Objective] To explore the clinical experience of Professor Zhang Juan on Elderly Diabetic Constipation and hope to provide a new perspective for future study about Chinese medicine treatment of Diabetes Mellitus(DM).[Method] Reviewed 103 cases from Sep. 2014 till now who were older than 65,diagnosed with DM and had constipation as primary symptom. Analyzed and summarized the syndrome differentiation and treatment of the cases. [Results] According to the etiology and pathogenesis of Elderly Diabetic Constipation ,Professor Zhang deems that its pathogenesis takes place in two stages:one is spleen deficiency,the other is kidney deficiency and proposes the therapy of“treat the middle-jiao if others are not working”,“nourish the natal qi with post-natal qi”,“combine disease,syndrome and symptom”and“treat in stages”.[Conclusion] The treatment on Elderly Diabetic Constipation raised by Professor Zhang is effective and her clinical experience has important clinical value .

To strengthen the medical students in patient safety education is the first step to effectively prevent medical accidents.But at present patient safety education has not been given enough attention by domestic mnedical colleges.Research group consulted literature at home and abroad related to patient safety courses, according to the Medical colleges patient safety curriculum guide proposed by The World Health Organization (WHO) Alliance for Patient Safety, opened the patient safety course in undergraduate medical education with the goal to improve the medical students to maintain patient safety consciousness, ability and methods and implemented scene simulation teaching and formative assessment.We achieved good teaching effect and appraisal by students.

Objective To explore the absorption properties and kinetics of nicorandil from small intestinal segments. Methods The absorption kinetics and permeability of nicorandil under different conditions were investigated by HPLC via the in situ perfusing method in rats. Results There was no significant difference in Ka of nicorandil under different concentrations and different pH.The absorption rate in rats descended in order of jejunum,duodenum,ileum and colon, as (4.69±0.05)×10-2 ,(3.35 ±0.04) × 10-2 ,(2.66± 0.05) × 10-2 and (0.89± 0.08) × 10-2 .h-1 . Conclusion The absorption of nicorandil in intestine complies with the passive transport mechanism and first order kinetics.Nicorandil is well absorbed in the whole intestine and can be prepared as delayed release and controlled release forms.

Objective To observe and evaluate the effect of ultrasound guided percutaneous ethanol injection for hyperparathyroidism secondary to chronic renal failure. Methods Fifty-three patients with secondary hyperparathyroidism in Nanjing General Hospital Military Command from January 2011 to May 2013 were treated by percutaneous ethanol injection. The echogenicity, size and blood supply of parathyroid glands were observed by color Doppler ultrasound before and after treatment. Parathyroid hormone (PTH) and volumes of parathyroid glands were analyzed and compared with non-paired t test. Results Before treatment, the parathyroid gland volume was (5.28±0.84) cm3. The enlarged parathyroid glands had homogeneous hypoechogenicity and abundant blood supply, and the PTH was (1041.6±37.1) ng/L. After treatment, the size of solitary parathyroid gland was (3.93±0.67) cm3 which did not change significantly compared with that before treatment. The echogenicity of parathyroid glands enhanced and blood supply decreased after injection ethanol into solitary parathyroid. PTH [(509.2±27.6) ng/L] decreased obviously (t=3.792, P < 0.05). Conclusion Color Doppler ultrasound guided percutaneous injection of ethanol has an important role in the treating of secondary hyperparathyroidism and the curative effect can be observed timely.

AIM:To investigate the timing and efficacy of vitrectomy for patients with vitreous hemorrhage(VH) due to proliferative diabetic retinopathy(PDR).METHODS:Retrospective analysis.Patients who presented to our hospital between Feburary 2012 and May 2014 with VH secondary to PDR treated with vitrectomy were included.All patients were divided into three groups according to the duration of VH.A group was less than 1mo for 22 eyes, B group was 1-3mo for 23 eyes, C group was more than 3mo for 25 eyes.All patients underwent intravitreal injection of ranibizumab 1-2wk before vitrectomy, and supplemented or finished panretinal photocoagulation (PRP) intraoperatively or postoperatively.Patients with cataract accepted phacoemulsification and intraocular lens implantation.Eyes filling silicone oil were implanted intraocular lens in the second phase.All patients were followed up 24 to 42mo (mean:28.7mo).We assessed the intraoperative complications such as hemorrhage, iatrogenic retinal hole, and postoperative complications such as vitreous hemorrhage, neovascular glaucoma.Macular edema and best corrected visual acuity were observed at every follow-up.RESULTS:There was no significant difference for other baseline data (P>0.05) but DR stage between three groups (P=0.033).There was significant difference of last follow up visual acuity between three groups (P<0.001).The significant difference can be seen between group A and B (P=0.03).The same outcome showed between Group A and C(P<0.001).There was no significant difference between Group B and C (P>0.05).The percentage of visual acuity was 0.5 and above in the three groups were:41%, 23%, 0 respectively.The patients with visual acuity of less than 0.1 were 5%, 26% and 40% respectively.Silicone oil filling rate of three groups were:9%, 26%, 40% respectively and there was no significantly difference between three groups on postoperative complications (P>0.05).CONCLUSION:Patients with VH due to proliferative diabetic retinopathy undergoing early vitrectomy may get better visual acuity than who accepting delayed vitrectomy.

Objective To develop a new kind of tracheal catheter for large or medium -sized surgical anesthesia as a medical equipment of respiratory management,and to rescue the patients with anhelation of respiratory arrest,which is essential to first-aid treatment and will be widely used clinically.Methods The disposable non-toxic transparent plastic was adopted,which was reinforced by the spiral stainless steel wire with regular separations.The diameter of the tracheal catheter varied with the different models.The tracheal catheter was composed of the items put into the trachea when applied for anesthesia such as the inflatable bladder and liquid mouth,the ones connected with the anesthesia machine such as the ring lines regulating direction of the front end of the catheter,and the syringe adapters for the liquid and gas.Results The flexible,air-proof tracheal catheter,with its direction adjustable,injected the medicine through its front end.Conclusion The tracheal catheter can be used for intratracheal medication,and will be popularized clinically.

AIM:To investigate the mechanism of apoptosis during the process of adult rat mesenchymal stem cells(MSCs)differentiating into neuron-like cells in vitro.METHODS:The MSCs were isolated primarily from adult rats bone marrow by density gradient and then expanded in medium as undifferentiated cells for 3-5 generations.The MSCs were divided into three groups at random.The control group was induced with ?-mercaptoethanol(?-ME).Meanwhile,the U0126 group was given ?-ME and U0126(10 ?mol/L)added at the beginning of induction.The PMA groups were treated with ?-ME and different concentrations of PMA since pre-induction.The effects of U0126 and PMA on the activity of neuron-like cells were observed by MTT.The effects of U0126 and PMA on the expression of neuron specific marker nestin and expression of apoptosis-related protein caspase,Bcl-2,Bax in neuron-like cells were detected by using immunocytochemistry method.TUNEL technique was used to detect apoptosis index.RESULTS:Compared to control group,neuron viability,nestin and Bcl-2 increased and neuron apoptosis decreased in U0126 group(P

To investigate the value of the guidance of three dimensional (3-D) reconstruction of multi-slice spiral CT (MSCT) for the placement of pedicle screws, the 3-D anatomical data of the thoracic pedicles were measured by MSCT in two embalmed human cadaveric thoracic pedicles spines (T1-T10) to guide the insertion of pedicle screws. After pulling the screws out, the pathways were filled with contrast media. The PW, PH, TSA and SSA of developed pathways were measured on the CT images and they were also measured on the real objects by caliper and goniometer. Analysis of variance demonstrated that the difference between the CT scans and real objects had no statistical significance (P > 0.05). Moreover, the difference between pedicle axis and developed pathway also had no statistical significance (P > 0.05). The data obtained from 3-D reconstruction of MSCT demonstrated that individualized standards, are not only accurate but also helpful for the successful placement of pedicle screws.

Objective To observe the efficacy and untoward reactions of FOLFOX4 regimen and XELOX regimen in the treatment of patients with advanced colorectal cancer.Methods Fifty four advanced colorectal cancer patients were randomly divided into two groups.Group A (FOLFOX4):28 patients were treated with oxaliplatin 85 mg/m2 on day 1,LV 200 mg/m2 as a 2h infusion followed by bolus 5 -FU 400 mg/m2 and a 24h infusion of 5 -Fu 600 mg/m2 ,repeated for consecutive days every 2 weeks.One cycle was 14 days and efficacy was evaluated after 4 cycles.Group B(XELOX):26 patients were treated with oxaliplation 130mg/m2 on day 1,capecitabine 1 000 mg/m2 orally daily for 14 days.One cycle was 21 or 28 days and efficacy was evaluated after 2 cycles.Efficacy of the two groups was evaluated at 2 cycles.Results All 54 patients were available for evaluating objective response.In A group,the overall response rate was 46.4%,and the overall response rate was 42.3% in B group.The overall response rate of A group was slightly higher than B group,but there was no statistically significant difference(χ2 =0.093,P =0.791 ).Adverse reactions:thrombocytopenia incidence rate and the peripheral nerve toxicity had no significant differences between the two groups(χ2 =0.552,0.108,P =0.550,0.787).The incidence rates of nausea, vomit,diarrhea and leucocytopenia in B group were lower than those in A group(χ2 =9.495,4.862,6.273,P =0.003,0.033,0.108).The incidence rate of hand -foot syndrome was higher in B group than in A group(χ2 =13.389,P =0.000),but the severity was less(grade Ⅰ ~Ⅱ).Conclusion The response rate in the treatment of advanced colorectal cancer was similar between XELOX and FOLFOX4 regiments,but XELOX regiment has the advantages of more convenience,better safety.Thus,XELOX regiment is worth recommending as a first -line therapy for the treatment of patients with advanced colorectal cancer.

Objective To observe the clinical effects of pemetrexed alone or pemetrexed combined with platinum in the treatment of advanced non -squamous non -small cell lung cancer who failed first line therapy. Methods 34 patients with advanced NSCLC who had failed to previous chemotherapy and all of these patients had been confirmed with pathology or cytology.Pemetrexed monotherapy group included 14 cases and pemetrexed plus platinum group included 20 cases.21 days as one cycle.All patients who received 2 or more cycles could be evaluated. Results No complete response (CR)occurred.There were 3 cases of partial response (PR),15 cases of stable disease(SD)and 16 cases of progressive disease(PD)in the 34 patients.The disease control rate was 52.9%(18 /34).The median progressive free survival was 2.7 months.The major toxic reaction included leucopenia,anemia and gastrointestinal response.Conclusion Pemetrexed or pemetrexed combined with platinum can prolong the survival time of some patients of non -squamous non -small cell lung cancer who failed first line therapy.The toxic effects can be tolerated.