AIM:To investigate the protection mechanisms of rosiglitazone on diabetic nephropathy.METHODS:Rat mesangial cells(MC) were incubated in media containing 5.5 mmol/L normal control glucose,25 mmol/L high concentration glucose,25 mmol/L glucose +20 ?mol/L rosiglitazone maleate.Cells proliferation were assessed by CCK-8.Synthesis of fibronectin(FN),type Ⅳ collagen(Col-Ⅳ),transforming growth factor-?1(TGF-?1) and matrix metalloproteinase inhibitor-1(TIMP-1) in supernatant were determined by ELISA method,the activities of matrix metalloproteinase-2,9(MMP-2,9) in supernatant were determined by gelatinase zymography.RESULTS:Compared with control group,MC cultured with high concentration glucose showed a high growth rate and increased synthesis of Col-Ⅳand FN,decreased the activities of MMP-2 and MMP-9,and increased secretion of TGF-?1 and TIMP-1.Compared with high glucose group,these changes could be reversed by rosiglitazone intervention.CONCLUSION:Rosiglitazone could inhibit high concentration glucose-induced proliferation of mesangial cells,decrease synthesis of extracellular matrix,and increase degradation of extracellular matrix.

AIM: To investigate the effects of fenofibrate(FB) and rosiglitazone(RG) on the signal passway of p38 mitogen-activated protein kinases(p38 MAPK) in glomerular mesangial cells cultivated in high concentration of glucose.METHODS: Rat mesangial cells(MC) were incubated in 5.5 mmol/L normal control glucose,25 mmol/L high glucose(HG),HG+100 ?mol/L fenofibrate(FB+HG),HG+20 ?mol/L rosiglitazone maleate(RG+HG),respectively.The fibronectin(FN) and type Ⅳ collagen(Col-Ⅳ) in supernatant were determined by ELISA.The expressions of p38MAPK and phospho-p38MAPK proteins in cytoplasm and nuclei were detected by Phospho-ELISA.The mRNA expression of p38MAPK was detected by semi-quantitative reverse transcription polymerase chain reaction(RT-PCR).RESULTS: Compared with normal control,the Col-Ⅳand FN in supernatant in HG group were much higher,the expression of p-p38MAPK was increased in cytoplasms and nuclei.Col-Ⅳ and FN were obviously decreased with the treatment of FB or RG,and the expression of p-p38MAPK in nuclei was down-regulated,but the expression of p-p38MAPK in intracytoplasm had no changes.There were no significant differences of the expressions of total protein and mRNA of p38MAPK among four groups.CONCLUSION: FB,RG could inhibit the activation of p38MAPK in nuceli of MC cultivated in high concentration of glucose,and then reduce the synthesis of extracellular matrix.

Objective To investigate the effect and safety of alprostadil in the treatment of diabetes complicating chronic kid‐ney disease to provide reference for clinical treatment .Methods 84 cases of diabetes complicating chronic kidney disease in this hospital from September 2013 to January 2015 were selected and divided into the observation group(44 cases) and the control group (40 cases) according to the voluntary principle .The control group used the epalrestat treatment ,while the observation group was combined with using alprostadil on the basis of control group .The effective rate ,serum creatinine ,blood urea nitrogen(BUN) ,uri‐nary albumin excretion rate ,C‐reactive protein(CRP) ,IL‐6 levels and adverse reactions were compared between the two groups .Re‐sults The effective rate of the observation group was 93 .18% ,which was significantly higher than 80 .00% in the control group , the difference was statistically significant (χ2 =4 .251 ,P=0 .005);the CRP and IL‐6 levels after treatment in the observation group were improved ,the difference was statistically significant (P<0 .05);the CRP and IL‐6 levels after treatment in the observation group[(0 .45 ± 0 .05)mg/L ,[(0 .72 ± 0 .11)μg/L] were significantly superior than[(1 .05 ± 0 .14)mg/L ,(1 .25 ± 0 .24)μg/L] in the control group ,the differences were statistically significant(P<0 .05);BUN ,urinary albumin excretion rate ,TNF‐αand endogenous creatinine clearance rate after treatment in the observation group were (6 .41 ± 1 .12)mmol/L ,(41 .12 ± 4 .46)μg/min ,(75 .54 ± 6 .64)ng/L and (92 .94 ± 8 .24)% ,which in the control group were (7 .39 ± 1 .05)mmol/L ,(91 .48 ± 7 .31)mmol/L ,(111 .42 ± 7 .69)ng/L and (81 .55 ± 9 .54)% respectively ,the improvement in the observation group was better than the control group ,the difference was statistically significant (P<0 .05);the occurrence rate of adverse reactions was 18 .18% in the observation group and 17 .50% in the control group ,showing the difference was not statistically significant (P>0 .05) .Conclusion Alprostadil in treating diabetes complicating chronic kidney disease has better effect ,conduces to improve the level of urinary albumin and inflammatory with high safety ,and is worthy of clinical promotion and application .

Objective To investigate clinical effect of fluvastatin in the treatment of early diabetic nephropa-thy,to provide a reference for clinical treatment.Methods 90 patients with diabetic nephropathy were selected,the patients were divided into observation group(50 cases)and control group(40 cases).Conventional hypoglycemic ther-apy used in the control group,and valsartan treatment also used.The observation group received fluvastatin on the basis of treatment of control group.The efficacy,urinary albumin excretion rate,inflammatory markers,serum creatinine and other indicators and adverse reactions were compared.Results The effective rate of the observation group was 90.00%,which was significantly higher than 75.00% of the control group,the difference was statistically significant (χ2 =4.325,P <0.05).After treatment,the BUN,UAER,TC,TG,LDL of the observation group were (6.54 ± 1.24)mmol/L,(40.43 ±4.21)μg/min,(3.81 ±0.47)mmol/L,(2.51 ±0.34)mmol/L,(2.41 ±0.64)mmol/L, the improvement was better than the control group,the differences were statistically significant (t =5.547,5.225, 5.457,4.957,5.339,all P <0.05).After treatment,the CRP,IL -6,IL -18,TNF -αin the observation group and control group were significantly improved compared with before treatment,the differences were statistically significant (P <0.05 ).After treatment,the CRP,IL -6,IL -18,TNF -αlevels of the observation group were (4.14 ± 0.87)mg/L,(88.17 ±8.54)pg/mL,(139.64 ±9.48)ng/L,(40.17 ±5.22)ng/L,the improvement was better than the control group,the differences were statistically significant (t =6.914,6.357,5.847,7.054,all P <0.05 ). Conclusion Fluvastatin in the treatment of early diabetic nephropathy has good effect,which will help to improve inflammatory cytokines and proteinuria and protect renal function,it is worthy of clinical application.

Objective To explore the effect of repaglinide intensive treatment on islet β-cell function and long-term control of blood glucose in newly diagnosed type 2 diabetic patients. Methods Self-control and inter-group control prospective study was conducted in 80 newly diagnosed type 2 diabetic patients who were treated with short-term repaglinide intensive treatment and islet β-cell function was assessed by 75 g oral glucose tolerance test (OGTT) before and after repaglinide treatment. The changes of △I30/△G30 ratio, blood lipid, HOMA A and HOMA B were examined. Results After treatment, in successful group, middle group and defeat group, the fasting plasma glucose levels were decreased from 8.9±1.5, 8.6±1.6,9.0±2.0 to 5.0±1.4,6.3±0. 7,6.5±0. 9 mmol/L, 0. 5 h postprandial glucose levels were decreased from (12.6±1.6, 12.6±1.5, 12.4±1.3 to 8.4±1.0, 6.8±0. 7, 8. 6±0. 9)mmol/L,and 2 h postprandial glucose levels were decreased from (13.0±1.2, 13. 1±1.3, 13. 3±1.4 to 9.2±0.9, 6.6±0. 7, 9.2±0. 9)mmol/L,respectively (all P <0. 005). The ratio of △I30/△G30 was increased froml. 69±0. 31, 1.72±0. 33, 1.79±0. 36 to 4. 47±0. 62, 4. 42±0.46,12. 00±0.46 in the three groups, respectively (P<0.05). HOMA B was significantly improved (P<0. 05), while triglycerides and HOMA A were decreased(P<0. 05). The levels of fasting blood glucose and postprandial blood glucose in 21 patients were maintained within normal range for more than six months. There were significant differences in the ratio of △I30/△G30, age, repaglinide dosage and the time of reaching target of glucose [4.47±0.62 vs. 2. 0± 0.46; 39±8 vs. 56±9; 2.0±1.5 vs. 5.0±2.5; 32.4±8.0 vs. 53.3±7.6; all P<0.05] between successful group and defeat group. Conclusions The short-term intensive treatment with repaglinide can significantly improve the early secretion phase of insulin and the islet β-cell function, reconstruct of the physiological model of insulin secretion and relieve the disease.

Objective:To investigate the clinical features and perinatal outcomes of twin pregnancies with complete placenta previa (CPP).Methods:We conducted a retrospective study on 266 women with CPP, including 62 twin pregnancies (twins group) and 204 singleton pregnancies (singleton group), who gave birth in Peking University Third Hospital from January 2012 to December 2020. T-test, nonparametric test and Chi-square test were adopted for univariate analysis. Differences between the two groups regarding clinical features and perinatal outcomes were compared using multivariate logistic regression or multivariate linear regression. Results:The incidence of twin pregnancy with CPP was 2.11% (62/2 937). Placenta accreta spectrum disorders (PAS) accounted for 48.4% (30/62) and 53.9% (110/204) in the twin and singleton group, respectively, but the difference was not statistically significant ( χ 2=0.58, P>0.05). In terms of antepartum hemorrhage, the proportion of women affected, those with first onset <29 weeks, amount of bleeding ≥200 ml, and the number of episodes of bleeding ≥3 were significantly higher in the twin group than those in the singletons [56.5% (35/62) vs 39.7% (81/204); 35.5% (22/62) vs 12.7% (26/204); 17.7% (11/62) vs 4.9% (10/204); and 21.0% (13/62) vs 10.3% (21/204), χ 2=5.42, 16.62, 10.78, and 4.86, respectively, all P<0.05]. Multivariate Logistic regression analysis showed that compared with the singleton group, the twin group was at higher risk of antepartum hemorrhage volume >200 ml, the number of antepartum hemorrhage episodes ≥3, preterm delivery before 34 weeks and 32 weeks, emergency cesarean section, and emergency cesarean section caused by antepartum hemorrhage [a OR(95% CI)=4.36(1.17-16.30), 3.15(1.01-9.79), 17.24(5.36-55.46), 9.85(2.32-41.77), 3.98(1.72-9.20), and 3.10(1.22-7.85), respectively, all P<0.05]. Multivariate linear regression analysis showed that the gestational week at the emergency cesarean section in the twins group was about 2.22 weeks (0.17-4.27 weeks) earlier than that in the singletons. The postpartum hemorrhage amount and the risk of postpartum hemorrhage after cesarean section, infusion of red blood cells, and hysterectomy did not differ significantly between the two groups. Conclusions:Compared with singleton pregnancies, the proportion of preterm delivery, cesarean sections, especially those caused by antepartum hemorrhage, is significantly higher among twin pregnancies combined with CPP. Accordingly, preterm delivery should be actively prevented, and the timing of cesarean section should be individualized according to the condition of the mothers and babies, and early delivery may be considered.