OBJECTIVE:To evaluate the status quo and tendency of utilization of hypoglycemic drugs in medical insurance inpatients.METHODS:DDD was used to analyze the data of utilization of hypoglycemic drugs in medical insurance inpatients in class A grade three hospital during 2007～2009.RESULTS:The consumption sum of hypoglycemic drug used for medical patients increased year by year.The rates of increase were up to 14.04% for 2008 and 21.65% for 2009.The consumption sum of insulin increased rapidly.The rate of drug combination was 81.57% among which the rate of using two-drug was 68.66%.CONCLUSION:The new type of hypoglycemic drugs have become the main drugs in the hypoglycemics market.Domestic drug manufacturers should develop effective,safe,economical and be benefit for the treatment of complication so as to decrease medical costs and save the resources of medical insurance.

Objective To study the use of early bile duct to bile duct end-to-end(side) anastomosis for extrahepatic bile duct injuries.Methods The clinical data of 25 patients with extrahepatic bile duct injuries with early bile duct to bile duct end-to-end(side) anastomosis were retrospectively analyzed.Results Bile duct injuries happened in laparoscopic cholecystectomy (n=17),laparoscopic exploration of common bile duct (n=1),laparotomy (n=5),and knife wound (n=2).All of the repairs were successfully carried out.Except for one patient who was lost to follow-up,the other patients were followed for over 2 years.There was no bile duct stenosis.One patient died after 5 months of repair in other hospital because of a recurrent bile duct calculus.Conclusions Early bile duct to bile duct end-to-end(side) anastomosis had a good long-term results.The operation needs to be done by a good surgeon or supervised by an experienced specialist in biliary surgery.A prolonged period of T tube stenting is a prerequisite for success.

Percutaneous nephrostomy was applied in some other urologic diseases and the efficacy was evaluated. Percutaneous nephrostomy for percutaneous nephrolithotomy (PNL) was performed in patients with various renal, perinephric and bladder diseases (n=79). The tract establishment, operation duration and complications were observed and the efficacy was assessed. The results showed that the tracts were successfully established in 79 cases. The operation lasted 4-20 min. 12F-16F single tract was established in nephrohydrop patients and 16F-20F single or multiple tracts were established in patients with pyonephrosis, renal cortical abscess, renal cyst and perinephric abscess. During dilation, no leakage of liquor puris was noted. Establishment of 18F single tract was achieved in one urinoma patient. In two patients with foreign body in kidney, the foreign bodies were removed via established 14F single tract. 18F tracts were established in 2 patients with bladder contracture, which was followed by the placement of 16F balloon urethral catheter for drainage. No complications, such as massive bleeding, intestinal injury and spreading of infection took place in our series. All the patients were followed up for 2-12 months. No long-term complications such as dropping of drainage tube occurred. It is concluded that as a minimally invasive technique, percutaneous nephrostomy has the advantages of convenience, simplicity and causing less complications and can be used for various urologic diseases.

BACKGROUND: Presently, it is a certain preventive effect of local emplacement of various isolated materials during operation and postoperatively drug-controlled inflammatory reaction on adhesion between epidural and nerve root after laminectomy.OBJECTIVE: To study the preventive effect of chitosan and titanium net on epidural cicatricle adhesion after laminectomy.DESIGN, TIME AND SETTING: Randomized controlled animal study, which was performed in Guiyang Medical College from June to December 2005.MATERIALS: Eighty adult rabbits, weighing (2.0±0.2) kg, were used to establish vertebral plate resection models. Chitosan was provided by Shanghai Qisheng Biological Agent Industry Company, and titanium net by Guizhou Kelun Pharmacology Company Limited.METHODS: Eighty adult rabbits were randomly divided into four groups, including control group (0.5 mL saline), titanium net group (titanium net in the size of 1.0 cm × 0.8 cm was covered on defect region of vertebral plate and fixed on processus spinosus of upper and lower cone, bilateral muscles and soft tissues), chitosan group (2 mL chitosan), and chitosan + titanium net group (combination of chitosan and titanium net). Six rabbits were sacrificed in the 2nd and 4th weeks postoperatively, and eight rabbits were chosen as the samples in the 8th week.MAIN OUTCOME MEASURES: Morphological changes of cicatricle.RESULTS: Cicatricle was clearer in the control group. Titanium net could relieve peripheral cicatricle of dura mater and effectively isolate peripheral cicatricial tissue and spinal dura meter. Chitosan could remarkably prevent from cicatricle adhesion and inhibit inflammatory reaction. The combination of chitosan and titanium net could effectively inhibit proliferation of cicatricle surrounding dura meter.CONCLUSION: Association of chitosan and titanium net can effectively inhibit cicatricle adhesion surrounding dura meter after laminectomy.

Objective To evaluate the clinical efficacy of berberine for the treatment of insulin resistance (IR) in women with polycystic ovary syndrome (PCOS).Methods Sixty PCOS-IR women were randomized into treatment group and control group,30 cases in each group.At the end of the trial,26 cases in the treatment group (4 cases dropped out) and 29 cases in the control group (one case dropped out) completed the trial.The treatment group was treated with berberine orally,and the control group was treated with metformin orally,the treatment for the two groups lasting 3 months.Before and after treatment,we observed the parameters of body mass index (BMI),homeostasis model of assessment for insulin resistance index (HOMA-IR),fasting plasma glucose (FPG),fasting insulin (FINS),2-hour postprandial glucose after oral glucose tolerance test (OGTT2hPG) and 2-hour postprandial insulin after OGTT (OGTT2hINS),blood lipid levels of total cholesterol (TC),triglyceride (TG),low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C),and sexual hormones of follicle-stimulating hormone (FSH),luteotropic hormone (LH),testosterone (T) and LH/FSH ratio.Results BMI,HOMA-IR,TC,TG and LDL-C of the two groups were decreased after treatment (P ＜ 0.05 or P ＜ 0.01 compared with those before treatment),but the differences between the two groups were insignificant(P ＞ 0.05).Serum levels of T and LH as well as LH/FSH ratio in the treatment group were also decreased (P ＜ 0.05 or P ＜ 0.01 compared with those before treatment and those in the control group after treatment).Conclusion Berberine can improve HOMA-IR,decrease serum sexual hormones levels,and regulate the blood metabolism in PCOS-IR women,and its effect is similar to that of metformin.

Objective To analyse the influence of esmolol on plasma N terminal pro-brain natriuretic peptide ( NT-proBNP) , heart-type fatty acid binding protein ( H-FABP) and cardiac function in acute cerebral infarction patients with myocardial enzyme abnormalities.Methods 86 acute cerebral infarction patients with myocardial enzyme abnormalities from September 2010 to July 2014 in our hospital were selected and divided into experimental group and control group randomly (43 cases in each group).All patients were accompanied by myocardial enzyme abnormalities, patients in control group were given basic treatment, while patients in experimental group were given esmolol hydrochloride intravenous injection on the basis of control group.Plasma NT-proBNP, H-FABP levels and cardiac function were analyzed in two groups.Results Myocardial enzyme levels had no significant difference between two groups on admission.Plasma NT-proBNP levels also had no statistical differences after admission hospital of 6 h, 15 h and 3 d , and experimental group was significantly lower than control group ( P<0.05 ) after admission hospital of 5 day and 7 days.H-FABP levels had no statistical differences after admission hospital of 6 h, 15 h, and the experimental group was significantly lower than the control group (P<0.05) after admission hospital of 3, 5, 7 days.Cardiac function with Killip classification showed no significant difference when on admission and after admission hospital of 3 days, and the experimental group was significantly better than control group (P<0.05) after admission hospital of 5, 7 days.Conclusion Acute cerebral infarction patients with myocardial enzyme abnormalities given esmolol on the basic treatments significantly reduce NT-proBNP and HAFBP levels, and improve cardiac function, which is worthy of promotion in clinical applications.

Objective To compare the effect of high volume continuous blood purification (CBP) with routine CBP on multiple organ dysfunction syndrome(MODS).Methods 38 patients with MODS were randomly divided into high volume CBP group( treatment group,18 cases) and routine CBP group (control group,20 cases).And they were respectively detected on mean arterial pressure(MAP),dosage of Dopamine,PaO2/FiO2,APACHE [ score,lactic acid,length of stay and mortality in ICU post-treatment 24h and 48h.Results Compared with control group,MAP and PaO2/FiO2 on treatment group were more higher( P ＜ 0.05 ),while dosage of Dopamine,APACHE Ⅱ score,lactic acid were significantly shorter than these of treatment group( P ＜ 0.05 ),and length of stay and mortality in ICU were significantly lower than those of treatmen group [ ( 8.54 ± 4.15 ) d vs ( 11.82 ± 5.76) d,P ＜ 0.05:22.2％ vs 35.0％,P ＜0.05 ].Conclusion High volume CBP could reduce the mortality in ICU compared with control group routine CBP.

The present study aims to isolate neural stem cells from neonatal rat hippocampus and induce them to differentiate into cholinergic neurons. A multipotent cell line derived from the hippocampi of neonatal rats which had the ability to form clones was incubated in serum-free DMEM/F12 medium added with 20ng/ml basic fibroblast growth factor (bFGF) and B27. After differentiation of the neural stem cells, immunocytochemistry was used to detect nestin, the antigen of the cell clone, and β-tubulin (Tuj 1 ), glial fibrillary acidic protein (GFAP) and galactocerebroside (Galc), the markers specific for neurons, astrocytes and oligodendrocytes, respectively. Embryonic chick skeletal muscle extract was used to induce the differentiation of the neural stem cells into cholinergic neurons. The results showed that the cell line isolated from the hippocampi of neonatal rats expressed nestin and had the potential to form clones and differentiate into neurons, astrocytes and oligodendrocytes. Embryonic chick skeletal muscle extract can induce 9.6% of the isolated cell line to differentiate into cholinergic neurons compared with 3.9% in controls. These findings suggested that the cell line, which expressed nestin antigen, was a multipotent cell line capable of self-renewing, and was believed to contain stem cells of the CNS. These neural stem cells can be induced to differentiate into cholinergic neurons by using embryonic chick skeletal muscle extract.

ObjectiveTo investigate the effects of propofol on calcium/calmodulin-dependent protein kinase Ⅱ α ( CaMK Ⅱ α) activity in hippocampus in mentally depressed rats after electroconvulsive therapy (ECT).MethodsHealthy adult male SD rats aged 2-3 months weighing 180-220 g were used in this study.Mentally depressed model was induced by chronic unpredictable mild stress.Forty mentally depressed rats were randomly divided into 4 groups (n =10 each): mental depression group (group D),propofol group (group P),ECT group (group E),propofol + ECT group (group DPE).Groups D and P received intraperitoneal normal saline 8 ml/kg or propofol 80 mg/kg once a day for 7 consecutive days respectively.Group E received ECT once a day for 7 consecutive days.Group DPE received propofol 80 mg/kg + ECT once a day for 7 consecutive days.Sucrose preference test was performed at 1 d before and 1 d after treatment,and Morris water maze test was performed at 1 d before and 3 d after treatment.The rats were sacrificed after Morris water maze test,and hippocampi were removed for determination of CaMK Ⅱ α and phosphorylated CaMK Ⅱ α(pCaMK Ⅱ α )expression,and pCaMK Ⅱ α/CaMK Ⅱ α ratio was caculated.ResultsCompared with group D,the sucrose preference percentage was significantly increased in groups E and DPE,the escape latency prolonged and space exploration time shortened,and the expression of CaMK Ⅱ α and pCaMK Ⅱ α down-regulated,pCaMK Ⅱ α/CaMK Ⅱ α ratio decreased in group E,the escape latency was significantly shortened and space exploration time prolonged,and the expression of pCaMK Ⅱ α up-regulated in group DPE ( P ＜ 0.05).Compared with group E,the escape latency was significantly shortened,space exploration time prolonged,and the expression of CaMK Ⅱ α and pCaMK Ⅱ α up-regulated,and pCaMK Ⅱ α/CaMK Ⅱ α ratio increased in group DPE ( P ＜ 0.05).ConclusionPropofol can reduce the cognition impairment induced by ECT in mentally depressed rats through enhancing CaMK Ⅱ α activity in hippocampus.

Objective To evaluate the effect of low-dose ketamine on the efficacy of electroconvulsive therapy (ECT) under propofol anesthesia in depressed rats. Methods Sixty adult male SD rats weighing 200-250 g were used in this study. The depression model was established by chronic unpredictable mild stress (CUMS). The animals were then randomly divided into 6 groups (n = 10 each): control group (group C), depression group (group D), propofol group ( group P), propofol + ECT group ( group PE), ketamine + propofol group ( group KP), and ketamine + propofol + ECT group (group KPE). Groups P and KP received intraperitoneal propofol 100 mg/kg and ketamine 10 mg/kg + propofol 80 mg/kg respectively, and groups PE and KPE received ECT after intraperitoneal injection of propofol 100 mg/kg and ketamine 10 mg/kg + propofol 80 mg/kg respectively once a day for 7 consecutive days. All rats underwent sucrose fluid consumption and Morris water maze tests before CUMS, after CUMS, and after treatment. Results Compared with group C, the sucrose consumption percentage was significantly decreased, the escape latency was prolonged, and the time spent in the target quadrant (the original platform quadrant) was shortened after CUMS in D, P, PE, KP and KE groups ( P ＜ 0.05). Compared with group D,the sucrose consumption percentage was significantly increased (P ＜ 0.05), while no significant change in the escape latency and time spent in the target quadrant was found after treatment in group KPE ( P ＞ 0.05 ), and the sucrose consumption percentage was significantly increased, the escape latency was prolonged, and the time spent in the target quadrant was shortened after treatment in group PE ( P ＜ 0.05). Compared with group PE, the sucrose consumption percentage was significantly increased, the escape latency was shortened, and the time spent in the target quadrant was prolonged after treatment in group KPE ( P ＜ 0.05). Conclusion Low-dose ketamine can not only enhance the efficacy of ECT under propofol anesthesia in depressed rats, but also reduce cognitive impairment induced by ECT.