Major points: Zhongwan (CV 12), bilateral Zusanli (ST 36) and Neiguan (PC 6); for excessive cold-dampness, plus Pishu (BL 20) and Sanyinjiao (SP 6); for Liver-qi affecting stomach, plus Yinlingquan (SP 9) and Taichong (LR 3); for deficiency of both spleen and sto mach, plus Pishu (BL 20) and Weishu (BL 21). Forty-six cases of diabetic gastric disorder were treated with acupuncture and 30 cases got marked effect, 16 cases got effect and the total effective rate reached 100%.

The key words, social network and author cooperation network in papers ( published in 2003-2014 ) on reform in domestic public hospitals were analyzed using Ucinet and CiteSpace visual softwares with CNKI as the data source.The current situation in reform in domestic public hospitals was revealed by mining its research hotspots, progress and author cooperation .Some suggestions were put forward for strengthening the reform in domestic public hospitals .

Objective To explore the technique of massive facial scar revision. Methods All 12 patients in the group were treated with expanded deltopectoral skin flap. In the primary surgery, expander was implanted underneath deltopectoral flap region through an incision inferior to the clavi-cle. The skin perforators of transverse cervical artery and thoracoacromial artery were ligated during surgery, and the internal thoracic artery was carefully preserved. After the deltopectoral skin flap was fully expanded, the second surgery was performed and the facial scar was released and the normal ana-tomic position of eyes, nose and month was restored. The deltopectoral skin flap was planed according to the size of the defect. The excised facial scar was converted to the flap pedicle and a hinge-like con-nection was formed. The flap was delayed and three weeks after the second surgery, the pedicle was divided. The flap from the pedicle was applied for the mental region scar revision. Results Unilateral or bilateral dehopectoral skin flaps were employed for the repair of extensive facial scar in 12 patients. Satisfactory results were achieved in all these patients. Conclusion Expanded deltopectoral skin flap is a good technique for the repair of extensive facial scar.

Objective To explore the application effect of interactive health education in insulin injections of aged patients with type 2 diabetes in the incipient stage of diagnosis and treatment. Methods 100 cases of aged patients with type 2 diabetes were hospitalized into endocrinology department from January 2014 to December 2014, the pen insulin injections were conducted for them at the beginning. They were equally divided into experimental group and control group through random number method. And, the general education guidance was conducted in control group. Meanwhile, the diabetes health education team was established in observation group on the basis of control group. Then, it was educated through the interactive lectures, interviews, teaching, repeated teaching, psychological intervention and individual assessment. Before and after education, the KAP survey of standard insulin injections were used for the patients in two groups to evaluate their degree of proficiency in the knowledge and skills about insulin injections, and the incidence of glucose metabolism level and low blood sugar. Results After intervention, the insulin injection skill in observation group was better than that of in the control group, (64.6%,31/48 vs. 24.5%, 12/149,χ2=16.441, P<0.01), while the level of glycosylated hemoglobin was reduced from (7.95±0.65)%to (6.58±0.62)%(t=7.85, P<0.01). Conclusions In the incipient stage of diagnosis and treatment, the ability of aged patients with type 2 diabetes in learning new knowledge and technology was improved through interactive health education mode. Besides, the insulin injections were standardized. Also, the glucose metabolism was improved, and the incidence of hypoglycemia was significantly reduced to ensure the patients′safety when the insulin was injected outside hospital, which was worth being clinically applied and promoted.

Objective:To explore the clinical features of recurrence after choledocholithotomy and to analyze the risk factors.Methods:The clinical data of 730 patients with choledocholithiasis who were treated in our hospital from January 2005 to July 2016 were analyzed retrospectively,550 cases who were received choledocholithotomy were defined as laparotomy group,30 cases with laparoscopic common bile duct exploration (LCBDE) were defined as the LCBDE group,and 150 cases with endoscopic sphincterotomy (EST) were defined as EST group.The recurrence rate of the three groups were compared.The patients of three groups were divided into recurrence group (n=227) and non recurrence group (n=503) according to the recurrent situation,then the clinical features and risk factors of recurrent patients were analyzed by univariate and multivariate Logistic regression analysis.Results:The recurrence rate of EST group was 38.67％,which was significantly higher than that of LCBDE group with 26.67％ and the laparotomy group with 29.27％,and there was statistical difference (P＜0.05).The results of univariate analysis showed that there were statistically significant differences in age,history of HBV infection,jaundice,abnormal total bilirubin,peripapillary diverticulum,biliary infection,biliary stricture,papillary stenosis,sphincter of Oddis dysfunction,history of biliary surgery,cholecystectomy,bile duct diameter ≥ 15 mm,bile duct angle ≤120°,operation type,stone quantity ≥ 2 grains,stone diameter ≥ 10 mm,with or without gallstones (P＜0.05).The results of Logistic multivariate regression analysis showed that age,having peripapillary diverticulum,having history of biliary surgery,bile duct diameter ≥ 15 mm,stone quantity ≥ 2grains and EST operation type were the independent risk factors of the recurrence after choledocholithotomy (P＜0.05).Conclusion:There are many risk factors of recurrence after choledocholithotomy,and operation method should be based on the size and the number of the stones,and the constitution of patients.Preventive measures should be strengthened to control the recurrence after choledocholithotomy.

Objective To explore a novel strategy to repair traumatic soft tissue defects in the head and face by tissue expansion in the early stage.Methods Eighteen patients with traumatic soft tissue defects were treated with thorough debridement leaving the wound unclosed or simply closed with thin split-thickness scalp skin grafting,and adjacent expander implantation in the early stage and expanded flap transposition in the second stage.Results There were 11 male patients and 7 female patients ranging in age from 3.5 to 40 years [mean,(19.4±12.2) years],with average 15 months follow-up (range,3-67 months).The average expansion time was 74.3 days (range,53-96 days).The total of 18 patients with 22 expanders were treated with satisfactory results.All the flaps survived and the skin color,texture and contour well matched to those of the peripheral tissue.Only one complication of infection happened in the 18 cases (5.56％) and total 22 expanders (4.55％),which was similar to the rate reported in the literature.There were no any other complications related to the expander.Conclusions Debridement and tissue expansion in the early stage have been proved a more effective strategy to repair traumatic soft tissue defects in the head and face,which can not only achieve satisfactory color,unbulky and well matched texture similar to normal,but also can avoid unnecessary donor site injuries and does not increase the infection rate of tissue expansion.

Objective To discuss the application effect of peer support education in improving theself-management ability of old patients with diabetes. Methods A total of 160 cases of old patients with type 2 diabetes who were treated and hospitalized from June 2014 to August 2015 were selected, then equally divided into observation group and control group through using random number method.Finally, 76 cases were studiedin observation group, while 75 cases in control group. The health education guidance of conventional diabetes had been used in two groups for six months, and the peer support education was also conducted for the patients in observation group on the basis of conventional education. The self-management ability, insulin standard injection knowledge-belief and attitude-behavior/practice (KAP) and glycosylated hemoglobin (HbA1c) value of old patients with diabetes were observed before intervention, 3 months and 6 months later, respectively. Also,the hypoglycemia frequency in two groups was compared during intervention. Results After three months of intervention, the score of diet, exercise management, glucose monitoring, foot care, pharmaceutical administration and smoke for self-management ability in observation group was 4.63 ± 0.92, 4.18 ± 0.97, 2.86 ± 0.96, 2.35 ± 0.59, 4.01 ± 1.43 and 0.62 ± 0.29, respectively, while that of these indicators in control group was 3.69 ± 0.83, 3.52 ± 0.67, 1.75 ± 0.67, 1.63 ± 0.72, 3.05 ± 1.39 and 0.59 ± 0.38. Except smoke (P > 0.05), the differences between two groups were statistically significant (t=2.987-5.965, P < 0.05). After six months of intervention, the score of diet, exercise management, glucose monitoring, foot care, pharmaceutical administration and smoke for self-management ability in observation group was 5.86±0.93, 5.37±0.61, 3.97±0.94, 5.06±0.92, 5.81±0.73 and 0.89 ± 0.31, respectively, while that of these indicators in control group was 3.68 ± 0.96, 3.65 ± 0.95, 1.86 ± 0.88, 2.65±0.88, 3.21±1.13 and 0.81±0.39. The difference was statistically significant (t=9.336-15.633, P<0.01), except smoke (P>0.05). Then, the insulin was normally injected in observation group after six months of intervention, the score of knowledge, attitude and behavior was 5.63 ± 1.87, 43.17 ± 6.03 and 16.57 ± 1.59, while that in control group was 3.76 ± 0.83, 23.71 ± 0.59 and 10.16 ± 0.95. The differences between two groups were statistically significant (t= 8.569, 15.623, 6.751, P<0.01). Also, the level of glycosylated hemoglobin was decreased from (8.17 ± 0.32) % to (7.16 ± 0.41) %, and the difference was statistically significant (t=-3.560, P=0.000). Conclusions Peer support education couldenhance the self-management consciousness of old patients with diabetes, standardize the insulin injection, improve the ability of self-management and improve glucose metabolism index so that it is worthy of being clinically popularized and applied.

Objective To develop a nylon membrane chip for rapid and systematic detection of the diabetes-associated 45 mutant loci in mitochondrial DNA(mtDNA).Methods The mutant-and wild-type probes were designed for detection of 45 mutant loci in mtDNA with Primer Premier 5.0 and NCBI BLAST softwares and the 90 probes with 8 poly T were immobilized on the Hybond N~+ nylon membranes which were treated with 5?SSC Buffer by UV-crosslinking;Then asymmetric PCR was employed to obtain the target single strand DNA(ssDNA).The PCR products were labeled with biotin after purification.NBT/BCIP was used as substrate that yields a very intense purple signal followed by AP-avidin,and the signals were observed in 24 samples with known sequences to evaluate the chips,each sample was repeatedly measured three times.Results The specific target fragments of 45 loci can be amplified under the same condition with nine sets of primers.The annealing temperatures of the wild-type [(59.01?1.42)℃] and mutant-type [(59.34?1.29)℃ ] probes are so close(t=1.046,P =0.301)that hybridization can be performed at the same temperature.The spots on the membrane chip are distinct,regular and well-distributed.The results of positive-and negative-control are perfect.The signals of negative probes and the background are similar.The results of chip were nearly concordant with that of DNA sequences(?~2=113.132,Kappa value =0.888,P = 0.000)except for T16189C mutant.Conclusions We have successfully developed a nylon membrane chip for rapid and systematic detection of the diabetes-associated 44 mutant loci in mtDNA.It could be used for screening for diabetic patients and high-risk people.

ObjectiveTo investigate the correlation between electro-acupunctured point Houxi(SI3)and activated brain function areas, contrast the images produced with electroacupuncture at left and right points Houxi and make a comparison with electroacupuncture at point Hegu(LI4)in patients with peripheral facial paralysis.MethodPatients with peripheral facial paralysis, six on the left side and six on the right side, were enrolled as subjects. A scan of the whole brain was taken using fMRI during electroacupuncture stimulation. The images were processed using SPM software. An analysis using at-test (P<0.01) showed differences in brain functional images produced with electroacupuncture at different points.ResultElectroacupuncture at left point Houxi increased the signals of brain regions: rightcaudate nucleus, right cingulate gyrus, right parahippocampal gyrus, right superior temporal gyrus, the brainstem and the cerebellar vermis. Electroacupuncture at right point Houxi increased the signals of brain regions: right medial frontal gyrus, left middle frontal gyrus, left anterior cingulate gyrus, rightcingulate gyrus and right superior temporal gyrus.ConclusionThere is a difference in the image between electroacupuncture at point Houxi and at point Hegu or Dicang(ST4). There is also a larger difference in the image between bilateral points Houxi. The brain regions with high-frequency or low-frequency signals are not consistent. The results further prove the scientificalness of “Point Hegu is indicated for diseasesin the face and mouth” and also show that the cognominal acupoints on the two sides ofthe human body may have some differences, e.g. the conduction pathways are not completely the same and the therapeutic effects are not completely consistent.

Objectives To analyze the clinical characteristics of drinking-water type endemic arsenism in population lived in the diseased areas before and after water improvement in Inner Mongolia,so as to assess the natural development and the effects of human intervention measures.Methods Residents of four villages lived in Hangjinhouqi Bayinnaoer city Inner Mongolia were followed-up and their skin lesions were examined in 2004 (before water improvement),2010 (complete water improvement),2014 (after water improvement).Meanwhile,blood pressure and heart rate of the subjects were measured.The arsenic poisoning skin damage indexing was in accordance with endemic arsenic poisoning diagnostic criteria (WS/T 211-2001).Results Totally,229,122,161 people were investigation in 2004,2010,2014,respectively.The clinical grading of arsenic exposed population were mainly normal and suspicious cases in 2004,accounting for 61.6％ (141/229) and 22.7％ (52/229),respectively.The clinical grading of normal,suspicious,mild and severe cases were 20.5％ (25/122),31.1％ (38/122) and 48.4％ (59/ 122),respectively,in 2010,which were significantly different compared with those of 2004 (x2 =68.53,P ＜ 0.01).The clinical grading percentages of normal and suspicious of the subjects in 2014 were 46.6％ (75/161) and 39.8％ (64/161),respectively,which were significantly different compared with those of 2010 (x2 =45.22,P ＜ 0.01).Meanwhile,91 subjects examined in 2004 were re-examined in 2010 and 47 subjects examined in 2010 were reexamined in 2014.Totally,12 cases were migitation,accounting for 13.2％ (12/91),52 cases were aggravation,accounting for 57.1％ (52/91) in 2010,and 25 cases were migitation,accounting for 53.2％ (25/47),9 cases were aggravation,accounting for 19.1％ (9/47) in 2014.The differences of skin lesion transition between these two periods were significant (x2 =28.66,P ＜ 0.05).In addition,the systolic pressures and diastolic pressure of the subjects were (132.19 ± 21.21),(126.99 ± 18.32),(147.69 ± 22.65);(84.88 ± 14.13),(76.52 ± 10.08),(84.39 ± 13.89)mmHg in 2004,2010 and 2014,respectively,which declined in 2010 compared with them of 2004 (all P ＜ 0.05) and raised in 2014 compared with them of 2010 (all P ＜ 0.01).The heart rate of the subjects were (76.05 ± 12.56),(78.86 ± 11.69),(82.05 ± 11.26)times/min.The heart rate of the subjects raised in 2010 and 2014 compared with that of 2004 (all P ＜ 0.05).Conclusion The skin lesions induced by arsenism could be effectively alleviated through water improvement,but the late stage changes such as the cardiovascular system injury are still worthy of attention.