Volume 88  ·   Issue 18  ·  2008

The study of metabolic syndrome has been favored by scholars in the fields of endocrinology, diabetes, cardiovascular diseases and even basic medicine.

Editor's Note 2007<The Guidelines for the Prevention and Treatment of Diabetes in China project is based on the "Ninth Five-Year National Diabetes Prevention and Treatment Plan", adhering to the principle of prevention as the first, and under the leadership of Professor Yang Wenying, chairman of the Diabetology Branch of Chinese Medical Association, and organizing experts from all over the country to formulate it.

Objective To observe the relationship of liver fat content to insulin resistance and metabolic syndrome (MS) in nonalcoholic fatty liver disease ( NAFLD ) patients without known diabetes mellitus (DM). Methods 106 patients diagnosed as with fatty liver by uhrasonography, 61 males and 45females, aged 47 ± 14, underwent anthropometric examination and laboratory tests including lipid profile,fasting and 2 hour serum glucose and insulin after 75 g glucose load. CT scanning was used to determine the fat content in liver. Homeostasis model assessment insulin resistance (HOMA-IR) was calculated.Metabolic syndrome was defined based on the ATP Ⅲ criteria. Results The liver fat content in all subjects was distributed from 0 to 34.7% [ median (quartile) 6.34% (3.11% - 10.82% ) ]. Forty-five of the 106patients (42.45 % ) were diagnosed as with MS. When the liver fat increased by quartile order [ ＜ 3.11%(n=26),3.11% -6.34% (n=27),6.34% -10.82% (n=27),and ≥10.82% (n=26)], the percentages of MS were 19.2% (n=5), 29.6% (n=8), 48.1% (n=13), and 73.1% (n=19)respectively (P ＜0.05). Stepwise Logistic regression analysis (forcing liver fat in the model) showed that being female, liver fat content, fasting glucose, systolic blood pressure, BMI, and history of hypertension were significant risk factors of MS, and HDL-C and fasting insulin were significant protection factors of MS.The standard partial regression coefficient of liver fat content was higher than those of fasting blood glucose,systolic blood pressure, and BMI. Stepwise multiple linear regression analysis demonstrated that liver fat content was a significant risk factor of HOMA-IR while BMI and waist circumference were not. Conclusion Compared with BMI and waist circumference, liver fat content is a stronger risk factor of IR and MS.

Objective To explore the relationship of different types of abdominal obesity to risk of metabolic syndrome (MS). Methods Visceral fat area (VA) and substantial fat area (SA) were assessed by CT in 846 patients, 470 males and 376 females, aged 55 ± 12, who suffered from at least one cardiometabolic risk factor and divided into 4 groups according to their VA and waist circumference (WC) :non-obesity, masked visceral fat obesity (VFO), pseudo-VFO, and VFO groups. Blood pressure, fasting blood glucose, fasting serum insulin, and lipid profile were also measured. The MS risks of different types of abdominal obesity were compared. Results The prevalence rate of masked VFO of males was 10.9% (51/470), significantly higher than that of female (4.8%, 18/376). The prevalence rate of MS of the male patients with masked VFO was 43. 1% , significantly higher than that of those in non-obesity group (25.0%), and lower than those of the males in the pseudo-VFO group (78.7%) and in the VFO group ( 88.6% ) , whereas the MS prevalence rate of the males in the pseudo-VFO group was significantly higher than those in the non-obesity and masked VFO groups. On the other hand, the MS prevalence rate of the female patients with masked VFO was 33.3%, not significantly different from that of the female patients in the non-obesity group ( 31.2% ), but significantly lower than those of the pseudo-VFO and VFO groups (78.7% and 90.9% respectively). The MS prevalence rate of the female pseudo-VFO patients was also significantly higher than those in the non-obesity and masked VFO groups. Logistic regression analysis showed that WC and VA were independent risk factors for MS [ OR (95% CI) = 1.13 ( 1.10 - 1.17) ,1. 01( 1.01 - 1.02) ,respectively, P ＜ 0.01 ). Condusion Different types of abdominal obesity have important impacts on the risk of metabolic syndrome. Masked VFO, even though with normal WC, and pseudo-VFO have considerably higher cardiometabolic risks.

Objective To analyze the association of stroke and metabolic syndrome as well as its component combinations in Chinese adults. Methods Logistic regression was used to analyze the data,including anthropometric measurement, fasting plasma glucose (FPG), blood lipids, and histories of smoking, drinking, and anamnesis, of 47 414 subjects, 22 305 males and 2 5105 females, aged 20 - 75,obtained from Chinese National Health and Nutrition Survey in 2002. Results ( 1 ) Blood pressure and waist circumference were the most important factors associated with stroke. Along with the clustering of the risk factors, the subjects became more liable to suffer from stroke. Logistic regression showed that after adjustment for age, sex, smoking status, and LDL-C level, the odd ratio (OR) values of the individuals with one, two, three, and four or more factors were 3.01 (1.89 -4.81),4. 37(2.72 -7.01 ),9.20(5.75 - 14.73 ), and 13.09 (7.98 - 21.49) respectively. (2) The combinations of raised hypertension plus hyperglycemia and low LDL-C and central obesity were the most hazard groups, with the OR values of 16.58(95% CI 8.78 -31.32) for stroke. The OR value for the full metabolic syndrome was 10.79 (95% CI6.81 - 17.10). Hypertriglyceridemia was not an independent risk factor of stroke. (3) The relationships of metabolic risk factors and stroke were various among different age groups. Stroke was not related with blood glucose, blood pressure, serum lipids, and obesity in the subjects under 35 ; in those aged 35 - 55, diastolic Bp and low HDL-C were most significantly related to stroke; as for those above 55, systolic Bp and waist circumference were most significantly related to stroke. Conclusion Central obesity cored metabolic syndrome is an important risk factor of stroke. Different combinations of the components attribute variously to stroke. In people above middle age, stroke is related to metabolic risk factors.

Objective To evaluate the curative efficacy of transurethral 2 μm thulium laser urethrotomy in the treatment of urethral stricture and atresia. Methods 192 patients suffering from urethral stricture ( n = 179) or atresia ( n = 13 ), all male, aged 45.4 (38 - 56 ), underwent transurethral 2 μm thulium laser urethrotomy. The maximum flow rate (MFR) was measured before operation, immediately after removing the catheter, and 3 and 6 months postoperatively. Results All the patients got fluent urination immediately after the catheter removal with the mean MFR of ( 16.7 ± 3.1 ) ml/s, significantly higher than that before the operation [ ( 3.2 ± 0. 3 ) ml/s, P ＜ 0. 01 ]. 157 patients got permanent fluent urination without recurrence; 35 patients got recurrence 1 to 3 weeks after the catheter removal and got final cure 3 months later after periodic urethra dilatation. Besides, 6 patients encountered incontinence and all finally got convalescence after physical therapy and exercise. The mean MFR of all the patients 3 months and 6 months postoperatively were ( 18.7 ± 3.1 ) ml/s and ( 19.2 ± 2.8) ml/s respectively, both significantly higher than that before operation ( both P ＜0. 01 ). Conclusion Transurethral 2 μm thulium laser urethrotomy is a safe and efficient method in the treatment of urethral stricture and atresia.

：Objective To study therelationship of the risk factors to the coronary artery stenosis severity in coronaryatherosclerotic heart disease (CAD). Methods 286 CAD patients, 206 males and 80females,aged 61.6, underwent coronary angiography and then were divided into 3 groups according toits results: Group A with single vessel lesion, Group B with double vessel lesions, andGroup C with triple/left main vessel lesions. Peripheral blood samples were collected tomeasure the levels of uric acid, C reactive protein, cholesterol, low density lipoproteincholesterol (LDL-C), high density lipoprotein cholesterol, and triglyceride. Spearmancorrelation analysis and multiple linear regression were used to analyze the relationshipbetween the risk factors including age, bodyweight, and blood lipids and uric acid.Results There was significant difference among the three groups at age and LDL-C ( both P ＜ 0.05 ). Age and LDL-C of Group C [ (62 ± 10), ( 3.0 ± 0.7 )mmol/L] were significantly higher than those of Group A [ ( 59 ±11 ), (2.8 ± 0.6 )mmol/L, both P ＜ 0.05 ]. Age ( r = 0. 163 )and LDL-C ( r = 0. 149 ) were significantly associated with coronary artery stenosisseverity ( both P ＜ 0.05 ). Conclusion The severity of coronary artery stenosis is affected by ageand LDL-C. Triple/left main vessel lesions are likely to be seen in the patients witholder age and higher blood level of LDL-C.

Objective To evaluate the toxicity and efficacy of combination regimen with oxaliplatin plus fluorouraeil and leucovorin(FOLFOX) as post-operative adjuvant chemotherapy in local advanced gastric cancer. Methods Twenty-five gastric cancer patients, 2 at the stage Ⅱ , 17 at the stage Ⅲ, and 6 at the stage Ⅳ received the FOLFOX regimen after surgery : intravenous infusion of oxaliplatin 85 mg/m2 for 2 h on day 1, intravenous infusion of leueovorin 200 mg/m2 for 2 h on days 1 - 2, and intravenous bolus injection of 5-fluorouraeil (5-FU) 400 mg/m2 on days 1 - 2, and continuous infusion of 5-FU 600 mg/m2 for 22 h on days 1 -2;and this regimen was repeated every 2 weeks. The effect and adverse reactions were recorded.Results The median disease free survival time and overall survival time were 26.0 months and 38.0 months respectively. The frequent grade 3/4 toxicity of the FOLFOX regimen included: neutropenia ( 12.4% ),thrombocytopenia (8.2%), and nausea (7.5%). Conclusion The post-operative adjuvant chemotherapy of FOLFOX regimen has expectable efficacy in treatment of gastric cancer with light and well tolerable toxicity.

Objective To develop a rapid and reliable approach for testing the copy number of survival motor neuron (SMN) gene and analyze the compound heterozygous deletions of SMN1 gene.Methods Peripheral blood samples were collected from 38 non-homozygous deletion pediatric patients with SMA, 30 homozygous deletion patients with SMA, and 35 un-related healthy persons. SMN1 and SMN2genes were amplified separately with allele-specific PCR (AS-PCR). Meanwhile, two irrelevant genes were amplified as internal quality control respectively. The copy numbers of SMN1 and SMN2 were determined by denaturing high-performance liquid chromatography (DHPLC). Results (1) A protocol combining multiplex allele-specific PCR and DHPLC was developed to separate SMN1 and SMN2 and to determine the copy numbers of them. The copy numbers of SMN1 and SMN2 varied from 1 to 4 and a clear-cut differentiation among the different copy number ranges could be observed for the two genes. (2) One single copy of SMN1 were detected in 20 of the 38 non-homozygous deletion patients with SMA (52. 6% ).Heterozygous deletions were determined in these 20 patients. Two copies of SMN2 were detected in 15 of the 20 patients with one copy of SMN1 (75.0% , 15/20). Other 5 of the 20 patients were with 3 copies of SMN2 (25.0%, 5/20). (3) One single copy of SMN1 was detected in 24 of the 30 (80%) parents of SMA patients with homozygous deletion. Conclusion SMN copy number can be rapidly and reliably determined by the method of multiplex AS-PCR combined with DHPLC.

Objective To study the pathological change of benign hyperplastic prostate after removal of the innervation of eholinergic parasympathetic pelvic nerve. Methods Sixty-five male spontaneous hypertension rats (SHRs) were randondy assigned into 3 groups : operation group ( n = 30 )undergoing truncation of bilateral originating branches of parasympathetic pelvic nerve of major pelvic ganglion ( MPG ) followed by cystostomy, sham operation group ( operation control group, n = 30 )undergoing cystostomy, and normal control group ( n = 5 ) not undergoing operation. 3, 7, 11, 15 and ≥21days after operation 6 rats from the 2 operation groups and 1 from the control group were sacrificed to observe the gross morphology and histological and cellular changes of the prostate glands. Results The prostate of the operation group on post-operational day 7 showed mild granular solidification and such change progressed gradually over time, the ratio of prostate wet weight/rat body weight was( 0.4764±0.0125 ) mg/g on clay 3, then gradually decreased, and became (0. 2749 ± 0. 0197 ) mg/g ≥21 days post-operationally; while the ratio of prostate tissue dry weight/wet weight on day 3 was (0. 1966 ± 0.0062), then gradually increased,and became ( 0. 2596 ± 0. 0035 ) ≥ 21 days post-operationally. HE staining showed that the glandular structure gradually became dilated and rounded, with accumulation of prostatic fluid. The glandular epithelial cells showed gradual degeneration, necrosis, and detachment. The glandular epithelium became progressively thinner, the smooth muscles elongated and thinned progressively, and the stromal components showed mild to moderate overgrowth. Electron microscopy showed that the glandular cells gradually underwent vacuolar degeneration and the structures of the basement membrane became fuzzy. The smooth muscle cells degenerated mildly, and the fibroblasts and collagenous fibers in the stroma overgrew slowly.All these histological changes were not found in the sham operation control and normal control groups.Conclusion Remarkable atrophy occurs in benign hyperplastic prostatic gland after radical removal of the innervation of cholinergic parasympathetic pelvic nerve. Such operation may represent a novel therapy for BPH.

Objective To explore the effects of sulfur dioxide (SO2) on the proliferation and apoptosis of aorta smooth muscle cells in hypertension ratsand possible mechanism thereof. Methods Sixteen 4-week-old male spontaneously hypertensive rats (SHRs) were randomly divided into 2 equal groups:control and Na2SO3/NaHSO3 (a SO2 donor ) -treated group. Eight 4-week-old male WKY (Wistar Kyoto) rats were assigned for normal control group. Five weeks later, the pressure was measured. The rat aortas were dyed with Hart's method. The morphometric parameters were calculated by Leica workstation.The plasma level of SO2 was determined by HPLC method. VSMC apoptosis was measured by TUNEL technique. The expression levels of proliferating cell nuclear antigen ( PCNA), Bcl-2, Fas and caspase-3were detected by immunohistochemical assay. Results ( 1 ) Compared with those of the WKY rats, the blood pressure, ratio of media to lumen radius, and proliferation index (PI) of the SHRswere increased [(172 ± 10)mm Hg vs (112 ± 9)mmHg,0.073 ± 0.004 vs 0.057 ± 0.004,0.32 ± 0.06 vs0.05 ±0.03, respectively], but the plasma level of SO2 and the apoptosis index (AI) were decreased in the SHRs [(6.4 ± 1.5)μmoL/L vs (11.3 + 1.0)μmol/L, 0.16 ± 0.07 vs 0.30 ± 0.19, respectively]. The expression of Bcl-2 was increased (0. 209 ±0. 007 vs 0. 202 ± 0. 006), and the expression levels of Fas and caspase-3 of SHRs were both lower than those of the WKY rats (0.205 ±0. 006 vs 0. 211±0.005, 0.229 ± 0. 005 vs 0. 244 ± 0. 010, respectively). (2) Compared with the SHR control group, the systolic blood and the ratio of media to lumen radius were decreased [ (128 ± 7)mm Hg,0. 066 ± 0. 002,respectively], but the plasma level of SO2 was increased [ (8.3 ± 1 ) μmol/L] for the SHR + Na2SO3/NaHSO3 group. Plwas lower (0. 14 ± 0.03) and Al was higher (0.40 ± 0. 11) in SHR + Na2SO3/NaHSO3 group than those in SHR control group. The expression of Bel-2 of VSMCs was down-regulated (0.199 ± 0. 006), but the levels of Fas and caspase-3 were up-regulated (0.218 ± 0. 003 and 0.251 ± 0.011respectively) in the SHR + Na2SO3/NaHSO3 group. Conclusion SO2 may attenuate the structural remodeling through reducing the proliferation and enhancing the apoptosis of smooth muscle cells in SHRs.SO2 may modulate the process of apoptosis possibly through the downward regulation of the level of Bcl-2 and enhance the expression of Fas and caspase-3.

Objective To investigate the influence of recombinant transforming growth factor-β3(TGF-β3 ) on collagen synthesis and deposition. Methods Plasmids pcDNA3. 1 ( + )-TGF-β3 and pcDNA3.1 ( + )-TGF-β3 were constructed. Rat hepatic stellate cells (HSCs) of the strain HSC-T6 were cultured as cell model of fibrosis and divided into 4 groups: blank control group, pcDNA3. 1- enhanced green fluorescent protein (EGFP)-transfected group ( negative control group), pcDNA3. 1 ( + )-TGF-β3transfected group, and pcDNA3.1 ( + )-TGF-β3 transfected group. A positive cell clone stably and highly expressing TGF-β1 was established after being screened by G418 medium, pcDNA3.1 ( + )-TGF-β3 was transfected into the positive clone. Real-time PCR was used to detect the mRNA expression of TGF-β3.Western blotting was used to detect the protein expression of TGF-β1, collagen Ⅰ , matrix metalloproteinase (MMP)-2, MMP-9, and tissue inhibitor of metallo-proteinase (TIMP)-1. Results There was no significant difference in the TGF-β3 mRNA expression between the TGF-β3 positive clone group and the TGF-β3 transfected group. The mRNA and protein expression levels of TGF-β3 , collagen Ⅰ , MMP-2, and TIMP-1 of the TGF-β3 positive clone group were all significantly higher than those of the blank control,negative control groups ( all P ＜ 0.05 ), and the MMP-9 mRNA expression of the TGF-β3 positive clone group was significantly lower than those of the blank control and negative control groups ( all P ＜ 0.05 ) ; and the mRNA and protein expression levels of MMP-9 of the TGF-β1 positive clone group were significantly lower than those of the blank control and negative control groups( all P ＜0.05). The TGF-β1 and MMP-2 mRNA expression levels of the TGF-β3 transfected group were not significantly different from those of the positive clone group (all P ＞ 0.05), the mRNA expression levels of collagen Ⅰ and TIMP-1 of the TGF-β3transfected group were significantly lower than those of the positive clone group ( both P ＜ 0.05 ), and the mRNA expression level of MMP-9 of the TGF-β3 transfected group was significantly higher than that of the positive clone group (P ＜ 0.05). The protein expression levels of TGF-β1 , collagen Ⅰ , and TIMP-1 of the TGF-β3 transfected group were all significantly lower than those of the positive clone group (P ＜ 0.05) , the protein expression level of MMP-9 of the TGF-β3 transfected group was significantly higher than that of the positive clone group ( P ＜ 0.05 ), and the protein expression level of MMP-2 of the TGF-β3 transfected group was not significantly different from that of the positive clone group. Conclusion Recombinant TGF-β3eukaryotic expression vector reduces the synthesis of collagen and inhibits the collagen deposition by adjusting the expression of matrix metalloproteinases and their inhibitors.

A 19-year-old male was admitted to hospital on 31 May 2007 due to abdominal pain and fever after 13 years of congenital choledochal cyst operation. The abdominal space was found to occupy for more than 1 month.

Bone marrow mesenchymal stem cells (MSCs) are a kind of adult stem cells present in the bone marrow stroma. Friedenstein and Petrakova [1] first screened them from bone-forming progenitor cells of bone marrow in 1966. They are considered to be a non-hematopoietic subset of cells, and they are called MSCs or mesenchymal progenitor cells.

In the United States, nearly two-thirds of adults are overweight or obese, and the risk factors of cardiovascular diseases including hypertension, dyslipidemia and type 2 diabetes can be effectively prevented.

In recent years, there has been an increasing trend of reports of pseudopenia of platelets caused by EDTA dependence, and its clinical incidence is 0.09% ~0.21% [1].

Cross-contamination between cell lines is one of the major problems faced by biomedical research worldwide. Many studies have shown that 18% ~36% of human tumor cell lines are pseudo cell lines or have incorrect identity [1].