[Summary] As of 2014, an estimated 387 million people have diabetes mellitus ( DM) worldwide, which represents 8.3%of the adult population.China Noncommunicable Disease Surveillance in 2010 shows that the overall prevalence of DM is estimated to be 11.6%(approximately 113.9 million) in the Chinese adult population, with the prevalence among men of 12.1%and women of 11.0%, respectively.Control of blood glucose is fundamental to DM management.Despite the availability of several antihyperglycemic agents, only 53%of patients with DM achieve the recommended goals for DM care of HbA1C<7.0%.According to the National Health and Nutrition Examination Survey and the Behavioral Risk Factor Surveillance System Survey during the period of 10 years in the United States, 33.4%to 48.7%of persons with DM still have not met the targets for glycemic control, blood pressure or lipid level.In order to improve glycemic control, there is a need for new therapeutic options with innovative mechanisms of action and acceptable safety profiles.As a newly developed class of oral antidiabetic drugs, sodium-glucose co-transporter 2 inhibitors(SGLT2i) have recently been approved for the treatment of patients with type 2 diabetes mellitus, including canagliflozin, dapagliflozin, and empagliflozin.Evidence from clinical trials has suggested promising efficacy and safety of SGLT2i when used as monotherapy or in combination with other antihyperglycemic medications.SGLT2i significantly reduce HbA1C and fasting plasma glucose, and are well tolerated in general with a low intrinsic propensity to cause hypoglycemia, as well as rare severe renal or cardiovascular adverse events reported.

The glycemic variability is one component of unified glucose tetrad concept.The long-term glycemic fluctuation may enhance the oxidative stress reaction,which can promote the development of micro vascular complications.The relationship between the glycemic variability and the CVD deserves further investigation.CGMS is helpful to monitor the glucose fluctuation especially in those with fragile diabetes and no symptom hypoglycemia.The suitable regime is the key point to control glycemic variability,even after the desired HbA1c target is attained. Abstract:Summ ary:The glycem ic variab ility is one component of un ified glucose tetrad concept.The long-term glycem ic fluctuation m ay enhance the oxidative stress reaction,wh ich can promote the developm ent ofm icro vascu lar comp lications.The rela-tionsh ip between the glycem ic variab ility and the CVD deserves further investigation.CGMS is helpfu l to mon itor the glu-cose fluctuation espec ially in those w ith fragile d iabetes and no symptom hypoglycem ia.The su itab le regim e is the key point to control glycem ic variab ility,even after the desired HbA1c target is attained.

Objective To investigate the changes of blood glucose and insulin after intake of staple food containing potato,sorghum or wheat in healthy adults. Methods This study had a cross-over design. A total of 12 healthy adults were recruited and randomly averaged into 3 groups. After fasting for 10 hours,all the subjects were treated with steamed buns of potato,sorghum and wheat flours(100 g in raw flour),respectively. Serum glucose,insulin,triglyceride(TG),total cholesterol(TC)and uric acid(SUA) were measured at fasting,0.5 h,1 h,2 h and 3 h. After a wash period for 3 days,subjects crossed over to alternate group at second intervention and third intervention on the 5 th and 9 th day. During each intervention,the entire above index were tested. Results Postprandial insulin levels at 3 h was significantly higher in the potato steamed buns group(4.74 μU/ml)than in the sorghum steamed buns (1.65 μU/ml)group(P =0.028). There were no statistical differences in blood glucose and fasting,0.5 h,1 h,2 h insulin level. Conclusion Postprandial insulin level at 3 h was higher in potato flour steamed buns than in sorghum flour steamed buns.

Objective To establish a model of isoniazid induced necrosis and apoptosis in HepG2 cell and to observe the expressions of Fas/Fas ligand (FasL) in this model.Methods HepG2 cells were treated with different dosages of isoniazid (0,1,2,4,6 and 8 mg/mL) or blank control for 24 hours.Flow cytometer was used to observe the cellular morphology of the HepG2 cell.Annexin V/propidium iodide double staining and flow cytometry were employed to detect the necrosis and apoptosis of HepG2 cells.The expressions of Fas/FasL on the cells were also determined by flow cytometry.The data were analyzed by one-way ANOVA.The comparisons between the drug groups and the control group were performed by using Dunnett t test. Results The higher the dose of isoniazid (4,6,8 mg/mL) was,the more necrosis and apoptosis were observed.In the 4,6 and 8mg/mL isoniazid arms,the total mortality rates were all higher than the control group [(32.1 ±7.5)％,(34.9±8.1)％,(38.2±9.4)％ vs (7.2±1.5)％ respectively](t=4.62,5.14 and 5.75,respectively; all P＜0.01 ).The expression levels of Fas increased along with the dose of isoniazid increasing [(8.7±2.2)％,(11.5±2.8)％,(12.3±3.0)％ and (10.6±2.9)％ in isoniazid 2,4,6and 8 mg/mL arms,respectively],which were all higher than that in control arm [(3.1 ±0.8) ％](t=2.97,P＜0.05; t=4.46,P＜0.01; t=4.88,P＜0.01; t=3.98,P＜0.05).Furthermore,the expressions of FasL increased as well when the dose of isoniazid increased.The expression levels of FasL were (16.2±3.5)％,(21.7±4.8)％ and (18.7±4.9)％,respectively in isoniazid 4,6 and 8 mg/mL arms,which were all higher than that in the control group [(7.4±1.4)％](t=3.11,P＜0.01; t=5.06,P＜0.01; t=3.99,P＜0.05).HepG2 cell necrosis increased with isoniazid of 8 mg/mL.However,the increase of apoptosis was not observed.Conclusion Isoniazid can induce HepG2 cell necrosis and apoptosis,and the apoptosis may be related with the increased expressions of the Fas/FasL on the cells.

Nationally and internationally,there is an growing emphasis on formative assessment for medical education.Teachers are enabled to apply the reflective teaching methods in their classes through careful theoretical trainings and practical guidance.By the application,shortcomings of students are found effectively,so that teachers can adjust their teaching plans and reach a higher teaching quality.

Objective To investigate the influence of combined kinetotherapy with non-drug sleep on delirium in patients with mechanical ventilation. Methods 107 cases with acute exacerbation of chronic obstructive pulmonary diseases (COPD) respiratory failure and mechanical ventilation were randomly divided into the treatment group of 54 cases, and the control group of 53 cases. Two groups of patients were given conventional treatment, the treatment group while giving to kinetotherapy and non-drug sleep:an eye mask earplugs at night. Observe the difference of the incidence of delirium, duration of delirium, number of days of mechanical ventilation, case fatality rate. Results The incidence of delirium in the treatment group was 59.3%(32/54), while that was 77.4%(41/53) in the control group, the difference was significant, χ2=4.042,P=0.044. The duration of delirium in treatment group was (1.75 ± 1.05) d, while that was (2.56 ± 1.25) d in the control group, the difference was significant, t=-2.955, P=0.004. The number of days of mechanical ventilation in treatment group was (6.41 ± 2.84) d, while in the control group was (8.68 ± 3.85) d, the difference between the two groups was significant, t=-3.478,P=0.001. The case fatality rate in treatment group was 5.6%(3/54), while in the control group was,11.3%(6/53) , the difference between the two groups was no significant, P=0.283. Conclusions Kinetotherapy cooperate with non-drug sleep can reduce the incidence of delirium, duration of delirium and number of days of mechanical ventilation in patients with mechanical ventilation. This method are simple and it is worth spreading.

Objective To study the change of serum ?-glucuronidase(?-G) activity before and after different therapy for hepatic carcinoma patients.Methods We detected the ?-G activity in sera from 52 patients and normal controls using the ELISA technique.Results The serum ?-G activity titer(17 2?2 4) in hepatic carcinoma patients was significantly higher than control group(6 5?1 3),(P0 05);there was significantly difference before(17 4?2 3) and after(10 6?1 8) embolism interventional treatment(P

Objective To investigate the effects of traditional transmyocardial laser revascularization (T-TMLR) and non-transmural myocardial laser revascularization (N-TMLR) on myocardial ischemic and necrotic areas and angiogenesis. Methods In rabbit models, using Evans′ blue -TTC stain and HE stain technique for measuring ischemic and necrotic areas and observing angiogenesis. Results After T-TMLR and N-TMLR,compared with the control group, the ischemic areas significantly decreased and significant elevation of angiogenesis was observed. But no difference in necrotic areas was observed among the three groups. Conclusion N-TMLR can achieve the same effects with T-TMLR. Inducing angiogenesis via laser channels and decreasing ischemic area may be one of the predominant mechanisms of TMLR whereas laser channels themselves open or not has no relation to the effects of TMLR.

Objective To observe the effects of aerobic training on plasma tissue plasminogen activator/plasminogen activator inhibitor-1 and postaglandin I2/thromboxanes A2 in rats fed a high methionine diet. Methods Ninetysix male Wistar rats were randomly divided into a normal diet control group (CR), a high methionine diet group (MR)and a high methionine diet plus 90 min aerobic training intervention group (T + MR). After 8 weeks of training, the plasma level of homocysteine (Hcy) 6-keto-PGF1α, TXB2, t-PA and PAI-1 were measured. Results Plasma Hcy in the MR group increased two-fold as compared with the CR group, whereas t-PA/PAI-1 and 6-keto-PGF1α/TXB2 of the MR group decreased significantly. Plasma Hcy in the T + MR group significantly decreased, while plasma t-PA/PAI-1 and 6-ketoPGF1α/TXB2 increased significantly compared with the MR group. The above parameters were not different in the T + MR group from those of the CR group. Conclusions Hyperhomocysteinemia could be induced by a high methionine diet.Proper training can decrease the plasma Hcy level of rats fed with a high methionine diet, and correcting the imbalance of t-PA/PAI-1 and 6-Keto-PGF1α/TXB2 could prevent the development of hyperhomocysteinemia.

Objective To observe the effects of aerobic exercise on the plasma content of homocysteine (Hcy),total nitric oxide synthase(T-NOS) and nitric oxide (NO) in rats fed a high methionine diet. Methods A total of 24 male Wistar rats were randomly divided into a normal diet(CR)group,a high methionine diet(MR) group and a high methionine diet plus swimming group(T+MR),and treated accordingly for 8 weeks.At the end of the treatment,all the animals were tested for plasma T-NOS,NO and homocysteine levels.Results Plasma homo-cysteine doubled,whereas T-NOS and NO levels in the MR group decreased significantly as compared with the CR group,suggesting that hyperhomocysteinemia was induced by the high methionine diet.Plasma homocysteine content decreased significantly in the T+CR group,but plasma T-NOS and NO increased significantly compared with the MR group.These indicators were not significantly different for the T+MR group from those of the CR group. Conclu-sion Adequate aerobic exercise can decrease the plasma level of homocysteine in rats fed a high methionine diet,and increase the plasma level of T-NOS and NO,helping prevent the development of hyperhomocysteinemia.