Objective To study the effect of danshao shugan granule combined with metformin in treatment of nonalcoholic fatty liver and its effects on lipid and uric acid metabolism.Methods 80 patients of nonalcoholic fatty liver who received therapy from February 2014 to February 2015 in our hospital were selected as research objects.According to random number table,those patients were divided into the observation group (n=40) cases in each group and the control group (n=40).The control group was treated with metformin, while the observation group was treated with danshao shugan granule combined with metformin.Then blood lipid level, FBG, FINS, IR, SUA level, SOD, MDA level, therapeutic effect of two groups after treatment were compared.Results After treatment, TG,TC in observation group was significantly less than the control group (P<0.05); FBG, FINS, IR, SUA levels in the observation group were significantly lower than the control group ( P<0.05 ); SOD level higher than the control group, MDA level significantly less than the control group (P<0.05); The total effective rate of observation group was statistically higher than that in the control group (P<0.05).Conclusion Danshao shugan granule combined with metformin is well for nonalcoholic fatty liver,which can improve the glucose, lipid, uric acid metabolism and insulin resistance, and can protect the liver function.

Objective:To better understand the clinical characteristics of children with pneumocystis pneumonia(PCP).Methods:Seven cases of non-human immunodeficiency virus infected children with PCP admitted to pediatric intensive care unit(PICU) at Xi′an Children′s Hospital from January 1, 2019 to December 31, 2019 were enrolled.Clinical findings, laboratory examination results, diagnosis, treatment, and outcome data were retrospectively reviewed.Results:There were seven children enrolled in this study including six boys and one girl.The average age was(6.09±3.80)years.Six patients received a long-term steroid or immunosuppressive therapy, and the average duration of medication was(80±30)days.One patient was eventually diagnosed with immunodeficiency disease despite no history of steroid and immunosuppressive therapy.Fever, cough and progressive dyspnea were the main manifestations.The pulmonary signs were not obvious, however, the chest radiographs showed serious ground glass changes.Laboratory examination showed that white blood cell counts were normal, lymphocyte counts were decreased to varying degrees, while C-reactive protein, calcitonin and lipopolysaccharide increased slightly or normal.Lactate dehydrogenase significantly increased and PaO 2/FiO 2 decreased, respectively.All children combined with different degrees of heart, liver and digestive tract damage.Pneumocystis jirovecii infection was diagnosed by metagenomics next-generation sequencing(mNGS), of which one case was detected by bronchoalveolar lavage fluid, and the remaining six cases were detected by peripheral blood.After entering PICU, mechanical ventilation, intravenous injection of human immunoglobulin, and continuous renal replacement therapy were performed.None of the children used TMP-SMZ for prophylaxis outside the hospital.Among them, one case was diagnosed with PCP before entering PICU and was given TMP-SMZ for 20 days, while the remaining six patients started to receive TMP-SMZ after entering PICU.Finally, one patient was cured, three died and another three cases died after giving up treatment.The average hospitalization days were(11.28±8.78)days, and the average hospitalization costs were (78, 000±24, 000) RMB. Conclusion:Children with non-human immunodeficiency virus infected PCP usually have underlying diseases or immunodeficiency diseases.Due to non-specific manifestations, rapid progression and high mortality, clinicians should pay more attention to it.It is necessary to dynamically observe the respiratory symptoms, perform mNGS as soon as possible, and give TMP-SMZ treatment in time.TMP-SMZ prophylaxis can be given to patients who are highly suspected of PCP but unable to perform pathogenic examinations.

Objective To design an approach above the fibular head for treating posterolateral tibial plateau fracture,and to investigate its feasibility,advantages and disadvantages in clinical application.Methods Ten frozen adult cadaveric knees were dissected to observe the correlation of the important lateral structures and effect of knee flexion on tensity of the lateral collateral ligament.The distance (OA) from superior border of facies articularis capitis fibulae to lateral edge of articular surface of tibial plateau and the distance (OB) from the cross point of lateral collateral ligament and facies articularis capitis fibulae level to lateral edge of articular surface of tibial plateau were measured.According to the anatomic measurement results,the approach above the fibular head was designed.Then 12 patients with posterolateral tibial plateau fracture were treated through this approach,and the short-term clinical results were evaluated.Results The value of OA ranged from 9.43 to 14.92 mm (average,12.97±1.83 mm).At 0° of genuflex,the lateral collateral ligament was tense and the average value of OB was 4.87±0.33 mm.During the course of genuflex,the lateral collateral ligament got loose following which the value of OB became larger.At 60° of genuflex,the lateral collateral ligament was most loose,and the posterolateral tibial plateau could be exposed completely by drawing posterolaterally lateral collateral ligament and rotating medially tibia.All patients were followed up for 6 to 24 months (average,18 months).The average bone healing time was 10.2 weeks (8 to 12 weeks).According to Rasmussen's knee functional score system,the results were excellent in 10 cases and good in 2 cases.No complications occurred,such as numbness of limbs,instability of the knee and internal fixation loosening.Conclusion The approach above the fibular head is feasible,simple and safe for treating posterolateral tibial plateau fracture.

Objective To determine the effect of the modified UW (University of Wisconsin)solution in the treatment of acute renal tubular necrosis in newborn swine. Methods Ten one-week-old newborn swine were used to establish the animal model of acute renal tubular necrosis by clamping their renal arteries,and were divided into two groups: the model group( n = 5 ) and the treatment group ( n = 5 ) in which fructose diphosphate sodium UW solution was used. Sham surgery was performed on other five swine, which were used as the sham group. At 12 h,l d,2 d,3 d and 7 d after the operation,the urine volume,urine protein,blood urea nitrogen(BUN) and creatinine(Cr) were determined. At 12 h ,24 h and 7 d after the operation ,renal pathological examination was conducted. Results The renal pathological examination and the blood biochemistry tests showed that the animal model was successful. BUN and Cr in the model group and the treatment group were significantly higher than those in the sham group at 12 h after operation(P ＜0. 05) ,and they arrived at their peak values at 2 d after operation,showed remarkable decline at 7 d,especially in treatment group,and returned to the level of the sham group. The urine protein in the model group and treatment group were higher than those in the sham group at various times(P ＜0.05 or P ＜0.01) and it peaked at 1 d after operation,then declining gradually,especially in the treatment group. Compared with the sham group,there were a significant decrease in the urine volume at various times in the model group(P ＜0. 05 or P ＜0. 01 ) ,while in the treatment group,the decrease in the urine volume were significant only at 12 h, 1 d and 2 d( P ＜ 0. 05 ) ,and turned insignificant at 3 d and 7 d. The pathological examination showed that the pathological changes in the treatment group were significantly milder than those in the model group. Conclusion The modified UW solution is effective in reducing the acute renal tubular necrosis in newborn swine.

Objective To explore the efficacy of saxagliptin in the treatment of failed glycemic control of patients with type 2 diabetes mellitus on the basis of established treatments.Methods 172 cases of failed glycemic control of patients with type 2 diabetes mellitus from June 2013 to December 2014 in department of endocrinology of the first hospital of Ningbo were selected and received health education of 8 weeks, then received saxagliptin on the basis of established treatments for a consecutive treatment of 12 weeks.The HbA1c, fasting blood glucose ( FBG), 2-hours postprandial blood glucose (2hPBG), body mass index (BMI), insulin dosage and adverse event were observed.Results The FBG,HbA1c and 2hPBG after treatment of 12 weeks were significantly lower than those pre-treatment[(7.1 ±2.0)vs.(8.3 ±1.6)mmol/L,(10.2 ±2.3)vs.(15.2 ±2.9)mmol/L,(7.0 ±1.5) vs.(8.0 ±1.7)%], with significant difference (all P <0.05), while there was no significant difference in BMI between pre-and post-treatment [(24.4 ±3.0)vs.(24.9 ±2.7)kg/m2].The insulin dose after treatment of 12 weeks was significantly lower than that pre-treatment[(22.6 ±7.9)vs. (32.3 ±8.2) U/d], with significant difference (P <0.05).There were two patients dropout because of the intolerable digestive tract symptom. Conclusion The adding of saxagliptin could control FBG,2hPBG and HbA1c effectively and decrease insulin dose, without gaining weight in the treatment of failed glycemic control of patients with type 2 diabetes mellitus on the basis of established treatments.

Urinary sodium was measured by means of 24-hour urine collection in 186 patients with type 2 diabetes.All patients were categorized into quartiles of urinary sodium.There was a significant positive trend of association of greater carotid intima-media thickness(CIMT) with increasing urinary sodium quartile,even adjusting for age,smoking,and blood pressure (Ptrend＜0.01).Multiple linear regression analysis showed that 24-hour urinary excretion may be associated with CIMT in type 2 diabetes patients (β=0.074,P＜0.01).

The purpose of the present study was to investigate teacher-dominant action and focus on learning-oriented group.Medical teachers should pay more attention to three important aspects,such as optimizing teaching pattern,dealing with the relationship carefully among pre-class,inter-class and post-class.It is important to attach importance to pre-class,giving prominence to inter-class and also giving attention to post-class,which can form a harmonious,interactive and collaborate class.In addition,it stimulates deep processing interactions between teachers and students by increasing students learning interests,which is very helpful in improving teaching effects of medical image.

ObjectiveTo evaluate the value of National Institute of Health Stroke Scale (NIHSS) combined with CT angiography(CTA) to predict the clinical outcome of acute ischemic stroke patients at ultra-early stage.Methods70 patients with acute ischemic stroke underwent brain CTA within 6 hours from symptom onset and were divided into two groups according to NNIHSS score, and clinical outcome was compared between two groups.ResultsThere were 38 patients with arterial occlusion on CTA and 32 patients with normal CTA. The percentage of occlusion on CTA for patients presenting with more severe neurological deficits was higher than those patients with slight to moderate deficits. The patients with occlusion on CTA and presenting with more severe deficits had a poor clinical outcome (P<0.01). 78% of patients with normal angiograms had good outcome, only 44.7% patients with arterial occlusion had a good clinical outcome(P<0.05). Both CTA evidence of vessel occlusion and admission NIHSS score correlated with clinical outcome measured by discharge NIHSS score(r=0.25, P=0.04 and r=0.73, P=0.000 respectively). The sensitivity and specificity for predicting clinical outcome by using the NIHSS score alone was 56.65% and 85.29%, and positive predictive value (PPV+) was 80.00%. There was a sensitivity of 63.89%, a specificity of 73.53%, a PPV+ of 71.88% if CTA showed vessel obstruction. If NIHSS scores combined with CTA to predict clinical outcome, the result showed a sensitivity of 70.11%, a specificity of 91.18%, a PPV+ of 88.00%.ConclusionThose patients with vessel occlusion on CTA appear to have a worse clinical outcome. NIHSS combining with CTA may increase specificity for judging prognosis and guide treatment.

Objective To study the changes of ambulatory blood pressure parameters after endovascular treatment.Methods The ambulatory blood pressure of 7 patients with artery stenosis was tested before and after endovascular treatment,and the coefficient of variation(CV)was calculated.Results All patients' blood pressures decreased after endovascular treatment.The CV of blood pressure of patients with internal carotid stent decreased,but the CV of blood pressure in patients with vertebro-basilar artery stent increased.Conclusion The effects of stent on blood pressure is far from clear.

AIM: To investigate the expression of adhesion molecules in hepatocellular carcinoma (HCC), and analyze its clinical significance. METHODS: The expression of adhesion molecules of tumor tissues of 64 cases and adjacent tissues of 12 cases of HCC were detected with RT-PCR. RESULTS: ①The expression rates of E-cadherin, ICAM-1 , CD44, CD 44V , ? 5, ? 1 were 90 62%, 93 75%, 50 00%, 96 88%, 100%, 100%, respectively, and there was a significant difference between CD44 and other adhesion molecules. ②The expression level of E-cadherin, ICAM-1, CD44, CD 44V , ? 5,? 1 in liver cancer tissues were 1 24?0 54, 0 96?0 37, 0 62?0 73, 0 86?0 33, 0 97?0 49, 1 41?0 24, respectively, and there was a significant difference between CD44 and E-cadherin, ? 1. ③The expression level of E-cadherin and CD44 mRNA declined as HCC stage become higher, and there was a statistical difference in the expression level of CD44 mRNA between Ⅰ-Ⅱ stage and Ⅳ stage. The expression level of ICAM-1, ? 5, ? 1 had a trend to rise as HCC stage become higher, and there was a statistical difference in the expression level of ICAM-1 between Ⅰ-Ⅱ stage and Ⅳ stage. ④The expression level of ICAM-1,CD 44V , ? 5, ? 1 had positive correlation with tumor volume, tumor nodules, tumor metastasis, and had negative correlation with tumor encapsulation. E-cadherin and CD44 had negative correlation with tumor volume, tumor nodules, tumor metastasis, and had positive correlation with tumor encapsulation. All showed no significant correlation with the level of AFP , the degree of cirrhosis and the function of liver. CONCLUSION: There was a significant difference in the expression level of adhesion molecule mRNA in HCC, and their expression had Spearman correlation with each other. The expression level of adhesion molecule mRNA is associated with tumor volume, tumor nodules and tumor metastasis. [