Hypoglycemia is very common in daily blood glucose management of diabetic patients, and growing number of studies have proved that hypoglycemia plays an important role in the pathogenesis of cognitive dysfunction. There may be a bidirectional relationship between severe hypoglycemia and cognitive dysfunction, resulting in a vicious circle of mutual aggravation between hypoglycemia and cognitive dysfunction, but the specific mechanism is not clear. This article reviews the relationship between hypoglycemia and cognitive dysfunction, the mechanism of hypoglycemia induced cognitive dysfunction, and clinical management measures. The aim is to improve the understanding of the relationship between hypoglycemia and cognitive dysfunction, and to provide scientific basis for further exploring the mechanism of diabetes mellitus with cognitive dysfunction.

Objective To compare the effects of propofol versus sevoflurane combined with remifentanil anesthesia on the activity of nuclear factor-kappa B (NF-κB) in neutrophil granulocyte during one-lung ventilation (OLV) in patients undergoing radical resection of esophagus cancer.Methods Forty ASA physical status Ⅰ or Ⅱpatients of both sexes,aged 40-64 yr,with body mass index 18-25 kg/m2,undergoing radical resection of esophagus cancer,were randomized into 2 groups (n =20 each):propofol-remifentanil group (group P) and sevofluraneremifentanil group (group S).Anesthesia was induced with midazolam,sufentanil,etomidate and cisatracurium besylate in both groups.The patients were tracheal intubated and mechanically ventilated.Anesthesia was maintained with iv infusion of propofol 4-8 mg· kg-1 · min-1 in group P,or with inhalation of 1%-3% sevoflurane in group S,and with iv infusion of remifentanil 0.2μg· kg-1 · min-1 and intermittent iv boluses of cisatracurium besylate 7 mg in both groups.The Narcotrend index value was maintained between 40 and 50.Blood samples were taken from the radial artery at 5 min after intubation,the beginning of OLV,30,60 and 90 min of OLV,0 and 10 min after re-expansion of the collapsed lung,and the end of surgery for blood gas analysis and for determination of plasma concentrations of IL-1.The oxygenation index and respiratory index were calculated.The nuclear protein of neutrophil granulocytes was extracted for detection of NF-κB-DNA binding activity.Results Compared with group P,the respiratory index,plasma concentrations of IL-1 and NF-κB-DNA binding activity were significantly increased (P ＜ 0.05),and no significant change was found in the oxygenation index in group S (P ＞ 0.05).Conclusion Compared with sevoflurane-remifentanil anesthesia,propofol-remifentanil anesthesia can inhibit activation of NF-κB in neutrophil granulocyte and is helpful in attenuating the inflammatory response in lung tissues during OLV in patients undergoing radical resection of esophagus cancer.

Objective To explore the inhibitory effects of Zibu Piyin Recipe(ZBPYR)serum on neuron apoptosis induced by tunieamyein(Tm,5 μg/ml)and its mechamsm in vitro by using sero-pharmacological method.Method Totally 12 healthy adult male SD rats(220～250 g)(SPF)were divided randomly into control group and ZBPYR group,6 in each group,then the blank and ZBPYR serum were prepared.The mouse.neuroblastoma cell line Neum2a cells were treated with Tunicamycin(Tin,an inhibitor of N-glycoslytion)to establish the endoplasmic reticulum(ER)stress model.The cells treated by ZBPYR aerum of different concentrations were interventional groups,and the cells treated by blank serum were control group.The viability of Neuro2a cells was meusurcdd by MTT assay.Flow cytometry wus applied to observe the apoptosis of Neuro2a cells.Western blotting was utilized to detect the protein expressions of two molecules,ER molecular chaperone-ucose regulated protein 78(CRP78)and transcriptional factor CCAAT/enhancer-binding protein-homologous protein(CHOP).The results were analyzed by sNK-q test.Results Compared to Tm group(cell viability 0.1673±0.0213,apoptotic rate 62.7050±1.4056),The cell viability of interventional groups(5%0.5295±0.0373,10%0.5843±0.0428,15%0.6274±0.0324)increased significantly(P<0.05);and the apoptotic rate(5%47.8733±2.8166,10%46.3366±1.2748,15%39.8833±1.0524)reduced significantly(P<0.05).The protein expressions of GRP 78(5%2.1228±0.2251,10%1.3293±0.9443,15%;15%0.0931±0.1168)and CHOP(5%1.1776±0.2927,10%0.7290±0.1708,15%0.6577±0.1883)of interventional groups reduced significantly compared with Tm group(GRP78 2.9149±0.5355;CHOP 1.6611±0.2913)P<0.05.Condusions ZBPYR serurn could increase the cell viability of Neuro2a cells treated with Tm and inhibit cell apoptosis.Thereby it may have neuroprotective effects,and the mechanism may be associated with the inhibition of ER stress and apoptosis pathway.

OBJECTIVE: To determine the protective effects of nourishing spleen yin recipe (Zibu Piyin Recipe, ZBPYR), a compound traditional Chinese herbal medicine, on endoplasmic reticulum (ER) in neuronal cells responding to the stress by using sero-pharmacological method. METHODS: The mouse neuroblastoma cell line Neuro2a cells were treated with tunicamycin (Tm, an inhibitor of N-glycosylation). The ZBPYR-treated cell group was established by incubating cells with ZBPYR serum for one hour and treated with Tm. Reverse transcriptase PCR (RT-PCR) was utilized to detect the mRNA expressions from two genes after treatments, ER molecular chaperone glucose regulated protein 78 (GRP78) and transcriptional factor CCAAT/ enhancer-binding protein-homologous protein (CHOP). Lactate dehydrogenase (LDH) assay was also carried out to determine the LDH leakage from Neuro2a cells after treated with Tm and staurosporine (STS). RESULTS: The ZBPYR-treated cell group at all tested ZBPYR dosages showed significantly reduced expressions of both genes compared with Tm (5 microg/ml) treated control group (P<0.05). Therefore, ZBPYR serum inhibited the expressions of GRP78 and CHOP in mRNA level under ER stress induced by Tm. Different concentrations of ZBPYR serum pretreatment reduced the LDH leakage compared with the Tm and STS groups (P<0.05). Therefore, ZBPYR serum may inhibit the LDH leakage induced by Tm and STS. CONCLUSION: ZBPYR has neuroprotective effects. The mechanisms may be associated with inhibition of ER stress and mitochondrial dysfunction.

Objective To investigate the safety and clinical effect of combined anterior and posterior surgeries approach for the treatment of lumbosacral tuberculosis .Methods There were 31 cases of low lumbar and sacrum spinal tuberculosis in this se‐ries .All cases that anti‐tuberculosis treatment lasted 3 weeks before the operation received posterior transpedicular screw system in‐ternal fixation ,anterior radical focus debridement and auto‐grafting with iliac bone .Bed rest was for 6-12 weeks after surgery and no brace was needed .Anti‐tuberculosis treatment lasted 12 -18 months .Results The period follow‐up was 12 -43 months and there was one case of the formation of the sinus and bilateral abscess after surgical resection of re‐healing ,and there was no cases of bone block displacement .All tuberculosis lesions were healing .13 cases with neurological symptoms had recovery .There was no spondylolisthesis postoperative follow‐up;The heigh ,kyphosis correction and restore stability of vertebral body were satisfied .The patients had solid bony fusion without internal fixation loosening and rupture after 5-9 months .Conclusion It is a safe and effec‐tive method to treat lumbosacral tuberculosis by posterior transpedicular screw system internal fixation and anterior radical focus debridement with interbody autografting .which can thoroughly clear focus of spinal tuberculosis ,decompress sufficiently spinal cord ,correct effectively the kyphosis deformity and achieve the stability of a strong three‐column .

Objective:To apply two dimensional gel electrophoresis(2-DE) to initially analyze the protein expression in hippocampus of rats with spleen yin deficiency syndrome and to get the theory foundation for investigating the molecular mechanisms of Alzheimer's Disease and spleen yin deficiency syndrome.Methods:Rats model of spleen yin deficiency were set up by combination of improper diet,overstrain and consumption of body fluid.Qualitative changes of the proteome expression in hippocampus were compared between the model group and control group by two-dimensional gel electrophoresis.Results:The model group of spleen yin deficiency had the appearance of spleen yin deficiency,for example,irritability,increment in biting frequency,increase of rectal temperature and drinking water(P

Objective To study the serum levels of low molecule weight IgM (LMW IgM) in ankylosing spondylitis (AS) patients and rheumatoid arthritis (RA) patients and to evaluate the relationship of LMW IgM levels with the disease activities. Methods The levels of LMW IgM and pentameric IgM in AS patients, RA patients and healthy controls were measured with ELISA after separated using ultrafiltration assay. Differences in the percentage of LMW IgM between subject groups were analysed using Mann-Whitney U test. Results The percentages of LMW IgM increased dramatically in AS patients and RA patients compared with healthy controls (0.194 ± 0123, 0.061 ±0.026, 0.028 ±0.165 separately). The LMW IgM percentages were not correlated with the disease activities. Conclusion The increase of LMW IgM indicates humoral immune function abnormality in AS patients and RA. However, the mechanism needs further study.

Objective To study the imaging findings of hip involvement and to compare the sensitivity of radiography,CT,and MRI in the identification of hip involvement in patients with ankylosing spondylitis(AS).MethodsAnteroposterior radiography of the pelvis and MRI of hip were performed in 55 patients with AS.CT scan of hip was performed in 29 of 55 patients.T1-weighted,T2-weighted,short tau inversion recovery (STIR) and three dimensional balanced turbo field echo with water selective excitation (3D-BTFE-WATS) coronal sequences of hips were obtained in all patients,of which fat-saturated contrastenhanced T1-weighted sequence was performed in 24 patients.The imaging data of 55 patients were analyzed.The chi-square test was used to analyze the sensitivity in the identification of hip involvement among radiography,CT,and MRI.ResultsAmong 110 hips in all 55 patients,abnormal changes were detected in 13 hips by radiography,85 hips by MRI.The findings of radiography included bone erosions in 13 hips,joint space narrowing in 4 hips,syndesmophytes in 5 hips.MRI revealed bone erosive destruction in 31 hips,joint space narrowing in 4 hips,joint effusion in 80 hips,subchondral bone marrow edema in 32 hips,fat accumulation of bone marrow in 28 hips,enthesitis in 21 hips.Bilateral synovial enhancement was showed in 19 of 24 patients who underwent fat-saturated contrast-enhanced T1-weighted sequence.Of the 58 hip joints in 29 patients who underwent CT examination,not only did CT show all bone erosions detected by radiography and MRI,but CT revealed bone erosive destruction that were not identified by radiography in 10 hips and by MRI in 1 hip as well.Abnormal changes were detected in 10.3％ (6/58)by radiography,27.6％ (16/58) by CT,and 77.6％ (45/58) by MRI.The sensitivity of MRI in the identification of hip involvement is higher than that of radiography and CT ( x2 =53.22 and 29.08,P ＜ 0.05 ).In addition to chronic bone structural changes,MRI depicted acute inflammatory changes which could not be detected by radiography and CT.ConclusionsMRI can detect early acute inflammatory changes of hip joint that can not be showed by radiography and CT.Effusion of joint and synovial enhancement caused by synovitis are the most common MRI findings of the hip in patients with AS.

Objective To explore the imaging features of papillary thyroid microcarcinoma(PTMC) with real time contrast-enhanced ultrasound.Methods One hundredand forty-three cases with 149 thyroid nodules(no diffuse lession) were divided into two groups according to the diameter size(group 1,＜0.5 cm;group 2,0.5-1.0 cm) and examined by contrast-enhanced ultrasound during preoperation.Pathology was followed up as golden diagnosis criteria.Results Seventy-five benign tumors and 74 PTMC were confirmed by pathology.There were significant differences in echoes homogeneity between benign and malignant tumors in group 2(W =1 029.5,Z =-5.524,P =0.000) but no in group 1(W =933.0,Z =-1.738,P =0.082).And nonhomogeneous enhancement were showed in most PTMC in group 2.But most PTMC showed homogeneous enhancement in group 1.Conclusions Contrast-enhanced ultrasound is valuable in diagnosis of PTMC with the diameter size of 0.5-1.0 cm.

AIM: To explore the histochemical changes o f diabetic skin and the pathogenesis of impaired wound healing in diabetes. METHODS: 54 male Sprague-Dawley (SD) rats weighing 200-220 g wer e randomized into control and STZ-induced diabetic groups. The shaved skin speci mens from the back of rats were collected in 4, 8 and 12 weeks post STZ-inductio n, respectively. Hematoxylin-eosin dye was used for histological examination. Me a nwhile, the skin glucose contents were measured by Beckman's autoanalyzer. Skin AGEs concentrations were assessed by detecting total fluorescence in tissue coll agen and immunohistochemistry assay. RESULTS: The skin thickness in diabetic animals was decreased, w ith the features of multilayer epithelium structure disappeared in epidermis and collagen fibers atrophied, swollen and degenerated in dermis; The inflammatory responses in the dermis of diabetic animals were increased obviously. The result s also revealed that skin glucose contents in diabetic rats [(2.64?1.03)mg/ g skin] were 2-3 times higher than those in the controls [(0.74?0.33)mg/g s kin] (P