Nonalcoholic fatty liver disease (NAFLD) is the most common liver disorder, affecting 10%-24% of the general population, and the incidence is much higher (70% -80% ) in type 2 diabetic patients. Recent studies indicate that fatty liver is an emerging problem in the Asia-Pacific region and China. The community prevalence of NAFLD in Shanghai is 15%. A large body of evidences suggests that NAFLD is the hepatic manifestation of the metabolic syndrome. NAFLD is not only associated with the metabolic syndrome, it also predicts the development of type 2 diabetes and cardiovascular disease (CVD). The liver is a central organ for controlling and regulating glucose and lipids metabolism; intrahepatocellular lipid accumulation plays a key role in the development of metabolic-ally related disorders. It is crucial that specialists, especially endocrinologists, and practising clinicians should be aware of the strong association between NAFLD and increased risks of diabetes and CVD, NAFLD should be diagnosed correctly and defined timely in regarding its role as risk factors of underlying diabetes and CVD.

Researches in type 2 diabetes and non-alcoholic fatty liver disease have been made in recent years.The intimate connection between these two diseases has been analysed and explored.Whether non-alcoholic fatty liver disease is a hepatic complication of type 2 diabetes remains to be elucidated.The poor outcome of liver disease in patients with type 2 diabetes should be emphasized.

The progress in nonalcoholic fatty liver disease(NAFLD) research has shown an important role of hepatic steatosis in triggering insulin resistance and glucose/lipid metabolic disorders.As an early reversible therapeutic target for metabolic diseases,NAFLD has attracted increasing attention from endocrinologists and gastroenterologists,as well as deeping the studies in this field.Based on the recent progress in NAFLD research,this review mainly presents the new understanding and concept of NAFLD,discusses the features of the new guidelines and concensus for NAFLD treatment,and introduces some updated developments in NAFLD diagnosis and therapy.Furthermore,future directions of NAFLD research are also predicted in the article.

Objective To study the effect of caveolin-1 on renal injury and the expression of tight junction proteins in MRL/lpr mice kidney.Methods The mice were divided into 4 groups:5 mice in the normal control group (BALB/c mice);the MRL/lpr lupus mice (n=18) were randomly divided into the MRL/lpr group in which 6 mice were included;the negative control group in which 6 mice were included;the caveolin1 transfection group in which 6 mice were included.The changes of urine protein,the levels of urea (BUN) and creatinine (Cr) were detected.The expressions of claudin-5,occludin,ZO-1 and caveolin-1 protein were determined by western bloting.Analysis of variance was used to determine statistical significant differences between the two groups.A significance level of 0.05 was considered as signigicant.Results Compared with the control group,24 h urine protein [(2 894±437) mg,(412±72) mg],BUN [(8.7±1.5) mmol/L,(6.9±0.4) mmol/L],Cr [(106±22) μmol/L,(85±4) μmol/L] were significantly increased,level of caveolin-1 protein increased (265±17,61±6),the level of occludin (114±12,190±12),claudin-5 (60±5,80±6) and ZO-1 (98±11,206±15) protein decreased in the MRL/lpr group (P＜0.05).After caveolin-1 transfection,the levels of urinary protein [(1 253±249) mg,(2 894±437) mg],BUN [(6.5±1.3) mmol/L,(8.7±1.5) mmol/L],Cr [(78±17) μmol/L,(106±22)μmol/L] were significantly decreased,and the levels of occludin (218±16,114±12),claudin-5 (87±6,60±5)ZO-1 (313±17,98±11) were increased (P＜0.05).Conclusion The expression of caveolin-1 protein in the renal tissues of lupus nephritis increases.Caveolin-1 can reduce the expression of tight junction proteins and contribute to progres-sion of lupus nephritis.

Diabetes Mellitus, Type 2 ; complications ; Humans ; Non-alcoholic Fatty Liver Disease ; complications

Objective To study the effect of hydroxychloroquine (HCQ) on the suppressors of cytokine signaling (SOCS) in the kidney of MRL/lpr mice and evaluate the protection of HCQ on lupus nephritis.Methods Twenty-six rats were randomly divided into 3 groups:the control group which was consisted of 6 mice; the MRL/lpr group which was consisted of 10 mice; and the HCQ group which was consisted of 10.24-hour urinary protein level and anti dsDNA levels were tested.The expressions of SOCS-1 and SOCS-3 protein were determined by western blot.Analysis of variance was used to determine statistically significant differences between the two groups.A P value less than 0.05 was considered to be statistically significant.Results Compared with the control group,the levels of 24-hour urinary protein [(2 356.6±509.3) mg vs (440.3±90.1)mg] and anti ds-DNA (128.7±32.3 vs 14.9±1.4) were significantly increased in the MRL/lpr group,the expression levels of SOCS-1 and SOCS-3 protein were increased.After treated with HCQ,the levels of 24-hour urinary protein [(70.8±11.1) mg vs (2 356.6±509.3) mg] and anti-dsDNA (111.8±330.1 vs 128.7±32.3)were significantly decreased,the expression level of SOCS-1 and SOCS-3 protein decreased significantly (P＜ 0.05).Conclusion HCQ can inhibit SOCS expression in the kidney of lupus mice,reduce proteinuria and delay progression of immune disorders and lupus nephritis.

Objective To investigate the clinical value of Holter monitor(DCG) in the diagnosis and treatment of dilated cardiomyopathy (DCM).Methods According to NT-proBNP ＞ 2 000pg/mL,left ventricular ejection fraction (LVEF) ≤40％,New York Heart Association (NYHA) rated Ⅲ-Ⅳ,67 patients with DCM were divided into the high risk group and nonhigh risk group.All kinds of arrhythmia patients proportion was compared between the two groups,in order to understand the risk factors of DCM and arrhythmias.Results In high risk group,18 cases had ventricular tachycardia,the incidence rate was 66.7％,which was significantly higher than that of non high risk group (2 cases,5.0％) (x2 =29.271,P ＜ 0.01).While other arrhythmia,atrial premature beats,single premature ventricular contraction,atrial fibrillation and so on,had no statistical difference (P ＞ 0.05).Conclusion The DCM patients with various types of arrhythmia,ventricular tachycardia in patients directly influence the severity and prognosis,Holter monitor has an irreplaceable role.

Objective To observe the effect and safety of modified Yishen Zhuyang Huoxue Huazhuo Formula for polycystic ovarian syndrome (PCOS) in the TCM pattern of deficiency of spleen and kidney with phlegm-dampness. Methods Totally 123 cases were recruited into this study and randomized to two groups by central random approach, 64 cases in the observation group and 59 cases in the control group. Patients in the observation group were given the modified Yishen Zhuyang Huoxue Huazhuo Formula, while those in the control group were given compound cyproterone acetate tablet, for two treatment courses, three months for one course. The changes of ovarian volume and the number of follicles before and after treatment were observed. Adverse reactions were also evaluated. Results Bilateral ovarian volumes in both groups decreased after treatment (P<0.05, P<0.01), while the control group showed a significant better improvement (P<0.05). The number of follicles in the two groups decreased, but no significant difference were observed between the two groups (P>0.05). The rate of adverse reaction in the observation group was lower than the control group. Conclusion Modified Yishen Zhuyang Huoxue Huazhuo Formula is effective for PCOS patient by reducing the ovarian volume with a low incidence of side effect.

An early diagnosis of nonalcoholic fatty liver disease ( NAFLD) is meaningful to the prevention and cure of diabetes and cardiovascular disease ( CVD). The sensitivity and specificity of qualitative methods vary greatly, and these methods do not quantify liver fat content. Pathological diagnosis is a quantitative method, but it is invasive and inappropriate for clinical application. The establishment of H Magnetic Resonance Spectrum (1H MRS) opened up a brand-new era for noninvasive liver fat quantification. This review systemically introduces the new progress in noninvasive diagnosis of NAFLD.

Objective To analyze the correlation of discomfort experience and factual recollection (FR) in patients of intensive care unit (ICU). Methods Fifty-five ICU patients and 63 ward patients par-ticipated in the study. Standardized questionnaires were used to evaluate all patients" FR and the results underwent analysis. Results The prevalence of recollection of any type of discomfort in the ICU patients was 64%. The presence of an endotracheal tube, pain and hallucinations were identified as sources of dis-comfort.The median score for FR in the ICU patients was 7.25. The median score for FR in the ward pa-tients was 13.50. The difference between them was highly significant (t =3.34, P < 0.01 ). Logistic analysis revealed that discomfort, especially discomfort caused by the presence of an endotracheal tube, pain and hallucinations, was positively related to FR, 0R95%CI (1.2～2.1), P < 0.01. Conclusions The presence of an endotracheal tube, pain and hallucinations were most frequently reported as sources of discomfort in ICU patients and their memory was often impaired. FR and recollection of discomfort appear to be related significantly in ICU patients.