Objective To observe the clinical efficacy of different kinds of insulin combined with Metformin in the treatment of T2DM.Methods 120 T2DM patients were selected and divided into three groups according to different therapies of reducing blood sugar with 40 cases in each group.Group A was treated with insulin glargine combined with Metformin;Group B with insulin detemir combined with Metformin and Group C with protamine zinc insulin combined with Metformin .The time for reaching the standards of blood sugar and the corresponding usage amount of insulin of three groups were observed;After 6 months, the three groups were com-pared in terms of FBG, PBG HbA1c, HOMA-IR, TC, TG and LDL-C.Meanwhile, the incidence rate of hypoglycemia after treat-ment was observed.Results Time for reaching the standards of blood sugar in Group A, Group B and Group C was (6.9 ±2.3)d, (4.1 ±3.0)d and (3.8 ±1.5)d, respectively;the corresponding dosages of insulin of the three groups was (19.0 ±7.8)U, (12.1 ±5.9)U and (11.9 ±5.3)U, respectively, with significant difference between Group A and Groups C, D (p<0.05) and insignifi-cant difference between Group B and Group C (p>0.05).After 6 months, FBG, PBG, HbA1c, HOMA-IR in Group B, Group C and Group A were significantly reduced (p<0.05);with insignificance between Group B and Group C (p>0.05).6 months follow-ing the treatment, TC, TG and LDL-C in Group B, Group C and Group A were significantly different (p<0.05), with insignificant difference between Group B and Group C (p<0.05).The incidence rate of hypoglycemia in Group A, Group B and Group C was 22.5%, 20.0% and 5.0%, respectively, with those in Group B and Group C significantly lower than Group A (p<0.05) and in-significant difference between Group B and Group C (p>0.05).Conclusion The insulin detemir and protamine zinc insulin com-bined with Metformin has a better clinical efficacy in the treatment of T2DM.It can promptly control the blood sugar level and lead to a lower incidence rate of hypoglycemia.Therefore it is worthy of promotion.

Objective To explore the relationship of neutrophil and interleukin-8(IL-8)with exercise-induced asthma(EIA).Methods From May 15,2001 to Dec 19.2005 the levels of peripheral neutrophil superoxide anion and IL-8 in the blood and the induced sputum from patients with EIA,non EIA and normal control subjects were measured respectively before and after exercises,meanwhile a comparison was made among them.Results Before exercise:the level of neutrophil superoxide anion was slightly higher in EIA group and non EIA group than that in control group;however,the differences were insignificant;the IL-8 and MDA levels in blood and induced sputum were higher in EIA group and non EIA group than those in control group,but there was no significant difference between EIA group and non EIA group;however,they were significantly different between EIA group and control group,non EIA group and control group respectively( P 0.05).Conclusion Oxyradical produced by neutrophil and IL-8 has significant effect on the production of EIA.

Objective To study the interference effects of tetramethylpyrazine (TMP) on calcinuerin (CaN), c-fos and the nuclear antigen of proliferating cells in the proliferation of vascular smooth muscle cells (VSMCs) treated by angiotensinⅡ(Ang Ⅱ). Methods A cell proliferating model of VSMCs induced by Ang Ⅱ was established; the effects of TMP on CaN was detected by enzyme reaction phosphorus measurement; the effects of TMP on c-fos gene and PCNA expression were observed by immunocytochemical staining and image analysis technique (A value). Results The rats’ aortic smooth muscle cells were cultured in vitro successfully. CaN activities, cell proliferation activity and the expression levels of c-fos and PCNA increased significantly in VSMCs proliferation induced by Ang Ⅱ (P

0.05). The BHR distribution was slight 31.9%, mild 43.5%, moderate 24.6%, no severe BHR were found in this study, showing less correlation between the percentage of predicted FEV 1 and the PD 20FEV 1-His in the elderly (r=0.277, P

Objective To investigate the difficulties in posterior approach lumbar microendoscopic discectomy (MED). Methods We retrospectively analyzed records of 42 cases of lumbar disc protrusion (totally 45 interspaces) treated by MED from February 2002 to October 2003. Results Conversion to open surgery was required in 3 cases.No intra- or post- operative complications were seen.Follow-up survey for 2 ～ 22 months (mean,8 months) found the "good" or "excellent" results in 95 2% of the patients (40/42).Surgical difficulties were mainly classified into two aspects: technical and etiological,including 8 cases of failure of collimation between the passage and the interspace,5 cases of excessive bleeding disturbing the operation,3 cases of incomplete surgical apparatus,2 cases of incorrect passage localization,2 cases of hyperplasia in tiny joints,1 case of ossification of the posterior longitudinal ligament,1 case of nerve root edema,1 case of accretion,and 1 case of laceration,respectively. Conclusions Treatment of lumbar disc protrusion with MED gives satisfactory efficacy.Proper selection of patients and careful performance during surgery are essential to a successful procedure.

The clinical skills competitions for national medical students in China have been well organized for five times.Experience has been accumulated,and much has been emphasized on the low assessment efficacy throughout the competitions.However,few solutions has been brought about to conquer such problem.This article mainly focused on introducing a computerized clinical skill assessment system based on current clinical skills competition assessment.The system realizes functions such as team management,online marking,score calculation,data analysis,and real-time result presentation.Such appliance of computer,internet and information technology on conventional clinical skills evaluation could hopefully replace the traditional manual calculating procedures,improving the efficiency of the future competitions,to ensure their openness,impartiality,and equitability,as well as to deliver observatory appeal among audience.

Objective To discuss the application of role reversal teaching in the clinical course of rehabilitation medicine. Methods 64 students of a vocational college under clinical practice were divided into traditional teaching group (n=30) and role reversal teaching group (n=34). The achievement of knowledge and practice tests were compared after course. Results There was no significant difference in the score of knowledge test between the groups before clinical practice (P>0.05), however, the scores of both knowledge and practice tests were higher in the role reversal teaching group than in the traditional teaching group (P<0.001). Conclusion The role reversal teaching may improve the achievement of students for clinical course of rehabilitation medicine.

Objective To observe the effect of TanshinoneⅡA( TanⅡA) on endometriosis( EMS) rat model and study the possible mechanism. Methods EMS rat model was established by autologous endometrium transplantation. EMS rats were randomly divided into five groups: high-, medium-, low-dose TanⅡA group, mifepristone group and model control group( n=10), the other ten normal rats as normal control group.The rats in the model control group and normal control group were given 0.9% sodium chloride solution. The rats in the mifepristone group were given 25 mg . kg-1 . d-1 mifepristone. The rats in the high-, medium-, low-dose TanⅡA groups were given 30, 20 and 10 mg.kg-1.d-1 TanⅡA, respectively.Four weeks after the treatment, the volume of endometriotic implants in each rat was measured. Pathological changes of ectopic endometrium were observed under light microscope.Expression levels of Bcl-2, Bax and Caspase-9 in ectopic endomembrane of rats were determined by Western blotting. Results High and medium dose TanⅡA and mifepristone significantly reduced the volume of ectopic lesions(P<0.05).As compared with model control group, the inhibition rate of the ectopic lesions in low-, medium-, high-dose TanⅡA groups and mifepristone group was 17.81%, 57.78%, 58.88% and 64.12%, respectively.High and medium dose TanⅡA and mifepristone promoted atrophy of ectopic endometrium, inhibited the expression of Bcl-2 protein and promoted the expression of Bax and Caspase-9 in ectopic tissues( P<0.05) . Conclusion TanⅡA significantly decreases the size of ectopic lesions in rats, possibly through reducing the expression of Bcl-2 and increasing the expression of Bax and Caspase-9 to regulate cell apoptosis.

OBJECTIVE:To investigate therapeutic efficacy of bifidobacteria triple viable bacteria combined with infliximab in the treatment of moderate and severe ulcerative colitis(UC),and its effects on immune function. METHODS:Seventy-two UC pa-tients were selected from gastroenterology department of the First Affiliated Hospital of Chongqing Medical University during Jun. 2009 to Jan. 2015. They was divided into single group and combination group according to therapy plan,with 36 cases in each group. Single group was given infliximab 5 mg/kg,ivgtt,on 0,2nd,6th,8th week. Combination group was additionally given bi-fidobacteria triple viable bacteria 420 mg,tid. Both groups were treated for consercutive 2 months. Clinical efficacies were com-pared between 2 groups as well as the levels of humoral immunity and T cell function. The occurrence of ADR was observed in 2 groups. RESULTS:Clinical response rate of combination group was 86.11%,which was significantly higher than 52.78% of single group,with statistical significance (P<0.05). Before treatment,there was no statistical significance in humoral immunity and T cell function between 2 groups(P>0.05). After treatment,the levels of CD4+ and CD4+/CD8+ were significantly increased in both 2 groups,while the levels of CD8+,Th1 and Th2 were significantly decreased;the combination group was significantly better than the control group,with statistical significance (P<0.05);there was no statistical significance in CD3+ between 2 groups before and after treatment(P>0.05). After treatment,the levels of IgA and IgG were increased significantly in 2 groups,and the level of C3 was decreased significantly;the combination group was significantly better than the control group,with statistical significance (P<0.05);there was no statistical significance in IgM content and C4 level between 2 groups before and after treatment (P>0.05). There was no statistical significance in the incidence of ADR between 2 groups(P>0.05). CONCLUSIONS:Bifidobacteria triple viable bacteria combined with infliximab shows significant therapeutic efficacy in the treatment of moderate and severe UC, and can significantly improve humoral immunity function and the recovery of T cell level,with good safety.

Objective To studythe efficacy of levosimendan in treating refractory heart failure complicating severe renal in sufficiency.Methods Sixty-seven cases of refractory heart failure complicating severe renal insufficiency in the internal medicine department of our hospital were randomly divided into the levosimendan treatment group(L group,n=33)and dopamine treatment group(D group,n=34).The changes of N-terminal pro-B-type natriuretic peptide(NT-pro-BNP),left ventricular ejection fraction (LVEF)and glomerular filtration rate(GFR)before treatment and on 1,3,7,30 d after treatment were compared between the two groups and analyzed.Results Before the treatment,there were no statistically significant differences in the baseline indicators between the two groups(P＞0.05).The group L:the NT-pro-BNP level on 1,3,7 d after treatment was decreased significantly(P＜ 0.05),LVEF on 3,7 d was significantly increased compared with th baseline(P＜0.05)and GFR on 1,3,7,30 d was significantly increased compared with the baseline(P＜0.05).The group D:the NT-pro-BNP level on 7 d of treatment was significantly decreased(P＜0.05),LVEF on 7 d of treatment was significantly increased compared with the baseline(P＜0.05),and no statistically significant changes were observed in GFR on 1,3,7,30 d(P＞0.05).After treatment,NT-pro-BNP,LVEF and GFR significant level values in the group L were better than those in the group D.Conclusion Levosimendan is superior to dopamine in improving heart and renal function for the patients with refractory heart failure complicating severe renal insufficiency.