The value of surgery in the diabetes mellitus treatment receives much attention in the medical field,however,Chinese metabolic surgeons adopt the surgical experience from surgeries for morbid obesity in western countries.There are many controversies on the operative indication,operation method and postoperative follow-up of surgery for diabetes mellitus with low body mass index (BMI).Our nation has a large number of patients with diabetes mellitus and low BMI,in which uncheckedoperative indication,unstandard operation method and non-systematic follow-up are common problems.It has profound significance to investigate operative indication,operation method and efficacy evaluation for patients with diabetes mellitus and low BMI.

Objective To investigate the change of S-100B in serum in rats at varions times after exposure to different whole-brain irradiation doses and to explore the characteristics of the S-100B change in early radiation-induced brain injuries. Methods A model of brain radlation-induced injuries was estabhshed in the rat after whole-brain irradiation with a single dose of 2, 10, or 30 Gy of 4 MeV electron. The concentration of S-100B in serum was detected by means of enzyme-linked immunoserbent assay (ELISA) at different time points (1,6,12,24,3 days, 1 week, 1 month) after exposure. Results In terms of measuring time points, the serum concentration in all groups reached the fwst peak 6 hours after irradiation, declined after 12 hours, rose again after 24 hours, and started to decline again until the last time point (1 month), with the exception of the 2 Gy group, which reached the second peak at 3 days after irradiation. Conclusions The S-100B serum concentration was changed in the rats after whale-brain irradiation and these changes are positively related to the irradiation amount. It seems that the higher the dose, the higher the serum concentration and the differences between the dose groups are significant (via multiple regression models). The S-100B may be a valuable serum marker for the brain irradiation injury.

Despite the progress in the comprehensive management of colorectal cancer,locally advanced (T3 and T4 stages) and metastatic colorectal cancer is still a challenging problem.Although researches on neoadjuvant therapy and targeted therapy have obtained many encouraging results,many unanswered questions still remain.These include the indication of multivisceral resection for locally advanced colorectal cancer,the optimal management of patients with hepatic and (or) pulmonary metastasis.R0 resection was the first choice for the treatment of metastatic colorectal cancer,but it is only suitable for selected patients.Chemotherapy and targeted therapy are effective in converting some unresectable liver metastasis into resectable disease.This review focuses on recent improvements in the management of locally advanced colorectal cancer,as well as the management of hepatic and (or) pulmonary metastasis.

Eighty elderly patients undergoing elective resection for the prostate were randomly divided into two groups, the levobupivacaine (observe group) and bupivacaine (control group) were used for spinal anesthesia, respectively. The level of sensory block and maintain time were T7±4 and (224 ±28) min in observed group, those in control group were T6±3 and (227 ±30) min, respectively ( both P＞ 0. 05). The mean arterial blood pressure of control group was (71 ±8) -(72 ±8) mm Hg (1 mm Hg = 0. 133 kPa) from 5 to 30 min after injection; meanwhile that of observed group was(75 ± 9) mm Hg (P ＜ 0. 05). The incidences of hypotension and nausea were 10% (4/40) and 0% (0/40) respectively in observe group, and those were 30% (12/40) and 15% (6/40) respectively in control group (both P＜0.05). The results indicate that levobupivacaine and bupivacaine have similar anesthetic effects, but levobupivacaine has fewer side effects and is more suitable for elderly patients.

Objective To assess the efficacy of submucosal injection of thiotepa for the prevention of recurrence of superficial bladder cancer. Methods Sixty-six patients with superficial bladder cancer were chosen, they were randomly divided into injection group(33 cases)and control group(33 cases). In injection group, 33 patients had submucosal injection of thiotepa, after 30 minutes resection of bladder tumor were treated by PKRBt, after one week, they were given perfusion 27 mg BCG. In control group, 33 patients after the PKRBt were given perfusion BCG. Results The recurrence rate in injection group was 15.2%, and that of the control group was 27.3%. There was significant difference between the twO group (P<0.05). Con-clusions The submucosal injection of thiotepa , PKRBt and perfusion BCG could prevent tumor recur-rence,it has the following advantage,such as simple , safe, less side effect ,more economical. The submu-cosal injection is a practical method to prevent tumor recurrence and is worth popularizing.

Objective To discuss the effects of the changes of sex hormone levels on quality of life and nutritional status in middle-aged and elderly hospitalized men.Methods A total of 150 male patients (aged 45-90 years) were divided into 3 groups according to age:45-59-year (the middle-aged group),60-79 year (the elderly group),and over 80 year (the old old group) (n=50,each group).Levels of serum testosterone,follicle stimulating hormone (FSH),and luteinizing hormone (LH)were detected.The questionnaire (SF-36) and micro-nutrient assessment table (MNA) were conducted.Results Serum testosterone level was significantly lower in the old old group than in the elderly group and middle-aged group [(10.5±2.5) pmol/L vs.(13.1±2.0) pmol/L and (15.6±3.2) pmol/L,respectively,P＜ 0.05].Levels of FSH and LH were significantly higher in the old old group than in the elderly group and middle-aged group [(15.5±7.7)U/L vs.(12.7±5.1)U/L and (9.5±2.9)U/L,(9.8±3.7)U/L vs.(7.8±3.2)U/L and (5.4±2.0) U/L,respectively,P＜0.05].The 8 health latitude scores of SF-36 scale and nutritional status scores were significantly lower in the old old group than in the elderly group and middle-aged group (all P＜0.05).Relation analysis sho wed that age had a negative correlation with serum testocterone level (r=-0.389,P＜0.05),and had positive correlations with the levels of serum FSH and LH (r=0.427,r=0.520,both P＜0.05).After adjusting for age,serum testocterone level was positively correlated with physical functioning,role of physical activity,body pain,general health,vitality,mental health and nutritional status in SF-36 health scale (all P＜0.05),and had no obvious correlation with social function and emotional function health dimensions (all P＞0.05).Conclusions The sex hormone levels are changed with age,which can seriously affect the health state in middle-aged and elderly hospitalized men.

Objective To evaluate argon-helium cryoablation combined with transcatheter arterial chemoembolization (TACE) in treating advanced hepatocellular carcinoma (HCC). Methods The clinical data of 66 patients with pathologically-proved HCC were retrospectively analyzed. Based on the therapeutic scheme the patients were divided into TACE group (n=31) and combination group (TACE+argon-helium cryoablation, n=35). All the patients were followed up for 5-35 months. The complete remission rate, total effective rate and survival time were evaluated. The short-term and the long-term effectiveness were compared between the two groups. Results Both the complete remission rate and total effective rate of the combination group were significantly higher than those of TACE group (P<0.05). The median survival time of the combination group was significantly longer than that of TACE group (P=0.038). The half-year, one-year and 2-year overall survival rates of the combination group were higher than those of TACE group, although the differences were not statistically significant (P>0.05). Conclusion For the treatment of advanced hepatocellular carcinoma, argon-helium cryoablation combined with TACE can improve the short-term effect and prolong the progression-free survival time, although its exact effectiveness still needs to be confirmed by large sample, multi-central and randomized controlled studies.

ObjectiveTo assess whether intravenous contrast medium would result in acute kidney injury (AKI), and to determine the risk factors associated with contrast induced AKI (CI-AKI) and its outcome.Methods A retrospective observational study was conducted in intensive care unit (ICU) of Fuyang People's Hospital in Zhejiang Province from January 1st 2011 to December 31st 2014. All enrolled critically ill patients had accepted CT scan, and the hospital length of stay was longer than 48 hours, and the patients who needed renal replacement treatment were excluded. Patients were divided into contrast medium group and control group. AKI was defined according to Acute Kidney Injury Network (AKIN) criteria (serum creatinine content over 26.4μmol/L or 50% increase of it from baseline within 48 hours). The incidence of AKI was compared between the two groups, and risk factors for CI-AKI were determined by multiple logistic regression analysis. The relationship of CI-AKI and outcomes were also analyzed. Results A total of 2 370 critically ill patients were enrolled during the period. 474 (20.0%) of the 2 370 patients received contrast medium, and 70 of them suffered from CI-AKI (14.8%). In 1 896 patients who did not receive contrast medium, 235 of them suffered from AKI (12.4%). There was no significant difference in the incidence of AKI between two groups (χ2= 1.905,P = 0.168). After several confounding factors were adjusted, multiple logistic regression analysis showed that contrast medium was not found to associate with AKI in critically ill patients [odds ratio (OR) = 1.66, 95% confidence interval (95%CI) = 0.72-3.90,P = 0.201], and high acute physiology and chronic health evaluationⅡ (APACHEⅡ) score (OR = 1.70, 95%CI = 1.33-2.40,P< 0.001), sepsis (OR= 8.06, 95%CI =3.28-17.80,P< 0.001), shock (OR= 3.57, 95%CI = 1.73-8.01,P< 0.001) and use of nephrotoxic agent (OR= 1.96, 95%CI = 1.25-2.63,P = 0.015) were risk factors of CI-AKI. Ten of 70 patients with CI-AKI died (14.3%), and 21 out of 404 patients without CI-AKI, died (5.2%). There was no significant difference in the mortality rate (χ2= 8.060, P = 0.005). It was shown by multiple logistic regression analysis that age (OR=1.30, 95%CI = 1.05-1.71,P = 0.027), male sex (OR = 1.13, 95%CI = 1.05-1.20,P = 0.039), APACHEⅡscore (OR = 1.07, 95%CI = 1.03-1.18,P< 0.001), and sepsis (OR = 3.29, 95%CI = 1.92-6.46,P< 0.001) were highly associated with mortality of critically ill patients in whom contrast medium was used. However, the occurrence of CI-AKI showed no influence on the mortality rate (OR = 1.70, 95%CI = 0.88-3.56,P = 0.227).Conclusions The use of contrast medium is not a risk factor of CI-AKI in critically ill patients. CI-AKI will not raise mortality rate in ICU patients.

In terms of the characteristic of exonuclease I that can selectively catalyze the degradation of single-stranded DNA, we report a new sensitive electrochemical biosensor for the detection of breast cancer cells by using the aptamers of MUC1 that is overexpressed on the surface of MCF-7 cells. Because the binding of aptamer and MUC1 that is over-expressed on the surface of breast cancer cell MCF-7 can prevent its hybridization with the complementary probe DNA, the unhybridized single-stranded probe DNA that is immobilized on the electrode surface will be selectively digested by Exonuclease I and result in the removal of the signal molecule methylene blue. Therefore, by tracing the changes in electrochemical responses, the biosensor can be used to sensitively detect MCF-7 cells in a linear range from 103 to 106 cell/mL with a detection limit of 330 cell/mL, and easily distinguish the control islet β cells with high specificity.

The enrollment of international medical students has been expanding.How to improve the quality of medical education is a key point.To explore a better way and method to improve the quality of the medical teaching for foreign students in China,the preliminary experi-ences of teaching of Clinical Diagnostics for foreign students are reviewed.