Hyperglycaemia attenuates?-cell insulin secretion in response to plasma glucose elevation and reduces insulin-mediated glucose transport. The long-standing severe hyperglycaemia may irreversibly damage?-cells. However, in this regard, there are increasing evidences showing that short-term intensive insulin therapy may significantly improve the response to endogenous insulin by normalizing blood glucose, so as to induce a "honeymoon period" for several years in a considerable number of subjects with newly diagnosed type 2 diabetes. Thus, a question has been raised: whether or not insulin therapy should be taken as a part of the strategy of the primary treatment for type 2 diabetes? A number of experts believe that it is an important therapeutic strategy, however, others hold that insulin therapy may yield more cost than benefit and suggest that to halt this cycle of progressive metabolic deterioration by any means may transiently restore metabolic re-compensation in type 2 diabetes. This issue was discussed in the fourth meeting of China Group on Insulin Secretion and in 66th ADA scientific session this year. Here we offer our consideration on this question for your reference.

0.05).Conclusion The PAI-1 genotype perhaps may not be one of independent risk factors for both T2DM and FA-IMT in T2DM patients.

Objective To compare the clinical effects and safety between laparoscope radical surgery after neoadjuvant chemoradiotherapy and traditional surgery alone for treatment of rectal cancer patients. Methods A total of 122 patients with rectal cancer from January 2013 to January 2015 in Qingdao Tumor Hospital were divided into the observation group (61 cases) and the control group (61 cases) according to the different therapies. The patients in the observation group received laparoscope radical surgery after neoadjuvant chemoradiotherapy, and the patients in the control group received laparoscope radical surgery of rectal carcinoma. The operative, pathological, immunological indicators and the complications were analyzed retrospectively. Results There were no statistical differences in conversion to open laparotomy rate [6.6 % (4/61) vs. 4.9 % (3/61)], anus preservation rate [80.3 % (49/61) vs. 67.2 % (41/61)], radical rate [77.0 % (47/61) vs. 85.2 % (52/61)] in the observation group and the control group (χ2: 0.152, 2.711, 1.339 respectively, all P > 0.05). The proportion of terminal ileum in the observation group was significantly higher than that in the control group [60.3 % (38/61) vs. 21.3 % (13/61), χ 2= 21.058, P < 0.05]; the number of cleaned lymph nodes in the observation group was significantly lower than that in the control group (8±5 vs. 15±7, t= 5.834, P < 0.05). There were no significant differences between before the treatment and 7 d after surgery of the two groups in the levels of T cells, CD4+, CD8+, CD4+/CD8+and natural kill cells (P > 0.05). There were no significant differences between the observation group(24.6 %)and the control group(27.9 %)in postoperative complication rates (P> 0.05). Conclusion Laparoscope radical surgery after neoadjuvant chemoradiotherapy can reduce the number of lymph nodes dissection with low incidence rate of postoperative complications and implicit impacts on immune system,which is safe and worthy of wide application.

Objective: To understand the characteristics and causes of pesticide poisoning in Xuzhou city, and provide basis for formulating prevention and control measures. Methods: The cases of pesticide poisoning in Xuzhou City from 2005 to 2017 were collected from "Pesticide Poisoning Report Card" . The data were analyzed and assessed by EpiData. The SPSS 22.0 software was used for statistical analysis. Results: During the thirteen years, there were a total of 8092 cases of pesticide poisoning, among which, the number of occupational pesticide poisoning was 1 408, accounting for 17.4% of the total number of cases, 14 patients died, the case fatality rate was 0.1%. There were 2, 992 cases of male poisoning, accounting for 36.97% of the total number of cases, and 5, 100 cases of female poisoning, accounting for 63.03%. There were 6684 non-productive pesticide poisonings, accounting for 82.6% of the total number of cases; 387 deaths occurred, and the mortality rate was 5.8%. Among non-productive poisonings, the incidence of oral pesticide poisoning was 84.3%, and the incidence of accidental poisoning by pesticides was 15.7%. Organophosphorus pesticides poisoning cases accounted for the majority of oral pesticide poisoning cases. The overall incidence of pesticide poisoning showed a downward trend. The age of non-productive pesticide poisoning cases was mainly 15-44 years old, and the number of cases of poisoning were 4 029 cases (60.28%) . With the increase of age, the mortality rate of poisoning cases was higher, especially for those over 60 years old who died of oral pesticide poisoning (40.1%) . The peak of pesticide poisoning began to increase in the second quarter and reached its peak in the third quarter. Conclusion Although the cases of pesticide poisoning reported in Xuzhou City have been declining in recent years, the situation is still severe. The proportion of oral pesticide suicide accounts for a large proportion, and the mortality rate of elderly and female is relatively high, and the government should pay more attention. Workers should conduct safety education and psychological counseling to improve the knowledge and consciousness of safe use of pesticides.

Objective To explore the safety and effectiveness of bridging therapy in elderly patients with acute stroke due to posterior circulation large vessel occlusion.Methods A total of 160 eld-erly patients with acute stroke caused by posterior circulation large vessel occlusion admitted to our department were prospectively recruited and randomly divided into bridging group(n=80)and control group(n=80).The bridging group received thrombolysis treatment and then mechan-ical thrombectomy.The control group received mechanical thrombectomy directly.Prognosis and adverse reactions were compared between the two groups.Results The NIHSS score and BATMAN score after treatment were significantly decreased in both groups(P＜0.01),and the two scores were obviously lower in the bridging group than the control group(6.54±1.23 vs 7.12± 0.98,2.12±0.34 vs 2.87±0.44,P＜0.01).There was no statistical difference in the conversion rate of bleeding after cerebral infarction between the two groups(5.00％vs 3.75％,P＞0.05).The number of intraoperative thrombus removal was significantly lower in the bridging group than the control group(2.43±0.33 vs 2.98±0.41,P＜0.01).Remarkable difference was observed in the mRS score between the two groups after treatment(P＜0.05),with the proportion of mRS score ranging from 0 to 1 larger in the bridging group than the control group(52.50％vs 27.50％,P＜0.05).Conclusion Bridging thrombolysis can significantly improve the neurological function in elderly patients with acute stroke due to posterior circulation occlusion.

Objective To investigate the effect of the multi-material artifact reduction (MMAR) algorithm of wide-detector CT system in reducing the beam hardening artifacts in brain CT imaging. Methods Nine tubes with various iodine concentrations (0.1-16.0 mgI/ml) were placed in a uniform phantom filled with soft-tissue equivalent material. The phantom was scanned using different combinations of the tube voltage and current as follows:80 kV/530 mA, 100 kV/295 mA, 120 kV/190 mA and 140 kV/135 mA. The scanning was performed using the GE Discovery 750 and GE Revolution CT scanners, respectively. The CT values and standard deviations of the uniform areas between tubes were measured. The artifact index (AI) was calculated by using the standard deviation value outside the tubes as background noise. The artifact index values under different kV/mA combinations with different scanners were compared. CT brain images of 36 patients (n=18 on Discovery CT and n=18 on Revolution CT) were randomly selected. CT values of normal brain tissue and dark bands areas in the posterior fossa were measured for each case. The AI was calculated for these cases as for the phantom study. Paired t test was performed for phantom data analysis, and independent t test was performed for the clinical cases data analysis. Results The average AI values with Revolution CT(4.96±1.39, 4.80±1.57, 4.56±1.45, 4.76±1.57) were smaller than those of Discovery 750 (11.90 ± 6.61, 11.17 ± 5.61, 8.85 ± 4.59, 8.77 ± 3.85) under different tube voltage settings(t=3.714, 4.186, 3.745, 4.634,P<0.001). The higher the iodine concentration difference between tube pairs was, the higher the artifact index;As for clinical data, the difference in AI values between Revolution CT(2.31 ± 0.95) and Discovery 750(3.91 ± 1.32) was found statistically significant(t=4.066,P<0.001). Conclusion The multi-material artifact reduction algorithm implemented on the wide-detector Revolution CT scanner can significantly reduce beam hardening artifacts.

Objective To investigate the effect of the multi-material artifact reduction (MMAR) algorithm of wide-detector CT system in reducing the beam hardening artifacts in brain CT imaging. Methods Nine tubes with various iodine concentrations (0.1-16.0 mgI/ml) were placed in a uniform phantom filled with soft-tissue equivalent material. The phantom was scanned using different combinations of the tube voltage and current as follows:80 kV/530 mA, 100 kV/295 mA, 120 kV/190 mA and 140 kV/135 mA. The scanning was performed using the GE Discovery 750 and GE Revolution CT scanners, respectively. The CT values and standard deviations of the uniform areas between tubes were measured. The artifact index (AI) was calculated by using the standard deviation value outside the tubes as background noise. The artifact index values under different kV/mA combinations with different scanners were compared. CT brain images of 36 patients (n=18 on Discovery CT and n=18 on Revolution CT) were randomly selected. CT values of normal brain tissue and dark bands areas in the posterior fossa were measured for each case. The AI was calculated for these cases as for the phantom study. Paired t test was performed for phantom data analysis, and independent t test was performed for the clinical cases data analysis. Results The average AI values with Revolution CT(4.96±1.39, 4.80±1.57, 4.56±1.45, 4.76±1.57) were smaller than those of Discovery 750 (11.90 ± 6.61, 11.17 ± 5.61, 8.85 ± 4.59, 8.77 ± 3.85) under different tube voltage settings(t=3.714, 4.186, 3.745, 4.634,P<0.001). The higher the iodine concentration difference between tube pairs was, the higher the artifact index;As for clinical data, the difference in AI values between Revolution CT(2.31 ± 0.95) and Discovery 750(3.91 ± 1.32) was found statistically significant(t=4.066,P<0.001). Conclusion The multi-material artifact reduction algorithm implemented on the wide-detector Revolution CT scanner can significantly reduce beam hardening artifacts.