Objective To explore the clinical effects of sitagliptin alone or its combination with metformin on the patients with type 2 diabetes registered on their first clinic/hospital visits.Methods Eightytwo patients with type 2 diabetes who diagnosed with oral glucose tolerance test (OGTT),insulin test and glucagons stimulating C-peptide test from May 2011 to February 2012 in our hospital were randomly divided into two groups:the patients in control group took sitagliptin alone (control group,n =41) and the patients in experimental group took sitagliptin combined with metformin (experimental group,n =41).Eighty-two patients,after the mission,were given diabetic diet and moderate exercise therapy.Taking sitagliptin 100 mg,1 times/d;combined with metformin groups given sitagliptin 100 mg/d,metformin 250 mg,3 times/d.Six months later,the major indexes comparing between before and after treatment of weight,body Mass Index (BMI),glycosylated hemoglobin(HbA1c),OGTT,fasting plasma glucose (FPG),2 h plasma glucose (2 hPG),fasting insulin (FINS),2 h postprandial insulin (2 hINS),fasting C-peptide and 2 h postprandial C-peptide levels were measured to research the changes during the treatments.Results After treatments,all the indexes were decreased significantly,and the BMI,HbA1c,FPG,2 hPG,FINS,2 hINS,fasting C-peptide and 2 h postprandial C-peptide in the group with sitagliptin united with metformin were significantly lower than the group with sitagliptin((27.4 ± 1.2) kg/m2 vs.(27.9 ±1.5) kg/m2,t =-2.812;(8.1 ±1.2)％ vs.(8.8 ± 1.3)％,t =-2.953;(8.17 ±1.22) mmol/L vs.(9.22 ± 1.28) mmol/L,t =-4.940;(10.16 ± 1.68) mmol/L vs.(11.01 ± 1.62) mmol/L,t =-3.362; (9.22 ± 1.93) mU/L vs.(9.85 ± 1.59) mU/L,t =-2.212;(74.62±13.73) mU/L vs.(83.75 ± 13.12) mU/L,t =-5.235;(1.43 ±0.34) μg/L vs.(1.77 ±0.27)μg/L,t =-3.194; (6.80 ± 1.40) μg/L vs.(7.61 ± 1.64) μg/L,t =-4.480 ; P ＜ 0.05).Conclusion Sitagliptin is useful to treat type Ⅱ diabetes,plays important roles in improving patients' quality of life and insulin resistance,control of blood glucose,reduce the family and the burden of social health,and the effect will be more better when united with metformin.

Colon cancer is a common and deadly disease with high rising incidence rate.Proteomics has already become one of the hot topic and maken great progress in the research of colon cancer pathogenesis,early diagnosis,treatment and prognosis.In recent years,more and more colon cancer-associated biomarkers have been identified through proteomics-based approaches.This review will summarize the research progress of proteomics in colon cancer.

Objective To study the preventive effect of lipoxygenase inhibitor nordihydroguaiaretic acid (NDGA) on chronic atrophic gastritis (CAG). Methods To construct CAG rat model, 72 male rats were randomly divided into 6 groups, including normal group, CAG model group, NDGA group with different dose and positive groups (folacin). After feeding for 24 weeks, all rats were executed, their stomach mucous membrane was picked out and stained with H.E. The expression of 5-LOX and P16 protein in mucous membrane epithelia cells were detected by immunohistochemistry. Results The CAG incidence rate in model group was significant higher than normal group (77.8% vs 0% , P ＜0. 05), which indicated that C AG model rat was successfully established. The CAG incidence rate of model group was significantly higher than NDGA groups (77.8% vs 25% ,27.3% ,25%, P＜0.05), while no significant difference was found between positive group and NDGA groups (30% vs 25% ,27.3% ,25% , P＞0.05) .The expression of 5-lox in model group was higher than NDGA groups (44% vs 25% ,27% ,25%, P＜0.05). The expression of P16 protein in model group was lower than NDGA groups (66.7% vs 83.3% ,81.8% ,83.3%,P＜0.05) , and there were no significant differences between NDGA groups and positive group (83. 3%,81.8% ,83.3% vs 80%, P＞0.05). Conclusions NDGA could prevent the occurrence of N-ethyl-N-nitro-N nitrosoguanidine-induced chronic atrophic gastritis in rat. NDGA could down-regulate the expression of 5-LOX and up-regulate the expression of P16 in stomach mucous membrane of N-ethyl-N-nitro -N-nitrosoguanidine-induced chronic atrophic gastritis in rat.

Objective To identify regular roots for medical disputes by case studies for providing evidences for hospital management..Methods 200 cases of medical malpractice were selected consecutively and categorized according to the causes,dispute focus and expert opinions.Results The main factor to trigger medical disputes is dissatisfaction of the outcome,accounting for 50.5％.48.15％ of the disputes,however,result from dissatisfaction of the therapy process which constitutes a medical malpractice.Neglect or defects in treatment,surgical operation,information notice and medical papers were highly common causes.Conclusion Medical disputes result from a variety of causes,so are the roots of medical malpractice.Medical institutions are recommended to enhance medical quality management,make sufficient doctor-patient communication,and make high quality documentation of key medical activities,in an effort to minimize medical disputes and medical malpractice.

Objective To assess patients' self-management behaviors and examine factors influencing self-management behaviors in patients undergoing maintenance hemodialysis.Methods This research was conducted as a descriptive survey by 125 patients from a hemodialysis clinic in Tianjin.The data were collected with self-management behaviors questionnaire of hemodialysis patients and self-efficacy scale for managing chronic disease.Results Regression analysis revealed sex,educational level and selfefficacy were independent predictors for self-management behaviors.Conclusions Hemodialysis patients' self-management behaviors need to be improved in the future.Healthcare professionals should recognize the factors hindering self-management behaviors from the patients' perspective while assisting them with appropriate skills in making behaviors changes possible.

OBJECTIVETo observe the clinical effect of float needle therapy combined with reperfusion activity for pain induced by cyclomastopathy.

METHODSThirty-five female patients with cyclomastopathy were randomly divided into a comprehensive group (18 cases) and a float needle group (17 cases). In the comprehensive group, float needle manipulation was used at the centre of the biceps brachii belly or the ligature between the affected nipple and breast nodule, about 4 cm beside the exterior margin of the breast, and the reperfusion activity of the affected upper limb and breast was combined. In the float needle group, simple float needle therapy was adopted. In the two groups, treatment was started 7 ± 3 days before menstruation, once every other day. After 3-time treatment, the changes of short form McGill Pain Questionnaire (SF-MPQ) scores before and after treatment, the time of pain relieved during the first treatment, recurrence in 3 months after treatment and the adverse reaction were observed. Also, the clinical effects of the two groups were compared.

RESULTSImmediately at the end of the first treatment,after 3-time treatment and while followed up for one month, each item score and the total score of SF-MPQ were decreased apparently than the scores before treatment (all P < 0.05), and all the scores mentioned above of the comprehensive group were declined more obviously than those of the float needle group (all P < 0.05). The time of pain relieved during the first treatment of the comprehensive group was much shorter than that of the float needle group [(94.72 ± 33.67) s vs (162.06 ± 29.16) s, P < 0.01]. The recurrence rate of the comprehensive group in 3 months after treatment was 5.9% (1/17), which was better than 20.0% (3/15) of the float needle group (P < 0.01).

CONCLUSIONFloat needle therapy combined with reperfusion activity and simple float needle therapy can both safely and effectively improve cyclomastopathy, and the combination therapy is better than simple float needle therapy in the aspects of pain relieving effect at once and the long term effect.

Acupuncture Therapy ; Adult ; Breast Diseases ; pathology ; therapy ; Female ; Humans ; Hyperplasia ; Mammary Glands, Human ; pathology ; Middle Aged ; Needles ; Pain Measurement

Objective:To assess the safety,effectiveness and acceptability of oral midazolam sedation for dental treatment in children.Methods: Twenty-three health children aged 4 to 14(ASA Ⅰ),who were classified as 4 or 5 by modified Venham's clinic anxiety and cooperative behavior rating scale,referred for dental treatment were included in the study.Each child was treated under sedation with oral midazolam(0.15-0.70 mg/kg),and totally 45 sedations were conducted.At each visit,heart rate,arterial oxygen saturation,respiration rate,sedation and behavioral scores were recorded.The level of acceptance and satisfaction of the patients and their guardians were recorded after the treatment.Results: Among the 23 children,19 were boys and 4 were girls with mean age of 6.2 years old.In all the 45 treatments,the heart rate,respiratory rate and arterial oxygen saturation levels were within acceptable clinical limits.Forty planned treatments were completed satisfactorily.Oral sedation was ineffective in 3 children,and they were treated under general anesthesia.Only 2 guardians refused to have oral midazolam sedation again.Six of seven children who had regular dental check-up could be treated under normal condition.Conclusion: Oral midazolam(0.15-0.70 mg/kg) could be a safe and acceptable approach of sedation for pediatric dental patients.

Objective To evaluate islet cells functional recovery and clinical effects of dynamic blood sugar monitoring combined with insulin pump in newly diagnosed type 2 diabetes mellitus in the elderly.Methods 300 cases with newly diagnosed type 2 diabetes mellitus were randomly divided into treatment group (n=150) and control group (n=150) accompanying with three months follow-up.Body mass indexes (BMI),levels of hemoglobin A1c (HbA1c),fasting plasma glucose (FPG),2-h postprandial blood glucose,fasting insulin,2-h postprandial insulin,fasting C-peptide,2-h postprandial C peptide,and the percentage of patients who took oral hypoglycemic drugs alone without insulin could well control the blood glucose were compared between the two groups before versus after treatment.Results The levels of BMI,HbA1c,FPG,2-h postprandial blood glucose,fasting insulin,2-h postprandial insulin,fasting C peptide,2-h postprandial C peptide in the two groups were significantly decreased after treatment as compared with the pretreatment (P ＜ 0.05).The improvement of blood sugar spectrum was better in treatment group than in control group(P＜0.05) and the percentage of patients who took oral hypoglycemic drugs alone without insulin could well control the blood glucose was significantly higher in treatment group than in control group(21％ vs.3％,x2 =22.475,P＜0.05).Conclusions The clinical effects of dynamic blood sugar monitoring combined with insulin pump on newly diagnosed type 2 diabetes mellitus in the elderly is definite and can improve the recovery of islet cells function.It is worthy of clinical promotion.

Objective To study the application effect of multi-dimensional health education model in the outpatient department of gynecological painless surgery,and explore more standardized and more effective education method.Methods 2 639 patients were selected in Sir Run Run Shaw Hospital outpatient service of gynecological department from July 2010 to June 2011,and were randomly divided into the control group(1 302 cases) and the intervention group(1 337 cases).The control group adopted conventional health education,the intervention group adopted the multi-dimensional health education.Design form was used to analyze preoperative compliance of the two groups.Results The preoperative compliance of the intervention group was higher than those of the control group,the difference was statistically significant.Conclusions Multi-dimensional health education mode can improve the preoperative education compliance of patients in the outpatient service of department of gynecological painless surgery patients,reduce the rate of operation delay and anesthesia method alteration,reduce patient pain,increase peri-operative nursing quality of painless surgery.

Objective To explore the clinical characteristics of infratentorial primary angiitis in central nervous system (PACNS).Methods A total of 5 cases diagnosed as infratentorial PACNS in the neurology department of Navy General Hospital of PLA in 2015 were enrolled in the study.The clinical,imaging and pathological data were collected and analyzed.Results All the 5 cases were male with the median onset age of thirty-four.Five cases presented with dizziness,two with headache,three with walking unstable,two with facial numbness and one with dysarthria.Rising pressure of cerebrospinal fluid (CSF) (190-245 cmH2O,1 cmH2O =0.098 kPa) was found in 4 cases by the lumbar puncture,mildly increased number of leukocyte in 2 cases [(12-28) × 106/L],increased CSF protein in 3 cases(540-979 mg/L) and increased IgG index in 3 cases (0.84-1.45).Pons lesions were revealed by magnetic resonance imaging(MRI) in 4 cases,brachium pontis lesions in 2 cases,cerebellum lesions in 2 cases,one with midbrain lesion in 1 case,unilateral lesions in 4 cases and bilateral lesion in 1 case.Different degree of edema and mass effect were shown in all lesions by MRI.Patch like enhancement was found by contrast MRI in 5 cases and meningeal enhancement in 2 cases.Elevation of choline (Cho) peak was found by magnetic resonance spectroscopy (MRS) in 4 cases,reduction of N-acetyl aspartate (NAA) peak in 3 cases,appearance of lactate peak in 1 case and lipid peak in another case.Arterial spin labeling (ASL) was performed in 4 cases and no hyperperfusion was found.Susceptibility weighted imaging(SWI) was performed in 3 cases and microhemorrhage in the lesions was found in 2 cases and normal in 1 case.Magnetic resonance arteriography(MRA) was performed in 1 case and no stenosis was found.Digital subtraction arteriography(DSA) was performed in 1 case and multiple stenosis of the intracranial arteries was showed.Two cases had taken the stereotactic brain biopsy and the histopathologic diagnosis was angiitis.Five cases were treated with methylprednisolone and cyclophosphamide was added on in 1 case.Good prognosis was found in all cases.Conclusions Infratentorial PACNS mostly attacks middle-aged males.The lesions tend to locate in unilateral pons,brachium pontis,cerebellum and midbrain.Hemorrhage or microhemorrhage in lesions is often found by SWI and no hyperperfusion is shown by ASL,which would be useful to distinguish PACNS from malignant tumors.Given the limitations of brain biopsy in clinical practice,clinical and imaging features would be helpful to diagnose PACNS.