Volume 87  ·   Issue 18  ·  2007

The impact of diabetes on human health is becoming more and more serious, which is not only due to its widespread prevalence in the world, but also because the systemic complications (eye, kidney, nerve and cardiovascular) caused by diabetes have become the main causes of human disability and death.

At present, there are more and more experimental studies on the application of adult stem cells to promote wound repair, but because we know little about the cellular and molecular mechanisms of stem cells involved in wound repair, it is difficult to produce effective intervention measures.

Objective to analyze the relationship between myocardial insulin-like growth factor-1 receptor mRNA (IGF-1R mRNA) expression and myocardial morphology in experimental diabetic rats with different degrees of blood glucose, and to determine the role of IGF-1R mRNA in diabetic cardiomyopathy. Methods A diabetic rat model was made, and the morphological changes of myocardium were observed by light microscope and fluoroscopic electron microscope at 3 months after model formation. The expression of IGF-1R mRNA in myocardium under different blood glucose states was observed by in situ hybridization technique. Results IGF-1R mRNA was expressed in the myocardial cell membrane and cytoplasm of normal rats and diabetic rats (model group B and C) with the expression rates of 20%, 30% and 38%, respectively. The levels of blood glucose and glycosylated hemoglobin A1 (HbA1c) were positively correlated with the expression of IGF-1R mRNA in the myocardial cell membrane and cytoplasm of diabetic rats with the correlation coefficients of 0.869 and 0.865, respectively (both P<0.01), indicating that it was correlated with the changes of myocardial morphology and structure. Conclusion With the increase of blood glucose level, myocardial IGF in diabetic rats The change of IGF-1R mRNA expression is probably an important factor in the occurrence and development of diabetic cardiomyopathy.

Objective to analyze the relationship between baseline metabolic syndrome and its components and new diabetes mellitus in 10 years.Methods In 1992, 4154 people aged 35-64 years in Peking University and Shougang area were investigated for cardiovascular risk factors.In 2002, this population was followed up and re-examined. The data of both surveys were complete in 2740 people, and 2659 people who did not have diabetes mellitus at baseline survey were selected for analysis.Results (1) 112 cases of new diabetes mellitus in 10 years, the total incidence rate was 4.2%, 5.0% in males and 3.6% in females. (2) The prevalence of abnormal components of metabolic syndrome in the subgroup with diabetes mellitus was higher than that in the subgroup without diabetes mellitus; Among the subgroups with diabetes mellitus, the prevalence of abnormal fasting blood glucose was the highest, which was 71.43%. (3) After adjusting for age and gender, abdominal obesity, high triglyceride and abnormal fasting blood glucose were independent risk factors for new onset of diabetes mellitus, among which the relative risk of diabetes mellitus in the abnormal fasting blood glucose group was the greatest, with a relative risk (RR) of 7.14 (4.62~11.03). (4) Compared with those without metabolic syndrome and normal fasting blood glucose, the RR of diabetes mellitus in the subgroup with metabolic syndrome but normal fasting blood glucose was 2.91 (1.17, 7.21). Conclusion Metabolic syndrome has an independent predictive effect on new onset of diabetes mellitus; Among the abnormal components of metabolic syndrome, abnormal fasting blood glucose is the most predictive effect on new-onset diabetes, but the predictive effect of metabolic syndrome on new-onset diabetes cannot be explained by abnormal fasting blood glucose. Early intervention measures should be taken to prevent the occurrence of diabetes for those subgroups without abnormal fasting blood glucose but with metabolic syndrome.

Objective to investigate and analyze the characteristics and related factors of neuropathy in diabetic foot. Methods A unified survey was conducted on outpatient and inpatient patients with diabetic foot in 14 hospitals in 2004, including retrospective medical history, physical examination and biochemical examination. The classification, staging, neuropathy characteristics and related factors of foot ulcer were analyzed. Results 530 patients with diabetic foot and 337 patients with neuropathic ulcer (63.6%) were included in the statistics. Among them, 172 patients with simple foot neuropathic ulcer (32.5%), 165 patients with mixed ulcer (31.1%) and 193 patients with ischemic foot ulcer (36.42%) were included. The physical factors causing foot ulcer accounted for 62.4% ~84.9%. The course of disease of 3 (1,60) months in patients with neuropathic foot ulcer was significantly shorter than that of 5 (1,96) months in patients with ischemic foot ulcer (P<0.001). The course of disease of patients with mixed foot ulcer was 12 (1,108) The degree of foot ulcer was correlated with the course of diabetes, economic income, foot deformity, knee reflex, ankle reflex, tuning fork vibration, nylon wire sensory point, ankle brachial index (ABI), foot artery pulsation, fasting blood glucose and glycated hemoglobin. Conclusion Neuropathic ulcer is more common in patients with diabetic foot ulcer, and the prognosis of neuropathic damage is better than that of diabetic foot with vascular factors; The prognosis of mixed diabetic foot is poor.The examination of nylon wire sensory point, tuning fork vibration sensation and tendon reflex in peripheral neuropathy is the most simple and practical.

Objective to compare the efficacy and safety of metformin sustained-release tablets and Glucophage in the treatment of type 2 diabetes.Methods 150 patients with type 2 diabetes were randomly divided into two groups: 75 cases in the control group, oral Glucophage 500 mg each time, 3 times a day; In the experimental group, 75 cases were given oral metformin sustained-release tablets, 1500 mg each time, once a night. After 12 weeks of treatment, the efficacy of taking metformin sustained-release tablets was evaluated by glycosylated hemoglobin (HbA1c), fasting blood glucose (FPG), 2 h postprandial blood glucose (2hPG), and the area under the blood glucose curve (AUC). Results 140 cases completed the trial.After 12 weeks of drug treatment, the fasting blood glucose levels of the two groups were similar (6.7 mmol/L ± 1.1 mmol/L vs 7.0 mmol/L ± 1.3 mmol/L, P =0.07); The blood glucose decreased in the Glucophage group (6.9 mmol/L±1.4 mmol/L vs 6.7 mmol/L±1.1 mmol/L) before and after 2 h postprandial medication, and the difference between the groups was statistically significant (P =0.002); There was no statistically significant difference in the changes of AUC within 2 h postprandial between groups (P =0.64); The main adverse events were gastrointestinal reactions, and the incidence rate was 10.8% in the Glucophage group and 4.3% in the metformin sustained-release tablets group. The difference between the groups was not statistically significant (P =0.21). No patients withdrew from the study due to adverse events, and no serious adverse events occurred during the trial. Conclusion The clinical efficacy of domestic metformin sustained-release tablets and Glucophage in the 12-week study is comparable with the same hypoglycemic effect, and the patient compliance is good, and the adverse reactions are mild.

Objective to investigate the changes of plasma osteoprotegerin (OPG) levels in patients with type 1 diabetes mellitus (T1DM) before and after insulin therapy. Methods Twenty-two newly diagnosed patients with type 1 DM and 28 healthy individuals were selected. T1DM patients were treated with insulin for 6 months. Plasma OPG was measured by ELISA. High resolution extravascular ultrasound was used to detect endothelium-dependent vasodilation mediated by blood flow in brachial artery and endothelium-independent vasodilation mediated by nitroglycerin (GTN). Results Plasma OPG levels were 3.09 ng/L ± 0.70 ng/L before treatment in T1DM patients, which was significantly higher than that in the control group (2.07 ng/L ± 0.75 ng/L, P<0.01). After 6 months of treatment, plasma OPG levels were significantly decreased (2.58 ng/L ± 0.59 ng/L, P<0.01). The endothelium-dependent vasodilation function was significantly lower in T1DM patients before treatment (3.35% ± 0.67%) than that in the control group (5.17% ± 0.83%, P<0.01). After 6 months of treatment, there was significant improvement (4.27% ± 0.63%, P<0.01 The changes of FPG, HbA1c and CRP were correlated (all P<0.01). Conclusion The plasma OPG level of newly diagnosed patients with T1DM was significantly increased, and the plasma OPG was correlated with vascular endothelial function.

Objective to investigate the changes of serum pigment epithelial factor (PEDF) in patients with type 2 diabetic nephropathy (T2DM) and its significance in the development of diabetic nephropathy.Methods 49 healthy controls and 132 patients with T2DM were selected and divided into normal albuminuria group (NA) (48 cases), microalbuminuria group (MA) (50 cases) and clinical albuminuria group (PR) (34 cases) according to the 24-h urinary microalbumin excretion rate (UAER). Serum PEDF level was detected by enzyme-linked immunoassay (ELISA), urine microalbumin, glycosylated hemoglobin (HbA11c), fasting blood glucose (FPG), blood lipid and high sensitivity C-reactive protein (hs-CRP) were measured by immunoturbidimetry. Results Serum PEDF level in T2DM patients was significantly higher than that in healthy controls (2.7±1.3) mg/L, and serum PEDF (4.7±2.9) mg/L in MA group was significantly higher than that in NA group (3.7±2.2) mg/L, (P<0.01); The serum PEDF levels in PR group (5.7±2.8) were significantly higher than that in MA group (P<0.05). The serum PEDF levels were positively correlated with HbA1c (r =0.198, P<0.01), FPG (r =0.231, P<0.01), triglyceride (TG) (r =0.302, P<0.01), hs-CRP (r =0.214, P<0.01) and UAER (r =0.169, P<0.05), while negatively correlated with HDL cholesterol (r = -0.237, P<0.01). Multiple regression analysis showed that TG (β =0.314, P<0.01), hs-CRP (β =0.260, P<0.01) and UAER (β =0.148, P<0.05) were independent determinants of serum PEDF. Conclusion PEDF was significantly increased in T2DM patients, and gradually increased with the severity of albuminuria; TG, hs-CRP and UAER are independent influencing factors of serum PEDF. The elevation of serum PEDF level may be involved in the development and development of diabetic nephropathy.

Objective to determine the difference between bedside examination (POCT) instrument and automatic coagulation instrument in routine coagulation test and monitoring of heparin therapy. Methods the elderly patients with cardiovascular disease who received heparin anticoagulation were studied. Plasma prothrombin time (PT), international standardized ratio (INR), activated partial thromboplastin time (APTT) and fibrinogen content (Fbg) were detected by comparing Hemachron Jr Ⅱ and CG02 POCT instruments with automatic coagulation instrument STA-R, respectively. The plasma coagulation indexes of different heparin levels were statistically analyzed. Results There were good correlations between dry chemical bedside examination instrument and automatic coagulation instrument for the detection of coagulation parameters PT, INR, APTT and Fbg (r were 0.945, 0.966, 0.662 and 0.977, respectively, all P<0.05); There was a significant difference between Hemachron Jr Ⅱ and the automatic coagulometer in the detection of APTT (P<0.01). Conclusion the dry chemical bedside equipment is not suitable for reporting the coagulation test results simultaneously with the automatic coagulometer.

Objective to investigate the clinical characteristics and treatment methods of rare intrahepatic bile duct cystadenoma and cystadenocarcinoma. Methods the clinicopathological manifestations, diagnosis and treatment experience of 8 cases of intrahepatic bile duct cystadenoma and cystadenocarcinoma were retrospectively analyzed and discussed in combination with literature data. Results There were 3 males and 5 females in this group, 2 cases of cystadenoma and 6 cases of cystadenocarcinoma. 3 cases were asymptomatic, and 5 cases mainly showed abdominal pain with fever. Ultrasound examination is suitable for screening and follow-up, and CT examination can be combined for suspicious cases. Surgical treatment is the first choice of treatment, and thorough resection of tumor is the key to radically cure the disease, improve the survival rate and prevent the recurrence of tumor. The long-term follow-up effect of patients with thorough surgical resection is good. Conclusion Improving the diagnosis rate of intrahepatic bile duct cystadenoma and cystadenocarcinoma is crucial for treatment and prognosis, and thorough resection of tumor is the key to ensure the survival rate and reduce the recurrence rate.

Objective to observe the function and ultramicroscopic structure of sperm mitochondria in idiopathic asthenospermia, and to explore the role of mitochondria in sperm motility. Methods According to the diagnostic criteria of idiopathic asthenospermia, 151 patients with idiopathic asthenospermia were screened and divided into 3 groups according to grade A sperm motility, 15% ≤ A group<25%, 5% ≤ B group<15%, C group<5%. The function of sperm mitochondria in the three groups was examined and observed by electron microscope, and compared with 53 normal males. Results The coloring rate of mitochondrial succinate dehydrogenase (SDH) and mitochondrial membrane potential (MMP) in groups A, B and C were significantly different from those in normal groups (t =28.12, 38.82, 64.71; t =21.34, 33.60, 44.99, all P<0.01). The frequency of mitochondrial structural lesions between groups was significantly different (x2=60.85, P<0.01). The number of mitochondria in lesions increased with the decrease of sperm motility (regression x2=479.72, regression coefficient B =0.86, P<0.01). Sperm motility is closely related to mitochondrial structure and function.

Objective to investigate the predictive effect of heart rate changes in children with vasovagal syncope (VVS) in upright tilt test (HUT) on the therapeutic effect of metoprolol. Methods Twenty-six children with VVS who were positive for HUT or nitroglycerin-induced HUT (SNHUT) and received metoprolol were studied. According to the long-term follow-up data, the children were divided into effective group (16 cases) and ineffective group (10 cases). The changes of central rate in the two groups during HUT or SNHUT and its predictive value on the therapeutic effect of metoprolol were analyzed. Results There were no significant differences in age, gender, number of syncopes, course of disease, basal heart rate, blood pressure, SNHUT application, type of positive reaction and follow-up time between the two groups. The heart rate before positive reaction in the effective group was significantly faster than that in the ineffective group [(123±15) beats/min vs (96±17) beats/min, P<0.01]. There was no significant difference between the two groups in the basal heart rate in the recumbent position and the change of heart rate at the time of positive occurrence, and there was no significant difference in the change of mean blood pressure between the two groups. Taking the 30 beats/min increase of heart rate before positive reaction as the cut-off point, the sensitivity of predicting the efficacy of metoprolol treatment was 81% (13/16), the specificity was 80% (8/10), and the diagnostic accuracy was 81% (21/26). Conclusion It may be more effective to choose β-blockers for those with obvious increase of heart rate before positive reaction (those with heart rate>30 beats/min compared with basal value).

Objective to observe the expression difference of focal adhesion kinase (FAK) in different hepatocellular carcinoma tissues and the significance of FAK expression in judging the prognosis of hepatocellular carcinoma. Methods The clinical data of 50 patients with hepatocellular carcinoma in our institute were retrospectively analyzed. The expression of FAK mRNA in tumor tissues and peritumoral tissues was detected by real-time PCR, and the relationship between FAK mRNA expression and clinicopathology and prognosis of hepatocellular carcinoma was analyzed. Results The expression of FAK mRNA in tumor tissues was significantly higher than that in peritumoral tissues (P<0.001), the expression of FAK mRNA in tumor thrombus group was significantly higher than that in tumor tissues (P<0.05), and the expression of FAK mRNA in tumor tissues in tumor thrombus group was significantly higher than that in tumor thrombus-free group (P =0.003). The expression of FAK mRNA in tumor tissues in high invasion group was significantly higher than that in low invasion group (P =0.020). Univariate and multivariate analysis showed that FAK expression was an independent factor affecting the postoperative survival rate of hepatocellular carcinoma.

Objective to evaluate the functionality of islet β cells and its related indexes in individuals with normal glucose tolerance (NGT), impaired glucose regulation (IGR) and newly diagnosed type 2 diabetes mellitus (T2DM). Methods 178 patients were subjected to oral and intravenous glucose tolerance tests. △ I30/ △ G30), acute insulin secretion phase (AIR), β cell function index (HOMA β), fasting proinsulin (FPI) and proinsulin/insulin (PI/I) ratio reflected insulin secretion function. △ I30/ △ Compared with NGT group, G30 and AIR decreased by 38% and 39%, respectively, and HOMA β decreased slightly (19%); The function of islet β cells decreased significantly in T2DM group, with AIR decreased by 84%, △ I30/ △ G30 down 70%, HOM △ The ratio of FPI and PI/I in T2DM group was also significantly higher than that in NGT group (24.4 pmol/L ± 18.0 pmol/L or 10.9 pmol/L ± 6.7 pmol/L; 14.7% ± 10.5% or 10.0% ± 6.5%, P<0.05). △ I30/ △ G30 Conclusion IGR patients mainly showed phase defect of insulin secretion and decrease of HOMA β, and the quality of insulin secretion was decreased in diabetic stage. △ I30/ △ Both G30 and AIR can accurately reflect the function of pancreatic islet β cells in IGR patients, but AIR is more suitable in newly diagnosed patients with type 2 diabetes mellitus △ I30/ △ G30 must be corrected for insulin resistance.

Objective to repair the lateral maxillary sinus bone wall with mucosal defects in situ by using collagen sponge and acellular cancellous bone compounded with bone morphogenetic protein-2 (BMP-2), and to observe the in situ osteogenesis induced by BMP-2 and the repair of lateral maxillary sinus bone wall and mucosa. Methods to prepare the lamellar acellular cancellous bone compounded with BMP-2. The lateral maxillary sinus bone wall and adherent mucosa were removed by surgery, and the lateral collagen sponge faced the sinus cavity, and the defects were repaired in situ. Three months after surgery, the gross specimens and pathological sections were observed to understand the repair effect and osteogenesis. Results the health status of the rabbits was good after surgery. Three months after surgery, the gross observation showed that the defects of lateral maxillary sinus wall were well repaired, and the medial surface of sinus cavity was covered by new mucosa. Pathological examination showed that new bone was formed in the acellular cancellous bone of the experimental group, while only fibrous connective tissue was grown in the control group. Conclusion BMP-2 has the ability to induce osteogenesis, and collagen sponge can be used as mucosa Acellular cancellous bone/BMP-2/collagen sponge can be used to repair local bone wall with mucosal defect of maxillary sinus.

Objective to compare the changes of plasma protein in rats with liver cirrhosis induced by CCl4 by proteome technique and to study the effect of Fuzheng Huayu Decoction on plasma protein in rats with liver cirrhosis. Methods Male SD rats were randomly divided into three groups, and were given CCl4 (CCl4/olive oil: 1 volume ratio =1:1) intraperitoneal injection, CCl4 intraperitoneal injection + Fuzheng Huayu Decoction gavage, and olive oil intraperitoneal injection respectively. After 8 weeks, the liver collagen area was automatically analyzed by Masson tricolor staining method with image analyzer. The gel images were analyzed by two-dimensional gel electrophoresis technique with silver staining color development and PDQuest7.3 software. The protein spots with different expression in the three groups were identified by matrix-assisted laser desorption ionization time-of-flight tandem mass spectrometry. Results The degree of liver fibrosis in the Fuzheng Huayu Decoction intervention group was significantly lighter than that in the model group, and the collagen fiber area was less deposited in the liver (8.9%±3.7%vs 12.4%±4.7%,P<0.05). The expression of plasma glutathione peroxidase and its precursor, prealbumin, haptoglobin, apolipoprotein A-Ⅳ precursor, complement 4, α inhibitor heavy chain 4 and microtubule-associated regulatory kinase 1 was decreased in the plasma of liver cirrhosis rats, and the expression of liver regeneration-related protein and vimentin was increased in the Fuzheng Huayu formula intervention group, and the expression of liver regeneration-related protein and vimentin was increased in the plasma of liver cirrhosis rats, while the expression of Fuzheng Huayu formula intervention group was decreased. Conclusion CCl4 induces significant changes in the expression of protein related to oxidative stress, cell proliferation and transformation in the plasma of liver cirrhosis rats.

A 14-year-old male with no history of tuberculosis was diagnosed with chronic myeloid leukemia (chronic stage) by bone marrow image, chromosome and BCR/ABL fusion gene examination. The blood image returned to normal after treatment with hydroxyurea and interferon. After discharge, the blood image returned to normal after treatment with hydroxyurea and interferon. After treatment with hydroxyurea and interferon, the blood image returned to normal.

According to the statistics of the World Health Organization, the global infection rate of hepatitis C virus (HCV) is about 3%, 35,000 new cases of hepatitis C occur every year, and the positive rate of anti-HCV in general population in China is 3.2%. In 2004, the guidelines for prevention and treatment of hepatitis C in China proposed that the combination of peginterferon and ribavirin is the most effective antiviral treatment at present.

Hepatitis is a global health problem that threatens human health. According to the statistics of the World Health Organization (WHO), about 2 billion people worldwide have been infected with HBV, of which 350 million people are chronically infected with HBV [1]. About 1 million people die every year from severe hepatitis/liver failure, cirrhosis and primary hepatocellular carcinoma (HCC) caused by HBV infection.

In 1928, British bacteriologist Fleming discovered penicillin, which is a major milestone in the history of human medicine. Until today, antibiotics are still a powerful weapon for people to resist various pathogens [1-2]. Systemic infection or sepsis is the biggest threat to patients with severe burns, because of extensive deep burns, the natural barrier of body surface and body cavity is destroyed, the systemic immune function is imbalanced, and the susceptibility to pathogens is significantly increased.

90% of patients with type 2 diabetes mellitus (T2DM) have insulin resistance, which is also the main pathophysiological mechanism of T2DM. Early studies have found that short-term intensive insulin therapy can improve insulin resistance and control blood glucose in patients with T2DM in different course of disease [1-2].

The prevention and treatment of postoperative intestinal paralysis is always a difficult point in abdominal surgery. At present, supportive treatment is mainly adopted to solve this problem, and other measures include restricting the use of anesthetics; Use epidural anesthesia wherever possible; Early eating and out of bed activity; If necessary, cooperate with gastrointestinal decompression.

The 2002 Cardiovascular Risk Factors in Young Adults (CARDIA) Study, through a 10-year follow-up, showed that overweight patients on a low-calcium diet were prone to developing metabolic syndrome, which aroused concern about the metabolic effects of calcium supplementation.

As of February 2005, there were 987 kinds of medical journals in China, accounting for 20.7% of the scientific journals [1]. Medical journals are faced with a series of problems such as being in line with international standards, improving their academic influence and adapting to the development of medicine.

Professor Huang Ting, an outstanding member of the Communist Party of China, a famous surgeon and medical educator in China, former deputy editor-in-chief of Chinese medical journal, former deputy director of the surgical branch of Chinese medical association, and honorary editor-in-chief of Chinese surgical journal, died at 8: 45 on January 21, 2007 in Beijing at the age of 78.