Thiazolidinedione (TZD) is a powerful insulin sensitizer in the treatment of type 2 diabetes. It acts as a ligand to the nuclear receptor PPARγ (peroxisome proliferator-activated receptor-gamma) and induces transcription of PPARγ responsive genes. TZD controls lipid synthesis and storage in adipose tissue, liver and many other tissues through PPARγ. Derivatives of TZD, such as rosiglitazone (Avandia) and pioglitazone (Actos), are more powerful than metformin or berberine in insulin sensitization. Although they have common side effects such as weight gain and edema, these did not influence the side effects in general. However, recent findings of risk for congestive heart failure and bladder cancer have indeed significantly impaired their future in many countries. European countries have prohibited those drugs and in 2011, US will terminate application of rosiglitazone in clinics and hospitals. The multiple country actions may mark the end of TZD era. As a result, there is a strong demand for identification of TZD substitute in the treatment of type 2 diabetes. In this regard, literature about PPARγ ligands and potential TZD substitute are reviewed in this article. Histone deacetylase (HDAC) inhibitor is emphasized as a new class of insulin sensitizer here. Regulators of SIRT1, CREB, NO, p38, ERK and Cdk5 are discussed in the activation of PPARγ.

WGA-HRP was injected into the inferior colliculus in the rat in order to study the non-auditorial afferents of the inferior colliculus. In the diencephalon and truncus encephali, retrograde labeling was observed in many non-auditorial regions: bilateral (with contralateral predominance) cuneate nucleus, gracile nucleus, nucleus of spinal tract of trigeminal nerve, nucleus medullae oblongatae centralis dorsalis; bilateral (with homolateral predominance) locus ceruleus, nucleus reticularis pontis oralis, laterodorsal tegmental nucleus, substantia nigra, sub-parafascicular nucleus, perifornical nucleus; bilateral medial parabrachial nucleus, deep tegmental nucleus of midbrain, lateral hypothalamic area; homolateral deep layer of superior colliculus, zona incerta; contralateral nucleus of solitary tract; and posteromedian septum, central tegmental nucleus, dorsal nucleus of the raphe. The afferent neurons from cuneate nucleus, gracile nucleus, nucleus of spinal tract of trigeminal nerve, nucleus of solitary tract mainly located below the level of obex. The results mentioned above suggested that the inferior colliculus is not only an auditorial relay nucleus, but also a complex body which is of different functions.

Objective To study the clinical efficacy and safety of oxymatrine in auxiliary treatment of hepati-tis B virus(HBV) related primary hepatocellular carcinoma (PHC).Methods 345 patients were divided into treat-ment group (174 cases) and control group (171 cases).The control group was given hepatic artery chemoemboliza-tion therapy.The treatment group added with oxymatrine.The near future curative effect of solid tumor and patients'immune function,liver function,the improvement of the quality of life change,and adverse reaction were observed. Results KPS score of the treatment group was better(Z =-3.296,P <0.05),more significant in the near future curative effect of solid tumor (χ2 =4.676,P <0.01).The immune function of the treatment group was significantly improved [ Within group: t(treatment group:CD3) = 2.544, t(treatment group:CD4) =2.446, t(treatment group:CD8) = 2.745, t(treatment group:CD4 /CD8) =2.873,t(treatment group:NK) =2.542,t(control group:CD3) =2.614,t(control group:CD4) =2.337,t(control group:CD8) =2.545,t(control group:CD4 /CD8) =2.336, t(control group:NK) =2.672, P <0.05; Between groups: t(after treatment:CD3) =2.947, t(after treatment:CD4) =2.846,t(after treatment:CD8) =2.943,t(after treatment:CD4 /CD8) =2.879,t(after treatment:NK) =2.798,P <0.01].In the treatment group,the effect was more significant in the improvement of ALT,HBV -DNA,AFP[Within group:t(treatment group:ALT) =2.676,t(treatment group:HBV -DNA) =2.682,t(treatment group:AFP) =2.611,P <0.01,t(control group:ALT) =2.556, t(control group:AFP) =2.523,P <0.05,t(control group:HBV -DNA) =1.216,P >0.05;Between groups:t(after treatment:ALT) =2.417, t(after treatment:AFP) =2.432,P <0.05,t(after treatment:HBV -DNA) =2.674,P <0.01].Two groups appeared adverse reaction after chemotherapy,digestive system and hematopoietic system anomaly,the incidence rates of adverse events in the treatment group were lower than those in the control group (χ2 2 2 white blood cel s decreased =46.969,χthe pain =46.977,χheating =22.499,χ2nausea,vomiting =88.749,P <0.05).Conclusion The oxymatrine auxiliary treatment for HBV related PHC has curative effect,safe and reliable,and can significantly improve the patients quality of life,it is worth promoting.

This paper reports the post-operative care of 41 patients with Chiari malformation associated with syringomyelia. The nursing points included postoperative vital signs monitoring,management of the body posture and incision,observation of complications. Among these patients,21 of them had cerebrospinal fluid leakage,3 of them had cranial nerve palsy,a patient suffered from acute respiratory arrest caused by brainstem edema. Patients recovered and discharged after active appropriate treatment and care.

Objective To investigate the clinical features of Kawasaki disease.Methods A retrospective analysis was performed in 272 children diagnosed as Kawasaki disease from 2002 to 2006.Clinical data,laboratory findings and auxiliary examination results were collected for these patients.Results The male-to-female ratio Was 2.58:1.Onset ages between 1 to 3 years accounted for 59.2%of patients.Of these patients,100%had a fever for more than 5 days,76.1%transient polymorphous exanthema,74.6% bilateral conjunctival hyperemia,47.8%flare and fissure on the oral lip,58.5%strawberry tongue,22.8% firm swelling of hands and feet as well as flushing of palms and soles,3 1.2%subacute desquamation at the junctional site between nail bed and skin,36%cervical lymphadenopathy.Laboratory findings showed a significant increase in the count of peripheral blood leukocytes and pefipheral blood platelets as well as erythrocyte sedimentation rate in 80.5%,87.5%and 96.2% of Patients,respectively.Additionally,81.6%of these patients were positive for C reactive protein and the frequency of coronary aaery involvement was 54.3%.All patients were treated with aspirin,and high-dose intravenous immunoglobulin was given to 258 patients.Fever relieved and the condition was controlled in all patients with an average hospitalization period of 8.9 days.Conclusions Kawasaki disease should be suspected in Patients with exanthematous lesions,fever lasting for more than 5 days and poor response to antibiotic therapy.Peripheral blood platelet count and cardiac ultrasound are of great value in the diagnosis of Kawasaki disease.Aspirin iS the first choice in treating Kawasaki disease,and adjunctive high-dose intravennous immunoglobulin treatment may facilitate the quick control offever.

Objective To investigate the expression of Signal transducer and activator of transcription 2 (STAT2) gene in the peripheral blood mononuclear cells of patients with systemic lupus erythematosus, and to evaluate the possible connections between STAT2 gene expression levels and clinical features. Methods One hundred and forty-four SLE patients, 27 non-SLE patients with other rheumatisms and 58 normal controls were recruited for this research, and the subjects were surveyed for clinical data collection. SYBR Green Dye based real-time quantitative PCR method was used to compare the expression levels of STAT2 in patients with SLE and those in the controls. The correlation of the gene expression levels and disease activity and specificity was studied. Results STAT2 expression levels (5.2±1.7) in SLE patients were remarkably higher than those in non-SLE patients and normal controls (4.3±1.1, 4.5±1.2, P<0.01 in both). The expression levels of STAT1 were increased in active SLE patients(5.2±1.5), comparing with those observed in inactive SLE patients (4.8±2.9, P<0.01), and expression levels of STAT1 in SLE patients were negatively correlated with C3 levels in sera (r=-0.449, P<0.01) whereas were positively correlated with SLEDAI-2K score and 24 hour urine protein (r=0.317, 0.309, P<0.01 in both). Conclusion Over-expression of STAT2 gene in the peripheral blood cells is linked with the pathogenesis of systemic lupus erythematosus, and the elevated expression level of STAT2 is correlated with SEE disease activity.

A girl who aged eight years and seven months presented with prunosus patches on the right buttock for 8 years,gradual unilateral enlargement of the right lower limb for more than 7 years,and multiple vegetations for 1 year.Dermatological examination showed nevus flammeus and multiple malodorous vegetations over the right lower limb with high skin temperature.The right lower limb was thicker and longer than the left lower limb.X-ray examination,magnetic resonance imaging and Doppler ultrasound examination revealed high-flow vascular malformations.Pathological examination of the vegetations showed vascular proliferation,fibroblast proliferation and erythrocyte extravasation.She was diagnosed as Parkes-Weber syndrome accompanied by pseudo-Kaposi's sarcoma.

Objective To investigate the feasibility, safety and efficiency of endovascular treatment for patients with aorto-bilateral-iliac artery total occlusive disease.Methods A total of 35 patients with aorto-bi-iliac artery total occlusive disease treated with endovascular therapy in Peking Union Medical College Hospital and the First Hospital of Shijiazhuang between Jan 2012 and Dec 2013 were retrospectively analyzed.Results There were 33 males and 2 females, mean age (67 ± 6) years treated during the study period.Technical success rate was 100％.129 bare stents and 4 covered stents were implanted.There were no peri-operative death.Postoperative leg ankle brachial index (ABI) improved significantly (0.86 vs.0.28, P ＜ 0.28).Postoperative complications occurred in 2 patients (5.7％), including brachial artery thrombosis and rupture of external iliac artery post-dilation.The mean follow-up period was 16.5 months (2-28 months).Two patients (5.7％) were lost to follow up.Re-intervention was performed in 3 patients (8.6％) due to reocclusion of the stents.Primary patency was 91％ (30/33) Conclusions Endovascular treatment is effective for aorto-bi-iliac artery total occlusive disease with low complications and acceptable mid-term patent rate.

Objective To study the clinical feature, diagnossis and therapy of open spinal cord injury. Methods A retrospective study was performed in 15 patients with open spinal cord injury including 14 males and one female, at age range of 15-46 years (mean 23 years). There were two patients with open cervical spinal cord injury, 11 with open thoracic spinal cord injury and two with open lumbar spinal cord injury. Injury causes included sharp knife injury in 12 patients, firearm injury in two and stick stabbing in one. According to ASIA scale, there was one patient at Grade A, two at Grade B, seven at Grade C, four at Grade D and one at Grade E preoperatively. Foreign bodies were found in the wound in four patients. There were three patients combined with spinous process fracture, eight with vertebral plate fracture and five with vertebral body fractures. All 15 patients were treated by emergency management including vertical canal exploration, hematoma debridement or foreign body removal. Results Postoperative complications included cerebrospinal fluid leakage in two patients and wound infection ( without spinal cord infection) in one. There were different degrees of neural functional recovery in five patients. The post-operation ASIA scale: one patient at Grade A, three at Grade C, 10 at Grade D and one at Grade E,with no patient at Grade B. Conclusions For open spinal cord injury, emergency operation is necessary under adequate preoperative preparation. Preoperative identification of foreign bodies, exploration and decompression are beneficial to spinal cord function recovery and reduction of the incidence rate of postoperative complications like infection or hemorrhage.

Objective:To establish the quality standard for Tongduhuoxue Tablets.Methods: Radix Salvia miltiorrhiza and Rhizoma Corydalis in this prescription were identified by TLC. Tanshinone Ⅱ A was determined by HPLC and astragaloside was determined by dual wavelength TLC Scanning.Results:Radix Salvia miltiorrhiza and Rhizoma Corydalis could be detected by TLC. Determination method of tanshinone Ⅱ A and astragaloside was linear at the range of 0.04 ～ 0.8 ?g( r= 0.99998 ,n=7 ) and 0.3 ～ 6.0 ?g( r= 0.9991 ,n=7 ),average recovery was 98.6% ( RSD= 1.1% ,n=5 ) and 97.7% ( RSD= 1.8% ,n=5 ),respectively. Conclusions: The established method is accurate and reproducible. This study provides a method for the quality control of Tongduhuoxue Tablets.