Objective To investigate the features of female sexual dysfunction (FSD) in type 2 diabetic patients (T2DM)and to analyze its risk factors. Methods According to FSFI indexes in the sexual function questionnaire,227 female T2DM patients were divided into DM group without FSD [n=144,FSFI≥25] and DM+FSD group[n=83,FSFI<25]. 80 healthy women served as normal controls. The risk factors for FSD were analyzed using logistic regression analysis. Results The occurrence of FSD was 36.6%(83/227) in female T2DM patients. The levels of FSH,TSTO and LH were higher,and E2 was lower in DM+FSD group and DM group than those in NC group(P<0.01),but there was no statistical significance between DM+FSD group and DM group(P>0.05). The score of sexual desire[(2.54±0.58) vs (3.76±0.90) vs (4.59±1.22) score],sexual arousal[(2.30±0.42) vs (3.57±0.85) vs (4.81±1.00) score],vaginal lubricate[(3.35±0.29) vs (4.46±1.32) vs (5.14±0.83) score],orgasm[(2.75±0.68) vs (3.40±1.86) vs (4.02±1.25)score] and total score [(17.94±4.15) vs (24.71±6.33) vs (28.13±5.78) score] were lower in DM+FSD group and DM group than those in NC group. The score of sexual satisfaction[(3.45±1.68) vs (4.94±0.93),(4.99±0.86)score] and pain[(3.55±0.50) vs (4.58±0.47),(4.58±0.62)score] were lower in DM+FSD group than those in DM group and NC group(P<0.05),but there was no statistical significance between DM group and NC group(P>0.05). Logistic regression analysis showed that age,BMI and HbA1c were risk factors for FSD in T2DM patients (P=0.029,0.001,0.022,respectively). Conclusion The occurrence of FSD is common in female type 2 diabetic patients. BMI and HbA1c are the main risk factors for FSD.

Objective To study the effect of integrated tradition and western medicine on unstable angina.Methods Sixty-six patients with unstable angina were randomized into two groups:control group treated only with routine therapy(n=33) and experiment group treated with routine and jia jian luang gan jian therapy(n=33).The difference of EKG,symptoms and clinic comprehensive evaluation between before treatment and after-3-week-treatment were compared.Results The rate of symptoms and ECG improvement was higher in experiment group than control group(94% vs 73%;73% vs 45%).The difference of clinic comprehensive score between before treatment and after 3 weeks treatment was significantly higher in experiment group.Conclusion The treatment of integrated tradition and western medicine on patients with unstable angina is more effective.

Objective To explore the effect of swimming training on the microcirculations of cochlea in guinea pigs with tertram ethylpyrazine(TMP) treatment after chronic hypoxia.Methods 28 guinea pigs were divided into normal control group outside of cabin (A) and chronic hypoxia model group (B). After four weeks the model group were divided into the model control group (B 1),TMP treatment group (B 2),swimming training group(B 3) and swimming training with TMP treatment group (B 4).Until the given time,LDF was used to investigate the blood flow of every guinea pig's cochlea.The spiral ligament spreaded-slice optical lens was used to observe guinea pig's vascular veins, capillary appearance and RBC counts.Results There was significant difference in cochlear blood flow(CBF) and RBC counts between B 2,B 4 groups and B 1 group.CBF and RBC counts of B 3 group was improved comparing with B 1 gorup,so did that of B 4 group comparing with B 2.But no significant difference was found.Conclusion Swimming training can relieve the swelling on the thin blood vessel and improve the effect of TMP on the microcirculation in cochlea of guinea pigs under chronic hypoxia environment.

Objective To report the clinical experience of extracorporeal membrane oxygenation (ECMO)in the emergency management of fulminant myocarditis.Methods The patient,an 11 year-old boy,had fever for 4 day and abdominal pain,vomiting for 1 day and anuria for 12 hours.Electrocardiogram showed Ⅲ atrial-ventricular block,multifocal ventricular rhythm,bundle branch block,convulsivum multifocal ventricular tachycardia,extensive low voltage,ST-T elevation at lead Ⅰ,AVR,V1,V2,V3;and there were ST-T intrusion,T wave inversion at lead Ⅱ,Ⅲ,AVR,AVF,V4～5.Blood creatine kinase was 2 161 U/L,reatine kinase isoenzyme 109 U/L,α-hydroxybutyrate dehydrogenase 612 U/L,lactate dehydrogenase 696 U/L,troponin Ⅰ 22.1 U/L.Echocardiogram showed right atrium 4.4 mm,right ventricular 2.3 mm,severe tricuspid valve regurgitation,left ejection fraction 33％,left ventricular fractional shortening 15％,ventricular wall motion dyssynchrony.Blood lactate was 4.0 mmol/L.The patient's condition was still unstable after using dobutamin,dopamine,milrinone,furosemide,large dose methylprednisolone,intravenous human immunoglobin,phosphocreatine and so on.ECMO was used for cardio-pulmonary support.It is necessary to monitoring the consciousness,temperature,heart rate,respiration,blood pression,SaO2,urinary volume,ariterial blood gas,blood electrolytes,blood lactate,blood glucose,liver function,renal function,blood routine,activated clotting time(ACT),lower extremity blood supply and so on.ACT was maintained at 160～200 s.Heparin was used persistently[5～10 U/(kg·min)].Results ECMO system had been successfully used for 7 days.The cardiac function of the patient was improved significantly.There was no complication,such as hemorrhage,infection,and embolism.Heart arrest in the patient occurred three times,ventricular fibrillation and ventricular flutter occurred one time respectively during ECMO.The rhythm was recovered by electric defibrillation and antiarrhythmic drugs.On day 20,the patient was discharged.At the time of hospital discharge,the patient demonstrated good activity,with normal myocardial enzymes.The echocardiogram showed the size of the cardiac chambers and the contractile function of the myocardia were normal.Electrocardiogram showed Ⅰ degree atrial-ventricular block,complete right bundle branch block.Two weeks later,the electrocardiogram demonstrated complete right bundle branch block.Echocardiogram showed septal thickening(0.9 cm).Two months later,the electrocardiogram was just as that of two weeks before.Echocardiogram showed septal thickening(0.7 cm).The children had no symptom after he was discharged and acted without limitation.Conclusion ECMO is a kind of effective treatment for fulminant myocarditis.The key to desirable therapeutic effect is the timing of its application.

Objective: Little has been reported on the utilization of the preoperative preparing room before anesthesia.This article aimed to investigate how to improve work efficiency in the operation theatre by utilizing the preoperative preparing room.Methods: Two hundred patients undergoing elective surgery were equally randomized into an operation room group and a preoperative preparing room group,for which the preoperative preparations were made in the operation room and the preoperative preparing room,respectively.Records were made of such parameters as the anxiety score,mean arterial pressure(MAP) and heart rate(HR) of the patients,as well as the surgery rotation time.Results: The anxiety score,MAP and HR were significantly lower(P

AIM:To approach the therapeutic effects of mycophenolate mofetil(MMF)in hormonal resistance nephrotic syndromes.METHODS:Patients were diagnosed as nephrotic syndrome and treated with prednisone at the dose of 1 mg?kg-1?d-1 for over 8 weeks,and 24 patients with unsatisfactory results or were palindromic were selected,and several patients in the 24 patients had been treated with cyclophosphamide or cyclosporine A.All patients were treated with MMF combined with low dose hormone.The initial dose of MMF was 1.0-1.5 g/d for 3 months,later the dose were reduced,and the maintenance dose of MMF was 0.5-1.0 g/d,the dose of prednisone was 5-20 mg/d,the follow-up visit period more than six months.The changes on urine protein,serum albumin,liver function,renal function were compared before and after treatment.RESULTS:Before and after treatment,urine protein decreased from(3.4?1.7)g/d to(0.9?0.2)g/d,serum albumin increased from(19.6?5.4)g/L to(36.1?7.7)g/L.serum creatinine level decreased from(105.7?6.4)?mol/L to(90.1?5.8)g/L.20 patients(83.3%)pathogenetic condition were relieved,15 patients(65.2%)were with complete remission.5 patients(20.8%)were partially recovered,and 4 patients(16.6%)had no response.The adverse effects were observed,including gastrointestinal events(n=8,33.3%),bacterial pneumonia(n=4,16.6%),herpes zoster(n=1,4.1%),hepatic function mild damage(n=3,12.5%).CONCLUSION:It is safe and effective to combine MMF with low dose hormone in treatment of hormonal resistance nephrotic syndrome,which could become a therapeutic option for refractory nephrotic syndrome(RNS).

BACKGROUND: Growth-associated protein-43, a kind of protein relatedto axonal growth, plays a key role in promoting neural development, axonalregeneration, synaptic growth and structural and functional reconstructionand so on. In the study, we find that cyclovirobuxine D can protect braininjury in rats with experimental cerebral ischemia reperfusion.OBJECTIVE: To observe the effect of cyclovirobuxine D on the expression of growth-associated protein-43 mRNA in hypertensive rats with cerebral ischemia reperfusion.DESIGN: A randomized controlled animal experiment.SETTING: Foshan Hospital of Traditional Chinese Medicine of Guangdong Province; Central Laboratory of Guangdong Hospital of Traditional Chinese Medicine.MATERIALS: Cyclovirobuxine D is alkaloid monomer extracted from Chinese herb buxine. Cyclovirobuxine D powder with national protected traditional medicine number of ZYB20796057 was provided by Nanjing Xiaoyingyao Pharmaceutical Factory. Totally 120 two-to-three-month-old healthy male SD rats, of either gender, with body mass of 90 to 120 g, were used in this experiment.METHODS: This experiment was carried out in Foshan Hospital of Tra ditional Chinese Medicine of Guangdong Province and at the Central Laboratory of Guangdong Hospital of Traditional Chinese Medicine between June 2005 and March 2006. ①Stroke-prone-renovascular-hypertensive-rats models (RHRSP)were created by bilaterally narrowing the renal artery with silk loop clips. Totally 120 rats were randomly divided into blank group (n=20,renovascular hypertensive rats were given no treatments), sham operation group (n=20, rats were given only surgical trauma), model group (n=40, rats were given treatment of cerebral ischemia reperfusion) and cyclovirobuxine D-treated group (n=40, rats were given cyclovirobuxine D).② Unilateral occlusion of the middle cerebral artery ischemia reperfusion models were made with suture-occluded method. 6.48 mg/kg cyclovirobuxine D diluted by 1.5 mL normal saline was intraperitoneally injected into the rats of cyclovirobuxine D-treated group, twice per day; Normal saline was isochronously intraperitoneally injected into the rats of each subgroup of control group, 2 mL once, the method was the same as that of the cyclovirobuxine D-treated group; interval of injection time was 7 hours in each group. Rats in each group were executed on days 1, 7, 14 and 30after ischemia reperfusion. ③ Brain slice was prepared. The expression of growth-associated protein-43 mRNA of rats in each group was detected with in situ hybridization.MAIN OUTCOME MEASURES: ① The expression of growth-associated protein-43 mRNA around ischemia are following ischemia reperfusion for 2 hours. ②The expression of growth-associated protein-43 mRNA in hippocampus following ischemia reperfusion for 2 hours RESULTS: All the 120 rats entered the stage of result analysis. ① Immune in situ hybridization of growth-associated protein-43 mRNA: In situhybridization showed that expression of growth-associated protein-43 mRNA and expression of growth-associated protein-43 mRNA could be detected respectively in the hippocampus and marginal area of hematoma after ischemia and reperfusion.②The expression of growth-associated protein-43RNA around haematoma following cerebral ischemia reperfusion group as not found in blank group and sham-operation group; The expression of growth-associated protein-43 mRNA was found in the marginal zones around haematoma of rats in the model group on the 1st day following ischemia reperfusion and it was significantly increased on the 7th day, gradually reduced on the 14th day and still expressed on the 30th day but less,with significant difference at each time point (P ＜ 0.01); Expression of growth-associated protein-43 mRNA around haematoma at each time point was more in the cyclovirobuxine D-treated group than in the model group ,with significant difference (P ＜ 0.05). ③There was no significant difference of the expression of growth-associated protein-43 mRNA in hippocampus of rats following cerebral ischemia reperfusion between blank group and sham-operation group; Expression of growth-associated protein-43 mRNA was found in hippocampus of rats in the model group on the 1st day after modeling, and it reached the peak on the 7th day, gradually decreased on the 14th day and significantly decreased on the 30th day, but significantly more than that of sham-operation group; The expression of growth-associated protein-43 mRNA in hippocampus was significantly more at each time point in cyclovirobuxine D-treated group than in model group, with significant difference (P ＜ 0.01).CONCLUSION: Cyclovirobuxine D up-regulates the expression of growthassociated protein-43 mRNA after reperfusion and promotes axonal regeneration of rats with experimental cerebral ischemia.

Objective To explore the application and effect of case-based learning(CBL)in vas-cular surgery clinical teaching. Methods Totally 37 resident doctors were randomly divided into 2 groups respectively: CBL teaching group (n=21)and traditional teaching group (n=16). CBL teaching was con-ducted through the following procedures:selecting typical cases-establishing and applying typical case library-autonomous learning-holding regular seminars. Traditional teaching was conducted through the following procedures: basic theory studying-participating in clinical practice-participating in case discus-sion. Evaluation was conducted based on test socre (written test and clinical operational skill test)and res-idents' feedback of teaching effect. Data were statistically described and independent sample t test was performed. Results Theoretical exam score and clinical skill test score were high in CBL group than in traditional group ((thoretical score:(85.53 ±1.75) vs. (79.94 ±2.29);clinical skill test score:(85.10±1.64)vs.(80.31±1.82)). CBL teaching group had advantages in improving learning efficiency, cultivat-ing clinical thinking,promoting mastery and application of knowledge,broadening knowledge, promoting communication and expression ability and improving study enthusiasm ,et al . Conclusion CBL teaching can effectively improve the teaching quality and obtain higher evaluation. Typical case li-brary should be constantly improved and education of vascular surgical basic theory should be strength-ened to promote CBL.

Objective To discuss the effects of repairing nasal ala defects by free transplantation of autogenous auricle composite tissue flap. Methods 50 cases with nasal ala defects were repaired by free auricular composite tissue flap transplantation from Janu 2003 to May 2013. The defects size was 0.5cm x 0.7cm~1.3cm x 1.5cm. According to the size of the defects, full thick wedge-shaped auricle composite tissue flap were cut off, then inserted into the nasal ala defects area and fixed stablely, the donor sites were sutured directly avoiding ear cartilage. Salvianolate and hyperbaric oxygen were used in postoperative treatment for 5-7 days. Results 48 cases achieved good results, 2 cases had partial necrosis of composite tissue flap after operation, also achieved good results after reoperation. Over 3 months~5 years follow-up, all cases had satisfactory results. The volume of auricle composite tissue flap reduced less than 10%. Surgical incisions had a linear scar, good color matching, nostril symmetry. All patients were satisfied with the overall appearance. Conclusions Autogenous auricle composite tissue flap free transplantation for repairing middle and small size of nasal ala defects can recover ala formation and structure very well, nasal appearance can be improved greatly with nostril symmetry. There is no hypertrophic scar in donor sites. This method is simple and easy,and is also a good method for repairing nasal ala defects.

Objective To investigate the regulatory effects of miR-146a on inflammation factors production in C ryptococcus neoformans treated THP-1 cells.Methods Cryptcoo ccus neoformans strains were heat killed .Fluorescence quantitative RTP-CR and ELISA were used to detect the levels of IL -1βand TNF-αin THP-1 cells treated with heat-killed Cryptococcus neoformans.In addition, the production of IL-1βand TNF-αwere analyzed before and after Dectin-1or TLR 4 blocked .THP-1 cell lines that were respectively transfected with miR-146 a mimics and inhibitors were constructed and the production of IL-1βand TNF-αin these cell lines were analyzed after interfered with Cryptococcus neoformans.Results With the interference of heat-killed Cryptococcus neoformans, the expression of miR-146a was up-regulated in THP-1 cells, but was down-regulated after Dectin-1 or TLR4 blocked.The expressions of IL-1βand TNF-αinduced by heat-killed Cryptococcus neoformans were enhanced in miR-146a mimics transfected THP-1 cells, but was inhibi-ted in inhibitors transfected THP-1 cells.Conclusion Heat-killed Cryptococcus neoformans could up-regu-late miR-146a expression in THP-1 cells via Dectin-1 and TLR.miR-146a could negatively regulate the ex-pressions of IL-1βand TNF-αinduced by Cryptococcus neoformans.