Objective To investigate insulin sensitivity and beta cell function in female systemic lupus erythematosus (SLE) patients with different glucose tolerances. Methods Insulin sensitivity and beta cell function were compared between SLE patients and non-SLE subjects in the states of normal glucose tolerance (NGT), impaired glucose tolerance (IGT)and diabetes mellitus (DM) respectively.Furthermore, risk factors for insulin sensitivity and beta cell function in SLE patients were analysed by linear regression. Results In NGT state, insulin sensitivity and beta cell function of newly diagnosed SLE patients without glucocorticoids treatment were not significantly different from those of normal control group ( P ＜0. 05). Compared with newly diagnosed SLE patients without glucocorticoids treatment and normal control group, HOMA insulin resistance index (HOMA-IR) , In (HOMA-β), In (early phase insulin secretion index, EISI ) and In ( late phase insulin secretion index, LISI ) of SLE patients with glucocorticoids treatment were significantly higher( 1.91 ± 1.04 vs 0. 81 ±0. 75,0. 94 ±0. 27;5.05 ±0. 65 vs 4. 01 ±0. 63,4. 23 ±0.47;3. 14±0.81 vs 2.42 ±0.39,2.50±0.65;2.30 ±0.55 vs 1.62 ±0.57,1.56 ±0.43;P ＜0.05),while In ( Matsuda index, MI ) was significantly lower ( 4. 53 ± 0. 54 vs 5. 27 ± 0. 68,5. 18 ± 0. 38; P ＜0. 05). In IGT and DM state, HOMA-IR (2. 84 ± 1. 87 vs 1.82 ± 1.22, 3. 18 ±2. 29 vs 2. 94 ±2. 26) and In (HOMA-β) (5. 18 ±0. 93 vs 4. 06 ±0. 58, 3. 99 ± 1.04 vs 3.43 ±0. 83) were significantly higher in SLE patients with glucocorticoids treatment than those of non-SLE subjects ( P ＜ 0. 05 ) respectively. BMI and In (daily glucocorticords doses) were independent risk factors for insulin sensitivity, and age, the SLE disease activity index(SLEDAI) and In(daily glucocorticords doses) were related factors beta cell function.Conclusion In NGT, IGT and DM state,SLE female patients with glucocorticoids treatment have reduced insulin sensitivity and increased beta cell function, these changes are related to the use of glucocorticoids.

Objective A previously reported female diagnosed with type A insulin resistance syndrome bearing a heterozygous missense mutation of R1174W in the insulin receptor gene was followed for 7 years since the age of 16 years. Methods Five-hour oral glucose tolerance tests (OGTT) were done on baseline, the 3rd, 6th and 7th year respectively, with serum insulin and C-peptide measured at the same time points. Areas under of curve (AUC) of glucose, insulin and C-peptide were compared between the years.Acute insulin response (AIR) was determined at baseline and the 7th year. The dose response were insulin secretion rates at each time point during OGTT being plotted over the corresponding glucose levels, and the slopes of which quantified the insulin secretion responding to glucose. Results The follow up data showed that the glucose metabolism of the subject did not deteriorate over time with yearly glycosylated hemoglobin A1c (HbAlc) being normal (4.6%-5.5%), and hyperinsulinemic hypoglycemia was a persistent phenomenon observed at 4-5 hours post-load. The fasting and AUCs of serum insulin and C-peptide tended to decline without simultaneously increase of those of plasma glucose. The AIR decreased by 56% as compared to baseline. The dose response curves shifted downward as years went by. Conclusions It supports that with the alleviation of physiological insulin resistance after puberty, the gross hyperinsulinemia tends to ameliorate, and β-cell secretion does not deteriorate over time as glucose homeostasis maintains.

Cardiac Complexes, Premature/*physiopathology ; Electrocardiography

Arthritis, Rheumatoid/*complications ; Heart Diseases/etiology ; Lung Diseases/etiology ; Vasculitis/etiology

Objective B-type natriuretic peptide(BNP) have been used widely in the diagnosis and prognosis of cardiogenic diseases, but the association between BNP concentrations and non-cardiogenic critical illness is unknown. Our study aims at investigating the role of natriuretic peptide testing for predicting 28-day mortality of non-cardiogenic critically ill patients in emergency department (ED). Methods A total of 255 non-cardiogenic critically ill patients treated in the emergency department were prospectively enrolled and a sample of blood was obtained for BNP measurement from each patient. A variety of clinical and laboratory variables were recorded. After 28 days, the vital status of each patient was ascertained and the association between BNP values at presentation and mortality was assessed. Results 71 patients died during the 28-day observation period. Median BNP concentrations at presentation among decedents were significantly higher than those of survivors (326. 0 ng/L versus 50. 9 ng/L,P <0. 001). The optimal BNP cut point for predicting 28-day mortality was 114. 0 ng/L. In a multivariate analysis (Cox-regression), a BNP concentration greater than 114. 0 ng/L(RR 7. 268, 95% CI 3. 864-13. 672) and an Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) scores greater than 20 (RR 3. 330, 95% CI 1. 815-6. 109)were the independent predictors of the 28-day mortality. BNP concentration alone had an area under the receiver operating characteristic curve (AUC) of 0. 825 for predicting mortality. Conclusions BNP concentrations at presentation are strong predictor of 28-day mortality in patients with non-cardiogenic critically ill patients in ED, which is better than Rapid Acute Physiology Score (RAPS) , Rapid Emergency Medicine Score (REMS) and APACHE Ⅱ score.

Objective To construct a short hairpin RNA (shRNA) adenovirus vector targeting P85 and protein kinase B1 (PKB1/Akt1) and study its effects on the growth of SGC-7901 human gastric adenocareinoma cells. Methods P85 and Aktl shRNA expression frames were subcloned to pGSadeno adenovirus vector with homologous recombination technology to construct pGSadeno-P85 + Akt1 (rAd5-P + A) vector. After screening and amplification, the recombinant adenovirus vector was digested with PacI and transfected into SGC-7901 cells and then its titer and transfection efficiency were detected with fluorescent microscope. P85 and Akt1 mRNA protein expression was identified with real-time PCR and Western blot. The proliferative activity of tumor cells was evaluated with MTr assay and flow cytometry in vitro, rAd5-HK and rAd5-P + A mediated by adenovirus were injected into the established subcutancous SGC-7901 gastric adenocarcinoma in nude mice. During the observation period of 21 days, tumor volume was measured every 3 days to further testify the anti-tumor effect of rAd5-P + A on the SGC-7901 gastric adenocarcinoma cells and cell in situ apoptosis was detected with TUNEL assay. Results The adenovirus vector rAd5-P + A was successfully constructed and it dramatically downregulated P85 and Akt1 mRNA expression in SGC-7901 gastric adenocarcinoma cells. Compared with a control group of SGC-7901 cells and cells transfected with general adenovirus rAd5-HK as control, P85 and Akt1 protein expression 48 h and 72 h after rAd5-P + A transfection was decreased by 57.5% and 63. 7%, 67. 8% and 75.6% with statistical significance(P = 0. 005, P = 0. 003). Cell proliferative activity in rAd5-P + A transfected cells was suppressed from the second day (P <0. 001) and the decreased P85 and Akt1 expression was accompanied by 5.9% -7. 1% decrease of S phase fraction and 12. 1% - 13.7% increase of G0/G1 phase. The tumor volume of rAd5-P + A treated group was smaller than that of the control and rAd.5-HK group with statistical significance (F = 9. 871, P = 0. 025) . Moreover, rAd5-P + A could induce cell in situ apoptosis. Conclusions Adenovirus-mediated targeting P85 and Akt1 shRNA can inhibit the growth of SGC-7901 human gastric adenocarcinoma cells and this may provide a new strategy of combination gene therapy in gastric adenocarcinoma.

Objective To study the distribution of IL-10 and TNF gene polymorphisms in patients with gastroduodenal diseases in Hubei Han ethnic and their association with Helicobacter pylori (Hp) infection. Methods Six hundred and five patients with gastroduedenal diseases (196 chronic gastritis, 189 gastroduodenal ulcer and 220 gastric cancer) as well as 624 healthy controls were genotyped with PCR-RFLP method for IL-10-1082,-819,-592 and TNFα-308, lymphotoxin-α (LTα) Nco Ⅰ and AspH Ⅰ gene polymorphisms. Hp infection status was determined with ELLS& Results (1) There was significant difference of IL-10-1082 AG + GG genotype among the gastric cancer group with the non-malignant gastric diseases groups and healthy control group (P <0. 05). There was no significant difference of IL-10-592 and -819 gene polymorphisms among gastric cancer patients,non-malignant gastric disease patients and healthy controls (P>0. 05). The genotype frequencies of IL-10-819 were the same as those of IL-10-592. (2) Frequency of IL-10-1082 AG + GG genotype in gastric cancer patients with positive Hp was significantly higher than that in the other three groups (P < 0. 05). (3) Frequency of LTα Nco I AG genotype in gastric cancer patients with Hp infection was signiilcandy higher than that in Hp positive healthy controls (P < 0. 05). There were no other associations between TNFα-308, LTα Nco Ⅰ and AspH Ⅰ gene polymorphisms and Hp infection in gastroduodenal diseases. Conclusions (1) Allele AG + GG of IL-10-1082 was associated with gastric cancer in Han nationality of Hubei province. (2) IL-10-1082 AG + GG,LTct Nco ⅠAG heterozygous genotype may be associated with Hp infection in patients with gastric cancer in Han nationality of Hubei province.

Objective To evaluate the efficacy and safety profile of methotrexate (MTX), leflunomide (LEF) and low-dose MTX and LEF (MTX + LEF) combined treatment for psoriatic arthritis (PsA). Methods This was a 24 weeks, two-center, open-labeled, controlled trial All subjects fulfilled the moll and wright criteria for definite PsA. Subjects were given one of the 3 regimens, MTX, or LEF, or MTX + LEF. The primary end point was proportion of psoriatic arthritis response criteria(PsARC)response. The secondary end point was proportion of modified 20% improvement of American College of Rheumatolngy (ACR20) response. Results At week 24, the percent of patients achieving PsARC in MTX, LEF and MTX + LEF group were 75.0% ,68. 8% ,83.3% respectively, and the percent of patients achieving ACR20 were 66. 7% ,50. 0% ,83. 3% respectively. At week 24, tender joint counts, swollen joint counts, patient's assessment of pain, patient's global assessment (PGA), physician' s global assessment, health assessment questionnaire(HAQ)were significantly improved compared with base-line values(P <0. 05). At week 24, the improvement of patient's assessment of pain, HAQ, ESR were better in the MTX + LEF group compared with LEF group while the improvement of patient's assessment of pain, PGA, HAQ, ESR were better in the MTX group compared with LEF group (P < 0. 05). The incidence of treatment related adverse events was 38.5%, 38. 9% and 35% in MTX, LEF and MTX + LEF group respectively. There was no serious adverse reactions. Conclusion Low dose MTX + LEF regimen showed similar good efficacy and safety profde for PsA patients.

Objective To investigate the characteristics of post-transplantation diabetes mellitus and analyze its risk factors. Methods Extensive survey was carried out to understand the characteristics of post-transplantation diabetes mellitus in patients who received kidney grafting from February 1984 to December 2006. Results Three hundred forty-four post-transplantatian diabetes mellitus patients from 1872 ones after kidney grafting were found from February 1984 to December 2006. The prevalence of new onset post-transplant diabetes mellitus and impaired fasting glucose in kidney allograft recipients were 18. 4% and 12. 7% respectively, being significantly higher than that in general population and other inpatients. The options of immunosuppressants were significantly associated with the prevalence of post-transplantation diabetes mellitus. By multivariate logistic regression analysis, the baseline characteristics of the post transplantation diabetes mellitus patients were significantly associated with increased age(OR: 1. 309, P = 0. 049), elevated level of the triglyceride (OR: 1. 311, P = 0. 005), treatment with taerolimus (FK506) (OR: 1. 522, P = 0. 008), and large dose of intravenous pulsed prednisolane(OR: 1. 239, P = 0. 011), as compared with patients without post-transplantation diabetes mellitus. Besides, the number of patients with at least one acute rejection episode was significantly greater in the post-transplantation diabetic patients. Mycophenolate mofetil (OR: 0. 716, P = 0. 028) and diltiazem (OR: 0. 737, P =0. 015) were associated with lower risk of post-transplantation diabetes mellitus. Conclusions High prevalence of abnormal glucose metabolism in renal allograft recipients during hospitalization was observed. Many risk factors contributed to the development of post transplantation diabetes mellitus.

Objective To examine the expression of angiotensin Ⅱ (Ang Ⅱ) receptor subtypes in human left and right atrial tissue in atrial fibrillation underlying rheumatic heart disease. Methods Atrial tissue samples were obtained from 39 patients with rheumatic heart disease, 25 with atrial fibrillation(AF) and 14 with sinus rhythm(SR) during open heart surgery. AT1 and AT2 mRNA levels were measured with semi-quantitative reverse transcription polymerase chain reaction techniques. AT1 and AT2 protein levels were measured with immunohistochemical techniques. Results Compared with that of the SR group, left atrial inner diameter was significantly increased in the patients of the AF group. The AT1 mRNA and protein levels in the LA significantly increased in patients with AF compared with those in patients with SR (P < 0. 05), whereas AT2 mRNA and protein were not significantly altered. Investigations of Ang Ⅱ receptor subtypes' mRNA and protein levels in the RA did not exhibit any significant changes either in AT1 or AT2 in patients with AF and SR. Conclusions AF is associated with an up-regulation of AT1 in LA, but does not appear to influence the AT2 expression. This may indicate a possible pathophysiologie role for renin-angiotensin system in the development of AF. The series of effects mediated by ATI activation may be one of the molecular mechanisms involved in the process of atrial remodeling.