Objective To study the therapeutic effect of EUS-guided rendezvous (EUS-RV) when ERCP failed in patients with malignant obstructive jaundice. Methods 12 cases of malignant obstructive jaundice patients were underwent EUS-RV after unsuccessful ERCP. The operation success rate, liver function recovery 1 week and 1 month after operation, complication rates, hospital stay and patient survival were observed. Results All 12 patients were successfully operated and placed stents by endoscopic ultrasound puncture following by ERCP: 8 patients by the stomach, 4 patients by duodenum, the operation success rate was 100.00%; There were significant difference between the liver function recovery of preoperative and postoperative one week or postoperative one week and postoperative one month (P < 0.05). 1 bleeding occurred and were improved after conservative treatment, the complications rate was 8.33%; the hospital stay was (20.68 ± 5.76) d; the average survival time of patients was 224 d. Conclusion EUS-guided rendezvous may be the alternative treatment due to the diminutive trauma and good effect when ERCP failed in patients with malignant obstructive jaundice.

Objective To study the relationship between menstrual disorder and ovarian morphology of adolescent women in order to provide basis for diagnosis of adolescent polycystic ovary syndrome (PCOS).Methods We analyzed the clinical data of 212 patients with adolescent menstrual disorders 2 years after menstruation collected from the Department of Gynecology and Women's Health of First Affiliated Hospital of Xi'an Jiaotong University between September 2014 and September 2015.Results ① Oligomenorrhea was the most common in the 212 adolescent women (33.96 ％),followed by amenorrhea (16.51％).There was a significant difference in F-G score and acne score among patients with different types of menstrual disorder (F=1.39,1.77,all P＜0.05),the highest in those with oligomenorrhea.② The volume of the ovary,number of sinusoidal follicles,maximum area of the ovary in women with oligomenorrhea were significantly higher than those in non-oligomenorrhea women (t =2.89,5.76,6.23,all P＜ 0.05).③ Clinical manifestations differed significantly among normal ovarian group,MFO group and PCO group (x2=43.25,P＜0.05).Incidence rate of oligomenorrhea ranked the top in polycystic ovary group (49.30％),followed by multiple ovarian follicles group (42.59％),and there were significant differences in blood LH,T,and LH/FSH (F=3.45,2.43,2.76,all P＜0.05) was found in PCO group.There was significant difference in diagnosis of puberty PCOS (x2=26.58,P＜0.05).④ Among these 212 adolescent women,45 ones had puberty PCOS (21.23％).The ovary volume,number of sinus follicles,and the largest area in the obese patients were significantly higher than those in non-obese group (t =3.42,7.89,4.02,all P＜0.05);HOMA IR was also significantly higher than that in non-obese group (t =8.89,10.62,all P ＜ 0.05).Conclusion Oligomenorrhea is the most common menstrual disorder in adolescent women.Ovarian morphological abnormalities occur in most women with oligomenorrhea and obesity,who should be followed up regularly.

Objective To explore the current training programs for preventive medicine undergrad-uates in China's colleges and universities, so as to provide more clues for further optimizing the training program. Methods Twelve colleges and universities were selected in accordance with the stratification of 985, 211 and general colleges and universities and their training programs for preventive medicine under-graduates were collected in February, 2016. By comparing with the requirements of "The directory and introduction of undergraduate courses in colleges and universities (2012)" and the spirit of the second round of "undergraduate teaching evaluation of higher education institutions", training programs were described; t test and multivariate analysis of variance were used to compare differences among different levels of colleges and universities;SPSS 21.0 was used for statistical processing. Results In some colleges and universities, training programs were still not concrete and the setting of three common core courses (Health Education, Health Service Management and Women's Health Science) did not meet the require-ments of the new directory of 2012. All selected colleges and universities had established their standards of the minimum curricular credits ( including course system and internship practical training ) which were(245.33±27.01) credits. In course system, the required course and the elective course were (176.25±18.46) credits, (26.62±12.68) credits, respectively. The percentage of preventive medicine in required courses was relatively lower, only (21.99 ±3.50)％. In internship and practical training, the clinical practice and the specialty practice were (20.00 ±5.13) weeks, (27.33 ±7.78) weeks, taking (16.46 ±7.75) credits, (23.50 ± 9.86) credits, respectively. No differences were found in courses setting, credits distribution among 985, 211 and general universities and colleges, all P>0.05. Conclusion There still exist problems: training pro-grams are not concrete and the training system cannot fully reflect training objectives in some colleges and universities, needing to be further standardized and improved.

Objective:To explore the therapeutic effect and safety of thrombus aspiration catheter in young patients with acute ST-segment elevation myocardial infarction (STEMI) during primary percutaneous coronary intervention (PCI) .Methods :According to using thrombus aspiration catheter during emergency PCI or not ,a total of 79 young patients with acute STEMI were divided into aspiration group (n= 37 ,received thrombus aspiration ) and routine treatment group (n=42 ,didn't receive aspiration catheter ) .Coronary TIMI flow ,angina pectoris symptoms ,cardi-ac function and major adverse cardiovascular events (MACE) etc .after PCI were observed and compared between two groups .Results:Compared with routine treatment group after treatment ,there were significant rise in TIMI flow [ (2.33 ± 0.48) grade vs .(3.00 ± 0.00) grade] ,2h ST segment regression >50% rate (45.24% vs .70.27% ) and left ventricular ejection fraction on the first week [ (47.21 ± 9.28)% vs .(52.16 ± 7.87)% ];significant reduc-tion in angina pectoris symptom (50.00% vs .27.03% ) ,and NYHA cardiac function during follow-up [ (1.52 ± 0.71) class vs .(1.22 ± 0.42) class] in aspiration group , P<0.05 or <0.01. There was no significant difference in incidence of MACE between two groups , P>0.05 all .Conclusion:Application of thrombus aspiration catheter could improve coronary blood flow ,reduce symptoms of angina pectoris and improve cardiac function during primary PCI in young patients with acute STEMI ,and it's safe .

Objective To analysis the clinical effects of biliary-pancreatic double stents in pancreatic cancer patients with obstructive jaundice.Methods From July 2008 to October 2011,a total of 60 patients with advanced pancreatic cancer were randomly divided into two groups to receive biliary-pancreatic double stents (n =28) or biliary stent only (n =32) according to the odd and even numbers of their admission date.Changes in liver function,abdominal pain,quality of life scores (QOL) were compared between two groups.Results The stents were placed successfully in 54 patients (90.0％),in which symptoms were relieved or gradually disappeared in all patients after the procedure.One week after stents placement,the serum total bilirubin decreased significantly from 164.32 ±45.16 μmol/L before ERCP to 63.25 ±27.06 μmol/L (P ＜ 0.05),other parameters including ALT,AST,AKP and r-GT were also decreased significantly compared with those of pre-ERCP (P ＜ 0.01),but there was no significant difference between the two groups (P ＞ 0.05).25 cases in double-stents group and 29 cases in single-stent group had varying degrees of pain relief at 7d after ERCP,but the overall pain relief rate and complete pain relief rate in double-stent group were significantly higher than those in single-stent group (92.0％ vs.55.2％; 64.0％ vs.34.5％,P＜0.05).At 7d and 14d after ERCP,Karnofsky QOL score were improved significantly in double-stent group (P ＜ 0.05).It was significantly better than single-stent group at 14d after ERCP (P ＜0.05).No death or other severe ERCP-related complications were observed.Conclusion Biliary-pancreatic stent placement for pancreatic cancer could significantly improve liver function and relieve obstructive pain.In the ways of alleviating pain and improving quality of life scores,it was better than ERCP biliary stent placement,especially for patients with pancreatic cancer combined obstructive pain.It indicated that biliary-pancreatic stent placement was better than simple biliary stent placement for advanced pancreatic head cancer patients with obstructive pain.

Objective To investigate the correlation between carotid intima-media thickness (CIMT) and glucose fluctuation in patients with type 2 diabetes mellitus (T2DM).Methods Sixty-eight T2DM patients admitted to Beijing Military General Hospital from March to August 2012 were enrolled in the study,including 32 cases with CIMT thickening (CIMT ≥ 0.9 mm) and 32 cases with normal CIMT (CIMT ＜0.9 mm).The 72 h continuous blood glucose levels were monitored from the day of admission.Results There were no significant differences in the gender,age,body mass index (BMI),systolic and diastolic blood pressure,HDL-C,LDL-C,CHO,TG,glycosylate hemoglobin (HbA1c),fasting blood glucose(FBG) and postprandial average blood glucose (MPBG) between two groups (P ＞ 0.05).The atherosclerosis (AS) score and mean amplitude of glycemic excursion (MAGE),glucose standard deviation,frequency of glycemic excursion (FGE) and absolute mean of daily differences (MODD) in patients with thickening CIMT were (11 ± 7) years,(6.9 ± 3.0) mmol/L,(2.8 ± 1.2) mmol/L,(3.4 ± 1.5) times/d,(2.8 ± 1.3) mmol/L,(4.5 ± 1.0) score,respectively ; while those in patients with normal CIMT were (8 ±6) years,(4.2 ± 1.1) mmol/L,(1.6 ± 0.5) mmol/L,(2.2 ± 0.8) times/d,(2.0 ± 1.0) mmol/L,(3.3 ±0.6) score,respectively.There were significant differences between two groups (all P ＜ 0.05).Pearson correlation showed that CIMT was positively correlated with MAGE,FGE,MODD,course of disease,diastolic blood pressure,LDL-C,MPBG and AS score (P ＜ 0.05).Multiple stepwise regression analysis showed that MAGE,MBPG were the influencing factors of CIMT.Conclusions The CIMT of patients with T2DM is closely correlated with glucose fluctuation,indicating that reduction of blood glucose fluctuation and MAGE,MPBG levels may delay the occurrence of diabetic macroangiopathy.

Objective To observe the difference in serum level of oxidative stress between first diagnosed type 2 diabetes mellitus (T2DM) patients and healthy person with normal glucose,compare the difference in serum level of oxidative stress between T2DM patients with continuous subcutaneous insulin injection (CSII) and multiple subcutaneous insulin injection (MSII),and further explore the possible mechanism of CSII superior to MSII.Methods Sixty patients with first diagnosed T2DM were divided into CSII group and MSII group by random digits table,with 30 patients in each group and given 14 days treatment of CSII and MSII respectively.Thirty healthy person were selected with age and sex matched in same period as control group,then fasting plasma glucose (FPG),2-hour postprandial blood glucose (2 h PG),glycosylated serum protein (GA),fasting insulin (FINS),superoxide dismutase (SOD),reduced glutathione (rGSH) and malondialdehyde (MDA) before and after treatment was measured and analyzed.Results The FPG,2 h PG,GA,HOMA model of insulin resistance (HOMA-IR) and MDA before treatment in CSII group and MSII group was higher than that in control group [FPG:(13.81 ± 3.14),(13.58 ±2.10) mmol/L vs.(5.21±0.42) mmol/L; 2 h PG:(21.72 ±4.43),(22.07 ±3.86) mmol/L vs.(6.19 ± 0.47) mmol/L;GA:(28.74 ± 4.40),(28.83 ± 5.01) mmol/L vs.(13.24± 1.26) mmol/L;HOMA-IR:0.45 ±0.13,0.43 ±0.12 vs.0.20 ±0.15;MDA:(4.37 ± 1.13),(4.44 ± 1.07) mmol/L vs.(2.37 ±0.58) mmol/L] (P ＜ 0.01),and the HOMA model 3 cell function index (HOMA-β),SOD and rGSH was lower than that in control group [HOMA-β:0.98 ±0.17,0.96 ±0.12 vs.1.91 ±0.19;SOD:(29.63 ±9.29),(28.07 ±9.62) mU/L vs.(41.00 ± 12.89) mU/L;rGSH:(157.03 ±46.58),(165.23 ±45.66) ng/L vs.(212.00 ± 61.67) ng/L] (P ＜ 0.01).There was no significant difference between CSII group and MSII group (P ＞ 0.05).The FPG,HOMA-β,SOD and MDA after treatment in CSII group was no significant difference compared with that in control group (P ＞ 0.05).But the FPG and MDA after treatment in MSII group was higher than that in control group(P＜ 0.01 or ＜ 0.05),and the HOMA-β and SOD was lower than that in control group (P ＜ 0.01).The FPG,2 h PG,GA and MDA after treatment in CSII group was lower than that in MSII group (P ＜ 0.01 or ＜ 0.05).The HOMA-β was higher than that in MSII group (P ＜ 0.01).Multi-factor analysis results showed that the HOMA-β and FPG (r =-0.919,P ＜ 0.01),2 h PG (r =-0.904,P ＜ 0.01),GA (r =-0.830,P ＜ 0.01) and MDA (r =-0.653,P ＜ 0.01) was negatively correlated,and SOD (r =0.454,P ＜ 0.01) and rGSH (r =0.394,P ＜ 0.01) was positively correlated.Conclusions Oxidative stress level of first diagnosed T2DM is significantly higher than that of healthy people.Two intensive insulin treatment for first diagnosed T2DM can reduce blood glucose level,oxidative stress levels and improve insulin resistance and β cell function.CSII can effectively reduce blood glucose,reduce the level of lipid peroxidation and improve β-cell function compared with MSII.

Objective To assess the factors that influence the accuracy of real-time continuous glucose monitoring system (RT-CGM).Methods A total of 79 diabetic patients wore RT-CGM for three days continuously while calibrating by interphalangeal glucose values 4-8 times a day.We counted matching rate of interphalangeal glucose values and RT-CGM probe value,and analyzed correlation of the matching rate with MAGE,SDBG,MBG,AUC10,AUC3.9,and NGE by Pearson correlation analysis and multiple linear regression analysis.Then we grouped corresponding match rate by MAGE and MBG,compared the difference among groups.Furthermore,we analyzed correlation of RT-CGM probe values of all-day,fasting-postprandial,and nighttime and the corresponding interphalangeal glucose values by Pearson correlation analysis.Results Pearson correlation analysis showed that the matching rate was negatively correlated with the MAGE,SDBG,MBG,and AUC10.MAGE,MBG,and NGE were in the regression equation.MAGE ＜3.9 mmol/L,matching rate was 81％,3.9 ≤ MAGE＜7 mmol/L,matching rate was 67％,MAGE≥7 mmol/L,the matching rate was 52％,the difference among 3 groups was statistically significant (P＜0.01).MBG＜7.8 mmol/L,matching rate was 78％,7.8 ≤ MBG＜ 10 mmol/L,matching rate was 68％,MBG ≥10 mmol/L,the matching rate was 57％,the difference among 3 groups was statistically significant (P ＜ 0.01).When Youden index was 0.409 and MAGE was less than 3.745 mmol/L,the match rate was more than 75％.When Youden index was 0.369 and MBG was less than 8.38 mmol/L,the matching rate was more than 75％.The correlation coefficients of all day,fasting,postprandial and nighttime probe values and the corresponding interphalangeal glucose values were 0.958,0.963,0.944,and 0.965 (all P＜0.01).Conclusions The probe values show good consistency with the interphalangeal glucose values,are able to be used for blood glucose assessment.Blood glucose fluctuations influences accuracy of RT-CGM,the smaller the blood glucose fluctuations,the smaller the mean glucose concentration,the smaller the effective blood glucose fluctuations in frequency,the higher would be the accuracy.It seems to be more effective to do calibration during fasting and nighttime.

Objective To investigate the glycemic fluctuation and endothelial function in patients of coronary heart disease complicated with type 2 diabetes mellitus (T2DM).Methods Fifty eight patients with coronary heart disease were enrolled in the study,including 40 cases complicated with T2DM (group A) and 18 cases without T2DM (group B).All subjects underwent continuous glucose monitoring system (CGMS) and high-resolution ultrasound detection on brachial artery for endothelium-dependent flowmediated dilatation (FMD).According to the results of CGMS,patients with 3 times of standard deviation of blood glucose (SDBG) less than a mean blood glucose in group A were classified as low glucose excursion group (group A1 ),others were classified as high glucose excursion group (group A2 ).The association of glucose fluctuation with FMD in group A was analyzed.Results Compared to group B,the levels of mean amplitude of glycemic excursions (MAGE),the largest amplitude of glycemic excursions (LAGE) and mean postprandial glucose excursion (MPPGE) were elevated and the levels of FMD were lower in group A1 and A2 (P ＜0.05).Compared to group A1 the levels of MAGE,LAGE,MPPGE and absolute means of daily differences were significantly higher [(5.4 ±0.9) vs.(3.7±0.4),(6.3 ± 1.8) vs.(4.6 ±0.8),(4.7±1.0) vs.(3.5±1.2),(2.45 ±0.75) vs.(1.81 ±0.66)mmol/L,respectively]and the FMD levels were lower [ (3.2 ± 1.0) vs.(5.2 ± 1.2) ％ ]in group A2 ( all P ＜ 0.05 ).All CGMS parameters were significantly correlated with FMD in group A2 (P ＜ 0.05 ).Multiple stepwise regression analysis showed that MAGE,systolic blood pressure were the independent impact factors of FMD.Conclusions Patients of coronary heart disease complicated with T2DM have prominent glycemic fluctuation and decreased FMD and the glycemic fluctuation may be associated with the impairment of FMD.

Objective To analyze the efficacy and safety of glimepiride treatment as initial monotherapy in newly diagnosed patients with type 2 diabetes mellitus (T2DM).Methods This was a subgroup analysis of the GREAT study,which investigated the efficacy and safety of glimepiride as initial monotherapy in Chinese patients with T2DM.This analysis was performed in 209 patients with disease duration less than 6 months and never received any anti-diabetic drugs.The change of HbA1C,fasting plasm glucose (FPG),2 h postprandial blood glucose (2hPPG),homeostasis model assessment for β-cell function index (HOMA-β),homeostasis model assessment for insulin-resistance index(HOMA-IR),the percentage of patients with HbA1C ＜ 7.0％ at endpoint and the incidence of hypoglycemia were evaluated after 16-weeks treatment.Results After 16-weeks glimepiride treatment,HbA1C value reduced significantly from baseline to endpoint,the reduction was statistically significant (9.21％ ± 1.65％ to 6.69％±0.83％,P＜0.001),69.7％ of the patients achieved HbA1C ＜7.0％ at study endpoint.Glimepiride-treated patients also achieved a significant improvement in FPG [from (10.15 ± 2.13) mmol/L to (7.23 ± 1.50) mmol/L,P＜0.001] and 2hPPG [from (17.21 ±4.14) mmol/L to (11.62 ± 3.34) mmol/L].HOMA-β was improved from 17.21± 15.19 [11.62 (2.90,115.8)] to 41.13 ± 44.12 [28.00 (5.1,360.00)],and HOMA-IR was reduced from 2.32± 1.90 [1.76 (0.60,12.80)] to 2.07 ± 1.74 [1.63 (0.4,12.3)].The incidence of all reported symptomatic hypoglycemia was 18.2％,and the incidence of confirmed hypoglycemia was 3.8％.Conclusion This analysis showed that glimepiride treatment as an initial mono-therapy could effectively improve blood glucose control in newly diagnosed patients with T2DM,and the treatment may improve islet β cell function,and the safety profile is reasonably good.