 years vs 28.12 ± 16.88 years, 71.3% vs 60.8%, both P ＜ 0.05). Blood type B predominated among patients with positive family history (19.9%), while blood type O among those without ( 16.8% ), and no statistical difference was noted in the distribution of blood type between the two groups of patients (P ＞ 0.05). Conclusions ①The incidence of vitiligo accords with the rules of polygenic inheritance and shows a familial aggregation, and the closer the blood relationship, the higher the incidence of vitiligo.②The incidence of vitiligo seems unrelated to sex. ③The mean age at onset is younger in patients with positive family history than those without, but appears unaffected by paternal or maternal inheritance. ④Patients with positive family history show a higher frequency of bilateral distribution of vitiligo lesions, but no difference in other clinical manifestions from patients without.

BACKGROUND:Each clinical treatment option for avascular necrosis of the femoral head has its own advantages and disadvantages, but early diagnosis and early treatment are firmly rooted in most of orthopedic doctors, and the purpose of treatment is focused on how to preserve the femoral head and how to maintain the hip function.
OBJECTIVE:To summarize the current opinions and studies concerning the treatment of avascular necrosis of the femoral head, including core decompression and porous tantalum rod implantation, and to elucidate the clinical results and cost-effectiveness of the use of porous tantalum rod.
METHODS:The PubMed database was searched by the first author for the articles on the aspect of pathogenesis, risk factors, disease staging and treatment options of avascular necrosis of the femoral head from January 1985 to August 2013 with the key words of“avascular necrosis”,“osteonecrosis of the femoral head”and “tantalum rod”in titles or abstracts. Literatures exhibiting poor correlation with the research purpose and duplicate literature were excluded, and final y, 42 articles were included in result analysis.
RESULTS AND CONCLUSION:The key point of treating avascular necrosis of the femoral head depends on early diagnosis and early intervention. Core decompression plus porous tantalum rod implantation is a minimal y invasive technique in treating early-stage avascular necrosis of the femoral head, in which the subchondral fracture and the femoral head col apse do not occur. If core decompression and porous tantalum rod implantation is used properly, this option does delay or prevent the progress of avascular necrosis of the femoral head. But, if avascular necrosis of the femoral head is in late stage, which means that subchondral fracture and the femoral head col apse occur, the clinical results of this option are poor. Although porous tantalum rod implantation in the treatment of early-stage avascular necrosis of the femoral head demonstrates good exciting short-term results, the clinical value of its long-term results and cost-effectiveness should be elucidated in multicentre, double-blinded, randomized, control ed trials in the future.

ObjectiveTo sum up the diagnosis and differential diagnosis of concealed penis,analyze the indications and advantages of different operative methods for concealed penis.Methods62 children with concealed penis were treated by different surgical operations according to the different types,and the effect of surgical treatment was arelyzed.ResultsOpertaions were successed in all 62 cases,children were discharged after 5 ～ 10 operation days.After follow-up for 3 months to 2 years,62 children had received good recovered with an effective exposure of penis and no severe edema and other complications.ConclusionChildren with concealed penis should be given personalized scheme,choose the best method to extend the length of the penis and improve the penis appearance.

OBJECTIVE Optimizing the infection control process to prevent the infection in the Operating room.METHODS Based on the operating room materials,the problems were found out then with the help of the comprehensive analysis to get the best evidence,finally use the systemic method to optimize the infection control process in the operating room.RESULTS Optimal process was corresponding to the requirements of National Medical department,and has good maneuverability,so it was easy to carry out for the nurses.Comparing the control group and the observation group,we could found: the monitoring of the cleaning of occult blood on surgical instruments(P