Objective To explore the cost-effectiveness and clinical effect of three platinum based chemotherapy regiments for advanced non small cell lung cancer (NSCLC).Methods 100 patients who were diagnosed as NSCLC,were randomly divided into four groups.The group Ⅰ received NP which was given NVB and DDP.The group Ⅱreceived GP which was given GEM and DDP.The group Ⅲ received TP which was given taxotere and DDP.The clinical effect,adverse reaction and cost effectiveness of the three groups were assessed.Results The clinical effective rates of the three groups were 31.43%,36.36%,37.50% from Ⅰ to Ⅲ group.The adverse events of the group Ⅰ and group Ⅱ were more than those of the group Ⅲ.In the adverse effects of treatment,the major cytotoxicity was digestive reaction and leukopenia in the two groups,but they were tolerable.The ratios of cost effectiveness in the four groups were 550.22yuan,556.48yuan,583.23yuan from Ⅰ to Ⅲ group.Conclusion The NP group is the best one in total cost.

Objective To explore the relationship between serum osteocalcin levels and glucolipid metabolism in elderly type 2 diabetic patients with non-alcoholic fatty liver disease (NAFLD).Methods Data collected from 97 patients with type 2 diabetes mellitus(T2DM)admitted to the Department of Geriatric Endocrinology of the First Affiliated Hospital of Zhengzhou University from June 2014 to April 2015 were retrospectively analyzed.Patients were divided into the T2DM group(type 2 diabetic patients without NAFLD,n＝ 47)and the NAFLD group(T2DM patients with NAFLD,N ＝ 50).Healthy elderly subjects (n ＝ 30)from the same period served as the control group.Body mass index(BMl),osteocalcin,fasting blood glucose,fasting insulin,homeostasis model assessment for insulin secretion index (HOMA-β) and insulin resistance (HOMA-IR),glycosylated hemoglobin(HbA1c),total cholesterol,triglyceride,high-density lipoprotein cholesterol(HDL-C)and low-density lipoprotein cholesterol(LDL C)were compared between the 3 groups.Results Levels of fasting blood glucose,fasting insulin,HbAlc,total cholesterol,triglyceride,LDL-C and HOMA IR were higher,while levels of HDL-C,HOMA-β and osteocalcin were lower in the T2DM and NAFLD groups than in the control group(all P＜＜0.05).Levels of BMI,fasting glucose,fasting insulin,HbAlc,total cholesterol,triglyceride,LDL-C and HOMA-IR were higher and levels of osteocalcin were lower in the T2DM group than in the NAFLD group(all P＜0.05).Pearson correlation analysis showed that the osteocalcin level was negatively correlated with fasting blood glucose,HbA1C,HOMA IR and BMI(r＝-0.701,0.442,-0.337 and 0.543,P＜0.05 or P＜0.01),and positively correlated with HOMA-β (r ＝ 0.341,P ＜ 0.05) in the NAFLD group.With serum osteocalcin as the dependent variable,multiple linear regression results showed that fasting blood glucose was an independent influencing factor for serum osteocalcin(β＝-1.57,P＜0.05)in the fatty liver group.Conclusions Serum osteocalcin levels significantly decrease in elderly T2DM patients with NAFLD,are closely correlated with glucolipid metabolism,and may have some important clinical significance in the prevention and treatment of NAFLD in elderly patients with type 2 diabetes.

Objective To investigate the prevalence and features of thyroid nodules in middle and aged patients with type 2 diabetes mellitus(T2DM). Methods High-resolution ultrasonography was used to detect thyroid nodules in 132 cases middle and aged patients with type 2 diabetes and 89 patients without diabetes.The nodule features and its relationships with related indicators in diabetic patients were analyzed. Results The prevalence of thyroid nodules in middle and aged patients with type 2 diabetes was higher than that without diabetes (67.4％ vs. 53.9％,P＜0.05),and most occurred in 50 to 59 age group (66.7％ vs. 42.9％) without dependence on changes in thyroid functions and volumes.In diabetes group,the prevalence of thyroid nodules were 59.5％ in male and 81.3％ in female (P＜0.05),no obvious difference was observed in the size and number of thyroid nodules between male and female,multiple nodules and micronodule (＜ 1.0 cm) had the higher incidences in both sexes.The prevalence of thyroid nodules was increased with aging,but not with diabetes duration and glycosylated hemoglobin (HbAlc) level (x2 =0.797,P=0.372; x2 =1.078,P =0.229). Conclusions It is common that thyroid nodules combined with diabetes in middle and aged patients,thyroid ultrasound screening and regular following-up of patients aged ≥50 years have important clinical significance.

Objective To investigate the characteristics of the blood glucose fluctuation in elderly patients with type 2 diabetes mellitus (T2DM). Methods The 92 elderly patients with T2DM (the elderly group) and 58 young and middle-aged patients with T2DM (the non-elderly group) were monitored using the continuous glucose monitoring system(CGMS). The characteristics of glucose profiles of the two different age groups, and of the different glycosylated hemoglobin (HbA1c) level groups in the elderly were comparatively analyzed. Results (1)There was no significant difference in HbA1c level between the elderly group and the non-elderly group. Compared with the non-elderly group, the elderly group showed the increases in blood glucose fluctuant coefficient [BGFC, (2.68±1.00) mmol/L vs. (2.12±0.74) mmol/L, t=-3.691, P＜0.001], in postprandial glucose excursion (PPGE) of breakfast and supper [(5.96±2.47) mmol/L vs. (5.11±2.44) mmol/L, t=-2.058, P＜0.05; (5.17±2.15) mmol/L vs. (4.16±2.28) mmol/L, t=-2.730, P＜0.01], in the time to postprandial glucose peak of breakfast and lunch [(112.5±29.7) min vs. (97.0±27.2) min, t=-3.225, P＜0.01; (140.0±39.7) min vs. (118.1±42.6) min, t=-3.195, P＜0.01], in the frequency of hypoglycemia (26.3% vs. 5.5%, P＜0.05), and showed the largest amplitude of glycemic excursions [LAGE, (9.66±2.48) mmol/L vs.(8.40±3.13) mmol/L, t=-2.720, P＜0.01]. (2)In the elderly, along with decreased HbA1c, the incidence of hypoglycaemia increased (P＜0.05); And along with increased HbA1c, the amplitude of blood glucose fluctuation increased. There were significant differences in BGFC, PPGE of breakfast and lunch, and LAGE among different HbA1c level groups (P＜0.01, P＜0.05, P＜0.05, P＜0.001). (3)HbA1c was positively correlated with FBG, mean blood glucose (MBG), percentage of time at glycemia (PT7.8, PT11.1), the lowest blood glucose (LBG), the highest blood glucose (HBG), BGFC, PPGE and LAGE (r=0.899-0.289, all P＜0.001). Multiple stepwise regression analysis indicated that MBG, FBG and PT7.8 was the independent influential factor of HbA1c (adjusted R2=0.807, P＜0.05). Conclusions The elderly patients with T2DM are at a particularly high risk for postprandial hyperglycemia and nocturnal hypoglycemic episodes, CGMS could show glucose fluctuation characters of T2DM patients diurnally, and provide a clinical basis for reasonable therapy.

Objective:To investigate the clinical efficacy of 3D printed osteotomy guide plate combined with "Jail" screw technique in the treatment of tibial plateau fractures involving external posterior condylar collapse.Methods:From January 2016 to January 2021, 41 patients (22 males and 19 females) with tibial plateau fractures involving external posterior condylar collapse were treated with 3D printed osteotomy guide plate combined with "Jail" screw technique and followed up. The age was 47.4±11.5 years (range, 22-69 years). According to Schatzker fracture type, 18 cases were type IV, 14 cases were type V and 9 cases were type VI. All fractures were closed, and 12 of them were complicated with lateral meniscus injury, but none of them were complicated with nerve and vascular injury. The time from injury to operation was 7.2±3.4 d (range, 4-17 d). All patients underwent 3D CT scanning and digital modeling before operation. According to the modeling results, a 1∶1 solid size fracture model was made by 3D printing, and the osteotomy guide plate and the "Jail" screw preset guide plate were designed. During the operation, the tibial lateral condyle osteotomy was performed with customized osteotomy guide plate. After reduction, the fixation of the fracture was performed with the preset guide plate using "Jail" screw. Postoperative fracture reduction was evaluated according to Rasmussen score, and knee function was evaluated by Hospital for Special Surgery (HSS) score.Results:All the 41 patients were followed up for 15.2±5.8 months (range, 6-26 months). Immediate postoperative radiographs showed good fracture reduction, and the average healing time was 14.1±1.2 weeks (range, 12-17 weeks). One year after operation, the Rasmussen score of knee joint was 17.4±1.6 points (range, 13-19 points), of which 31 cases were excellent, 8 cases were good, and 2 cases were fair, with an excellent/good rate of 95% (39/41). HSS scores was 87.3±5.6 points (range, 68-95 points), including 30 excellent cases, 10 good cases and 1 fair case, with an excellent/good rate of 98% (40/41). The range of motion of knee joint was 126.8°±3.8°. At the last follow-up, no serious complications such as common peroneal nerve injury, popliteal vascular injury, postoperative infection, or internal fixation failure occurred.Conclusion:3D printed osteotomy guide plate combined with "Jail" nail placement technique is an effective method for tibial plateau fractures involving external posterior condylar collapse, and the postoperative treatment results are satisfactory. The use of customized osteotomy guide plate is more accurate and less damaging. The use of "Jail" screw preset guide plate can ensure more accurate screw placement.

Objective To investigate the correlation between the expression levels of miRNAs and the pathogenesis of diabetes mellitus.Methods A total of 120 patients with type 2 diabetes recruited from October 2014 to October 2016 and 40 healthy individuals as a control group were included in this study,and diabetic patients were further divided into newly diagnosed group(n=40),prediabetes group(n =40),and susceptibility group (n =40).The fasting blood of four groups were collected,and real-time RT-PCR was applied to measure the expression levels of miRNAs including miR-9,miR-124a,miR-375,miR-29a,miR-126,miR-197,miR-233,and miR-320.The relationship between the pathogenesis of disease and miRNAs expression levels was analyzed.Results The levels of miRNA in the three diabetes groups were obviously higher than in the control group(P＜ 0.05).The miRNA expression level showed a certain trend in diabetic patients.The higher levels of miR-9,miR-124a,miR-375,and miR-29a were observed in the three diabetes groups,while the levels of miR-126,miR-197,miR-233,and miR-320 were decreased in these three groups.The expression levels of miR-9,miR 124a,miR-375,and miR-29a of miRNAs were correlated with the onset of diabetes(RR =5.96,6.32,5.24.5.69,all P＜ 0.05).Conclusions The level of miRNA is associated with the onset of diabetes that suggests it may be used to predict the occurrence and development of diabetes.

Objective To investigate the clinical effect of Metformin on inflammation,intestinal flora imbalance,and metabolic impairment in elderly patients with type 2 diabetes mellitus(T2DM) Methods A total of 74 elderly patients with T2DM admitted to our hospital from October 2014 to October 2016 were included in this study and assigned into an intervention group(n=37)and a control group(n=37)according to the sequence of admission.The intervention group was treated with 0.5 g Metformin once a day for 2 weeks,while the control group was given a placebo with the same frequency as in the intervention group.Fresh pre-and post-treatment stool samples were collected in sealed sterile anaerobic growth bags for the detection of changes in patient intestinal flora.Serum inflammatory factor levels,blood glucose levels,and blood lipid levels were measured.Results Before treatment,the numbers of beneficial intestinal flora(bacillus bifidus,bacillus acidi lactici,and bacteroides)in the intervention group were lower than in the control group(all P＜0.05);The levels of serum inflammatory factors(CRP,IL-6,and TNF-α)in the intervention group were higher than in the control group(all P ＜0.05);The levels of parameters for glucose and lipid metabolism(HbA1c,FPG,TC,TG,and LDL-C)in the intervention group were higher than in the control group,while the level of HDL-C was lower than in the control group (all P ＜ 0.05).After treatment,the number of beneficial intestinal flora significantly increased in the intervention group(all P＜0.05)but was not different from that in the control group(all P＞0.05);The levels of serum inflammatory factors had significant reductions in the intervention group compared with pre-treatment levels(all P＜0.05)but demonstrated no difference from those in the control group(all P＞0.05);Parameters for glucose and lipid metabolism in the intervention group showed improvement(all P ＜0.05)after treatment but no difference was observed between these two groups(all P＞0.05).Conclusions Metformin can effectively control blood glucose and blood lipid levels in elderly patients with T2DM,improve the chronic inflammatory state,increase the number of beneficial intestinal bacteria,and regulate flora imbalance.

Background/Aims: The risk factors of colorectal stricture associated with ulcerative colitis (UC) carcinogenesis in the long-term disease duration remain unclear. Methods: This study included all UC patients registered from a prospectively maintained database between June 1986 to July 2018. The demographic data, clinical features, and outcomes in patients with dysplasia and stricture were assessed using univariable analysis and multivariate logistic regression models. Results: A total of 246 eligible patients were in-cluded in the analysis. The median follow-up time was 13.0 years (interquartile range [IQR], 9.0 to 16.0). There were 35 cases (14.2%) of colorectal stricture. Patients with stricture had worse clinical outcomes. Stricture formation (odds ratio [OR], 9.350; 95% confidence interval [CI], 2.842 to 30.762), inflammatory polyps (OR, 5.464; 95% CI, 1.692 to 17.638), disease duration of more than 10 years (OR, 3.223; 95% CI, 1.040 to 9.985), and age >40 years at diagnosis (OR, 8.499; 95% CI, 1.903 to 37.956) were significantly associated with high-grade dysplasia or colorectal cancer. In addition, disease duration of more than 5 years (OR, 3.211; 95% CI, 1.168 to 8.881), moderated anemia (OR, 3.373; 95% CI, 1.472 to 7.731), and primary sclerosing cholangitis (OR, 5,842; 95% CI, 1.395 to 24.468) were contributing factors for the development of colorectal stricture. Conclusions Colorectal stricture had the highest risk for malignant transformation.Earlier initiation of colonoscopic surveillance in UC patients with risk factors for stricture should be considered to prevent stricture formation and further malignant transformation.

OBJECTIVETo develop and evaluate a mouse model of nonalcoholic steatohepatitis (NASH) induced by a high-fat and high-fructose (HFHFr) diet.

METHODSSix-week-old C3H mice were randomly divided into groups for HFHFr diet experimental modeling, high fat-only (HF) diet controls, high fructose-only (HFr) diet controls, and standard chow (SC) diet controls. The standard HFHFr diet was modified so that it consisted of 76.5% standard chow, 12% lard, 1% cholesterol, 5% egg yolk powder, 5% whole milk powder, and 0.5% sodium cholate, along with 20% fructose drinking water. At the end of experimental weeks 4, 8, and 16, measurements were taken for the NASH-related parameters of body mass, serum levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST), lipid profile, and wet liver weight (upon sacrifice). In addition, histological changes in the liver were evaluated by hematoxylin-eosin (HE) and oil red O staining. The significance of differences between groups was assessed by statistical analysis, using the

METHODSof t-test, Wilcoxon rank sum test, x2 test, F test or Fisher's test as appropriate.

RESULTSAs compared to the mice in the SC group at the corresponding time points, the mice in the HFHFr and HF groups showed significantly higher body mass and wet liver weight, as well as more extensive and robust lipid disposition in hepatic tissues as evidenced by oil red O staining. However, HE staining indicated that the HFHFr and HF groups had different degrees of macrosteatosis accompanied with intralobular inflammatory foci, with the former showing more remarkable NASH-related histological changes. Analysis at the end of week 16 showed that about 80% of the mice in the HFHFr group had developed NASH [nonalcoholic fatty liver disease (NAFLD) activity score (NAS): less than 5]. The levels of low-and high-density lipoprotein (LDL and HDL) cholesterol, as well as the levels of ALT and AST, were increased from the end of week 4 to the end of week 8 for the HFHFr and HF groups. At the end of week 16, the two groups differed in the extent of increase in total cholesterol and LDL and HDL cholesterol, with only the HFHFr group showing statistically significant changes. Specifically, at the end of week 16, the HFHFr group showed ALT levels of 108.5 +/- 93.34 U/L (F=5.099, P =0.005 vs. HF group: 44.30 +/- 35.71 U/L, HFr group: 46.70 +/- 17.95 U/L, SC group: 24.70 +/- 6.57 U/L), AST levels of 316.30 +/- 208.98 U/L (F=6.654, P=0.001 vs. HF: 132.12 +/- 75.43 U/L, HFr: 143.30 +/- 38.53 U/L, SC: 122.60 +/- 12.76 U/L), total cholesterol levels of 5.18 +/- 0.58 mmol/L (F=72: 470, P =0.000 vs. HF: 3.94 +/- 0.75 mmol/L, HFr: 2.30 +/- 0.50 mmol/L, SC: 2.02 +/- 0.24 mmol/L), HDL cholesterol levels of 3.05 +/- 0.49 mmol/L (F=25.413, P =0.000 vs. HF: 2.65 +/- 0.54 mmol/L HFr: 1.77 +/- 0.47 mmol/L, SC: 1.58 +/- 0.16 mmol/L), LDL cholesterol levels of 1.11 +/- 0.23 mmol/L (F =83.297, P =0.000 vs. HF: 0.72 +/- 0.17 mmol/L, HFr: 0.27 +/- 0.04 mmol/L, SC: 0.20 +/- 0.05 mmol/ L).

CONCLUSIONThe present study suggests that a mouse model of NASH can be successfully induced by a 16-week modified HFHFr diet.

Objective To report the operative procedures and clinical outcomes of open reduction and internal fixation for the treatment of tibial plateau fractures involving anteromedial margin caused by hyperextension varus injury.Methods From December 2013 to December 2015,11 patients with tibial plateau fracture involving anteromedial margin caused by hyperextension varus injury were treated at our department.They were 6 males and 5 females with a mean age of 42.3 years (range,from 19 to 65 years).Simple medial column fracture happened in 2,fractures of medial and lateral columns in 4,fractures of medial and posterior columns in 3,and 3-column fractures in 2 cases.The cortical bone fractures of anteromedial margin were fixated by open reduction and internal fixation using self-clipped joint line plating.Bone grafting was conducted if necessary.Results The 9 patients were followed up for an average of 17.6 months (range,from 12 to 30 months).All the fractures healed.The average time for radiographic bony union and full weight bearing was 11.4 weeks (range,from 9 to 14 weeks) and 16.1 weeks (range,from 14 to 19 weeks),respectively.On average,the Rasmussen's radiological grading scored 16.9 (range,from 14 to 18)immediately after operation;the Hospital for Special Surgery scores of all the patients at 12 months postoperatively averaged 89.1 (range,from 75 to 94),yielding an excellent to good rate of 92.3％.The average range of motion of the affected knee was from 2.3° to 125.1°.There were significant differences in both tibial plateau angle and posterior slope angle on radiography between preoperation and postoperation (P ＜ 0.05).There were no significant differences in either tibial plateau angle or posterior slope angle on radiography between immediate postoperation and 12 months postoperation (P ＞ 0.05).Partial incision necrosis occurred postoperatively in one case which was uneventfully healed after wound management.One case complicated with preoperative common peroneal nerve injury reported dorsal sense of numbness which was healed after administration of neurotrophic drugs.No screw loosening,plate breakage or fixation failure was found during follow-ups.Conclusions It is difficult to treat the tibial plateau fractures involving anterumedial margin caused by hyperextension varus injury.Internal fixation with joint line plating is an appropriate treatment for this fracture pattern,leading to satisfactory clinical outcomes.