Objective To evaluate the status of abnormal glucose metabolism in patients being alive over 3years after liver transplantation and discuss the possible mechanism of post-transplant diabetes mellitus ( PTDM ).Methods In this study, the clinical data of patients with liver transplantation were collected from April 2001 to December 2008. Patients with diabetes mellitus before operation and those who had died and failed to appear during follow-up were exluded. 199 patients living over 3 years after liver transplantation were follow-up. The prevalence of PTDM was evaluated according to fasting plasma glucose(FPG). Among those without diabetes according to FPG,32patients underwent 75 g oral glucose tolerance test (OGTT) , and fasting and 2 h plasma glucose and insulin were determined. 32 patients were divided into three groups [normal, impaired glucose regulation ( IGR ) , and PTDM groups], proportion of PTDM and homeostasis model assessment ( HOMA ) index were calculated. Results In patients alive over 3 years after liver transplantation, the prevalence of PTDM was 34.67% according to FPG. The OGTT result showed that the proportion of PTDM was 9.38%, IGR, including impaired fasting glucose(IFG) and impaired glucose tolerance ( IGT ) , was 56. 25% , while 34. 37% remained normal. The homeostasis model assessment β cell function index( HOMA-β ) decreased progressively from normal group, IGR group to PTDM group,and that in PTDM group was significantly lower than those in normal and IGR group( P＜0.01 ). IGR group had the highest homeostasis model assessment for insulin resistance (HOMA-IR) and PTDM group the next, and HOMA-IR in IGR group was significantly higher than normal group. Conclusion In patients alive over 3 years after liver transplantation, the prevalence of PTDM reached 44.05%. Insulin resistance existed during early period of impaired glucose regulation, while the degeneration of β cell progressed with the worsening of impaired glucose regulation.

The response of murine lymphoreticular tissue with Special reference to regional lymph node after implantation of Ehrlich ascites carcinoma cells was investigated histologically and ultrastructurally. The tumor induced a vigorous histological response in both regional and nonregional lymph nodes that was proliferation of immunoblasts with enlargement of paracortical area in early stage and enlargement, fusion of germinal centers with an increased number of plasma cells in the medullary cords during the late stage of tumor growth.The results suggested that the response of lymph nodes might be mainly related to cell-mediated immune mechanism in the early stage and humoral immunity during the late stage of tumor growth. Regional lymph node gave reaction earlier and more vigorously in participating cell-mediated immunity, nonregional lymph node might be more significantly involved in humoral immunity. It was observed ultrastructurally that sinus histiocyte engulfed tumor cell in which the cooperation with lymphocyte might be necessary. The experimental results indicated that the increased number of immunoblast in paracortex may be considered as an indicator for antitumor cellmediated immunity with an important prognostic significance for host bearing tumor.

ObjectiveTo explore the long-term fluctuation of fasting plasma glucose (FPG) and its effect on prognosis in patients surviving for more than 1 year after renal transplantation.MethodsFour hundred and forty-six patients underwent kidney transplantation from January,1993 to December,2008.According to preoperative FPG levels,patients were divided into diabetic,impaired fasting glucose (IFG),and normal fasting glucose (NFG)groups. The changing trend of FPG level was observed and analyzed. For 428 non-diabetic patients before transplantation,the prevalence and different outcomes of post-transplantation diabetes( PTDM ) according to FPG after transplantation were analyzed.The characteristics of the patients with persistent PTDM ( P-PTDM ) and transient PTDM (T-PTDM) were compared.The incidence of complications and patient survival between the PTDM group and non-PTDM groups were also compared.ResultsFPG level was increased early and then decreased in patients after renal transplantation.Of the 428 patients,87 developed into PTDM ( 20.3％ ) including 15 T-PTDM patients ( 17.2％ of total PTDM ),who eventually recovered to NFG or IFG.Compared with P-PTDM group,the incidence of acute rejection episodes was higher for T-PTDM ( P =0.043 ).The incidence of infections,hypertension,and dyslipidemia within the first year,was higher in PTDM group compared with non-PTDM group but patient survival was not different within a mean follow-up of ( 5.65 ± 3.68 ) years.ConclusionPTDM will not be permanent and may recover to NFG or IFG in the course of the disease.Acute rejections are associated with the onset of T-PTDM.The overall patient survival is not affected by PTDM,although complications,such as infections,hypertention,and hyperlipidemia are more frequently encountered in PTDM patients.

A cerebral arteriovenous malformation is a congenital disorder characterised by an abnormal connection between the arteries and the veins in the brain. It causes intracranial bleeding, seizures, severe headache, and progressive neurological deficits. The therapeutic strategies were usually established on the basis of clinical experiences due to lack of ideal models of arteriovenous malformation in the past .In order to further increase the success rate of surgery and decrease complications, this article reviews the advances in establishment and application of animal models of cerebral arteriovenous malformation in recent years.

Objective To investigate the clinical and MR features of fungal encephalopyosis and fungal granuloma.Methods The clinical and MR data of 10 cases with fungal encephalopyosis and fungal granuloma confirmed by surgical pathology or clinical serum were analyzed retrospectively.Then we analyzed the clinical conditions,MR signals,lesion enhancement,DWI and MRS performance characteristics of the 10 cases.Results Six cases were fungal encephalopyosis,among which 2 cases occurred in the sella turcica after surgery which located in and above the sella turcica.2 cases occurred in the frontal lobe after frontal surgery and 1 case of them was multiple encephalopyosis.2 cases of encephalopyosis without operation history were located in the left frontal lobe and right cerebellum respectively.The abscess walls of these cases were thin and showed high tension.Furthermore,it had annular significant signal enhancement and high signal in DWI scan.One case of huge fungal granuloma located in the frontal lobe and into the sinuses which showed uneven signal enhancement. The Cho level was significantly increased.Three cases of cryptococcal granuloma showed multiple lesions located in the bilateral basal ganglia region and 2 out of them accompanied with cephalomeningitis.Conclusion The MR performance of fungal encephalopyosis was quite similar with bacterial brain abscesses,which makes the differential diagnosis difficult.The brain fungal granuloma MRS may display a significant increase of Cho level which might be related with gliosis.It shows certain characteristics of brain MR performance of cryptococcal granuloma which are multiple lesions,preferential distribution of basal ganglia region and accompanying cephalomeningitis.

Cerebral Hemorrhage ; diagnosis ; Cerebral Infarction ; diagnosis ; Diagnosis, Differential ; Humans ; Medicine, Chinese Traditional

Objective To investigate the glycemic fluctuation and endothelial function in patients of coronary heart disease complicated with type 2 diabetes mellitus (T2DM).Methods Fifty eight patients with coronary heart disease were enrolled in the study,including 40 cases complicated with T2DM (group A) and 18 cases without T2DM (group B).All subjects underwent continuous glucose monitoring system (CGMS) and high-resolution ultrasound detection on brachial artery for endothelium-dependent flowmediated dilatation (FMD).According to the results of CGMS,patients with 3 times of standard deviation of blood glucose (SDBG) less than a mean blood glucose in group A were classified as low glucose excursion group (group A1 ),others were classified as high glucose excursion group (group A2 ).The association of glucose fluctuation with FMD in group A was analyzed.Results Compared to group B,the levels of mean amplitude of glycemic excursions (MAGE),the largest amplitude of glycemic excursions (LAGE) and mean postprandial glucose excursion (MPPGE) were elevated and the levels of FMD were lower in group A1 and A2 (P ＜0.05).Compared to group A1 the levels of MAGE,LAGE,MPPGE and absolute means of daily differences were significantly higher [(5.4 ±0.9) vs.(3.7±0.4),(6.3 ± 1.8) vs.(4.6 ±0.8),(4.7±1.0) vs.(3.5±1.2),(2.45 ±0.75) vs.(1.81 ±0.66)mmol/L,respectively]and the FMD levels were lower [ (3.2 ± 1.0) vs.(5.2 ± 1.2) ％ ]in group A2 ( all P ＜ 0.05 ).All CGMS parameters were significantly correlated with FMD in group A2 (P ＜ 0.05 ).Multiple stepwise regression analysis showed that MAGE,systolic blood pressure were the independent impact factors of FMD.Conclusions Patients of coronary heart disease complicated with T2DM have prominent glycemic fluctuation and decreased FMD and the glycemic fluctuation may be associated with the impairment of FMD.

Objective To evaluate the sensitivity of three different clinical consciousness scales to patients with disorders of consciousness.Methods A total of 84 patients in vegetative state (VS) were selected and scored by the consciousness scales including Glasgow Coma Scale (GCS),Coma Recovery Scale-Revised (CRS-R) and Chinese Vegetative State Scale (CVSS) respectively.The patients were followed every 2 weeks for 12 weeks or every 4 weeks for 12-24 weeks.The assessment finished in 6 months or till the time when patients emerged from minimally conscious state ( MCS.The diagnostic sensitivity and the sensitivities of each sub-scale in CRS-R were evaluated when the patients with MCS emerged from VS.The diagnostic consistency with other scales was observed and analyzed by Spearman correlation as well.The Spearman -relate was used to analyze the correlations among the total scores of three scales in the patients on admission (36 patients with acute and 48 patients with chronic phase).Results Of 84 VS patients,there were 47 emerged to MCS.CRS-R was the most sensitive in the diagnosis of MCS (P ＜ 0.05 ) among all scales.The visual subscale is the most sensitive among all the CRS-R subscales ( P ＜0.01 ).Among the 84 patients,the remaining 37 were diagnosed as VS by all three scales.The total scores correlation analysis showed that the score of CRS-R significantly correlate with that of GCS in acute and chronic phase ( P ＜0.01 ) and significantly correlate with that of CVSS only in the acute stage ( P ＜ 0.05 ).Conclusions It is indicated that CRS-R,especially the visual subscale of CRS-R is the more sensitive tool for detecting.MCS during recovery process in the disorders of consciousness.As to the patients with deep unconsciousness and with no significant recovery,the three instruments are in good agreement to determine the degree of disorders of consciousness.It is suggested that CRS-R can be widely used to assess the level of consciousness in various stages.

Objective To observe the effects of ginkgolides on hypoxia tolerance in mice and on myocardial ischemia injury in rats.Methods The mice were given isoprenaline 20 mg/kg(ip) and the survival time of the mice model under the hypoxic condition was recorded. Rat myocardial ischemia was induced by subcutaneous injection of over- dosage isoprenaline(8 mg/kg). Before modeling, rats were pretreated with ginkgolides 10, 20, 40 mg/kg, of ginkgo biloba( EGb) Extract 300 mg/kg, Propranolol 5 mg/kg,or vehicle for four days. The histological changes of myocardiim, serum creatine phosphokinase (CPK) level and lactate dehydrogenase (LDH) activity, myocardial lactate dehydrogenase(LDH) and superoxide dismutase (SOD) content were detected.Results Ginkgolides could prolong the survival time in the mice under a hypoxic condition, lessen the isoprenaline- induced rat myocardial ischemia, inhibit the activities of serum CPK and LDH and the increase of MDA content in ischemic myocardial tissue, enhance superoxide dismutase (SOD) activity. Conclusion Ginkgolides enhance to hypoxia the tolerance in mice and prevent rats from myocardial ischemic injury. The protective mechanism may be related to its inhibition of the activity of platelet activating factor and oxygen free radical. 

Objective To investigate the effect of liraglutide on the expression of NF-kappa B (NF-κB), tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) in renal tissue of insulin resistance rats. Method The rats were divided into 4 groups, control group ,high fat group ,liraglutide low dose group [100 μg/(kg· d)], liraglutide high dose group[100 μg/(kg·d)]. Detection of serum creatinine and urea nitrogen by automatic biochemical analyzer, and 24 h urine micro albumin was determined by immunoassay. The protein concentration of serum NF-κB,TNF-α and IL-6 was measured by ELISA. The expression of NF-κB,TNF-α and IL-6 mRNA in renal tissues was determined by RT-PCR. Results Compared with the control group, the serum creatinine, blood urea nitrogen,urinary protein, and the expression of NF-κB, TNF-α and IL-6 were significantly higher in high fat group, respectively (P < 0.05). The glomerular basement membrance thickening and foot process fusion were seen under electron microscope. Liraglutide high dose intervention can significantly reduce these changes. Conclusions Liraglutide can inhibit the expression of NF-κB,TNF-α and IL-6 in renal tissues of high fat induced insulin resistance rats,in a concentration dependent manner, which possibly improve renal function.