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.

Objective To compare effects of compound Xueshuantong capsule and benazepril on inflammatory cyto-kines in type 2 diabetic patients with early diabetic nephropathy (DN), and its therapeutic mechanism thereof. Methods Ninety-four patients with type 2 diabetes were divided into diabetes without albuminuria group (DM,n=24) and early DN group (DN,n=70). DN group was then divided into three subgroups:group A (n=24) treated by benazepril alone, group B (n=22) treated by compound Xueshuantong capsule and group C (n=24) treated by compound Xueshuantong capsule combined with benazepril for 3 months. Levels of fasting blood glucose, glycosylated hemoglobin, serum creatinine, blood urea nitro-gen, lipid profiles, fibrinogen and urinary albumin excretion rate (UAER) were examined before and after treatment. The se-rum levels of hypersensitive c-reactive protein (hs-CRP), interleukin-6 (IL-6) and tumor necrosis factor-α(TNF-α) were determined as well. Results The serum levels of hs-CRP, IL-6 and TNF-αwere significantly higher in DN group than those of DM group (P<0.01). After treatment, the serum levels of UAER, hs-CRP, IL-6 and TNF-αwere significantly re-duced in groups A, B and C compared with those before treatment (P<0.01), and which were decreased more significantly in group C. The levels of blood lipids and fibrinogen decreased obviously in group C compared with those of group A and B ( P<0.01). Conclusion Compound Xueshuantong capsule combined with benazepril not only can improve the blood fat and high coagulation state in patients, but also impossibly retard the development of early DN through decreasing serum concen-trations of hs-CRP, IL-6 and TNF-αand inhibiting inflammatory reaction.

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 influence of the expression of retinoic acid receptor genes on the development of B cells in lymph nodes of young children. Method: In situ hybridization was performed on the frozen section of lymph node of young children (≤age 5 ). Six digoxin labeled antisense RNA probes for retinoic acid receptors mRNA(RAR?、?、?、RXR?、?、?)were used. The expression and distribution of retinoic acid receptor genes in lymph nodes and their influence on the differentiation and maturation of B cell were observed. RT-fluorescent PCR was also used to observe the expression levels of retinoic acid receptor genes and their relation to the maturation of B cells. Results: In situ hybridization showed all the 6 retinoic acid receptor genes were expressed in lymphocytes and reticular cells of lymph node, and the distribution was widespread. RT fluorescent PCR also showed a varying expression of 6 retinoic acid receptor genes in lymph node among different age children, but lower in children younger than 1 year, and then increased gradually with the development of immune system. Conclusion: The expression and regulation of retinoic acid receptor genes may take part in the ontogenesis of B cells, and play a key role in the regulation of retinoic acid and enforce the anti-infective immunity in children.

Objective:To explore the effect of autoimmune regulator to TLRs expressions on peripheral antigen presenting cells(APC).Methods:①pEGFPC3-AIRE plasmid was transfected with liposome.②Confocal microscopy was used to observe the effect of transfection.③RT-PCR assay was used to detect the expressions of AIRE and TLR1-9 in RAW264.7cells at 36,48,72,96 h after transfection.Results:①The plasmid was transfected into RAW264.7 cells successfully,and the efficiency of transfection was 60~70%.②AIRE transfected RAW264.7 cells were achieved,and the best time was 72 h.③At 72 h after transfection,the expressions of TLR1,4,5,9 increased,and TLR3,7,8 reduced.The expression of TLR2,6 increased at 96 h.Conclusion:AIRE may regulate the immune response by control TLR expression in APC.It maintain the effective response to pathogen and tolerance state to self tissues through the effects to different TLRs.

40 cm H 2O (1 cm H 2O=0.098 kPa) in 4.Among the 5 children without urinary complaints,2 had detrusor hyperreflexia,2 had detrusor-sphincter dyssynergia,and 1 was generally normal.Postoperatively the improvement of urinary incontinence rate was greater in patients with primary TCS (28.6%,8/28) than those with secondary TCS (0%,0/7;P=0.048). It was greater in patients with non-lipoma TCS (100%,3/3) than those with lipoma TCS ( 15.6%,5/32;P=0.004).It was greater in patients with meningocele TCS (36.4%,8/22) than those with myelomeningocele TCS(0%,0/6;P=0.047).It was greater in patients born without urological symptoms (80%,4/5) than those born with urological symptoms(17.4%,4/23;P=0.019).Urodynamic studies also showed the incidence of detrusor hyperreflexia after surgery was lower in primary TCS (24.2%,8/32) than in secondary TCS(71.4%,5/7;P=0.015);the incidence of detrusor underactivity was lower in non-lipoma TCS (12.5%,1/8) than in lipoma TCS(56.3%,18/32;P=0.027);decreased compliance rate was lower in meningocele TCS than in myelomeningocele TCS(100%,6/6;P=0.0052).The rates of detrusor hyperreflexia,decreased compliance and detrusor underactivity postoperatively were lower in those born without urinary symptoms (0,0/10;20%,2/10;20%,2/10) than in those with (34.89%,8/23;60.9%,14/23; 65.2%,15/23;P=0.032,P=0.031,P=0.017, respectively). Conclusions Urodynamic examinations are effective in evaluating the lower urinary tract function in children with TCS after surgery.Patients with TCS have various abnormal urodynamic findings.Pathological types of TCS and the presence of symptoms at birth influence urinary function after surgery.

Objective: To investigate the effect of retinoic acid on the differentiation and development of B lymphocytes, and explore the mechanism of vitaminA in increasing the production of antibodies. Method: In vitro cultured cells from children’s normal mesentery lymph nodes, before and after administration of retinoic acid or retinoic acid antagonist, the changes of cell surface markers were analyzed by flowcytometry to observe the differentiation and maturation of B cells. Results: During culture in vitro, the percent of mature CD19+IgM+ B cells increased and relatively immature CD19+IgM- B cells decreased gradually, and the changes were especially obvious at 48 h. The administration of retinoic acid further increased the percent of CD19+IgM+ B cells, and the enhancement was markedly at 24 and 48 h (P