Compared with proinflammatory processes in the development of type 2 diabetes,our knowledge on anti-inflammatory cytokines is rather limited.Anti-inflammatory cytokines such as adiponectin,interleukin 1 receptor antagonist(IL-1RA),transforming growth factor-β1 (TGF-β1),growth differentiation factor-15 (GDF-15),omentin,and secreted frizzled-related protein 5 (SFRP5) are strongly associated with increased risk of type 2 diabetes:Adiponectin and omentin levels decreased before type 2 diabetes,in contrast,concentrations of IL-1RA,TGF-β1,GDF-15 are increased.Change of SFRP5 levels in impaired glucose tolerance and type 2 diabetes remains controversial.This paper will summarize and recommend studies that investigated associations between circulating levels of anti-inflammatory cytokines and type 2 diabetes.

Objective To build high availability cluster using VMware to improve availability of hospital information system.Methods Virtual machines were installed in VMware server to act as backup servers.High availability software continuously detected status of physical servers using heartbeat signals.Results When physical servers failed,high availability cluster switched services automatically.The business switched to virtual machine quickly and smoothly.Conclusion High availability cluster based on VMware can improve HIS availability and lower implementation costs effectively.

Based on vector auto-regression (VAR) model, this paper takes advantage of Granger causality test, variance decomposition and impulse response analysis techniques to carry out a comprehensive study of the factors influencing the price of Chinese herbal, including herbal cultivation costs, acreage, natural disasters, the residents' needs and inflation. The study found that there is Granger causality relationship between inflation and herbal prices, cultivation costs and herbal prices. And in the total variance analysis of Chinese herbal and medicine price index, the largest contribution to it is from its own fluctuations, followed by the cultivation costs and inflation.
Agriculture ; economics ; Commerce ; Costs and Cost Analysis ; Drugs, Chinese Herbal ; economics ; Humans ; Models, Statistical ; Plants, Medicinal ; growth & development ; Regression Analysis

Objective To investigate the delivery mode of pregnant women with prior cesarean section in Northern China,and their clinical characteristics.Methods A multi-center observational study of 1 068 women who had prior cesarean delivery in 24 medical centers in Northern China was conducted between December 2013 and May 2014.The clinical data,including general condition,antenatal examination results,delivery mode,and maternal and fetal outcomes,were collected and compared between vaginal delivery and cesarean section.Mann-Whitney U test and Chi-square test were used for statistical analysis.Results The median age of the 1 068 women were 32 years (range,18-45 years).Thirty-seven (3.5％) had a history of prior vaginal delivery.There were seven twin pregnancies and all delivered by cesarean section.Thirty-five women had suspected uterine rupture and underwent cesarean section,but were confirmed without uterine rupture during the operation.There was no maternal and fetal/neonatal death.Of the 1 068 women,43(4.0％) had successful vaginal birth and 1 025 (96.0％) underwent repeat cesarean sections.Compared with cesarean section group,vaginal delivery group tended to have a greater thickness of the lower uterine segment in the third trimester as shown by ultrasound [(3.3 ± 0.9) vs (2.9± 1.1) mm,Z=-2.240,P=0.025],a higher percentage of prior vaginal delivery [16.2％(6/37) vs 4.6％(31/673),x2=9.570,P=0.009],a lower rate of regular antenatal examination [58A％(25/43) vs 73.2％(742/1 0t3),x2=4.737,P=0.026],a shorter hospital stay[(3.7±2.4) vs (5.9±3.8) d,Z=-6.043,P=0.000],and lower 1-min Apgar score (9.1 ±2.2 vs 9.9±3.9,Z=-2.410,P=0.016),but without difference in the 5-min Apgar score (9.9±0.4 vs 9.6± 1.3,Z=-0.947,P=0.344).Conclusions Rate of vaginal delivery for women with prior cesarean section in Northern China is low.Vaginal birth with prior cesarean section is relatively safe,especially for those with a previous history of vaginal delivery.

Objective To improve the diagnosis and treatment of sliding hernia of adult urinary bladder. Methods Clinical data of 32 cases of adult sliding hernia of the bladder from 1984 to 2009 were analyzed retrospectively. Discomfort was complained in all the 32 patients along with palpable mass. Twentynine cases suffered from urgency of micturition, ascheturesis and dysuria, 15 cases had interruption of urination. The mass was saddle-shaped in 29 cases, when the bladder was filling. In all the 32 cases of hernia block were in a sense of fluctuations and flat on percussion. In 26 cases the bladder appeared a dumbbell-shaped image on cystography. By B-ultrasonic examination an opaque dark area of fluid was detected in 29 cases when there was retention of urine. Results Preoperatively 29 cases were diagnosed of bladder sliding hernia, 3 cases with misdiagnosis ( misdiagnosis rate of 9.4% ). 32 cases were cured by surgical treatment. The prolapsed portion of the bladder including stones in 2 cases were resected. 32 cases were followed up from 1 to 5 years without recurrence. Conclusions Once the sliding hernia of the bladder is diagnosed, patient should receive surgery. Intraoperatively the key of preventing inadvertent cut or missed diagnosis is familiar with pathological anatomy and careful exploration.

OBJECTIVEWe used functional magnetic resonance imaging (fMRI) to explore the effects of noxious coldness and non-noxious warmth on the magnitude of cerebral cortex activation during intraoral stimulation with water.

METHODSSix male and female subjects were subjected to whole-brain fMRI during the phasic delivery of non-noxious hot (23 °C) and no- xious cold (4 °C) water intraoral stimulation. A block-design blood oxygenation level-dependent fMRI scan covering the entire brain was also carried out.

RESULTSThe activated cortical areas were as follows: left pre-/post-central gyrus, insula/operculum, anterior cingulate cortex (ACC), orbital frontal cortex (OFC), midbrain red nucleus, and thalamus. The activated cortical areas under cold condition were as follows: left occipital lobe, premotor cortex/Brodmann area (BA) 6, right motor language area BA44, lingual gyrus, parietal lobule (BA7, 40), and primary somatosensory cortex S I. Comparisons of the regional cerebral blood flow response magnitude were made among stereotactically concordant brain regions that showed significant responses under the two conditions of this study. Compared with non-noxious warmth, more regions were activated in noxious coldness, and the magnitude of activation in areas produced after non-noxious warm stimulation significantly increased. However, ACC only significantly increased the magnitude of activation under noxious coldness stimulation.

CONCLUSIONResults suggested that a similar network of regions was activated common to the perception of pain and no-pain produced by either non-noxious warmth or noxious coldness stimulation. Non-noxious warmth also activated more brain regions and significantly increased the response magnitude of cerebral-cortex activation compared with noxious coldness. Noxious coldness stimulation further significantly increased the magnitude of activation in ACC areas compared with noxious warmth.

To investigate the effects of didannsine(ddI)on the morphological alterations of dorsal root ganglion(DRG)neurons,dissoci-ated DRG cells from rat embryo were studied.DRG cells were cultured for 3 days and then treated with ddI for additional 3 claysin differ-ent concentrations(1μg/ml,5 μg/ml,10μg/ml and 20 μg/ml,respectively).Afarthat,DRG cells were processedformicrotubule as-soeiated protein 2(MAP2)labeling and observed under confocal laser scanning microscopy(CLSM).The results showed that both thenumber and length of neurites of the DRG cells after exposed to ddl significantly down-regulated in a dose-dependentmanner compared withcontrol group,thus suggesting that ddI may have inhibitory effects on neufite regeneration and outgrowth in dissociated DRG cultures.

Objective To evaluate the value of endothelial function of brachial artery in predicting coronary artery disease in elderly patients. Methods Flow-mediated vasodilation (FMD)and nitroglycerin mediated dilation (NMD) were measured by high-frequency ultrasound in 98 patients with coronary artery disease and 37 controls. All the subjects were diagnosed by coronary arteriography. They were divided into coronary artery blockages ＜ 50% subgroup, 50%-75%subgroup, ＞75% subgroup or coronary blockages in 0, 1, 2, 3 branch (es) subgroups. The correlations between FMD or NMD and the pathological extent or branches of coronary artery were studied and the predictive value of FMD and NMD were analyzed with ROC curve. Results In coronary artery disease group, FMD and NMD were significantly decreased as compared with the control group. They were closely related with coronary artery disease (r= -0. 54, -0. 52, P＜0.01), and were weakly correlated with severity and range of coronary arterial lesion (P＜0. 01).With ROC curve analysis, FMD and NMD could be used to predict coronary artery disease.Conclusions Endothelial function can be used as an index to predict coronary artery disease.

Objective To investigate the relationship between inflammatory factors,including C-reactive protein( CRP),tumor necrosis factor alpha (TNF-α),adiponectin,leptin and gestational diabetes mellitus (GDM) and their changes in puerperiunr Methods From June 2008 to May 2010,40 cases with gestational diabetes mellitus,40 cases of normal pregnancy were enrolled in this study.Fasting venous blood were obtained at early pregnancy (10 - 12 weeks),late pregnancy (36 -38 weeks) and day 3 and 42 of postpartum.Serumal adiponectin,leptin and TNF-α were measured by ELISA,and serumal CRP were measured by particle enhanced immunoturbidimetric method.The levels of those 4 cytokines and homeostasis model assessment insulin resistance (HOMA-IR) index were compared between two groups.And the changes of 4 cytokines were calculated in puerperium.The receiver operating characteristic (ROC) for TNF-α predicting GDM was designed.Results ( 1 ) The relationship between cytokines and HOMA-IR:the levels of adiponectin of (5.7 ± 1.8 ) mg/L in the GDM group were significantly lower than ( 8.1 ± 2.7 ) mg/L in control group in early pregnancy,and the level of adiponectin was negatively correlated with HOMA-IR (r=-0.333,P＜0.05).The levels of (28 ± 10) μg/L of leptin,( 10.0 ±3.4) ng/L of TNF-α and (4.7 ± 1.1 ) mg/L of CRP in GDM group were significantly higher than ( 20 ± 8 ) μ,g/L of leptin,(4.6 ±2.7) ng/L of TNF-α,(2.4 ± 1.2 ) mg/L of CRP in control group,which were positively correlated with HOMA-IR ( r =0.411,0.529,0.308,all P ＜ 0.05 ).In late pregnancy,the level of adiponectin ( 3.9 ±2.2) mg/L in the GDM group was significantly lower than ( 6.6 ± 2.7 ) mg/L in control group,and the level of adiponectin was negatively correlated with HOMA-IR ( r =- 0.344,P ＜ 0.05 ).The levels of ( 37 ±13) μg/L of leptin,( 12.7 ±2.6) ng/L of TNF-α and (6.7 ±3.6) mg/L of CRP in the GDM group were significantly higher than ( 30 ± 13 ) μg/L of leptin,(5.8 ± 2.1 ) ng/L of TNF-α,( 4.4 ± 3.1 ) mg/L of CRP in control group,which were positively correlated with HOMA-IR (r =0.414,0.487,0.285,all P ＜0.05).Multiple linear regression analysis showed that the level of TNF-α at early and late pregnancy was most correlated with HOMA-IR ( r =0.390,0.284,all P ＜ 0.05 ).( 2 ) The level of the cytokines and HOMA-IR in puerperium:at day 3 of postpartum,the level of adiponectin of (3.3 ± 1.1) mg/L in the GDM group was significantly lower than (6.2 ± 1.5 ) mg/L in control group,which was negatively correlated with HOMA-1R (r =- 0.283,P ＜ 0.05 ).The levels of ( 31 ± 13 ) μg/L of leptin,( 10.1 ± 5.7 ) ng/L of TNF-α and (35.1 ±6.5) mg/L of CRP in the GDM group were significantly higher than (21 ± 15) μg/L of leptin,(5.6 ± 3.0) ng/L of TNF-α,(30.5 ± 8.5) mg/L of CRP in control group.And leptin and TNF-α levels were positively correlated with HOMA-IR (r=0.372,0.494,all P ＜0.05).At day 42 of postpartum,the level of adiponectin in GDM group was negatively correlated with HOMA-IR ( r =- 0.299,P ＜ 0.05 ),and the levels of leptin and TNF-α were positively correlated with HOMA-IR ( r =0.401,0.442,all P ＜0.05 ).Multiple linear regression analysis showed that the level of TNF-αt at day 3 and day 42 was most correlated with HOMA-IR ( r =0.363,0.274,all P ＜ 0.05 ).( 3 ) ROC analysis of data from early pregnancy showed that the threshold for TNF-α to predict GDM was 5.45 ug/L.Conclusion TNF-ot might be the index to predict GDM and evaluate prognosis.

Objective To analyze the negative experience from medical practice of medical students by Balint group case study,and to explore new approach for training doctor-patient communication skills.Methods 10 times of Balint group activities were held in Zhongshan Hospital of Fudan University,with one case each time.Grounded theory approach were applied for analyzing discussion record.Results The cases were occurred in doctor-patient interaction,teamwork,conflict between one's personal life and vocational development planning.Trigger events involved doctor-patient conflict,conflict of values,decision making problem while conffronted with incurable patients,role ambiguity,unfair treatment.Topics of discussion included emotional experience with patients,career development orientation,medical teamwork,clinical education of medical student.Conclusion Through practice of Balint group,medical students in teaching hospital can improve their awareness of complicating psycho-social problem of patients and themselves,as well as handling it.And it can improve the professional identity,professional growth and professional self-identity.