Objective To explore the relationship between osteoporosis and chronic vascular complications in elderly male patients with type 2 diabetes and to evaluate its related risk factors.Methods A retrospective study was conducted in 428 elderly type 2 diabetic patients.The bone mineral density (BMD) of lumbar spines (L2 ～L4),femoral neck,Ward's triangle were measured by dual X-ray absorptiometry,and chronic vascular complications in patients were tested.The correlation between BMD and chronic vascular complications was analyzed.Results Diabetic course was longer in osteoporosis group than in non-osteoporosis group (P＜0.05).Levels of fasting blood glucose (FBG) and postprandial blood glucose (PBG) were significantly higher in osteoporosis group than in non-osteoporosis group (P＜ 0.05).The incidences of diabetic nephropathy,diabetic retinopathy,diabetic neuropathy and hypertension were higher in osteoporosis group than in non-osteoporosis group (59.8％ vs.12.0％,41.8％ vs.22.3％,33.6％ vs.24.5％,and 35.7％ vs.26.1％,respectively,all P＜0.05).Logistic analysis showed that diabetic course,FBG and diabetic nephropathy were correlated with diabetic osteoporosis (OR =1.055,1.168,7.401,95％ CI:1.015-1.096,1.073-1.273,4.303-12.727,P=0.007,0.001,0.001).Conclusions Osteoporosis has a close relationship with diabetic microvascular complications in elderly diabetic patients.Diabetic nephropathy plays an important role in the development of diabetic osteoporosis.It is helpful for osteoporosis prevention to early monitor and intervene on microvascular complications index such as urinary albumin in elderly patients with type 2 diabetes.

Objective To study the clinical characteristics, treatment methods and prognosis of primary gastrointestinal diffuse large B-cell lymphoma (PGI-DLBCL). Methods The clinical data of 40 patients with PGI- DLBCL were retrospectively analyzed. All the cases had received surgery treatment. Results In 40 patients with PGI-DLBCL, the major clinical presentation included abdominal pain in 15 cases (37.5%), abdominal mass in 6 cases (15.0%), abdominal discomfort in 5 cases (12.5%), abdominal distension in 5 cases (12.5%), and hematemesis in 5 cases (12.5%). Fifteen cases were misdiagnosed as gastric cancer, 5 cases as colon cancer, and 4 cases as digestive tract ulcer. The misdiagnosis rate was 60.0% (24/40). The survival rates of 1- , 2- and 3- year were 62.3%, 57.5% and 52.6%. The univariate analyses result showed that the clinical stage, international prognosis index (IPI) and treatment method were associated with survival rate (P<0.01), but the gender, age and disease distribution were not associated with survival rate (P > 0.05). The 3-year survival rate of clinical stage Ⅰ - Ⅱ was significantly higher than clinical stageⅢ-Ⅳ(68.0%vs. 13.3%), the 3-year survival rate of IPI 0-2 scores was significantly higher than 3 - 5 scores (66.7% vs. 7.6%), and the 3- year survival rate of surgery combined with postoperative chemotherapy was significantly higher than simple surgery (75.0%vs. 20.0%), there were statistical differences (P<0.01). Conclusions The patients with PGI- DLBCL have no obvious clinical manifestions and a higher misdiagnosed rate. Modified IPI, clinical stage and surgery combined with postoperative chemotherapy are the influencing factors of prognosis.

The development of medical imaging diagnosis technology has brought forward higher requirements for the teaching of oral and maxillofacial medical imaging diagnostics, In this study, we intro-duce the methods and concepts of comparative imaging to guide students to analyze and compare oral and maxillofacial diseases from different perspectives, and to promote the students' understanding of the disease image and mastery of disease diagnosis, improve the students' ability to choose the appropriate imaging method in the future clinical work. Comparative imaging is one of the important teaching methods in the diagnosis of oral and maxillofacial medical imaging, and it is also the direction of its future development.

The bladder meridian of foot-taiyang is considered as key of six meridians and the yang of the yang, which is the pivot of transportation for qi and blood in the meridians and zang-fu. The running route and treatment characteristic of bladder meridian is closely related with chronic fatigue syndrome (CFS). The bladder meridian belongs to brain and connects with governor vessel, which has a close relationship with zang-fu function, quality of sleep and fatigue. Besides, the running route of bladder meridian is highly consistent with the surface projections of important anatomical structures such as muscle, nerve and sympathetic trunk, etc. Therefore, regulating the meridian-qi of bladder meridian can harmonize five-zang and calm the mind, but also effectively relieve physical and mental fatigue in CFS.
Acupuncture Points ; Acupuncture Therapy ; Fatigue Syndrome, Chronic ; therapy ; Humans ; Meridians

Objective To evaluate the relationship between sternum protection and bone marrow suppression in postoperative radiotherapy for esophageal carcinoma. Methods Total of 98 postoperative patients with thoracic esophageal carcinoma were randomly divided into experimental group (52 cases) and control group (46 cases). All patients were given intensity-modulated radiotherapy (IMRT), with the dose of 50-50.4 Gy. The patients in experimental group were irradiated by 6 fields (4-fields in front, 2-fields behind) which were crossed to avoid direct exposure to the sternum. The patients in control group were irradiated by 5 fields (3-fields in front, 2-fields behind) with front-middle of the field passing through the sternum. Concurrently all patients received 2 cycles of cisplatin chemotherapy. Results Dmean, V20 and V30 of the sternum in the experimental group were (20.21 ±3.60) Gy, (40.78 ±7.19) % and (33.78 ±9.44) %, which were lower than those in the control group [(30.91±5.21) Gy, (81.01±4.81) %, (51.60±6.84) %], respectively (P<0.05). However, the volume and dose distribution of lung, spinal cord and heart were similar between the two groups (P> 0.05). Both the incidence rates of bone marrow suppression at 14th day and 35th day after radiotherapy were significantly higher in the control group (52.2%, 73.9%) than those in the experimental group (28.8 %, 50.0 %) (P< 0.05), and the incidence rate of bone marrow suppression at 7th day after radiotherapy was similar between the two groups. Conclusion Protecting and sketching for sternum in postoperative radiotherapy for esophageal carcinoma can reduce the incidence of bone marrow suppression effectively, which would not increase the radiation dose in the lung, heart and spinal cord.

Objective To explore the clinical effect of the atlanto-axial pedicle screw internal fixation to reconstruct upper cervical spine instability. Methods Using atlanto-axial pedicle screw and internal fixation system combined with autogenous iliac bone graft to treat 21 patients with upper cervical spine instability. Type Ⅱ odontoid process old fracture was 13 patients, odontoid process nonunion was 5 patients, injury of the transverse ligament was 3 patients. They were placed in 84 atlanto-axial pedicle screws, autogenous bones were placed in the posterior arch of atlas and axis to fusion, so that atlanto-axial complex got stabilized. Results The left lateral cortical bone of atlas vertebral pedicle was broken by screws in 2 patients, but the spinal cord and vertebral artery was intact. X-ray film showed the atlas and the fracture of dens of axis was completely replaced in all patients. The position of screw and vertebral artery or spinal cord was good in CT image. According to JOA score standard, 15 cases of all were excellent, 3 cases were good,2 cases were common,1 case was bad, and the rate of excellent and good was 85.71%(18/21).Seventeen cases were followed up for 12-26 (12.83 ± 4.23) months, all patients had acquired bone fusion and found no screw and plate fracture. Conclusions Atlanto-axial pedicle screw combined with screw-plate system fixation to treat upper cervical spine instability, can significantly enhance the biomechanical stability of the atlanto-axial interbody, bone grafting fusion rate is higher, the application value of the atlanto-axialfusion is higher.

?AIM: To explore the relation of homocysteine ( Hcy ) and its metabolic related indicators with primary angle-closure glaucoma ( PACG) .?METHODS: In this study, a total of 150 PACG patients and 150 controls were enrolled. The patients with PACG were diagnosed by applanation tonometer, Humphrey perimetry ( HVF ) , optical coherence tomography ( OCT ) , gonioscope. The normal controls were recruited from physical examination center. Blood samples were collected and the plasma was used to determine homocysteine, vitamin B12 and folic acid. DNA was extracted to determine the methylenetetrahydrofolate reductase ( MTHFR ) C677TT genotype and gene polymorphism.?RESULTS:There was a statistically significant difference (t=2. 04,P=0. 04) in mean homocysteine levels between patients with PACG ( 16. 11 ± 1. 66μmol/L ) and controls (15. 74± 1. 52μmol/L). The level of vitamin B12 in PACG group was 248. 09 ± 119. 07pg/mL and the control group was 230. 21 ± 142. 93pg/mL. No statistically significant difference was found on the vitamin B12 level between the two groups ( t = 0. 84, P = 0. 40 ). The folic acid levels showed no statistically significant differences( t=1. 65,P=0.17) between the PACG group(12. 02±7. 81ng/mL) and the control group (13. 15 ± 6. 25ng/mL). The frequency distribution of the MTHFR C677T genotypes was found to be significantly associated (χ2 =6. 2,P<0. 05) with PCAG (CC 84. 7%, CT 4. 7%, TT 10. 7%) as compared to the controls (CC 94. 7%, CT 2. 0%, TT 3. 3%). The frequency distribution of TT genotypes of MTHFR C677T in the PACG group was significantly higher than that in the control group. Moreover, our findings showed significant difference (χ2=14. 2,P<0. 05) between the allele frequency of the C677T single nucleotide polymorphism within the MTHFR gene in POAG patients ( T 87. 0%, C 13. 0%) and the control group(T 95. 7%,C 4. 3%) .?CONCLUSION: These results show that the Hcy level and the TT genotypes of MTHFR C677T were higher in the PACG patients than in controls. Therefore, our data suggests that high Hcy level and the related indicators are associated with high PACG risk.

Objective Autoantibodies and corresponding immune complexes involved directly in the development of rheuma -toid arthritis ( RA) .The effect of anti-mutated citrulline vimentin antibodies contained immune complex ( AMCV-IC) on the function of fibroblast-like synoviocytes ( FLSs) is still unclear .The aim of the study was to investigate the effect of AMCV-IC in serum of RA pa-tients on the proliferation of RA-FLSs. Methods Serum samples of RA , SLE ( systemic lupus erythematosus ) and healthy people were collected from outpatients and hospitalized patients in Nanjing General Hospital of Nanjing Military Region from March 2012 to March 2013 , including 20 RA patients ( 10 patients with serum AM-CV+and 10 patients with serum AMCV -) , 10 SLE patients and 10 healthy people .Serum AMCV of SLE patients and healthy people was negative .Serum IC was extracted by affinity chromatography with im-mobilized protein G and was divided into AMCV +-IC group,AMCV--IC group,SLE-IC group, and control group.The levels of AMCV were detected by ELISA .We cultivated RA patients'arthral FLSs in vitro .FLSs were stimulated with AMCV +-IC,AMCV--IC, SLE-IC and CON-IC (50,100,200,and 400μg/mL),respectively.And the effect of IC on RA-FLSs was detected by CCK-8. Results Compared with AMCV --IC group (1.37 ±0.86, 1.31 ±0.10),SLE-IC group (1.36 ±0.06, 1.38 ±0.03) and CON-IC group (1.08 ±0.02, 1.04 ±0.06),the A values of AMCV +-IC group (1.53 ±0.11, 1.58 ±0.05) were obviously higher after stimulating RA-FLSs with 50 and 100μg/mL IC for 24 h (P<0.05);Similarly, compared with AMCV --IC group (1.32 ±0.04, 1.38 ±0.07), SLE-IC group (1.31 ±0.10, 1.29 ±0.01) and CON-IC group (1.13 ±0.06, 1.03 ±0.09),the A values of AMCV +-IC group (1.53 ±0.16, 1.57 ±0.06) were obviously higher after stimulating RA-FLSs with 200 and 400μg/mL IC for 24 h (P<0.05). Meanwhile , the A values of AMCV --IC group and SLE-IC group were obviously higher than CON-IC group under different concentra-tions of IC(P<0.05). Conclusion AMCV+-IC can stimulate the proliferation of RA-FLSs more effectively compared with AM-CV--IC, SLE-IC and CON-IC under different concentrations of IC and involve in the pathogenesis of RA .

Objective To investigate the actual situation of implementation of the project to reduce water arsenic in endemic arsenic poisoning areas in Shanxi province,and to provide a scientific basis for prevention and control of the disease.Methods In June 2011,a questionnaire survey of 151 arsenic endemic villages was carried out in Shanxi province.The actual situation of implementation of the project to reduce water arsenic was investigated.Water samples were collected and arsenic level was determined by atomic fluorescence spectrometry.Results In the 151 arsenic poisoning villages 126 villages had changed the water,and the rate was 83.44％.In these villages,22 villages did not use the water improvement utilities properly.Of the 33 water improvement projects to reduce arsenic,23 operated normally.The projects covered 110 villages,beneficiary population of 97 920 people,accounting for 46.9％(97 920/208 736) of the total population.Water arsenic exceeded the national standards(≤0.05 mg/L) in 10 of the water improvement projects which covered 31 villages,including 15 nonendemic villages and 16 diseased villages.There were a population of 24 764 people in the diseased villages.Conclusions In Shanxi endemic arsenic poisoning areas,water improvement efforts need to be strengthened; the quality of water improvement project needs to be improved,and the project's later management and maintenance also need to be further strengthened.

Objective To investigate the analgesic effect of salmon calcitonin(sCT)and its effect on expression of calcitonin receptor(CT-R)in periaqueductal gray(PAG). Methods Rat models of neuropathic pain were prepared by chronic constriction injury(CCI). Thermal withdrawal latency(TWL)and mechanical nociceptive threshold(MNT)were measured using hot plate test and yon Frey monofilaments test. The distribution of CT-R in PAG was detected by immunohistochemical method. CT-R protein was quantitatively determined by western blotting. Fourty male SD rats were randomized into 5 groups: normal group, sham-CCI group, CCI group, CCI plussubcutaneous sCT group, and CCI plus microinjection of sCT into PAG group. Results TWL, MNT, andexpression of CT-R in PAG showed no difference between normal group and sham-CCI group(P＞0. 05). TWL and MNT in CCI group were significantly lower than those in normal group(P＜0.05), and expression of CT-R in CCI group was significantly higher than that in normal group(P＜0.05). TWL, MNT and expression of CT-R in CCI rats increased significantly after sCT therapy(P＜0. 05), and the effect was more marked in PAG injection group than subcutaneous injection group(P＜0.05). Conclusions sCT raises the pain threshold and increase the expression of CT-R in PAG of CCI rats, while PAG injection showed more marked effect than subcutaneous injection.