Amino acids (AA) as substrates of gluconeogenesis could promote endogenous glucose production.Some AA can enhance insulin secretion. Recently,many studies have found that some AA can also activate mammalian target of rapamycin-S6 kinase 1 ( mTOR-S6K1 ) pathway,resulting in maintaining pancreatic β cell function on one hand,and on the other hand,inhibiting insulin signal transduction of insulin-sensitive cells and thus causing insulin resistance.

Diabetes mellitus impacts patient survival and quality of life mainly due to its acute and chronic complications.Pancreas transplantation may restore normoglycemia and reduce the complication of insulin-dependent diabetes,thus improving the quality of life and prolonging patient's survival.Although pancreas transplantation requires major surgery and life-long immunosuppression therapy,it currently remains the gold stand for patients with type 1 diabetes mellitus,who do not respond to conventional therapy.Meanwhile,potential of the islet transplantation,insulin-producing cells replacement therapy,and artificial pancreas as the alternative to pancreas transplantation are under investigation.

Antenatal corticosteroid administration to women at risk of preterm delivery within 34 gestational weeks can effectively reduce the incidence of respiratory distress syndrome, intraventricular hemorrhage, and necrotizing enterocolitis in preterm infants. Due to concerns that antenatal corticosteroids may impair the development of the newborn's nervous system, there is a controversy regarding the use of antenatal corticosteroids in pregnant women ≥34 gestational weeks and those with complications. This article reviews the short- and long-term effects of antenatal corticosteroid administration on the nervous system of neonates born to women at different gestational ages and with comorbidities. More and higher-quality evidence is required for routine application of antenatal corticosteroids in pregnant women ≥34 gestational weeks.

Static database can not meet the requirement of web development. The dynamic database which is based on the dynamic memory and management technologies has become the preferred choice. This paper compares five primary methods for web database access, and an example is given to illustrate how ASP.NET access SQL server.

Mid-ventricular hypertrophic obstructive cardiomyopathy (MVHOCM) is a rare type of cardiomyopathy thatcan be accompanied by apical aneurysm.We presented here a case report of MVHOCM with cornary artery disease.The sixty-fouryears old man was sent to hospital because of ventricular tachycardia.Large inversion T wave was showed on electrocardiography in the presence of abnormal coronary arteries and normal cardiac enzyme.Echoeardiogmphy showed an hourglass appearance of the leftventricle with an aneurysm in the apex and a pressure gradient between the outflow tract of left ventricle and the middle of the leftventricle was revealed by left-heart catheterization.

Objective:To observe therapeutic effects of dexmedetomidine combined metoprolol on subarachnoid hemorrhage (SAH) complicated myocardial injury (MI) .Methods:According to random number table , a total of 131 SAH + MI pa‐tients were divided into control group (n=31) ,metoprolol group (n=34) ,dexmedetomidine group (n=32) and combined treatment group (n=34 ,received metoprolol combined dexmedetomidine ) .Plasma levels of norepinephrine (NE) ,epi‐nephrine (E) ,brain natriuretic peptide (BNP) and cardiac troponin I (cTnI ) were measured ,echocardiography etc .were used to assess MI recovery condition before and after treatment in all groups .Results:Compared with before operation , there was significant rise in LVEDd on 1d after operation ,significantly reduced on 3d after operation and recovered to nor‐mal on 7d after operation ( P<0.05 all);significant reduction in LVEF on 1d after operation ,significantly rose on 3d after operation and recovered to normal on 7d after operation ( P<0.05 all);significant rise in levels of cTnI ,BNP ,NE and E on 1d after operation ,started to reduce on 3d after operation and recovered to normal on 7d after operation in metoprolol group ,dexmedetomidine group and combined treatment group , P< 0.05 all;compared with control group ,metoprolol group and dexmedetomidine group on 7d after operation ,there was significant reduction in LVEDd ,and significant rise in LVEF and significant improvement in cardiac function ;significant reductions in plasma levels of NE [ (1.37 ± 0.08) pmol/L ,(1.05 ± 0.09) pmol/L ,(1.19 ± 0.07) pmol/L vs .(1.01 ± 0.06) pmol/L] ,E [ (6.17 ± 0.41) pmol/L ,(6.02 ± 0.34) pmol/L ,(6.06 ± 0.29) pmol/L vs .(5.26 ± 0.26) pmol/L] ,cTnI [ (0.22 ± 0.02)μg/L ,(0.11 ± 0.03)μg/L ,(0.17 ± 0.02)μg/L vs .(0.09 ± 0.01)μg/L] and BNP [ (1126.81 ± 11.27) ng/L ,(1014.09 ± 14.29) ng/L ,(1154.09 ± 16.52) ng/L vs .(954.09 ± 9.31) ng/L] in combined treatment group ,P<0.05 all .Conclusion:Either dexmedetomidine or meto‐prolol ,or their combination can effectively inhibit SAH complicated myocardial injury ,improve cardiac function ,but com‐bined treatment possesses the best effective effect .

Objective To explore the clinical effect of blood purification combined with fasudil in elderly cardiac surgery patients with postoperative acute kidney injury.Methods Fifty elderly cardiac surgery patients with postoperative acute kidney injury were divided into control group and study group by random digit table method with 25 cases each.The 2 groups were treated with routine drug and blood purification,the study group was additionally given fasudil injection 30 mg + 0.9％ sodium chloride injection 50 ml vein pumping,1 time/12 h,for 7 d.The urine volume,urine N-acetyl-β-D-glucosaminidase (NAG),urine γ-glutamyl transpeptidase (γ-GTP),urine α 1-microglobulin (α 1-MG),serum creatinine (SCr),blood urea nitrogen (BUN) and creatinine clearance rate (CCr) were observed,and the acute physiology and chronic health evaluation (APACHE) Ⅱ score was computed.Results There were no statistical differences in the indexes before treatment between the 2 groups (P＞ 0.05).The urine volume after treatment 3,5,7 d in study group was more than that in control group [(38.72 ± 2.68) ml/h vs.(31.68 ± 2.52) ml/h,(47.24 ±3.73) ml/h vs.(40.24 ± 2.52) ml/h、(63.80 ± 2.50) ml/h vs.(56.60 ± 3.30) ml/h],urine NAG,urine α 1-MG,urine γ-GTP,SCr and BUN were lower than those in control group [NAG:(25.05 ±5.44) U/L vs.(28.04 ± 5.21) U/L,(24.06 ± 3.43) U/L vs.(27.23 ± 6.43) U/L,(22.08 ± 3.25) U/L vs.(26.23 ± 4.41) U/L; α 1-MG:(24.05 ± 3.65) mg/L vs.(26.74 ± 6.74) mg/L,(22.98 ± 3.58) mg/L vs.(25.57 ± 3.58) mg/L,(20.95 ± 3.78) mg/L vs.(25.48 ± 3.45) mg/L; γ-GTP:(8.2 ± 0.4) U/L vs.(10.8 ± 3.8) U/L,(7.3 ± 0.2)U/L vs.(10.5 ± 2.5) U/L,(6.5 ± 1.4) U/L vs.(9.7 ± 2.6) U/L; SCr:(206.52 ± 6.72) μ mol/L vs.(255.16 ±6.75) μmol/L,(182.98 ±6.26) μmol/L vs.(252.23 ±9.53) μmol/L,(33.25 ±7.95) μmol/L vs.(170.75 ± 7.94) μ mol/L; BU N:(19.61 ± 3.23) mmol/L vs.(20.25 ± 3.25) mmol/L,(16.76 ± 2.06) mmol/L vs.(18.32 ± 4.84) mmol/L,(12.28 ± 2.26) mmol/L vs.(14.27 ± 4.54) mmol/L],CCr was higher than that in control group [(18.66 ± 3.89) ml/min vs.(13.28 ± 3.25) ml/min,(27.76 ± 4.36) ml/min vs.(16.23 ± 4.18)ml/min,(33.79 ± 5.58) ml/min vs.(22.12 ± 4.65) ml/min],there were statistical differences (P ＜ 0.05).The APACHE Ⅱ score before treatment and after treatment 5,7 d in control group were (32.20 ±4.51),(26.38 ±5.28) and (21.43 ±4.22) scores,in study group were (33.05 ±3.82),(22.15 ±3.42) and (13.25 ± 2.15) scores.There was no statistical difference in the APACHE Ⅱ score before treatment (P ＞ 0.05),the APACHE Ⅱ score after treatment was improved,furthermore APACHE Ⅱ score after treatment 5,7 d in study group were better than those in control group,there were statistical differences (P ＜ 0.05).Conclusions The treatment effect of blood purification combined with fasudil is remarkable in elderly cardiac surgery patients with postoperative acute kidney injury.At the same time,it has high security and very important clinical significance.

BACKGROUND: Extensive liver resection or liver transplantation operated on patients with combined hepatic cirrhosis and other complications correlates with high morbidity and mortality.Child-Turcotte-Pugh scoring system is now widely used in the assessment of liver function.This classification scheme includes three clinical indicators and two biochemical indices;however,it seems difficulty on directly evaluating functional status of hepatocytes.OBJECTIVE: To explore the practicability of bioluminescence adenosine triphosphate (ATP) determination assay to assess the functional reserve of residual hepatocytes,DESIGN,TIME AND SETTING: Case contrast study,which was carried out in the Second Affiliated Hospital,Sun Yat-sen University from January 2005 to March 2006.PARTICIPANTS: Thirty-two patients who underwent major extra-and intra hepatic surgery including liver transplantation were randomly divided into three groups based on hepatic cirrhosis grading standard,including normal group (n=7),macronodular cirrhosis group (n=9),and micronodular cirrhosis group (n=16).METHODS: Routine examination and biochemical indexes of liver were performed preoperatively,including glutamic oxalacetic transaminase (GOT) and total bilirubin (TBIL).Liver specimens were delivered by aseptic technique during operation and enzymatic digested.Cell suspension was cultured and centrifuged.Hepatocytes were counted and dispensed cell suspension to be used for ATP extraction and measurement.MAIN OUTCOME MEASURES: ATP content,preoperative biochemical parameters of liver function,and correlation between biochemical parameters and ATP content.RESULTS: The ATP content in the macronodular cirrhosis group was significantly higher than that in the micronodular cirrhosis group and normal group (P=0.000 1,0.004).While,the ATP content in the micronodular cirrhosis group was also significantly higher than that in the normal group (P=0.004).ATP content (mole/cell) wassignificantly positively correlated with serum glutamic oxalacetic transarninase (r=-0.609 3,P=0.000 2) and TBIL (r=0.614 5,P=0.000 2).CONCLUSION: ATP assay can directly evaluate functional reserve of liver parenchyma and reflect high operative risk status (HORS) and course of postoperative recovery in major hepatic resection.

OBJECTIVETo investigate the association of fasting and postpiandial triglyceride with carotid intima-media thickness among type 2 diabetic patients in southeast China.

METHODSA total of 78 type 2 diabetic patients from southeast China were recruited. All the subjects underwent a standardized mixed-meal test (SMMT) and an oral glucose tolerance test. Carotid intima-media thickness (IMT) was measured by color doppler ultrasound examination.

RESULTSPostprandial triglyceride (PTG) after SMMT increased significantly in type 2 diabetic patients. The carotid IMT in patients with postprandial hypertriglyceridemia was significantly greater than that in patients with postprandial normal-triglyceridemia (0.90 mm vs 0.81 mm, P < 0.05), which remained significant after adjustment for fasting TG and HDL-c levels, and the IMT in patients with fasting hypertriglyceridemia only had tendency to increase compared to patients with fasting normal-triglyceridemia (0.87 mm vs 0.84 mm, P > 0.05).

CONCLUSIONThe results suggest that postprandial hypertriglyceridemia may be an independent risk factor of early atherosclerosis in type 2 diabetes.

Carotid Arteries ; diagnostic imaging ; Diabetes Mellitus, Type 2 ; blood ; diagnostic imaging ; Eating ; Female ; Humans ; Male ; Middle Aged ; Risk Factors ; Triglycerides ; blood ; Tunica Intima ; diagnostic imaging ; Tunica Media ; diagnostic imaging ; Ultrasonography

Objective To review our experience in the diagnosis and management of paralysis of the right hemidiaphragm after liver transplantation. Methods 60 adult patients received liver transplantation from February 2001 to March 2007 in Sun Yat-sen Memorial Hospital were retrospectively analyzed. The pathophysiologic changes, clinical progress, and management of serious respiratory complications caused by post-transplant paralysis of the right hemidiaphragm were studied. Results Among 60 patients, 40 developed postoperative respiratory complications, and 5 were due to paralysis of the right hemidiaphragm. The 5 patients presented with paradoxical respiration and the ventilator supporting times were 14, 16, 34, 45, and 60 days, respectively. Tracheostomy was performed in 4. These patients developed pneumonia in 5, atelectasis in 4, acute respiratory distress syndrome (ARDS) in 4, hepatopulmonary syndrome in 4, and pulmonay interstitial edema in 3. Among the 5 patients, 4 patients survived and 1 patient died of ARDS and multiple organs failure 31 days after the transplantation. Conclusions After liver transplantation, strict monitoring of the respiratory function and timely use of a respirator for patients with the paralysis of the hemidiaphragm is very important. For patients with suspicious hemidiaphragm paralysis, tracheostomy should be decisively performed.