Objective To investigate the clinical characteristics and the risk factors for chronic complications in hospitalized early-onset type 2 diabetic mellitus patients. Methods The clinical data of 462 hospitalized type 2 diabetic mellitus patients were retrospectively analyzed. The patients were divided into early-onset group (age of diagnosis ≤40 years, 120 cases) and late-onset group (age of diagnosis>40 years, 342 cases) according to the age of diagnosis of diabetes. The clinical characteristics were compared and risk factors for chronic complications of early-onset type 2 diabetes were explored. Results The percentage of family history of diabetes, fasting plasma glucose, triglyceride and diastolic blood pressure in early-onset group were significantly higher than those in late-onset group:70.0％(84/120) vs. 52.3％(179/342), (8.68 ± 3.08) mmol/L vs. (8.07 ± 2.74) mmol/L, 1.69 (1.06, 2.92) mmol/L vs. 1.48 (1.07, 2.24) mmol/L and (84 ± 10) mmHg (1 mmHg = 0.133 kPa) vs. (81 ± 10) mmHg, and there were statistical differences (P<0.01 or <0.05). The incidence of hypertension, systolic blood pressure and 2h C-peptide in early-onset group were significantly lower than those in late-onset group: 44.2％(53/120) vs. 60.2％ (206/342), (134 ± 17) mmHg vs. (138 ± 18) mmHg and (3.99 ± 2.47) μg/L vs. (4.75 ± 2.65) μg/L, and there were statistical differences (P<0.01 or < 0.05). There were no statistical differences in smoking percentage, body mass index, glycated hemoglobin, total cholesterol, low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) between 2 groups (P>0.05). The incidences of peripheral vasculopathy and cerebrovascular disease in early-onset group were significantly lower than those in late-onset group:13.3％(16/120) vs. 24.3％(83/342) and 11.7％(14/120) vs. 22.8％(78/342), but the incidence of diabetic nephropathy was significantly higher than that in late-onset group: 37.5％ (45/120) vs. 27.8％ (95/342), and there were statistical differences (P<0.05 or <0.01). There were no statistical differences in incidences of coronary heart disease, diabetic retinopathy and diabetic neuropathy between 2 groups (P>0.05). Multivariate Logistic stepwise regression analysis result showed that age, duration of diabetes, hypertension, smoking, levels of glycated hemoglobin and triglyceride were the risk factors for chronic complications in early-onset type 2 diabetic mellitus patients. Conclusions The clinical characteristics are different between early-onset and late-onset type 2 diabetic mellitus patients. Early-onset patients are more prone to diabetic nephropathy, while late-onset patients are prone to macrovascular diseases such as peripheral vascular disease and cerebrovascular disease. Comprehensive management should be administered for early-onset type 2 diabetic mellitus patients to prevent chronic complications especially microvascular complications.

Objective To explore the effects of repetitive transcranial magnetic stimulation ( rTMS ) on cognitive function in patients with mild cognitive impairmen ( MCI).Methods Fifty patients with MCI were randomly divided into rTMS treatment group ( rTMS group ) and piracetam treatment group ( control group ) , 25 patients in each group .The stimulated point of rTMS treatment were in the bilateral prefrontal area , for one time a day, continuous treatment for 6 d as a courses in rTMS group patients .Two courses of treatment was interval of 3 weeks, a total of 4 courses.The patients of control group were treated with piracetam 0.8 g, 3 times a day, for taking 16 weeks.Before and after treatment, the event-related potentials P300 and Montreal Cognitive Assessment (MoCA) scale examination were taken in two group respectively .Results Compared with before treatment , the P300 latency significant was significantly shortened and amplitude increased , scores of MoCA scale and delay memory were significantly increased (P<0.05-0.01) after treatment in the rTMS group.Compared with the control group, the difference of those had statistical significance ( all P<0.05 ) .The difference of those had no statistical significance before and after treatment in control group .Conclusion rTMS treatment can improve memory and cognitive in patients with MCI .It can delay the progress of dementia to some extent .

Objective To observe the efficacy and safety of arginine vasopressin receptor antagonist tolvaptan for treating hyponatremia caused by syndrome of inappropriate secretion of antidiuretic hormone (SIADH).Methods Six patients diagnosed with SIADH were enrolled in this study.Four cases were allocated to tolvaptan group (oral tolvaptan 15-60 mg/d,the dosage was adjusted based on the level of serum sodium).Two cases were allocated to regular treatment group (liquid was limited 1 000 ml/d,intravenous drip was less than 3％ sodium chloride and/or oral salt capsule 10-15 g/d several times was adjusted based on the level of serum sodium).Data of the level of serum sodium at 4,7 d,baseline value of serum sodium,serum sodium at the first normal time,24 h urine and weight change were collected.Safety assessment was given before and after treatment,including medical history,physical examination,electrocardiogram,laboratory tests,and incidence of adverse events.Results The level of serum sodium in tolvaptan group increased from the first day of the treatment.During the period of treatment,serum sodium at 4 d increased 22,16,14,11 mmol/L compared with the baseline value respectively.No obvious change of sodium was observed in regular treatment group compared with the baseline value.For 7 d treatment,serum sodium level increased 14,13,14,13 mmol/L in tolvaptan group compared with the baseline level respectively.Only 2 cases in regular treatment group increased 4 mmol/L,and sodium level in regular treatment group did not reach the lower limit of normal level of serum sodium.In tolvaptan group,all patients urine output increased after 1 d treatment and began to stabilize in 3 d.24 h urine putouts were much more than 1 500 ml during treatment.Urine putouts 780-1 400 ml were observed in regular treatment group.There was no difference before and after treatment.Although weight dropped after treatment in the two groups,weight in tolvaptan group fell obviously.In the two groups,there was no difference in blood pressure and heart rate before and after treatment.There were no serious complications and adverse events.Conclusions Compare with regular treatment,arginine vasopressin receptor antagonist is more effective therapy because it can correct the SIADH in patients with hyponatremia and reduce water retention.It also has a good security.

Objective By estimation and analysis of imaging characteristics of "dry"and "wet" laser print to appreciate the imaging quality of two different printing ways and its advantages and disadvantages respectively.Methods ①28 routine MRI and 28 routine CT images were selected,the imaging quality of MR and CT images including brightness,contrast,detail display,diagnostic performance and general impression were evaluated by 6 radiologists;②CT and MR images of skull,lumbus,knee and hand joint adjusted to the best states, then printed by "dry" and "wet" laser printer;③The sensitive characteristic curve both "dry" and "wet" printing were made with opital densimeter,SMPTE card,then an objective evaluation of stabilization was done.Results ①The imaging quality for the dry imaging possess in 56 cases,the much worse was 0.3%,the best was none,the slightly worse,medial and slightly better was 31.9%,58.9% and 8.9% respectively;②The maximum density of the dry film and the wet film was 3.34 and 3.62 respectively,the dynamic range of the latter was more wide than that of former;③The wet films exposed to temperatures from 40℃ to 100℃,did not show a noticeable alteration in optical density,but the dry film showed gray scale degradation at temperatures above 70℃.Conclusion In imaging quality,stability of film,brightness and contrast of film,"wet" laser film is better than that of "dry" laser film,but "dry"laser film has still good diagnostic function that can be used in clinical diagnosis.

[Summary] Glucose-dependent insulinotropic polypeptide ( GIP) is known to promote the release of insulin fromβcells, but this function suffers from a defect in obese patients. More and more evidences suggest that GIP is the bridge between a high-fat diet, obesity, insulin resistance, and type 2 diabetes. With the deepening of research in GIP in type 2 diabetes and obesity, GIP may provide new ideas for the treatment of type 2 diabetes and obesity.

Objective In order to provide important theoretical basis for further improving design of DC-7/7A high altitude partial pressure suit and FTF-2 air ventilation suit (named as A suit and B suit), the performance of ventilating heat dissipation of DC-7/7A and FTF-2 was studied. Methods Five healthy volunteers were enrolled to took participate in A group and B group tests. Environmental weather conditions for A and B suits were set at Tdb 40℃ and 45℃,rh 45% and 40% respectively, and the test time was 90min and 120 min respectively. Results During the test for A group and B group, Ts ranged from 31.5℃ to 34.5℃ for human comfort. Average skin temperatures of the lower part of the body were from 33.1℃ to 33.8℃. Skin temperatures of the legs did not obviously change or slightly lowered. Heart rate showed an increase of 12 beats/min and 14 beats/min. Sweat quantities were measured to be 0.288?0.056kg/1.5h and 0.445kg?0.077 kg/2h respectively. Evaporation rates were 77.4?3.6% and 84.2?2.4% respectively. Subjective uncomfortable sensation was more obvious as test time went on. Conclusion The results of the ventilating heat dissipation for both groups were quite good, but the findings suggested that the number of the ventilating holes for some important sites should shall be re-considered. Pilots wearing A group and B group with ventilation function would still suffer from mild heat stress and obvious subjective discomfort in hot enviroment.

Objective To investigate the effects of melatonin on oxidative stress and metabolisms of glucose and lipid of diabetic patients.Methods By means of random,single-blind,placebo-parallel control clinical trial,91 of diabetic patients were randomly divided into melatonin group and placebo group.The parameters of Glutathione Peroxidase (GSH-Px),Superoxide Dismutase(SOD)and Malondialdehyde(MDA),as well as the profiles of glycemia and lipidemia were observed before and after 8 weeks treatments,respectively.Results Before treatment,both the serum levels of GSH-Px and SOD of diabetic patients were decreased significantly,whereas the serum level of MDA increased significantly.After 8 weeks consecutive melatonin treatment,the serum levels of GSH-Px and SOD increased significantly,whereas the serum level of MDA decreased significantly compared with pre-treatment in the melatonin group.There were no significant variations of serum levels of GSH,SOD and MDA observed before and after treatment in the placebo group.There were significan benefit on FBG and HbA1c after 8 weeks treatment compared with pre-treatment.The other profile of glycemia and lipidemia such as PBG,TG,TC,LDL-C and HDL-C hed no significant variations compared with pre-treatment.There were no significant variations of the profiles of glycemia and lipidemia compared with pre-treatment in the placebo group.Conclusion Melatonin significantly inhibits oxidative stress provoked by hyperglycemia and has beneficial effects on the glucose homeostasis of diabetic patients.

Objective To explore the possibility of rapamycin to up-regulate radiosensitivity of nasopharyngeal carcinoma (NPC) and its molecular mechanism.Methods In vitro,with untreated cells as the control,NPC cells were treated with rapamycin,irradiation (IR),or both rapamycin and IR.Phosphorylation of S6 and GSK3β,expression of Cyclin D1,clonogenic survival,number of residual γH2AX foci,and cell cycle status between study groups were compared.In vivo,athymic mice bearing CNE1 tumor were similarly treated.Tumor weight,Cyclin D1 and phosphorylated S6 in the xenograft model were compared between study groups.Results The results showed that rapamycin alone decreased the phosphorylation of S6 and glycogen synthase kinase 3 β (GSK3β),and the expression of Cyclin D1 in NPC cells.Thus,rapamycin-treated NPC cells had lower cell viability,higher DNA damage and more G1 arrest than the control,which was reflected by the in vivo study that rapamycin significantly attenuated tumor growth and decreased the levels of Cyclin D1 and phosphorylated S6.Moreover,the combination of rapamycin and IR caused the highest cell death,DNA damage,G1 arrest and tumor regression compared to those treated either alone.Conclusions Rapamycin up-regulate NPC radiosensitivity by inhibiting signal transduction of Akt/mammalian target of rapamycin (mTOR)/S6 pathway and Akt/GSK3β pathway,and by downregulating Cyclin D1 expression.

Objective To analyze the anesthetic methods and surgical procedures in the treatment of inpatients in N 2 People' s Hospital of Deyang after Wenchuan earthquake. Methods More than 900 patients were sorted for injury triage, among whom 83 patients received emergency surgery within 72 hours after earthquake, and 21 received surgery after 72 hours. After 10 days of the earthquake, the hospitalized patients needing further surgery have been transferred to hospitals in safe regions. Of all patients, 89 (85.58%) were with injuries of extremities, 11 (10.6%) with cerebral trauma, 3 with thoracic injury, and 1 (1.0%) with abdominal trauma. Perioperative noninvasive blood pressure, electrocardiogram, pulse and oxygen saturation were detected during the surgery. All patients were cured except that one patient with traumatic flail chest died 12 hours after the surgery. Results Of all patients undergone surgeries, 35 patients (33.7%) received combined spinal-epidural anesthesia (CSEA), 33 (31.7%) received nerve plexus block (NPB), 5 (4.8%) had CSEA plus NPB, 28 were under general anesthesia (GA) [17 (16.3%) were intubated and 11(10.6%) were non-intubated] and 3 (2.8%) received monitored anesthesia care (MAC). The average ratios of operation time to time for patients stayed in operation room were (51.29±12.38)% in GA group, (53.24±11.39)% in NPB group, (58.43±9.26)% in CSEA group and (77.15±9.27)% in CSEA plus NPB group. There was a significant difference between CSEA + NPB group and the other three groups (P<0.01), and there was no significant difference among GA group, NPB group and CSEA group (P > 0.05). Conclusions During the initial period of rescue, the most common type of injuries are fractures. CSEA plus NPB is encouraged to use as they have the advantages of shorter operation time, higher operation throughput, safety and faster convalescence of the victims.

Objective To investigate the long -term angiography and clinical outcome of encephalo -duro-myo-synangiosis (EDMS) for the treatment of children w ith moyamoya disease. Methods The clinical and imaging data of before and after procedure in children w ith moyamoya disease treated w ith EDMS w ere analyzed retrospectively. Results A total of 21 children w ith moyamoya disease w ere enroled, including 13 females and 8 males, aged 4 to 16 years. The initial symptom: transient cerebral ischemic attack in 15 cases, ischemic stroke in 4 cases, and hemorrhagic stroke in 2 cases. Matsushima clinical classification: type Ⅰ in 8 cases, type Ⅱ in 7 cases, type Ⅳ in 3 cases, type Ⅴ in 1 case, and type Ⅵ in 2 cases. Suzuki stage: stageⅡ in 4 cases, stage Ⅲ in 11 cases, stage Ⅳ in 5 cases, and stage Ⅴ in 1 case. Ten children underw ent bilateral operation and 11 underw ent unilateral operation (a total of 31 sides). They w ere folow ed up for 13 to 91 months (mean 39.8 months). Three children had transient ischemic attack, 2 had cerebral infarction, 7 had facial edema, and none of them died during the perioperative period. The clinical symptoms w ere improved significantly in 14 sides (45.2%), good in 13 sides (41.9%), and general in 4 sides (12.9%) 1 year after operation. The proportion of children w ith modified Rankin Scale (mRS) score 0-2 after operation w as significantly higher than that before procedure (95 .2% vs.71.4%; χ2 = 4.29, P = 0.041). The middle meningeal artery and deep temporal artery participated in the blood supply of cerebral cortex in different degrees w ere observed by cerebral angiography again for 31 sides, excelent in 25 (80 .6%) and fair in 6 (19.4%). Conclusions The long-term angiography and clinical outcome in children w ith moyamoya disease treated w ith EDMS is good.