Objective To make a cross-sectional assessment of the morbidity of lower extremity arterial disease (LEAD) in inpatients with type 2 diabetes mellitus (T2DM) and to analyze its risk factors,thus providing evidence for its clinical prevention.Methods We enrolled 664 inpatients with T2DM from June 2012 to June 2013 and collected clinical data,including age,gender,duration of diabetes,body mass index,smoking,fasting & postprandial blood glucose levels,glycosylated hemoglobin,serum lipids,renal function,fibrinogen,neck ultrasonography,lower extremity vascular ultrasound,ankle brachial index and treatment records.Logistic multiple regression analysis was conducted to identify risk factors for LEAD.Results A total of 247 cases met the diagnostic criteria for LEAD,with morbidity reaching to 37.2％.The percentages of morbidity in patients with different durations of diabetes were:23.12％ (≤ 5 years),27.95％ [(5 10) years],38.71％ [(1015) years],51.16％ [(15-20) years],62.34％ (≥ 20 years).The differences were statistically significant (P＜0.05).Of the patients in the LEAD group,73.2 ％ were treated with antihypertensive medications and 54.6％ were treated with statins.The goal attainment rates for total cholesterol,lowdensity lipoprotein cholesterol,high-density lipoprotein cholesterol and triglycerides were 56.3％,39.3％,47.4％ and 61.5％,respectively,in the LEAD group and 45.1％,34.5％,35％,and 49.4％,respectively,in the non-LEAD group.With the exception of the rates for low density lipoprotein cholesterol,the rates between the two groups are statistically significant (P＜0.05).Significant differences in age,BMI,blood pressure,coronary heart disease,cerebrovascular disease,carotid intima-media thickness,carotid artery plaque,and carotid artery stenosis were also observed between the two groups (P＜0.05 for all parameters).Logistic multiple regression analysis revealed that age,history of diabetes,cerebrovascular disease,carotid artery plaque,and carotid artery stenosis were risk factors for LEAD.Conclusions The morbidity of LEAD is 37.2％ in type 2 diabetic patients.Age,history of diabetes,cerebrovascular disease,carotid artery plaque,and carotid artery stenosis are risk factors for LEAD,while traditional risk factors for atherosclerosis,including hypertension,levels of cholesterol and low-density lipoprotein cholesterol,smoking,and non-drug intervention,are risk factors for LEAD in type 2 diabetic patients.

Objective To compare the Roussouly classification of old thoracolumbar fractures combined with post-traumatic kyphosis with that of normal adults, evaluate the effect of different kyphosis angles on sagittal curvature of the thoracolumbar spine so as to provide a theoretical basis for the clinical status and clinical treatment plan of old thoracolumbar fractures combined with post-traumatic kyphosis.Methods A retrospective case control study was made on 49 cases of old thoracolumbar fractures with post-traumatic kyphosis treated from January 2014 to December 2015 (fracture group).Damaged segments of the spine were T11 in four cases, T12 in 14, L1 in 25 and L2 in six.Another 52 normal adult volunteers were chosen as controls.Whole spine X-ray film of the two groups was taken, and the difference in Roussouly classification of the sagittal spine curvature was compared between the two groups.Patients in fracture group were separated into subgroups depending on the Cobb angle (0°-10°, 10°-20°, 20°-30°, 30°-40°, respectively), and the difference in Roussouly classification was compared among subgroups.Results Roussouly classification in control group was five cases of type 1, 12 tpye 2, 25 type 3 and 10 type 4.Results in fracture group was 14 cases of type 1, 11 type 2, eight type 3 and 16 type 4.There were significant differences in Roussouly types between the two groups (P<0.05).According to Roussouly classification, there were two cases of types 1 and 2 and seven cases of types 3 and 4 in subgroup of Cobb angle between 0°-10°;four cases of types 1 and 2 and 10 cases of types 3 and 4 in subgroup of Cobb angle between 10°-20°;12 cases of types 1 and 2 and four cases of types 3 and 4 in subgroup of Cobb angle between 20°-30°;seven cases of types 1 and 2 and three cases of types 3 and 4 in subgroup of Cobb angle between 30°-40°.There were significant differences in Roussouly types among subgroups (P<0.05).Further, Roussouly types 1 and 2 were significantly increased when the Cobb angle was >20° (P<0.05).Conclusions Post-traumatic kyphosis in old thoracolumbar fractures affects spine sagittal curvature.Patients with sagittal spinal imbalance (Roussouly types 1 and 2) are more with increased Cobb angle.Moreover, Cobb angle >20°may be the reference basis for clinical intervention.

Objective To investigate the clinical effects and indications of the vacuum sealing drainage (VSD) in the treatment of severe diabetic foot gangrene.Methods We randomly recruited 60 cases,who had suffered from diabetic foot gangrene(DFG) at the grade of 3 -5,according to Wagner scale into VSD treatment groups and treated them with VSD methods.At the same time,62 DFG cases who had given routine drainage treatment one year ago were retrospectively analyzed as control group.The observed items included the wound healing time,number of dressing,outcome of treatment ( healing rate),the average days in hospital,total expenses of hospitalization and so on.Results The wound healing time of VSD treatment group and routine treatment group were ( 30.5 ± 6.8 ) days and ( 53.8 ± 5.5 ) days,respectively ( t =2.636,P ＜ 0.01 ).The numbers of dressing were( 15.0 ± 4.7) days and ( 29.5 ± 6.1 ) days,respectively ( t =2.374,P ＜ 0.01 ).The healing rates were 96.7％ (58/60) and 87.1％ (54/62),respectively(P ＜0.01 ).The average period in hospitalization were (20.1 ± 3.5 ) days and ( 36.5 ± 4.6 ) days,respectively ( t =2.564,P ＜ 0.01 ).Total expenses of hospitalization were(20 155.6 ± 153.8) yuan RMB and(41 465.5 ± 146.6) yuan RMB,respectively(t =2.873,P ＜0.01 ).All the differences were statistically significant.Conclusion The VSD method is effective for the treatment of severe diabetic foot gangrene(DFG).It is able to reduce the time of wound healing significantly,increase the healing rate,shorten the hospitalization period and cut the general expenses during hospitalization.It' s an effective method for the treatment of DFG.

Objective To compare the difference of cutpoint and clinical significance of HbA1C for the diagnosis of abnormal glucose metabolism in two population groups with different ages.Methods According to oral glucose tolerance test(OGTT),the cutpoint and clinical significance of HbA1C for the diagnosis of type 2 diabetes and impaired glucose regulation(IGR)were investigated in the two population groups.Results The mean HbA1C of 1 064 young subjects in an academy and 1 671 aged subjects in a community were 5.31% ±0.41% and 5.79% ±0.71%,respectively.The cutpoints of HbA1C for diagnosis of diabetes were 5.7%(specificity 86.7%,sensitivity 66.7%)and 5.9%(specificity 73.8%,sensitivity 80.1%)in the two population groups,and 5.6% for diagnosis of IGR (specificity 82.8%,sensitivity 55.8%)and 5.7%(specificity 60.9%,sensitivity 64.3%),respectively.87.8%,78.7%,and 38.5% were diagnosed diabetes by current OGTT criteria at HbA1C levels of ≥5.7%,≥5.9%,and≥6.5%,IGR being 61.6%,39.6%,and 4.1%,and normal glucose tolerance being 24.4%,10.0%,and 0.4%.Conclusion The cutpoints of HbA1C for diagnosis of diabetes and IGR are different in populations with different ages and HbA1C levels.As one of diagnostic criteria for diabetes,HbA1C 6.5% with relatively higher specificity and lower sensitivity must be combined with fasting blood glucose,random blood glucose,and OGTT.

Objective :To explore influence of CYP2C19 gene polymorphism on clopidogrel resistance after percutane‐ous coronary intervention (PCI) in patients with coronary heart disease (CHD).Methods :A total of 100 CHD pa‐tients ,who were treated and received PCI in our hospital ,were selected .There were 24 cases with clopidogrel re‐sistance (CR ,CR group) and 76 cases without CR (NCR ,NCR group).According to CYP2C19 genotype ,patients were divided into rapid metabolism CYP2C19*1／*1 (n＝49) ,medium metabolism CYP2C19*1／*2 (n＝28) and*1／*3 (n＝11) ,and slow metabolism CYP2C19*2／*2 (n＝9) and *2／*3 (n＝3).Relationship among differ‐ent genotypes ,CR ,maximum platelet aggregation rate (MPA) and incidence of major adverse cardiovascular events (MACE) were analyzed .Results :With rapid metabolism CYP2C19*1／*1 as the base ,there was significant rise in CR risk in medium metabolism (CYP2C19*1／*2 and *1／*3 ,OR＝4. 16 ,5. 03 , P＜0.05 both) and slow metab‐olism (CYP2C19*2／*2 and *2／*3 ,OR＝7.04 ,17. 6 , P＜0.01 both ) ,medium metabolism increased by 4. 16 and 5. 03 times respectively ,while slow metabolism increased by 7. 04 and 17. 60 times respectively .Compared with rapid metabolism genotype ,there were significant rise in MPA and incidence rate of MACE in medium and slow me‐tabolism genotypes , P＜0.05 or ＜0. 01 ;incidence rate of MACE in CR group was significantly higher than that of NCR group (20. 8% vs.5. 3%, P＝0.02).Conclusion : CYP2C19 gene polymorphism possesses certain influence on CR after PCI in CHD patients .Those with medium or slow metabolism genotypes are more likely to suffer from CR ,higher MPA and incidence rate of MACE .

OBJECTIVE To evaluate the efficacy and safety of dimethyl fumarate （DMF） in the treatment of multiple sclerosis （MS）. METHODS Retrieved from CBM， Web of Science， PubMed， the Cochrane Library， Embase， CNKI， Wanfang Data， and VIP， randomized controlled trials （RCTs） about DMF （trial group） versus other drugs or placebo （control group） were collected. After data screening and extraction， quality evaluation， meta-analysis was conducted by using RevMan 5.3 software. RESULTS A total of 6 literature were included， involving 638 patients. Results of meta-analysis showed that the proportion of patients with lesion changes after treatment in the trial group was lower than control group [MD＝－0.65， 95%CI（－1.27， －0.02）， P＝0.04]； there was no statistical significance in recurrence rate [RR＝1.06， 95%CI（0.52，2.17）， P＝0.88]， the proportion of patients with new lesions after treatment [RR＝1.05， 95%CI（0.62，1.80）， P＝0.85]， expanded disability status scale after treatment [MD＝0.02，95%CI （－0.18， 0.23）， P＝0.82]， the incidence of adverse events [RR＝1.33， 95%CI（0.97， 1.84）， P＝0.08] or severe adverse events [RR＝0.95，95%CI（0.48，1.90），P＝0.89] between 2 groups. Results of sensitivity analysis showed the study obtained unstable recurrence rate and the incidence of adverse events， while other results were robust. CONCLUSIONS DMF can control the lesion progression in MS patients to some extent and doesn’t increase the incidence of adverse events and serious adverse events， but there is no significant advantage in reducing the recurrence rate and controlling the disability progression.

Myogenous temporomandibular disorder (M-TMD) is one of the main subtypes of temporomandibular disorder (TMD) and typically manifests as masticatory myofascial pain; the incidence of TMD has been increasing annually in recent years. Botulinum toxin type A (BTX-A) is a potent neurotoxin produced by Clostridium botulinum. BTX-A inhibits the release of acetylcholine from the presynaptic membrane, thereby blocking neuromuscular junction signaling. The noncosmetic application of BTX-A in the oral and maxillofacial regions is a prominent research topic. In recent years, an increasing number of studies have focused on the application of BTX-A in the treatment of M-TMD. The results of a literature review revealed that an appropriate dose (10-50 U unilaterally) of BTX-A administered in a single injection into the masticatory muscles can effectively treat myalgia over a period of 3-6 months. Common adverse effects, such as masticatory weakness and facial paralysis, are transient and can be avoided by standardized injection techniques. However, there is a lack of standardized guidelines for injection techniques in clinical practice.