Objective To investigate the pathogenesis of hepatogenic diabetes.Methods The fasting and 2-hour postprandial plasma glucose,fasting sertum insulin,glutamate decarboxylase antibody,insulin release index (IRI)and insulin sensitivity index(ISI)Was determined and analyzed in 135 liver cirrhosis patients.Results The incidence of hepatogenic diabetes wag 39.3%(53/135)in liver cirrhosis patients.The incidence of hepatogenic diabetes in post hepatitis C liver cirrhosis patients(53.3%.16/30)was muchh igher than that in post hepatitis B liver cirrhosis patients(37.1%,26/70)and alcohofic liver cirrhosis patients(31.4%.11/35)(P＜0.01).The fasting serum insulin,IRI and the positivity rate of glutamate decarboxylase antibody was much higher in hepatogenic diabetes than that in controls(P＜0.01),and ISl was much lower than that in controls(P＜0.01).Conclusions The development of hepatogenic diabetics is relsted with the etiological factor of liver cirrhosis.Besides impairment of the hepatocellular function and insulin resistance,viral infection and immunologic derangement and so on results in impairment of beta cell of islet function.Relative or absolute deficiency of insulin secretion is an important influential factor in the development of hepatogenic diabetics.

To identify the expression of the molecule recognized by Pf18-3 mAb (Pf18-3 molecule) on various cells. Meth-ods: The expression of pr18-3 molecule was assayed by flow cytometry and confocal laser scanning microscope . Result: The molecule recog-nized by Pf18-3 mAb expressed on TSC and other stromal cells. Whereas, fresh thymocytes were Pf18-3 negative. Interestingly, the expressionof Pf18-3 molecule was gradually up-regulated on thymocytes after activation by ConA. This molecule mainly expressed on CD4+ CD8+ andCD4+ CD8- cells. Under confocal laser scanning microscope, the staining of fluorescence showed as ring around the cell, it changed grsduallystronger and thicker with activation. Conclusion: This study indicated that the Pf18-3 molecule was co-expressive molecule of MTSC and acti-vated tlymocytes,it was concemed closely about the activation of CD4+ C D8+ and CD4+ CD8- cells.

Objective To evaluate liver protection provided by ulinastatin in rats with liver fibrosis.Methods Fifty pathogen-free male Sprague-Dawley rats,weighing 180-220 g,aged 6-8 weeks,were randomly divided into 5 groups (n =10 each) using a random number table:control group (group C),carbon tetrachloride (CCl4) group,low-dose ulinastatin group (group L),medium-dose ulinastatin group (group M),and high-dose ulinastatin group (group H).Hepatic fibrosis was produced by subcutaneous injection of 50％ CCl4 peanut oil solution two times a week for 8 weeks.After hepatic fibrosis was produced (at 9th week),ulinastatin 2.5× 104,5.0× 104 and 10.0× 104 U/kg were injected via the caudal vein in L,M and H groups,respectively,once a day for 7 days.Blood samples were collected after 24 h of fast on 8th day for determination of serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) concentrations by ELISA.The rats were then sacrificed and livers were removed for microscopic examination of pathologic changes with light microscope.The expression of interleukin-1β (IL-1β),IL-2,IL-6,IL-8,Toll-like receptor 4 (TLR4),and tumor necrosis factor-alpha (TNF-α) mRNA and protein was detected by RT-PCR and Western blot.Results Compared with group C,the serum AST and ALT concentrations were significantly increased in CCl4,L and M groups,the expression of IL-1β,IL-2,IL-6,IL-8,TLR4 and TNF-α mRNA and protein was up-regulated in CCl4 group,and no significant change was found in the parameters mentioned above in group H.Compared with group CCl4,the serum AST and ALT concentrations were significantly decreased in M and H groups,no significant change was found in the serum AST and ALT conccntrations in group L,and the expression of IL-1β,IL-2,IL-6,IL-8,TLR4 and TNF-α mRNA and protein was down-regulated in group H.The pathologic changes of hepatic tissues were attenuated in M and H groups as compared with group CCl4.The pathologic changes of hepatic tissues were almost recovered to the normal structure in group H.Conclusion Ulinastatin can produce liver protection in rats with liver fibrosis.

Objective To discuss Extracorporeal Membrane Oxygenation(ECMO) management method and effect during inter-hospital transport of potential cardiac death donors after cardiac death (DCD).Methods 8 potential donors after cardiac death with brain injury were supported by ECMO for inter-hospital transport.All donors were inserted Medtronic overall cannula into one side femoral artery and venous.The position of catheters were guided by ultrasound.The front-end of venous catheter located in the junction of atrium and inferior vena cava,meanwhile the front-end of artery catheter was below renal artery.100 IU/kg heparin was injected before inserting cannulas.Flow of ECMO maintained at 2.0～3.0 L/min,and oxygen flow was 2～3 L/min during ECMO supporting.When hemodynamics of potential donors were stable,patients were moved into ambulance with ECMO for inter-hospital transport.Results A total of 8 ECMO transports were performed for central circulatory collapse caused brain injury.Patients were previously cannulated and on ECMO prior to transport and transported a distance of more than 100 kilometer from our institution by ambulance.ECMO running times were 120 min,and operation process circulatory stable.Conclusion ECMO can ensure inter-hospital transport of potential donors after cardiac death safety.

To explore the relationship between the perioperative change in erythrocytic pyruvate kinase (PK) activity and surgical hyperglycemia in the patients undergoing upper abdominal surgery under intravenous procaine balanced anesthesia. Seventeen patients with ASA grade Ⅰ～Ⅱ, being scheduled for selective cholecystectomy or subtotal gastrectomy, were randomly enrolled in our study. PK activity of erythrocytes and its pertinent modulators, such as adenosine triphosphate (ATP), adenosine diphosphate (ADP), inorganic phosphate (Pi), magnesium, plasma glucose and serum insulin were dynamically assayed in the surgical patients receiving intravenous procaine balanced anesthesia. The results showed that PK activity was decreased significantly at 10 min and 24 hours after operation as compared with that of preoperative period. Changes in PK activity were positively correlated with ATP/ADP ratio( r =0 680, P 0 05). It is our supposition that the decreased PK activity and the disturbance of glycolytic pathway might be directly or indirectly induced by anesthesia and surgical trauma, leading to hindrance of utilization of glucose and Pi, as well as synthesis of ATP. Therefore, an inhibition of glycolytic reaction is one of the important mechanisms of "surgical hyperglycemia".

ObjectiveTo evaluate the efficacy of fiberoptic bronchoscope( FOB )-guided tracheal intubation with laryngeal mask airway (LMA) in patients undergoing anterior cervical spine surgery.MethodsForty ASA Ⅰ or Ⅱ patients of both sexes,aged 18-55 yr,weighing 50-75 kg,mallampatis Ⅰ or Ⅱ,scheduled for anterior cervical spine surgery under general anesthesia,were randomly divided into 2 groups( n =20 each): FOBguide tracheal intubation (group FOB) and FOB-guided tracheal intubation with LMA group (group LMA).Anesthesia was induced with mindazolam 0.04 mg/kg,fentany 3-4 μg/kg,cis-atracuriun 0.2 mg/kg and propofol 2 mg/kg.Tracheal intubation was performed at 3 min after cis-artracurium iv.Auditory evoked potential index was maintained at 10-20.The intubation time,the number of successful intubation,hypertension,tachycardia and hypoxemia were recorded.The number of successful LMA placement,LMA placement time and LMA shift after extubation were recorded.Blood stain at LMA removal and complications were also recorded.ResultsThe rate of successful LMA placement at first attempt was 90％ and placement time was ( 13 ± 3) s.The rate of successful intubation in the both groups was 100％.The intubation time was significantly shorter and the rate of successful intubation at first attempt was higher in group LMA than in group FOB ( P ＜ 0.05).Hypertension,tachycardia and hypoxemia were not found in the two groups.The number of LMA shift was 8 (40％).The number of blood stain and slight sore throat was 1 respectively in group LMA.There was no other complications in the both groups.Conclusion FOB-guided tracheal intubation with LMA can provide effective ventilation during operation,improve the success rate at first attempt and shorten the intubation time in patients undergoing cervical spine surgery.

ObjectiveTo study the expression of Twist in invasive ductal carcinoma of breast and its relationship with cell proliferation and angiogenesis.MethodsThe expression of Twist and Ki-67 was detected in 60 cases with invasive ductal carcinoma of breast by immunohistochemistry.Ki-67 index and microvascular density(MVD) were calculated.ResultsThe positive expression rate of Twist was 56.7％ (34/60) in invasive ductal carcinoma of breast.Ki-67 index and MVD in the patients with positive expression of Twist was higher than those in the patients with negative expression of Twist[(57.05 ± 16.37)％ vs.(25.32 ± 16.16)％,(34.30 ± 12.25)％ vs.(23.04 ± 10.45)％,P＜ 0.05 ].ConclusionsThe overexpression of Twist is found in invasive ductal carcinoma of breast.To stimulate cell proliferation and angiogenesis may be one of the pathways of Twist to contribute to the invasion and metastasis of breast cancer.

Objective To explore the pathogenesis of thrombocytopenia in chronic type B hepatitis. Methods The serum thrombopoietin (TPO) levels, bone marrow megakaryocyte (MK) count, platelet-associated immunoglobulin G (PAIgG), splenic index (SPI), prothrombin activity (PTA) were measured in 76 chronic type B hepatitis patients with thrombocytopenia. Results The regression analysis revealed that the platelet count was correlated with parameters including the serum TPO levels, bone MK count, SPI and PTA (r was 0.450, 0.521, -0.438, 0.428 respectively, P<0.05). The regression equation was Pt=36.38+0.23 TPO-0.57 SPI+0.69 MK, R<'2>=0.57, F=18.78, P<0.01. Conclusion It suggests that decline of thrombopoiedn, myelosuppression and hypersplenism may contribute to thrombocytopenia in chronic type B hepatitis patients.

The study was conducted to investigate the effect of different forms of trivalent chromium on growth hormone (GH) secretion and pituitary mRNA expression in finishing pigs.A total of 96 finishing pigs with an initial average body weight 65 kg were blocked by body weight and randomly assigned to four treatments with three replicates.Pigs were offered one of four diets including a control diet or the control diet supplemented with 200 μg/kg chromium from either chromium chloride (CrCl3),chromium picolinate (CrPic) or Chromium nanocomposite (CrNano) for 40 days.During the trial,all pigs were given free access to feed and water.At the end of the feeding trial,blood samples were taken via auriculares at 15 min intervals for 3 hours.Eight pigs from each treatment were slaughtered for backfat thickness and longissimus muscle area (LMA),and three pituitaries were collected to determine GH mRNA level.The results showed that average daily gain of pigs fed supplemental CrNano was increased by 6.31 (P<0.05),feed gain ratio was decreased by 4.61% (P<0.05),backfat thickness was decreased by 24.32 % (P<0.05),and LMA was increased by 20.22% (P<0.05).The results of GH dynamic secretion showed that supplemental CrNano increased the mean level,lowest value,peak value and peak duration of GH by 42.62% (P<0.05),87.94%(P<0.05),26.60% (P<0.05),and 17.19%(P<0.05),respectively.The mean level and peak value of GH in pigs fed Supplemental CrPic was increased by 36.58% (P<0.05),27.18%(P<0.05),respectively.Pituitary mRNA expression of GH in pigs fed diet containing chromium from CrNano was increased by 27.63%(P<0.05).These results indicated that chromium nanocomposite increased GH mRNA expression and secretion in finishing pigs,through which growth was promoted and carcass characteristic was improved.

The ketogenic diet(KD) treatment program planned for a 2 years old and 5 months boy suffered from severe cerebral complications after ependymoma operation in the Children′s Hospital of Nanjing Medical University at December 2018 was analyzed retrospectively.The patient developed various complications, including cerebral hemorrhage, hydrocephalus and hernia after the operation of ependymoma, with coma, fever and convulsion, and 1 month of anti-infection and antiepileptic treatment was ineffective.After 2 weeks of 4∶1 KD, fever and convulsion were effectively relieved without obvious side effects.One month later, the patient regained consciousness, demonstrating that KD can be applied to treat severe cerebral complications after ependymoma operation.