Volume 86  ·   Issue 36  ·  2006

Insulin resistance and islet cell function defect are two important pathophysiological bases of type 2 diabetes mellitus (T2DM). Up to now, the definition of insulin resistance refers to the decrease of the physiological effects of insulin on muscle, fat and liver. However, in recent years, it has been found that insulin receptors exist on both β and α cells of pancreatic islets, and it is speculated that insulin may have an important effect on pancreatic islet cells, and "islet cell self-resistance" may be an important cause of abnormal secretion of insulin and glucagon (Glc), malcompensatory proliferation of pancreatic islet β cells and increased apoptosis in T2DM.

The rapid growth of diabetes mellitus has made it a major public health problem in the world, and the diseases of eyes, kidneys, nerves and blood vessels caused by it are one of the main causes of human mourning and disability. The survey of complications of inpatients with diabetes mellitus in endocrinology departments of 30 provinces and cities in China from 1991 to 2000 by the Diabetes Society of Chinese Medical Association showed that 24.3% of patients with diabetes mellitus were complicated by retinopathy, 33.6% by renal disease, 60.3% by neuropathy and 14.9% by coronary heart disease [1]. According to a recent survey of chronic complications of diabetes mellitus in Shanghai, the prevalence of retinopathy, microalbuminuria, neuropathy and peripheral vascular disease in newly diagnosed diabetic patients reached 12.9%, 20.0%, 25.3% and 9.0%, respectively, and 8.0%, 10.5%, 24.6% and 7.7% in people with impaired glucose regulation, respectively [2]. Therefore, the prevention and treatment of diabetes mellitus and its complications is imminent.

Objective to evaluate the effect of silymarin on experimental dimethylnitrosamine (DMN) -induced liver fibrosis in Wistar rats. Methods Sixty-one male Wistar rats were randomly divided into 15 normal control groups; 23 rats in the DMN model group were injected intraperitoneally with DMN 10mg/kg twice a week for 8 consecutive weeks; Twenty-three rats in the silymarin group were modeled by the same method. From the day of modeling, silymarin (Ligalone) 50 mg · kg-1 · d-1 was given by gavage once/d for 8 weeks. After 8 weeks of experiment, the rats were sacrificed by neck amputation, and blood was taken to detect alanine aminotransferase (ALT), aspartate aminotransferase (AST), albumin and total bilirubin, and liver tissue was taken to determine the hydroxyproline content of liver tissue; Results Serum ALT in silymarin group (128 U/L ± 25 U/L vs 59 U/L ± 19 U/L, P<0.01); AST (246 U/L ± 61 U/L vs 159 U/L ± 39 U/L, P =0.001); Total bilirubin (mean rank: 37 vs 23, P =0.003) was significantly lower than that in the model group; Compared with the model group, the content of hydroxyproline in liver tissue of silymarin group was 42.6% lower, and the grade and score of liver fibrosis were significantly improved (12.8±4.4 vs 6.2±2.4, P =0.001). Conclusion Silymarin can inhibit liver inflammation, protect liver function, and partially block and reverse liver fibrosis induced by DMN.

Objective to investigate the efficacy and safety of transurethral holmium laser enucleation of the prostate in the treatment of benign prostatic hyperplasia. Methods the data of 68 patients with benign prostatic hyperplasia aged 65.7 years (50~91 years) treated with transurethral holmium laser enucleation of the prostate were retrospectively analyzed, and the efficacy and complications were evaluated. Results the operation time was 45~158 min, with an average of 87 min, and the tissue weight of the resected specimens was 31~128 g, with an average of 61 g. And the whole operation went smoothly, without prostate resection syndrome and other serious complications. The indwelling urinary catheter was placed for 1 to 4 days after operation, with an average of 2.8 days; The patients were hospitalized for 2 to 5 days, with an average of 3.6 days, and were followed up for 1 to 13 months, with an average of 7.6 months. The symptoms of urinary obstruction were significantly improved, the IPSS decreased from 25.7±6.9 to 7.7±4.3 (P<0.01), and the mean maximum urinary flow rate increased from (8.1±4.2) ml/s to (18.8±4.6) ml/s (P<0.01). Two cases had temporary urinary incontinence after operation, and all recovered within 3 months after sphincter function exercise.One case had mild posterior urethral stricture after operation, and recovered after transurethral dilatation.Conclusion Transurethral holmium laser enucleation of the prostate is a safe and effective new method for the treatment of benign prostatic hyperplasia, which is highly effective, minimally invasive, safe, with few complications and short hospital stay.

Objective to investigate the expression and amplification of fibroblast growth factor 3 (FGF3) gene in bladder transitional cell carcinoma and its clinicopathological significance. Methods The expression and amplification of FGF3 in 100 cases of bladder transitional cell carcinoma and 30 cases of adjacent normal bladder mucosa were detected by immunohistochemistry, fluorescence in situ hybridization and tissue microarray technique, and the correlation between them was analyzed in combination with the clinicopathological data of tumors. Results The immunohistochemical results showed that all normal bladder mucosa showed negative reaction of FGF3 protein; Among 89 cases of bladder transitional cell carcinoma, 20 cases (22%) showed positive expression of FGF3, and it was significantly more common in tumors with low differentiation (G3 grade), middle and late invasion (T2-4 stage) or tumor diameter ≥3 cm (all P<0.05). FISH detection in this group showed that in 63 cases of bladder transitional cell carcinoma, 10 cases (16%) showed positive expression of FGF3 gene, and there was significant correlation with tumor size and clinical stage (all P<0.05). Conclusion The upregulation of FGF3 protein expression in transitional cell carcinoma of bladder is closely related to the malignant clinicopathological phenotype of the tumor, and may be involved in the malignant progression of some tumors; Amplification of FGF3 gene in transitional cell carcinoma of bladder is the main mechanism of upregulation of the expression of FGF3 protein encoded by FGF3 gene.

Objective to investigate the intervention effect and possible mechanism of emodin on pancreatic fibrosis in rats with chronic pancreatitis. Methods the rat model of chronic pancreatitis was prepared by intrapancreatic injection of trinitrobenzenesulfonic acid (TNBS). Different doses (20, 40, 80 mg/kg) of emodin were used for nasogastric feeding intervention, and normal saline was used as a control. The pathological changes of rat pancreas were observed, and the content of pancreatic collagen fibers was analyzed by Van Gieson staining; Results (1) The serum levels of hyaluronic acid were 87 μ g/L ± 22 μ g/L, 78 μ g/L ± 25 μ g/L and 62 μ g/L ± 19 μ g/L in the low-dose, medium-dose and high-dose emodin-treated groups, respectively, which were significantly lower than those in the model control group (113 μ g/L ± 27 μ g/L, all P<0.05); The serum laminin levels were 67 μ g/L±14 μ g/L, 57 μ g/L±12 μ g/L and 44 μ g/L±10 μ g/L, respectively, which were significantly lower than those in the model control group (86 μ g/L±17 μ g/L, all P<0.05); (2) The degree of pancreatic fibrosis in the emodin-treated group was milder than that in the model group, and the degree of fibrosis decreased with the increase of emodin dose, and the degree of fibrosis decreased in the high-dose emodin group was statistically significant compared with the model control group (P<0.05); (3) The area occupied by positive staining of pancreatic collagen fibers was 39%±7%, 38%±4% and 36%±5% in low-dose, medium-dose and high-dose emodin groups, respectively. The degree of fibrosis in high-dose emodin group was lighter than that in the model control group (42%±6%), and the difference was statistically significant (P<0.05); (4) The expression levels of TGF-β 1 protein were 44.3%±2.1%, 39.2%±1.8% and 28.8%±1.6% in low-dose, medium-dose and high-dose emodin groups, respectively. Compared with the model control group (60.7%±1.7%), the high-dose emodin group was lower than the model control group (P<0.05); There were significant differences between the high-dose emodin group and the medium-and low-dose groups (all P<0.05). Conclusion Emodin has anti-pancreatic fibrosis effect in the rat chronic pancreatitis model, and this effect is related to the expression of TGF-β 1 protein.

Objective to study the clinical characteristics of early onset type 2 diabetes mellitus (T2DM) and to explore the risk factors related to its chronic complications. Methods 2713 patients with T2DM with a course of disease within 10 years were divided into early onset (EOD) and late onset (LOD) groups according to whether the onset age was more than 40 years old. The clinical data of the two groups were compared to analyze the clinical characteristics of EOD patients and the risk factors related to chronic complications. Results (1) Compared with LOD group, the proportion of smokers in EOD group was higher (29.2% vs 22.0%, P<0.01), the positive rate of family history of diabetes was higher (28.6% vs 13.1%, P<0.01), the proportion of patients with poor control of blood glucose (FPG and HbA1c) was higher (80.8% vs 74.6% and 77.3% vs 72.7%, respectively, P<0.05), the proportion of blood TG (2.5±2.4mmol/L vs 1.9±1.5 mmol/L, P<0.01) and BMI (24.4kg/m2±4.6 kg/m2 vs 23.6kg/m2±3.7 kg/m2,P<0.01) The prevalence of metabolic syndrome (MS) in EOD group was higher than that in LOD group (18.9% vs 10.7%, P<0.01). (2) The incidence of microvascular and neurological complications in EOD group was higher than that in macrovascular complications, and the incidence of neurological complications such as pain (10.6% vs 7.10%, P<0.05), sensory loss (6.20% vs 2.80%, P<0.01), diarrhea (6.00% vs 3.70%, P<0.05) and early nephropathy (13.00% vs 8.00%, P<0.01) in early onset patients were higher than that in LOD group. Multivariate Logistic regression analysis suggested that age, disease course, hypertension, smoking, positive family history and hyperTGemia were the important factors related to the occurrence and development of chronic complications. Conclusion EOD patients showed more severe metabolic disorders and were more likely to complicate various microvascular and nerve damages in early stage, while late onset T2DM patients were more likely to complicate cardiovascular and cerebrovascular diseases, hypertension and other macrovascular diseases

Objective to investigate the expression of α-cell signal transduction pathway molecules in pancreatic islets of obese rats fed high-fat diet and treated with high-dose streptozotocin (STZ) de-β cells and its possible mechanism.Methods Thirty SD rats were divided into high-fat diet fed obese (HF) group and normal diet fed normal control (NC) group. After 20 weeks of feeding, (1) the levels of fasting blood insulin (Ins), glucagon (Glc), free fatty acid (FFA) and triglyceride (TG) were measured. (2) The degree of peripheral insulin resistance was evaluated by normal blood glucose hyperinsulin clamp test (7 rats in NC group and 7 rats in HF group). (3) Eight rats in NC group and HF group were treated with high-dose streptozotocin (STZ) de-β cells, namely NC-B group and HF-B group. The blood glucose was controlled with insulin, and the animals were sacrificed after 5 days, and the islet cells were isolated. (4) The α-cell Glc, insulin receptor substrate-1 (IRS-1) and insulin receptor substrate-1 (IRS-1) were compared between the two groups by real-time quantitative polymerase chain reaction method The levels of FFA, Ins and Glc in HF group were significantly higher than those in NC group (FFA 508 (394-622) μ mol/L vs 325 (240-410) μ mol/L, Ins 23.7 (14.0-33.4) mIU/L vs 11.5 (3.6-19.4) mIU/L; Glc 345 (298.6-391.4) pg/ml vs 256 (226.4-285.6) pg/ml; P<0.05); (2) The expression of Glc mRNA in HF-B group was 34.2%±2.1% higher than that in NC-B group, and the expression of IRS-2 and PI3K mRNA was 28.5%±1.8% and 21.3%±1.6% lower, respectively (all P<0.01), while IRS-1 was only 7.0%±1.2% lower than that in NC-B group (P>0.05). (3) The correlation analysis showed that the blood FFA level was negatively correlated with GIR in HF group (r = -0.675, P<0.01); The expression of IRS-2 mRNA was also negatively correlated with the expression of IRS-2 mRNA in α cells (r = -0.458, P<0.05). Conclusion The expression of islet signal transduction molecules in islet α cells of obese rats induced by high fat diet was decreased, and it was related to the increase of blood FFA level.

Methods Fasting blood glucose, insulin and proinsulin were measured in 352 newly diagnosed patients with type 2 diabetes mellitus, and intravenous glucose tolerance test was performed to evaluate the area under the insulin curve (AUC), acute insulin secretion phase (AIR), homeostatic model β cell function index (Homa β) and insulin resistance index (Homa IR). Results AUC of diabetic patients was significantly lower than that of normal patients (834.2 pmol/L vs 7934.7 pmol/L, median, P<0.001); AIR was deleted (-33.7 pmol/L vs 6962.0 pmol/L, P<0.001). Stratification analysis showed that AIR was significantly weakened (317.3 pmol/L) when fasting blood glucose was>7.0 mmol/L, and disappeared when fasting blood glucose was greater than 9.0 mmol/L. Homa β was about 30% (3.7 ± 0.9 vs 5.9 ± 0.9, P<0.001), and fasting proinsulin (PI) and its ratio to insulin (PI/I) were significantly increased (22.6 pmol/L ± 14.7 pmol/L vs 11.5 pmol/L ± 7.1 pmol/L, P<0.001; 30.1% ± 20.5% vs 12.1% ± 9.6%, P<0.001).

Objective to observe the expression of FOXP3 mRNA in CD4+ CD25+ T cells and CD4+ T cells in adult patients with occult autoimmune diabetes mellitus (LADA), and to investigate the immunopathogenesis of FOXP3 mRNA. Methods The percentage of CD3+, CD4+, CD8+ and CD4+ CD25+ T cells was detected by flow cytometry in 67 patients with LADA, 30 patients with type 2 diabetes mellitus and 30 normal controls. CD4+ T cells were isolated by magnetic beads, and the expression level of FOXP3 mRNA in CD4+ T cells was detected semi-quantitatively by real-time-PCR method. Results Compared with normal controls, CD4+ CD25+ T cells were increased in LADA patients (4.1 ± 1.9 vs 2.8 ± 1.5, P<0.01), and the proportion of CD4+ CD25+ T cells in CD4+ T cells was increased (11.9 ± 5.0 vs 8.2 ± 3.7, P<0.01). The expression level of FOXP3 mRNA in CD4+ T cells of LADA patients was significantly decreased (0.52-fold, P<0.01, n =10). Conclusion LADA

Objective to investigate the prevalence and main risk factors of chronic renal complications in diabetes mellitus and pre-diabetes mellitus. Methods the established cohort of diabetes mellitus and impaired glucose regulation in Shanghai was screened. Fasting blood and morning urine were collected three times on different days within 3~6 months. The ratio of urinary albumin/urinary creatinine ranged from 30~299.9 μ g/mg was used to determine microalbuminuria, and the glomerular filtration rate was estimated by serum creatinine concentration. Results A total of 406 cases were screened, including 244 cases with diabetes mellitus; There were 162 patients with impaired glucose regulation, with an average age of 67.5 ± 13.8 years. (1) The prevalence of microalbuminuria in diabetic and impaired glucose regulation was 20.9% and 10.5%, respectively; (2) The proportions of mild, moderate and severe decrease in glomerular filtration rate were 41.6%, 37.0% and 1.2% in diabetic patients, and 34.2%, 47.2% and 1.9% in impaired glucose regulation, respectively. The prevalence of renal insufficiency calculated by glomerular filtration rate was 38.2% and 49.1% in diabetic and impaired glucose regulation; (3) The prevalence of microalbuminuria in hypertension, central obesity, dyslipidemia, cardiovascular disease history and elderly diabetic patients was significantly increased. Systolic blood pressure, waist circumference, fasting blood glucose and cardiovascular disease history were independently related to the occurrence of microalbuminuria in hyperglycemic patients. (4) The glomerular filtration rate decreased significantly with the increase of age. The proportion of renal insufficiency calculated by glomerular filtration rate was higher in hypertensive patients (48.5%). After excluding the influence of age, the glomerular filtration rate was positively correlated with the ratio of urinary albumin/urinary creatinine<300 μ g/mg. Serum creatinine, age and systolic blood pressure were independently correlated with the glomerular filtration rate<60ml · min-1 · (1.73 m2) -1 in hyperglycemia patients, respectively. Conclusion The prevalence of chronic renal complications in Shanghai community hyperglycemia population has reached a high level. Besides examining the excretion of urinary albumin, the glomerular filtration rate should be evaluated in the detection of chronic renal complications in hyperglycemia patients.

Laparoscopic splenectomy is safe and effective, and has become the first choice of splenectomy abroad. However, due to the high cost of laparoscopic surgery, its popularization and popularization in China is limited. We applied the second-stage splenic pedicle dissection technique to laparoscopic surgery, which achieved satisfactory results and significantly reduced the surgical cost.

reverse engineering (RE) is the general term of digital technology, geometric model reconstruction technology and product manufacturing technology related to changing real objects into computer aided design (CAD) models. It is the process of transforming existing products or real object models into engineering design models and conceptual models, and on this basis, dissecting, deepening and recreating existing products [1].

A 41-year-old female was seen for more than 3 months because of repeated dizziness and neck pain, and tendon reflex (+ +).

acetyl-CoA carboxylase (ACC) is an enzyme that promotes the synthesis of fatty acids in the study of the pathogenesis of obesity and diabetes mellitus (DM) in recent years. It is at the intersection of fat and sugar metabolism, and plays an important role in carbohydrate and fat metabolism. ACC may become a new target in the treatment of diabetes mellitus in the future.

How to induce donor-specific hyporesponsiveness to reduce or even stop immunosuppressants, reduce the incidence of rejection and improve the long-term survival of transplanted kidneys is a hot topic in organ transplantation research.It has been reported abroad [1] that donor-specific bone marrow cells (DBMC) transfusion under anti-lymphocyte globulin (ALG) induction therapy successfully induced donor-specific hyporesponsiveness and significantly improved the long-term survival rate of transplanted kidneys.However, anti-lymphocyte globulin induction therapy has the risk of aggravating infection and graft versus host disease (GVHD) and increasing the treatment cost.We [2] have carried out a clinical study of donor-specific immune hyporesponsiveness induced by DBMC infusion in renal transplant recipients under the application of conventional immunosuppressants in China earlier. At present, the longest follow-up has been more than 6 years. Now, the short-term and long-term efficacy of renal transplant recipients with DBMC infusion and renal transplant recipients with non-DBMC infusion at the same time were observed. The report is as follows.

insulin resistance is a key factor in the pathogenesis of type 2 diabetes.Correspondingly, increasing insulin sensitivity is also a key therapeutic strategy to overcome type 2 diabetes.Ciliary neurotrophic factor (CNTF), as a ciliary ganglion motor neuron trophic factor, is a member of gp130 receptor cytokine familie.Recently, it has been reported that CNTF can be used for weight loss treatment in rodents and humans.Obesity is highly correlated with type 2 diabetes.After treatment with CNTF in obese mice, it can significantly improve the metabolic status (such as reducing plasma glucose, insulin, free fatty acid and triglyceride levels, and improving glucose tolerance).

Although many secondary stroke prevention has been applied in the clinic, patients still have a high risk of recurrent stroke.

Bone marrow mesenchymal stem cells (MSCs) have the function of supporting hematopoiesis in vivo and in vitro, so transplantation with MSCs may enhance the transplantation effect. Recent studies have confirmed that transplantation with MSCs can promote hematopoietic stem cell implantation and hematopoietic recovery [1,2]. Previous studies have found that there are pathological changes in bone marrow hematopoietic microenvironment of acute leukemia patients, including changes in cell composition and function. However, it is still unclear whether and the degree of influence of bone marrow MSCs in acute leukemia patients are affected. In addition, the source of MSCs is limited, and the homing efficiency of allogeneic MSCs is low. Therefore, in this study, autologous bone marrow MSCs from acute leukemia patients were obtained, cultured and expanded in low serum medium, and their proliferation ability, multidirectional differentiation and supporting hematopoietic function in vitro were observed, so as to clarify their biological characteristics and provide detailed experimental basis for further clinical application of autologous MSCs.

The partial D phenotype (or partial D phenotype) of the Rh blood group system can be divided into 6 phenotypes: DⅡ (D category Ⅱ,DⅡ) ~ DVII (D category VII,DVII) (DⅠ has been abolished), among which the DⅥ (Dcategory VI,DⅥ) phenotype is of significant clinical significance [1]. The DⅥ phenotype can lead to severe neonatal hemolytic disease in pregnant women with RhD positive fetus [2]. If patients with DⅥ phenotype are misdetected as RhD positive and receive RhD positive blood, the risk of developing anti-RhD is also very high [3]. Wagner et al. [4] found that DⅥ in European population can be divided into three types with different molecular structures, and the molecular structure of this phenotype has not been studied in China.We studied the molecular structure of DⅥ phenotype type Ⅲ (Dcategory VI phenotype type Ⅲ) in 7 Chinese Han population.

At present, myocardial protection methods in open heart surgery are all exogenous, and the myocardial protection effect is limited, especially for some severe heart diseases.Recent studies have found that ischemic preconditioning (IP) is a powerful endogenous myocardial protection mechanism in mammals including humans, and has a long-term reliable myocardial protection effect.However, there are still many inconveniences in clinical application, and will cause new damage.Based on the principle of IP, this study discussed the effect and mechanism of adenosine preconditioning on myocardial protection in open heart surgery.

Hearing impairment is one of the most common birth defects. Studies at home and abroad show that the incidence of hearing impairment in high-risk newborns is as high as 2% ~4%, so it is particularly important to perform hearing examination on these newborns. Hearing impairment occurring in neonatal period can affect the development of speech-language, cognition and emotion of children, but if early diagnosis and early intervention treatment can make these children acquire speech ability equivalent to their developmental age.

A 15-year-old female was admitted to hospital for 14 days due to multiple painful nodules throughout her body. Physical examination showed that the vital signs were stable, and the swollen lymph nodes of about 3 cm ×4 cm could be reached under the right axillary, with movement, mass, and mild tenderness. Cystic nodules of about 2 cm ×2 cm in size at the right temporal parietal were tender. Multiple nodules could be seen on the trunk and the back of the thigh. The nodules were divided into two categories: one was red on the surface, protruding from the epidermis, about 0.5 cm ×1 cm in size, and obvious tenderness; The other type was subcutaneous or intermuscular nodules, about 2 cm ×4cm in size, with tenderness, and no other positive signs. Blood routine showed that leukocytes were 13.3~15.5×109/L, neutral lobulated nuclei were 77%, neutral rod nuclei were 3% ~6%, lymph were 10% ~23%, hemoglobin was 112g/L, and platelets (315~422) ×109/L; erythrocyte sedimentation rate 84 mm/1 h; B-ultrasound showed splenomegaly (thickness 4.26 cm), no enlarged lymph nodes in retroperitoneum, multiple enlarged lymph nodes were detected on the body surface, multiple hypoechoic nodules of different sizes were detected between the muscle layer, fat layer and muscle layer of the left leg, with blood flow inside. Chest CT showed multiple high density nodules in the lung.

A 17-year-old woman suffered from progressive hearing decline in her right ear for half a year, occasionally tinnitus, but no pulsation. Clinical examination: red mass was seen behind the tympanic membrane. CT cross-section and coronal high-resolution CT (HRCT) showed that the horizontal segment of the internal carotid artery was obviously tortuous and expansive, and soft tissue shadow was seen in the tympanic chamber, which was connected to the external internal carotid artery of the skull base through the inferior tympanic tube, and the inferior tympanic tube was enlarged (Figure 1). Enhanced transverse CT showed poor intratympanic mass enhancement due to partial volume effect. MRI scans: T1WI (Figure 2A) and T2WI (Figure 2B) showed no obvious abnormal signal lesions in the inferior tympanic chamber outside the cochlea, showing low signal (or no signal) empty signs; After enhancement, T1WI showed obvious thickening and twisting of the horizontal segment, ascending segment and parasellar internal carotid artery of the carotid artery (Figure 3); MRA showed that the internal carotid artery outside the skull base tortuously circled in the tympanic chamber and then entered the horizontal segment of the internal carotid artery, and connected with the horizontal segment of the internal carotid artery. The horizontal segment of the internal carotid artery and the parasellar internal carotid artery also showed tortuous thickening and dilation (Figure 4).