Objective To investigate the relationship between fasting plasma glucose (FPG) and islet α-cell and β-cell function in patients with type 2 diabetes mellitus (T2DM).Methods Four hundred and thirty-seven patients with T2DM were divided into 3 groups according to the level of FPG:F1 group:FPG ≤ 6 mmol/L (73 cases),F2 group:6 mmol/L ＜ FPG ≤ 7 mmol/L (103 cases),and F3 group:FPG ＞ 7mmol/L (261 cases),and 30 cases of healthy people were selected as control group.Oral glucose tolerance test,insulin releasing test and glucagon releasing test were performed to observe the differences of glucagon,glucagon/ insulin,the ratio of 30 min insulin and blood glucose value after glucose load (△ I30/△ G30),and the area under curve of insulin (AUC1) among the 4 groups and the correlation analysis was performed between glucagon and other indicators.Results Glycosylated hemoglobin (HbA1c),plasma glucose 120 at min after glucose load in F1,F2 and F3 group were significantly higher than those in control group,and there were statistical differences (P ＜0.05).In F1,F2,F3 group,with the increase of the HbA1c,the course of disease and plasma glucose at 120 min after glucose load showed increasing trend.The triglyceride in F2 group and F3 group was significantly higher than that in F1 group and control group,and low density lipoprotein cholesterol in F3 group was significantly higher than that in F1 group,F2 group and control group,and there were statistical differences (P ＜ 0.05).The glucagon at 60,120 min after glucose load in F1 group,30,60,120 min after glucose load in F2 group,and 30,60,120,180 min after glucose load in F3 group was significantly higher than that in control group,and there were statistical differences (P ＜ 0.05).The glucagon at 60,120,180 min after glucose load in F2 group,at fasting and 30,60,120,180 rain after glucose load in F3 group was significantly higher than that in F1 group,and there were statistical differences (P ＜ 0.05).The glucagon at fasting and 30,60,120,180 min after glucose load in F3 group was significantly higher than that in F2 group,and there were statistical differences (P ＜ 0.05).The area under curve of glucagon in control group was 9.5 ±0.3,in F1 group was 9.7 ± 0.2,in F2 group was 9.9 ± 0.2,in F3 group was 10.2 ± 0.3,and there were statistical differences among the 4 groups (P ＜ 0.05).The glucagon/insulin at fasting and 30,60 min after glucose load in F1 groups,fasting and 30,60,120 min after glucose load in F2 group,fasting and 30,60,120 min after glucose load in F3 group was significantly higher than that in control group,and there were statistical differences (P＜ 0.05).The glucagon/insulin at fasting and 60,120 min after glucose load in F2 group,fasting and 30,60,120,180 min after glucose load in F3 group was significantly higher than that in F1 group,and there were statistical differences (P ＜ 0.05).The glucagon/insulin 30,60,120,180 min after glucose load in F3 group was significantly higher than that in F2 group,and there were statistical differences (P＜ 0.05).The homeostasis model of assessment for insulin resistance index (HOMA-IR) in F2 group and F3 group was significantly higher than that in control group and F1 group,in F3 group was significantly higher than that in F2 group,and there were statistical differences (P＜ 0.05).The insulin sensitivity index (ISI) in F2 group and F3 group was significantly lower than that in control group and F1 group,in F3 group was significantly lower than that in F2 group,and there were statistical differences (P ＜ 0.05).The homeostasis model of assessment for islet β-cell function index (HOMA-β) and △I30/△G30 in F1,F2,F3 group were significantly lower than those in control group,and there were statistical differences (P ＜ 0.05).The AUC1 in F2 group was significantly lower than that in control group,and AUC1 in F3 group was significantly lower than that in control group,F1 group and F2 group,there were statistical differences (P ＜0.05).The results of Pearson correlation analysis showed there was negative correlation between glucagon and △I30/△G30,HOMA-β,body mass index,ISI,AUC1 (r =-0.229,-0.153,-0.151,-0.146,-0.136,P＜0.01 or ＜0.05),and there was positive correlation between glucagon and FPG,area under curve of glucose (AUCG),HbA1c,course of disease and HOMA-IR (r =0.545,0.476,0.273,0.193,0.189,P ＜ 0.01).The results of multiplestepwise regression analysis showed there was positive correlation between glucagon and FPG,AUCG,HbA1c,course of disease (P ＜0.01 or ＜0.05),and there was negative correlation between glucagon and △I30/△ G30 (P ＜ 0.05).Conclusions Islet β-cell function is decreased with the increasing of FPG,while islet α-cell function is increased,especially in those with higher levels of FPG.Regulation of glucagon should be concerned to make the blood glucose target easier to reach,at the same time of protecting β-cell function.

Objective To explore the risk factors and outcomes associated with pulmonary hemorrhage in very low and extremely low birth weight infants.Methods Retrospective analysis were performed to predict risk factors for pulmonary hemorrhage in very low and extremely low birth weight infants (birth weight less than 1200g) admitted to NICU of Shengjing Hospital from Jan.2010 to Dec.2015.Infants at similar birth weight without pulmonary hemorrhage were as controls.We compared the characteristics of both maternal and infants.Multivariable Logistic regression models were derived to predict pulmonary hemorrhage.Short outcomes of the infants were assessed.Results Of the 435 neonates,71 developed pulmonary hemorrhage (pulmonary hemorrhage group),364 were as controls (control group).Gestational age[(28.2±1.7)week],birth weight[(936±192)g] in pulmonary hemorrhage group were significantly lower than those in control group[(29.5±2.1)week,(1033±134)g,t=4.776,5.145,P<0.01].Neonatal respiratory distress syndrome(RDS)(76.1%),pulmonary surfactant (PS)use(PS use≥2 courses)[76.1%(9.9%)],patent ductus arteriosus (PDA)(66.2%)were significantly higher than those in control group[41.2%,30.8%(4.1%),38.7%;χ2=33.457,28.970(4.074),32.798,P<0.05].Antenatal corticosteroids utility ratio (21.1%)was lower than that in the control group (41.2%;t=10.177,P< 0.001).Multiple factors Logistic stepwise regression analysis showed that RDS (OR=3.739,95%CI 1.383-10.113,P<0.05 ),PDA (OR=2.206,95%CI 1.205-4.093,P<0.05),and 5 minutes Apgar score <7(OR=2.851,95%CI 1.191-6.828) were independent risk factors of pulmonary hemorrhage,and higher birth weight (OR=0.998,95%CI 0.996-1.000,P<0.05) and the use of antenatal corticosteroids (OR=0.432,95%CI 0.224-0.834,P<0.05) were the protection factors in pulmonary hemorrhage.In pulmonary hemorrhage group,the incidence of intracranial hemorrhage,retinopathy of prematurity and severe bronchopulmonary dysplasia(16.9%,12.7% and 18.3%) were significantly higher than those in control group (5.8%,4.4% and 2.2%;χ2=36.824,7.520 and 33.568,P<0.01);Compared to control group,the mortality in pulmonary hemorrhage group was higher (49.3% vs.14.0%;χ2=46.634,P<0.01).Conclusion Pulmonary hemorrhage in very low and extremely low birth weight infants is associated with multiple factors.Prevention of premature birth and prenatal corticosteroids treatment can help prevent the occurrence of pulmonary hemorrhage.The incidences of poor outcomes are higher in newborns with pulmonary hemorrhage.

Objective · To observe the effects of custom made fiber posts on the fracture resistance of young permanent teeth treated with calcium hydroxide for different time. Methods · Forty-five extracted human young permanent teeth (premolar) were selected and randomly assigned to 9 groups.One group was the control group and the rest 8 groups were treated with conventional root canal preparation. Of these 8 groups, 4 groups (F Ⅰ , F Ⅲ , F Ⅵ ,FⅨ ) were restored by custom made fiber posts after being treated with calcium hydroxide for 1, 3, 6, and 9 months respectively, and other 4 groups (C Ⅰ ,CⅢ , C Ⅵ , C Ⅸ ) were not restored by custom made fiber posts. All samples underwent fracture strength tests and their fracture modes were analyzed for the possibility of second repair. Results · The fracture load was decreased with the treatment time after being treated with calcium hydroxide for 1 month (P<0.01). The fracture loads in groups restored by custom made fiber posts were increased after being treated with calcium hydroxide for 6 and 9 months (P<0.05, P<0.01). After being treated with calcium hydroxide for 1 month, groups restored by custom made fiber posts were likely to have fracture modes that facilitate the second repair as compared with groups not restored by custom made fiber posts (P<0.05). Conclusion · The restoration by custom made fiber posts can increase the fracture resistance of young permanent teeth treated with calcium hydroxide for medium and long term ( ≥ 1 month).

Object To study the inhibitory effects and mechanism of pseudolaric acid B (PAB) on the growth of LiBr cell line. Methods PAB in different concentrations was added into the medium in which LiBr cells were cultured. The changes of cell morphology were observed by phase contrast microscope. Cytotoxicity of PAB was detected by MTT. The number of apoptotic cell was calculated by double fluorescent staining. The level of p21 WAF1 protein was measured with immunocytochemistry. Results The growth of LiBr cell line was remarkably inhibited by PAB. The IC 50 values of PAB for LiBr cells was 2.5?10 -5 mol/L. The inhibitory rate and the apoptotic cell rate were related with the medicine concentration. The level of p21 WAF1 protein in LiBr cells treated with PAB was obviously increased. Conclusion PAB can effectively inhibit the proliferation of LiBr cell line.

[Objective] To explore the activity aberration of primary insomnia (PI) patients with resting-state fMRI.[Methods]Resting-state fMRI datasets of 60 PI and 60 healthy controls were acquired.We investigated the cortical connectivity patterns of the insula in PI and independent-sample t-test were used to compare the brain activity abnormalities between two groups.[Results] In PI,we found enhanced connectivity between left insular with the left middle cingulate cortex,the Frontal_Sup_Media and right Parietal_Inf,as well as decreased connectivity with the left precentral gyrusand the right fusiformgyrus (P ＜ 0.05).The right insular show increased FC with the right middle cingulate cortex,the right fusiform gyrus and the right middle frontal gyrus,as well as decreased FC with the right precentral gyrus and the right middle temporal gyrus (P ＜ 0.05).[Conclusion] This study provides additional evidence of brain functional integration alterations in PI.Those may help us understand the possible neural mechanisms of PI.

[Objective]To explore the efficacy of T2* mapping for evaluating inflammatory activity in the patients with Crohn disease(CD).[Methods]A total of 98 CD patients underwent MR enterographywith T2*WI. T2* values were measured by put-ting regions of interest on the thickening bowel wall on T2*mapping. The activity of bowel segment was scored by magnetic resonance index of activity(MaRIA),to analyze the relationship between T2*values with CD activity.[Results]A total of 160 bowel segments were evaluated and includedinactive(MaRIA<7,n=26),mild(7≤MaRIA<11,n=23),and moderately-severe(MaRIA≥11, n = 111)active lesions. The differences in T2* values amongthese three groups were significant(all P < 0.05). T2* values of 160 bowel segments correlatedclosely withMaRIA(r=0.743,P<0.05). High accuracy of T2*values was shown for differentiating inac-tive from active CD(AUC=0.877)anddifferentiating inactive-mild from moderate-severe CD(AUC=0.848). The threshold T2*value of 20 ms allowed differentiation of mild from moderate-severe CD with74.5%sensitivity and 84%specificity.[Conclusions]T2*values, as thequantitative indexof T2*mapping,correlate well with CD activity and showsatisfiedefficacy for diagnosing inflammatoryactivity.

Objective To explore the risk factors and short outcomes associated with late-onset sep-sis (LOS) in very low and extremely low birth weight infants.Methods Retrospective analysis were per-formed to predict risk factors for LOS in very low and extremely low birth weight infants (birth weight less than 1 200 g) admitted to NICU of Shengjing Hospital from Jan 2010 to Dec 2015.Infants with similar birth weight without LOS were as controls.We compared the characteristics of maternal and neonatal periods in both groups.Multivariable Logistic regression models were derived to predict LOS sepsis.Short outcomes of the infants were assessed.Results Total of 381 very low birth weight infants were admitted during the study period.LOS occurred in 138 infants(36.2%,138/381),who developed sepsis at a mean age of (19.8 ± 11.0)days;the mean gestational age,birth weight and hospitalization time were(29.4 ± 2.1)week,1 064 (953,1 126)g and 55(43,72)d.Other 243 cases were control,mean gestational age,brith weight and hospi-talization time were(29.3 ± 2.0)week,1 060(955,1 144)g and 49(37,63)d.Ninety-seven cases had posi-tive blood culture(70.3%,97/138) in LOS group.Out of the 138 cases of LOS,8 cases(5.8%,8/138) died from their sepsis with a positive blood culture.Infants with LOS were more likely to have a long-term use of ventilation and peripherally inserted central catheteh(PICC),the failure of early enteral feeding,delayed com-plete enteral feeding time and the longer hospital stays compared to uninfected infants.Multivariate Logistic regression analysis showed that long-term use of PICC(OR 1.039,95%CI 1.012-1.067,P=0.004)was an independent risk factor for LOS in very low birth weitht infants. Septic infants,compared with nonseptic infants,had significantly more serious morbidity,including white matter damage(20.3% vs.10.3%),necro-tizing enterocolitis(9.4% vs.2.9%),retinopathy of prematurity(10.9% vs.3.7%),and cholestatic jaun-dice(19.6% vs.11.9%)(P<0.05).Conclusion A number of factors are related to LOS.LOS is associated with poor prognosis of preterm infants.Long-time PICC is a risk factor for LOS.

Objective:To investigate the risk factors for concomitant cardiac autonomic neuropathy in diabetic patients and to develop a Nomogram prediction model.Methods:One hundred and fifty-eight diabetic patients admitted to in Southern Hospital Zengcheng Branch from March 2019 to March 2021 were selected. Patients with normal heart rate variability were the diabetic group, and patients with abnormal heart rate variability were the group with diabetes mellitus complicated by cardiac autonomic neuropathy. Logistic regression analysis was used to analyze the risk factors of cardiac autonomic neuropathy. Nomogram models were developed and model performance was evaluated. Decision curve analysis (DCA) was used to assess the net clinical benefit of the Nomogram model.Results:Comparison of general data showed that fasting blood glucose, tumour necrosis factor-α (TNF-α), glomerular filtration rate (eGER), uric acid, C-reactive protein (CRP), interleukin-6 (IL-6), free fatty acids (FFA), standard deviation of sinus heart beat RR interval (SDNN), and duration of diabetes compared to the diabetic group had statistically significant ( P<0.05); the results of the subject work characteristics (ROC) curve analysis showed that the best cut-off values for fasting glucose, TNF-α, eGFR, uric acid, CRP, IL-6, FFA, SDNN and duration of diabetes were >7.53 mmol/L, >98.45 ng/L, ≤94.79 ml/(min·1.73 m 2), > 87.3 μmol/L, >6.22 μmol/L, >37.84 ng/L, >839.19 μmol/L, ≤ 95.88 ms, >9 years; multi-factorial Logistic regression analysis showed that fasting glucose (>7.53 mmol/L), TNF-α (>98.45 ng/L), CRP (>6.22 μmol/L), IL-6 (>37.84 ng/L), FFA (>839.19 μmol/L), SDNN (≤95.88 ms), and duration of diabetes (>9 years) were risk factors for the development of cardiac autonomic neuropathy in diabetic patients; internal validation showed that the Nomogram model predicted a C-index of 0.706 (95% CI 0.668 - 0.751) for the risk of cardiac autonomic neuropathy. The DCA results showed that the Nomogram model predicted a risk threshold of >0.25 for the development of cardiac autonomic neuropathy and that the Nomogram model provided a net clinical benefit. Conclusions:There are many risk factors for cardiac autonomic neuropathy, and the nomogram model based on risk factors in this study has good predictive power and may provide a reference for clinical screening of high-risk patients and further improvement of treatment planning.

Objective To assess the diagnostic value of magnetization transfer MRI (MTI) for bowel inflammation and fibrosis in humans with Crohn disease (CD). Methods From July 2014 through April 2017, 31 patients with a confirmed diagnosis of CD were prospectively recruited from the First Affiliated Hospital of Sun Yat Sen University. They were scheduled for elective surgery due to bowel obstruction and other complications, and underwent preoperative MR enterography (MRE) and MTI within 15 days of surgery. All cases had available intestinal specimens identified on MRE and resected bowel segments for region by region matching. All patients underwent breath hold conventional MRE and MTI examinations, and then the magnetization transfer ratios (MTRs) of pathological bowel segments were measured. Using region by region correlation between MTI and surgical specimen, the bowel segments were resected to stain with HE for evaluating bowel inflammation, Masson for bowel fibrosis, and typeⅠcollagen staining for the deposition of typeⅠcollagen within the bowel walls. The histologic sections from the most severe areas were scored as 0 (normal), 1 (mild), 2 (moderate) and 3 (severe). The correlations between MTR and histologic scores were analyzed by using Spearman rank correlation or partial correlation. The differences in MTR among different grades of bowel fibrosis were analyzed by one way ANOVA. The efficacy of MTR for predicting bowel fibrosis was evaluated by receiver operating characteristic curves analysis. The difference in MTRs between purely inflammatory bowel walls and mixed fibrotic and inflammatory bowel walls was analyzed by Student s t test. Results Sixty two resected bowel specimens from 31 patients including 9 purely inflammatory bowel walls and 53 mixed fibrotic and inflammatory bowel walls were obtained in this study. There were significant differences in MTR among non fibrotic [(21.45 ± 2.65)%], mildly [(30.88 ± 6.14)%], moderately [(35.14 ± 4.31)%] and severely [(35.14 ± 4.31)%] fibrotic walls (F=38.397,P<0.01). MTRs strongly correlated with fibrosis scores (r=0.681, P<0.01). High accuracy of MTRs was shown (curve under area=0.905, P<0.01) for differentiating moderately severely fibrotic from non fibrotic and mildly fibrotic bowel walls. Using MTR of 31.50% as a cutoff value, the sensitivity and specificity were 93.6% and 80.0%, respectively. The MTRs of purely inflammatory bowel walls [(21.45 ± 2.65)%] were significantly higher than that of mixed fibrotic and inflammatory [(36.28±5.21)%] bowel walls (t=-13.052,P<0.01). MTRs correlated with the scores of type Ⅰ collagen (r=0.325, P=0.044) but did not correlate with inflammation scores (r=-0.024, P=0.857). Conclusions MTI enables quantitative evaluation of bowel fibrosis in patients with CD and can be used to differentiate purely inflammatory CD from mixed fibrotic and inflammatory CD.

Objective To determine the correlation between intravoxel incoherent motion (IVIM) parameters and both histologic inflammatory and fibrotic grades of Crohn disease (CD) in adults. Methods Prospectively, 17 patients (77 lesions) with a clinical and pathological diagnosis of CD in the first affiliated hospital of sun yat-sen university from July 2015 to June 2016 underwent MRE 15 days before surgery. All patients underwent T2WI, IVIM and enhanced MRI and calculated IVIM parameters include diffusion-related coefficient (D), perfusion-related coefficient (D*) and perfusion-related fraction (f). Histological intestinal inflammation and fibrosis was scored using the surgical histopathology as reference standard and further divided into mild-moderate (score 1 to 2) and severe (score 3 to 4) groups. Intestinal microvessel density (MVD) were also analyzed. Differences in IVIM parameters among different histological inflammation and fibrosis grades were assessed with the Kruskal-Wallis test. The Wilcoxon test was used for assessing differences in f between mild-moderate and severe fibrosis. The bivariate correlations between IVIM parameters and histological inflammation and fibrosis grades were analyzed using partial correlation . The bivariate correlations between IVIM parameters and MVD were analyzed using Spearman rank correlation. The areas under the receiver operating characteristics curves (AUROC) were analyzed to evaluate the efficacy for distinguishing severe from mild-moderate fibrosis. Results Of 77 surgical specimens, there were 41 mild-moderate and 36 severe inflammatory bowel segments, along with 22 mild-moderate and 55 severe fibrotic bowel segments. Positive correlation was shown between histologic inflammatory and fibrotic scores (r=0.592, P<0.01). MVD (42.7 ± 39.9)/HP presented weak positive correlation with histologic inflammatory scores (r=0.332, P=0.003) while no correlation with histologic fibrotic scores (r=0.129, P=0.262) was presented. Neither the D nor the D* values significantly correlated with histologic inflammation or fibrosis (P>0.05) while the f value significantly correlated with both histologic inflammation and fibrosis (P<0.05). Significant correlation was present between the f value and histologic inflammatory and fibrotic scores, respectively (r=-0.280, -0.520;P<0.05). There was significant difference in the f value between mild-moderate and severe fibrosis(Z=-5.255,P<0.01). The AUROC for the f value to distinguish between patients with mild-moderate fibrosis and severe fibrosis were 0.885. Using a threshold fractional perfusion of 0.33, the sensitivity and specificity values were 95.5％ and 81.8％, respectively. No correlation between f, D and D*value with histologic fibrotic scores (r=0.129, P=0.262) was presented. Conclusion The f value derived from IVIM could help to evaluate the severity of intestinal inflammation and fibrosis CD in adults.