Objective To explore the therapeutic effect of hyperbaric oxygen therapy (HBO) in the treatment of neuropsychological disorders in senile patients with type 2 diabetes mellitus combined with cerebral infarction. Methods A total of 70 senile patients with type 2 diabetes mellitus combined with cerebral infarction were randomly divided into two groups: treatment group receiving HBO plus routine medicine treatment and control group receiving routing medicine treatment only. A suit of senile neuropsychological tests was administered pre and post treatment by an experienced psychometrician who was blinded to treatment group assignments. Results Neuropsychological disorders were improved partly in control group while the efficacy in treatment group was markedly improved(P<0.01). Spearman rank correlation analysis revealed that the improvement degree of neuropsychological disorders was positively correlated with hyperbaric oxygen therapy (HBO) (r= 0.502,P<0.05), the time of test before therapy (r=0.260, P<0.05) and the time of test after therapy (r=0.386, P<0.05), and was negatively correlated with hyperlipoidemia (r=-0.261, P< 0.05), glycosylated hemoglobin(GHbAlc) (r=-0.321,P<0.05) and body mass index(BMI) (r= 0.360,P<0.05). Multiple stepwise regression analysis showed that HBO and hyperlipoidemia were the independent predictors for the improvement degree of neuropsychological disorders. Conclusions HBO is an efficacious way to treat neuropsychological disorders in senile patients with type 2 diabetes mellitus combined with cerebral infarction.

Lymphocyte subsets in peripheral blood and function of CD4+CD25+ regulatory T cells(Tregs) were assayed in patients during different periods of Graves' disease ( GD ).Breakdown of Tregs' function lead to the wild proliferation of CD4+T lymphocyte,and may play an important role in the pathogenesis of GD.It is difficult to fully restore the Tregs' function to normal after successful medication in Graves' disease,this phenomenon may lead to easy relapse of GD.

Objective To investigate the relationship between serum ferritin and p-cell function,insulin resistance in elderly patients(age>60 years)with type 2 diabetes and impaired glucose tolerance.Methods Total 1143 patients with type 2 diabetes,448 patients with impaired glucose tolerance(IGT),and 2 950 subjects with normal glucose tolerance(NGT)were recruited for the measurments of height,weight,serum triglyceride(TG),total cholesterol,fasting plasma glucose(FPG),fasting insulin(FINS),postprandial 2 h plasma glucose(2hPG),and serum ferritin.Homeostasis model assessment of insulin resistance(HOMA-IR)and QUICK index were used to estimate insulin resistance,and homeostasis model assessment of β cell function(HOMA-p)and disposition index(DI)to evaluate p-cell function.Results The results showed that the level of serum ferritin was significantly higher in type2 diabetes mellitus group than NGT group(P<0.01).HOMA-IR was gradually increased,and HOMA-β,QUICK,and DI decreased from NGT to IGT,type 2 diabetes mellitus groups(all P < 0.05).Spearman and partial correlation analysis showed that partial adjustment for age and sex,serum ferritin was positively associated with FPG,2hPG,TG,FINS,and HOMA-IR,and negatively associated with HOMA-β,QUICK,and DI.Stepwise regression showed that serum ferritin was associated with QUICK,BMI,and TG.Conclusion The results suggest that iron overload exists in elderly patients with type 2 diabetes.With increasing serum ferritin level,insulin resistance increases and p-cell function decreases in the elderly patients with abnormal glucose metabolism.

Blood C-peptide,first-void fasting urinary C-peptide/creatinine ratio ( UCPCR ),second-void fasting UCPCR,and 24 h urinary C-peptide (UCP) were determined in 90 type 2 diabetics and 30 health volunteers.The results showed that first-void fasting UCPCR and second-void fasting UCPCR were positively related to 24 h UCP and the index of islet β-cell function( all P＜0.01 ).

Soladulcidine is a steroidal alkaloid abundant in Solanum dulcamara L. with antitumor and other biological activities. In this study, ten soladulcidine derivatives were synthesized through esterification at C-3-hydroxy group, modification at NH group of F ring of esterification of E ring-opening products. The in vitro antiproliferative activity of these synthesized derivatives against prostate cancer (PC-3) cell line was assessed. Within this series of compounds, compound 19 exhibited the most potent inhibitory effect against the proliferation of PC-3 cell line (IC50=4.80±.9μmol/L).

Background Congenital fibrosis of extraocular muscles (CFEOM) affects patient' s appearance and quality of life,and no effective treatment for this disease is available.Imaging study is helpful for exploring the pathogenesis of CFEOM.Objective This study was to describe the characteristics of CFEOM associated with limb movement disorder using magnetic resonance imaging (MRI).Methods A family with CFEOM associated with limb movement disorder was investigated in Renmin Hospital of Wuhan University.Disease history was collected and the pedigree was investigated.Ophthalmologic examinations,including corrected visual acuity,refractive error,slitlamp examination,ophthalmoscopic examination,force of levator palpebrae superioris,ocular movement,eye position,forced duction test,and bell phenomenon examination,were performed.Ocular orbital and cranial MRI was performed in 4 CFEOM patients and 10 normal subjects to compare the structures of the extraocular muscles,motor nerve and cranium.Oral informed consent was obtained from each patient prior to any medical examination.Results A total of 1 1 members from 3 generations were investigated in this study,presenting with 4 cases of disease.The mode of inheritance of this family complied with the Mendelian autosomal dominant inheritance law.Clinical signs included disturbance of eye movement,deviation of eye position,ptosis,lack of Bell sign and positive reaction of passive pull test.In addition,unstable gait,improper body limb alignment,dysphasia and mental retardation were ohserved in 1 patient,which coincided with the diagnostic criteria of type 3 CFEOM.MRI results demonstrated that the levator palpebrae superioris,superior rectus and superior oblique muscle were clearly thinner,and the medial rectus,lateral rectus,inferior rectus muscle were thinning in the patients,showing significant differences in comparison with the normal controls(P＜O.05).The oculomotor and abducens nerves became thinner and even absent in the patients.Cranial MRI showed that Ⅲ-3 in the pedigree with callosum was shorter than that of the normal controls,suggesting that patient suffered from corpus callosum hypoplasia.Meanwhile,cranial MRI indicated the presence of cerebellar hypoplasia and the expansion of the fourth ventricle.Conclusions MRI demonstrates consistent abnormalities of the oculomotor nerves and abducens nerves in the affected individuals in this CFEOM 3 family,and some affected members exhibit two types of central nervous system abnormalities-corpus callosum and cerebellar hypoplasia.These findings suggest that CFEOM 3 is primarily a neuronal disease.

Objective To observe the changes of the bilateral hippocampal volume (BHV) and 1H-MRS appearance of chronic alcohol dependent (CAD) patients and to provide quantitative information for the clinical diagnosis of CAD. Methods The conventional MR imaging including three-dimensional fast spoiled gradient recalled echo (3D-FSPGR) and 1H-MRS were performed on 16 patients with CAD (CAD group)and 18 cases of volunteer ( control group). The BHV were measured in both groups and the standardized BHV in CAD group and control group were compared. 1H-MRS metabolites including N-acetylaspartate (NAA), Choline compounds (Cho), Creatine (Cr), and myoinositol (mI) of the bilateral cephalic hippocampus were acquired. The ratios of Cho/Cr, Cho/NAA, NAA/Cr and mI/Cr within the bilateral cephalic hippocampus of the two groups were compared. The t test was used to compare the BHV and the ratios of 1H-MRS in the bilateral cephalic hippocampus between the two groups. Results In CAD group,the left and the right hippocampal volume were 1. 881 ±0. 292, 2. 139 ±0. 328 respectively while they were 2. 106 ±0. 245 and 2. 267 ±0. 271 respectively in the control group. The BHV had no significant difference between the left and the right in either the CAD group or the control group (t =0. 232, 0. 147 respectively,P ＞ 0. 05). The BHV had no significant difference between the CAD group and control group(t = 0. 424,0. 131 respectively ,P ＞0. 05 ). The Cho/Cr and NAA/Cr in the right cephalic hippocampus of the CAD group were 1. 225 ±0. 210 and 1. 145 ±0. 034 respectively, while they were 1. 429 ±0. 286, 1. 612 ±0. 444 respectively in the control group(t =0. 321,0. 408 ,P ＜0. 05 ). The Cho/NAA, mI/Cr in the right cephalic hippocampus and the Cho/Cr, Cho/NAA, NAA/Cr and mI/Cr in the left cephalic hippocampus between the two groups had no statistically significant difference. Conclusion 1H-MRS could potentially provide early diagnostic evidence for CAD patients before the onset of cerebral morphological changes.

This article reported a case of a male patient with primary hyperparathyroidism(PHPT) caused by an ectopic parathyroid adenoma in the anterior superior mediastinal. Hospital routine examinations indicated hyperlipidemia, hyperuricemia, type 2 diabetes with nephropathy, chronic kidney disease in stage Ⅳ, elevated PTH, hypercalcemia, hypophosphatemia, clinically highly suspected hyperparathyroidism. There was no obvious abnormality of parathyroid ultrasound, while 18F-FDG systemic metabolic imaging and 99mTc-MIBI dual-phase parathyroid imaging suggested that an ectopic parathyroid gland in the anterior superior mediastinal which was hyperactive. Evaluations of anterior pituitary function, pancreas, and endocrine-related hormones showed no obvious abnormalities, and thus we ruled out the possibility of multiple endocrine adenomas, combined with the patient′s symptoms and previous medical history, and ruled out the possibility of tertiary hyperparathyroidism, the patient was diagnosed as PHPT caused by the anterior superior mediastinal ectopic parathyroid adenoma. To restore the blood calcium to normal, the patient was treated with intravenous rehydration, diuresis, calcitonin to promote urinary calcium excretion, and zoledronic acid to inhibit bone resorption. Further thoracoscopic mediastinal tumor resection was performed, and the diagnosis of parathyroid adenoma was confirmed by pathology. All the indicators were normal and no recurrence of hyperparathyroidism was found during the follow-up. Integration of the patient′s clinical manifestations, biochemical indicators, and imaging examinations are necessary to diagnose PHPT qualitatively and location-specifically. In particular, it is necessary to pay attention to whether there is the possibilities of ectopic adenoma and multiple endocrine adenomas, to reduce the rates of missed diagnosis and recurrence.

Objective: To observe the effects of electroacupuncture (EA) on the protein and gene expressions of Bax, Caspase-3 and Bcl-2 in cerebral cortex of type 2 diabetic rats with cognitive impairment (CI), and to explore the mechanism of EA in improving the learning and memory abilities. Methods: A total of 100 Sprague-Dawley (SD) rats were divided into a normal group (n=10) and a model group (n=90) by random number table method. Rats in the model group were intraperitoneally injected with a small dose of streptozotocin (STZ) to establish the type 2 diabetic models, after being fed with high-fat and high-sugar diet for 1 month. Twenty CI rats were selected from the 50 successful model rats by the Morris water maze (MWM) test and randomly divided into a model group and an EA group according to the blood glucose level and MWM data (n=10). Rats in the EA group received acupuncture at Zusanli (ST 36), Neiting (ST 44) and Yishu (Extra), of which Zusanli (ST 36) and Neiting (ST 44) were stimulated by EA apparatus, 20 min/time, once a day for 6 d a week and 4 consecutive weeks. The rats in the model and the normal groups were fixed without treatment. After 4-week treatment, the random blood glucose level of the rats was measured; the learning and memory abilities of rats were measured by MWM; terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) assay was used to detect apoptotic cells; Western blot (WB) and real-time quantitative polymerase chain reaction (RT-qPCR) were used to detect the protein and gene expressions of Bax, Caspase-3 and Bcl-2 in cerebral cortex. Results: After modeling, the random blood glucose level and the escape latency tested by MWM were significantly increased, and the number of crossing the platform tested by the MWM was decreased in the EA and model groups, and were significantly different from those in the normal group (P<0.05 or P<0.01), while the differences between the model group and the EA group were not statistically significant (all P>0.05). After 4-week treatment, the random glucose level and the escape latency tested by MWM were significantly increased (both P<0.05), and the number of crossing the original platform tested by the MWM was significantly reduced (P<0.01), the protein and gene expressions of Bax and Caspase-3 were significantly increased (all P<0.001), the protein and gene expressions of Bcl-2 were significantly reduced (both P<0.001), and the number of neuron apoptosis was significantly increased (P<0.001) in the model group than in the normal group; the random blood glucose level was significantly reduced (P<0.05), the escape latency tested by MWM was significantly shortened (P<0.05), and the number of crossing the original platform tested by MWM was significantly increased (P<0.05), the protein and gene expressions of Bax and Caspase-3 were significantly reduced (all P<0.001), the protein and gene expressions of Bcl-2 were significantly increased (both P<0.001), and the number of neuron apoptosis was significantly reduced (P<0.001) in the EA group than in the model group. Conclusion: EA can improve the learning and memory damages induced by type 2 diabetic model rats with CI; the action mechanism may be achieved via anti-apoptosis.

OBJECTIVETo compare two techniques of the transarticular screw placement in the lower cervical spine, and to suggest and confirm a new technique of the placement.

METHODSThe techniques of transarticular screw placements used by Takayasu (group A) and Dalcanto (group B) were applied in eight cervical specimens. The splits of facets,the encroachment of the cervical nerve roots and transverse foramens were observed and analyzed. The numbers of transarticular screws which not gone through the facets were counted in both group A and B, respectively.

RESULTSSixty-four transarticular screws were implanted,thirty-two for group A, the same for group B. Although no splits of the facets were seen in group A, two transarticular screws did not go through the facets. There were ten splits of facets in group B, in which seven involved the inferior border of the inferior facets and three for the lateral border. No superior facets were found to be broken both in group A and B. Eight screws encroached the transverse foramens in group A and none in group B. Eleven of anterior branch and eight of posterior branch of lower cervical nerve roots were involved in group A, two and nine respectively in group B.

CONCLUSIONThere are high risk of injury of anterior branch of cervical nerve root and vertebral artery if the screws are too long and the Takayasu's technique is used. However, the rate of facet split is high if the Dalcanto's technique is applied.

Aged ; Aged, 80 and over ; Bone Screws ; Cervical Vertebrae ; surgery ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Male ; Middle Aged