It summarized the differentiation and treatment ideas and experiences in using Chinese herbs of Prof.FAN in treating impaired glucose tolerance (IGT) and newly diagnosed type 2 diabetes mellitus (T2DM).Professor FAN creatively proposed the syndrome differentiation and treatment plans,which had the characteristics of combining movement with immobility,orderly and continuous,and the differentiation thinking of combing the characteristics with commonnesss.It had unique characteristics of using string of herbal drugs skillfully in clinical medication.

Objective To investigate the effect of the increased pulse pressure on cerebrovascular hemodynamic index.Methods From January 2014 to October 2016,the application of the method of cross-sectional study,6 006 consecutive health subjects examined and detected with ultrasound noninvasive cerebral hemodynamic index (CVHI) at the Physical Examination Center,Pu′er People′s Hospital,Yunnan Province were enrolled.In order to control the influence of age and gender on the results,according to age and gender in the increased pulse pressure group (≥60 mmHg),and the same sex and age difference of not more than 1 years old were selected as the inclusion criteria in the normal pulse pressure group (60 mmHg).Finally,1 115 subjects were enrolled as a control group for comparative analysis.The study population was divided into an increased pulse pressure group (n=590) and a normal pulse pressure group (n=1 115) in a mixed manner.The differences of CVHI index and its integral score of both groups were compared.The correlation of the increased pulse pressure level and changes of cerebrovascular hemodynamic accumulative scores were analyzed.Results The minimum velocity,mean velocity,and critical pressure in the increased pulse pressure group were significantly lower than those in the normal pulse pressure group (P<0.05),while the differences of the peripheral vascular resistance,characteristic impedance,pulse wave velocity,dynamic resistance,diastolic blood pressure,and critical pressure were significant higher than those in the normal pulse pressure group.There were significant differences (P<0.01).The integral values of cerebral hemodynamics in the increased pulse pressure group and the normal pulse pressure group were 76±22 and 88±19 respectively.There was significant difference (P<0.01).The proportion of the integral value <75 was 34.4% (203/590) and 15.6% respectively (174/1 115,P<0.01).With the increase of pulse pressure level,the integral value of cerebral hemodynamics showed a significant downward trend,there was a significant negative correlation between the two (r=-0.312,P<0.01).Conclusion The increased pulse pressure may result in the changes of cerebral hemodynamic indexes and its integral values.There is a significant negative correlation between the pulse pressure level and the integral value of cerebral hemodynamics.

Objective To investigate effect of low molecular weight heparin (LMWH)on oxidative stress and renal function in elderly patients undergoing gastrectomy of stomach neoplasms. Methods 90 elderly patients undergoing radical surgery were randomly divided into LMWH group (Ⅰ group,n=45)and control group (Ⅱ group,n=45). Patients inⅠ group received a subcutaneous injection of LMWH(100 u/kg,1/d)from the time before anesthesia induction to postoperative 5 days,and patients in Ⅱ group were given equal volume of saline. Venous blood samples were collected to determine level of malondialdehyde(MDA),aldose reductase(AR)activity level,superoxide dismutase(SOD)activity level,catalase (CAT)activity level,creatinine(Cr)and blood urea nitrogen(BUN)before anesthesia induction(T0 ),at the end of the surgery(T1 ),on postoperative 1 day(T2),3 days(T3)and 5 days(T4)respectively;urine specimen were also collected to measured albumin(Alb)and N-acetyl-beta-D-amino glycosidase enzymes(NAG)at the same time points. Results There were obvious statistical differences in MDA,AR,SOD and CAT at different time points by intra-group comparison (P<0.05 ). MDA and AR rose first and then fell in two groups,and both reached the peak at T2 ,whereas SOD and CAT had the opposite trends. There were obvious statistical differences in MDA,AR,SOD and CAT at T1 ~T3 (P<0.05 ). MDA and AR inⅠgroup at T1 ,T2 and T3 was lower than those in groupⅡ(P<0.05 ),whereas SOD and CAT inⅠgroup at T1 ,T2 and T3 were significantly higher than those in group Ⅱ(P<0.05). Cr and BUN of both groups were found no significant statistical difference within the group and between groups(P>0.05).Alb/Cr of both groups at T1 and T2 were significantly higher than those at T0 (P<0.05 ),while Alb/Cr in Ⅰ group at T1 was obviously lower than Ⅱgroup(P<0.05 ).NAG/Cr in both groups at T1 ,T2 and T3 were significantly higher than those at T0 (P<0.05 ),while NAG/Cr inⅡ group at T4 was still higher than that at T0 (P<0.05 ),and NAG/Cr inⅠgroup at T1 ~T4 was obviously lower thanⅡgroup (P<0.05 ). MDA and AR in both groups at T1 ,T2 were positively correlated with Alb/Cr and NAG/Cr respectively(P<0.05 ),whereas SOD and CAT in both groups at T1 ,T2 were negatively correlated with Alb/Cr and NAG/Cr respectively(P<0.05 ). Conclusion Oxidative stress reaction resulted from radical surgery of elderly patients is associated with perioperative renal damage. LMWH could reduce oxidative stress in elderly patients,and alleviate the kidney damage,as well as protect the renal function.

Objective:To study the effect of flavonoids extracts from semen Astragali complanati (FAC) on the growth of hepatocellular H22 cells and elucidate its action mechanism. Methods:The mouse model bearing H22 tumor cells was established. The effects of FAC on the growth of xenografted H22 tumor, the immune organ, survival time, phagocytic function of macrophages, and lymphocyte transformation in tumor-bearing mice were observed. Results:The growth of H22 transplanted tumor was significantly inhibited by FAC at high, middle and low doses,compared with normal control group (P<0.05). The tumor-inhibiting ratio in cyclophosphamide (CTX) group was similar with that in FAC high-dose group (P>0.05). FAC markedly elongated the survival time of tumor-bearing mice. The high, middle and low doses of FAC elongated the survival time of tumor-bearing mice by 64.9%, 56.7% and 28.1%, which were significantly different with control group (P<0.01). The high, middle and low doses of FAC greatly increased the thymus index and spleen index of tumor-bearing mice (P<0.05, vs control) and elevated the phagocytic function of macrophages and lymphocyte transformation capability (P<0.01, vs control). The effect of CTX on immune function of tumor-bearing mice was opposite with FAC. The difference between CTX group and control group was significant (P<0.01). Conclusion: FAC inhibits the growth of H22 hepatoma, elongates the survival time, and elevates the non-specific immune function of tumor-bearing mice, indicating that FAC maybe exert its anti-tumor effect via regulating immune function of tumor-bearing mice.

Objective To assess the efficacy of triple therapy including proton pump inhibitor (PPI), levofloxacin and amoxicillin for the first-line treatment of H. pylori infection, and the relation between H. pylori eradication and CYP2C19 genetic polymorphism. Methods Two hundred and five H. pylori-positive patients were divided into group E_(20) (esomeprazole 20 mg twice daily), group E_(40)(esomeprazote 40 mg twice daily),group R (rabeprazole 10 mg twice daily) and group L (lansoprazole 30 mg twice daily). Besides PPI, all patients were received levofloxacin 500 mg daily and amoxicillin 1000 mg twice daily for 1 week. The CYP2C19 genotypes were detected in 161 patients. The eradication of H. pylori were analyzed by intention-to-treat (ITT) and per protocol (PP) methods.ResultsThe H. pylori eradication was 86.70% in group E_(20), 88.5% in group E_(40),73.5% in group R and 78.1% in group L. Whereas the H. pylori eradication was 90% in patients with PM genotype,81.5% in patients with HetEM genotype and 82.1% in patients with HomEM genotype. The H.pylori eradication was 83.4% and 79.00% by per protocol (PP) and intention-to-treat (ITT) analyses,respectively. There was no significant difference in H. pylori eradication among four groups (P>0.05), and no relation was found between H. pylori eradication and genotypes (P>0.05). Conclusions PPI based triple therapy was effective in eradication of H. pylori, which is not influenced by CYP2C19 genotypes.

Objective To observe the expression and influence of SH2-B in hepatocarcinoma,and to investigate the molecular mechanisms of canceration in hepatocarcinoma.Methods By using SABC imunohis-tochemistry,the expressions of SH2-B were detected in 27 cases of hepatitis,29 cases of hepatocirrhosis and 47 cases of hepatocarcinoma.Hepatocarcinoma cell (HepG)2 with a low-expressed SH2-B was selected using immunofluorescence assay.There were 3 groups:the transfected group (transfected with pcDNA3.1 -SH2-B), the vector group (transfected with pcDNA3.1 )and the blank group (without transfection).After gene transfec-tion,SH2-B expression was detected by Western blotting;cell proliferation was measured by MTT assay;cell colony was counted by colony formation test;and cell cycle was analyzed by flowcy tometer.Results The posi-tive rate of SH2-B in hepatocarcinoma (95.7%)was significantly higher than 55.2% in hepatocirrhosis (χ2 =1 8.64,P <0.01 )and 25.9% in hepatitis (χ2 =40.01 ,P <0.01 ).After being transfected with pcDNA 3.1 -SH2-B,SH2-B expression dramatically increased in HepG2 cells.After cultured for 48 h,the average optical density value of the transfected group was 1 .1 2 ±0.1 9,obviously higher than 0.45 ±0.1 1 in the vector group (t =-31 .55,P <0.01 ),which indicated that cells proliferation was significantly enhanced after being trans-fected with SH2-B.The cell colony numbers of the transfected group was 1 66 ±1 4,significantly higher than
82 ±8 in the vector group (t =-20.33,P <0.01 )and 78 ±9 in the blank group (t =-1 9.64,P <0.01 ), which indicated that the cell colony numbers increased after being transfected with SH2-B.The S stage cells of the transfected group was (45.7 ±5.8)%,significantly higher than (1 9.4 ±4.7)% in the vector group (t =-20.33,P <0.01 )and (20.5 ±5.1 )% in the blank group (t =-34.69,P <0.01 ),which indicated that SH2-B could enhance promote cell cycle of HepG2 cells.Conclusion The expression of SH2-B in hepatocar-cinoma is high,and it may be involved in the canceration of hepatocarcinoma though promoting cell cycle,cell proliferation and cell transformation.

Objective To investigate the relationship between peri-menopausal women blood lipid level and the gallstone disease in order to provide theoretical basis for the prevention of gallbladder stone.Methods Seventy-two patients with gallbladder calculus from Department of Hepatobiliary Surgery Jinshan District Central Hospital of Shanghai and 52 healthy women coming for physical examination as the control group.Participants were divided into five age groups (20-29,30-39,40-49,50-59 and 60-69 years old) and two age stages (young period (30-40 years old) and peri-menopausal period (45-55 years old)),total cholesterol (TC),triglyceride (TG),high density lipoprotein (HDL-C),low-density lipoproteins (LDL-C) and Body Mass Index (BMI) were determined and compared between the stone group and the control group at different age stages.Results In comparison of the menopausal transition period,the stone group had significantly lower blood TC,HDL-C and LDL-C levels than the control group (TC:(4.58 ± 0.27) mmol/L vs.(5.15 ± 0.26) mmol/L,t=3.112,P ＜0.01 ;HDL-C:(1.17 ±0.11) mmol/L vs.(1.40 ±0.08) mmol/L,t =3.351,P ＜0.01 ;LDL-C:(2.71 ± 0.30) mmol/L vs.(3.15 ± 0.26) mmol/L,t =2.437,P ＜ 0.05).For the young period,there were no significant difference on blood lipid level and BMI was observed between the stone group and the control group (P ＞ 0.05).The fat HDL-C level in blood was significantly lower in the stone group in the menopausal transition period than in the young period ((1.17 ± 0.11) mmol/L vs.(1.33 ± 0.07) mmol/L,t =2.455,P ＜ 0.05).The control group had significantly higher peri-menopausal TC,TG,LDL-C levels in blood and BMI than those in the control group young period (P ＜ 0.05) ; And HDL-C level,no significant difference (TC:(5.15 ± 0.26)mmol/L vs.(4.47 ± 0.34) mmol/L,t =3.175,P ＜ 0.01 ; TG:(1.88 ± 0.39) mmol/L vs.(1.10 ± 0.24)mmol/L,t=3.066,P＜0.01;LDL-C:(3.15 ±0.26) mmol/L vs.(2.71 ±0.31) mmol/L,t =2.261,P＜0.05;BMI:(24.75±0.99) kg/m2vs.(21.73±1.11) kg/m2,t=4.217,P＜0.01).Conclnsion For perimenopausal (45-55 years old) females,decline of serum TC,HDL-C and LDL-C levels may be related to the formation of cholesterol stone.Lower HDL-C level is closely associated with formation of cholesterol stone,indicating that it may be one of the measures to prevent gallbladder stone by adjusting blood fat in perimenopausal women.

Objective To investigate the effect of different frequencies of endoscopic ultrasonography (EUS) on diagnosis of duodenal submucesal lesions. Methods A total of 210 elevated duodenal lesions detected by routine endoscopy in 201 patients were examined by EUS at different frequencies according to lesion features and image clarity. Endoscopic resection was applied in 27 lesions with informed consents,and pathological findings were compared with the results of EUS. Results The accuracy of EUS was 81.4% (22/27). Ultrasound of low frequency was superior in displaying overview of lesion and was more suitable for lesions larger than 1.5 cm in diameter or lesions of hyperecho. On the other hand,ultrasound of high frequency was more reliable to reveal minute structures and could be employed in scanning lesions smaller than 1.5 cm in diameter. Combination of different frequencies of ultrasound could provide more details in larger lesions. Conclusion Application of appropriate frequency or combined frequencies of ultrasound in examination of elevated duodenal lesions is beneficial to achieve more accurate diagnosis.

Objective To evaluate the clinical efficacy and safety of endoscopic submucosal dissection (ESD) guided with endoscopic ultrasonography (EUS) for rectal neuroendocrine neoplasms(NENs).Methods A retrospective analysis was performed on 58 patients with rectal ENEs who underwent ESD from January 2011 to December 2015 in JiangSu Province Hospital.Manifestations of EUS, clinicopathological characteristics, proliferation activity grade, complete resection rate, complications and follow-up results of lesion were studied.Results Those treated by ESD included 58 patients with 64 lesions of rectal NENs.EUS results showed that 3 lesions originated from mucosa, 3 from muscularis mucosa and 58 from submucosa.A total of 34 lesions located within 5 cm from anus, 26 in 6-10 cm from anus and 4 more than 10 cm from anus.All 64 lesions were successfully treated by ESD.The mean maximum diameter of the lesions was 0.8 cm(0.2-3.5 cm), and the mean procedure time was 31 min(10-60 min).The complete resection rate was 93.8% (60/64).There were 4 patients with positive basal surgical margin, and two of them underwent additional surgery and two others were treated with argon plasma coagulation after rejecting surgery and ESD.Histological examination determined that 59 lesions were pathologic grade 1(G1) and 5 were pathologic grade 2(G2).Delayed bleeding occurred in 4 cases after ESD,which was managed by medicine in 1 case and endoscopic treatment in 3 cases.No perforation occurred after ESD.During a mean follow-up period of 22.9 months(3-48 months), no lymph node metastasis or distant metastasis was observed.Conclusion EUS is able to distinguish the origin of rectal NENs and aid determining the range and depth of ESD.ESD appears to be a safe, feasible and effective procedure for providing accurate histopathologica1 evaluations as well as curative treatments for rectal NENs limited to submucosa.

Objective:To observe the clinical efficacy of endoscopic submucosal dissection (ESD) in the treatment of superficial esophageal cancer (SEC), and to explore the application value of ESD in the treatment of SEC.Methods:From January 2016 to December 2019, at The First Affiliated Hospital With Nanjing Medical University, the clinical data of 368 patients with SEC and receiving ESD treatment were retrospectively analyzed, induding the general condition, the circumferential proportion of lesions, effectiveness of ESD treatment (en bloc resection rate, complete resection rate, curative resection rate, operation time and resected lesion area), incidence of complications and follow-up. 368 patients were divided into stenosis group (94 cases) and non-stenosis group (274 cases) according to the occurrence of esophageal stenosis after ESD. The circumferential proportion of lesions, operation time and resected lesion area were compared between stenosis group and non-stenosis group, and the independent risk factors of esophageal stenosis after ESD were analyzed. Independent sample t test, chi-square test and binary logistic regression analysis were used for statistical analysis. Results:Among 368 patients, 270(73.4%) were male and 98 (26.6%) were female; the age was (64.4±7.6) years old. The circumferential proportion of lesions of 231 cases (62.8%) was <1/2 circle, 49 cases (13.3%) was 1/2 to <2/3 circle, and 88 cases (23.9%) was ≥2/3 circle. The en bloc resection rate of the lesion was 98.6%(363/368), the complete resection rate and curative resection rate were both 97.8% (360/368). The operation time was (89.4±47.9) min. The area of resected lesion was (12.5±8.9) cm 2. The incidence of perforation during operation, delayed bleeding and stenosis was 0.3% (1/368), 0.5% (2/368) and 25.5% (94/368), respectively. The followed-up period was 8 to 53 months, and the median follow-up period was 25 months. During the follow-up period, no recurrence or new lesion was found, and no lymph node or distant metastasis occurred. The circumferential proportion of lesions of 38 cases (40.4%) of stenosis group and 193 cases (70.4%) of non-stenosis group was <1/2 circle, respectively, the circumferential proportion of lesions of 9 cases (9.6%) and 40 cases (14.6%) was 1/2 to <2/3 circle, respectively, the circumferential proportion of lesions of 47 cases (50.0%) and 41 cases (15.0%) was ≥2/3 circle, respectively, and the difference was statistically significant ( χ2=47.30, P<0.01). The operation time of stenosis group was longer than that of non-stenosis group, the resected lesion area was larger than that of non-stenosis group ((126.1±56.3) min vs. (76.8±37.2) min, (17.5±10.7) cm 2 vs. (10.8±7.4) cm 2), and the differences were statistically significant ( t=9.57 and 5.41, both P<0.01). The results of binary logistic regression analysis showed that circumferential proportion of lesions ≥2/3 circle, operation time and the resected lesion area were independent risk factors for the occurrence of esophageal stenosis after ESD (odds ratio=0.253, 1.018 and 1.041, 95% confidence interval 0.116 to 0.551, 1.011 to 1.025, 1.007 to 1.076, all P<0.05). Conclusions:ESD is a safe and effective way to treat SEC, with low local recurrence rate and few complications, which is worthy of further clinical promotion.