Today,more and more patients with diabetes are requiring surgical intervention.Not only the metabolic disturbance of carbohydrate will be aggravated by surgical stress,but also the risk of perioperative complications and mortality have been greatly increased in patients with diabetes.Therefore,a complete preoperative assessment and blood glucose management of preoperative,intraoperative,and postoperative periods are needed to get full assurance for diabetic patients to undergo surgery and to pass through the perioperative period smoothly.

Traditionally it has been widely accepted that our genes together with adult lifestyle factors determine our risk of developing noncommunicable diseases such as type 2 diabetes mellitus ,cardiovascular disease and obesity in lat-er life.Currently, there is substantial evidence that the early life environment plays a key role in determining our suscepti -ble to such diseases in later life .As an increased focus on the understanding of central insulin resistance , central nerve sys-tem plays an extremely important role in regulating the peripheral glucose homeostasis .Substantial studies have indicated that it may be regulated by epigenetic mechanisms .Epigenetics can be defined as the study of heritable changes in gene ex-pression that do not involve alterations in the DNA sequence .Epigenetic processes play a central role in regulating tissue specific gene expression and hence alterations in these processes can induce long -term changes in gene expression and me-tabolism which persist throughout the lifecourse .This review will focus on the epigenetic machanisms of central neuroregula-tion between early life environment and glucose metabolism in adulthood .

Objective To observe the effect of ShenQi Wuweizi Tablet (Tablet composed of pilose asiabell root, astragalus root, and schisandra fruit) on anxiety before college entrance examination.Methods Totally 227 patients were randomized into a treatment group (113 cases, treated with Shenqi Wuweizi Tablet, 3 tablets each time and 3 time a day), and a control group (114 cases, treated with alprazolam, 0.4 mg each time and 3 times a day). The treatment course was 6 weeks for both groups. Before treatment and at the end of the 1st, 2nd, 4th and 6th week of treatment, the clinical effect was assessed with Hamilton Anxiety Scale (HAMA) and Clinical Global Impression (CGI), and Self-Rating Anxiety Scale (SAS). And at the same time, the untoward reactions was also observed.Results At the end of the 1st week of treatment, the HAMA score was significantly decreased in the control group (P

Objective To investigate the status of glycemic control in a group of type 2 diabetes mellitus patients combined with pe-ripheral arterial disease before and after operation .Methods Patients with lower extremity arterial occlusive disease who were in charge in vascular surgery of Peking Union Medical College Hospital from 2002 to 2012 were involved .Type2 DM out patient without lower extremity arterial occlusive disease were involved as control .We measured blood pressure ,blood glucose and blood lipid .Fasting,2hPG and average plasma glucose of two groups patients were Compared ,at the same time we observed the difference of plasma glucose before and after operation.The Student′s t test and ANOVA analysis were used to compare the difference of before and after operation and between groups . Results Total of sixty DM patients with lower extremity arterial occlusive disease were involved ,and sixty five patients were involved in control group.There was no difference in age between two groups (65.8 ±8.9 vs 63.0 ±10.0years).The DM patients with lower extremity arterial occlusive disease had longer duration of DM (12.2 ±7.1 vs 7.7 ±5.9years).PAD group had higher fasting plasma glucose (8.3 ± 2.7 vs 7.7 ±2.3mmol/L),post breakfast and lunch plasma glucose (10.7 ±2.9 vs 9.0 ±2.4mmol/L,10.6 ±3.1 vs 8.9 ±4.1mmol/L) than control group .There was no significant difference in post dinner plasma glucose of two groups .Patients with PAD obtained a good plas-ma glucose after they made an operation but insulin Volume had no change ,which was as fasting plasma glucose (7.7 ±2.1 vs 6.8 ± 2.8mmol/L),breakfast (10.5 ±2.5 vs 8.5 ±3.4mmol/L),lunch(10.5 ±3.1 vs 8.7 ±3.8mmol/L)and average plasma glucose (9.6 ± 1.8 vs 8.2 ±2.9mmol/L).Post dinner plasma glucose had no difference in two groups .Conclusion Type 2 DM patients combined with lower extremity arterial occlusive disease had a longer duration of diabetes and higher plasma glucose .At the same,therapy and operation can improve blood glucose control .If a DM patient has a poor plasma glucose ,we should find its reason ,and deal with complication ,then plasma glucose can be controlled better .

[Summary] Next-generation sequencing is a revolution in the approach of genetic testing. It broadens the insight on the genetic diagnosis and research of monogenetic diabetes,which is represented by neonatal diabetes mellitus and maturity onset diabetes of the young.And it reveals advantages in exploring novel mutations.

Objective To investigate the effects of acellular allo-dermis for repairing skin defects in clinic.Methods A total of 78 cases were studied in this article. All of these patients were treated by acellular allo-dermis plus autologous epiderm skin complex grafts. Among these patients, 10 patients were injuried with skin,and soft tissue avulsion, 23 patients with limbs eschar wounds caused by burn,and after scar excision,45 patients with wounds undergoing plastic operations. Results 78 cases had satisfactory effects in appearance and functions. The complex skin grafts of 69 cases among all the 78 cases were alive. The complex skin grafts of the other 9 cases were partially skin sheet alive. Conclusions Acellular allo-dermis is an ideal skin surrogate, it has good tissue elasticity and tolerance. It can not only ensure the appearance and functions similar to thicker skin graft, but also reduce scar produce in donor site.

Improving insulin resistance is the key to prevention and treatment of type 2 diabetes.Treatment aimed at insulin resistance can prevent type 2 diabetes in an earlier stage with a better effect, prevent the deterioration of β-cell function, and decrease the rate of the progression to atherosclerosis.

Objective To study the effects of green tea extract on the decrease of serum lipids and body mass index in middle-aged person.Methods A total of 248 middle-aged person with mild hypercholesterolemia were randomly divided into 2 groups and assigned to receive tablets containing green tea extract or placebo for 20 weeks.The serum lipids and body mass index were measured.Results The levels of serum total cholesterol and lower-density lipoprotein,and the body mass index were significantly decreased with the treatment of green tea extract(all P

Objective To study the clinical characteristics of very elderly patients aged 80 years and over with diabetes mellitus (DM).Methods Clinical data of 95 very elderly patients with diabetes mellitus were retrospectively analyzed.Results Among 95 patients,patients with type 2 diabetes mellitus accounted for 98.9％ (94/95),patients with asymptomatic onset accounted for 35.8％ (34/95).The incidence of acute complications of diabetes mellitus was 11.6 ％ (11/95).Chronic complications of peripheral neuropathy and diabetic nephropathy were more common,and their incidences were 83.2％ (79/95) and 45.3％ (43/95),respectively.The percentage of patients with multiple chronic complications was up to 45.3％ (43/95).The percentage of DM patients combined with hypertension,coronary heart disease,cerebral infarction,hyperlipidemia or cardiac valve calcification was 80.0％ (76/95),48.4％ (46/95),77.9％ (74/95),42.1％ (40/95)and 33.7％ (32/ 95),respectively.There were 29 patients (30.5％) with the simultaneous presence of DM,hypertension,cerebral infarction,coronary heart disease,and hyperlipidemia in a same patient.The proportion of DM patients with low serum albumin was 47.4％ (45/95),and the rate achieving the target low density lipoprotein level was only 35.8％ (34/95).In the treatment,67.4％ (64/95) of patients were treated with oral hypoglycemic agents combined with insulin injection.The incidence of hypoglycemia was 24.2％ (23/95),and 69.6％ (16/23) of them had no self-conscious hypoglycemic symptoms.Conclusions Chronic complications are common in elderly diabetes mellitus patients.The elderly DM patients are prone to have many complications at the same time,with a higher incidence of hypoglycemic value under 3.9 mmol/L and lower rate of hypoglycemic symptoms.

Objective To study the expression of intercellular adhesion molecule-1 (ICAM-1 ) in the rat cardiac heterotopic allo- grafts and the effect of cyclosporin A on prevention of allograft rejection. Methods Heart transplantated animals were divided into three groups: Group Ⅰ(control), Group Ⅱ(CsA 7. 5mg/kg B W, daily) and Group Ⅲ(CsA l5mg/kg B W, daily). Acute cardiac rejection grade was valued by the standrd of ISHLT(1990 ). Immunohistochemistry was performed to analyze the expression of ICAM-1 in heart grafts and donor aorta segments. Results After heart transplantation, it was found that from day 1 to 3, there was sligtly inflammatory infiltratiation, the rejection was graded 1A of 1B, But from day 11 to 12, there were disseminated inflammation and cardiac necrosis with serous hyperemia, exutation, edema, acute vasculitis and myocarditis. The rejection grade was 3B or 4, and could be reduced 1to 2. 5 grades by administration of CsA. It was also found that both in heart graft and donor aorta segments the expression of ICAM-1 on the endothelium cells, infiltrated lymphocytes was clearly increased. It was time-dependent and could be down-regulated by administra- tion of CsA. On Day 1 and Day 3 the suppressing function of CsA on expressing of ICAM-1 showed singificant dosage-dependent. But from Day 7 to Day 11, it appeared dosage- independent. Conclusiou Trea tment with CsA is an effect ive methed to down- regulate I - CAM-1 expression and could reduce the lympphocyte migration and filtration. These results may explain, in part, the mechanism of CsA reducing acute rejection in a rat cardiac transplantation medel.