Thiazolidinedione (TZD) is a powerful insulin sensitizer in the treatment of type 2 diabetes. It acts as a ligand to the nuclear receptor PPARγ (peroxisome proliferator-activated receptor-gamma) and induces transcription of PPARγ responsive genes. TZD controls lipid synthesis and storage in adipose tissue, liver and many other tissues through PPARγ. Derivatives of TZD, such as rosiglitazone (Avandia) and pioglitazone (Actos), are more powerful than metformin or berberine in insulin sensitization. Although they have common side effects such as weight gain and edema, these did not influence the side effects in general. However, recent findings of risk for congestive heart failure and bladder cancer have indeed significantly impaired their future in many countries. European countries have prohibited those drugs and in 2011, US will terminate application of rosiglitazone in clinics and hospitals. The multiple country actions may mark the end of TZD era. As a result, there is a strong demand for identification of TZD substitute in the treatment of type 2 diabetes. In this regard, literature about PPARγ ligands and potential TZD substitute are reviewed in this article. Histone deacetylase (HDAC) inhibitor is emphasized as a new class of insulin sensitizer here. Regulators of SIRT1, CREB, NO, p38, ERK and Cdk5 are discussed in the activation of PPARγ.

WGA-HRP was injected into the inferior colliculus in the rat in order to study the non-auditorial afferents of the inferior colliculus. In the diencephalon and truncus encephali, retrograde labeling was observed in many non-auditorial regions: bilateral (with contralateral predominance) cuneate nucleus, gracile nucleus, nucleus of spinal tract of trigeminal nerve, nucleus medullae oblongatae centralis dorsalis; bilateral (with homolateral predominance) locus ceruleus, nucleus reticularis pontis oralis, laterodorsal tegmental nucleus, substantia nigra, sub-parafascicular nucleus, perifornical nucleus; bilateral medial parabrachial nucleus, deep tegmental nucleus of midbrain, lateral hypothalamic area; homolateral deep layer of superior colliculus, zona incerta; contralateral nucleus of solitary tract; and posteromedian septum, central tegmental nucleus, dorsal nucleus of the raphe. The afferent neurons from cuneate nucleus, gracile nucleus, nucleus of spinal tract of trigeminal nerve, nucleus of solitary tract mainly located below the level of obex. The results mentioned above suggested that the inferior colliculus is not only an auditorial relay nucleus, but also a complex body which is of different functions.

Objective To study the clinical efficacy and safety of oxymatrine in auxiliary treatment of hepati-tis B virus(HBV) related primary hepatocellular carcinoma (PHC).Methods 345 patients were divided into treat-ment group (174 cases) and control group (171 cases).The control group was given hepatic artery chemoemboliza-tion therapy.The treatment group added with oxymatrine.The near future curative effect of solid tumor and patients'immune function,liver function,the improvement of the quality of life change,and adverse reaction were observed. Results KPS score of the treatment group was better(Z =-3.296,P <0.05),more significant in the near future curative effect of solid tumor (χ2 =4.676,P <0.01).The immune function of the treatment group was significantly improved [ Within group: t(treatment group:CD3) = 2.544, t(treatment group:CD4) =2.446, t(treatment group:CD8) = 2.745, t(treatment group:CD4 /CD8) =2.873,t(treatment group:NK) =2.542,t(control group:CD3) =2.614,t(control group:CD4) =2.337,t(control group:CD8) =2.545,t(control group:CD4 /CD8) =2.336, t(control group:NK) =2.672, P <0.05; Between groups: t(after treatment:CD3) =2.947, t(after treatment:CD4) =2.846,t(after treatment:CD8) =2.943,t(after treatment:CD4 /CD8) =2.879,t(after treatment:NK) =2.798,P <0.01].In the treatment group,the effect was more significant in the improvement of ALT,HBV -DNA,AFP[Within group:t(treatment group:ALT) =2.676,t(treatment group:HBV -DNA) =2.682,t(treatment group:AFP) =2.611,P <0.01,t(control group:ALT) =2.556, t(control group:AFP) =2.523,P <0.05,t(control group:HBV -DNA) =1.216,P >0.05;Between groups:t(after treatment:ALT) =2.417, t(after treatment:AFP) =2.432,P <0.05,t(after treatment:HBV -DNA) =2.674,P <0.01].Two groups appeared adverse reaction after chemotherapy,digestive system and hematopoietic system anomaly,the incidence rates of adverse events in the treatment group were lower than those in the control group (χ2 2 2 white blood cel s decreased =46.969,χthe pain =46.977,χheating =22.499,χ2nausea,vomiting =88.749,P <0.05).Conclusion The oxymatrine auxiliary treatment for HBV related PHC has curative effect,safe and reliable,and can significantly improve the patients quality of life,it is worth promoting.

This paper reports the post-operative care of 41 patients with Chiari malformation associated with syringomyelia. The nursing points included postoperative vital signs monitoring,management of the body posture and incision,observation of complications. Among these patients,21 of them had cerebrospinal fluid leakage,3 of them had cranial nerve palsy,a patient suffered from acute respiratory arrest caused by brainstem edema. Patients recovered and discharged after active appropriate treatment and care.

Objective To summarize the efficacy of cervical pedicle screw fixation in the treatment of cervical spinal cord injury without fracture and dislocation.Methods From September 2007 to March 2010,21 patients with cervical spinal cord injury without fracture and dislocation combined with developmental cervical stenosis were managed by pedicle screw fixation in unstable segments,and then single open-door laminoplasty in stenosis segments.The clinical outcomes were reviewed and summarized.Results All the patients received follow-up of 1-3 years.Two patients had superficial wound infection,which was cured by dressing change.One presented intra-incisional hematoma one week post-operatively and was cured by hemostasis and drainage.One had door-reclosing without symptom aggravation.There was neither perforation of pedicle screws nor breakage,loosening or displacement of internal fixation.The curvature of cervical lordosis at follow-up had significant rectification in comparison with that at preoperation,but showed unobvious change as compared with that immediately after operation.According to the modified Japanese Orthopedic Association (JOA) score,the neurological score improved from preoperative 4-15 points to 9-17 points at the final follow-up,which revealed more than 80％ of recovery in 13 patients,50％ -80％ of recovery in six and 5％ -50％ of recovery in two,with the average recovery rate of 75％.Conclusion For unstable segments in patients with cervical spinal cord injury without fracture and dislocation combined with developmental spinal stenosis,posterior pedicle screw fixation can avoid the risk of further spinal cord injury in single open-door laminoplasty and restore the physiological curvature of cervical vertebrae,which provides solid foundation for backward drift of spinal cord and creates favorable condition for recovery of spinal cord function.

A girl who aged eight years and seven months presented with prunosus patches on the right buttock for 8 years,gradual unilateral enlargement of the right lower limb for more than 7 years,and multiple vegetations for 1 year.Dermatological examination showed nevus flammeus and multiple malodorous vegetations over the right lower limb with high skin temperature.The right lower limb was thicker and longer than the left lower limb.X-ray examination,magnetic resonance imaging and Doppler ultrasound examination revealed high-flow vascular malformations.Pathological examination of the vegetations showed vascular proliferation,fibroblast proliferation and erythrocyte extravasation.She was diagnosed as Parkes-Weber syndrome accompanied by pseudo-Kaposi's sarcoma.

Objective To explore the effect on effect of combined use of Y27632 (ROCK II inhibitor)and TDZD-8(GSK-3β inhibitor)on axonal regeneration of dorsal root ganglion (DRG) neurons in neogenetic rats. Methods All the thoracolumbar DRGs of two neogenetic Sprague-Dawley (SD)rats(<5 days)were harvested under the stereopsis raicrostat,and then the DRG neurons were cultured,purified and indentified.Fifteen adult female SD rats were randomly divided into three groups,ie,complete paraplegia group(5 rats),sham operation control group(5 rats)and normal group(5 rats)respectively.The T8-10 spinal cord extracts (SCEs) were harvested in the complete paraplegia group,sham operation control group and normal group respectively at day 7 after spinal cord injury.The experiment was divided into group A(DRG neurons + PBS),group B(DRG neurons + complete paralysis SCE),group C(DRG neurons + complete paralysis SCE + different concentration Y27632),group D(DRG neurons + complete paralysis SCE + different concentration TDZD-8)and group E(DRG neurons + complete paralysis SCE + proper concentration Y27632 and TDZD-8).The average axonal length and expression intensity of Tubulin βⅢ at distal end of neuronal axons were observed after two days of co-culture respectively in intro. Results (1)The average axonal length and expression intensity of Tubulin βⅢ at axon shaft and growth cone in the group B were significantly shorter and weaker than that in the group A,with statistical difference.(2)In the group C,the average axonal length and expression intensity of Tubulln βⅢ at axon shaft and growth cone in 5-10 μmol/L Y27632 treatment groups were more than that in the group B but lower than that in the group A.The average axonal length and expression intensity of Tubuhn βⅢ at axon shaft and growth cone in 20-50 μmol/L Y27632 treatment group were longer and stronger than that in the group A and the group B,especially the group B.Among different concentration Y27632 treatment groups,there was a longest average axonal length and strongest expression intensity of Tubulin βⅢ in 30 μmol/L treatment group.(3) In the group D,there was a longer average axonal length in 0.5-3 μmol/L TDZD-8 treatment group than that in the group A and the group B,with the longeat average axonal length in l μmool/L TDZD-8 treatment group.In 5-25 μmol/L TDZD-8 treatment groups,the average axonal length showed no difference compared with the group B but wns shorter than that in the group A.In all different concentration TDZD-8 treatment groups,the expression intensity of Tubulin βⅢ at axon shaft and growth cone was significantly stronger than that in the groups A and B.(4) In the group E,although the average axonal length was increased in the group E,there was no statisilcal difference compared with the group A,30 μmol/L Y27632 treatment group and l μmol/L TDZD-8treatment group.There was a significantly longer average axonal length in the group E than it in the group B and the expression intensity of Tubulin βⅢ at axon shaft and growth cone was stronger in the group E compared to the group A,30 μmol/L Y27632 treatment group and l μmol/L TDZD-8 treatment group.Conclusion The complete paralysis SCEs obviously inhibits DRG axonal growth,induces axonal retraction and growth cone collapse.High concentration of Y27632 can more obviously promote the axon growth compared with the low concentration,while the low concentration of TDZD-8 can obviously promote the axon growth.Combined use of appropriate concentration of TDZD-8 and Y27632 can promote the axon growth and induce the axons branching,as facilitates the formation of the axon circuit.

Objective To analyze lesional and clinical characteristics of Langerhans cell histiocytosis in children.Methods A clinical retrospective study was performed on 126 patients with Langerhans cell histiocytosis collected from 2006 to 2011 at the Hunan Children's Hospital.Results Of the 126 patients,the youngest was 2months old,and the oldest was 9 years old.The ratio of male to female was 2.5 ∶ 1.Clinical manifestations included eczematid,seborrheic lesions,hemorrhagic maculopapules,yellow nodules and white macules.Of the three clinical phenotypes of Langerhans cell histiocytosis,Letter-Siwe disease was the most prevalent,and most cases of LetterSiwe disease were associated with hepatosplenomegaly,abnormal chest X-ray,impaired hematopoietic function and multifocal bone injuries.The clinical grade was mainly Ⅲ and Ⅳ in patients with Letter-Siwe disease,Ⅰ in patients with eosinophilic granuloma,and varied from Ⅰ to Ⅳ in patients with Hand-Schuller-Christian disease with Ⅱ as the most common.Of these patients,those with eosinophilic granuloma had the oldest average age with bone as the only affected organ,while those with Letter-Siwe disease had the youngest average age with the greatest number of affected organs.The treatment of Langerhans cell histiocytosis included surgical operation and combined chemotherapy.Conclusions Langerhans cell histiocytosis has characteristic skin lesions and diverse clinical manifestations.Pathology has diagnostic significance to Langerhans cell histiocytosis.Therapy strategies and curative effects are dependent on the severity of,and the organs affected by Langerhans cell histiocytosis.

Objective To investigate the feasibility, safety and efficiency of endovascular treatment for patients with aorto-bilateral-iliac artery total occlusive disease.Methods A total of 35 patients with aorto-bi-iliac artery total occlusive disease treated with endovascular therapy in Peking Union Medical College Hospital and the First Hospital of Shijiazhuang between Jan 2012 and Dec 2013 were retrospectively analyzed.Results There were 33 males and 2 females, mean age (67 ± 6) years treated during the study period.Technical success rate was 100％.129 bare stents and 4 covered stents were implanted.There were no peri-operative death.Postoperative leg ankle brachial index (ABI) improved significantly (0.86 vs.0.28, P ＜ 0.28).Postoperative complications occurred in 2 patients (5.7％), including brachial artery thrombosis and rupture of external iliac artery post-dilation.The mean follow-up period was 16.5 months (2-28 months).Two patients (5.7％) were lost to follow up.Re-intervention was performed in 3 patients (8.6％) due to reocclusion of the stents.Primary patency was 91％ (30/33) Conclusions Endovascular treatment is effective for aorto-bi-iliac artery total occlusive disease with low complications and acceptable mid-term patent rate.

Objective To observe the clinical effect of digital acupoint pressure on sensory dysfunction in hemiplegic patients after stroke. Methods From March to December, 2015, 60 hemiplegic patients with sensory dysfunction after stroke were randomly divided into control group and observation group with 30 cases in each group. The control group received routine rehabilitation exercise, while the obser-vation group received digital acupoint pressure in addition. Fugl-Meyer Assessment for Sense (FMA-S), Fugl-Meyer Assessment for Motor (FMA-M) and modified Barthel index (MBI) were used to evaluate the sensory dysfunction, motor function and activities of daily living be-fore and eight weeks after treatment. Results After treatment, the scores of FMA-S, FMA-M and MBI increased in both groups (t>6.430, P<0.01), and the scores were higher in the observation group than in the control group (t>2.100, P<0.05). Conclusion Digital acupoint pressure can facilitate the recovery of sensory dysfunction, improve the motor function and the activties of daily living in hemiplegic patients after stroke.