OBJECTIVE To explore the risk factors and preventive measures of nosocomial infection among the diabetes mellitus patients with cerebrovascular accident.METHODS A retrospective survey on 574 diabetes mellitus patients with cerebrovascular accident was conducted.RESULTS The result showed that 126 of the 574 patients had nosocomial infection,the rate of infection was 22%.The risk factors of nosocomial infection included: age,hospitalized days,invasive treatment procedures and operation,application of antibiotics,course of diabetes mellitus,fasting plasma glucose(FPG),glycosylated hemoglobinA1C(HbA1C),clinical type of cerebrovascular accident,consciousness and bulbar palsy. The main infection sites were at lungs,urinary tract and intestines.The chief pathogens were Gram-negative bacteria.CONCLUSIONS Nosocomial infection is a high frequent complication in diabetes mellitus with cerebrovascular accident.Preventing and controlling the risk factors can reduce the rate of nosocomial infection among the diabetes mellitus patients with cerebrovascular accident.

Objective To evaluate the curative effects of sitagliptin in the treatment of type 2 diabetes mellitus complicated with nonalcoholic fatty liver disease(NAFLD).Methods 200 type 2 diabetes mellitus patients with NAFLD were selected and randomly divided into the observation group and the control group,100 cases in each group.The observation group received sitagliptin treatment,while the control group was treated with metformin.Before and 3,6 months after treatment,the body weight,body mass index(BMI),liver function(AST,ALT,GGT),OGCT synchronous exsanguinate assay(fasting and 2 h after breakfast glucose,insulin),blood lipid(TC,TG)and glycosylated hemoglobin(HbAlc),and other biochemical indicators were monitored and compared,as well as 1HMRS scan images. Results In the two groups after treatment,ALT,GGT,AST,FPG and 2h PG all improved significantly(t≥2.35,P <0.05),but ALT,GGT,AST,FPG and 2h PG in the observation group all improved better than those in the control group(t≥4.99,all P <0.05).In the two groups after treatment,TC,TG,HbAlc,BMI,HOMA -IR all improved significantly(t≥5.63,all P <0.05),but those of the observation group improved more significantly(t≥3.90,all P <0.05 ).In the observation group after treatment,liver lipid content (IHCL)was (10.3 ±2.9 )%,which was significantly lower than (27.8 ±4.5)% before treatment(t =32.69,P <0.05).In the control group after treatment, IHCL was (18.4 ±3.5)%,which was significantly lower than (26.9 ±4.6)% before treatment(t =14.70,P <0.05),but in the observation group after treatment IHCL was significantly lower than that in the control group after treatment(t =17.82,P <0.05).Conclusion Sitagliptin can significantly improve the blood glucose,blood lipid, liver function,insulin resistance in type 2 diabetes mellitus patients with NAFLD,which has good clinical curative effects and is worthy of clinical promoting.

Objective To study the effects of glucagon-like peptide-1 (GLP-1) analogues combined with metformin on body glycemic control and insulin resistance in patients with type 2 diabetes mellitus (T2DM).Methods The medical records of 132 patients with obese T2DM who were treated in our hospital from Jan.2014 to Jun.2017 were retrospectively analyzed.The patients were divided into observation group and the control group according to the random number table method,66 cases each.The control group were treated with metformin combined with imimol.The observation group were treated with metformin combined with GLP-1 analogue.The difference of (body mass index,BMI),(glycosylated hemoglobin,HbA1c),(fasting blood glucose,FBG),(2 hour postprandial blood glucose,2 h PBG),(triglyceride,TG),(total cholesterol,TC),(high density lipoprotein-cholesterol,HDL-C),(low density lipoprotein-cholesterol,LDL-C),(fasting insulin,FINS),(fasting C peptide,FCP),(homeostatic model assessment of insulin resistance,HOMA-IR),(homeostatic model assessment-β cell,HOMA-β)between the two groups were compared.Results Statistical analysis showed that there was no significant difference in the pre-treatment related indexes between the two groups (all P＞0.05).The BMI,waist-to-hip ratio of the observation group were more obvious after treatment (P＜0.05).The levels of HbA1c,FBG and 2 h PBG in the observation group and the control group were 6.85±1.49 vs 8.92 ±1.02 (％),5.99 ±2.09 vs 7.21±3.04 (mmol/L),7.90±2.04 vs 9.78 ±3.47 (mmol/L)(all P＜0.05).The levels of TG,TC and LDL-C in the observation group were significantly lower than those in the control group,and the level of HDL-C was significantly increased (P＜0.05).The level change of FINS (15.08±3.21 vs 11.05±2.8)(mIU/L),FCP (2.21±0.84 vs 1.84±0.71)(pmol/L),HOMA-IR (1.33±0.09 vs 2.15±0.12) and HOMA-β(54.29±10.98 vs 32.15 ±6.43) were more obvious in the observation group than in the control group between before and after treatment(all P＜0.05).The incidence of adverse reactions during the treatment was 3.04％ vs 28.79)(P＜0.05).Conclusions GLP-1 analogue combined with metformin is effective in treatment of obese T2DM.The patient's blood sugar control effect is better,and the safety is higher.The body's insulin secretion level is increased,the insulin resistance is reduced,and the islet β cell function is obviously restored.It has positive significance in delaying the development of diabetes,thus worthy of clinical promotion.

Objective To discuss the clinical value of bidirectional quantitative detection of MSCT in the diagnosis of diabetic lung injury.Methods From May 2016 to July 2017,120 patients with diabetes in Wenzhou Hospital of Traditional Chinese Medicine were selected as diabetic group,and 50 healthy people were selected as control group.The two groups received the pulmonary function test ( PFT) and the MSCT bidirectional quantitative detection,the test results of the two groups were analyzed.And the correlation of indicators of MSCT bidirectional detection and PFT detection indicators was analyzed.Results After examination,the maximum inspiratory lung volume (Vin),maximum expiratory volume (Vex),respiratory volume (EVvin,EVvex)-emphysema,EIvin (%),EIvex (%) in the diabetic group were (3 627.64 ±867.43)mL,(3 785.34 ±835.64)mL,(476.95 ±326.25)mL,(236.53 ±86.18)mL,(9.26 ±4.85)%,(4.11 ±2.58)%,respectively,which were significantly lower than those in the control group (t＝11.151,13.809,21.317,21.623,24.76,26.708,all P＜0.05).The Vin,Vex,EVvin,EVvex,EIvin(%),EIvex(%) in the patients with ≤5 years of diabetes were (3 627.64 ±867.43)mL,(3 785.34 ± 835.64)mL,(326.25 ±56.95) mL,(236.53 ±86.18) mL,(9.26 ±4.85)%,(4.11 ±2.58)%,respectively,which were significantly higher than those in the patients with ＞5-10 years of diabetes mellitus (t＝129.09,36.01,21.03,12.38,22.17,19.48,all P＜0.05).Conclusion MSCT bidirectional quantitative detection is of great signif-icance for patients with diabetes lung injury,and plays a significant role in clinical treatment.

OBJECTIVE To introduce the construction of undergraduate specialty of clinical pharmacy based on the concept of outcome-based education （OBE），and to provide new idea and enlightenment for the construction of undergraduate specialty of clinical pharmacy in Chinese universities. METHODS Through the establishment and construction of training objectives and graduation requirements ，teaching reform was designed and implemented ，and the construction of teaching support system and teaching quality assurance system were completed. RESULTS The clinical pharmacy department of our university established the training direction of clinical pharmacy talents under the guidance of post competence ，including clarifying the training needs of undergraduate talents based on the overall requirements of national undergraduate education ；defining the social and industrial needs of clinical pharmacy talents based on the normative documents or concepts of clinical pharmacy ；clarifying the post and ability needs of clinical pharmacy talents based on the investigation of graduates and clinical pharmacists ；clarifying the development needs of clinical pharmacy based on the current situation and trends at home and abroad ；forming characteristic training objectives combined with the regional characteristics and school positioning ， so as to construct training objectives and graduation requirements. The OBE concept was introduced into the undergraduate teaching reform of clinical pharmacy ；the pharmacy talent training direction were established under the guidance of post competence ；the training system was designed by reverse design method；a training mode of both innovation and practical ability was built so as to promote teaching reform ，strengthen the construction of grass-roots teaching organizations and teaching staff ， and improve the construction of teaching quality assurance system. CONCLUSIONS The undergraduate training mode of clinical pharmacy specialty based on the concept of OBE is helpful to improve students ’personal comprehensive quality and professional knowledge and skills. The established undergraduate training model of clinical pharmacy specialty is in line with the modern educational concept and social needs ，and provides theoretical basis and practical experience for the training mode of clinical pharmacy professionals.