10.3969/j.issn.2095-4344.2013.25.019

435 patients with type 2 diabetes were divided into 2 groups according to their fatty liver,then the relations between fatty liver and various parameters in two groups were observed and analyzed by statistical methods.Body mass index,HbA_1c and triglyceride were the risk factors for fatty liver.The prevalences of metabolic syndrome,hypertension and coronary heart disease in fatty liver group were significantly higher than those in the control group.

Objective To investigate the effect of bisphosphonate medication (zoledronic acid,aclasta) on spinal fusion for osteoporotic patients through radiographic,clinical,and biological assessments.Methods A total of 79 patients with osteoporosis who were candidates for single-level posterior lumbar interbody fusion was randomly assigned to the experimental group (zoledronic acid injection,5mg,on the third day after surgery) or the control group (the same amount of saline injection,on the third day after surgery).Functional radiography and CT scans were used to evaluate fusion status.Bridging bone formation was graded into 3 categories:Grade A (bridging bone through bilateral vertebral),Grade B (bridging bone through a unilateral vertebral),or Grade C (incomplete bony bridging).The incidence of vertebral compression fractures occurring after surgery was assessed by means of MR imaging.A solid fusion was defined as less than 5° of angular motion in flexion-extension radiographs and the presence of Grade A or B bridging bone.Bone metabolic markers (β-C-terminal telopeptide of type Ⅰ collagen,β-CTX; and N-terminal propeptide of type Ⅰ collagen,PINP) were measured to investigate the biological effects of zoledronic acid on spinal fusion.Bone mineral density of femoral neck was measured by the dual X-ray absorptiometry.Clinical outcome was evaluated by means of the Oswestry Disability Index (ODI).Results Grade A or B bridging bone was more frequently observed in the experimental group at 3,6,and 9 months postoperatively (all P ＜ 0.05,respectively,Mann-Whitney U-test).At 12-months postoperative follow-up,bridging bone and solid fusion were not significantly different.No vertebral fractures were observed in the experimental group,whereas 6 patients in the control group showed vertebral compression fractures(P ＜ 0.05,Mann-Whitney U-test).Biochemical analysis of bone turnover demonstrated that zoledronic acid inhibited bone resorption from the early phase of the fusion process and also suppressed bone formation.Poor clinical results in the control group were demonstrated by ODI.Conclusions Osteoporosis patients undergoing spinal fusion who take bisphosphonates throughout the postoperative period was recommended.

Objective To analyze and compare the incidence of diarrhea between cerebral hemorrhage and infarction. Method We observed and compared the time when diarrhea occurred in both 147 cases of cerebral hemorrhage patients and 142 cases of cerebral infarction patients by using statistical methods. Result The incidence of diarrhea in former group was 36.05%, and that of latter was 16.91%. Conclusions The incidence in patients with diarrhea of cerebral hemorrhage was markedly higher than that of patients with cerebral infarction. This may attribute to the higher intracranial pressure in cerebral hemorrhage patients than that of cerebral infarction ones. The complications of reduction of immune function,intestinal infection and hypoproteinemia may be the other factors resulting in the higher incidence of diarrhea in cerebral hemorrhage patients than that of cerebral infarction ones.

Ultrasound-guided peripheral nerve block is widely used in clinical practice because of its high accuracy and safety. Residents must pass formal training to master this technique. However, residents are not familiar with the related anatomical structure of nerve block, and lack of basic ultrasonic knowledge, operation skills, simulation training, understanding of the corresponding complications, the optimal concentration and dose of local anesthetic drugs. In order to solve the above problems, we have taken measures such as basic theoretical knowledge learning, application of anatomy and ultrasound software, simulation training and grading training so that residents in standardized training of anesthesiology could fully grasp the clinical application of ultrasound-guided peripheral nerve block techniques.

Objective To determine the detection rate of duodenal papilla and the diagnostic rate of small bowel diseases by capsule endoscopy(CE)and its possible influencing factors.Methods A total of 369 cases with suspected small bowel disease who had undergone CE were retrospectively reviewed. The de- tection rate of duodenal papilla and that of small bowel disease were calculated respectively. The detection rate of duodenal papilla in another 369 patients having received gastroscopy was also counted in order to findout the miss detection rate of forward-viewing endoscopy. The CE findings were reviewed at the rate of 1 im-age and 15 images per second by hand-motion respectively. The detection rate of duodenal papilla was calcu-lated,and the number of frames showing duodenal papilla was counted. Differences of detection rate of duo-denal papilla were also analyzed by different age and gender groups. In addition,the potential difference in detection rate of duodenal papilla between different bowel preparations before CE of two different reviewing approaches was also investigated respectively. Results The miss detection rate of duodenal papilla with for-ward-viewing gastroscopy was 22. 0%. The detection rate of duodenal papilla reviewed at the rate of 1 image by hand-motion,where less frames were needed to visualize duodenal papilla(3. 7vs7. 0),was significantly higher than that at the rate of 15 images per second(32. 2%vs13. 6%,P=0. 001). The diagnostic rate of small bowel diseases was also significantly higher than that of duodenal papilla by CE(67. 2%vs32. 2%,P=0. 000). Age and gender were not significantly correlated with the detection rate of duodenal papilla. No significant correlation was found between various kinds of bowel preparation before CE at different viewing rate and the detection rate of duodenal papilla. Conclusion It iS relatively difficult to identify duodenal pa- pilla by CE,as they are peculiarly positioned in anatomy,so the detection of duodenal papilla does not nec- essarily represent the detection rate of small bowel diseases. The major factors that influencing the detection of duodenal papilla by CE include local anatomy,viewing rate and technical limitations of CE.

While the number of the enrolled postgraduate students is continuously increased and the various reforms go in depth, there appear some new problems and contradictions in the education of doctorial students.Among those problems,the lack of the doctorial student resource,especially the lack of the excellent doctorial student resource,is the most prominent problem that re- stricts the progress of the doctorial student education.In order to solve these problems,this article analyzes the factors influencing the resource of the students and put forward the strategy to deal with these factors.

Objective To investigate the reflectance confocal microscopy (RCM) features of mycosis fungoides (MF).Methods Four male and two female patients with MF,who were aged 7-73 years with a clinical course of 1-5 years,were collected from June 2011 to May 2012 in the department of dermatology.Of the six patients,two were in patch stage,three in plaque stage,and one in tumor stage.All the cases were confirmed by histopathological,immunohistochemical and relevant examinations.For each patient,three lesions were selected and investigated using RCM,and one of the three lesions was subjected to histopathological examination.Results RCM features of MF included hyperkeratosis,disarray of honeycomb of stratum spinosum,reduced refractivity of dermal papillary rings,roundish or round scattered hyperrefractive cells in the epidermis,infiltration of a small quantity of inflammatory cells in the papillary dermis.Occasionally,some round to oval hyporefractive cells aggregated to form vesicle-like structures.These RCM features correlated well with histopathologic findings.Conclusion Combined with clinical manifestations,RCM may serve as a noninvasive auxiliary tool for the diagnosis of MF.

Objective To study the alterations in neurobehavior of rats with diffuse axonal injury(DAI) and to evaluate the potential role of basic fibroblast growth factor(bFGF). Methods A weight-drop device was employed to build the DAI model.An injection of bFGF subdurally and subcortically was given to the bFGF therapeutic group(n=60).Besides,normal control(n=20) and injured control group(n=60) were established.The elevated walkway test,prehensile traction test,sensorimotor integration test and the Morris' water maze test were adopted to examine the motor and memory abilities.After the implantation of skull electrodes,P3-like potential was explored in rats before and after injury. Results After DAI,the scales of the elevated walkway test,prehensile traction test,sensorimotor integration test and the Morris' water maze test were decreased,and the rats in the bFGF therapeutic group presented a better behaviour in the early stage.The latency of P3-like potential prolonged significantly in rats with DAI,with the P3-like potential in the injured control group longer than that in the bFGF therapeutic group(P

Objective To study the alterations in pathology and immunohistochemistry in rats with diffuse axonal injury(DAI) and the effects from basic fibroblast growth factor(bFGF). Methods A weight-drop device was employed to produce DAI in rats.In the treatment group(n=60),bFGF was injected subdurally and subcortically.Besides,normal control group(n=20) and injury-control group(n=60) were also established.The pathological changes were observed by light microscopy and electromicroscopy,and the expression of brain-derived neurotrophic factor(BDNF),growth associated protein-43(GAP-43) and glial fibrillary acidic protein(GFAP) were also examined by immunohistochemistry. Results Typical pathological changes were observed in the basal portion of pons,corpus callosum and white matter of cerebral hemisphere in the rats with DAI.And an upregulation of GFAP,GAP-43 and BDNF was also found.In the treatment group,better outcomes of pathological changes were observed.bFGF increased the expression of BDNF and GAP-43,while inhibited the immunoreactivity of GFAP. Conclusion Topical application of bFGF can improve brain tissue regeneration and speed function recovery in rats with DAI,though its long-term effect warrants further study.