There have appeared many new insulin analogues in recently years. Two of them are rapid-acting insulin analogues(aspart,lispro).The regions between the insulin analog molecules were modified,which have shorter time than regular human insulin in onset of action,peak,duration of acting,and are better in decreasing postprandial glucose and opportunity of hypoglycemia before next meal.The another insulin analogues were galargine and detemir.They were obtained from changing insulin isoelectric point and increasing molecular weight,which lengthen time for disintegration,absorption and action and have little absorption variation and no overt peak.They can simulate physiological base insulin excretion.

Objective To explore the effect of angiotensin Ⅱ antagonist on left ventricular hypertrophy(LVH) and insulin resistance in elderly patients with diabetes mellitus and hypertension. Methods One hundred and twenty elderly patients with diabetes mellitus and essential hypertension with LVH by echocardiography entered the study. Patients were randomized into the telmisartan (80～160 mg/d) group or perindopril (4～8 mg /d) group. After treatment of telmisartan or perindopril,patients were followed-up for 8 months.Plasma sample was collected from each patient before and after treatment of telmisartan or perindopril,respectively.Then plasma levels of cholesterol,fasting plasma glucose(FPG), insulin and Homeostasis Model Assessment Insulin Resistance (HOMA-IR) were investigated.The echocardiography before and after 8 months of treatment with telmisartan or perindopril were also examined. Results Data were analyzed and showed that: (1)After 8 months of treatment with telmisartan or perindopril, blood pressure was reduced from 159/101 to 142/89 mm Hg(P

Objective To evaluate the clinical efficiency of humanized anti-CD52 monoclonal antibody (Campath-1H) and anti-CD25 monoclonal antibody (Zenapax) induction therapy in intestinal transplantation patients.Method The data of 6 patients receiving Campath-1H and 5 patients receving Zenapax induction therapy in intestinal transplantation between 2007 and 2012 were analyzed retrospectively.The counts of peripheral blood lymphocytes and monocytes,incidence of rejection and infention,and liver and kidney toxicity of recipients were recorded before and 3 months after transplantation.Results Of 6 intestinal transplantation patients receiving Campath-1H induction therapy,1 died of acute heart failure on the postoperative day 3,and the rest 5 patients had a powerful depletion of lymphocytes and monocytes in 8 weeks,followed by gradual increases after 8 weeks.The percentage of peripheral blood CD3 + T cells,CD4 + T cells,and CD8 + T cells was dropped to 5％ before administration,and remained at a steady low level in the first 8 weeks after induction.Of 5 patients receiving Zenapax induction therapy,1 died of Aspergillus infection on the postoperative day 25,and the rest 4 patients had an obeivous increase of lymphocytes and monocytes on the postoperative day 1.Counts of lymphocytes and monocytes kept steady at normal levels from the 1st to 12th week.One case of mild rejection was found in Campath-1H group.One case of mild,one moderate and one severe rejection were detected in Zenapax group.All rejections were successfully cured by prompt anti-rejection therapy.There were no significant difference in serum creatimine,urea nitrogen,alanine aminotransferase or total bilirubin after 3 months in comparison to preoperation.Conclusion Both Campath-1H induction therapy and Zenapax induction therapy successfully induce immune tolerance in patients with intestinal transplantation.Campath-1H seems to offer better immunosuppression against Zenapax during the first 3 months posttransplantation.

Objective To investigate the clinical efficacy of laparoscopic surgery for pelvic radiation induced enteritis (PRIE).Methods The retrospective cross-sectional study was conducted The clinical data of 66 patients with PRIE who were admitted to the Nanjing General Hospital of Nanjing Military Command from January 2012 to December 2015 were collected.Laparoscopic surgery will be applied to patients based on patients' clinical manifestations after completing relative examinations.Observation indicators:(1) surgical situations:surgical method,conversion to open surgery,reoperation,surgical incision length,grade of abdominal adhesions,surgical time,volume of intraoperative blood loss,duration of postoperative hospital stay;(2) occurrence of surgical complications;(3) follow-up situations.Follow-up using telephone interview was performed to detect patients' survival and recurrence of PRIE up to April 2016.Measurement data with normal distribution were represented as x±s.Results (1) Surgical situations:① of 59 patients with small intestinal obstruction,11underwent laparoscopic small intestinal resection or enterostomy,including 2 with conversion to open surgery due to dense adhesions,1 due to uncertainty of tumor recurrence and 1 due to intestinal canal dilatation affected vision;48 underwent laparoscopic resection of ileocecum,including 1 1 with conversion to open surgery due to dense adhesions,2 due to iliac vessels injury and 4 due to injuries of sigmoid colon,rectum and bladder.Four patients with colonic obstruction and proctitis underwent laparoscopic colostomy,without conversion to open surgery.One patient received conversional open surgery and underwent intestinal resection of internal fistula + exclusion of rectal stump due to intestine-rectum fistula induced dense adhesions.One patient with anal atresia underwent laparoscope-assisted resection of pelvic tissues and rectal stump.One patient with localized peritonitis underwent laparoscope-assisted ileostomy.② Among 66 patients,4 received reoperations,including 2 with cervical cancer and 2 with rectal cancer,reoperations of 4 patients were respectively caused by intestine-rectum fistula,rectovaginal fistula,anastomotic fistula and ostomy + stoma reversion.Of 4 patients with reoperations,1 received conversion to open surgery due to dense adhesions and then underwent intestinal resection of internal fistula+exclusion of rectal stump,1 with rectovaginal fistula underwent laparoscopic colostomy,1 with anastomotic fistula underwent resection and anastomosis of small intestine due to dense adhesions and 1 underwent laparoscopic ileostomy and stoma reversion.③ Sixty-six patients received 70 operations,including 46 laparoscopic surgeries and 24 conversion to open surgeries.Surgical incision length and average length were respectively 3.0-6.0 cm,4.0 cm in 46 laparoscopic surgeries and 8.0-25.0 cm,15.5 cm in 24 conversion to open surgeries.Grade 0,1,2 and 3 of abdominal adhesions were detected respectively in 7,13,13,13 laparoscopic surgeries and in 1,1,12,10 conversion to open surgeries.Operation time,volume of intraoperative blood loss and duration of postoperative hospital stay were respectively (128±50) minutes,(108±56) mL,(30± 15)days in 46 laparoscopic surgeries and (173±44) minutes,(222± 105) mL,(38± 19) days in 24 conversion to open surgeries.(2) Occurrence of surgical complications:1 patient was complicated with bladder injury in 46 laparoscopic surgeries,and 2,4 and 2 patients in 24 conversion to open surgeries were respectively complicated with bladder injury,colorectal injury and injury of right iliac vessels,they received intraoperative symptomatic treatment.Two,3,3,6 and 1 patients were respectively complicated with pleural effusion,wound infection or dehiscence,venous catheter infection,anastomotic fistula and cholestatic cholecystitis after 46 laparoscopic surgeries.One,5,1,4,2 and 1 were respectively complicated with pleural effusion,wound infection or dehiscence,venous catheter infection,anastomotic fistula,cholestatic cholecystitis and abdominal wall hemorrhage after 24 conversion to open surgeries.They were improved by symptomatic treatment.(3) Follow-up situations:all the 66 patients were followed up for 4-50 months,with a median time of 26 months.During the follow-up,3 patients died of intraperitoneal infection,short bowel syndrome and pulmonary infection,and 3 patients had PRIE.Conclusion The appropriate surgical method is selected based on clinical manifestations of patients,and laparoscopic surgery is safe and feasible for PRIE.

Objective: The aim of our work was to investigate the effects of n-3 polyunsaturated fatty acids on apoptosis, granzyme B and perforin expression of intestinal epithelial cells of chronic rejection after small intestinal transplantation. Methods: Small bowel transplantation was performed and rats were divided into three groups: Group 1, Lewis-to-Lewis, group 2, F344-to-Lewis, dietary corn oil, Group 3, F344-to-Lewis, dietary fish oil. All recipients were killed after 16 weeks of posttransplantation. The apoptosis rate of mucosal cells were evaluated by flow cytometry. The expressions of granzyme B and perforin were analyzed by reverse transcriptase RT-PCR. Results: A high apoptotic rate was observed when the allografts demonstrated one or more histological features of chronic rejection. N-3 polyunsaturated fatty acids decreased the rate of the apoptosis and inhibitted the expressions of granzyme B and perforin. Conclusion: N-3 polyunsaturated fatty acids can suppress the chronic rejection in small intestinal transplantation.

Objective To predict B cell epitopes in Sj22, Sj23, Sj14-3-3, Sj26 of Schistosoma japonicum with bioinformatics, and evaluate the antigenicity of these epitope proteins. Methods The complete DNA sequences of S.japonicum were predicted by BioSun system, the target B cell epitope genes were selected, cloned and expressed. The expressed fusion proteins were detected with the sera of schistosomiasis patients and health people for evaluation of their antigenicity. Results Eight B cell epitopes from four molecules of S.japonicum were predicted. The B cell epitopes of Sj22 probably located in 56-62 and 127-133 amino acids. The B cell epitopes of Sj23 probably located in 149-156 and 160-167 amino acids. The B cell epitopes of S14-3-3 probably located in 118-125 and 130-137 amino acids. The B cell epitopes of Sj26 probably located in 143-149 and 191-197 amino acids. The predicted epitope genes were cloned into pET-32c plasmid and expressed. Three of eight expressed fusion proteins of epitopes were reacted with the sera of schistosomiasis patients but not with health people. Conclusion Three epitope antigens with potential diagnosis value are determined.

Objective To evaluate the efficiency of monitoring parameters and methods of immunosuppresive treatment in intestinal transplantation and to provide scientific evidence for establishment of Intestinal Transplant Registry.Methods The data of 15 patients receiving intestinal transplantation between 1994 and 2009 were analyzed retrospectively for one year. The patients were fallen into 3 eras (1994-1995, 2003-2006, 2007-2009) according to different immunosuppresive strategies. The perioperative status and one-year survival rate were followed up. The monitoring frequency of implications of intestinal transplantation, such as rejection, infection, toxic and side-effects, was evaluated. The monitoring parameters were examined in the proportion of lymphocytes, concentration of tacrolimus, and function of the liver and kidney during a follow-up period of one year.Results During 1994-1995 and 2003-2006, the survival time of grafts was under one year. During 2007-2009, the 6-month and one-year survival rate in 5 patients (grafts) was 100% and 83.33% respectively; The increased frequency of rejection occurred during 7 to 12 months after operation; The closure of abdominal stoma was postponed from postoperative six months to one year; Asymptomatic mild rejection after operation was examined (10/13, 76.92%).Conclusion During one year postoperation, monitoring methods, parameters and frequency for immunosuppressive treatment in intestinal transplantation are rational, and may monitor the disease conditions of the patients.

Objective To explore the enrichment technique of Schistosoma japonicum cercariae on the water surface,so as to establish a new method combined with the existing technology to detect the cercarial infested water body quickly and sensitive-ly. Methods Soybean oil,gasoline,kerosene and isophorone were screened as expanding agents. The cercariae were enriched by the thrust of the expanding agents when diffusing on the water surface,and PE adsorption film and C-6 film were applied to seize them so as to determine the infectivity of the water quickly. The relationship between the dose of expanding agents and dif-fusion radius were explored. Results Gasoline,kerosene and isophorone were suitable expanding agents,and the diffusion ef-fect of isophorone was the best. After the enrichment by the expanding agents,the detection rate of cercariae of the method seiz-ing cercariae with the film significantly improved in the water. Conclusion This new method could effectively improve the de-tection rate of the cercarial infested water and is suitable for the low-degree infested water.

Objective To understand the potential impact of south-north water transfer project on transmission and distribution of Schistosomiasis japonica, and to put forward the countermea-sures of prevention of the disease transferring into other places. Methods The information on the progress of south-north water transfer project and factors related to the distribution of Schistosoma juponicum were collected, and the suggestions on improving the countermeasures were obtained through the group discussions and field visits. Results The potential impact of the project on the disease transferring is existed, mainly the disease transferring will be through the Lixia River basin in Jiangsu Province, and Chaohu areas of Anhui Province in the east route, and Sihu areas of Hubei Province in the middle route. The snail transferring northward will be affected both by the project and global warming, as a result, the endemic areas of Schistosomiasis will probably transfer into the Hongzehu and Chaohu areas in the future. Conclusion In the east route of the project, if the project is not combined with Schistosomiasis control, the endemic areas of Schistosomiasis will extend into other regions, the loss in the society and economy will be very large.

OBJECTIVE: To explore the genetic basis for a pedigree affected with Charcot-Marie-Tooth (CMT) disease through high-throughput sequencing. METHODS: Potential variants of the genes associated with CMT were screened by next-generation sequencing (NGS) of the members of the pedigree. RESULTS: NGS has revealed that the two affected sisters both harbored homozygous c.1A>G variant of the GDAP1 gene, which caused replacement of the first amino acid Methionine by Valine (p.Met1Val). Their parents were both carriers of the heterozygous c.1A>G variant. The variant was unreported previously and has an extremely low frequency in the population. Meanwhile, one of the sisters and the mother also carried heterozygous c.710A>T variant of the BAG3 gene. CONCLUSION The homozygous c.1A>G variant of the GDAP1 gene probably underlay the CMT in both children. Above result has enabled clinical diagnosis and genetic counseling for this pedigree.
Adaptor Proteins, Signal Transducing/genetics* ; Apoptosis Regulatory Proteins/genetics* ; Charcot-Marie-Tooth Disease/genetics* ; Child ; Female ; Fibula/abnormalities* ; Homozygote ; Humans ; Mutation ; Nerve Tissue Proteins/genetics* ; Pedigree