Type 2 diabetes mellitus (T2DM) is a disease related to over-consumption of high-calorie foods, lack of exercise, and obesity. Insulin resistance is a state that tissue or cell responsiveness to insulin decreases. Previous studies have found that the renin-angiotensin aldosterone system (RAAS) is involved in the development of T2DM. Angiotensin converting enzyme inhibitors (ACEI) or angiotensin II receptor antagonists (ARB) can delay the progression of insulin resistance, but the underlying mechanisms are still unclear. This paper reviews the recent progress in the understanding of the relationship between insulin resistance and the RAAS in T2DM.

To identify the risk factors for carotid arteriosclerosis in patients with newly diagnosed hypertension to provide a basis for the prevention of carotid arteriosclerosis in these patients.

A total of 513 patients (aged over 18 years) with newly diagnosed hypertension at our hospital were included in this study. According to color Doppler ultrasound results, the patients were divided into either a carotid arteriosclerosis group (n = 233) or a non-carotid arteriosclerosis group (n = 280). Fasting blood glucose, blood lipids, renal function, blood pressure, 24-hour ambulatory blood pressure, cardiac ultrasound, and microalbuminuria were compared between the two groups by t-test. Then, logistic regression analysis was performed to identify the risk factors for carotid arteriosclerosis. The detection rates of left ventricular hypertrophy and microalbuminuria were compared between the two groups by χ² test.

Age, blood glucose, 24-h pulse pressure, nighttime pulse pressure, and daytime diastolic blood pressure were significantly higher in the carotid arteriosclerosis group than in the non-carotid arteriosclerosis group (t = 6.47, P<0.001; t = 2.60, P = 0.035; t = 1.13, P = 0.034; t = 0.79, P = 0.008; t = 0.34, P<0.001, respectively). Age was identified to be a risk factor (β>0, OR>1, P<0.001) and HDL was identified to be a protective factor (β<0, OR<1, P = 0.019) for carotid arteriosclerosis. The detection rates of left ventricular hypertrophy and microalbuminuria were significantly higher in the carotid arteriosclerosis group than in the non-carotid arteriosclerosis group (χ² = 13.17, P = 0.000; χ² = 9.80, P = 0.002).

Age can increase the risk of carotid arteriosclerosis in patients with newly diagnosed hypertension. HDL has a protective effect against carotid arteriosclerosis.

Ovarian cancer is one of the most common gynecological malignancies and has the highest case fatality rate among all gynecological malignancies. Tumor markers are very important for early diagnosis, curative effect monitoring, and prognosis assessment in ovarian cancer. CA125 and HE4 are the most widely used serum tumor markers in ovarian cancer, but they have some flaws. Thus, finding more sensitive and specific tumor markers is of great importance. In recent years, with the rapid development of the second generation sequencing technology, circulating tumor DNA, circulating tumor cells, and miRNA have provided a new train of thought for identifying new tumor markers for ovarian cancer.

To observe the safety and feasibility of combined administration of dexmedetomidine with fexmedetomidine in alleviating emergence agitation during recovery from pediatric laparoscopic surgery.

Sixty 2-10-year-old children who underwent high ligation of the processus vaginalis or herniorrhaphy at the People′s Hospital of Wuxi Affiliated to Nanjing Medical University from October 2015 to December 2016 were randomly divided into three groups (n=20 each). Before anesthesia induction, the patients were intravenously injected with fexmedetomidine 1 mg/kg (group F), dexmedetomidine 0.5 μg/kg plus fexmedetomidine 1 mg/kg (group FD), or normal saline (group C). Mean arterial pressure (MAP) and heart rate (HR) were recorded before extubation (T₀), at extubation (T₁), and 5 min after extubation (T₂). During the time course of recovery and extubation, respiratory events and psychomotor agitation were recorded.

Compared with group C, MAP and HR at T₀, T₁, and T₂ in group FD, and MAP and HR at T₂ in group F were significantly decreased (P<0.05). Compared with group F, MAP and HR at T₂ in group FD were significantly decreased (P<0.05). The incidence rates of respiratory events and psychomotor agitation in group FD were significantly lower than those in other groups (P<0.05).

Dexmedetomidine combined with dexmedetomidine can effectively prevent psychomotor agitation during recovery from pediatric laparoscopic surgery and improve the security, without prolonging the recovery and extubation time.

To compare the effect of one-step and two-step approach in establishing 5/6 nephrectomy model of renal failure.

One-step and two-step approach were used to establish the model of 5/6 nephrectomy, and the mortality rate and the levels of creatinine and urea nitrogen were recorded in the two groups at the end of week 4, week 8 and week 12 after the operation.

The mortality rate was 17.65% in the one-step group at the end of the 4th week, compared with 29.41% in the two-step group at the same time after the operation. The renal failure models were successfully established in the two groups, and there was no significant difference in the levels of creatinine and urea nitrogen between the two groups at the end of the 8th week.

One-step and two-step approach can successfully establish 5/6 nephrectomy model of renal failure, and the one-step approach may produce lower mortality.

To investigate the relationship of breast cancer associated macrophages (TAMs) with clinicopathological characteristics in breast cancer, including tumor invasion and metastasis.

Eighty breast cancer tissues and matched tumor adjacent breast tissues were collected from patients treated at the Tumor Hospital of Shaanxi Province from January 2015 to August 2016. All the tissue samples were subjected to immunohistochemical staining for CD68, TGF-β1, uPA, and MMP-9, and their relationship or correlation with clinicopathological characteristics was identify by the chi-square test or Fisher exact test.

The positive expression rates of CD68, TGF-β1, uPA, and MMP-9 in breast cancer were 65.00% (52/80), 57.50% (46/80), 56.25% (45/80), and 48.75% (39/80), respectively, all of which were significantly higher than those in matched tumor adjacent breast tissues [8.75% (7/80), 10% (8/80), 12.5% (10/80), and 11.25% (9/80), respectively; P<0.001]. The positive expression rates of CD68, TGF-β1, uPA, and MMP-9 were related closely to tumor TNM stage and lymph node metastasis (P=0.038, 0.033, 0.017, and 0.025; P=0.004, 0.037, 0.005, and 0.038), respectively, but were not associated with patient age or tumor clinicaopathological type. The correlation analysis showed that there was a positive correlation between the expression of CD68, TGF-β1, and uPA in breast cancer tissues (r=0.588, P<0.001; r=0.357, P=0.001).

TAMs are highly expressed in breast cancer tissues and closely related to tumor invasion and lymph node metastasis. TAMs may be important in tumor invasion and metastasis and can be an important marker of poor prognosis in breast cancer.

Anesthesiology is a high-risk specialty in clinical medicine teaching. In this paper, we analyze the special characteristics of education for anesthesiology based on the present situation and the particularity regarding the cultivation of anesthesiology students. Various learning patterns have been used to motivate students. We also introduce the specific implementation of these methods in the teaching of contents to improve students′ clinical thinking ability to facilitate their role change from medical students to clinicians.

L1 cell adhesion molecule (L1CAM) is a kind of cell adhesion molecule consisting of a series of protein domains, playing an important role in the regulation of nerve cell movement and growth. Studies show that L1CAM expressed in tumor cells can promote cell proliferation, migration, invasion, and metastasis, which affects the prognosis of patients with tumors. Recently, some researchers have detected L1CAM expression in early endometrial carcinoma tissue by immunohistochemistry and analyzed the adverse influence of L1CAM on the prognosis of patients with endometrial carcinoma. This article discusses the mechanism of L1CAM in tumor cell metastasis, especially the relationship between L1CAM and epithelial-mesenchymal transition (EMT), and its influence on the prognosis of patients with endometrial cancer, in order to further explore the adverse prognostic factors of endometrial carcinoma and provide evidence for more precise treatment of this malignancy.

To evaluate the clinical efficacy of ultrasound-guided sciatic and femoral nerve block anesthesia in the treatment of elderly patients with lower extremity fractures.

Thirty-four elderly patients with fractures of unilateral knee or below the knee were included in this study. There were 21 men and 13 women, and they ranged in age from 68 to 83 years old, with an average age of (74.08±7.70). All the patients underwent sciatic and femoral nerve block anesthesia. The anesthesia operation, onset, and duration were recorded. The visual acuity was simulated and the changes of vital signs were evaluated. The intensity of preoperative, intraoperative, and postoperative pain was also evaluated using the visual analogue scale (VAS). Blood pressure, blood oxygen saturation before and after anesthesia at different time points, time to food intake, and postoperative complications were recorded. Heart rate, systolic blood pressure, diastolic blood pressure, and blood oxygen saturation at different time points were compared using one-way repeated measures analysis of variance. The VAS score was compared using the t-test.

The operation time for sciatic nerve block and femoral nerve block was (6.0±1.2) min and (1.5±1.4) min, respectively; the onset time was (15.0±6.2) min and (7.1±6.2) min, and the duration time was (16.0±7.2) h and (7.0±5.2) h, respectively. The VAS scores before surgery, at 30 minutes after the beginning of surgery, and after surgery were (2.1±1.2), (1.9±0.6), and (1.8±0.7), respectively, and there was no statistical difference between them. Heart rate, systolic blood pressure, diastolic blood pressure, and blood oxygen saturation at different time points did not differ significantly (P>0.05). GradeⅠnerve block effect was achieved in 31 (91.17%) cases, and gradeⅡwas achieved in three (8.83%) cases. The adverse reaction of the patients after operation were less, and the symptoms were obviously alleviated after treatment.

Ultrasound-mediated sciatic and femoral nerve block can provide satisfactory anesthetic effect for patients with unilateral lower limb fractures, with less disturbance to vital signs and fewer postoperative complications.

对扩张型心肌病患者的T波峰末间期进行科学规范的测量，并将其与正常人群进行比较。

回顾性分析2010年1月至2011年6月在中国医学科学院阜外医院接受心脏再同步治疗的扩张型心肌病患者病例资料，选择其中33例术前心电图资料完整者作为观察组，对其术前自身心律的心电图进行分析。从南京医科大学附属逸夫医院体检中心心电图室导出2016年9月检查的40份正常人心电图，将这40名正常人作为对照组进行研究。依次测量12个导联的T波波峰到T波终末的时间间期，最终取12导联中数值最大的T波波峰到T波终末的时间间期作为某一个体的T波峰末间期。QT间期也定义为12个导联中QRS波起始到T波终末时间间期的最大值。比较2组差异。

观察组33例患者中，29例（87.9%）患者T波峰末间期在胸前导联测得。与对照组相比，观察组的T波峰末间期更长[（119.7±23.6）ms vs （94.5±16.3）ms，t=5.368，P=0.000]，T波峰末间期离散度更大[（45.2±18.2）ms vs （30.0±17.7）ms，t=3.593，P=0.001]，但是T波峰末间期/QT间期比值在2组间没有差异（0.26±0.04 vs 0.25±0.04，t=1.350，P=0.181）。

无论在扩张型心肌病患者中还是在正常人中，绝大多数研究对象可以在胸前导联准确测量到T波峰末间期。与正常人群相比，扩张型心肌病患者心室跨壁复极离散度更大。

To systematically review the effectiveness and safety of amiodarone combined with spirolactone versus amiodarone alone in the treatment of paroxysmal atrial fibrillation.

The databases of PubMed, Cochrane Library, WanFang Data, CNKI, and VIP were searched by computer to identify articles published up to October 2016 that reported randomized controlled trials (RCTs) on amiodarone combined with spirolactone versus amiodarone alone for treating paroxysmal atrial fibrillation. Two reviewers independently screened the literature according to the inclusion and exclusion criteria, extracted the data, and assessed the methodological quality of the included studies using the modified Jadad scale. Then meta-analysis was conducted using RevMan5.3 software.

Four RCTs involving 388 patients were included. The meta-analysis showed that compared with the single use of amiodarone (control group), the combination treatment (test team) was associated with comparable safety (OR = 0.66, 95% CI: 0.11-4.03, P = 0.65), significantly higher maintenance rate of sinus rhythm (OR = 0.38, 95% CI: 0.22-0.67, P = 0.0007), and significantly delayed enlargement of left atrial diameter (WMD =-1.72, 95% CI: -2.14--1.30, P<0.000 01).

The existing evidence suggests that amiodarone combined with spirolactone is better than amiodarone alone in the treatment of paroxysmal atrial fibrillation with regard to increasing the maintenance rate of sinus rhythm and significantly delaying the enlargement of left atrial diameter, although their safety is comparable.

To investigate the effect of atorvastatin intervention on glucose and lipid metabolism, inflammatory cytokine levels, and carotid atherosclerosis in patients with type 2 diabetes mellitus.

A total of 196 patients with type 2 diabetes mellitus treated at our hospital between January 2015 and December 2016 were collected and divided into either a control group (n=98) or an atorvastatin group (n=98) according to treatment method. The patients in both groups were treated with basic treatment, and the patients in the atorvastatin group were additionally treated with atorvastatin. The changes of glucose metabolism, lipid metabolism, inflammatory cytokine levels, and carotid artery atherosclerosis-related indexes were analyzed and compared between the two groups.

After treatment, FPG, HbA1c, INS, and HOMA-IR levels were not statistically significant between the two groups of patients [(6.42±1.21) mmol/L vs (6.27±1.05) mmol/L, t=0.406, P=0.572; (6.21±0.65)% vs (6.08±0.73)%, t=0.662, P=0.339; (13.04±1.21)% vs (12.83±1.15)%, t=0.316, P=0.606; (3.75±0.27) vs (3.64±0.35), t=0.283, P=0.692), respectively]. TC, TG, and LDL-C were significantly lower and HDL-C was significantly higher in the atorvastatin group than in the control group [(3.18±0.33) vs (4.76±0.39), t=2.738, P=0.009; (1.69±0.14) vs (2.13±0.31), t=3.012, P=0.003; (1.74±0.27) vs (3.08±0.39), t=3.974, P=0.001; (1.26±0.21) vs (1.04±0.15), t=2.458, P=0.014), respectively]. CRP, IL-6, TNF-α, ICAM-1, VCAM-1, and Selectin levels were significantly lower in the atorvastatin group than in the control group [(0.83±0.09) vs (0.92±0.11), t=2.576, P=0.036; (1.83±0.25) vs (2.32±0.36), t=3.119, P=0.025; (33.83±4.15) vs (41.92±6.11), t=3.102, P=0.029; (198.83±14.15) vs (210.92±15.11), t=2.583, P=0.035; (457.83±41.15) vs (501.92±38.11), t=2.104, P=0.043; (20.04±1.91) vs (25.83±2.09), t=2.722, P=0.031), respectively]. IMT, plaque thickness, plaque size, and plaque number were significantly lower in the atorvastatin group than in the control group [(1.05±0.12) mm vs (1.30±0.16) mm, t=3.501, P=0.012; (2.64±0.37) mm vs (3.23±0.55) mm, t=3.164, P=0.019; (0.078±0.021) cm² vs (0.093±0.025) cm², t=4.068, P=0.001; (3.54±0.62) vs (4.23±0.92), t=2.083, P=0.042, respectively]. In multivariate logistic regression analysis, IMT was significantly associated with atorvastatin, HDL-C, TC, TG, LDL, CRP, IL-6, and TNF-α.

Atorvastatin can regulate lipid metabolism and reduce inflammatory cytokine levels and carotid atherosclerosis in patients with type 2 diabetes mellitus.

比较鼻内镜下鼻前庭囊肿电动切割揭盖术及唇龈沟径路鼻前庭囊肿切除治疗鼻前庭囊肿的效果。

回顾性分析2009年8月至2015年12月在扬州市第一人民医院行手术治疗的58例鼻前庭囊肿患者，26例接受鼻内镜下鼻前庭囊肿电动切割揭盖术（观察组），32例接受唇龈沟径路鼻前庭囊肿切除术（对照组），依据不同术式分成2组，对2组手术出血量、手术时间、术后疼痛评分、囊肿复发率等方面进行比较，采用SPSS 19.0软件进行统计学分析。

观察组和对照组在手术出血量、手术时间、术后患者疼痛评分方面行统计学比较，差异均有统计学意义（P<0.05）。观察组患者术后经术后3个月~2年的随访观察均未复发，对照组患者经术后3个月~2年的随访观察3例复发。

鼻内镜下鼻前庭囊肿电动切割揭盖术具有以下优点：复发率低、手术损伤小、出血少、时间短、术后患者舒适度好等，是治疗鼻前庭囊肿的确切方法。

To investigate the effect of hydrophilicity of titanium with micro/nanotopographical surface on the cell viability and osteogenic differentiation in rat bone marrow mesenchymal stem cells (rBMSCs).

Methods of anodic oxidation and sandblast-alkali heat were utilized to establish scale structures. rBMSCs were seeded on these two titanium discs, cell viability was detected at 1, 3, 5 and 7 days by CCK8 assay. Total protein values and alkaline phosphatase (ALP) activity were examined at 7 and 14 days. ALP, collagen-I(COL1) and runt related transcription factor 2 (RUNX2) mRNA expression at 7 days were detected by qRT-PCR. The t test was used to compare water static contact angle, CCK8, total protein concentration and PCR detection index of osteogenic differentiation.

The titanium surface treated by anodic oxidation was regular ordered nanotube arrays, while that treated by sandblast-alkali heat exhibited a three dimensional mesh nano porous structure, which both groups presented a similar micro-nanotopographical feature. However, the static contact angle of water in anodic oxidation group was significantly enhanced than that of sandblast-alkali heat group (83.3±2.3 vs 47.7±2.0, t=11.54, P<0.001). Compared with anodic oxidation group, rBMSCs on the discs modified by sandblast-alkali heat showed enhanced cell viability at 3, 5 and 7 days (0.66 ±0.03 vs 0.52 ±0.03, 1.15 ±0.06 vs 0.85 ±0.05, 1.58 ±0.07 vs 1.26 ±0.07), and these differences were statistically significant (t=2.962、3.845、3.183, P=0.042、0.018、0.033). After 7 and 14 days, the total protein concentration of rBMSCs in sandblasting alkali heat group was higher than that of anodic oxidation group [(389±45) μg/ml vs (226±32) μg/ml, (1070±59) μg/ml vs (760±65) μg/ml], whose differences were statistically significant (t=3.319、3.518, P=0.029、0.025). Moreover, ALP activity of rBMSCs of sandblasting alkali heat group at 7 days and 14 days was higher than that of anodic oxidation group [(2.11±0.32) U/gprot vs (1.00±0.21) U/gprot, (6.13±0.57) U/gprot vs (3.92±0.51) U/gprot], which showed statistically significant difference (t=2.912、2.976, P=0.043、0.041). Finally, mRNA levels of ALP, COL1 and RUNX2 in rBMSCs of sandblasting alkali heat group is higher than that of anodic oxidation group at 7 days (1.86 ±0.24 vs 1.00 ±0.15; 2.05 ±0.16 vs 1.00 ±0.14; 2.28 ±0.18 vs 1.00 ±0.12), and these difference was statistically significant (t=3.383、5.012、5.710, P=0.028、0.007、0.005).

Micro-nanotopographical surface of titanium implant in sandblast-alkali heat group promotes cell viability and osteogenic differentiation of rBMSCs, which may be affected by its hydrophilicity.

Schizoaffective disorder is a kind of psychogenic co-occurrence of both psychotic and affective symptoms. Although the latest DSM-5 diagnostic criteria have been published, there are still many problems related to the clinical application of the DSM-5 diagnostic criteria. This paper reviews the evolution of the diagnosis of schizoaffective disorder as well as its latest diagnostic criteria, etiology, treatment, and prognosis evaluation.

To detect the changes in the expression levels of miR-34a/SIRT1 and P53 in cataract lens in rats.

Thirty-six lenses from SD rats were divided into three groups: clear lenses of young and old rats and cataractous lenses. Expression of miR-34a/SIRT1 mRNA in the clear lenses of young and old rats and cataractous lenses was detected by real-time RT-PCR, and SIRT1 and P53 expression was detected by Western blot.

Real-time PCR analysis showed that miR-34a expression was significantly up-regulated, accompanied by down-regulation of SIRT1 mRNA expression in rat cataractous lenses (t = 12.60, P = 0.0002; t = 3.299, P = 0.03, respectively). miR-34a expression was significantly lower (t = 9.609, P = 0.0007) and SIRT1 mRNA expression was significantly higher (t = 7.242, P = 0.0019) in clear lenses of old rats than in clear lenses of old lenses. Western blot analysis showed that SIRT1 protein expression was significantly down-regulated, accompanied by up-regulated expression of acetylated P53 protein in rat cataractous lenses (t = 8.924, P = 0.0009; t = 9.280, P = 0.0008, respectively). SIRT1 protein expression was significantly higher (t = 3.419, P = 0.0345) and acetylated P53 protein expression was significantly lower (t = 4.768, P = 0.0089) in clear lenses of old rats than in clear lenses of old lenses.

High expression of miR-34a is related to cataract in rats, possibly by decreasing SIRT1 protein expression and promoting the acetylation of P53.

In the surgical resection of intracranial tumors, exact localization of the intracranial mass is the key to achieving complete tumor resection to reduce the recurrence rate but preserve or improve the patient′s neurological functions. At present, imaging guided neuronavigation techniques include intraoperative CT (iCT), intraoperative MRI (iMRI), and intraoperative ultrasound (ioUS). iCT and iMRI are restricted not only by time and space, but also by expensive equipment and the need for a dedicated room. Therefore, their use has been limited. IoUS ensures rapid, reproducible, and cost-effective real-time intraoperative imaging without those limitations to help surgeons understand the spatial location of the lesions after craniotomy. In this regard, standard B-mode ultrasound offers significantly useful morphologic information, and different Doppler modalities as well as contrast-enhanced ultrasound offer information regarding tumor vascularization and perfusion. Intraoperative elastosonography appears to be of value in evaluating tumor borders, parenchymal infiltration, and tumor consistency, which needs further research. This paper introduces the application of ioUS in neurosurgery.

Coronary artery ectasia (CAE) is defined as the inappropriate dilatation of a coronary artery, with the luminal diameter 1.5 or more times wider than that of adjacent normal segments. The main clinical manifestations of CAE are angina and myocardial infarction, and its pathological manifestations are characterized by an extensive destruction of musculoelastic elements, particularly elastin fibers, which are the predominant components of the extracellular matrix of the coronary wall. There is obviously slow coronary blood flow and microcirculation dysfunction in dilated coronary artery. Coronary angiography is the gold standard for CAE diagnosis, and treatments for coronary artery disease (CAD) are recommended for most CAE patients in an individualized manner, but nitrates should be avoided. The prognosis of CAE patients is similar to that of CAD patients with lesions of the three main coronary arteries.

Gastric cancer is a malignancy with high morbidity and mortality. In recent years, the development of targeted therapy and immunotherapy has revolutionized the therapeutic model for various cancers. Identifying proteins exclusively expressed in tumors is a research direction in this field. Claudin-18 is expressed in gastric mucosa, participates in the barrier function, and has unique expression patterns in gastric cancer. Therefore, Claudin-18 is a promising target for the treatment of gastric cancer. This paper will review the function and expression pattern of Claudin-18 as well as its potential role in the treatment of gastric cancer.

To compare the safety of different doses of alteplase for intravenous thrombolysis in patients with acute cerebral infarction to provide a basis for clinical rational use of this drug.

A total of 283 acute cerebral infarction patients were randomly divided into a low dose group (n=140) and a standard dose group (n=143). The medical records of all patients were collected, and the prognosis of patients was evaluated with the modified Rankin scale (mRS), with an mRS score of 0-2 indicating a good prognosis. The chi-square test or Mann-Whitney U test was used to compare the clinical efficacy and mortality of the two groups, and to evaluate the safety of different doses of alteplase for intravenous thrombolysis in patients with acute cerebral infarction.

At 24 h and 3 days after thrombolysis, there was no significant difference in the National Institute of Health stroke scale (NIHSS) between the two groups [6 (2, 12) vs 5 (2, 10), Z=0.361, P=0.718; 4 (2, 11) vs 4 (2, 10), Z=0.118, P=0.906]. At 7, 28, and 90 d after thrombolysis, there was no significant difference in the proportion of patients with a good prognosis between the two groups (52.86% vs 53.85%, χ²=0.002, P=0.962; 64.29% vs 62.94%, χ²=0.013, P=0.911; 70.00% vs 72.03%, χ²=0.06, P=0.807). There was no significant difference in the rate of hemorrhagic transformation between the two groups after thrombolysis (6.43% vs 7.69%, χ²=0.040, P=0.842). By 90 days after thrombolysis, 11 patients in the low dose group and 12 patients in the standard dose group died, and there was no significant difference in mortality between the two groups (χ²=0.120, P=0.73).

Different doses of alteplase for intravenous thrombolysis in patients with acute cerebral infarction have similar safety and efficacy, and low doses of alteplase for intravenous thrombolysis is worthy of clinical application.