Objective To study the effects of berberine (BBR) on the gene mRNA expression of fat-specific protein 27 (FSP27) and PR domain containing 16 (PRDM16) signal pathway in visceral white adipose tissues (VWAT) from type 2 dia? betic (T2DM) Chinese hamsters, and explore the related mechanisms. Methods The obese insulin-resistant (OIR) hamster model was induced by high-fat diet, and T2DM hamster model was created by OIR hamster model injected with low-dose streptozotocin. The control group was fed with standard laboratory chow. After the induction, the hamsters were randomly di?vided into control, OIR, obese T2DM and BBR-treated T2DM groups. After nine-week BBR treatment, real-time quantita?tive PCR was used to measure the gene mRNA expression changes of VWAT FSP27 and PRDM16 signal pathway and their target genes from different groups. Results Compared with control group, the gene mRNA expressions of PRDM16, CtBP-1, CtBP-2, C/EBPβ, PPARγ, PGC1α, PGC-1β and brown adipose tissue-specific genes such as UCP-1, Cidea, Elovl3, PPARα, and Acox, Cpt1 and Acadm were decreased and that of FSP27 and white adipose tissue-specific genes including Resistin, MEST and Serpina3k were increased in VWAT in OIR and obese T2DM groups. BBR treatment down-regulated FSP27 expression, enhanced PRDM16 signal pathway, and induced the gene mRNA expression of brown adipose tissue-spe?cific genes in VWAT of obese T2DM group to develop browning gene phenotype of VWAT, and then improved fat-induced insulin resistance. Conclusion The decreased FSP27 expression and increased PRDM16 expression are involved in the molecular mechanisms of browning of visceral white adipose tissues induced by BBR, and which contributes to improve ab?normal lipids metabolism and fat-induced insulin resistance in VWAT by enhancing consumption of energy as heat to re?store VWAT function.

Sixty-two patients with type 2 diabetes were treated with acarbose combined intensive insulin therapy( combined intensive group)or intensive insulin therapy alone (simple intensive group).As the blood glucose control reached the target,the mean amplitude of glycaemic excursion (MAGE),the absolute difference between the mean of daily differences ( MODD ),and standard deviation of blood glucose (SDBG) in combined intensive group were lower than those in simple intensive group [ ( 3.76 ± 1.47 vs 6.52 ± 1.57 ) mmol/L,( 0.57 ±0.49 vs 1.10 ±0.69 )mmol/L,( 1.44±0.60 vs 2.42±0.92 ) mmol/L,all P＜0.01 ].Daily mean blood glucose (MBG) of the former group was better than that of the latter group [ (7.08±0.69 vs 8.27 ± 1.31 ) mmol/L,P＜0.01 ].By the end of treatment,HbA1c [ 6.77％ ± 0.57％ vs 7.21％ ±0.83％,P＜0.05 ],incidence of hypoglycemia( 29％ vs 48％,P＜0.01 ),and body mass index[ (24.14±2.7 vs 27.63±3.41 ) kg/m2,P＜0.01 ] in combined intensive group were statistically improved more than those in the simple intensive group.

Objective:To observe the changes of skeletal muscle indexes in elderly patients with type 2 diabetes complicated with sarcopenia treated with sitagliptin and acarbose.Methods:A total of 60 patients over 60 years old with type 2 diabetes complicated with sarcopenia in Dalian Municipal Central Hospital from January 2019 to January 2020 were selected and divided into two groups by random number table method.One group received sitagliptin and metformin,and the other group received acarbose and metformin. The changes of skeletal muscle indexes, glucagon-like peptides-1 (GLP-1), insulin resistance index (HOMA-IR) and inflammatory indexes were compared between the two groups at baseline and 36 weeks after treatment.Results:After treatment, the skeletal muscle index (SMI) of sitagliptin group was increased (5.94 ± 1.52 vs. 5.99 ± 1.52), and the difference was statistically significant ( P<0.05). Muscle strength and SMI decreased in acarbosse group (18.75 ± 4.64 vs. 17.72 ± 4.44, 6.09 ± 1.74 vs. 6.00 ± 1.71), with statistical significance ( P<0.05). GLP-1 increased in sitagliptin group, 0 min: (10.65 ± 1.68) pmol/L vs. (12.41 ± 1.88) pmol/L; 60 min: (22.79 ± 2.85) pmol/L vs. (25.51 ± 2.79) pmol/L; 120 min: (24.26 ± 2.94) pmol/L vs. (29.49 ± 2.91) pmol/L; 180 min: (11.68 ± 1.84) pmol/L vs. (12.88 ± 1.83) pmol/L. There were significant differences ( P<0.05). HOMA-IR and CRP decreased: 4.73 ± 3.04 vs. 3.16 ± 2.41, (2.39 ± 0.50) mg/L vs. (2.33 ± 0.43) mg/L, and the differences were statistically significant ( P<0.05). HOMA-IR in acarbose group decreased after treatment (5.80 ± 3.94 vs. 4.00 ± 1.63), and the difference was statistically significant ( P<0.05). Comparison between the two groups after treatment, the decreased value of muscle strength in sitagliptin group was less than that in acarbose group, and the difference was statistically significant ( P<0.05). GLP-1 and overall GLP-1 area under the curve in sitagliptin group were higher than those in acarbose group (67.64 ± 6.81 vs. 58.98 ± 6.72), with statistical significance ( P<0.05). HOMA-IR and CRP in sitagliptin group were lower than those in acarborose group: 3.16 ± 2.42 vs. 4.00 ± 1.63, (2.33 ± 0.43) mg/L vs. (2.41 ± 0.70) mg/L, with statistical significances ( P<0.05). Conclusions:Sitagliptin therapy improves muscle mass and protects muscle strength in elderly patients with type 2 diabetes mellitus and sarcopenia.

Objective: To compare the efficacy of unrelated cord blood transplantation (UCBT) and HLA-identical sibling peripheral blood stem cell transplantation (PBSCT) for the treatment of adult hematological malignancies. Methods: From April 2011 to December 2015, a total of 81 patients receiving single-unit UCBT and 57 patients receiving HLA-identical sibling PBSCT were enrolled in this study. All of the patients received myelablative conditioning. Cyclosporine combined with mycophenolate mofetil was adopted for GVHD prophylaxis. Results: The cumulative incidence of neutropil engraftment at day-42 was 95.0% and 100% in UCBT and sibling PBSCT groups, respectively (P=0.863) . Platelet engraftment at day 100 was 87.3% (95%CI 76.8%-93.1%) in UCBT group, which was significantly lower than that of sibling PBSCT group[98.2% (95%CI 87.3%-99.7%) ] (P=0.005) . There were no significant differences in terms of Ⅱ-Ⅳ acute GVHD or Ⅲ-Ⅳ acute GVHD in two groups (P=0.142, 0.521) . The 3-year chronic GVHD and extensive chronic GVHD were 14.9% (95%CI 5.2%-23.5%) and 11.2% (95%CI 2.9%-18.7%) , respectively in UCBT group, which was significantly lower than that of sibling PBSCT group[35.2% (95%CI 19.4%-47.8%) , 31.4% (95%CI 16.2%-43.9%) ] (P=0.008, 0.009) . The 3-year transplant-related mortality (TRM) was similar between two groups (30.1% vs 23.2%, P=0.464) . The relapse rate at 3-year in UCBT group[12.9% (95%CI 6.6%-21.5%) ]was significantly lower than that in sibling PBSCT group[24.3% (95%CI 13.5%-36.8%) ] (P=0.039) . There were no significant differences in terms of overall survival (OS) and disease-free survival (DFS) between two groups (58.6% vs 54.8%, P=0.634; 57.0% vs 52.4%, P=0.563) . But GVHD-free and relapse-free survival (GRFS) in UCBT group [55.7% (95%CI 44.1%-65.8%) ]was significantly higher than that of sibling PBSCT group[42.9% (95%CI 29.8%-55.3%) ] (P=0.047) . Conclusions For adult hematological malignancies, the incidences of acute GVHD and TRM were similar between UCBT and sibling PBSCT recipients, and the incidences of chronic GVHD and relapse were lower in UCBT recipients. UCBT recipients had higher GRFS rate although OS and DFS were similar between two groups, which may reflect the real recovery and better quality of life following UCBT.

Objective: To compare the clinical efficacy of umbilical cord blood transplantation (UCBT) and hematopoietic stem cell transplantation from HLA-matched sibling donors (MSD-HSCT) in the treatment of myelodysplastic syndrome-EB (MDS-EB) or acute myeloid leukemia with myelodysplasia-related changes (AML-MRC) . Methods: A cohort of 64 patients (including 38 cases of MDS-EB and 26 cases of AML-MRC) who received UCBT/MSD-HSCT from February 2011 to December 2017 were retrospectively analyzed. Results: ①Compared with MSD-HSCT group, UCBT group had a higher proportion of AML-MRC patients [52.8% (19/36) vs 25.0% (7/28) , P=0.025], and a lower median age [13 (1.5-52) years vs 32 (10-57) years, P=0.001]. ②The engraftment of neutrophils both in UCBT and MSD-HSCT groups on +42 d was 100%, and the median engraftment time was 17.5 (11-31) d and 11.5 (10-20) d, respectively. The engraftment of platelet at +100 d in UCBT group was 91.4%, the median engraftment time was 40 (15-96) d; The engraftment of platelet at +100 d in MSD-HSCT group was 100%, and the median engraftment time was 15 (11-43) d. ③There were no statistically significant differences in terms of the cumulative incidence of Ⅱ-Ⅳ and Ⅲ/Ⅳ aGVHD of 100 d and transplant related mortality (TRM) of 180 d, relapse rate, overall survival (OS) , disease-free survival (DFS) between UCBT and MSD-HSCT groups (P>0.05) . ④The 3-year cumulative incidence of chronic GVHD (cGVHD) and severe chronic GVHD in UCBT group were lower than of MSD-HSCT group [28.3% (95%CI 13.4%-45.3%) vs 67.9% (95%CI 46.1%-82.4%) , P=0.002; 10.3% (95%CI 2.5%-24.8%) vs 50.0% (95%CI 30.0%-67.1%) , respectively, P<0.001]. The cumulative 3-year incidence of GVHD-free and relapse-free survival (GRFS) of UCBT group was significantly higher than of MSD-HSCT group [55.0% (95%CI 36.0%-70.6%) vs 28.6% (95%CI 13.5%-45.6%) , P=0.038]. Conclusion UCBT could obtain better quality of life after transplantation than MSD-HSCT in treatment of MDS-EB/AML-MRC.

Objective: To explore the clinical efficacy and safety of unrelated umbilical cord blood transplantation (UCBT) in the treatment of refractory and relapsed acute leukemia (AL) patients. Methods: The clinical data of 22 refractory and relapsed AL patients who were treated with UCBT as salvage therapy from November 2009 to May 2017 were retrospectively analyzed. All patients received a myeloablative conditioning regimen for prevention of graft-versus-host disease (GVHD) with cyclosporine A (CSA)/short course of mycophenolate mofetil (MMF). Results: ①Of 22 patients, 9 cases were male and 13 female. The median age was 23 (15-44) years and median weight of 52.5 (43-82) kg. All patients were transplanted with a median umbilical cord blood nucleated cells of 3.07 (1.71-5.30)×10⁷/kg (by weight), the median CD34⁺ cells was 1.60 (0.63-3.04)×10⁵/kg (by weight). ②The myeloid cumulative implantation rate was 95.5% (95%CI 45.2-99.7%) after transplantation of 42 d, with the median implantation time of 19 (13-27) d. The platelet cumulative implantation rate after transplantation of 120 d was 81.8% (95%CI 54.2-93.6%), the median implantation time of 42 (20-164) d. ③The incidence of Ⅱ-Ⅳ, Ⅲ-Ⅳ aGVHD and the 2 year cumulative incidence of cGVHD were 36.4%, 13.6% and 40.3% respectively. ④ The transplant related mortality (TRM) after transplantation of 180d was 22.7%, 2 year cumulative rate of relapse was 18.7% (95%CI 3.6-42.5%), 2 year disease-free survival rate (DFS) and overall survival rate (OS) were 53.7% and 58.1%, respectively. Conclusion The preliminary results show that the use of UCBT is safe and effective for refractory and relapsed AL patients who fail to respond to conventional chemotherapy.

Objective To study the curative efficacy and safety of single-unit umbilical cord blood transplantation (sUCBT) for malignant hematologic diseases,which is provided by China's public cord blood bank.Methods We retrospectively analyzed 409 cases of malignant hematologic diseases who accepted myeloablative single-unit unrelated donor UCBT without ATG at our center between May 2008 and December 2016.A comparative analysis was made on the total nuclear cells (TNC) of the umbilical cord blood before freezing and after thawing,the cells of CD34+,the recovery rate of cells and the clinical effect of UCBT.Result 409 units of umbilical cord blood used in UCBT respectively came from eight China's public cord blood banks.The average TNC of 409 units of umbilical cord blood before freezing and after the tubular recovery were respectively 18.5 × 108 and 16.34 × 108 (p =0.000).The average recovery rate of the tubular recovery was 88.5％,and there was significant difference among cord blood banks (P =0.000).The average TNC of umbilical cord blood before freezing and transfusion were respectively 18.5 × 108 and 15.86 × 108 (p =0.000).The average recovery rate of umbilical cord blood transfusion was 85.9％,with the difference being significant among cord blood banks (P =0.000).The average number of CD34+ cells before freezing and after the tubular recovery was 11.18 × 106and 8.68 × 106 (p =0.000).The average recovery rate of CD34+ cells after the tubular recovery was 80.75 ％,with the difference being significant among the cord blood banks (P =0.000).At 42nd day after UCBT,the cumulative incidence of neutrophil engraftment was 95.4％,and the median time of the engraftment was 17 days (11-38 days).The cumulative incidence of platelet engraftment at 120th day was 84.6％,and the median time of the engraftment was 36 days (14-93 days).The cumulative incidence of erythrocyte engraftment at 60th day was 92％,and the median time of engraftment was 22 days (9d-60 days).After the umbilical cord blood provided by each bank was used in UCBT,it got the difference in cumulative incidence of engraftment.The P values for cumulative incidence of neutrophil,platelet and erythrocyte engraftment were respectively 0.004,0.01 and 0.000 2,with the differences being statistically significant.At 100th day after UCBT,the cumulative incidence of Ⅱ-Ⅳ and Ⅲ-Ⅳ degrees of acute graft-versus-host disease (aGVHD) was respectively 28.63％ and 15.7％.After umbilical cord blood provided by each bank was used in UCBT,it got the difference in cumulative incidence of aGVHD.There was no significant difference between Ⅱ-Ⅳ and Ⅲ-Ⅳ degrees (P =0.809 and 0.68 respectively).At 3rd year after UCBT,the cumulative incidence of relapse was 15.89％.After umbilical cord blood provided by each bank was used in UCBT,there was no significant difference in the cumulative incidence of relapse (P =0.898).At 3rd year after UCBT,the overall survival (OS) rate and disease free survival (DFS) rate were respectively 66.7％ and 59％.After umbilical cord blood provided by each bank was used in UCBT,it got the difference in OS and DFS.There was no significant difference in OS and DFS (P =0.566 and 0.703 respectively).At 3rd year after sUCBT,the rate of graft-versus-host diseases/relapse-free survival (GRFS) was 54.3％.After umbilical cord blood provided by each bank was used in UCBT,there was no significant difference in the rate of GRFS (P =0.449).Conclusion The umbilical cord blood provided by China's public cord blood bank was used in UCBT.It has a high safety and good efficacy in treating malignant hematologic diseases.But it needs to set up the standardized and normalized quality-control system of umbilical cord blood for China's public cord blood bank.

Objective To observe the clinical effects of arthroscopic reconstruction for anterior cruciate ligament ( ACL ) tear using tension-relieving technique and enhanced recovery after surgery ( ERAS ) . Methods Between May 2014 and June 2016, 80 patients with ACL tear were randomly di-vided into 2 equal groups. The experimental group was treated with arthroscopic reconstruction using hamstring tendon autograft and tension-relieving technique followed by ERAS; the control group was treated with arthroscopic reconstruction using hamstring tendon autograft only followed by conventional postoperative re-covery. The 2 groups were compared in terms of knee flexion angles at postoperative 2nd, 4th and 8th weeks, and the IKDC ( International Knee Documentation Committee ) , HSS ( Hospital for Special Surgery ) , and Lysholm scores at postoperative 3rd, 6th and 12th months. Results The 80 patients obtained an average follow-up of 12. 3 ± 1. 7 months. Arthroscopy one year postoperation revealed fine ACL growth without laxity or other complications in the experimental group. Joint stiffness appeared in one case at 2 months postoperation and ACL laxity was observed in 3 cases by arthroscopy at 12 months postoperation in the control group. The knee flexion angles at postoperative 2nd, 4th and 8th weeks, and the IKDC, HSS and Lysholm scores at postoperative 3rd, 6th and 12th months in the experimental group were significantly better than those in the control group ( P <0. 05 ) . In both groups, the IKDC, HSS and Lysholm scores at postoperative 3rd, 6th and 12th months and the knee flexion angles at postoperative 2nd, 4th and 8th weeks were all significantly im-proved than the preoperative values ( P <0. 05 ) . Conclusion In arthroscopic reconstruction for ACL tear, tension-relieving technique combined with ERAS can promote functional recovery of the knee and reduce postoperative complications, facilitating early recovery of sports function.

Objective:To study the correlation between serum uric acid (SUA) and vascular calcification in middle-aged and elderly men.Methods:Using the Yiduyun electronic medical record retrieval system, a cross-sectional study was conducted on the clinical data of 2 786 male patients aged ≥40 years who underwent lung CT examinations in Dalian Central Hospital, Dalian University of Technology from January 2010 to October 2022. According to the degree of pulmonary CT vascular calcification, they were divided into vascular calcification group (1 296 cases)and non vascular calcification group (1 490 cases). The clinical data were collected and the correlation between SUA and vascular calcification were analyzed.Results:The levels os SUA in the vascular calcification group was higher than that in the non vascular calcification group: 311.50(270.25, 359.00) μmol/L vs. 284.00(251.00, 318.00) μmol/L, there was statistical difference ( F = 14.16, P<0.01). The constituent ratio of hyperuricemia in vascular calcification group was higher than that in non vascular calcification group : 25.62%(332/1 296) vs. 11.68%(174/1 490), there was statistical difference ( χ2 = 20.15, P<0.01). Spearman correlation analysis found a positive correlation between SUA level and vascular calcification in middle-aged and elderly men ( r = 0.489, P<0.01). Binary Logistic regression analysis results showed that SUA, body mass index (BMI), diastolic blood pressure(DBP), fasting plasma glucose(FPG) were positively correlated with vascular calcification ( P<0.01); after adjusting the influence of BMI, DBP and FPG on male vascular calcification, SUA was still a risk factor for vascular calcification. Conclusions:In the middle-aged and elderly male population, with the increase of blood uric acid, vascular calcification increase, and the elevated blood uric acid level is an independent risk factor for vascular calcification.

Objective To analyze the incidence and risk factors of postoperative pulmonary complications(PPCs)in elderly patients undergoing video-assisted thoracoscopic surgery(VATS).Methods Elderly patients aged≥65 years who underwent VATS in Peking Union Medical College Hospital from January 2013 to December 2017,were reviewed retrospectively and divided into non-PPCs group and PPCs group.General information,past medi-cal history,and postoperative complications were recorded in a uniform case report form.The clinical factors with statistical significance in univariate analysis and important clinical significance according to experience were ana-lyzed with Logistic regression to evaluate the independent risk factors for PPCs.Results A total of 900 patients were included,and 48(5.3%)of them suffered PPCs.Multivariate logistic regression showed that pre-operative smoking history,history of stroke,chronic obstructive pulmonary disease(COPD)and pulmonary lobectomy were independent risk factors for PPCs in elderly patients after VATS.Conclusions Elderly patient is a high-risk group for PPCs after VATS.The risk factors include smoking history,stroke,COPD and scope of surgery.Therefore,perioperative management needs to optimize,and monitoring should be strengthened for these high-risk patients.