In recent years,several studies have revealed that diabetic patients may have decreased mortality compared with non-diabetic patients from acute hyperglycemia in intensive care units (ICUs),and the patients without diabetic history are most likely to benefit from intensive insulin therapy.This probably suggests a potential "protective" effect in diabetic patients with critical illness.Possible "protective" mechanisms include the adaptive reaction to chronic oxidative stress state in diabetes,the decreased incidence of acute complications followed by critical illness,and some non-biological factors.Thus much more attention of glycemic management should be paid to those hyperglyemic patients without diabetic history in ICUs.

Objective To assess the efficacy and safety of thiazolidinediones combined with metformin in treatment of polycystic ovary syndrome.Methods Electronic database searching was performed on Medline,Cochrane Library,EMbase,EBSCO,ScienceDirect,OVID,Springer LINK,Wiley,Chinese biology and medicine(CBM),China National Knowledge Infrastructure(CNKI),and Chongqing VIP Database;meanwhile,unpubished literature,conference papers and dissertations were also searched manually.The data included those from the establishment to November 2009.Randomized or clinical controlled trials concerning the thiazolidinediones and metformin combination therapy for PCOS were selected and assessed for the methodological quality,and Meta-analysis was performed using statistical software Revman 5.0.Results Five randomized controlled trials met the inclusion criteria and were included.Compared to metformin group,thiazolidinediones combined with metformin significantly improved insulin resistance(P

Objective High mobility group box 1 (HMGB1) mediates the inflammatory immune response as well as the prolif-eration, differentiation and migration of cells , neverthless, little study has been done on the changes of HMGB 1 expression in hepatoma tissues.The aim of the article was to investigate the changes of HMGB 1 mRNA and protein expression in hepatocellular carcinoma (HCC) tissues. Methods Real-time fluorescence quantitative PCR and Western blotting were applied to detect HMGB 1 mRNA and protein expression in HCC tissues and their paracancerous tissues of 13 cases.Immunofluorescence localization was used to analyze the changes of HMGB1 distribution in hepatic cells . Results The expression of HMGB1 mRNA and protein in HCC tissues (4.01 ±0.81) and (1.37 ±0.34) increased significantly in comparison with those in paracancerous tissues (5.76 ±1.28) and (0.52 ±0.12) ( P<0.01).Nucleo-cytoplasmic translocation of HMGB1 was observed in hepatocarcinoma cells . Conclusion There is increased expression of HMGB1 in HCC tissues, which shows HMGB1 mediates the carcinogenesis of HCC .

Acute kidney injury (AKI) is a serious clinical problem with high morbidity and mortality. Renal replacement therapy (RRT) is an important tool for treating patients with AKI. The 2011 Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline for AKI points out that RRT should be discontinued when renal function has recovered enough to meet the body needs or when RRT is no longer consistent with treatment goals. However, the specific reference index of weaning RRT is unclear. The guiding roles of traditional indicators such as urine output (> 400 mL/24 h), serum creatinine (SCr, decreasing trend), creatinine clearance (CCr, > 20 mL/min), and novel biomarkers such as neutrophil gelatinase-associated lipocalin (NGAL), hepatocyte growth factor (HGF), interleukins (IL-6, IL-10), kidney injury molecule-1 (KIM-1), kynurenic acid, etc. for discontinuation of RRT in AKI patients were reviewed. Particularly, the importance of biomarkers for this purpose was highlighted.

Seventy cases were classified into wind-cold and wind-heat on the basis of syndrome differentiation. Acupoints of Yangming meridians of both hand and foot and points located in the face, including major points: Yangbai (GB 14), Cuanzhu (BL 2), Jingming (BL 1),Chengqi (ST 1), Dicang (ST 4), Jiache (ST 6), Juliao (ST 3), and Hegu (LI 4). Subcutaneous needling is applied. Recovery rate is 91.4%

Aim To study the transport of geniposide and geniposide in Zhizi Bopi Decoction in MDCK cell membrane model. Methods The safety concentration of geniposide and Zhizi Bopi Decoction in MDCK cells were determined by MTT assay. Then the MDCK cell membrane model was used to investigate the transport of drugs. Firstly, the effects of time, drug concentra-tion, P-gp inhibitor and EDTA on the absorption and transport of geniposide were studied systematically. Secondly, the differences were compared between the transport of the same concentration of geniposide as single compound and that in Zhizi Bopi Decoction in MDCK cell model. The drug concentration was deter-mined by high performance liquid chromatography ( HPLC) to calculate the apparent permeability coeffi-cient (Papp). Results Geniposide transport in MDCK cell monolayer was time and concentration dependent. P-gp inhibitors had no significant effect on its transport and the transport of geniposide was enhanced by ED-TA. The absorption Papp of different concentrations of geniposide in Zhizi Bopi Decoction were ( 8. 96 ± 0. 35 ) × 10 -7 cm · s-1 , ( 8. 95 ± 0. 38 ) × 10 -7 cm · s-1 and (9. 16 ± 0. 30) × 10 -7 cm·s-1, significantly higher than the absorption Papp of geniposide as single compound(5. 85 ± 0. 44) × 10 -7 cm·s-1, (6. 88 ± 0. 38) × 10 -7 cm·s-1 and (6. 31 ± 0. 19) × 10 -7 cm ·s-1 ( P<0. 05 ) . Conclusion The transport of ge-niposide in MDCK cell membrane model is passive transport and is not affected by P-gp. Geniposide may transport via the paracellular route. The Zhizi Bopi De-coction can increase the absorption of geniposide.

Objective To compare the differences in responsive ability and oxidative stress damage between type 2 diabetic rats and normal rats under acute sepsis associated with stress hyperglycemia.Methods GK rats with type 2 diabetes and Wistar rats were established critical ill models of sepsis by intraperitoneal injection of 5 mg/kg lipopolysaccharide(LPS).Before and after LPS injection,serum levels of proinflammatory cytokines tumor necrosis factor α (TNF-α),interleukin (IL)-1β3,and IL-6,and anti-inflammatory cytokine IL-10 were determined.Malondialdehyde (MDA) and total antioxidative capacity (T-AOC) levels in serum and tissues (lung,liver,kidney,heart) were measured by colorimetric determination.Results Before LPS injection,serum levels of TNF-α,IL-6,and IL-10 in GK rats were higher than those of Wistar rats.The serum levels of TNF-α,IL-6,and IL-10 after LPS injection were raised in both GK rats and Wistar rats (all P＜0.05).At baseline,serum MDA level of GK rats was higher than that of Wistar group [(25.76 vs 12.71) μmol/L,P＜0.05],while T-AOC level were lower [(0.60 vs 2.8) U/ml,P＜0.05].One hour after LPS injection,the serum MDA level in two kinds of rats significantly increased compared with those of their baseline levels [(32.30 and 20.19) μmol/L,both P＜0.05],while their serum T-AOC level decreased [(0.20 and 2.08) U/ml,P＜0.05]).There were no signigicant differences in the change trend of serum MDA and T-AOC between the two kinds of rats.MDA and T-AOC levels in tissues had no significant difference before and after LPS injection in GK and Wistar rats (P＞0.05).Conclusions The rats with type 2 diabetes had lowered level of proinflammatory factors and raised level of anti-inflammatory factors under acute sepsis,presenting better tolerance and lowered probability of inflammatory diffusion compared with normal rats.

Objective To evaluate the feasibility of 80 kV tube kilovoltage in aortic artery CT angiography with 256-slice CT. Methods A total of 62 patients undergoing aortic artery CTA were enrolled into this study and divided into conventional tube kilovoltage (120 kV, n = 31 ) and low tube kilovoltage (80 kV, n = 31 ). The signal-to-noise ratio (SNR) , contrast-to-noise ratio (CNR), volume CT dose index (CTDIvol) and effective dose (E) were evaluated, respectively. Results The mean image SNR was ( 35.92 ± 5.04) and ( 33.95 ± 8. 30) for conventional tube kilovoltage and low tube kilovoltage,respectively, with no significant difference (t = 1. 131, P =0. 263). The mean image CNR was (30. 32 ±4.78) and (28.71 ± 7.96 ) for conventional tube kilovoltage and low tube kilovoltage, respectively, with no significant difference ( t = 0. 964, P = 0. 339 ). The average effective dose ( E ) was ( 14. 28 ± 0.96 )mSv and (9. 72± 0. 81 )mSv for conventional tube kilovoltage and low tube kilovoltage, respectively, with significant difference ( t = 20. 12, P ＜ 0. 001 ). Conclusions 80 kV tube kilovoltage aortic artery CTA can reduce radiation dose by 31.9% , and contrast dose 50% ,and maintain image quality compared with 120 kV tube kilovoltage.

Objective:To explore the influencing factors of massive blood transfusion during liver transplantation and establish a prediction model for massive blood transfusion.Methods:Clinical data were analyzed retrospectively for 103 patients undergoing liver transplantation performed by the same surgical team of our hospital in 2018 from Department of Blood Transfusion Affiliated Drum Tower Hospital Nanjing University Medical School. According to the intraoperative volume of red blood cells, they were divided into two groups of massive transfusion (≥12U, n=40) and non-massive transfusion (<12U, n=63). General patient data and preoperative laboratory parameters were compared between two groups. Logistic regression analysis was utilized for constructing a prediction model for massive transfusion during liver transplantation. Results:No significant inter-group difference existed in gender, age or blood group ( P>0.05) while preoperative diagnosis, hemoglobin (Hb), hematocrit (HCT), platelet count (PLT), international normalized ratio (INR), prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), total bilirubin (TBIL), direct bilirubin (DBIL) and end-stage liver disease (MELD) score were correlated with intraoperative massive blood transfusion ( P<0.05). By Logistic regression analysis, the predictive model of massive blood transfusion in liver transplantation was Y = 3.545-0.112 × HCT-0.009 ×P LT + 0.005×DBIL. The area under ROC curve was 0.813 and the sensitivity and specificity 80.0% and 71.4% respectively. Youden's index of 0.514 indicated that if Y value was greater than or equal to 0.514, massive blood transfusion might occur. Conclusions:Preoperative HCT, PLT and DBIL may be employed as independent predictors of intraoperative massive transfusion during liver transplantation. The prognostic model has demonstrated an excellent sensitivity and specificity.

Objective To describe the status quo of position rotation in self-injection of insulin, and explore its influencing factors, so as to provide the basis for regulating the rotation of injection. Methods A convenient sample of 176 patients coming from endocrinology in a third grade first-class hospital were surveyed by self-designed self-injection of insulin in patients with site rotation behavior questionnaire survey. Results 176 diabetics of their own insulin injection site rotation score was 12-27 (17.79 ± 2.81) points. The age, knowledge sources, the numbers of injection sites were mainly influence to insulin injection site rotation factor score. Conclusions Diabetics insulin injection site rotation behaviors is not standard, rotation of different parts is worrying. It is necessary to strengthen the education and guidance of the site rotation of the patients.