Large vascular lesions have become one of the main causes in the death and disability of type 2 diabetes mellitus (T2DM). The article systematically and in-depthly studied the mechanism of large vascular lesions in T2DM, in order to seek effective drug prevention and treatment. It was of vital importance in the improvement of prognosis of T2DM patients. In traditional Chinese medicine (TCM), the basic pathogenesis of T2DM large vascular lesions was deficiency in origin and excess in superficiality, in whichqi-yin deficiency was the origin and the obstruction of collaterals was the superficiality. In western medicine, the body endothelial dysfunction, oxidative stress reaction and abnormal gene expression and so on could cause T2DM large vascular lesions. This article summarized related research literatures on both TCM and western medicine in recent years. It discussed studies on mechanism of T2DM large vascular lesions.

Objective To investigate the predictive value of neutrophil and lymphocyte ratios (NLR)for the prognosis in patients with acute cerebral infarction. Methods From January 2014 to December 2015,307 consecutive patients with acute cerebral infarction admitted to the Department of Neurology,the Fifth Affiliated Hospital of Zhengzhou University were enrolled retrospectively,including 80 females and 227 males. They were divided into ether a good prognosis group (n = 195)or a poor prognosis group (n = 112)according to the scoring criteria of the modified Rankin scale (mRS). The age,gender, past medical history,National Institutes of Health stroke scale (NIHSS)score were documented on admission. The NLR values were calculated according to the neutrophil and lymphocyte counts on admission. Logistic regression analysis was used to analyze the influencing factors of poor prognosis of acute cerebral infarction. The receiver operating characteristic curve (ROC)was used to evaluate the predictive effect of the NLR level on patients with acute cerebral infarction on admission. Results (1)Compared with the good prognosis group,the age,incidence of recurrent cerebral infarction,NIHSS score on admission, NLR levels on admission in the poor prognosis group were higher. There were significant differences between groups (69 ± 12 years vs. 62 ± 14 years,25. 0% [28 / 112]vs. 14. 4% [28 / 195],5. 00 [3. 00, 9. 00]vs. 3. 00 [1. 75,5. 00],and 3. 66 [2. 62,7. 91]vs. 2. 47 [1. 94,3. 40];all P < 0. 05). There were no significant differences in other baseline data and clinical characteristics between the groups (all P >0. 05). (2)Multivariate logistic regression analysis showed that the increase of the age,NLR level on admission,and increased NIHSS score on admission,were independent risk factor for poor prognosis (OR 1. 030,1. 148,and 1. 427,respectively,95% CI were 1. 007 -1. 053,1. 059 -1. 246,and 1. 247 -1. 634, respectively;all P < 0. 05). (3)The diagnostic cut-off value of the NLR level on admission for the poor prognosis in patients with acute cerebral infarction was 2. 84. Its sensitivity was 69. 6% and specificity was 64. 6% . Conclusion The increase of the NLR level on admission had certain reference function on the poor prognosis in patients with acute ischemic stroke.

Objective To investigate the effects of ribs in high intensity focused ultrasound (HIFU)beam path on formation of coagulative necrosis in cattle liver in vitro in the same acoustic power. Methods The HIFU ablation was carried out in the manner of a single dot in the liver in vitro. The liver was ablated by HIFU in free field,then the ribs were placed between the focal plane and transducer,directing the beam axis through the intercostals space, lied at the rib edge and on the centre of middle rib. For each of these axial arrangements,the plane of the front surface of ribs was placed 3 cm,6 cm or 9 cm in front of the focus. After HIFU exposure,the tissue necrosis rate(TNR),the maximum length,width,depth and position of the coagulated necrosis in the liver were measured. Results ①The TNR was 100% in the free field. When the ribs were placed 3 cm in front of the focal plane,directing the beam axis through the intercostals space, the TNR was 100%. When directing the beam axis lied at the rib edge and on the centre of middle rib,the TNR decreased sharply. When the ribs were placed 6cm and 9cm in front of the focal plane, the TNR was more than 50%. ②When the ribs were placed in HIFU beam path, the volume of necrosis decreased compared with those in free field. The relationship between the ribs and beam axis, the location of ribs placed away from the focal plane different,the volume,length,width and position of the coagulated necrosis different. ③ When the ribs were close to the focal plane,unacceptable damage could been observed on the surface of ribs.When the ribs were far away from the focal plane, the ribs were safe. Conclusions The volume of necrosis decrease when the ribs are placed in HIFU beam path. The relative location of ribs and HIFU beam axis, the location of ribs away from the focal plane are relative with the volume of the coagulated necrosis. When directing the beam axis through the intercostals space, the volume of necrosis is large, and the shape of coagulated necrosis is regulated. When the ribs are closed with the focal plane,ribs are damaged probably.

Objective To investigate the enhancing effect of microbubble contrast agent SonoVue of different dosage on high-intensity focused ultrasound (HIFU) ablation in goat livers in vivo. Methods Twenty goats were divided into 4 groups randomly. Animals in group 1,2 and 3 were bolus-injected of 0.01 ml/kg,0. 03 ml/kg and 0.05 ml/kg of SonoVue intravenously before HIFU exposure, respectively,and those in group 4 were not given injections as control. After injection 20s, the livers were ablated using HIFU performed in the manner of a single dot set by a computer system using a clinical device. The frequency of HIFU was 0.8 MHz,the intensity of HIFU was 19 100 W/cm2 ,the distance from skin to the target liver tissue was 30 mm,the exposure time was set at 15 s for all animals in the four groups. All animals were euthanized 7 days after HIFU, volumes of coagulated necrosis were measured. Pathological examinations were performed to analysis the exposure regions. Results Under the same parameters of exposure, coagulated volumes in group 1,2 and 3 were larger than those in group 4, the difference was significant (P < 0.05),and the coagulated volumes increased gradually with the dosage of SonoVue increasing from group 1 to group 3, the difference was significant (P<0.05). Pathological examinations confirmed that there were no residual unaffected tissues within the exposed volume. Two remarkable changes were observed in one goat in group 37 days after HIFU:the surrounding adjacent tissue outside the reactive zone necrotized and the skin were destroyed. Conclusions The enhancing effects of microbubble contrast agent in HIFU ablation is related with the dosage of the microbubble contrast agent SonoVue. The higher the SonoVue dosage,the larger the volume destroy in the target tissue.

Objective To investigate the effects ofLiuwei-Dihuang Pills combined with Ginkgo Biloba Leaves Extract Tablets on diabetic complications in patients with type 2 diabetes mellitus (T2DM). Methods Seventy-eight patients with T2DM were randomized into a TCM treatment group and a conventional treatment group by random number table method, 39 in each group. The patients in the conventional treatment group were regularly using antihyperglycemic drugs or insulin. On the basis of conventional treatment group, the patients in the TCM treatment group were additionally treated withLiuwei-Dihuang Pills and Ginkgo Biloba Leaves Extract Tablets. Intima-media thickness (IMT) of internal carotid artery, vibration perception threshold (VPT) and diabetic retinopathy in both groups were detected before the treatment, 12 and 36 months after the treatment.Results The VPT in the left foot 12 months after the treatment in the TCM treatment group were significantly lower than that in the conventional treatment group (13.98 ±4.38 Vvs. 18.70 ±2.43 V;t=2.764, P=0.008). IMT of internal carotid artery (left: 0.81 ± 0.16 mmvs.0.70 ± 0.10 mm,t=3.120,P=0.003; right: 0.81 ± 0.17 mmvs. 0.73 ± 0.12 mm,t=2.286,P=0.026), VPT (left foot: 14.82 ± 6.45 Vvs. 20.63 ± 9.75 V,t=2.714, P=0.009; right foot: 16.73 ± 7.10 Vvs. 20.73 ± 10.35 V,t=2.001,P=0.048) and incidence of diabetic retinopathy (35.9%vs. 53.8%;χ2=5.804,P=0.016) 36 months after the treatment in the TCM treatment group were significantly lower than those in the conventional treatment group.ConclusionsLiuwei-Dihuang Pills combined with Ginkgo Biloba Leaves Extract Tablets can effectively reduce the progression of diabetic complications in patients with T2DM.

Objective To investigate integrated status of community inpatients with type 2 diabetes mellitus.Methods 240 cases of type 2 diabetic patients in the Zhangjiagang Aoyang Hospital were included in the study from May 1,2007 to Dec 31,2008.A uniform questionnaire was applicated.Gender,disease duration,age,academic qualifications,occupation,education,height,weight,waist circumference,hip,relevant medical history and so on were collected.Results The onset age of inpatients with type 2 diabetes was (48.91 ± 12.38),onset age of male was(46.32 ±12.08),which was significantly lower than female (52.42 ± 11.97) (P ＜ 0.01).The onset age female and male proportion also had significant differences,age onset of male was in advance.The average body mass index was (24 ±3.47)kg/m2,most of the inpatients were workers and farmers,the level of education was primary and secondary.Multiple regression analysis hints,risk factor of onset age is the family history of diabetes,the history of hypertension,male,low academic qualifications.Percentage of newly diagnosed patients was 28.3％,about one-third in patients were with the metabolic syndrome,hyperlipidemia,high blood pressure,fatty liver.Conclusions Education level of the inpatients was lowe in the community,so strengthening diabetes education was required.The persons in the commuities who were male,or with the family history of diabetes,with high blood pressure history were of the communities require for early screening of diabetes mellitus,so the occurrence and development of diabetes woule be controlled.

Objective Cervical heterotopic heart transplantation model was established in different inbred strains of mice with modified cuff technique. Inbred male Balb/c mice and C57BL/6 mice were selected as donors and recipients, respectively. Mice were randomly assigned into four groups: control group (the donor hearts were perfused through coronary artery with 200 μl, 0℃～4℃ St. Thomas Ⅱ solution during 2 to 3 min, then they were immersed in it for 15 min), CsA group ( the donor hearts were perfused with the same method as for the control's and intraperitoneal injection of CsA 5 mg· g-1 · d -1 was given after surgery ), H2-B1 transfection group (the donor hearts were perfused through coronary artery with 200 μl, 0℃ -4℃ St. Thomas Ⅱ solution contained with 30 μg H2-Bl plasmid vectors during 2 to 3 min, then they were immersed in it for 15 min ), and H2-B1 + CsA group ( the donor hearts were perfused with St. Thomas Ⅱ solution contained H2-Bl gene plasmid and intraperitoneal injection of CsA was given after surgery as mentioned above. ). At 1,3 and 7 days after transplantation, three allografts were harvested at each time points in all of the groups, respectively, for pathological examination and analysis of CD40 expression with immunohistochemistry assays. The expression of Th1/Th2 cytokines were also determined with flow cytometry. The survival time of rest allografts were observed. Results Histological features for rejection were observed more apparent in the grafts of control group than those in other groups, especially those in H2-Bl + CsA group. The expression of CD40 in H2-Bl + CsA group and CsA group was lower significantly than that of the control group ( P ＜0.01 ), so was the expression of CD40 in the H2-Bl group as compare with that of the control group (P ＜0.05). No significant difference between H2-Bl group and CsA group (P ＞0.05 ) at 7 days was observed. The expression of IL-2, TNF-α (Th1 cytokines) in control group was much higher than that in other groups, and the expression of IL-4 ( Th2 cytokine) in control group was much lower ( P ＜0.05 ). The level of IL-4 in CsA group increased significantly at 3 days ( P ＜ 0.05 ), with a peak level at 7 days after transplantation (P＜0.01). The survival time of grafts was significantly prolonged in CsA group (P＜0.01), H2-Bl group (P＜0.05) and H2-Bl+CsA group(P＜0.01). Conclusion Treating the donor hearts with H2-Bl plasmid vectors at the time of transplantation may suppress rejection in the heart allografts and prolong the survival time through some presumed mechanisms such as preventing upregulation of CD40 expression, relucing the production of IL-2 and TNF-α, increasing the production of IL-4, and as a result, inducing immune tolerance, as well as improving the function of transplanted heart grafts.

Objective To investigate the effects of Blastocyst MHC gene transfection to coronary on the survival time of mouse heart grafts and the mechanism. Methods Inbred male Balb/c mice and C57BL/6 mice were selected as donors and recipients respectively, to construct mouse cervical heart transplantation models. In the control group, the donor hearts were perfused using the 0～4 ℃ St. ThomasⅡ solution; in the cyclosporine A (CsA) group, the donor hearts were perfused as same as the control's and received intraperitoneal injection of CsA (5 rng·g-1·d-1) after surgery; in the transfection group, the donor hearts were perfused using St. Thomas Ⅱ solution with Blastocyst MHC gene plasmid; in the combined treatment group, the donor hearts were perfused using St. Thomas Ⅱ solution with Blastocyst MHC gene plasmid and received intraperitoneal injection of CsA (5 mg·g-1·d-1) after surgery. The survival time of transplanted heart allografts were observed, and their histopathological changes and the degrees of coronary intimal hyperplasia were estimated.Blastocyst MHC gene mRNA expression levels were detected by real-time fluorescence quantitative RT-PCR. Flow cytometry was applied in assessment of the levels of CD4+ CD25+ regulatory T cells (Treg) and CD3+ CD8+ T cells. Results The survival time in the CsA group, transfection group and combined treatment group was significantly longer than in the control group (P＜0.05) and that in the combined treatment group was the longest, up to (20. 50 ± 5. 61) days. On the postoperative day 1 and 3, Blastocyst MHC gene mRNA expression level in the transfection group was significantly higher than that in the control group (P＜0.05). On the postoperative day 7, the degrees of rejection and coronary intimal hyperplasia in the combined treatment group were the lightest. On the postoperative day 7 the number of Tregs in the CsA group and the combined treatment group was significantly increased as compared with that in the control group (P＜0.05), but that of CD3 + CD8+ T cells in the CsA group and the combined treatment group was less than that in the control group (P＜0.05). Conclusion Blastocyst MHC gene transfection in mouse transplanted cardiac allograft can extend its survival time through upregulation of Treg and downregulation of CD3 + CD8 + T cells in the mice. The combination of Blastocyst MHC gene and CsA may exert the synergic effects.

Objective To explore early aberrant change of the function and grey matter volume within default-mode network in patients with type 2 diabetes mellitus (T2DM) by Independent component analysis and voxel-based morphometry.Methods Twenty-nine T2DM patients and thirty-three healthy control subjects were recruited in this study between May 2014 and January 2015,and the demographic and clinical data (fasting plasma glucose and HbA1c level) were obtained.General cognition was assessed by MMSE and MoCA in all subjects.Resting-state fMRI and T1-weighted imaging were performed in all subjects.Then the z-maps of default-mode network were obtained from Resting-state fMRI by independent component analysis,and the grey matter volumes were extracted by VBM.Finally,two-sample t-test was performed in the function and grey matter volume of DMN between two groups,and pearson correlation coefficients among zFC values extracted from significantly different brain regions,grey matter volumes and durations of T2DM patients were calculated.Results Patients with T2DM showed decreased Z value around the right anterior cingulated cortex and the right medial pre-frontal cortex(cluster=121,t=-3.81,P＜ 0.05).There was no significant difference in grey matter volume between the two groups,and no correlation between Z value or duration and grey matter volume was found.Conclusions It suggests the abnormality of connectivity of default-mode network may precede the abnormality of grey matter volume in type 2 diabetes mellitus patients.The DMN might be a new potential tool in monitoring the change of cognition in patients with type 2 diabetes mellitus.

Objective To study the metabolic characteristics in type 2 diabetes mellitus with different BMI.Methods 233 patients with type 2 diabetes mellitus were divided into 2 groups. The first group was the BMI ＜25kg/m2 ,the second group with BMI ≥25kg/m2. The blood sugar、 blood-fat 、blood uric acid、type-B ultrasonic of liver were analyzed. Results The waistline、hip circumference、limosis c-peptide 、total cholesterol 、triglyceride and morbidity of fatty liver and hypertension of the second group were higher than the first group. Conclusion Over weigh patients of type 2 diabetes had IR、hyperlipemia、hypertension 、fatty liver. The rate and the severity of the artery diseases in type 2 diabetes mellitus increased wit the increase of the BMI. So weigh reduction could decrease the development of the artery diseases in type 2 diabetes.