BACKGROUND: Insulin resistance and impaired insulin secretion are the key complications of polycystic ovary syndrome (PCOS). The incidences of insulin resistance syndrome (IRS), impaired glucose tolerance (IGT) and diabetes mellitus have been clearly shown to be race-related, thus the association between polycystic ovary syndrome and insulin resistance was race-related.OBJECTIVE: To analyze the correlation of insulin resistance with body mass index (BMI), blood lipids and plasma glucose in Tibetan patients with PCOS.DESIGN: A prospective study based on Tibetan population.SETTING: Department of Cardiology, General Hospital of Chinese PLA; Second Department of Internal Medicine,General Hospital of Tibetan Military Area Command of Chinese PLA.PARTICIPANTS: Thirty-six Tibetan PCOS patients, aged 25-42 years with a mean age of (32±5) years were selected from the Second Department of Internal Medicine and Department of Gynecology, General Hospital of Tibetan Military Area Command of Chinese PLA. Another 36 female inpatients were selected as the controls (control group), aged 24-35 years with a mean age of (30±5) years.METHODS: The disease histories were collected and general conditions were recorded. Oral glucose tolerance test (OGTT, 75 g) was conducted for all the subjects. All the subjects werefasted for 12 hours to collect venous blood samples to detect the levels of hormone, fasting insulin, total cholesterol, triglyceride, high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C). Ovary was detected with echocardiography. The insulin resistance index was calculated by the homeostasis model assessment (HOMA-IR) was calculated by the formula:fasting insulin (mlU/L)×FPG (mmol/L)/22.5. The blood pressure, BMI and levels of blood lipids, plasma glucose and insulin were compared between the PCOS group and control group.MAIN OUTCOME MEASURES: Blood pressure, BMI and levels of blood lipids, plasma glucose and insulin were observed in both groups.RESULTS: All the 36 PCOS patients and 36 controls were involved in the analysis of final results. ① The BMI, systolic blood pressure and diastolic blood pressure in the PCOS group were higher than those in the control group (t =3.426 5,2.448 4, 2.212 5, P ＜ 0.05-0.01). ② The levels of total cholesterol, triglyceride and LDL-C in the PCOS group were higher than those in the control group (t=2.104 9, t =2.304 7, 2.400 0, P＜ 0.05-0.01), whereas the level of HDL-C was lower that in the control group (t =4.800 0, P＜ 0.01). ③ The levels of fasting insulin and 2-hour plasma glucose and HOM in the PCOS group were higher than those in the control group (t =7.809 5, 12.365 0, 2.789 9, P＜ 0.01).CONCLUSION: Tibetan PCOS patients present a clustering of atherosclerotic risk factors, including obesity, adverse lipid profile, hypertension, hyperglycemia, etc.

Objective To investigate the nursing points of the mechanical ventilated patients after percutaneous endoscopic gatrostomy (PEG). Methods The nursing approaches of 28 mechanical ventilated patients after percutaneous endoscopic gatrostomy in our department was analyzed retrospectively. Results The nutritional status of the 28 patients was improved to different degree after enteral nutrition (EN) support by PEG. Thereby, the nutritional requirement of the mechanical ventilated patients was ensured effectively. Among these patients, 4 patients could take food by mouth after taking off ventilator and extubation and stoma tube was pulled out, 15 patients were discharged carrying with stoma tube and convalescent care was continued, 3 patients died of primary diseases. Conclusions The PEG is a simple,safe and cost-effective approach of nutritional support for EN of mechanical ventilated patients. The key point of insuring EN of severe patients is intensive nursing and to prevent and reduce the complication of PEG.

Objective　To investigate the association betwee n the β3-adrenergic receptor gene (β3-AR) and obesity. Methods　147 patients with obesity and 106 controls were selected. Genotype of the β 3-AR was determined by polymerase chain reaction (PCR) and restriction fragme nt length polymorphism methods (RFLP). Body mass index (BMI) was detected. Results　The frequency of Arg64 allele of β3-AR gene in the obesit y g roup (20.3%) was significantly higher than those in the control group (10.2%) ( P=0.001) . The distribution of Trp64Arg and Arg64Arg genotype in the patient group (38.7% and 0.9%) were both higher than that in the control group (19.0% and 0.7%). In the female subj ects, the Trp64Arg mutation and frequency of Arg64 allele of the β3-AR gene in the obesity group(40.6% and 20.3%) were also higher than those in control (16 . 7% and 9.5%)(P<0.01). Conclusions　These results suggest th at the Trp64Arg mutation of the β3-adrenergic-receptor gene may be associat ed with increased body fat.

Objective To determine the reference intervals for thyroid function tests during the second half of pregnancy (20-40 gestational weeks),and to assess the relationship between thyroid peroxidase antibody (TPOAb) levels and the incidence of gestational thyroid diseases.Methods Levels of thyroid stimulating hormone (TSH),free thyroxine (FT4),TPOAb and urinary iodine excretion were determined in 4 729 pregnant women,who received prenatal health care at First Affiliated Hospital of Nanjing Medical University from July 2011 to August 2013.Among these women,2 568 were selected using the recommendations of the American National Academy of Clinical Biochemistry,and were divided into five groups according to their gestational age:≥ 20 to ＜24 weeks (682 cases),≥ 24 to ＜28 weeks (1 322 cases),≥ 28 to ＜32 weeks (178 cases),≥ 32 to ＜36 weeks (185 cases) and ≥ 36 to ≤ 40 weeks (201 cases).Reference intervals of thyroid function tests in the second half of pregnancy were calculated.The reference values of thyroid functions in different gestational weeks were compared,and the reference intervals of thyroid functions in the second half of pregnancy were determined.The effects of maternal age and positive TPOAb on gestational thyroid diseases were analyzed.A non-parametric test,analysis of variance or Chi-square test was used for statistical analysis.Results (1) Reference intervals for maternal thyroid function in the second half of pregnancy in our hospital were established [TSH:0.65-5.27 mU/L and FT4:8.74-14.84 pmol/L].(2) The percentage of thyroid diseases was higher using the non-pregnancy reference intervals (TSH:0.27-4.20 mU/L and FT4:12.00-22.00 pmol/L) than using the pregnancy reference intervals [64.0％ (3 025/4 729) vs 16.1％ (763/4 729),x2=47.465,P ＜ 0.01],which manifested as a higher rate of clinical hypothyroidism and simple hypothyroxinemia [5.4％ (255/4 729) vs 0.4％ (20/4 729),x2=14.321;54.1％ (2 560/4 729) vs 9.1％ (429/4 729),x2=47.108;both P＜0.01] and a lower rate of subclinical and clinical hyperthyroidism [1.2％ (58/4 729) vs 3.3％ (155/4 729),x2=6.650;0.3％ (13/4 729) vs 0.6％ (27/4 729),x2=2.062;both P＜0.05].(3) The incidence of clinical hypothyroidism and simple hypothyroxinemia in pregnant women aged ＞30 years was higher than in those aged ≤ 30 years [0.7％ (10/1 377) vs 0.3％ (10/3 352),x2=4.257;11.7％ (161/1 377) vs 8.0％ (268/3 352),x2=16.102;both P＜0.05].The incidence of clinical hypothyroidism and clinical hyperthyroidism in TPOAb positive women was higher than that in TPOAb negative women [2.7％ (9/335) vs 0.3％ (11/4 394),x2=44.009;3.9％ (13/335) vs 1.2％ (52/4 394),x2=16.784;both P＜0.01].Conclusions The established pregnancy-specific reference ranges of thyroid function tests can reduce the missed diagnosis and misdiagnosis of gestational thyroid diseases.Maternal age ＞30 years and positive TPOAb may increase the risk ofgestational thyroid diseases.

BACKGROUND: The fracture of adjacent vertebrae after vertebroplasty has been widely concerned. The finite element study of the influence of three cement diffusion types on the stress change of adjacent vertebrae after vertebroplasty has not been reported at home and abroad. OBJECTIVE: To analyze the stress changes of the adjacent vertebrae of the affected vertebrae under different loads using the finite element method. METHODS: Based on the original CT data of one L1 vertebral compression fracture patient and three L1 vertebral consolidation patients with bone cement distributed in the form of dispersion, mixture and agglomeration, the finite elements of T11-L1 vertebral functional unit compression fracture and three types of bone cement dispersion were established by dividing grids, defining material attributes and assembling models, using software such as Mimics 19. 0, Geomagic Studio 2013 and SolidWorks 2017. The models underwent three levels of pressure 0. 3 MPa (low pressure), 1. 0 MPa (medium pressure) and 4. 0 MPa (high pressure) and four load directions of forward bending, backward extension, lateral bending and rotation, respectively. The stress distribution of T12 and L2 vertebrae under different pressures and loads was observed. RESULTS AND CONCLUSION: (1) The increase of the stress of the adjacent vertebrae was positively correlated with the increase of the axial stress after the injection of bone cement. (2) The maximum stress of the adjacent vertebrae was significantly higher than that of the diffusion type and the mixed type under the four loading directions of the agglomerate type of bone cement, and the stress of the mixed type of the adjacent vertebrae was lower than that of the agglomerate type and the diffusion type under the forward bending and lateral bending loads. (3) The results showed that the agglomerate type of bone cement is an important factor leading to the increase of the stress of the adjacent vertebrae. The mixed cement distribution may reduce the risk of adjacent vertebral fractures.

Practical ability training is one of the core tasks during the education for master of public health (MPH).We got a deeper understanding of practical ability cultivation situation for MPH in our school and got a more accurate recognition of the existed problems through conducting questionnaire for three grades MPH of professional degree and related tutors.We analyzed the advantages and disadvantages of the existing mode and reflected on curriculum design,teaching method reform and practical ability training reform,etc based on the results of the questionnaire and years of experiences.

Objective To realize the effect of WHO multimodal hand hygiene improvement strategy (MHHIS)on improving hand hygiene compliance of health care workers(HCWs).Methods From June to December 2012,HCWs in a hospital was intervened by adopting MHHIS,hand hygiene compliance rate before and after intervention was com-pared,and effectiveness of intervention was assessed.Results Hand hygiene compliance of doctors and nurses improved from 14.06%(35/249)and 28.62%(81/283)before intervention to 31.73%(79/249)and 57.60%(163/283)after inter-vention respectively(both P <0.05).Except outpatient and emergency department,hand hygiene compliance of the other departments significantly improved (all P <0.05);hand hygiene compliance of various hand hygiene indicators significantly improved except ‘after contact with patient surrounding’(all P <0.05),the differences were statistically different (P<0.05).Conclusion Using WHO MHHIS can effectively improve hand hygiene compliance of HCWs.

BACKGROUND: Hepatic oval cells (HOCs) possess the potential of self-renewal, replication, and clone, proliferation and differentiation into mature hepatocytes under a certain condition. HOCs can be used as biomaterial for constructing biological artificial liver in vitro, employed for in vivo transplantation, as well as for tissue engineering as seed cells. HOCs can be widely used for improving clinical treatment of liver diseases. OBJECTIVE: To establish adult Wistar rat models of HOC proliferation, to perform/n vitro isolation and culture of HOCs, and to study the possibility of induction and differentiation of HOCs into hepatucytes. DESIGN: Observational study. SETTING: Institute of Gastroenterology, Nanfang Hospital, Southern Medical University. MATERIALS: Experiments were performed at the Laboratory of Institute of Gastroenterology of Nanfang Hospital from December 2003 to February 2006. Thirty-six healthy male Wistar rats aged 3-4 months (150-200 g) were provided by Experimental Animal Center of Southern Medical University. METHODS: Male Wistar rats were orally fed with ethionine received two-thirds partial hepatectomy (2/3 PH). HOCs were harvested and purified by two-steps perfusion and Percoll density gradient centrifugation, and then cultured in vitro and induced with hepatocyte growth factor (HGF), oncostatin M (OSM) and fibroblast growth factor-4 (FGF4). MAIN OUTCOME MEASURES: Identification and differentiation of HOCs. RESULTS: The concentration of HOCs was about 1.34×108 L-1 in each rat model after in vitro isolation. These cells were round, oval or polygon, about 1/6 1/3 the size of normal hepatocytes. The nucleus-cytoplasm ratio was relatively large. After 2 weeks, clone-like proliferation of HOCs could be observed. Laser scanning confocal microscopy indicated positive expression of stem cells markers Thy-1 and C-kit in cytoplasm and membrane of HOCs. Immunocytochemistry demonstrated positive stem cells marker alpha fetoprotein (AFP) in cytoplasm of HOCs. HOCs can stably passage and its shape gradually changed after inducing with HGF, OSM and FGF4. HOC volume became larger and HOCs lost their ability of sticking to the wall of culture flask. Apparent positive stain of cytoplasm albumin (Alb) was detected 14 days after induction, and the positive ratio increased along with the extension of inducing duration. Results of cytochemistry indicated a brown or black deposit after glucose-6-phosphotase (G-6-P) staining and red particles after periodic acid-Schiff (PAS) staining. CONCLUSION: Adult Wistar rat models of HOC proliferation are replicated by ethionine feeding combined with 2/3 PH. HOCs can be obtained through collagenase perfusion and Percoll density gradient centrifugation. Rat HOCs can be passaged and cultured in vitro. Under a certain condition, HOCs can be induced and differentiated into hepatocytes.

Objective To assess the value of clinical applications of whole-body diffusion-weighted imaging (WB-DWI) in diagnosing patients with malignant tumors compared with positron emission tomography (PET). Methods A total of 22 patients with highly suspected malignant tumors underwent WB-DWI after PET. The differences between the two imaging methods were compared in displaying lesions, and the correlation between ADC and SUV value was analyzed. Results More lesions were showed with WB-DWI than PET. There was no significant difference between the two methods in detecting the lesions of lung, mediastinal septum or abdomen (P>0.05), but more lesions in skeleton were showed with WB-DWI (P<0.05). No significant correlation between ADC and SUV value was found. Conclusion Compared with PET, WB-DWI can detect more tumor lesions. The sensitivity of WB-DWI in detecting metastatic tumors of bone is higher than that of PET.

Objective To compare the difference between four-axis positioning 3D printing guide assisted puncture and manual puncture percutaneous vertebroplasty,to clarify the clinical efficacy of 3D printing guide assisted percutaneous vertebroplasty,and to explore its clinical application value.Methods A total of 70 patients who underwent single-segment vertebroplasty for osteoporotic vertebral compression fractures in our hospital were randomly divided into a manual group(control group)and a guide plate group(observation group).Thirty-five patients in the control group underwent PVP under the traditional manual puncture,and 35 patients in the observa-tion group underwent PVP under the four-axis positioning 3D printing guide assisted puncture.The general data,perioperative data,imaging data,preoperative and postoperative functional scores of the two groups were collected and compared.Results In terms of intraoperative fluoroscopy times,operation time,and postoperative adverse reactions,the observation group was significantly lower than the control group,and the difference was statistically significant(P<0.05).However,there was no significant difference between the two groups in intraoperative blood loss,bone cement leakage,and whether bone cement perfusion included fracture sites.In terms of clinical efficacy,the ratio of anterior vertebral height,postoperative VAS score and postoperative JOA score of the two groups were significantly better than those before operation,and the difference was statistically significant(P<0.05).At the same time point before and after operation,there was no significant difference in the height ratio of the anterior edge of the injured vertebra,VAS score and JOA score between the two groups(P>0.05).Conclusion The clinical efficacy of four-axis positioning 3D printing guide plate-assisted puncture is the same as that of experienced clinicians with free hand puncture for PVP,which can quickly relieve pain and improve dysfunction.However,guide plate assistance can shorten the operation time,reduce the number of fluoroscopy and postoperative adverse reactions,and make vertebroplasty faster and safer.