Objective To evaluate the therapeutic effect and safety of insulin lispro mix 50/50 combined with mefformin in newly diagnosed overweight/obese type 2 diabetic mellitus patients.Methods Sixty-two patients with newly diagnosed overweight/obsess type 2 diabetic mellitus were randomly divided into observation group (32 cases) and control group (30 cases) by systematic sampling method.The observation group received insulin lispro mix 50/50 combined with metformin,and the control group received recombinant human insulin and insulin glargine.The therapeutic effect and safety were compared between the 2 groups.Results There were no statistical differences in the blood glucose before eating,before retiring and at mane primo 3:00 between the 2 groups (P ＞ 0.05).There were no statistical differences in the time of blood glucose standard and rate of hypoglycaemia between the 2 groups (P ＞ 0.05).Daily insulin dosage and costs in the observation group were lower than those in the control group [(0.6 ± 0.1) U/kg vs.(0.8 ± 0.1) U/kg and (15.8 ±2.1) yuan/d vs.(21.3 ±2.6) yuan/d],and there were statistical differences (P ＜0.05).Conclusion Insulin lispro mix 50/50 combined with mefformin provides a convenient,effective and safe therapy for newly diagnosed overweight/obese type 2 diabetic mellitus patients and high cost performance.

Vascular cognitive impairment (VCI) is a cognitive impairment caused by cerebrovascular disease and its risk factors,its mechanism is very complex Recent studies have shown that cerebral microbleed (CMB) is correlated with VCI.This article reviews the relationship between CMB and VCI.

Object To investigate clinical features,surgical strategy and prognostic factors of bone metastasis from thyroid cancer.Methods A total of 46 patients with bone metastasis from thyroid cancer,who had undergone surgical treatment from January 1999 to July 2011 and had complete follow-up data,were enrolled in this retrospective study.There were 20 males and 26 females,aged from 40 to 87 years (average,56.87 years).Forty two (91.3％) cases of metastatic lesion located in axial skeleton,while 4 (8.7％) in limbs.The tumor histology type was well-differentiated in 35 patients and poorly differentiated in 11 cases.Nineteen patients (41.3％) had an isolated metastatic bone lesion,while other 27 patients (58.7％) had multiple lesions.Kaplan-Meier survival curve and Cox regression model were performed to identify prognostic factors among 19 factors including gender,age,tumor subtype,number of bone metastasis,site of bone metastasis,visceral metastasis,skeletal-related events,timing of metastasis,whether metastatic lesion was detected when thyroid cancer was diagnosed,whether thyroid surgery was performed,whether 131Ⅰ therapy was performed,whether chemotherapy or radiotherapy were performed,preoperative general condition (good or poor),surgical type (excisional surgery or palliative surgery),characteristics of metastatic lesion (osteolytic or mixed),intraoperative blood loss,whether measures were applied to prevent intraoperative bleeding,perioperative complications and long-term complications.Results Excisional surgery was performed in 36 patients (78.3％),while palliative surgery in other 10 patients (21.7％).The average amount of blood loss was 2603.26ml.The postoperative 5-year survival rate and 10-year survival rate were 37.3％ and 12.4％,respectively.Univariate analysis showed the significant prognostic factors include tumor subtype,number of bone metastasis,whether 131Ⅰ therapy was performed,and preoperative general condition (good or poor).Multivariate analysis showed the independent prognostic factors were number of bone metastasis (solitary or multiple) and whether 131Ⅰ therapy was performed.Conclusion For patients with bone metastasis from thyroid cancer,the prognostic factors are useful for determining indications for operation and improving treatment outcome.

Objective:To assess the efficacy and safety of oncoplastic breast-conserving surgery (OBCS) in the treatment of early breast cancer. Methods:The clinicopathological data of breast cancer patients who were treated with OBCS (67 cases) and standard breast-conserving surgery (SBCS;117 cases) in Affiliated Cancer Hospital of Guangxi Medical University were retrospectively analyzed. Postop-erative complication, specimen weight, margins, and surgery re-excision rate between the two groups were compared. Results:Sero-ma (14.9%versus 48.7%, P<0.001), hematoma (4.5%versus 14.5%, P=0.035), and poor wound healing (3.0%versus 11.9%, P=0.036) were more common in the SBCS group than in the OBCS group. The patient satisfaction in the OBCS group was statistically higher than in the SBCS group (P<0.05). Compared with standard surgery, oncoplastic techniques can be employed for significantly larger tumors (25.04 mm versus 21.14 mm, P<0.001). OBCS resulted in higher mean specimen weights (92.24 g versus 57.44 g, P<0.001), wider clear nearest margins (12.04 mm versus 9.58 mm, P<0.001), and wider furthest margins (24.16 mm versus 15.24 mm, P<0.001). No statisti-cal increase was observed in further surgery re-excision of margins. Conclusion:OBCS is more successful than standard wide local exci-sion in treating larger tumors and obtaining wider radial margins. Oncoplastic approach showed no increase in postoperative complica-tion rate. The postoperative complication was excellent. OBCS is a safe and effective procedure for early breast cancer.

OBJECTIVETo evaluate the clinical effects of arthroscopic reconstruction of anterior cruciate ligament (ACL) and minimally invasive reconstruction of posteromedial corner (PMC).

METHODSThere were 22 cases of ACL and PMC tear were performed with reconstruction from March 2012 to February 2014. The patients were 29.4 years old on average, including 8 males and 14 females. ACL reconstruction was performed under arthroscopy and PMC reconstruction was performed minimally invasively through the ACL incision. The stability of knee was assessed by anterior drawer test,Lachman test,vulgus stress test and Slocum test. The function of knee was assessed by Lysholm score and Tegner activity rating. MRI of knee was checked 12 months after operation.

RESULTSThe stability tests of all patients were negative at 2 and 6 months after operation, and there was one positive case in anterior drawer test and another positive case in vulgus stress test at 12 months after operation. Lysholm score of all patients 12 months after operation was 96.8 +/- 6.8, which was significantly better than 32.0 +/- 11.2 before operation. Tegner activity rating of all patients at 12 months postoperatively was 6.1 +/- 0.9, which was significantly better than 0.9 +/- 0.5 before operation. It showed the grafts were very well in the MRI 12 months postoperatively.

CONCLUSIONArthroscopic ACL reconstruction and minimally invasive PMC reconstruction can restore the stability of knee.

Adult ; Anterior Cruciate Ligament ; physiopathology ; surgery ; Anterior Cruciate Ligament Injuries ; Anterior Cruciate Ligament Reconstruction ; Female ; Humans ; Knee Injuries ; physiopathology ; surgery ; Knee Joint ; physiopathology ; surgery ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; Treatment Outcome ; Young Adult

Objective To evaluate the surgical procedures and both oncological and functional outcome in patients with bone tumors of the shoulder girdle.Methods Seventy-one patients including 61.pts with malignant tumor and 10 pts with giant cell tumors of the shoulder girdle treated in our department from July 1998 to July 2006 were studied retrospectively.According to the location,there were 15 pts with scapula tumor and 56 pts with proximal humeral tumor.Forty-two male pts and 29 female pts were included in this study with an average age of 36.5 years old ranging from 11.to 62 years old.Surgical procedures:forequarter amputation in 10 pts;Scapulectomy in 3 pts;Scapulectomy and artificial scapular replacement in 3pts;partial scapulectomy and proximal humerus resection with prosthetic reconstruction in 8 pts;proximal humerus resection and prosthesis replacement in 47 pts.Results Due to adequate soft tissue was preserved,the mean functional score was 28 for the pts with giant cell tumor according to MSTS functional scoring system,compared with the functional score 23 for the pts with malignant tumor because the deltoid muscle insertion was resected in the latter group.Among the thirty-seven patients with osteosarcoma,local recurrence occurred in four cases(10.8%),lung metastasis in five and bone metastasis in two.The seven patients died of disease.One patient iagnosed of malignancy in giant cell tumor died after distal metastasis.thtee patients with Ewing sarcoma died of the disease.No recurrence Wag observed in both five humeral chondrosarcoma and five scapular chondrosarcoma.Conclusion Tumot resection and proximal humeral prostbesis replacement is the optimal method for the sarcoma of shoulder girdle in term of preservation of elbow and hand function.Preservation of abductor insertion is necessary for good abduction function.The metastatic rate of proximal humeral osteosarcoma was lower than that of lower extremities.also the prognosis of oncological outcome.Intra-articular and extra-atticular tumor resection produced similar local recurrence rate in the present study,which suggested intra-articular resection may be an altemafive procedure.

AIM: To evaluate the clinical effect and the rotational stability of AcrySof Toric intraocular lens ( IOL ) implantation to correct preexisting corneal astigmatism in cataract surgery.
METHODS: Twenty-three patients ( 28 eyes ) were enrolled from the department of ophthalmology in the first Affiliated Hospital of Nanjing Medical University. All patients underwent similar phacoemulsification procedure combined with AcrySof Toric IOL implantation from June 2012 to December 2013. The uncorrected visual acuity ( UCVA ) , best corrected visual acuity ( BCVA ) , anticipated residual astigmatism, postoperative residual astigmatism, and Toric IOL axis were detected and measured.
RESULTS:Three months after operation, the UCVA of all eyes were 0. 75±0. 16 and the BCVA were 0. 84±0. 15, there was no significant difference between UCVA and BCVA ( t = 1. 036, P>0. 05 ). The anticipated residual astigmatism was ( 0. 28±0. 12 ) D. The actual residual astigmatism after 3mo of the operation was (0. 42±0. 17) D. There was no significant difference between anticipated and actual residual astigmatism (t=1. 259, P>0. 05). The mean axis rotation of Toric IOL was 3. 02o±1.56o (0o-7o) after 1d of operation and 3. 28o±1. 85o (0o-7o) after 3mo. Among all the eyes, 25 eyes ( 89%) rotated <5o, in 3 eyes (11%) rotated 5o-7o.
CONCLUSION: The AcrySof Toric IOL implantation shows good effectiveness, predictability and stability in correcting pre-existing astigmatism in cataract patients.

Objective To observe the clinical effect by using insulin detemir therapy in children and adolescents with type 1 diabetes mellitus(T1DM).Methods Thirty children and adolescents with T1DM were divided into 2 groups to receive Humulin R and Determir(observation group,n =15) or Humulin R and neutral protamine hagedorn (NPH) (control group,n =15)insulin therapy.Daily insulin dose,glycemic variability,incidence of non-severe and severe hypoglycemia events after the institution of insulin therapy were collected.Results The daily doses of insulin were (1.16 ± 0.30) U/kg in the observation group and(1.21 ± 0.35) U/kg in the control group,respectively.There was no clinically important change between 2 groups(t =0.526,P ＞ 0.05).Within-subject variation in fasting plasma glucose was significantly lower in observation group(29％)than that in control group(65％) (t =5.296,P ＜0.01).One case of severe hypoglycemia event occurred in the observation group,but 5 cases occurred in the control group(t =4.863,P ＜ 0.0l).Two cases of nocturnal hypoglycaemia(22:00-7:00) events occurred in the observation group,7 cases occurred in the control group(t =4.506,P ＜ 0.01).Conclusions Institution of insulin detemir therapy is associated with low within-subject variation in fasting plasma glucose and decreased rates of severe and nocturnal hypoglycemia while dose of insulin did not increase.This makes insulin detemir a valuable new tool for the treatment of children and adolescents with T1 DM.

Objective To investigate the risk factors for vascular cognitive impairment and the effet of cerebral microbleeds (CMBs) on cognitive function in patients with ischemic stroke.Methods The data of patients with ischemic stroke over the age of 50 were collected.The Montreal cognitive assessment (MoCA) scale and Alzheimer's disease assessment scale-cognitive subscale were used to evaluate cognitive function.Hamilton depression scale (HAMD) was used to evaluate the depression status in order to exclude the patients with depression.The patients with ischemic stroke were divided into either a cognitive impairment group or a non-cognitive impairment group according to the scale evaluation results.The demographic and clinical characteristics in both groups were compared,and the multivariate logistic regression analysis was used to look for the independent risk factors for cognitive impairment in patients with ischemic stroke.The Spearman rank correlation method was used to analyze the degree of CBMs,total score of MoCA,and the correlations of all cognitive domains scores.Results A total of 169 patients with ischemic stroke were enrolled in the study.There were 80 patients in the cognitive impairment group and 89 in the non-cognitive impairment group; 34 patients had CMBs and 135 had no CMBs.The age was older (71.99 ±6.01 years vs.64.47 ±6.15 years; t =8.014,P =0.000),years of education were fewer (4.51 ± 1.534 years vs.6.94 ±2.357 years; t =8.023,P =0.000),systolic blood pressure was higher (156.19± 17.53 mm Hg vs.142.04± 16.03 mmHg,1 mmHg=0.133 kPa; t =5.479,P =0.000),scale of white matter lesion was higher (7.33 ± 2.04 vs.4.39 ± 2.17; t =8.951,P =0.000),cerebral infarction volume was larger (7 123.8 ± 1 587.1 mm3vs.5 628.4 ± 1 017.8 mm3;t =7.201 ; P =0.000),proportion of the patients with history of previous stroke or transient ischemic attack was higher (46.2％ vs.28.1％;x2 =5.982; P=0.014),and number of CBMs was larger (x2 =17.565; P=0.000) in the cognitive impairment group.Multivariate logistic regression analysis showed that the age (odds ratio [OR] 1.115,95％ confidence interval [CI] 1.013-1.227; P =0.026),years of education (OR 0.490,95％ CI0.325-0.793; P=0.001),systolic blood pressure (OR 1.048,95％ CI 1.014-1.083; P =0.005),scale of white matter lesion (OR 2.044,95％ CI 1.466-2.851; P =0.000),and cerebral infarction volume (OR 2.204,95％ CI 1.386-3.503; P =0.001) were all the independent risk factors for cognitive impairment in patients with ischemic stroke.Compared to the non-CBM group,the age was older (72.06 ± 5.59 years vs.67.01 ±7.15 years; t =4.427; P =0.000),years of education were fewer (3.97 ± 1.381 years vs.6.25 ±2.317 years; t =7.367,P =0.000),systolic blood pressure was higher (155.03 ±20.16 mm Hgvs.147.16 ±17.32 mm Hg; t =2.290,P =0.023),scale of white matter lesion was more higher (7.03 ±2.139 vs.5.47 ±2.591; t =3.247,P =0.001),cerebral infarction volume was larger (6 968.5 ± 1 507.4 mm3 vs.6 177.0 ±1 477.1 mm3; t =2.735,P =0.007),and proportions of hypertension (82.4％ vs.41.5％ ;x2 =18.149,P =0.000),hyperlipidemia (88.2％ vs.39.3 ％ ;x2 =26.067,P =0.000),history of previous stroke or transient ischemic attack (70.6％ vs.28.1％ ;x2 =21.061,P =0.000) and coronary heart disease (94.1％ vs.45.2％ ;x2 =26.278,P=0.000) were higher in the CBM group.The MoCA total score (M[Q1 ～ Q3]; 24 [24 ～25]vs.28 [27 ～ 28] ; Z =-7.092,P =0.000) as well as the scores of attention (6 [5 ～ 6] vs.6 [6 ～ 6] ; Z =-2.502,P =0.012),abstraction (2[1 ～2] vs.2[2 ～2] ; Z =-2.382,P =0.017) and visuoexecutive (2[1 ～2] vs.4[4 ～5]; Z=-7.321,P=0.000) in the CMB group were significantly lower than those in the nonCBM group.The Spearman rank correlation analysis showed that the CMB grade was negatively associated with the MoCA total score (rs =-0.879,P =0.000) as well as the scores of visuoexecutive (rs =-0.895,P =0.000),attention (rs =-0.337,P =0.005),and abstraction (rs =-0.333,P=0.006).Conclusions The age,years of education,systolic blood pressure,degree of white matter damage,and cerebral infarction volume are the risk factors for vascular cognitive impairment.The visuospatial executive dysfunction,attention and abstract thinking decline significantly in ischemic stroke patients with CBMs.CMBs and their numbers are closely associated with cognitive impairment.The more the CMB numbers are,the more obvious the cognitive impairment will be.