OBJECTIVE:To systematically review the cost-effectiveness of insulin degludec(IDeg)in the treatment of type 1 diabetes mellitus(T1DM)and type 2 diabetes mellitus(T2DM). METHODS:A systematic review of literatures was conducted via PubMed,EMBase,The Cochrane Library,CNKI,Wanfang Data,VIP,IDF,ISPOR,ADA and EASD from the inception to Janu-ary 2016,to identify pharmacoeconomics evaluation literatures and non-economic studies related to IDeg in the treatment of T1DM and T2DM,compared with other basic insulin [insulin glargine(IGlar),insulin detemir(IDet),neutral protamine hagedom insulin (NPH)]. RESULTS:A total of 8 studies were included and all of them were carried out in European countries. In the short-term (one year),IDeg was more economical when compared with other basic insulin in patients with T1DM. The studies related to the long-term treatment of T1DM demonstrated different conclusions,but most of studies came to a conclusion that IDeg had good cost-effectiveness. For patients with T2DM,all of the studies demonstrated that IDeg was cost-effectiveness compared with IGlar. CONCLUSIONS:Compared with other basic insulin,IDeg can improve therapeutic efficacy and the quality of life,as well as re-duce the cost of ADR as hypoglycaemia. IDeg is a dominant or cost-effective treatment opinion.

Background and purpose:Cervical conization, including high frequency loop electrosurgical excision procedure(LEEP) has been widely used in the treatment of cervical diseases, but how to deal with the patients with pathological positive margin is a problem for clinicians.The purpose of this study was to discuss the option of adjuvant treatment after cervical conization with positive margins for patients with cervical neoplasm.Methods:The data of 528 patients who had cervical conization from 1998 to 2008 was reviewed, among which 54 patients with pathological positive margin was retreated and analyzed.Results:Fifty-four patients were divided into observation group and treatment group, 17 cases were in observation group and 37 cases in treatmeat proup.The recurrence / duration / progress rate was 17.6%(3/17), in treatment group it was 2.7%(1/37) in observation.CINⅠ-Ⅱ positive margins in both group had no recurrence;among 14 patients with CINⅢ, 1 lesion persisted, and 1 progressed to cervical squamous cell carcinoma, none in treatment group was recurrent;For those 10 patients with micro-invasive margin-positive cases, 1 progressed to squamous cell carcinoma, the remaining 9 cases were followed up for 26 months without recurrence after operation.One case in invasive cancer group had recurrence.Conclusion:The patients with CINⅢ margin-positive patients after conization should receive individualized treatment.The patient with microinvasive carcinoma should be retreated with either re-conization or hysterectomy;if with margin-positive CINⅢ after conization, or re-conization or directly treated according to guideline addressing for ⅠB, if margin showed microinvasive carcinoma.The patients with margin-positive invasive carcinoma after conization should be treated according to guideline.

Objective:We probe more direct operation pathways in sphenoidal sinus and saddle area, and take proper measures for correlated diseases which surpass scope of sphenoidal sinus by combining image data, which could prevent serious complication.Method:Under nasal endoscope, the operation approaches we adopted included trans-anterior ethmoid sinus-posterior ethmoid sinus-sphenoidal sinus pathway, trans-meatus nasi superior-posterior ethmoid sinus-sphenoidal sinus pathway, trans nasal septum-sphenoidal sinus pathway and trans-natural opening of sphenoid sinus anterior into sphenoid sinus pathway by taking upper edge of posterior naris as a consistent surgical landmark. Forty-six cases who had sphenoidal sinus mass with bone erosion recieved surgical treatment.Result:Twenty-one cases with cyst and pus cyst of sphenoidal sinus had been healed by trans-meatus nasi superior pathway;1 case with hematoma and organization in sphenoidal sinus had been cleared by trans-meatus nasi superior pathway;3 cases had hematoma and organization in sphenoidal sinus and pseudoaneurysm in internal carotid artery,one of them suffered fatal hemorrhage in surgical exploration, and cured by endovascular embolization, the other two only underwent nasal endoscopic examination,the diagnosis was established by DSA and they received interventional therapy;4 cases with papilloma in sphenoidal sinus had been treated by trans-natural opening of sphenoid sinus approach,and 3 cases were cured,1 case had only partial mass resection as the papilloma offended the outer wall of sphenoidal sinus diffusely;2 cases with cholesteatoma of sphenoid sinus have been removed completely by trans-meatus nasi superior approach;1 case with encephalomeningocele of sphenoidal sinus underwent sphenoidotomy by trans-natural opening of anterior of sphenoidal sinus, and intraoperative puncture showed characteristic cerebrospinal fluid,the exposed meninges were then repaird surgically;1 case with mycosis of sphenoidal sinus had been cured by thorough clearing of the leision in sphenoidal sinus combined with antifungal therapy;3 cases with malignancy of sphenoidal sinus had received major mass resection of sphenoidal sinus by trans-anterior ethmoid sinus-posterior ethmoid sinus approach, and followed with radio therapy and chemotheraphy;5 cases with NPC in-volving sphenoidal sinus had been treated by radio therapy and chemotherapy after pathological examinacation;5 cases with post-operative cerebrospinal rhinorrhea and granulation hyperplasia of sphenoidal sinus had been repaired successfully by trans-meatus nasi superior approach or tans-nasal septum approach.Conclusion:There are various surgical pathways to deal with sphenoidal sinus and correlated diseases under nasal endoscope.The operation will be direct, safe and minimal invasive if we choose the pathway properly. Thin slice CT scan and 3D reconstruction of sella, and DSA or angiography of brain before operation is one of effective means to prevent surgical complications for leisions beyond scope of sphenoidal sinus.

Objective To examine the expression of hypoxia inducible factor-1 α (hypoxia-inducible factor 1α,HIF-1α),tumor cell proliferation antigen Ki67 and vascular endothelial growth factor (VEGF) in breast cancer tissues,adjacent tissues and normal breast tissues.Methods Immunohistochemistry HRP method was used to detect the expression of HIF-1α,Ki67 and VEGF in 70 cases of breast cancer tissues and their adjacent tissues and 10 cases of normal breast tissues.Difference of the positive rate was assessed viax2 test,and the correlation between the 3 were analyzed in a disorderly classified manner.Results The positive expression rate of HIF-1α,Ki67 and VEGF in 70 cases of breast cancer tissues was 78.6％ (55/70),88.6％ (62/70) and 65.7％ (46/70) respectively,significantly higher than that in adjacent tissues and normal breast tissues (P ＜ 0.01).The positive expression rate of HIF-1 α,Ki67 and VEGF was closely related with clinical stage,lymph node metastasis and histological grade (P ＜0.05).The expression intensity of HIF-1α was positively correlated with Ki67 and VEGF in breast cancer (P ＜ 0.05).Conclusions Detection of HIF-1 α,Ki67,VEGF may be an important indicator to predict the development,invasion,metastasis and prognosis of breast cancer.Tissue hypoxia may promote the proliferation of breast cancer cell and angiogenesis.A presumption is that HIF-1αmay be a new t()get of breast cancer,thus it deserves further study.

OBJECTIVE: We probe more direct operation pathways in sphenoidal sinus and saddle area, and take proper measures for correlated diseases which surpass scope of sphenoidal sinus by combining image data, which could prevent serious complication. METHOD: Under nasal endoscope, the operation approaches we adopted included trans-anterior ethmoid sinus-posterior ethmoid sinus-sphenoidal sinus pathway, trans-meatus nasi superior-posterior ethmoid sinus-sphenoidal sinus pathway, trans nasal septum-sphenoidal sinus pathway and trans-natural opening of sphenoid sinus anterior into sphenoid sinus pathway by taking upper edge of posterior naris as a consistent surgical landmark. Forty-six cases who had sphenoidal sinus mass with bone erosion received surgical treatment. RESULT: Twenty-one cases with cyst and pus cyst of sphenoidal sinus had been healed by trans-meatus nasi superior pathway; 1 case with hematoma and organization in sphenoidal sinus had been cleared by trans-meatus nasi superior pathway; 3 cases had hematoma and organization in sphenoidal sinus and pseudoaneurysm in internal carotid artery, one of them suffered fatal hemorrhage in surgical exploration, and cured by endovascular embolization, the other two only underwent nasal endoscopic examination, the diagnosis was established by DSA and they received interventional therapy; 4 cases with papilloma in sphenoidal sinus had been treated by trans-natural opening of sphenoid sinus approach, and 3 cases were cured, 1 case had only partial mass resection as the papilloma offended the outer wall of sphenoidal sinus diffusely; 2 cases with cholesteatoma of sphenoid sinus have been removed completely by trans-meatus nasi superior approach; 1 case with encephalomeningocele of sphenoidal sinus underwent sphenoidotomy by trans-natural opening of anterior of sphenoidal sinus, and intraoperative puncture showed characteristic cerebrospinal fluid, the exposed meninges were then repair surgically; 1 case with mycosis of sphenoidal sinus had been cured by thorough clearing of the lesion in sphenoidal sinus combined with antifungal therapy; 3 cases with malignancy of sphenoidal sinus had received major mass resection of sphenoidal sinus by trans-anterior ethmoid sinus-posterior ethmoid sinus approach, and followed with radio therapy and chemotherapy; 5 cases with NPC involving sphenoidal sinus had been treated by radio therapy and chemotherapy after pathological examination; 5 cases with post-operative cerebrospinal rhinorrhea and granulation hyperplasia of sphenoidal sinus had been repaired successfully by trans-meatus nasi superior approach or tans-nasal septum approach. CONCLUSION There are various surgical pathways to deal with sphenoidal sinus and correlated diseases under nasal endoscope. The operation will be direct, safe and minimal invasive if we choose the pathway properly. Thin slice CT scan and 3D reconstruction of sella, and DSA or angiography of brain before operation is one of effective means to prevent surgical complications for lesions beyond scope of sphenoidal sinus.
Adolescent ; Adult ; Aged ; Endoscopy ; methods ; Female ; Humans ; Male ; Middle Aged ; Nasal Cavity ; surgery ; Paranasal Sinus Diseases ; pathology ; surgery ; Sphenoid Sinus ; pathology ; surgery ; Young Adult

Psoriasis is an autoimmune disease characterized by chronic skin inflammation, and its etiology and pathogenesis have not been fully elucidated to date. In the previous study, rhIL23R-CHR/Fc fusion protein had been found to significantly relieve the symptoms of psoriasis mice and the pharmacological mechanism had been initially elucidated.In this study, we established a psoriasis cell model (Act-HaCaT) using TNF-α-activated human immortalized keratinocytes (HaCat).In our current study, the lncRNA that plays a key role in the regulation of Act-HaCaT function by the rhIL23R-CHR/Fc fusion protein was screened by transcriptome sequencing combined with qRT-PCR.The results showed that rhIL23R-CHR/Fc fusion protein significantly inhibited cell proliferation and inflammatory factor production in Act-HaCaT.lncRNA ENST00000522718 was obtained by screening, and knockdown of ENST00000522718 was found to significantly inhibit cell proliferation and inflammatory factor production.Our findings suggest that ENST00000522718 plays an important role in the pathological mechanism of psoriasis.

OBJECTIVE: The aim of the study is to explore the establishment of paired-standardized patients (PSPs), which can cover the deficiency of standardized patients. METHOD: The outpatients and standardized patients consist of PSPs. The standard case of PSPs is established by the combination of PSPs and the laboratory and imaging information of the true patients. Then we apply the PBL model and PSPs to the clinic teaching in otorhinolaryngology. RESULT: The study of the ten standard cases of PSPs, which we have established, has enhanced the confidence and interest of medical students in clinical practice. CONCLUSION PSPs can cover the deficiency of standardized patients, which includes lacking of change and lively. At the other hand, PSPs can practice the medical students' clinical skills and the way of evidence-based medicine and can stimulate them to form the good habit of self-regulated learning.
Evidence-Based Medicine ; Humans ; Otolaryngology ; education ; Outpatients ; Problem-Based Learning ; Reference Standards

OBJECTIVE: The aim of the study is to cover the shortages of PBL, such as time-consuming, abstract, lacking of the course of clinic practice, and to introduce PBL to the teaching of otorhinolaryngology. METHOD: By the improvement of the international classic teaching model of PBL, we put forward "four-stage gradual expanding approach of PBL" and establish "four-stage gradual expanding approach of PBL in otorhinolaryngology". RESULT: Through the four stages of watching PBL, simulation PBL, internship PBL, practice PBL, we have accomplished the organic integration of theory teaching and clinical practice. CONCLUSION This teaching method is more adaptive to the teaching of otorhinolaryngology, and it can help the medicine students to establish the whole concept of medicine and can stimulate them to form the good habits of self-regulated learning and life-long learning efficiently.
Educational Technology ; Otolaryngology ; education ; Problem-Based Learning ; methods

OBJECTIVE: To explore the clinical characteristics and genetic basis of two brothers featuring X-linked alpha thalassemia mental retardation (ATR-X) syndrome. METHODS: An infant who had presented at the Qilu Children's Hospital in 2020 for unstable upright head and inability to roll over and his family were selected as the study subjects. The clinical features of the child and one of his brothers were summarized, and their genomic DNA was subjected to targeted capture and next generation sequencing (NGS). RESULTS: The brothers had presented with mental retardation and facial dysmorphisms. NGS revealed that they had both harbored a hemizygous c.5275C>A variant of the ATRX gene located on the X chromosome, which was inherited from their mother. CONCLUSION The siblings were diagnosed with ATR-X syndrome. The discovery of the c.5275C>A variant has enriched the mutational spectrum of the ATRX gene.
Humans ; Infant ; Male ; alpha-Thalassemia/diagnosis* ; Ataxia Telangiectasia Mutated Proteins/genetics* ; East Asian People ; Intellectual Disability/genetics* ; Mental Retardation, X-Linked/diagnosis* ; Pedigree ; X-linked Nuclear Protein/genetics*

Objective To observe the effects of electroacupuncture at"Ciliao","Zhongji","Sanyinjiao"and"Dazhui"on urodynamics and expression of ERK/CREB/Bcl-2 pathway in spinal cord tissue of neurogenic bladder rats after suprasacral spinal cord injury.Methods Sixty female SD rats randomly selected 24 and divided into blank group and sham-operation group(12 rats in each group),the remaining 36 rats were subjected to surgical modeling.After modeling,rats were randomly divided into the model group and the electroacupuncture group,with 12 rats in each group.The electroacupuncture group received unilateral electroacupuncture stimulation at acupoints"Ciliao","Zhongji","Sanyinjiao",and"Dazhui"for 30 minutes each time,once a day,for 7 consecutive days.After administration,urodynamic testing was performed,HE staining was used to observe the morphology of bladder detrusor tissue,TUNEL method was used to detected apoptosis in spinal cord tissue,Western blot was used to detected expressions of p-ERK1/2,p-CREB,p-p90Rsk,CRE,Bcl-2,and Bax proteins in spinal cord tissue.Results Compared with the sham-operation group,the basal pressure,maximum pressure,and leakage point pressure of the bladder in the model group increased significantly(P<0.01),while the maximum capacity and compliance of the bladder decreased significantly(P<0.01);the structure of bladder smooth muscle cells was severely damaged and disorderly arranged,accompanied by a large amount of inflammatory cell infiltration;the apoptosis rate of spinal cord tissue cells significantly increased(P<0.01),and the expressions of p-ERK1/2,p-p90Rsk,p-CREB,CRE,and Bcl-2 proteins in spinal cord tissue were significantly decreased,while the expression of Bax protein significantly increased(P<0.01).Compared with the model group,the basal pressure,maximum pressure,and leakage point pressure of the bladder in the electroacupuncture group decreased significantly(P<0.05),while the maximum capacity and compliance of the bladder increased significantly(P<0.05,P<0.01);the integrity of bladder smooth muscle cells was enhanced,the degree of cell edema was reduced,and inflammatory cell infiltration was reduced;the apoptosis rate of spinal cord tissue cells was significantly reduced(P<0.05),and the expressions of p-ERK1/2,p-p90Rsk,p-CREB,CRE,and Bcl-2 proteins in spinal cord tissue significantly increased,while the expression of Bax protein was significantly decreased(P<0.05,P<0.01).Conclusion Electroacupuncture can promote the repair of bladder detrusor tissue in rats with neurogenic bladder model after suprasacral spinal cord injury,increase the maximum capacity and compliance of the bladder,alleviate the high pressure state in the bladder,and its mechanism is related to activating the ERK/CREB/Bcl-2 pathway,reducing secondary apoptosis of damaged neurons,effectively improving bladder innervation,and protecting bladder function.