Nowadays,aging is the general trend of population development in the world.Type 2 diabetes is one of the most common chronic diseases in the elderly.Because of the atypical symptoms and signs,accompaniment of chronic cardiovascular disease and vulnerability to low blood glucose in the elder patients with diabetes,we should to make safe,effective,and individualized therapeutic programs for them.This paper will review the current prevalence,characteristics,and oral drug selection among elderly individuals with T2DM.

Objective:To investigate the clinical efficacy and safety of PCNL with the use of different percutaneous renal access in treatment of renal calculi.Methods:Percutaneous renal minimal access(F14～F16)or small access(F18～F20)was established randomly in 142 patients,and PCNL were performed in all patients.The clinical parameters including operative time,complication and stone-free rate were compared in the two groups.Results:The operative time of simple renal calculi were(78.3?15.6)min and(91.2? 18.2)min(P0.05)in small access group and minimal access group respectively.The operative time of complicated renal calculi were(115.3?20.1)min and(130.7?28.7)min(P

The main reason of recurrence and metastasis in breast cancer is the resistance for the radiotherapy and chemotherapy,and the mechanism of radio-resistance and chemo-resistance may be related to the DNA damage response (DDR).There is a complicated system of the DDR pathway,including cell cycle checkpoint,DNA repair,transcription and apoptosis to maintain the integrity of cell genes.In the cancer treatment,DDR occurs in various kinds of cytotoxic drugs and radiation to cause genetic damage,which limits the curative effect of chemotherapy and radiotherapy.This promotes the targeted therapy of DDR pathway,especially checkpoint kinase 1 (CHK1).Recently,the new viewpoint supports that CHK1 is a main marker of the DDR pathway activation,which shows that CHK1 not only activates the check point but also affects the DNA repair and apoptosis directly.Thus,the role of CHK1 in DDR will promote CHK1 inhibitor to be one of the new treatment strategies for the cancer patients who resist the radiation and chemotherapy.

Calculi ; chemically induced ; Ceftriaxone ; adverse effects ; Child ; Humans ; Lithiasis ; chemically induced

Abnormalities, Multiple ; diagnosis ; pathology ; physiopathology ; Branchio-Oto-Renal Syndrome ; diagnosis ; pathology ; physiopathology ; therapy ; Child ; Deafness ; etiology ; physiopathology ; Diagnosis, Differential ; Ear ; abnormalities ; Female ; Humans ; Kidney ; abnormalities ; Renal Insufficiency ; etiology ; physiopathology ; therapy

The rapid cooling contracture in myocardial protection is getting more and more attention. Rapid cooling contracture is referred to as the undepolarized myocardial contracture induced by rapid cooling, which is related with the sudden increase of Ca2+. The Ca2+ released from sarcoplasmic reticulum subsequently causes myocardial contracture through the myofilaments sliding. Its deleterious effects include: more energy consumption, impaired cardiac function, Ca2+ overload, et al. And some investigators have put forward some principals to prevent the bad influences of rapid cooling contracture.

Objective To get new more sensitive signs reflecting cartilage degeneration,which were added to the present ARA differential criteria of knee osteoarthritis and to compare the sensitivity and specificity before and after new items.Methods Through review analysis of the clinical feature,radiography and operative presentation of 115 adult patients,the new signs reflecting cartilage degeneration as items were found,which were added to the present ARA differential criteria of knee osteoarthritis as new criteria.Then the 112 patients who have received either knee joint replacement or arthroscopy were re diagnosed with both the present ARA criteria and the new criteria.Sensitivity and specificity were calculated and compared.Results "Extensive knee joint tenderness" with cartilage degradation and "lockage on motion or a positive Apler test" were significantly related to the meniscus degradation.A 39 7% sensitivity of these patients was obtained using the present ARA clinical criteria,while it reached 70 6% using the new clinical criteria ( P 0 05).Conclusion The two new items added to the present ARA criteria help to increase the sensitivity for diagnosis of knee osteoarthritis without influence on the specificity.

Sepsis and septic shock are common critical diseases in the ICU, which have a high mortality and seriously affect the patients'' quality of life.The pathogenesis of sepsis is very complicated and involves the changes in the functions of multiple systems and organs.Recently, the investigation into the potential mechanisms underlying the development of sepsis is becoming a hotspot all over the world.The author presents an overview on the advances in the studies of the pathogenesis of sepsis, relating to the imbalance of inflammatory response, immune dysfunction, abnormal blood coagulation, nerve-endocrine-immunity network, mitochondrial function damage, endoplasmic reticulum stress, autophagy, and genetic polymorphism, in order to provide some theoretical evidence for the prevention and treatment of sepsis in clinical practice.

Objective To discuss the ways to train qualified clinical engineers,and thereby to enhance the teamwork of clinical engineers.Methods The problems in training the clinical engineer were pointed out in training mode,knowledge reserve,innovation and etc,and some countermeasures were put forward accordingly.Results The countermeasures were proposed from the aspects of basic theoretical system,continuing education system,self-adaptive working mode,enhanced communication and etc.Conclusion The clinical engineer needs to utilize their own advantages to elevate their personal qualities and raise their profiles so as to meet the requirements of social and technological development.

Objective To investigate the balance between matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs) in the lung tissue in a rat model of ventilator-induced lung injury. Methods Thirty healthy male SD rats weighing 200-250g were randomly divided into 3 groups( n = 10 each) : group A spontaneous breathing; group B small tidal volume (VT = 7 ml?kg-1, RR = 40 bpm, FiO2=0.21) and group C large tidal volume (VT = 40 ml?kg-1, RR = 20 bpm, FiO2=0.21). The animals were mechanically ventilated for 4 h in group B and C. The lung injury was assessed by measurement of PaO2 /FiO2 . At the end of the experiment the animals were killed and the lungs were removed. The right lung was used for determination of the expression of mRNAs of MMP-2, MMP-9, TIMP-1 and TTMP-2 using RT-PCR and histologic examination. The left lung was weighed and then lavaged. The broncho-alveolar lavage fluid (BALF) was collected for total WBC and neutrophil counts and determination of total protein content and gelatinase activity. After lavage the left lung was heated at 60℃. The W/D lung weight ratio was calculated. Results PaO2/FiO2 was significantly lower after 4h mechanical ventilation in group C than in group A and B. The total WBC count and total protein content in BALF were significantly higher in group C than in group A and B. The W/D ratio of the left lung was significantly higher in group C than in group A and B. Microscopic examination showed that there were marked WBC infiltration and destructive changes of alveolar walls in group C. The levels of gelatinase (MMP-2 and MMP-9) activities in BALF were significantly higher in group C than in group A and B. The expression of the mRNA of MMP-2 and MMP-9 was significantly higher in group C than in group A and B, but there was no significant difference in the expression of the mRNA of TIMP-1 and TIMP-2 between group C and group A and B. Conclusion Large tidal volume ventilation can induce acute lung injury. MMP-2 and MMP-9 play an important role in the development of ventilator induced lung injury and the imbalance between MMPs and TIMPs contributes to the mechanism of ventilator-induced lung injury.