OBJECTIVE:To probe into the occurrence characteristics of the adverse drug reactions(ADR) in Lanzhou area and to intensify the reporting,monitoring and management of ADR.METHODS:A retrospective analysis was performed on 345 valid ADR cases.RESULTS:The ADR reports were mainly submitted by medical institutions,account for 88.70%.The clinicians and hospital pharmacists were the chief reporting personnel.16 drug categories totaled 143 varieties were involved in the ADR,leading the list were traditional Chinese medicine preparation that account for 48.70%and antibacterial drugs that account for 29.86%.CONCLUSION:The reporting and monitoring of ADR should be intensified so as to decrease the rate of missing report and incidence of ADR to a large extent.

Objective To explore the clinical efficacy of captopril combined with nifedipine in the treatment of type 2 diabetes mellitus complicated with hypertension.Methods 100 patients with type 2 diabetes mellitus complicated with hypertension were divided into two groups by randomized single blind method.The two groups were given conventional hypoglycemic therapy,50 cases in the control group were treated with captopril,while 50 cases in observation group received captopril combined with nifedipine sustained -release tablets.The clinical therapeutic effect was compared between the two groups.Results The effective rate of the observation group was 94%,which of the control group was 80%,the difference was statistically significant (χ2 =9.65,P<0.05).After treatment,the diastolic blood pressure[(80.45 ±3.65)mmHg],systolic blood pressure[(128.67 ±5.66)mmHg],fasting blood glucose[(6.65 ±0.37)μmol/L],2h postprandial blood glucose[(9.76 ±1.22)μmol/L]of the observation group were significantly reduced than before treatment (t =8.06,8.18,8.00,7.94,all P <0.05),and diastolic blood pressure and systolic blood pressure were significantly different with the control group(t=8.66,7.90,all P<0.05). After treatment,the serum creatinine (97.44 ±6.32)μmol/L,urea nitrogen (4.20 ±0.30) mmol/L and 24h urinary albumin (17.99 ±4.10) mg/L of the observation group were significantly reduced compared with before treatment (t=7.67,8.27,8.32,all P<0.05),and the indicators had significant differences with the control group(t=7.23, 7.65,7.67,all P<0.05).Conclusion Captopril and nifedipine sustained-release tablets in the treatment of type 2 diabetic patients with hypertension can effectively reduce the blood pressure,improve renal function,and it has good clinical application and promotion value.

Objective To explore the effects of high insulin and high glucose concentrations on glucose transport activity,the expression of insulin signaling peptides and glucose transporter 4(GLUT4) translocation in primary cultured rat adipocytes.Methods Isolated rat adipocytes were cultured for 24h at insulin(10 4?U/ml) and different concentration glucose(5,10,15 and 25mmol).Then the glucose uptake,cellular contents of insulin receptor substrate(IRS) 1/2,phosphatidylinositol 3-kinase 85 subunit(p85),protein kinase B(PKB) and GLUT4 were measured by Western blotting method.Results These adipocytes treated with insulin and different high concentration glucose had shown to impair glucose uptake in a dose-dependent manner,inhibited cellular IRS1 expression,impaired IRS2 protein expression independent on glucose concentration in the medium,it did not influence the contents of p85,PKB and GLUT4,but decreased GLUT4 translocation.Conclusions Chronic high insulin induced insulin resistance may be caused by the increasing glucose concentration surrounding the cells.The mechanism may be involved in affecting IRSs protein expression and GLUT4 translocation.

Objective To compare the clinical use of continuous glucose monitoring system (CGMS) and self-monitoring blood glucose (SMBG) when monitoring blood glucose level of patients with gestational diabetes mellitus (GDM) or type 2 diabetes mellitus (DM) complicated with pregnancy.Methods A total of 99 patients with GDM (n=70) and type 2 DM complicated with pregnancy (n=29) that whether hospitalized or in clinical of Peking University First Hospital were recruited from Aug 2012 to Apr 2013.The CGMS was used to monitor their blood glucose level during the 72-hour time period,while the SMBG was also taken seven times daily.The correlation between these blood glucose levels and their glycosylated hemoglobin (HbA1c) levels were analyzed by comparing the average value,the maximum and the minimum value of blood glucose,and the appeared time of these extremum values in these two monitoring methods,and the amount of insulin usage was recorded as well.Results (1) The maximum,minimum and the average blood glucose value in the GDM group were (8.7± 1.2),(4.5 ±0.6) and (6.3 ± 0.6) mmol/L of SMBG vs.(10.1±1.7),(3.1±0.7),(6.0±0.6) mmol/L of CGMS.These values in DM group were (10.1±2.2),(4.5±1.0),(6.9±1.1) mmol/L of SMBG vs.(12.2±2.6),(2.8±0.8),(6.6±1.1) mmol/L of CGMS.By using the two methods,the maximum and the average value of the two groups showed significant differences (P＜0.01) while the minimum value showed no significant differences (P＞0.05).(2) In the GDM group,the average blood glucose values of CGMS and SMBG were significantly correlated (r=0.864,P＜0.01).The maximum values presented the same result (r=0.734,P＜0.01).Correlation was not found in the minimum values of CGMS and SMBG (r=0.138,P＞0.05).In the DM group,the average valves of two methods were significantly correlated (r=0.962,P＜0.01),the maximum values showed the same result (r=0.831,P＜0.01).It can also be observed in the minimum values (r=0.460,P＜0.05).(3) There was significant correlation between the average value of CGMS and HbA1c level (r=0.400,P＜0.01),and the average value of SMBG and HbA1c level were correlated (r=0.031,P＜0.05) in the GDM group; the average values of CGMS (r=0.695,P＜0.01) and SMBG (r=0.673,P＜0.01) were both significantly correlated with the HbA1c level in the DM group.(4) In the GDM group,37％ (26/70) of the minimum values of SMBG appeared 30 minutes before breakfast,while 34％(24/70) of them appeared 30 minutes before lunch; 86％(60/70) of the maximum values of SMBG were evenly distributed 2 hours after each of the three meals.In the DM group,41％(12/29) of the minimum values of SMBG presented 30 minutes before lunch,while 21％(6/29) and 14％(4/29) of them were showed 30 minutes before breakfast and dinner respectively; about 30％ of the maximum values of SMBG appeared 2 hours after each of the three meals.(5) In the GDM group,23％(16/70) of the minimum values of CGMS occurred between 0:00-2:59 am.,and most of the other minimum values of CGMS were evenly distributed in the rest of the day,except for 3％(2/70) of them were found during 18:00-20:59 pm.43％(30/70) of the maximum values of CGMS appeared during 6:00-8:59 am.,only 1％(1/70) and 3％(2/70) of them presented during 0:00-2:59 am.and 21:00-23:59 pm.,and the rest were evenly distributed for the other times of the day.In the DM group,34％(10/29) of the minimum values of CGMS were found during 0:00-2:59 am.,14％(4/29) of them appeared during 9:00-11:59 am.and 15:00-17:59 pm.,45％(13/29) of the maximum values of the CGMS presented during 6:00-8:59 am.,none was found during 21:00-23:59 pm.,0:00-2:59 am.and 3:00-5:59 am.,and the rest were evenly distributed for the other times of the day.(6) 64％(45/70) of the patients in the GDM group did not require for insulin treatment,while 36％(25/70) of them did.For those patients who received insulin treatment,after CGMS,64％(16/25) of them adjusted the insulin dosage according to their blood glucose levels.In the DM group,14％(4/29) of them did not receive insulin treatment,while for the others who did(86％,25/29); 60％ (15/25) of them adjusted the insulin dosage according to their blood glucose levels after CGMS.Conclusions Both CGMS and SMBG could correctly reflect patients' blood glucose levels.It was more difficult to control the blood glucose levels in patients with type 2 DM complicated with pregnancy than the GDM patients.Compared with SMBG,CGMS could detect postprandial hyperglycemia and nocturnal hypoglycemia more effectively.

Objective To observe the changes of serum bilirubin(BIL) and high-sensitivity C-reactive protein(hs-CRP) after percutaneous coronary intervention(PCI) in acute myocardial infarction(AMI) patients.Methods The TBiI,IBil,DBil and hs-CRP levels in serum were detected in 60 AMI patients within 6 hours after attack with immunoturbidimetry before PCI,at the point of operation,6h,12h,24h,72h and 7d afer PCI.30 healthy persons were chosen as normal control.The two groups were compared.Results The hs-CRP level was increased gradually with time in AMI patients after PCI.The peak value was at 72h after PCI and it was significantly higher than those in the normal group( P ＜ 0.05 ).The TBil,IBil,DBil levels at pre-PCI point were significantly lower than the normal group (P ＜ 0.05).These index were gradually recovered to the normal group and no significancet differences between them (P ＞ 0.05 ).The coefficient correlation of hs-CRP and TBil,IBil,DBil were 0.44 ( P ＞ 0.05 ).Conclusion The TBil,IBil,DBil and hs-CRP levels in short time after attack of AMI with PCI presented a dynamic changing and recovered to the normal level.No associativity was observed between them,but as the follow-up index,it was significant for the disease turnover.

Objective To study the roles of advanced glycation end products and its receptor on fetal brain injury of gestational diabetes mellitus (GDM) rats.Methods Twenty one adult pregnant Wistar rats were administered streptozotocin (STZ) intraperitoneally to induce GDM rats model.The fourteen pregnant rats were divided into two groups according to the fasting glucose on the 3rd day of pregnancy:severe GDM group with the fasting glucose ＞ 16.7 mmol/L and mild GDM group with the fasting glucose between 6.7 - 16.7 mmol/L Another seven pregnant rats were chosen as the severe GDM and intervention with micronutrient group,receiving gavage with micronutrient during the whole pregnancy.Five control rats received the same volume of citric acid buffer.All the pregnant rats were tested fasting glucose from the tailvein and their weight on the pregnant day 3,13 and 19.Maternal serum levels of AGE were measured by ELISA and RAGE levels in the embryonic brain tissues were tested by immunohistochemistry.Results ( 1 ) There was no statistically significant difference of pre-pregnancy fasting glucose level among all groups (P ＞ 0.05 ).The fasting glucose levels on the 3rd day and the mean fasting glucouse level of pregnancy in the severe GDM group and the severe GDM and intervention with micronutrient group were higher than those of the control group ( P ＜0.05 ).And there was no significant difference between the severe GDM group and the severe GDM and intervention with micronutrient group (P ＞0.05 ).(2)The serum AGE levels in the severe GDM group and the mild GDM group were( 1037 + 38) ng/L and( 880 ± 34) ng/L respectively,with no significant difference ( P ＞ 0.05 ).The serum AGE levels in the control group and the severe GDM and intervention with micronutrient group were (857 ± 32 ) ng/L and (988 ± 37 ) ng/L,and the difference was statistically significant ( P ＜ 0.05 ).The serum AGE levels in the severe GDM and intervention with micronutrient group and in the mild GDM group had no significant difference ( P ＞ 0.05 ).( 3 ) The serum AGE levels in the severe GDM group,mild GDM group and the control group were positively associated with the mean glucose level of pregnancy ( r =0.603,P ＜ 0.05 ) and the grlucose on the 3rd day of pregnancy (r =0.704,P ＜ 0.05 ).(4)The fetal brain nerve cell number and morphology in the control group were normal.While in the mild GDM group fetal brain nerve cells decreased,the proliferation and swelling of glial cells were seen.In the severe GDM group and the severe GDM and intervention with micronutrient group,the fetal brain cells furtherly reduced,and large vacuole around the cells,deformation and debris of the cells were seen. Glial scar formation was visible in some fetal brain tissues.There was a few RAGE expression in the control fetal brain tissues.In the mild GDM group and the severe GDM group,RAGE expression increased significantly.And the RAGE expression intensity in the severe GDM and intervention with micronutrient group was between the severe and the mild GDM groups.Conclusions( 1 ) Abnormal fetal brain development of GDM rats was associated with the increase of maternal serum AGE and the enhancement of RAGE expression in fetal brain tissues,which suggested that AGE/RAGE pathway may play an important role in the fetal brain injury of GDM rats.(2) Micronutrients can reduce the brain damage of GDM fetuses.

Objective To analyze the characteristics of pre-gestational diabetes mellitus (PGDM) diagnosed during pregnancy (missed diagnosis before pregnancy), and to evaluate the effects of diagnostic time on pregnancy outcomes. Methods A retrospective study of 746 pregnant women who were diagnosed PGDM and delivered in Peking University First Hospital from January 1st, 2005 to December 31st, 2015 was conducted. The patients were divided into 2 group. Those diagnosed PGDM before pregnancy were defined as Group diagnosed before pregnancy, and those diagnosed during pregnancy were defined as Group diagnosed during pregnancy. In Group diagnosed during pregnancy, those diagnosed before 24 gestational weeks were defined as Group diagnosed during pregnancy A, and those diagnosed after 24 weeks were defined as Group diagnosed during pregnancy B. The prevalence of adverse pregnancy outcomes in each group were analyzed. Results (1) Rate of missed diagnosis for PGDM:the incidence of PGDM diagnosed before pregnancy was 32.2% (240/746), and those diagnosed during pregnancy (missed diagnosis before pregnancy) was 67.8% (506/746). (2) Blood glucose control during pregnancy: ①Group diagnosed before pregnancy and Group diagnosed during pregnancy: the highest glycosylated hemoglobin (HbA1c) in Group diagnosed before pregnancy was (6.6±1.1)%, higher than that in Group diagnosed during pregnancy [(6.3± 1.0)%, P=0.019]. However, there was no significant difference in the average HbA1c level between the 2 groups (P=0.616). The insulin needed percentage [90.8%(218/240) vs. 53.8%(272/506)] in Group diagnosed before pregnancy were higher than that in Group diagnosed during pregnancy (P<0.01).②Group diagnosed during pregnancy A and B:the highest HbA1c in Group diagnosed during pregnancy A was (6.9± 1.3)%, higher than that in Group diagnosed during pregnancy B [(6.1 ± 0.8)%, P<0.05]. And the average HbA1c in Group diagnosed during pregnancy A [(6.4±0.8)%] was also higher than that in Group diagnosed during pregnancy B [(6.0 ± 0.8)%, P<0.05]. In Group diagnosed during pregnancy B, 46.1%(187/406) used insulin, lower than the percentage in Group diagnosed during pregnancy A (85.0%, 85/100;P<0.01). ③There were no significant differences in the highest HbA1c and the average HbA1c between Group diagnosed during pregnancy A and Group diagnosed before pregnancy (P=0.020, P=0.037). There was neither no significant difference in the percentage used insulin during pregnancy between them (P=0.128). There were significant differences in the highest HbA1c and the average HbA1c between Group diagnosed during pregnancy B and Group diagnosed before pregnancy (P<0.01, P=0.014). There was also significant difference in the percentage used insulin during pregnancy between them (P<0.01). (3) Pregnancy outcome:①Group diagnosed before pregnancy and Group diagnosed during pregnancy: the cesarean section rate [72.5% (174/240) vs. 59.7% (302/506)] in Group diagnosed before pregnancy were higher than those in Group diagnosed during pregnancy (P<0.01). However, there were no significant differences in preterm birth rate, pre-eclampsia, macrosomia percentage, percentage of neonates being hospitalized between the 2 groups (P=0.546,P=1.000,P=0.671,P=0.804). ②There was no significant difference in preterm birth rate, cesarean delivery rate, macrosomia percentage, pre-eclampsia rate, percentage of neonates being hospitalized between Group diagnosed during pregnancy A and Group diagnosed during pregnancy B (P=0.887, P=0.495, P=0.841, P=1.000, P=1.000).③There was no significant difference in preterm birth rate, cesarean delivery rate, macrosomia percentage, pre-eclampsia rate, percentage of neonates being hospitalized between Group diagnosed during pregnancy A and Group diagnosed before pregnancy (P=0.875, P=0.093, P=0.662, P=1.000, P=0.837). The cesarean delivery rate was lower in Group diagnosed during pregnancy B than that in Group diagnosed before pregnancy (P=0.001). However, there were no significant differences in preterm birth rate, macrosomia percentage, pre-eclampsia rate, percentage of neonates being hospitalized between them (P=0.530, P=0.776, P=1.000, P=0.797). Conclusions The diagnosis of PGDM is commonly missed before pregnancy. Fasting plasma glucose should be used as screening test to identify PGDM at pre-pregnancy examination or first antenatal care. Using abnormal value of 2-hour glucose after 24 gestational weeks as the only way to diagnose PGDM is not suitable.

Objective To study three single nucleotide polymorphisms (SNP), SNP-43, -19 and - 63 of calpain-10 (CAPN10) gene in pregnant women with glucose metabolism disorders and their relationship with the risk of these disorders. Methods Totally, 270 pregnant women including 156 with an abnormal oral glucose tolerance test (study group) and 114 healthy controls were selected among those delivered at the Department of Obstetrics and Gynecology, Peking University First Hospital from Jan. 2005 to Dec. 2006. The SNP of CAPN10 gene at posifons 43, 19, and 63 were analyzed by primer-introduced restriction analysis-polymerase chain reaction (PIRA-PCR). Results (1) The frequencies CAPN10 SNP-19 2R/2R genotype (26.9% ,42/156) and 2R allele (48.9%, 152/312 ) were higher than those in controls (12.3% ,14/114 and 36.8% ,84/228, respectively; P=0.012, 0.006). (2) Stratified analysis according to family history of diabetes mellitus showed the proportion of the CAPN10 SNP-19 2R/2R+2R/3R genotypes (83% ,47/57) in the study group were significantly higher than that of control group (52%,11/21 ; P=0.009), and the proportion of SNP-63 T/T + T/C genotypes(47% ,27/57) in study group were significantly higher than that of control group (14%, 3/21 ; P=0.026) among those with positive family history. (3) The combined effect of CAPN10 SNP-43, -19 and -63 on glucose metabolism disorders was analyzed by comparing with the other haplotypes and showed that the haplotype 121 distribution in study group was significantly higher than those in controls(P=0.036), and 221 haplotype was significantly lower than controls (P=0.042). Conclusions (1) CAPN10 SNP-19 is associated with glucose metabolism disorders in pregnant women. And 2R allele might be the risk factor. CAPN10 SNP-19 2R/2R +2R/3R and SNP-63 T/T + T/C genotypes might increase the risk of glucose metabolism disorders in women with positive family history. Haplotype 121 might increase the risk of glucose metabolism disorders in pregnant women and 221 be a protective factor.

BACKGROUND : Chitosan, derived from chitin, has a poor solubility which limits its application greatly. For improving its dissolubility, according to the feature that intramolecular hydroxy and amino group in chitosan are easy to be chemically modified, and functional groups are introduced to improve its solubility and functionality to widen the range of its application, which has become one of the new trend of development for investigating the application of chitosan. OBJECTIVE: To sum up the research advancements in the application and modification of chitosan in carboxylation,acylation, alkylation, etherification, etc.RETRTEVE STRATEGY: The relevant articles published in English between 1998 and 2007 were searched for in Pubmed database with the key words of "chitosan, modification", and the relevant articles published between 1998 and 2007 were searched for in Elsevier Science database with the key words "chitosan, modification" and search "derivate" within search results in English. Articles closely related to the structural modification and application of chitosan were involved, and repetitive and old studies were excluded.LTTERATURE EVALUATION: Totally 154 articles were selected, and 30 of them are accorded with the inclusive criteria,including 5 are reviews, and the others are clinical or experimental studies.DATA SYNTHESTS: The intramolecular hydroxy and amino groups in chitosan are mostly modified because they are easy to be chemically modified. Recently, reports lay particular emphasis on the modification in carboxylation, acylation,alkylation, etherification, etc. Functional groups are introduced to improve its solubility and functionality to widen the range of its application.CONCLUSTON: The water-solubility of chitosan can be improved through structural modification and introducing multifunctional group, which can also bring about much more special efficacies.