Epidemiological studies have shown that patients with diabetes are prone to have depression and anxiety.This article reviews the evidence,mechanism,complications and strategy of selective serotonin reuptake inhibitors paroxetine in treatment of depression and anxiety in patients with type 2 diabetes mellitus.

BACKGROUND:There are currently various surgical methods of patel a fracture, and they have advantages and disadvantages, thus cannot wel meet the requirements of patients.
OBJECTIVE:To evaluate biomechanical properties of internal fixation plate to treat patel ar fracture and to provide theoretical evidence for clinical application.
METHODS:According to the statistics of patel a in the Chinese population, a titanium al oy spider internal fixation plate was designed and manufactured for the treatment of patel ar fractures. Knee joint specimens in six fresh cadavers were randomly divided into two groups and the comminuted fracture model of patel a were established. The models were fixed with internal fixation plate of patel a and NiTi patel ar concentrator. Biomechanical tests were carried out to compare the biomechanical properties.
RESULTS AND CONCLUSION:Both the two fixation methods could meet the 1-kN quadriceps femoris contraction. The internal fixation plate of patel a was superior to NiTi patel ar concentrator in the patel ar isolation shift, muscle strength and joint strength, as wel as mechanical properties of patel a-point surface. There were significant differences between the two groups (P<0.05). The internal fixation plate of patel a is designed in accordance with the anatomical and biomechanical properties of the patel a, the fixation strength can completely meet clinical requirement and deserve further application.

Objective To investigate the relationship between molecular subtypes of breast cancer and postoperative loco-regional recurrence (LR) in early breast cancer patients with 1-3 positive axillary lymph nodes (pN1) and to improve the individualized indications for post-mastectomy radiotherapy (PMRT)in these patients.Methods A total of 547 patients with pT1-2 N1M0 breast cancer,who received mastectomy between December 1998 and December 2009 in Sun Yat-sen University Cancer Center,were retrospectively analyzed.None of them received adjuvant radiotherapy after mastectomy.The patients were divided into luminal A group,luminal B group,HER-2-overexpressing group,and triple-negative group according to the molecular subtypes of breast cancer determined by immunohistochemistry and fluorescence in situ hybridization.The patients in different groups were compared in terms of LR rate (LRR) and LR-free survival (LRFS),and the risk factors for LR were analyzed in combination with clinical and pathological features.The Kaplan-Meier method was adopted to calculate LRR and LRFS;the Logrank test was used for survival difference analysis and univariate prognostic analysis.The Cox proportional hazards model was used for multivariate prognostic analysis.Results The luminal A group,luminal B group,HER-2-overexpressing group,and triple-negative group accounted for 30.0％,48.6％,9.3％,and 12.1％,respectively,of all the patients.The follow-up rate was 97.1％ ;334 patients were followed up for at least 5 years,and 127 were followed up for at least 10 years.Univariate analysis showed that,compared with the luminal A group,the HER-2-overexpressing group and triple-negative group had significantly higher 5-year LRRs (19.0％ vs 5.3％,x2 =4.28,P =0.026; 14.9％ vs 5.3％,x2 =5.02,P =0.015) and significantly lower LRFSs (73.5％ vs 91.1％,x2=7.27,P=0.005;80.6％ vs 91.1％,x2=4.77,P=0.021).Multivariate analysis revealed that HER-2 overexpression,triple-negative phenotype,age of ≤ 35 years,and stage pT2 were poor prognostic factors for survival (LRR and LRFS) (x2 =2.29,2.08,18.22,and 6.86,P =0.020,0.016,0.001,and 0.005;x2 =1.90,1.41,8.58,and 3.94,P=0.006,0.025,0.002,and 0.039).The 10-year LRRs of patients with 0,1,and ≥2 of the above risk factors were 4.3％,14.1％,and 31.9％,respectively (x2 =28.03,P =0.000).Conclusions Molecular subtyping is helpful for individualized evaluation of LR risk in early breast cancer patients with 1-3 positive axillary lymph nodes (pN1).PMRT should be recommended for the patients with 2 or more risk factors for LR.

Objective To investigate COL1A1 gene mutation by PCR-high resolution melting (PCR-HRM) and an-alyze the correlation between genotype and clinical phenotype in a child (proband) with osteogenesis imperfecta (OI). Methods The family history of OI pedigree along with the clinical data was collected. Blood samples from the proband and his family members, as well as 50 normal controls, were collected. The mutation of COL1A1 gene was screened using PCR-HRM and validated by the gene sequence. Results The detection of PCR-HRM showed the abnormal result of COL1A1 17 exon in proband with a lower melting temperature (Tm) value than that of normal controls by 0.4℃. There were signifi-cant differences in the standardization melting curve and the different melting curve between the proband and the normal controls. The sequencing result was c.1138G>A, which meant that cDNA of 1138 base G mutation into A. The mutations transformed the amino acid glycine into a serine at amino acid 380(P. Gly 380 Ser), which resulted in missense mutations. The proband’s father and grandmother had the same mutation of COL1A1 gene. The mutation was not found in the proband’s mother and normal controls. There was no report for such mutation in Chinese population. Pedigree analysis showed the fami-ly genetic characteristics of autosomal dominant inheritance. The proband was clinically diagnosed as OI type Ⅳwith more severe clinical phenotype. Conclusion PCR-HRM analysis is a new effective method for genetic screening of OI. COL1A1 mutation of c.1138G>A is a newly discovered mutation in Chinese population. Gly replaced inαhelical domain may lead to a more severe clinical phenotype.

Objective To explore the function of ERCC2/XPD polymorphisms in the repair of DNA damage induced by UVC. Methods Plas?mids stably expressing ERCC2/XPD rs13181 AA(Lys751)and ERCC2/XPD rs13181 CC(Gln751)were transfected into Chinese hamster ovary cells,and the stable ERCC2 transfected cell lines were obtained. MTT assay was used to compare the inhibitory rates of the transfected cells treated with UVC at different irradiation intensity. The DNA damage repair ability of the transfected cells treated with UVC for 1,3,6 and 24 h was detected by modified comet assay. Results Compared with UV5ERCC2(CC),UV5ERCC2(CC) was more sensitive to UVC with decreased cell viability. DNA damage level of UV5ERCC2(CC) cells was more serious than UV5ERCC2(CC). Conclusion DNA repair capacity of ERCC2/XPD rs13181A allelic is lower than its wild?type,suggesting that ERCC2/XPDpolymorphisms play a critical role in UVC?induced DNA damage repair.

Objective To explore the predictive value of primary tumor site for loco?regional recurrence ( LRR) in early breast cancer patients with one to three positive axillary lymph nodes after radical surgery. Methods The clinical data of 656 patients pathologically diagnosed with pT1?2 N1 M0 breast cancer who received radical surgery without postoperative radiotherapy in our hospital from 1998 to 2010 were retrospectively analyzed. In those patients, 156 had primary tumor located in the inner quadrant, 45 in the central quadrant, and 455 in the outer quadrant. LRR and local recurrence?free survival ( LRFS) were end points. The Kaplan?Meier method was used to estimate LRR and LRFS rates. The log?rank test was used for survival difference analysis and univariate prognostic analysis. Multivariate analysis was performed using the Cox regression model. Results The 5?and 10?year sample sizes were 416 and 191, respectively. The 5?and 10?year LRR rates were 8?6% and 12?9%, respectively, while the 5?and 10?year LRFS rates were 86?2%and 76?4%, respectively. The univariate analysis indicated that age, pT stage, Ki67 level, molecular classification, and primary tumor in the inner quadrant were significant influencing factors for LRR ( P=0?000,0?006,0?017,0?004,0?000). The multivariate analysis showed that age no greater than 35 years, primary tumor in the inner quadrant, and non?luminal subtype in molecular classification were independent prognostic factors for LRR and LRFS ( P=0?0012,0?012,0?005) . With an increasing number of risk factors ( ≥ 2 ) , patients with primary tumor in the inner quadrant had a dramatically increased LRR rate and a reduced LRFS rate, while patients with primary tumor in the outer or central quadrant kept the same LRR and LRFS rates. Conclusions The primary tumor site holds promise for prediction of LRR and LRFS in patients with pT1?2N1M0 breast cancer after radical surgery. Patients with primary tumor located in the inner quadrant have a high LRR rate and a low LRFS rate, which provides an excellent predictor for the risk of recurrence in patients with high?risk breast cancer.

Objective To evaluate the clinical effect of group cognitive behavioral therapy on blood glucose levels,anxiety and depression in patients with type2 diabetes mellitus.Methods Ninety three patients with type 2 diabetes mellitus were recruited and randomly divided into intervention group (n =48) and control group (n =45).Both groups received diabetes health education,patients in intervention group received additional group cognitive behavioral therapy.The glucose tolerance,glycosylated hemoglobin A1c were measured; the HAMA(Hamilton Anxiety Scale)scores,HAMD(Hamilton Depression Scale)scores and CSQ (Coping Styles Questionnaire) scores in patients were analyzed before and 6 months after treatment.Results After 6-month treatment the fasting blood glucose (6.33 mmol/L vs.5.94 mmol/L),1 h postprandial plasma glucose(12.40 mmol/L vs.11.46 rmool/L),2 h postprandial plasma glucose (10.24 mmol/L vs.9.13 mmol/L),A1 c (6.31％ vs.6.07％) in intervention group were decreased significantly,compared to baseline values (all P ＜ 0.05).The HAMA total score (9.98 vs.8.14),somatic anxiety (3.98 vs.3.48),psychic anxiety(6.00 vs.4.67),HAMD total score(10.74 vs.6.93),anxiety somatic(5.02 vs.3.26),block(2.24 vs.1.38)and sleep disorders(2.40 vs.1.40)in intervention group were all decreased significantly(P ＜ 0.01 or 0.05).There were significant differences in HAMA total score (8.14 vs.9.15),HAMD total score(6.93 vs.9.33),anxiety somatic(3.26 vs.4.38),block(1.38 vs.1.98)and sleep disorders(1.40 vs.2.03)between the intervention group and control group(P ＜ 0.01 or 0.05).And the negative coping style scores in intervention group was also lower than that of the baseline (26.74 vs..29.43).Conclusion The group cognitive behavioral therapy combined with diabetes health education for patients with type 2 diabetes mellitus may improve the glucose metabolism and depression and anxiety status of patients.

BACKGROUND: Transplantation of bone marrow mesenchymal stem cell and vascular endothelial growth factor(VEGF) can promote vascular regeneration and improve heart function. However, whether the combined application is superior to single application or not is still unclear.OBJECTIVE: To observe the effect of allogenetic bone manow stem cells transplantation combined with VEGF transfection on vascular regeneration and heart function of rats with acute myocardial infarction.DESIGN: Simple sample observation was used in culturing bone marrow mesenchymal stem cell of rats; Randomized controlled animal experiment was used in cell transplantation and gene transfection.SETTING: Department of Cardiology, Union Hospital of Huazhong University of Science and Technology; Cardiovascular Institute of Tongji Medical College MATERIALS: Totally 94 healthy male Wistar rats and expression vector PAdTrack/VEGF165 were used in this experiment.METHODS: This experiment was carried out at Cardiovascular Institute of Tongji Medical College between June 2004 and June 2005. ①Bone marrow mesenchymal stem cells of rats were isolated, purified and cultured in vitro, then labeled with bromodeoxyuridine(BrdU). ② Preparation , extraction, purification and identification of plasmid PAdTrack/VEGF165. ③Two weeks after coronary artery was ligated to create acute myocardial infarction model, rats were randomly divided into 4 groups (n=12 in each group): stem cell + plasmid group(50 μL BrdU-labeled bone marrow mesenchymal stem cell solution and 100 μL plasmid PAdTrack/VEGF165 were injected into the rats through multiple sites), stem cell group (50 μL bone marrow mesenchymal stem cell solution was injected through multiple sites), plasmid group (100 μL plasmid PAdTrack/VEGF165 was injected through multiple sites) , control group(100 μL serum-free DMEM was injected through multiple sites). ④ Immunohistochemistry andechocardiography were performed 4 weeks later.MAIN OUTCOME MEASURES: ①Immunohistochemical and haematoxylin-eosin stainings were conducted in the infarcted and ischemic areas of rats in each group; ② Blood vessel counts; ③Echocardiography.RESULTS: Totally 48 rats entered the stage of result analysis. ① BrdUlabeled transplanted cells could be seen at the infarcted and ischemic myocardium in the stem cell+plasmid group and stem cell group. Some transplanted cells at ischemic myocardium differentiated into vascular endothelial cells and formed newborn blood capillary. ②Density of Ⅷ factor positively-stained newborn blood capillary took stem cell +plasmid group ＞ plasmid group ＞ stem cell group ＞ control group in order (all P＜ 0.01).③Wall thickness and wall motion range improved after cell transplantation and gene transfection therapy. The increased range of ejection fraction took stem cell +plasmid group ＞ stem cell group ＞ plasmid group ＞ control group in order (all P ＜ 0.01) .CONCLUSION: Allogenic bone marrow mesenchymal stem cell transplantation and VEGF gene transfection could further boost vascular regeneration of infarcted ischemic area and improve wall thickness and heart function of rats.

Objective To observe the stellate ganglion block (SGB) on obstructive sleep apnea syndrome (OSAS) combined the curative effect of sleep respiration and blood pressure control in patients with hypertension.Methods Incorporating meets the criteria for the OSAS patients with high blood pressure in hospital order randomly assigned into normal group and experimental group and routine group was given antihypertension drugs,adjustment in lifestyle,continuous positive airway pressure (CPAP) treatment,the experimental group on the basis of conventional treatment at the same time give SGB to intervene.Using t test on admission and intervention were compared after a period of treatment in patients with sleep apnea and blood pressure control,using 2 test comparison blood pressure control rates of two groups patients.Results Compared with normal group,the experimental group after intervention in a course of apnea hypoventilation index (AHI),SaO2 and 24 h mean arterial pressure were obviously improved,the difference was statistically significant (P＜0.05).Conclusion SGB as a new treatment method,not only can improve clinical symptoms in patients with OSAS,but also make the patients get better control of blood pressure.

Background and purpose: Sorafenib hepatocellular carcinoma assessment randomized protocol (SHARP) and sorafenib in patients in Asia-Pacific region with hepatocellular carcinoma (ORIENTAL) had indicated that multi-kinase inhibitor sorafenib could prolong overall survival (OS) and time to progression (TTP) as well as improve progress free survival (PFS) in patients with advanced stage hepatocellular carcinoma. Drug-related adverse events in the course of treatment restricted its clinical application to a certain degree. This study was aimed to summerize the adverse events as well as the management of sorafenib in our clinic. Methods: Twenty-five cases clinically diagnosed as advanced hepatocellular carcinoma were enrolled from January 2008 to October 2009. All the patients who received sorafenib treatment met inclusion criteria as followed: (1) Progression of disease after trans-hepatic arterial chemoembolization therapy; (2) Extensive portal vein cancerous thrombus formation; (3) Portal zone or retroperitoneal lymph node metastasis or multiple remote metastasis, such as lung or bone; (4) Diffused poor blood supply to tumor; (5) Inform consent was obtained. All adverse events with different grade were observed during the beginning 12 weeks, and clinical treatment were carried out relatively. Results: Total of 25 cases were enrolled. Nine patients died of the disease, 3 of them died during the first 12 weeks, 3 patients abandoned sorafenib treatment, among them 2 died before the finish of 12 weeks treatment and 1 patient discontinued 5 months after the sorafenib treatment. Twenty cases finally assigned. Number of patients encountered drug-related adverse events were: HFSR (hand-foot-skin-reaction) 4(4/20), diarrhea 4(4/20), alopecia 5(5/20), rasb 4(4/20), fatigue 8(8/20), leukopenia and Thrombocytopenia 4(4/20), elevated blood pressure 1(1/20) and abdominal pain 1(1/20). After clinical management, 20 patients' sorafenib treatment were eventually not affected by adverse events. Conclusion: Sorafenib was well-tolerated and is a safe option of treatment for patients with advanced hepatocellular carcinoma.