Having been given Phenformin (DBI) for up to 6 months, 40 cases of NIDDM with normal hepatic and renal functions showed various degrees of hyperlactacidemia. The mean value of hyperlactacidemia increased with ages, but had no relation to the course of disease. Since DBI is liable to cause hyperlactacidemic coma, it is suggested that DBI, if indicated,should be used with great prudence, especially for those senile diabetics with impaired hepatic and renal functions.

In order to observe clinical therapeutic effects of different acupuncture and moxibustion methods on acute lumbago, the patients of acute lumbago were randomly divided into four groups: group A, filiform needle treatment group; group B, filiform needle plus cupping group; group C, filiform needle plus blood - letting puncture and cupping group; group D, filiform needle plus blood - letting puncture, cupping and moxibustion group. All the patients were treated respectively 5 and 10 times. Results showed that there were significant differences in the effective rate and cured rate as the group C and D compared with group A and B respectively (P

Objective To explore the changes of indicators for total parenteral nutrition (TPN) and parenteral nutrition (PN) combining enteral nutrition (EN) support in patients with severe acute pancreatitis (SAP), and to analyze the treatment effects of two groups. Methods 29 patients with SAP were randomly divided into two groups: TPN group (n=14) and PN+EN group (n=15). Nonoperative treatment were applied to the two groups. The changes of indicators and therapeutic outcome of two groups were recorded after nutrition support 14 days. Results After 14 days nutritional support, serum albumin (ALB), total serum protein (TSP), blood calcium, glutamic-pyruvic transaminase (ALT), glutamic-oxaloacetic transaminase (AST) in each group increased significantly (P<0.05). While blood glucose, serum amylase, leucocyte count decreased significantly (P<0.05). However, there were no significant difference between two groups except leucocyte count in all laboratory tests. The leucocyte count in the PN+EN group was significantly lower than that in the TPN group (P<0.05). In both group there was no difference found in serum total bilirubin (TB) before and after nutrition support (P>0.05). The APACHE II scores, average hospital days, average hospital charges, incidence of infection and mortality rate in the PN+EN group were significantly lower than that in the TPN group (P<0.05). ConclusionsPN combining EN support was superior to TPN in the treatment of patients with SAP.

Objective To explore the program of cultivating the nursing master students according to the present situation of China.Methods Delphi method was used in this study.Results In the type of scientific research,the order were the basic knowledge of nursing,clinical knowledge,research ability,ability of adapting society,teaching,management and the community nursing ability.In the type of clinic,the order were the basic knowledge of nursing,clinical knowledge,ability of adapting society,management,research ability,teaching and the community nursing ability.Conclusion According to the present situation of our country,the basic knowledge of nursing and the clinical skills should not be ignored.

Objective To evaluate the screening effect of osteoporosis self-assessment tool for Asians (OSTA) in middle aged and elderly healthy men in Chengdu.Methods A total of 4042 healthy men aged 40 to 106 years received dual energy X-ray absorptiometry (DXA) assay,and OSTA index evaluation.Measurement sites included lumbar spine (L1-4),left femoral neck,trochanter,Ward's area,total hip and femoral shaft.All persons were classified into highosteoporosis-group (OSTA≤-4),mediumosteoporosis-group (-4 ＜ OSTA≤≤-1),low osteoporosis-group (OSTA＞-1),or the low risk-group (OSTA＞-1) and high risk-group (OSTA≤-1) by OSTA scores.T-scores were compared between different measurement sites detected by DXA.The sensitivity,specificity,Kappa value and the area under receiver operating characteristic (ROC) curve (AUC) of OSTA in screening osteoporosis were evaluated.Results The prevalence of osteopenia and osteoporosis in lumbar spine,proximal femur were gradually increased along with aging.The detection rate of osteoporosis in lumbar spine and proximal femur were 16.2％ and 24.0％ respectively in subjects aged over 80 years.OSTA index in low-risk,medium-risk group,high-risk group were 85.0％,11.0％,4.0％ respectively.The detection rate of osteoporosis in lumbar spine and proximal femur were 2.6％ and 1.6％ in low-risk group,10.4％ and 10.4％ in medium-risk group,and 29.3％ and 30.5％ in high-risk group,respectively.Taking OSTA ≤-1 as the cut-off value,the sensitivity and specificity of OSTA in screening osteoporosis in lumbar spine and femur by T-score＜-1 were 28.1％,28.7 ％,89.0％ and 92.4％ respectively,and by T-score≤-2.5 were 51.6％,63.2％,86.7％ and 86.8％ respectively.The consistency of diagnosis result between T-score and OSTA index according to the three versus two risk levels was 0.153 and 0.197 versus 0.195 and 0.243 Kappa value,respectively.The AUC of OSTA index for lumbar spine and femur by T-score＜-1 and T-score≤-2.5 were 0.689 and 0.823,and for different age groups and different measurement sites were 0.639 and 0.899 (all P＜0.001).Conclusions OSTA index has a certain ability in screening osteoporosis in men aged over 50 years.There are different screening results on osteoporosis among the different age groups.

Objective To evaluate the therapeutic effect of endoscopic cryotherapy for Barrett's esophagus (BE). Methods A total of 22 consecutive patients, who were diagnosed as BE from January 2008 to May 2009, underwent endoscopic cryotherapy by using pressurized gas of C02. The data including effective rate, therapy courses and procedure related complications were retrospectively analyzed.Results Except for 2 cases of withdrawal, the other 20 patients completed the treatment with a total therapy number of 42 times (mean 2. 1 times/patient) and were followed up for 6 months. Complete histologic reversal of BE mucus was achieved in all 20 patients after 1-3 times of cryotherapy, among whom complete endoscopic reversal was obtained in 9 and effective endoscopic reversal in 11. Histologic recurrence was observed in 3 cases during the follow-up, including 2 of occult intestinal metaplasia and 1 of mild intestinal metaplasia, which achieved a BE mucosal reversal rate of 85% (17/20). Procedure related complications included 1 case of esophageal ulcer and 3 cases of mild or severe esophagitis, which were all cured after acid suppression treatment. Conclusion Endoscopic cryotherapy in BE is effective and safe, with the advantages of easy manipulation, less complications and good compliances.

ObjectiveTo explore the imaging features of fetal tuberous sclerosis complex by ultrasonography and magnetic resonance imaging.MethodsRetrospective analysis on the imaging characteristics of the 10 cases of fetuses confirmed as tuberous sclerosis complex who were examined in Hubei Maternal and Child Healthcare Hospital in July 2013 to December 2014 by ultrasonography and MRI, which was compared with the pathological data of specimens and follow-up after birth.ResultsEighteen cases were diagnosed as fetal cardiac rhabdomyoma by ultrasonography among all of the 996 fetuses, in which lesions were located on the ventricular wall near septum or elsewhere in the heart cavity on ultrasonography. Fetal cardiac rhabdomyoma was characterized by circular, homogeneous high echo (singleton in 4 cases, multiple in 14 cases). Among them no subependymal nodule was found by ultrasonographic. Ten cases of subependymal nodule were found by magnetic resonance imaging, which were diagnosed as tuberous sclerosis complex with cardiac rhabdomyomas, including 3 cases of brain subcortical tubers. The subependymal nodules under the lateral ventricle wall showed characteristic low signal nodules on T2WI, protruding from the ependymal surface. Of 18 cases, only 4 cases of fetal cardiac rhabdomyoma were found by MRI. Nine cases of ifnally had termination of pregnancy. Two cases were conifrmed as cardiac rhabdomyoma with intracranial nodules after pathological examination, and 1 case was conifrmed as tuberous sclerosis complex after birth. ConclusionsPrenatal ultrasonography can diagnose fetal cardiac rhabdomyoma successfully, and MRI can diagnose the fetal brain nodules sensitively. Once ultrasonography finds cardiac rhabdomyoma, it may be promising to diagnose fetal tuberous sclerosis complex by ultrasonography combined with MRI.

Gauze packing and drainage is a routine treatment for various types of fistula and sinus pressure ulcers. Because the external orifice of pressure ulcer or fistula is relatively small and the sinus deep, the conventional gauze packing has many drawbacks. Under the situation the operator is not skillful enough and no appropriate tools, it is necessary to pull the external orifice by tweezers to dilate the sinus and perform gauze packing and drainage, which brings great pain to patients, possibly leading to wound enlargement and delayed healing. At present, there is lack of auxiliary tools to improve gauze packing. Therefore, we developed and designed a gauze filler for packing and drainage of various kinds of fistula and sinus pressure ulcers, the device has the following advantages: good drainage effect, simple operation, low cost, safety and effectiveness. It not only improves the comfort of patients, reduces the number of dressing changes, reduce the number of dressing changes, shorten the hospitalization time and pay expense, but also reduces the burden of medical workers thus it is worthwhile to popularize and apply the newly designed gauze filler in clinical practice.

Objective To investigate the diagnostic value of ultrasound and MRI in fetal bronchopulmonary sequestration (BPS). Methods The 7 pregnant women with suspected fetal BPS were examined with a 1.5 T MR unit within 24 h after prenatal ultrasound in Hubei Maternal and Children's Hospital during July 2013 to February 2015. The imaging protocol included half-fourier acquisition single shot turbo SE (HASTE), true fast imaging with steady state precession (True FISP) in axial, frontal and sagittal planes relative to the fetal thorax. Prenatal MRI findings have been compared with postnatal enhanced computed tomography or biopsy. Results The locations of BPS were in left side in 5 cases and in right side in 2 cases. One case was complicated with congenital cystic adenomatoid malformation (CCAM) of lung. Ultrasound showed the intrathoracic mass as a hyperechoic lesion and the feeding artery could be found by Doppler ultrasonography. T2WI could reveal not only the hyperintense lesions with clear boundary, but also the hypointense feeding artery originating from systemic circulation. Compared with pathological examination or enhanced CT, both of the ultrasound and the MRI could locate the lesions;however 2 feeding arteries were misjudged. Conclusions Prenatal ultrasound is the first-choice diagnostic modality for BPS. MRI can demonstrate the location, morphology and the feeding arteries of the fetal BPS, and also estimate the volume of normal lungs, which could be an important supplement to prenatal ultrasound in prenatal diagnosis and prognostic prediction of BPS.

Objective To explore the clinical efficacy and safety of modified PPH combined with partial internal anal sphincterotomy in the treatment of circular mixed hemorrhoids.Methods Patients with annular mixed hemorrhoids were divided into two groups by a completely randomized controlled method.54 patients in the experimental group were treated with modified PPH combined with partial internal anal sphincterotomy,while 51 patients in the control group were treated with conventional PPH.The postoperative indicators,perioperative and long-term complication rates of the two groups were compared,and the clinical efficacy and safety were observed.Results The operation time in the experimental group was(48.35±4.37)minutes,which was higher than that in the control group(36.42 ±6.21)minutes(P＜0.05).The incidence of postoperative anastomotic stenosis in the experimental group was 1.9％,lower than 15.6％ in the control group(P＜0.05).Anal pain,urinary retention,first defecation time,long-term anal distention,the experimental group was significantly better than the control group,the difference was statistically significant(P＜0.05);The hospitalization time in the experimental group(4.8±0.62)days was not significantly different from that in the control group(5.1±0.54)days(P＞0.05).The amount of intraoperative bleeding and anastomotic bleeding in the experimental group[(17.28±2.22)ml,3.7％]were not significantly different from those in the control group[(16.75± 2.13)ml,3.9％](P＞0.05).Conclusion Compared with conventional PPH,the modified PPH combined with partial internal anal sphincterotomy slightly increases the operation time,but does not increase the risk of anastomotic bleeding,the incidence of rectal fistula,the amount of surgical bleeding,and the length of hospital stay.It can significantly improve postoperative anal pain,urinary retention,long-term distention symptoms,shorten the time of first defecation,ease the difficulty of defecation,and significantly reduce postoperative anastomotic stenosis,The long-term efficacy and safety are good.