BACKGROUND: Psychological disorders, such as depression and anxiety are relevant to pathogenesis and management of type 2 diabetes mellitus.OBJECTIVE: It was designed to investigate the influence of improving depression and anxiety in diabetes on metabolism of blood glucose.DESIGN: It was a randomized controlled comparative study.SETTING: It was conducted at the Cousulting Center for Clinical Psychology and the Endocrinology Department of Southwest Hospital Affiliated Third Military Medical University of Chinese PLA .PARTICIPANTS: Totally 43 inpatients with type 2 diabetes mellitus in the Endocrinology Department of Southwest Hospital Affiliated toThird Military Medical University of Chinese PLA were selected from October, 1999 to November 2000. All of them participated the investigation voluntarily, 24males and 19 females, with an age of 51±9 years old. They were randomly divided into 2 groups, 23 in experimental group and 20 in control group.METHODS: For experimental group, besides routine medications for diabetes, patients also Accepted anti-depression and anti-anxiety treatment, including paroxetine (20 mg, taking after breakfast everyday) and Alprazolam (0.4 mg, taking at noon, at evening and before sleep everyday). For control group, patients only Accepted routine medication for diabetes. Patients in the two groups were assessed before medication and after 4 weeks medication by Zung Self-Rating Depression Scale (SDS) and Zung Self-Rating Anxiety Scale (SAS). They were identified as depression and anxiety according to the Scales. Reduction rate of SDS/SAS score was used to assess the therapeutic effects: When the reduction rate was 50%-100%, the medication was significantly effective, when it was 25%-49% the treatment was effective, and when it was less than 25%, the treatment was noneffective.Reduction rate =(pre-treatment score-post-treatment score)/post-treatment score×100%. The fasting blood glucose level, 2-hour postprandial blood glucose level and the Glycosylated Hemoglobin (GHB, HbAl) were measured before treatment and after 4 weeks medication. Meanwhile, preprandial blood glucose level and 1-hour postprandial blood glucose level (6 times per day) were detected before treatment and at the 10th, 20th and 30th day during treatment. Reduction rate of blood glucose-(pre-treatment blood glucose level-post-treatment glucose level)/pre-treatment blood glucose level.MAIN OUTCOME MEASURES: These were main outcome measureglucose ①SDS/SAS scores, fasting blood glucose, 2-hour postprandial blood glucose and GHB before treatment and after 4 weeks treatment were measured in two group, ② and reduction rate of blood glucose.RESULTS: Six cases were omitted, 5 was in experimental group for financial pressure, intolerance to side effects of paroxetine and fears of the addiction of psychotropic drugs; the other one was in control group due to drop-out. There were 37 patients finished the investigation, 18 in experimental group and 19 in control group.①Comparison of SDS score/SAS core: After 4 weeks medication, it was observed that the post-treatment scores were significantly lower than pre-treatment scores in experimental group compared to control group[(41.05±7.05,41.88±10.57); (59.80±10.24,55.03±8.31 ), (t=2.41, 2.21, P ＜ 0.05)].②Comparison of fasting blood glucose, 2-hour postprandial blood glucose and reduction rate of blood glucose: After 4 weeks medication, the fasting blood glucose and 2-hour postprandial blood glucose in experimental group were significantly lower than those in control group(t=2.11,2.98, P ＜ 0.05-0.01)and the reduction rate of fasting blood glucose and 2-hour postprandial blood glucose in experimental group were significantly greater than those in control group (t=2.94,2.93,P ＜ 0.01). ③Comparison of GHB:After 4 weeks medication,the posttreatment GHB level in experimental group were significantly lower than pre-treatment GHB level[(8.2±2.0)%,(9.1±1.9)%, (t=2.14, P ＜ 0.05)].CONCLUSION: Anti-depression and anti-anxiety drugs not only can alleviate depression and anxiety symptoms significantly, but also can improve blood glucose metabolism. This may be attributed to an effect of anti-depression and anti-anxiety drugs in increasing the compliance of the patients to the medication for diabetes and decreasing the insulin resistance induced by negative moods.

Objective To explore the effect of linraglutide on expressions of plasminogen activator inhibitor 1 (PAI-1) and intercellular adhesion molecule 1 (ICAM-1) in cultured rat glomerular mesangial cells (RGMCs) stimulated by tumor necrosis factor α (TNF-α).Methods Cultured HBZY21 RGMCs were divided into 6 groups:normal control cells,TNF-α stimulated cells,liraglutide low (10 nmol/L),median (100 nmol/L) and high (1000 nmol/L) concentration incubated cells stimulated with TNF-α,PDTC intervention cells.The expressions of PAI-1 and ICAM-1 of each group were measured by ELISA and RT-PCR.Results The levels of PAI-1 and ICAM-1 protein and mRNA were remarkably increased by TNF-α (P＜0.05),and liraglutide could inhibit above up-regulated expressions (all P＜0.05).Compared with TNF-α-stimulated group,the expressions of PAI-1 and ICAM-1 were decreased by PDTC intervention (all P＜0.05).Conclusion Liraglutide can partly down-regulate the expressions of PAI-1 and ICAM-1 induced by TNF-α in RGMCs.

Objective To investigate the effect of intmopemtive intravenous penehyclidine hydrochloride on pulmonary function in patients undergoning thoracotomy.Methods Sixty ASA Ⅰ or Ⅱ patients aged 30-64 yr scheduled for elective radical esophagectomy for cancer were randomly divided into 2 group(n=30 each):penehyclidinc hydrochloride group and control group.Penehychdine hydrochloride 0.01 mg/kg(in nolmal saline 2 ml)was injected iv 20 min after opening the thoracic cavity in penehyclidine hydrochloride group.The equal vohlme of normal saline was injected iv in control group.Anesthesia was induced with fentanyl 2μg/kg,propofol 0.4μG/ml and rocuronium 0.6 mg/kg.The patients were tracheal intubated and mechanically ventilated.Anesthesia was maintained with remlfentanyl 0.1μg·min-1,propofol 2.0-2.5 μg/ml and intermittent iv injecfion of rocuronium.The use of remifentanyl and pmpofol was stopped 5 min before operation.Dynamic lung compliance (Cd) and peak airway pressure were monitored and recorded immediately before penehychdine hydrechlofide administration (T0) and at 3 min(T1),5 min(T2),10 min(T3),30 min(T4),1 h(T5),2 h (T6)after penehyclidine hydrochloride administration.Results There was no significant difference in Cd and peak airway pressure among different time points in control group(P>0.05).Cd was significantly higher,while peak airway pressure lower at T1-6 than at T0 in penehychdine hydrochlofide group(P<0.05).Cd wag significantly higher,while peak airway pressure lower at T1-6 in penehyclidine hydrochloride group than in control group(P<0.05) .Conclusion Intraoperative intravenous penehyclidine hydrochloride can improve the pneumodynamics and is helpful for ventilation in patients undergoing thoracotomy.

BACKGROUND: Avascular necrosis of the femoral head occurs in the hip joints at high load-bearing areas, it is a special form of aseptic bone necrosis. Bone marrow-derived mesenchymal stem cells may have an excellent repair effect for the necrosis of femoral head. OBJECTIVE: To understand bone marrow mesenchymal stem cell transplantation for treatment of early avascular necrosis of the femoral head, and to lay a foundation for further study. METHODS: Taking avascular necrosis of femur head, femur head necrosis, osteonecrosis, bone marrow mesenchymal stem cells, mesenchymal stem cells, multipotent stem cells in English as search terms, Pubmed database from January 2000 to April 2009 was retrieved; Taking avascular necrosis and bone marrow mesenchymal stem cells in Chinese as search terms, CNKI database from January 1989 to April 2009 was searched, Literatures were limited to English and Chinese languages. Inclusive criteria: Study of the biological characteristics and functions of bone marrow mesenchymal stem cells, the etiology and pathology of avascular necrosis of femoral head, bone marrow mesenchymal stem cell transplantation for treatment of avascular necrosis; Exclusive criteria: duplication of documents. RESULTS AND CONCLUSION: More than 800 literatures were screened out by computer search, according to inclusive and exclusive criteria, 38 documents of which were involved for analysis. Marrow mesenchymal stem cells can differentiate into chondrocytes, osteocytes and dipocytes under suitable cultural condition. With the development of stem cell engineering, marrow mesenchymal stem cell transplantation becomes an effective method for repairing osteonecrosis. This article describes the cause and the pathology of avascular necrosis of the femoral head, analyzes the theory basis for the treatment of avascular necrosis of the femoral head with marrow mesenchymal stem cell, and verifies its effect through comparing both animal and clinical experiments of this aspect at home and abroad, with the hope of seeking a better treatment.

PurposeTo explore the application of ultrasonography-guided core needle biopsy (US-CNB) in diagnosis of breast phyllodes tumor, in order to provide a reliable basis for operation selection, and to improve prognosis.Materials and MethodsFifty-seven patients with diagnosed or suspected phyllodes tumor of the breast (PTB) were retrospectively studied. Ultrasound results and US-CNB biopsy data were compared with surgical pathology results.ResultsFor all the 57 cases of PTB, US-CNB revealed 46 benign cases, 8 cases of suspected borderline PTB, and 3 cases of mesenchymal malignant tumors. The postoperative pathological diagnosis of all the patients included 48 cases of benign tumors, 6 cases of borderline tumors, and 3 cases of malignant tumors. Compared with the postoperative pathology, US-CNB had sensitivity of 95.83%, speciifcity of 100.00%, the coincidence rate of 96.49%, the misdiagnosis rate of 4.17%, and misdiagnosis rate of 0%. The Youden's index was 0.96, andKappa was 0.8345. ConclusionUS-CNB has high sensitivity, speciifcity and coincidence rate in diagnosis of PTB.

Objective To investigate the genetic damage of dust storm fine particles on human blood lymphocytes. Methods The chromosomal aberration test and cytochalasin B blocked test were used to investigate the effect in vitro of dust storm fine particles (PM2.5) (0, 33, 100, 300 ?g/ml)collected in Baotou and Wuwei cities on human lymphocytes. Results In both dust storm and normal ambient air fine particles treated cells revealed an increase in the chromosomal aberration level and micronuclei frequency (MNF). The chromosomal aberration(CA)were characterized as chromatid break, chromosome break, acentric fragment, dicentric chromosome and gaps. With the increase of treatment concentrations the aberration level and MNF increased and the mitotic index(MI) and the nuclear division index (NDI) values declined in a dose-response manner(P0.05). The treatments of normal ambient air PM2.5 from Baotou City were significant higher than those of Wuwei City, but the treatments of dust storm PM2.5 were not significant different between the cities. Conclusion Dust storm PM2.5 from Baotou City and Wuwei City may cause human lymphocytes genetic damage and its genetic toxicity is related to the dose.

In this paper, 172 non-public hospitals have been investigated covering east, central and western regions with structured and semi-structured questionnaire and group interviews. We found that the health insurance policies were the most concerned policies by non-public hospitals, accounting for 26.5% of the total. We also found that non-public hospitals from different areas, levels profit nature have different policy expectations, for example Eastern regional institutions wanted to make a breakthrough of the planning policies, the central region wanted to change the health personnel policy, while the western region is considered to be limited by land policy. Tertiary hospitals were more concerned about research projects and land policy, and secondary hospitals were more concerned about access policy. There were 44.8% of the surveyed institutions considered that regulatory policywasmore stringent public hospitals and public hospitals, and there were no difference between profit and non-profit hospitals. According to the survey results, this paper puts forward suggestion that we should implement more targeted policies, purchasing more services from non-public hospitals and enhanced supervision. Considering the survey results research team puts forward sensitive advice as: provide preferential policies in according with different kinds of institutions reinforce purchasing service and enhance non-public hospitals supervision.

[Objective] To discuss Professor JI Wei's clinical experience in treating ankylosing spondylitis.[Methods] To expound Professor JI Wei's academic thoughts and clinical experience in ankylosing spondylitis from aspects of etiology,pathogenesis,and syndrome differentiation and treatment variation, summarizing the characteristics of her prescriptions and ways of treatment as well as exemplifying them. [Results] Professor JI Wei believes that the basic pathogenesis of this disease is kidney deficiency and governor vessel vacuity,with wind,coldness,dampness,heat,phlegm,and blood stasis obstructing channels and collaterals. In her opinion,the major task of the early- and middle-term of this disease is to dispel wind and eliminate dampness and to alleviate impediment and free the vessels,and that of the late-term is to supplement the kidney and reinforce the governor vessel and to transform phlegm and disperse blood stasis. When treating the disease,we should correlate all four examinations,differentiating carefully the primary from the secondary, paying attention to the unique use of aconitum,monkshood,triptolide and other toxic drugs,as well as the black snake,scorpion,centipede and other animal medicinals,and attaching importance to ankylosing spondylitis complicated with inflammatory bowel disease ,treatment of uveitis and syndrome. [Conclusion] Professor JI Wei's clinical experience in treating ankylosing spondylitis is effective and worthy of wide application.

Encouraging and providing guidance to social forces to invest in health care industry is one of the key elements determined to deepen the health care reform.From four aspects of the unclear conception and undefinable functions of non-public hospitals, ambiguity of property rights of non-profit non-public hospitals, gradual reduction of traditional management measures, and deficiency of effective supervision on daily operations, this paper summarizes the major policy issues in non-public hospitals.To solve these problems, this paper conducts a systemic analysis of the historical experiences of the United States, Germany, Japan, and Taiwan.On this basis, this paper suggests that the government should clearly determine the connotation and extension of non-public hospitals, improve non-profit non-public hospital policy system, play a guiding role in planning and health insurance guidance, and strengthen the supervision of business operations.

Objective:To analyze the financial auditing method after changing the settlement method of outpatient medical income in hospitals under the background of launching “Jing Yi Tong” business line in public hospitals of Beijing.Methods:It summarized the key point of financing audit in outpatient medical income of hospitals under the settlement mode of “Jing Yi Tong”business,proposed the effective settlement method and suggestions on auditing.Results:Through close financial auditing,it effectively ensure the acuteness and completeness of outpatient medical income of hospitals,prevent the leak and man-made fraud in settlement process.Conclusion:The effective hospital financing audit was the main task for internal control,which played key role on improving hospital financing management level.