Objective To investigate the risk factors for severe hypoglycemia in the treatment of type 2 diabetes mellitus (T2DM) and to provide scientific rationales for the prevention of hypoglycemia in treating diabetes.Methods Clinical data of 49 T2DM patients with severe hypoglycemia (hypoglycemic group) and 98 T2DM patients without hypoglycemia as control group were retrospectively analyzed.Severe hypoglycemia was defined as that patient requiring assistance for intaking carbohydrate to alleviate hypoglycemia and plasma glucose concentration was less than 3.9 mmol/L.Clinical and biochemical indexes were analyzed by the single-factor analysis.Logistic regression model was established by multi factors regression analysis,and the receiver operating characteristic (ROC) curve was used to assess the performance of the logistic regression model.Results The mean serum glucose level was (2.3±0.7) mmol/L during hypoglycemia in hypoglycemia group.The mean age was higher in hypoglycemia group than in control group [(76.2±6,5) years vs.(69.8±11.5) years,P=0.001].The mean glycosylated hemoglobin Alc (HbAlc) level was lower in hypoglycemia group than in control group [(6.4±0.8)％ vs.(9.1± 2.5)％,P＜0.001].Endogenous creatinine clearance rate (Ccr) was lower in hypoglycemia group than in control group [(46.8±21.0) ml/min vs.(74.2 ± 24.5) ml/min,P＜0.001].Logistic regression analysis indicated that female and HbA1c level were the independent risk factors for severe hypoglycemia (OR=11.83,0.91 and 0.18,95％CI:1.82 76.93,0.86-0.97 and 0.08-0.44,respectiely] ; T2DM therapies with insulin and insulin secretagogues increased the risk of hypoglycemia (OR＝12.31 and 5.36,95％CI:1.70-88.88 and 1.08-26.56); however,duration of diabetes,body mass index (BMI),and urinary microalbumin (UMA) had no correlation with severe hypoglycemia (all P＞0.05).The area under the ROC curve was 96.5％ by the logistic regression model.Conclusions Gender,Ccr,HbA1c,insulin and insulin secretagogues are the main risk factors for severe hypoglycemia in T2DM patients.Preventive interventions of hypoglycemia should be taken earlier for the patients with the high risk factors.

Objective To study the effect of Fas gene transfection on bladder cancer cells. Methods Fas cDNA were transduced into bladder cancer cells EJ by DOTAP liposomal transfection regeant. Northern blot,in situ hybrization and flow cytometric evaluation were used to confirm the Fas mRNA and protein expression. The apoptosis and proliferation of EJ cells pre and posttransfection induced by cisplatin were analysed by flow cytometry、DNA ladder and MTT methods. Results Transfection of Fas gene can significantly upregulate the expression of Fas in human bladder cancer EJ cells. Apoptosis and decrease of proliferation were easily induced by cisplatin in the transfected EJ cells. Conclusions Fas system might involve in the development and progression of urogenital malignant tumors. Transfection of Fas gene by lipofectin can significantly upregulate the Fas expression in target cell. The synergistic cytotoxic effect obtainted in EJ cells suggested that combined use of Fas gene transfection and cisplatin may help in the treatment of cisplatin resistant bladder cancer.

Objective To investigate the change of matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of metalloproteinase-1 (TIMP-1) in the skin of diabetic rats, and to explore the potential role of MMP-9/TIMP-1. Methods Diabetic rats were induced with streptozotocin (STZ). Then all rats were maintained for 6 weeks. Routine pathological examination and immnnohistochemistry were made to reveal the histological and cytological appearances. RT-PCR and Western blotting were used to detect the expression of mRNA and protein of MMP-9 and TIMP-1 in the skin. Results Six weeks after STZ treatment, examination of HE-stained skin sections from normal and diabetic animals revealed that the epidermis and dermis layers were thinner in diabetic rats than those in control rats. The skin of diabetic rats showed features of atrophy such as disorganization of connective tissue fiber bundles and enlarged space between collagen fiber bundles. In contrast, thick bundles of connective tissue were observed in the dermis of normal rat skin. In normal skin, cells had a bipolar, spindle-shaped appearance in the thick collagen bundles, while in the skin of diabetic animals the interstitial cells had a rounded, shrunken and crenated appearance. The relative values of expression of MMP-9 in diabetic group were higher than those in normal group with significant difference, however, the relative values of expression of TIMP-I in diabetic group were lower than those in control group. Conclusion The changes in cutaneous histology and cytology appear earlier than skin wound. These "underlying disorders" may be associated with the imbalance of MMP-9/TIMP-1.

AIM:To investigate the imbalance between the expression of metalloproteinases (MMPs) and that of tissue inhibitors of metalloproteinase (TIMPs) during wound healing in diabetic rats. METHODS: Diabetic rats were induced with streptozotocin. All rats were maintained for 6 weeks. A full-thickness excisional wound was created on the back of each rat. Every group was randomly divided into 3 subgroups of 7 rats: 3 d group, 7 d group, 14 d group and animals were killed at 3rd, 7th and 14th day. Routine pathological examination, Masson′s trichrome staining and immunohistochemistry were made to calculate the score of epidermal and dermal regeneration, granulation tissue thickness, angiogenesis, matrix density, and infiltrated cells at different time points. RT-PCR and Western blotting were used to detect the expression of mRNA and protein of MMP-9 and TIMP-1 in the skin at those time points. RESULTS: Six weeks after streptozotocin treatment, Three days after injury, the wound healing rate of normal rats was faster than that of diabetic rats. From 3rd to 14th day, there were a lot of fibroblast and macrophage in normal skin, while few such cells were observed in diabetic skin. The other histological scores in normal skin were higher than those in diabetic rats at 7th and 14th day. Both MMP-9 and TIMP-1 had minimally detectable levels before wounding but exhibited rapid, significantly large increases within 3 d after wounding. Subsequently, they showed a rapid decline by 14 d. The relative values of expression of MMP-9 mRNA and protein in diabetic group were higher than those in normal group at different time points. However, the values of TIMP-1 mRNA and protein in diabetic group were significantly lower than those in control group. Significant difference was observed between two groups with the ratio of MMP-9/TIMP-1, higher in diabetic group than that in normal group. CONCLUSION: Abnormal reepithelialization, angiogenesis, inflammatory cell infiltration, collagen fibers generation, granulation tissue deposition, seem to be the basic histopathology that delays wound healing. The imbalance between MMPs and TIMPs in diabetic skin tissue before and after injury may be one of the important reasons of these alterations of histopathology.

Objective To explore clinical value of intraoperative extra strong electrical stimulation in the treatment of birth brachial plexus palsy. MethodsFrom July 2008 to September 2011,intraoperative extra strong electrical stimulation was applied in 9 cases of incomplete birth brachial plexus palsy after neurolysis.The latency and amplitude of compound muscle action potentials before and after electrical stimulation were recorded and the extent of improvement was compare.ResultsThe latency was improved in 7 cases with 8.02％ in average,amplitude in 8 cases with 185.97％ in average.The related nerve recover partial motor function in 8 cases in 2 weeks after operation.ConclusionIntraoperative extra strong electrical stimulation is a effective assistant technique to promote motor functional recovery of birth brachial plexus palsy.

Objective To relatively prolong the length of C7 nerve through microanatomical study and carry out direct anastomosis between the end of avulsed nerve and contralateral C7. Methods Fifteen cadaveric specimens and 30 sides of the adult brachial plexus was dissected. The C7 nerve was confirmed and measured by using electric vernier caliper. Parameters as follow: the length of C7 nerve from root to trunk; the length of C7 nerve from root to division(anterior and posterior division); transverse and longitudinal diameter of C7 nerve in root site, combination site between trunk and division, end site of anterior and posterior division. After dissected the nerve adventitia of binding site between division and cord and cut the distal end of anterior and posterior division, the length of C7 nerve from root to division (anterior and posterior division)was measured again. Results The measured result of the length C7 nerve: the length of C7 from root to trunk: (45.87 ± 10.43)mm; Before micro-dissected, the length of C7 from root to anterior division: (61.14 ±13.44)mm; the length of C7 from root to posterior division: (54.63 ± 11.35)mm after micro-dissected, the length of C7 from root to anterior division: (74.67±12.86)mm; the length of C7 from root to posterior division:(68.73± 11.86)mm; the prolonged length of anterior division: (13.15± 4.26)mm; the prolonged length of posterior division: (14.21 ± 6.98)mm. Conclusion Through dessecting the adventitia of binding site of division (anterior and posterior division) and cord of C7 nerve. The length of C7 nerve can be relatively prolonged.

Objective: To investigate the prevalence of metabolic disorder among the high school students in Guangzhou. Methods: A cross-sectional study among 4 620 high school students selected with stratified cluster sampling was conducted in Guangzhou. Height, weight, blood pressure, fasting plasma glucose (FPG) and serum lipid of TC, TG were measured. Household socioeconomic status, medical history, physical activities as well as personal diet and study habits were acquired with structured questionnaire. Results: The prevalence of central obesity was 11.5%. The overall prevalence of IFG and DM was 6.9%. The overall prevalence of both hypercholesteremia and hypertriglyceridemia was 13.4%. The prevalence of hypertension was 11.6%. With multivariable logistic regression, the results showed that: fast eating was associated with increased risk of central obesity (OR=1.79, 95%CI=1.47-2.18) and hypercholesteremia/hypertriglyceridemia (OR=1.27，95%CI=1.04-1.54). While students who ate slow had low risk of central obesity (OR=0.47, 95%CI=0.33-0.68), hypercholesteremia/hypertriglyceridemia(OR=0.71, 95%CI=0.54-0.94) and hypertension (OR=0.65, 95%CI=0.49-0.88). Students with sugar-sweetened beverages once a day or more had higher risk of central obesity (OR=1.60, 95%CI=1.08-2.38) while students without sugar-sweetened beverages consumption had low risk of IFG/DM (OR=0.57, 95%CI= 0.43-0.77) than those who consumed 1-2 times/week. Students without eating out habit had lower risk of hypercholesteremia /hypertriglyceridemia than those with eating out for 1-2 times/week (OR=0.78, 95%CI=0.62-0.98), and students who had lunch out of home or canteen had higher risk of hypercholesteremia /hypertriglyceridemia than those who ate at canteen (OR=1.38，95%CI=1.06-1.81). Conclusion The prevalence of metabolic disorder among high school students in Guangzhou is at a relatively high level. High eating speed, heavy sugared beverages intake and frequently eating out habits are associated with risk of metabolic disorder.

Objective To investigate the quality of life on brachial plexus injury patients in crosssectional study method and acquire related data. To analysis the effect factors and try to study on the methods which help to improve the quality of life of these patients. To our knowledge, this is the first study that measures quality of life of the brachial plexus injury patients in China. Methods Research participants completed the Chinese version of the World Health Organization Quality of Life Assessment-Bref (WHOQOL-BREF) and the 5-items version of International Index of Erectile Dysfunction Questionnaire (IIEF-5) for male.Data were typed into computer and analyzed with SPSS version 13.0. Correlations between domain scores and hospital stay, age, and family monthly income variables were analyzed with Spearman non-parameter correlation analysis. Results Fifty-one valid questionnaires were retrieved. The average score of these patients in physical, psychological, environment domains were 11.47 ± 2.36, 12.37 ± 2.28 and 11.62 ± 2.22, respectively. They were significantly lower than the norm groups in national studies which were 15.8 ± 2.9, 14.3 ±2.5 and 13.2 ± 2.4 (P ＜ 0.01 ). The average score of IIEF-5 was ( 17.83 ± 4.65), significantly lower than the normal score of 22 (P ＜ 0.01 ). Significant correlation was found among physical domain and age(P ＜ 0.05),family monthly income (P ＜ 0.05) and IIEF-5 score(P ＜ 0.01). Psychological domain also has significant correlation with IIEF-5 score (P ＜ 0.05) and so does environment domain with family monthly income (P ＜0.05). Conclusion Brachial plexus injury patients showed a reduction in quality of life scores. Even though the physical aspect was the most affected, there is evidence that the psychological, environmental domains and erectile function remained far from the ideal conditions expected for the general population. The effect factors are complex and there still remain much work to do.

Objective To explore the clinical design and therapeutic effect of total root avulsion of brachial plexus by contralateral C_7 nerve transfer for directly repairing C_8T_1 via prespinal route combined with functioning gracilis transplantation. Methods Twelve cases of total roots avulsion of brachial plexus were operated at 1 month to 3 months after injury.The contralateral C_7 nerve was successfully transferred to directly repair avulsed C_8T_1 roots or lower trunk via prespinal route.At 2nd operation stage after 4 to 8 months,the functioning gracills transplantation was preformed to reconstruct the elbow flexion and fingers extension. Results Follow-ups were carried out in all 12 cases who had been discharged for 9 to 36 months after the first operation.The positive Tinel signs of ulnar or median nerves were located in the proximal arm at 3 months after 1st operation,in the elbow or proximal forarm at 6 months,and in the wrist or distal forarm at 9 months.At 12 months the positive Tinel signs were found in the plam or fingers in 9 cases.The contraction of sternocostal part of pectoralis major was found at 9 mooths in 7 cases.There were the restoration of the taction-pain sensation in the palm, finger, and medial side of forearm and the contraction of flexor carpi ulnaris and flexor digitorum(M_3)in 5 cases at 15 to 18 months after 1st operation.In 7 patients the flexion of elbow and extension of fingers and thumb restored at 9 to 12 months after the 2nd operation.Their elbow flexion was 90°-120°and M_3(Highet's method),and their finger and thumb extension M_3. Conclusion There is the possibility of the operative design and clinical application of total root avulsion of brachial plexus by contralateral C_7 nerve transfer for directly repairing C_8T_1 via prespinal route combined with functioning gracilis transplantation.There are not only the restoration of sensation and flexion of wrist and fingers,but also the restoration of elbow flexion and fingers extension.

Objective To explore the clinical classification of the brachial plexus root injury in adult.MethodsAll 155 cases of adult brachial plexus root injury in the First Affiliated Hospital of Sun Yat-sen University,were collected and analyzed on their characteristic,operative methods,and clinical outcome so as to find the distribution and incidence of different type of brachial plexus root injury and set up the clinical classification of adult brachial plexus root injury.ResultsBrachial plexus root injuries in adult could be classified into three types and seven subtypes.Type A is upper brachial plexus root injury,including type AⅠ (C5,C6 completely avulsion or rupture injury,with/without phrenic nerve injury),type AⅡ (C5-C7 completely injury),and type AⅢ (C5-C7 completely injury accompanied with C8,T1 incompletely injury).Type B is lower brachial plexus root injury,including type BⅠ[ C8,T1 (with/without C7)completely injury ] and type BⅡ (C8,T1,C7 completely injury,accompanied with C5、6 incompletely injury).Type C is total brachial plexus root injury,including type CⅠ(C5-T1 completely root avulsion) and type CⅡ(C7-T1 root avulsion accompanied with C5、6 root or trunkrupture).For the cases of every type,u pper brachial plexus root injury type A have 86 cases,in which type AⅠ 6 cases,type AⅡ 27 cases and type AⅢ 53 cases; lower brachial plexus root injury type B have 6 cases,in which type BⅠ 2 cases and type BⅡ 4 cases; total brachial plexus root injury type C have 63 cases,in which type CⅠ 51 cases and type CⅡ 12 cases. ConclusionExcept the upper,lower,and total three types,brachial plexus root injuries in adult could be classified further into seven subtypes.The distribution of different type of adult brachial plexus root injury is overbalance:upper type A (55.5％) is more often seen,total type C(40.6％) followed and lower type B(3.9％) is the least seen.In upper brachial plexus root injury,type AⅢ(61.6％) is more often seen,type AⅡ(31.4％) followed and type AⅠ(7％) is less seen.