Large vascular lesions have become one of the main causes in the death and disability of type 2 diabetes mellitus (T2DM). The article systematically and in-depthly studied the mechanism of large vascular lesions in T2DM, in order to seek effective drug prevention and treatment. It was of vital importance in the improvement of prognosis of T2DM patients. In traditional Chinese medicine (TCM), the basic pathogenesis of T2DM large vascular lesions was deficiency in origin and excess in superficiality, in whichqi-yin deficiency was the origin and the obstruction of collaterals was the superficiality. In western medicine, the body endothelial dysfunction, oxidative stress reaction and abnormal gene expression and so on could cause T2DM large vascular lesions. This article summarized related research literatures on both TCM and western medicine in recent years. It discussed studies on mechanism of T2DM large vascular lesions.

Objective To investigate the effects ofLiuwei-Dihuang Pills combined with Ginkgo Biloba Leaves Extract Tablets on diabetic complications in patients with type 2 diabetes mellitus (T2DM). Methods Seventy-eight patients with T2DM were randomized into a TCM treatment group and a conventional treatment group by random number table method, 39 in each group. The patients in the conventional treatment group were regularly using antihyperglycemic drugs or insulin. On the basis of conventional treatment group, the patients in the TCM treatment group were additionally treated withLiuwei-Dihuang Pills and Ginkgo Biloba Leaves Extract Tablets. Intima-media thickness (IMT) of internal carotid artery, vibration perception threshold (VPT) and diabetic retinopathy in both groups were detected before the treatment, 12 and 36 months after the treatment.Results The VPT in the left foot 12 months after the treatment in the TCM treatment group were significantly lower than that in the conventional treatment group (13.98 ±4.38 Vvs. 18.70 ±2.43 V;t=2.764, P=0.008). IMT of internal carotid artery (left: 0.81 ± 0.16 mmvs.0.70 ± 0.10 mm,t=3.120,P=0.003; right: 0.81 ± 0.17 mmvs. 0.73 ± 0.12 mm,t=2.286,P=0.026), VPT (left foot: 14.82 ± 6.45 Vvs. 20.63 ± 9.75 V,t=2.714, P=0.009; right foot: 16.73 ± 7.10 Vvs. 20.73 ± 10.35 V,t=2.001,P=0.048) and incidence of diabetic retinopathy (35.9%vs. 53.8%;χ2=5.804,P=0.016) 36 months after the treatment in the TCM treatment group were significantly lower than those in the conventional treatment group.ConclusionsLiuwei-Dihuang Pills combined with Ginkgo Biloba Leaves Extract Tablets can effectively reduce the progression of diabetic complications in patients with T2DM.

Objective To investigate the predictive value of neutrophil and lymphocyte ratios (NLR)for the prognosis in patients with acute cerebral infarction. Methods From January 2014 to December 2015,307 consecutive patients with acute cerebral infarction admitted to the Department of Neurology,the Fifth Affiliated Hospital of Zhengzhou University were enrolled retrospectively,including 80 females and 227 males. They were divided into ether a good prognosis group (n = 195)or a poor prognosis group (n = 112)according to the scoring criteria of the modified Rankin scale (mRS). The age,gender, past medical history,National Institutes of Health stroke scale (NIHSS)score were documented on admission. The NLR values were calculated according to the neutrophil and lymphocyte counts on admission. Logistic regression analysis was used to analyze the influencing factors of poor prognosis of acute cerebral infarction. The receiver operating characteristic curve (ROC)was used to evaluate the predictive effect of the NLR level on patients with acute cerebral infarction on admission. Results (1)Compared with the good prognosis group,the age,incidence of recurrent cerebral infarction,NIHSS score on admission, NLR levels on admission in the poor prognosis group were higher. There were significant differences between groups (69 ± 12 years vs. 62 ± 14 years,25. 0% [28 / 112]vs. 14. 4% [28 / 195],5. 00 [3. 00, 9. 00]vs. 3. 00 [1. 75,5. 00],and 3. 66 [2. 62,7. 91]vs. 2. 47 [1. 94,3. 40];all P < 0. 05). There were no significant differences in other baseline data and clinical characteristics between the groups (all P >0. 05). (2)Multivariate logistic regression analysis showed that the increase of the age,NLR level on admission,and increased NIHSS score on admission,were independent risk factor for poor prognosis (OR 1. 030,1. 148,and 1. 427,respectively,95% CI were 1. 007 -1. 053,1. 059 -1. 246,and 1. 247 -1. 634, respectively;all P < 0. 05). (3)The diagnostic cut-off value of the NLR level on admission for the poor prognosis in patients with acute cerebral infarction was 2. 84. Its sensitivity was 69. 6% and specificity was 64. 6% . Conclusion The increase of the NLR level on admission had certain reference function on the poor prognosis in patients with acute ischemic stroke.

Objective To investigate the effects of ribs in high intensity focused ultrasound (HIFU)beam path on formation of coagulative necrosis in cattle liver in vitro in the same acoustic power. Methods The HIFU ablation was carried out in the manner of a single dot in the liver in vitro. The liver was ablated by HIFU in free field,then the ribs were placed between the focal plane and transducer,directing the beam axis through the intercostals space, lied at the rib edge and on the centre of middle rib. For each of these axial arrangements,the plane of the front surface of ribs was placed 3 cm,6 cm or 9 cm in front of the focus. After HIFU exposure,the tissue necrosis rate(TNR),the maximum length,width,depth and position of the coagulated necrosis in the liver were measured. Results ①The TNR was 100% in the free field. When the ribs were placed 3 cm in front of the focal plane,directing the beam axis through the intercostals space, the TNR was 100%. When directing the beam axis lied at the rib edge and on the centre of middle rib,the TNR decreased sharply. When the ribs were placed 6cm and 9cm in front of the focal plane, the TNR was more than 50%. ②When the ribs were placed in HIFU beam path, the volume of necrosis decreased compared with those in free field. The relationship between the ribs and beam axis, the location of ribs placed away from the focal plane different,the volume,length,width and position of the coagulated necrosis different. ③ When the ribs were close to the focal plane,unacceptable damage could been observed on the surface of ribs.When the ribs were far away from the focal plane, the ribs were safe. Conclusions The volume of necrosis decrease when the ribs are placed in HIFU beam path. The relative location of ribs and HIFU beam axis, the location of ribs away from the focal plane are relative with the volume of the coagulated necrosis. When directing the beam axis through the intercostals space, the volume of necrosis is large, and the shape of coagulated necrosis is regulated. When the ribs are closed with the focal plane,ribs are damaged probably.

Objective To investigate the enhancing effect of microbubble contrast agent SonoVue of different dosage on high-intensity focused ultrasound (HIFU) ablation in goat livers in vivo. Methods Twenty goats were divided into 4 groups randomly. Animals in group 1,2 and 3 were bolus-injected of 0.01 ml/kg,0. 03 ml/kg and 0.05 ml/kg of SonoVue intravenously before HIFU exposure, respectively,and those in group 4 were not given injections as control. After injection 20s, the livers were ablated using HIFU performed in the manner of a single dot set by a computer system using a clinical device. The frequency of HIFU was 0.8 MHz,the intensity of HIFU was 19 100 W/cm2 ,the distance from skin to the target liver tissue was 30 mm,the exposure time was set at 15 s for all animals in the four groups. All animals were euthanized 7 days after HIFU, volumes of coagulated necrosis were measured. Pathological examinations were performed to analysis the exposure regions. Results Under the same parameters of exposure, coagulated volumes in group 1,2 and 3 were larger than those in group 4, the difference was significant (P < 0.05),and the coagulated volumes increased gradually with the dosage of SonoVue increasing from group 1 to group 3, the difference was significant (P<0.05). Pathological examinations confirmed that there were no residual unaffected tissues within the exposed volume. Two remarkable changes were observed in one goat in group 37 days after HIFU:the surrounding adjacent tissue outside the reactive zone necrotized and the skin were destroyed. Conclusions The enhancing effects of microbubble contrast agent in HIFU ablation is related with the dosage of the microbubble contrast agent SonoVue. The higher the SonoVue dosage,the larger the volume destroy in the target tissue.

Objective To evaluate the relationship between the incidence rate of hepatic encephalopathy in patients with cirrhosis and the model for end-stage liver disease (MELD).Methods The total of 120 patients with decompensated cirrhosis were enrolled and followed-up.MELD score was obtained to observe the incidence of hepatic encephalopathy.Results The incidence of hepatic encephalopathy was 44.17％(53/120).MELD score in hepatic encephalopathy patients was significantly higher than that in none hepatic encephalopathy patients[(21.69 ± 9.22) scores vs.(9.32 ± 4.63) scores],and there was significant difference (P ＜ 0.05).With the increase of MELD score,the incidence of hepatic encephalopathy increased (P ＜ 0.01).The best critical value of MELD score was 14.13 scores (the sensitivity of 86.05％ and the specificity of 88.37％),when MELD ≥14.13 scores,the incidence of hepatic encephalopathy within 3 months was significantly higher [63.16％(48/76) vs.11.36％(5/44)] (x2 =30.32,P＜ 0.01).Conclusion MELD can help predicting the incidence of hepatic encephalopathy in decompensated cirrhosis patients.

Objective To explore early aberrant change of the function and grey matter volume within default-mode network in patients with type 2 diabetes mellitus (T2DM) by Independent component analysis and voxel-based morphometry.Methods Twenty-nine T2DM patients and thirty-three healthy control subjects were recruited in this study between May 2014 and January 2015,and the demographic and clinical data (fasting plasma glucose and HbA1c level) were obtained.General cognition was assessed by MMSE and MoCA in all subjects.Resting-state fMRI and T1-weighted imaging were performed in all subjects.Then the z-maps of default-mode network were obtained from Resting-state fMRI by independent component analysis,and the grey matter volumes were extracted by VBM.Finally,two-sample t-test was performed in the function and grey matter volume of DMN between two groups,and pearson correlation coefficients among zFC values extracted from significantly different brain regions,grey matter volumes and durations of T2DM patients were calculated.Results Patients with T2DM showed decreased Z value around the right anterior cingulated cortex and the right medial pre-frontal cortex(cluster=121,t=-3.81,P＜ 0.05).There was no significant difference in grey matter volume between the two groups,and no correlation between Z value or duration and grey matter volume was found.Conclusions It suggests the abnormality of connectivity of default-mode network may precede the abnormality of grey matter volume in type 2 diabetes mellitus patients.The DMN might be a new potential tool in monitoring the change of cognition in patients with type 2 diabetes mellitus.

Objective To investigate integrated status of community inpatients with type 2 diabetes mellitus.Methods 240 cases of type 2 diabetic patients in the Zhangjiagang Aoyang Hospital were included in the study from May 1,2007 to Dec 31,2008.A uniform questionnaire was applicated.Gender,disease duration,age,academic qualifications,occupation,education,height,weight,waist circumference,hip,relevant medical history and so on were collected.Results The onset age of inpatients with type 2 diabetes was (48.91 ± 12.38),onset age of male was(46.32 ±12.08),which was significantly lower than female (52.42 ± 11.97) (P ＜ 0.01).The onset age female and male proportion also had significant differences,age onset of male was in advance.The average body mass index was (24 ±3.47)kg/m2,most of the inpatients were workers and farmers,the level of education was primary and secondary.Multiple regression analysis hints,risk factor of onset age is the family history of diabetes,the history of hypertension,male,low academic qualifications.Percentage of newly diagnosed patients was 28.3％,about one-third in patients were with the metabolic syndrome,hyperlipidemia,high blood pressure,fatty liver.Conclusions Education level of the inpatients was lowe in the community,so strengthening diabetes education was required.The persons in the commuities who were male,or with the family history of diabetes,with high blood pressure history were of the communities require for early screening of diabetes mellitus,so the occurrence and development of diabetes woule be controlled.

BACKGROUND:Occluder implantation in patients with congenital heart disease can increase in vivo platelet adhesion and aggregation, resulting in thrombosis on the occluder surface. OBJECTIVE:To investigate the effect of the occluder on platelet function in patients with congenital heart disease undergoing transcatheter closure. METHODS: Clinical data from 124 patients with congenital heart disease undergoing transcatheter closure were retrospectively analyzed. These patients were divided into groups of atrial septal defect in 46 cases, patent ductus arteriosus in 43 cases and ventricular septal defect in 35 cases according to the types of congenital heart disease. The positive rates for peripheral blood CD62p, CD63 RESULTS AND CONCLUSION:There was no difference in the positive rates of peripheral blood CD and thrombin sensitive protein were compared before and 6 hours, 24 hours, 12 months after occluder implantation. 62p, CD63 and thrombin sensitive protein among three groups prior to occluder implantation. Up to 6 hours after occluder implantation, the expression levels of peripheral blood CD62p, CD63 and thrombin sensitive protein reached peak in the three groups, especialy in the patients with atrial septal defect and ventricular septal defect, then gradualy decreased. After 12 months, the expression levels of CD62p and CD63 recovered in the patients with patent ductus arteriosus and ventricular septal defect, but stil maintained a higher level in those with atrial septal defect (P < 0.05). The expression of thrombin sensitive protein showed no difference among the three groups at different time. These findings indicate that after occluder implantation, the platelet activation is more remarkable and lasts longer in the patients with atrial septal defect and ventricular septal defect, especialy in those with ventricular septal defect.

Objective To investigate the effects of Blastocyst MHC gene transfection to coronary on the survival time of mouse heart grafts and the mechanism. Methods Inbred male Balb/c mice and C57BL/6 mice were selected as donors and recipients respectively, to construct mouse cervical heart transplantation models. In the control group, the donor hearts were perfused using the 0～4 ℃ St. ThomasⅡ solution; in the cyclosporine A (CsA) group, the donor hearts were perfused as same as the control's and received intraperitoneal injection of CsA (5 rng·g-1·d-1) after surgery; in the transfection group, the donor hearts were perfused using St. Thomas Ⅱ solution with Blastocyst MHC gene plasmid; in the combined treatment group, the donor hearts were perfused using St. Thomas Ⅱ solution with Blastocyst MHC gene plasmid and received intraperitoneal injection of CsA (5 mg·g-1·d-1) after surgery. The survival time of transplanted heart allografts were observed, and their histopathological changes and the degrees of coronary intimal hyperplasia were estimated.Blastocyst MHC gene mRNA expression levels were detected by real-time fluorescence quantitative RT-PCR. Flow cytometry was applied in assessment of the levels of CD4+ CD25+ regulatory T cells (Treg) and CD3+ CD8+ T cells. Results The survival time in the CsA group, transfection group and combined treatment group was significantly longer than in the control group (P＜0.05) and that in the combined treatment group was the longest, up to (20. 50 ± 5. 61) days. On the postoperative day 1 and 3, Blastocyst MHC gene mRNA expression level in the transfection group was significantly higher than that in the control group (P＜0.05). On the postoperative day 7, the degrees of rejection and coronary intimal hyperplasia in the combined treatment group were the lightest. On the postoperative day 7 the number of Tregs in the CsA group and the combined treatment group was significantly increased as compared with that in the control group (P＜0.05), but that of CD3 + CD8+ T cells in the CsA group and the combined treatment group was less than that in the control group (P＜0.05). Conclusion Blastocyst MHC gene transfection in mouse transplanted cardiac allograft can extend its survival time through upregulation of Treg and downregulation of CD3 + CD8 + T cells in the mice. The combination of Blastocyst MHC gene and CsA may exert the synergic effects.