Objective To evaluate the efficacy and safety of acarbose tablets combined with protamine zinc recombinant lai pulp mixing insulin injection in the treatment of elderly patients with type 2 diabetes.Methods 170 elderly patients with type 2 diabetes were randomly divided into the observation group and the control group.85 cases in the observation group were given acarbose tablets combined with protamine zinc recombinant lai pulp mixing insulin injection,85 cases in the control group received aspart 30.The patients were followed up for 12 weeks,the blood glu cose levels,blood glucose fluctuation,glycosylated hemoglobin (HbAlc),the incidence of hypoglycemia and insulin dosage were observed.Results' The level of fasting plasma glucose (FPG) (t =9.92,P ＜ 0.05),2h postprandial blood glucose(2hPG) (t =18.18,P ＜0.05),the mean blood glucose within 4h(t =13.62,P ＜0.05),days of average blood glucose fluctuations (t =14.56,P ＜ 0.05) of observation group dropped significantly compared with that before treatment;HbAlc achieved rate(6.5％)of the observation group and control group were 35.29％,28.23％,re spectively,HbAlc achieved rate (7.0％) of observation group and control group were 57.64％,52.94％,the differences were not statistically significant(all P ＞ 0.05).The dose of insulin was significantly lower in the observation group(20.11 ±3.36) u/d than(35.78 ±4.68) u/d in the control group(t =25.08,P ＜0.01).There were 2 cases of hypoglycemic events and 3 cases in the control group.Conclusion Protamine zinc recombinant insulin lispro injection combined with acarbose has reliable clinical efficacy and safety.

The article gives a brief account of the application of clinical observation to the evaluation of medical students' core competence. It expounds the key points in the assessment about their professional values,attitudes and behavior, emphasizing the application scope, working principle and advantages and disadvantages in the rank evaluation as well as the methods to enhance the effectiveness of evaluation.

Objective To compare the clinical effectiveness among disposable circumcisionsuture device and Shang Ring in treating redundant prepuce and phimosis.Methods The clinical data of 224 cases of circumcisions done by disposable circumcision suture device(n =112)and Shang Ring(n =112)were retrospective1y analyzed. Operation time,intra -operational bleeding and postoperative complications among two techniques were compared. Results Disposable circumcision suture operation and Shang ring circumcision without significant difference in the operation time and intra -operational bleeding.There result was (6.1 ±0.8)min vs (6.5 ±1.7)min and (2.0 ±0.0)mL vs (1.8 ±0.0)mL(P >0.05).The incidence of postoperative complications with incision pain rate was 21.43% vs 50.89%,infection rate was 14.29% vs 6.25%,frenum area incision edema rate was 8.04% vs 25.89%,and the postoperative hematoma and healing time was (8.0 ±1.7)d vs (14.0 ±1.2)d,the differences were statistically significant(P <0.05).Conclusion Each of two techniques has its own advantages and disadvantages.The treatment decision making should be a detailed description to the patients,we propose that school -age children should choose Shang Ring built -in method and the others should use disposable circumcision suture device depending on the situation.

Guided bone regeneration technique (GBR) is regarded as one of the most important methods to increase the bone amount of alveolar ridge, which is often recommended to be applied in the dental implantation surgery. Barrier membrane is utilized in GBR technique to cover the bone defect and create a secluded space, which prevents the connective tissue from growing into the space and facilitates the growth priority of bone tissue. In recent years, along with the emerging of different kinds of barrier membranes and bone grafting materials, the scope of clinical application of this technology is continuously expanded. This article reviews the classification and property of the membranes and the application situation of guided bone regeneration technology in the field of dental implantation.

Objective To observe the enhanced inhibitory effect of adenovirus (Ad)-mediated HCCS1 combined with 5-FU on the growth of LoVo cells, and to explore the molecular mechanisms.Methods RT-PCR and Western blot were used to detect the expression of HCCS1 in LoVo cells infected with Ad HCCS1. CCK-8 assay was applied to observe different inhibitory effects of different treatments on growth of LoVo cells. The apoptotic rates were detected by using flow cytometry. The apoptotic proteins were detected by using Western blot. Results ① The recombinant adenovirus, Ad HCCS1, could trigger the expression of HCCS1 in LoVo cell. ② In comparison with controls (92.23%±3.77%), the cell viability rate of LoVo was only (11.23±4.61 )% on 96 h after the combination treatment of 5-FU and Ad-HCCS1 (P<0. 01). ③ The apoptotic rate was (27.57±1.78)% on 72 h after the combination treatment, which was higher than that in 5-FU treated cells (8.64±0.94)%, Ad-HCCS1 treated cells (13.19±1.32)% and 5-FU Ad treated cells (12.16±1.28)%, (P<0. 01). ④ Cathepsin D was only detected in Ad HCCS1-infected cells. When treated with 5-FU, the procaspase-8 was decreased and the cleaved Bid was increased in cytosol. The lowest level of Bax and the highest level of cytoso C and cleaved caspase-3 were detected in cytosols of 5-FU+Ad HCCS1 treated cells. Conclusion The inhibitory and proapoptotic effects are significantly enhanced in LoVo cells when treated with Ad-HCCS1+5-FU. The key protein of the cross-talk is Bax and these data provided a new strategy to treat colorectal carcinomas.

Objective To evaluate extended vs standard left lateral lobectomy for left lateral lobe hepatolithiasis.Methods A retrospective study was conducted on the clinical data of 110 patients who underwent hepatectomy for hepatolithiasis limited to left lateral lobe of the liver.Results 42 patients received left lateral lobectomy, 68 patients did left hemihepatectomy.There were no marked difference between the two groups in the operation time, introperation or postoperation blood loss, bile leak and bleeding on the hepatic cut surface, liver function and the postoperative hospital stay.The incidence of residual and recurrent stones was 14.3％ and 11.9％ in left lateral lobectimy group and 0％, 0％ in left hemihepatectomy group.Conclusion Left hemihepatectomy for left lateral lobe hepatolithiasis is a safe and effective procedure.

Objective To compare the survival conditions of patients with insulinoma after enucleation of insulinoma or partial resection of pancreas.Methods The clinical data of 99 patients with insulinoma,treated with surgery from May.2003 to Aug.2015 were retrospectively analyzed.Of the 99 patients,38 received enucleation of insulinoma alone and 61 received partial resection of pancreas.The overall data were analyzed by SPSS 21.0 software.Results Average survival of patients after enucleation of insulinoma (103.3 months) was longer than that of patients after partial resection of pancreas (77.5 months),and the difference had statistical significance (P=0.006).The difference of the incidence of most chronic or temporary complications had no statistical significance between the two groups (P＞0.05),except for new-onset diabetes (P=0.004).Conclusion Enucleation of insulinoma should be firstly recommended for patients with insulinoma in suitable size,which can provide patients with better survival condition.

Objective To define the correlation between mutation of DNA-LigaseⅣ gene and radiosensitivity.Methods Nasopharyngeal squamous carcinoma cell line (CNE), lung adenocarcinoma cell line (SPC-A1) and breast adenocarcinoma cell line(MCF-7) after irradiation were assessed with specific biological parameters. Polymerase chain reaction, cloning and sequencing techniques were used to determine the sequence of DNA-LigaseⅣ gene in these three cell lines. Then the impact of homologous change and mutation on hydrophicity-hydrophobicity of genic products was analyzed.Results The surviving fractions derived from irradiation were different with more radiosensitivity in the CNE cell line than in the others. In three cell lines, the homology of LigaseⅣ gene were: 99.95%,99.99%,99.98%, respectively. Some mutations including transversion and transition were detected and led to alterations in the hydrophicity-hydrophobicity function of products. Higher radiosensitivity of CNE was associated with amino-acid substitutions: 313aa His→Arg,538aa Gly→Arg,579aa Lys→Arg and 585aa Asn→Ser.Conclusion These results suggest that LigaseⅣp play an important role in the ligation of DNA double strand breaks and certain mutations bring about changes in radiosensitivity.

Objective To improve the recognition to synovial sarcoma in spine by discussing the imaging features of the disease.Methods The clinical and imaging data of 4 cases (2 cases of male,2 cases of female) with synovial sarcoma in spine were analyzed retrospectively, which were confirmed by surgery and pathology,the imaging features and surgical pathology were mainly analyzed.Results All the 4 patients underwent conventional CT and MRI examination,3 of which underwent CT and MRI contrast enhancement examination.On CT plain scan,2 cases showed equal density,2 showed slightly high density.After enhancement,3 cases showed inhomogeneous enhancement.On T1WI,2 cases showed low signal intensity,2 showed iso-signal intensity.On T2WI,1 case showed high signal intensity,1 showed slightly high signal intensity,and 2 showed mixed high signal intensity.On Fat suppression sequence image,2 cases showed hyperintensity,1 had mixed hyperintensity,and 1 had slightly hyperintensity.On DWI,4 cases showed obviously hyperintensity.On T1WI enhancement,1 case had significant enhancement,2 showed inhomogeneous enhancement.Conclusion The CT and MRI manifestation of synovial sarcoma in spine has certain characteristics.Combined with clinical manifestations, CT and MRI are significantly helpful to improve the cognition and diagnosis of synovial sarcoma in spine.

The authors compared the purpose,and the main content of three international standards in medical education developed by the Institute for International Medical Education (IIME), World Health Organization Western Pacific Regional Office (WHO/WPRO), and World Federation for Medical Education (WFME) respectively. The IIME's standard is deferent from the others. The IIME's standard contains seven broad educational outcome domains and 60 items in the domains. The purpose of IIME's standard is to improve the common core competency of individual medical graduates of each medical school in the world, and the standard focuses the outcome of medical education and belongs to summative individual evaluation. The WHO/WPRO's and WFME's standards are quite similar. They define the standards across nine broad areas of medical schooling divided into 38 sub-areas. The ultimate goal of the WHO/WPRO's standard is to encourage national governments to adopt a quality assurance process in medical education. The aim of the two standards is to promote the quality assurance of medical schools. Both of the two standards focus the whole process of medical schooling and medical schools, and belong to formative evaluation.