Objective To retrospectively study the variation of glucose in patients with insulinomas. Methods The medical records of patients who underwent operations in the last 20 years at Peking Union Medical College Hospital were reviewed retrospectively. Patients who received repeated operations, or just exploratory laparotomy or liver biopsy were excluded. The clinical data were collected and analyzed. Results There were 245 patients, including 103 males and 142 females. The mean age was (42.2+ 14.6) years old. The mean value of preoperative fasting glucose was (1.47+0. 57) mmol/L, and the ratio of insulin to glucose was greater than 0.3 in 87.4% patients. The glucose level rose gradually after removal of the tumor(s). The blood sugar rising more than 1 time over the baseline value at one hour after resection was observed in 79.6% patients. For all the other patients, the glucose level rose to this level in the morning of the first postoperative Day 1. Rebound hyperglycemia was common after operations, and the glucose gradually returned to normal, with a mean level of 5.56 mmol/L at the time when the patients were discharged home. Conclusions Patients with insulinomas had a serum fluctuation in glucose (low→high→normal) during the perioperative period.Intraoperative glucose test combined with ultrasound and frozen section helped to localize and to remove all the lesions. Rebound hyperglycemia after surgery should be treated with insulin pump actively to minimize the incidence of complications.

Objective To provide information support for military medical service drilling with actual arms in field medical clinic. Methods The local netwok was built based on Intranet mode for military medical service. A distributed wartime military medical service information system was developed. The long-range consultation was carried through a consultation vehicle. The field medical clinic information system was integrated with No.1 Military Medical Project. Results The system has been used in drilling with actual arms of field medical clinic for three years. Conclusion The result shows that the system can satisfy the need of information management of field medical clinic and enhanced the efficiency of management greatly.

Objective To summarize the clinical features and technical key points on brain death during decision-made process in children with suspected brain death.Methods Twenty-four coma children with Glasgow coma scale score 3 and no spontaneous respiration were collected from May 2015 to February 2017 in Beijing Children's Hospital,Capital Medical University to make the brain death determination.All children received at least one confirmatory test.According to the Chinese standards for determining brain death (pediatric),all patients were divided into brain death group and non-compliance group.The clinical features were analyzed.The sensitivity,specificity,false positive rate and false negative rate of electroencephalogram (EEG),short latency somatosensory evoked potential (SLSEP) and transcranial Doppler sonography (TCD) were calculated.Results Among these 24 cases,there were 16 males and 8 females,aged 5.6 (2.0,8.8) years old.Ten cases met the criteria of brain death.Twelve (50％,12/24 cases) cases received autonomic breathing test.A total of 25 tests were conducted,of which 21 were successful.The completion rates of EEG,TCD and SLSEP were 100.0％ (24/24 cases),83.3 ％ (20/24 cases) and 54.2％ (13/24 cases),respectively.EEG had the highest sensitivity (100％) and specificity (79％).SLSEP had good sensitivity (100％),but the specificity was only 40％.The combination of EEG with SLSEP had the highest specificity and sensitivity,both of which were 100％,and the false positive rate and false negative rate were 0.Conclusions The key to determine brain death successfully is to make adequate preparations,to receive formal training and to apply standard operation.In the determination of brain death in children,EEG has a good sensitivity and specificity in single confirmation test,which is the priority item.The combination of EEG with SLSEP is the most advantageous.

OBJECTIVETo study the effect of Mudan Granule (MD) on the glucose metabolism and beta cell function in monosodium glutamate (MSG) induced obese mice with insulin resistance (IR).

METHODSMSG obese mice were induced by subcutaneous injecting MSG (4 g/kg for 7 successive days in neonatal ICR mice). Forty MSG mice with IR features were recruited and divided into four groups according to body weight, fasting blood glucose, triglyceride (TG), total cholesterol (TC), and the percentage of blood glucose decreased within 40 min in the IR test, i.e., the model group (Con), the low dose MD group, the high dose MD group, and the Metformin group (Met). Besides, another 10 ICR mice were recruited as the normal control group (Nor). The water solvent of 2.5 g/kg MD or 5 g/kg MD was respectively administered to mice in the low dose MD group and the high dose MD group. Metformin hydrochloride was given to mice in the Met group at 0.2 g/kg body weight. Equal dose solvent distilled water was administered to mice in the Nor group and the Con group by gastrogavage, once per day. All medication was lasted for 15 weeks. Insulin tolerance test (ITT) and oral glucose tolerance test (OGTT) were performed after 6 weeks of treatment. Beta cell function was assessed by hyperglycemic clamp technique. The morphological changes in the pancreas were evaluated by hematoxylin-eosin (HE) staining. Changes of iNOS, NF-kappaB p65, and p-NF-kappaB p65 in the pancreas were tested.

RESULTSCompared with the Nor group, the blood glucose level, AUC, and fasting blood insulin, ONOO-contents, iNOS activities, and the expression of iNOS, NF-kappaB p65 subunit, pNF-kappaB p65 subunit obviously increased; decreased percentage of blood glucose within 40 min in ITT, glucose infusion rate (GIR), Clamp 1 min insulin, and Max-Insulin obviously decreased in the Con group (P < 0.05, P < 0.01). Compared with the Con group, the aforesaid indices could be improved in the Met group (P < 0.05, P < 0.01). In the low dose MD group, AUC, iNOS activities, and the expression of iNOS and p-NF-kappaB p65 subunit obviously decreased; percentage of blood glucose within 40 min in ITT and GIR obviously increased (P < 0.05, P < 0.01). In the high dose MD group, AUC, ONOO-contents, iNOS activities, and the expression of iNOS, NF-kappaB p65 subunit, and p-NF-KB p65 subunit obviously decreased; percentage of blood glucose within 40 min in ITT, Max-Insulin, and GIR obviously increased (P < 0.05, P < 0.01).

CONCLUSIONMD could significantly improve IR and functional disorder of 3 cells in MSG obese mice, which might be associated with lowering inflammatory reaction in the pancreas.

Animals ; Disease Models, Animal ; Drugs, Chinese Herbal ; pharmacology ; Female ; Insulin Resistance ; Insulin-Secreting Cells ; drug effects ; metabolism ; Male ; Metformin ; pharmacology ; Mice ; Mice, Inbred ICR ; Mice, Obese ; Obesity ; chemically induced ; metabolism ; Pancreas ; cytology ; drug effects ; Sodium Glutamate

Objective To evaluate the clinical characteristics,diagnosis and treatment method of pancreatic sinistral portal hypertension caused by tumors in the body and tail of the pancreas.Methods A retrospective review of 40 patients diagnosed with pancreatic sinistral portal hypertension at Peking Union Medical College Hospital from January 2007 to December 2012 was performed.Results The Initial symptoms were epigastric pain and discomfort (n =12),emaciation (n =5),low-back pain (n =4),splenomegaly (n =2),hematemesis and melena (n =4),hypoglycemic coma (n =1).All 40 patients had splenomegaly and varices in the gastric fundus with normal liver function.8 had combined esophageal varices.24 had hypersplenism and 26 had elevated serum CA19-9 level.25 patients received surgical intervention and 15 were treated conservatively.Pathology confirmed malignancy in 29 patients and benign lesions in 11.Thirty-five patients (35/40,88％) were followed up for 12 to 72 months.For patients undergoing surgery,hypersplenism and varices in the gastric fundus were all relieved.There was no upper gastrointestinal bleeding occurred during follow-up.For patients treated conservatively,hypersplenism remained stable and among them 4 patients had upper gastrointestinal bleeding,and successfully treated by medication,therapeutic endoscopy and interventional therapy.Conclusions Patients with pancreatic sinistral portal hypertension caused by tumor in the body and tail of the pancreas can be cured successfully by surgery.In those patients portal hypertension can present as initial clinical manifestation.

Objective To study the diagnosis and treatment of pancreatic sinistral portal hypertension with splenomegaly.Method From January 2010 to December 2012,twenty-six cases of pancreatic sinistral portal hypertension with splenomegaly were retrospectively analyzed.Results The underlying pancreatic diseases were chronic pancreatitis (n=12,46 ％),pancreatic pseudocyst (n=5,19％),mass of pancreatic body and tail (n=6,23％),autoimmunie pancreatitis (n=2,8％) and pancreatic trauma (n=1,4 ％).All the 26 patients presented with splenomegaly,but there was no evidence of cirrhosis or abnormal hepatic function.Three cases presented with a history of upper gastrointestinal bleeding.Gastroscopy or upper gastrointestinal visualization revealed all 26 patients had varices in the gastric fundus and 6 patients had inferior segment oesophageal varices simultaneously.19 patients underwent operative treatment,2 patients underwent splenic artery embolization and 5 patients were treated conservatively.22 patients were followed up for 6 months to 30 months,the follow-up rate was 85 ％,and there were no upper gastrointestinal bleeding.Hypersplenism disappeared in all the 19 patients after operation.2 patients succumbed to pancreatic malignant tumor.Conclusions Splenomegaly is one characteristic clinical manifestation of pancreatic sinistral portal hypertension.It could be cured by operation.The choice of treatment depends on the patient's condition.The management of the primary pancreatic disease should also be emphasized.

In this paper are described the construction of biological valves poppet and the establishment of mathematical model according to cardiac valves hydrokinetics and the theory of membrane. Finite elements of biological valves leaflets connected with biological valves poppet are analyzed. The method of constructing geometric model is reasonable. CAD of biological valves poppet is realized by structured programming and parameterization.
Bioprosthesis ; Computer Simulation ; Computer-Aided Design ; Finite Element Analysis ; Heart Valve Prosthesis ; Humans ; Models, Theoretical ; Prosthesis Design ; methods

This study is to evaluate the effects of the metformin (Met) on β cell function of diabetic KKAy mice. Female diabetic KKAy mice selected by insulin tolerance test (ITT) were divided randomly into two groups. Con group was orally administered by gavage with water, Met group with metformin hydrochloride at a dose of 0.2 g x kg(-1) for about 12 weeks. ITT and glucose tolerance tests (OGTT) were determined. Beta cell function was assessed by hyperglycemic clamp. Pancreatic biochemical indicators were tested. The changes of gene and protein expression in the pancreas and islets were also analyzed by Real-Time-PCR and immunostaining. Met significantly improved glucose intolerance and insulin resistance in KKAy mice. Fasting plasma glucose and insulin levels were also decreased. In addition, Met markedly increased glucose infusion rate (GIR) and elevated the Ist phase and maximum insulin secretion during clamp. It showed that Met decreased TG content and iNOS activities and increased Ca(2+) -Mg(2+)-ATPase activity in pancreas. Islets periphery was improved, and down-regulation of glucagon and up-regulated insulin protein expressions were found after Met treatment. Pancreatic mRNA expressions of inflammation factors including TLR4, NF-κB, JNK, IL-6 and TNF-α were down-regulated, p-NF-κB p65 protein levels also down-regulated by Met. And mRNA expressions of ion homeostasis involved in insulin secretion including SERCA2 and Kir6.2 were up-regulated by Met. Met increased SIRT5 expression level in pancreas of KKAy mice under the hyperglycemic clamp. These results indicated that chronic administration of Met regulated pancreatic inflammation generation, ion and hormone homeostasis and improved β cell function of diabetic KKAy mice.
Animals ; Blood Glucose ; Diabetes Mellitus, Experimental ; drug therapy ; Down-Regulation ; Female ; Glucose Tolerance Test ; Homeostasis ; Inflammation ; drug therapy ; Insulin ; secretion ; Insulin Resistance ; Insulin-Secreting Cells ; drug effects ; Interleukin-6 ; metabolism ; Metformin ; pharmacology ; Mice ; NF-kappa B ; metabolism ; Pancreas ; drug effects ; Tumor Necrosis Factor-alpha ; metabolism

Since the application of biomedical nanotechnology in the field of drug delivery breathes new life into the research and development of high-end innovative agents, a substantial number of novel nano-drug delivery systems (nano-DDSs) have been successively developed and applied in the clinical practice. Among them, small molecule pure drug and prodrug-based nanoassemblies have grasped great attention, owing to the facile fabrication, ultrahigh drug loading and feasible industrial production. Herein, we provide an overview on the latest updates of small-molecule nanoassemblies. Firstly, the self-assembled prodrug-based nano-DDSs are introduced, including nanoassemblies formed by amphiphilic monomeric prodrugs, hydrophobic monomeric prodrugs and dimer monomeric prodrugs. Then, the recent advances on nanoassemblies of small molecule pure chemical drugs and biological drugs are presented. Furthermore, carrier-free small-molecule hybrid nanoassemblies of pure drugs and/or prodrugs are summarized and analyzed. Finally, the rational design, application prospects and clinical challenges of small-molecule self-assembled nano-DDSs are discussed and highlighted. This review aims to provide scientific reference for constructing the next generation of nanomedicines.

Objective To evaluate the changes in refractive state in high-myopic patients with rhegmatogenous retinal detachment after vitrectomy combined with cataract surgery.Methods Clinical data of 30 patients of rhegmatogenous retinal detachment in the Affiliated Hospital of Qingdao University from January 2016 to March 2017 was retrospectively analyzed,and these patients were randomly dividedly into two groups:high myopia (15 patients of 15 eyes) and non high myopia group (15 patients of 15 eyes),in which patients firstly underwent vitrectomy combined with phacoemulsification and silicone oil tamponade,followed by intraocular lens (IOL) implantation after the removal of silicone oil 3 months later.The two groups were continuously followedup for 6 months after IOL implantation.Before vitrectomy,the axial length,corneal curvature were measured for calculating the predictive spherical equivalent (SE).Then axial length and corneal curvature at 1 month,3,6 months after IOL implantation were measured for calculating the actual SE.The best corrected visual acuity (BCVA) was recorded before and after operation and the LogMAR was calculated in each groups.The SE,axial length,corneal curvature before vitrectomy and 1 month,3,6 months after IOL implantation were respectively compared in each group.The relationship between the refractive prediction errors and the preoperative axial length in the high myopia group was evaluated.Results The LogMAR visual acuity was improved in both groups,and the difference between before and after treatment was statistically significant (both P ＜0.05).The SE at 1 month,3,6 months after surgery showed significantly myopic shift in the high myopic eyes,and the myopic shift gradually increased with time,with statistically significant at each time point (all P ＜ 0.05),but there was no significant difference in myopic shift between before and after surgery as well as among each time point after surgery in the non-high myopic eyes (P ＞ 0.05).Axial length and corneal curvature at 1 month,3,6 month after surgery in the high myopia group were significantly increased (all P ＜ 0.05),whereas those in the non high myopia group did not change significantly (all P ＞ 0.05).By simple linear regression analysis,the refractive prediction errors had a negative correlation with the preoperative axial length in the high myopia group (R2 =0.580,P =0.001).Conclusion The LogMAR visual acuity after vitrectomy combined with cataract surgery is improved in patients with rhegmatogenous retinal detachment.Postoperative axial length growth and corneal curvature increase are presented in patients with high myopia,and the longer the preoperative axial length is,the more myopic shift the eye shows.