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 relationship between infarct location and prognosis after emergency percutaneous coronary intervention (PCI) treatment in patients with acute myocardial infarction.Methods Consecutive 121 patients with ST elevation myocardial infarction (STEMI) who underwent primary PCI were divided into 3 groups according to the infarct location.Their clinical,ECG,echocardiography and coronary angiography features were analyzed,and the follow-up was made. Results Compared with inferior wall infarction group and inferior wall infarction combined with right ventricular infarction group,anterior wall myocardial infarction group had higher CPK-MB and cTnT,less frequent collateral,reduced ST-segment resolution,higher mortality rates in hospitalization and one year after discharge.On the other hand,inferior infarction combined with right ventricular infarction group had more occurrences of shock and atrial vetricular block or ventricular arrhythmia,more incidence of multivessel disease and thrombus,and higher readmission rate.Conclusion Patients with anterior wall myocardial infarction and inferior wall in

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 analyze the risk factors for perioperative acute cerebral vascular accident (PACVA) and put forward the corresponding preventive measures.Methods The clinical data of elderly patients in our hospital who suffered from PACVA in recent 5 years were retrospectively studied.The correlation between risk factors and the occurrence of PACVA was analyzed.Results One hundred and fifty cases were enrolled in the study.Seventy eight cases of them suffered from PACVA with the average age of 70 years ranging from 60 to 98 years.Fifty six cases(71.8%)were found PACVA in one week after operation.Multiple regression analysis showed that hypertension, history of cerebrovascular disease, unstable blood pressure and obesity were independent risk factors for PACVA.The newly diagnosed perioperative atrial fibrillation and carotid atheroselerosis were the high risk factors for PACVA.Conclusions PACVA is one of the common perioperative complications.Necessary check, monitor and treat measures should be taken in the perioperative period, especially for patients with risk factors.

Objective To assess the value and clinical applicability of non-treponemal antigen serologic test and Treponema pallidum antigen serologic test in the diagnosis of congenital syphilis. Methods Totally,7800 newborns were collected from the out-patient and in-patient department. Toluidine red unheated serum test (TRUST) was conducted to quantitatively detect non-treponemal antibodies and Treponema pallidum particle agglutination assay (TPPA) to qualitatively detect specific treponemal antibodies in these subjects. The results of first serology test for syphilis were assessed for neonates with confirmed congenital syphilis. The sensitivity and specificity in the diagnosis of congenital syphilis were compared between TPPA and TRUST.Results Of the 7800 newborns undergoing syphilis serology testa, 60 were positive for TPPA and TRUST,including 15 cases of congenital syphilis, 47 were positive for TPPA but negative for TRUST, including 5 cases of congenital syphilis. The sensitivity and specificity were 75% (5/20) and 99.41% (7734/7780) respectively for TRUST in the diagnosis of congenital syphilis, 100% (20/20) and 98.88% (7693/7780) respectively for TPPA. Conclusion TPPA seems more applicable than TRUST to the screening for congenital syphilis.

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 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.