Objective To investigate the relationship between with or without non?alcoholic fatty liver disease(NAFLD) and diabetic retinopathy(DR) in type 2 diabetes mellitus(T2DM)?Methods Clinical and laboratorial data of 517 cases T2DM hospitalized patients were collected,and the patients were divided into two groups according to if the NAFLD was complicated or not?Group A was T2DM with NAFLD and group B was T2DM without NAFLD?The general information and the laboratorial checking results were Compared, then various index were used as the independent variable, DR was used as the dependent variable for Logistic regression analysis?Results (1)In the 517 cases of T2DM patients,the incorporative rate of the NAFLD was 65?7%(349/517)?(2)Compared with group B,the levels of body mass index(BMI),insulin resistance index (HOMA?IR),glutamyltransferase(GGT),alanine aminotransferase(ALT),aspartate aminotransferase(AST), triglyceride(TG),total cholesterol(TC),low?density lipoprotein cholesterol(LDL?C) and uric acid(UA) for group A were significantly increased, while the high?density lipoprotein cholesterol ( HDL?C ) level was significantly decreased?All the differences were statistically significant( P<0?05)?( 3) Logistic analysis showed that the duration of the extension,hypertension,the increasing level of NAFLD,LDL?C were the risk factors of DR?Even though excluded the influence of duration,high blood pressure and LDL?C level,NAFLD was still the risk factor for T2DM complicated by the DR( OR=2?176,95% CI ( 1?354,3?199) )?Conclusion NAFLD and DR are closely related, so early diagnosis and intervention of NAFLD may prevent the occurrence and development of DR.

Objective To explore the expressions of endoplasmic reticulum stress (ERs) related factors including inositol requiring enzyme-1α(IRE1αα),p-IRE1 α,c-jun N-terminal Kinase(JNK),and p-JNK in rats with non-alcoholic fatty liver disease,and to investigate the effect of intervention with glucagon-like peptide 1 (GLP-1) analogue.Methods Forty male Sprague-Dawley rats were divided into normal chow group(n =15) and high-fat diet group(n=25).After 12 weeks,5 rats of each group were used to assess the establishment of rat models with non-alcoholic fatty liver disease.Then the high-fat diet group rats were divided into high-fat diet group (HF,n =10) and GLP-1 group(HG,n=10) and treated with normal saline and GLP-1 analogue for4 weeks respectively.Body weight and biochemical markers in rats were measured.The expressions of IRE1α,p-IRE1α,JNK,and p-JNK were measured by Western blot.Results Compared with the NC group,the levels of body weight,plasma triglyceride (TG),total cholesterol (TC),low density lipoprotein-cholesterol (LDL-C),alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in HF group were significantly higher (all P ＜ 0.01),high density lipoprotein-cholesterol(HDL-C) was decreased(P＜0.01),and p-IRE1 α/IRE1 α and p-JNK/JNK were increased(P＜0.05 and P＜0.01).After GLP-1 treatment,body weight,plasma TG,TC,LDL-C,AST,ALT in HF group were significantly lowered(P＜0.05 or P＜0.01),HDL-C was increased(P＜0.01),p-IRE1 α/IRE1 α and p-JNK/JNK were decreased (P＜0.05 and P＜0.01).Conclusion GLP-1 analogue may improve hepatic steatosis via regulating ERs related IRE1 α-JNK signaling pathway.

OBJECTIVETo investigate the clinical efficacy of Panlongqi tablet (Chinese characters) combined with lumbar facet joint release for lumbar spinal stenosis of type Fengshi Bizu (Chinese characters).

METHODSSince February 2012 to February 2013, 120 patients with lumbar spinal stenosis of Fengshi Bizu (Chinese characters) syndrome were retrospectively studied. According to different treatment methods, 120 patients with lumbar spinal stenosis were divided into Panlongqi tablet (Chinese characters)group and control groups, respectively. In Panlongqi tablet (Chinese characters)group, 60 patients were treated by Panlongqi tablet (Chinese characters) combined with lumbar facet joints release solution including 26 males and 34 females with an average age of (60.40±3.36) years old ranging from 46 to 65 ; the course of the disease was 2 to 15 years (averaged 7.6 years). In control group the other 60 patients were treated with lumbar facet joint release including 24 males and 36 females with an average age of (61.20±2.47) years old ranging from 48 to 63; the course was 3 to 14 years (averaged 6.9 years). The clinical effect of patients were evaluated by JOA and ODI score before treatment, at 4 weeks and 3 months after treatment.

RESULTSAll patients were followed up for 4 to 7 months (means 5.6 months). After 3 months,7 cases in control group recurrenced symptoms,only 1 case in Panlongqi tablet (Chinese characters) group recurrenced. At 4 weeks and 3 months of follow-up, ODI score and JOA score of Panlongqi tablet group were much better than those of the control group.

CONCLUSIONFor lumbar spinal stenosis of type Fengshi Bizu (Chinese characters),which were treated with lumbar facet joint release with Panlongqi tablet(Chinese characters), supplemented by back muscle exercise, in relieving waist and low back pain symptoms and improving functional status of lower lumbar spine, can obtain satisfactory clinical outcome, is a good method of conservative treatment for such diseases.

Aged ; Combined Modality Therapy ; Drugs, Chinese Herbal ; administration & dosage ; Exercise Therapy ; Female ; Humans ; Lumbosacral Region ; physiopathology ; Male ; Middle Aged ; Punctures ; Retrospective Studies ; Spinal Stenosis ; drug therapy ; physiopathology ; therapy

In this study, the ameliorative effects of Flos Abelmoschus manihot on mice with chronic inflammatory bowel disease (IBD) were investigated and its effects on the structure of the intestinal flora as well as the lipid profile in feces of IBD mice were analyzed. All animal welfare and experimental procedures followed the regulations of the Animal Ethics Committee of Nanjing University of Chinese medicine. A mouse model with chronic IBD induced by dextran sulfate sodium (DSS) was used to evaluate changes in body weight, disease activity index (DAI), colonic histopathological damage as well as gene expression levels of inflammatory factors in the colon. Fecal samples from mice in each group were collected and subjected to Illumina high-throughput sequencing to detect the abundance of intestinal flora; samples were analyzed by UHPLC-Q-Exactive^® HF Quadrupole-Orbitrap^® of untargeted lipidomics, which detects lipid content in feces. Administration of Flos Abelmoschus manihot could significantly restore the body weight and ameliorate colonic histopathological damage in IBD mice. Sequencing of the gut microbiota revealed that the species diversity and richness of the gut microbiota in IBD mice were decreased, with a significant increase in the abundance of Verrucomicrobia and a significant decrease in the abundance of Bacteroidetes; Flos Abelmoschus manihot significantly increased the richness and diversity of intestinal microbiota in IBD mice, increased the number of taxa species at each level, and restored the abundance of bacteria in the phylum Bacteroidetes. Analysis of fecal lipid profiles identified the most significant changes in sphingolipid and glycerophospholipid metabolic pathways in IBD mice, with Flos Abelmoschus manihot inhibiting ceramide and sphingomyelin synthesis in sphingolipid metabolism. In summary, Flos Abelmoschus manihot can effectively improve the disease condition of mice with chronic IBD, and it has the effect of regulating intestinal flora homeostasis and lipid metabolism, but the related mechanism between the two still needs to be deeply explored.

Objective To explore the possible relationship between environmental contamination by Aspergillus and invasive aspergillosis.Methods From November 2005 to October 2006,samples were collected from the environment (air in corridors,air in wards,surfaces and tap water) twice a month,and from patients (nose,pharynx and sputum) at a liver transplantation department (LTD),neurologic surgery intensive care unit (NSICU) and central intensive care unit (CICU) in our hospital,and subjected to fungal culture.The Aspergillus density was determined in these environments.The isolates of Aspergillus flavus were genotyped by random amplification of polymorphic DNA (RAPD) assay to investigate the origin of infection.Results The mean aspergillus density was 12,10.75,0 and 20 cfu/m~3 at LTD,NSICU,CICU and corridors respectively.The five most prevalent species of aspergillus in these environments in decreasing order were Aspergillus flavus,Aspergillus fumigatus,Aspergillus niger,Aspergillus versicolor and Aspergillus clavatus.RAPD demonstrated that the genotypes ofA.flavus isolated from two patients were identical to those of the environmental strains in NSICU.The A.flavus genotypes from 3 patients in CICU were all different from those of the environment strains in CICU,but the genotypes were identical from two of the three patients.Conclusions Aspergillus contamination of different degree does exist at LTD,NSICU and CICU. The genotypes of A.flavus are identical from patients and environment in NSICU,suggesting that the clinical infection may originate from hospital environment.

To observe the effects of total flavones of Metasequoia glyptostroboides Hu et Cheng (TFM) on volume-overload cardiac hypertrophy and the expression of c-Fos protein in rat. Methods　Volume-overload cardiac hypertrophy of rat was induced by aortocaval shunts. The rats were given ig TFM (400, 40 and 4 mg/kg/d). c-Fos protein in the ventricles were measured by immunocytochemical study. Results　TFM at the above dosage decreased heart weight and contents of RNA and protein in the myocardium, inhibited the expression of c-Fos protein in the ventricles. Conclusion　TFM can prevent volume-overload cardiac hypertrophy in rats. The inhibitory effects on the expression of c-Fos protein may be its mechanism in the molecular level.

Aging can cause degenerative changes in the function of multiple tissues and organs in the body. Gastrointestinal diseases and intestinal dysfunction are very common in the elderly people. The purpose of this study is to explore the effect of the total extract of Astragalus membranaceus (Fisch.) Bge. on intestinal function and gut microbiota homeostasis in natural aging mice, which will provide clues for further mechanism study. The natural aging mice model is established and animal experiments follow the regulations of the Animal Ethics Committee of Nanjing University of Traditional Chinese Medicine. The overall health of the mice was evaluated by the "frailty index" scoring method. The intestinal absorption and transport function were measured by detecting intestinal glucose absorption capacity, transport time, lipase and amylase activities of aging mice. Intestinal inflammation was assessed by detecting inflammatory cytokines by enzyme-linked immunosorbent assay (ELISA). The pathological changes in the intestines of aging mice were tested by hematoxylin-eosin (H&E) staining and alizarin blue (AB) staining. The qRT-PCR method was used to explore the gene transcription level related with the proliferation and differentiation of intestinal stem cells. Microbiota analysis based on 16S rDNA were used to evaluate the composition of gut microbiota. The results showed that Astragalus had a tendency to reduce the "frailty index" of aging mice, but did not show a significant difference. In some indicators of aging phenotype, Astragalus has the most significant effect on hair loss and physical fitness. In terms of intestinal function, Astragalus could increase intestinal glucose absorption capacity, shorten intestinal transportation time and promote lipase secretion in aging mice. The levels of inflammatory cytokines such as tumor necrosis factor-α (TNF-‍α) in the aging intestinal tissue were reduced after Astragalus administration. Astragalus also ameliorated the pathological degeneration of the intestinal tissue of aging mice by increasing the length of small intestinal villi, the thickness of colonic mucosa and goblet cell number. In addition, Astragalus elevated the expression of genes associated with the proliferation and differentiation in jejunum and modulated gut microbiota, especially restoring the abundance of Lachnospiraceae. Taken together, the above research results demonstrate the total extract of Astragalus as a key factor improving the intestinal function and gut microbiota homeostasis of aging mice.

Objective: To observe whether liraglutide protects HepG2 cells from lipotoxicity by affecting mitogen-activated protein kinase (MAPKs) pathway. Methods: HepG2 cells were induced with 400μmol/L palmitic acid, and cells were treated with a final concentration of 100 nmol/L liraglutide. In addition, JNK inhibitor (SP600125) and p38 MAPK inhibitor (SB203580) were added in advance, respectively. Apoptosis rate, malondialdehyde (MDA) content, and caspase3 activity were detected. Western blot was used to detect p38 mitogen-activated protein kinase (p38 MAPK), c-jun amino terminal kinase (JNK), cytochrome oxidase P450 2E1 (CYP2E1), glucose regulatory protein 78 (GRP78), activated caspase 3, B cell lymphoma associated Protein X (Bax), B cell lymphoma 2 (Bcl-2), and expression of C/EBP homologous protein (CHOP) protein. LSD or Dunnett’s T3 test were used to compare the mean of multiple samples. Results: Palmitic acid increased the phosphorylation of p38 MAPK and JNK in HepG2 cells (P< 0.05). Furthermore, it increased the expression of GRP78, CHOP, CYP2E1, MDA, Bax, caspase3 and apoptosis rate, but inhibited the expression of Bcl-2 (Pvalue < 0.05). SP600125 and SB203580 had inhibited oxidative stress and apoptosis induced by palmitic acid (including CYP2E1, MDA, Bax, Bcl-2, caspase3, CHOP) (P< 0.05). The phosphorylation level of p38 MAPK and JNK was reduced with liraglutide and the expression of apoptosis-related proteins (Bax, Bcl-2, caspase3, CHOP) (P< 0.05) was regulated. There was no significant difference in the effect of liraglutide on apoptotic proteins (Bax, Bcl-2, caspase-3, CHOP) (P> 0.05) after pretreatment with those two inhibitors. Conclusion Palmitic acid has strong lipotoxicity to HepG2 cells and induces apoptosis. Glucagon-like peptide-1 analogue, liraglutide may improve lipotoxicity of palmitic acid by mediating p38 MAPK and JNK pathways.

OBJECTIVETo discuss the pathological and clinical characteristics,methods of therapies and perioperative considerations of cervicothoracic spinal fractures and dislocations in patients with ankylosing spondylitis (AS).

METHODSThirteen patients with ankylosing spondylitis and cervicothoracic spinal fractures and dislocations were treated from January 2001 to March 2009, including 11 males and 2 females,aged varied from 33 to 60 years (mean 46) in 11 males and from 36 to 59 years (mean 47.5) in 2 females respectively. The symptom duration of AS was from 12 to 27 years (means 14.5 years). The chief complains were pain around cervical part and shoulder blades, some accompanied with decrease of motor power and sensation in upper or lower limbs. Spine radiographs revealed a displaced fracture of cervicothoracic spine. Laboratory examination presented positive results of HLA-B27 test. Fusion of fracture and ASIA neurological function grade variation were observed.

RESULTA total of 13 patients, who underwent operation, were followed up for 12 to 43 months(means 35.6 months). There were 6 patients were treated with anterior cervical discectomy and fusion, 4 with anterior cervical corpectomy and fusion, 1 with laminectomy and fusion and 2 with combined anterior and posterior stabilisation. The bone fusion were observed after reduction of fractures and dislocations ultimately. Twelve patients acquired an improved neurological status in different degrees, and only one suffered from persistent neurological impairment loss. The complications occurred in 5 cases during perioperation.

CONCLUSIONThis study suggests that most cervicothoracic spinal fractures and dislocations in patients with AS are extremely unstable and require operations. If operative method is proper and operative process accurate, either anterior,posterior or combined approach can achieve good spinal myeloid functional recovery with low rates of operative complications occurrence, under the guidence of imaging manifestation.

Adult ; Cervical Vertebrae ; injuries ; surgery ; Female ; Humans ; Joint Dislocations ; diagnosis ; surgery ; Male ; Middle Aged ; Spinal Fractures ; diagnosis ; surgery ; Spondylitis, Ankylosing ; complications ; Thoracic Vertebrae ; injuries ; surgery

OBJECTIVETo compare open and arthroscopic methods for treatment of recalcitrant lateral epicondylitis.

METHODSA prospective trial of 26 patients (28 elbows) with recalcitrant lateral epicondylitis were treated between May 2006 and September 2008. The mean duration of conservative care was 23. 0 months (4 - 60 months). The mean follow-up was 17.4 months (4 - 32 months). The patients were randomized divided into two groups, 13 elbows with an open Nirschl procedure and 15 with an arthroscopic Nirschl procedure. All patients had pre- and post-operative assessment using VAS (visual analog scale) scores, Mayo 12 points elbow scores, time of return to work or sports, satisfaction, and so on.

RESULTSThere were no significant differences in VAS scores at rest and activities of daily living, time of return to work or sports and satisfaction between the two groups. But there was a statistically significant difference in VAS scores at work and sports and Mayo 12 points elbow scores between the two groups. 100% of the patients had excellent or good results in the open group and 93.3% in arthroscopic group. There were no severe complications in this series.

CONCLUSIONSBoth open and arthroscopic Nirschl procedures are valid and reliable treatments for patients with refractory lateral epicondylitis. The patients in the open group have a better function in the return-to work and sports postoperatively than the arthroscopic group.

Adult ; Arthroscopy ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Orthopedic Procedures ; methods ; Prospective Studies ; Tennis Elbow ; surgery ; Treatment Outcome