Objective To observe the difference in serum level of oxidative stress between first diagnosed type 2 diabetes mellitus (T2DM) patients and healthy person with normal glucose,compare the difference in serum level of oxidative stress between T2DM patients with continuous subcutaneous insulin injection (CSII) and multiple subcutaneous insulin injection (MSII),and further explore the possible mechanism of CSII superior to MSII.Methods Sixty patients with first diagnosed T2DM were divided into CSII group and MSII group by random digits table,with 30 patients in each group and given 14 days treatment of CSII and MSII respectively.Thirty healthy person were selected with age and sex matched in same period as control group,then fasting plasma glucose (FPG),2-hour postprandial blood glucose (2 h PG),glycosylated serum protein (GA),fasting insulin (FINS),superoxide dismutase (SOD),reduced glutathione (rGSH) and malondialdehyde (MDA) before and after treatment was measured and analyzed.Results The FPG,2 h PG,GA,HOMA model of insulin resistance (HOMA-IR) and MDA before treatment in CSII group and MSII group was higher than that in control group [FPG:(13.81 ± 3.14),(13.58 ±2.10) mmol/L vs.(5.21±0.42) mmol/L; 2 h PG:(21.72 ±4.43),(22.07 ±3.86) mmol/L vs.(6.19 ± 0.47) mmol/L;GA:(28.74 ± 4.40),(28.83 ± 5.01) mmol/L vs.(13.24± 1.26) mmol/L;HOMA-IR:0.45 ±0.13,0.43 ±0.12 vs.0.20 ±0.15;MDA:(4.37 ± 1.13),(4.44 ± 1.07) mmol/L vs.(2.37 ±0.58) mmol/L] (P ＜ 0.01),and the HOMA model 3 cell function index (HOMA-β),SOD and rGSH was lower than that in control group [HOMA-β:0.98 ±0.17,0.96 ±0.12 vs.1.91 ±0.19;SOD:(29.63 ±9.29),(28.07 ±9.62) mU/L vs.(41.00 ± 12.89) mU/L;rGSH:(157.03 ±46.58),(165.23 ±45.66) ng/L vs.(212.00 ± 61.67) ng/L] (P ＜ 0.01).There was no significant difference between CSII group and MSII group (P ＞ 0.05).The FPG,HOMA-β,SOD and MDA after treatment in CSII group was no significant difference compared with that in control group (P ＞ 0.05).But the FPG and MDA after treatment in MSII group was higher than that in control group(P＜ 0.01 or ＜ 0.05),and the HOMA-β and SOD was lower than that in control group (P ＜ 0.01).The FPG,2 h PG,GA and MDA after treatment in CSII group was lower than that in MSII group (P ＜ 0.01 or ＜ 0.05).The HOMA-β was higher than that in MSII group (P ＜ 0.01).Multi-factor analysis results showed that the HOMA-β and FPG (r =-0.919,P ＜ 0.01),2 h PG (r =-0.904,P ＜ 0.01),GA (r =-0.830,P ＜ 0.01) and MDA (r =-0.653,P ＜ 0.01) was negatively correlated,and SOD (r =0.454,P ＜ 0.01) and rGSH (r =0.394,P ＜ 0.01) was positively correlated.Conclusions Oxidative stress level of first diagnosed T2DM is significantly higher than that of healthy people.Two intensive insulin treatment for first diagnosed T2DM can reduce blood glucose level,oxidative stress levels and improve insulin resistance and β cell function.CSII can effectively reduce blood glucose,reduce the level of lipid peroxidation and improve β-cell function compared with MSII.

Objective To assess the factors that influence the accuracy of real-time continuous glucose monitoring system (RT-CGM).Methods A total of 79 diabetic patients wore RT-CGM for three days continuously while calibrating by interphalangeal glucose values 4-8 times a day.We counted matching rate of interphalangeal glucose values and RT-CGM probe value,and analyzed correlation of the matching rate with MAGE,SDBG,MBG,AUC10,AUC3.9,and NGE by Pearson correlation analysis and multiple linear regression analysis.Then we grouped corresponding match rate by MAGE and MBG,compared the difference among groups.Furthermore,we analyzed correlation of RT-CGM probe values of all-day,fasting-postprandial,and nighttime and the corresponding interphalangeal glucose values by Pearson correlation analysis.Results Pearson correlation analysis showed that the matching rate was negatively correlated with the MAGE,SDBG,MBG,and AUC10.MAGE,MBG,and NGE were in the regression equation.MAGE ＜3.9 mmol/L,matching rate was 81％,3.9 ≤ MAGE＜7 mmol/L,matching rate was 67％,MAGE≥7 mmol/L,the matching rate was 52％,the difference among 3 groups was statistically significant (P＜0.01).MBG＜7.8 mmol/L,matching rate was 78％,7.8 ≤ MBG＜ 10 mmol/L,matching rate was 68％,MBG ≥10 mmol/L,the matching rate was 57％,the difference among 3 groups was statistically significant (P ＜ 0.01).When Youden index was 0.409 and MAGE was less than 3.745 mmol/L,the match rate was more than 75％.When Youden index was 0.369 and MBG was less than 8.38 mmol/L,the matching rate was more than 75％.The correlation coefficients of all day,fasting,postprandial and nighttime probe values and the corresponding interphalangeal glucose values were 0.958,0.963,0.944,and 0.965 (all P＜0.01).Conclusions The probe values show good consistency with the interphalangeal glucose values,are able to be used for blood glucose assessment.Blood glucose fluctuations influences accuracy of RT-CGM,the smaller the blood glucose fluctuations,the smaller the mean glucose concentration,the smaller the effective blood glucose fluctuations in frequency,the higher would be the accuracy.It seems to be more effective to do calibration during fasting and nighttime.

BACKGROUND: Propranolol is a nonselective competitive adrenergic β-receptor blocker capable of suppressing sympathetic nerve excitation. Postmenstrual osteoporosis may be associated with the changes of sympathetic nerve activity.OBJECTIVE: To observe the effect of propranolol on tibial morphology in ovariectomized rats, and compare it with that of estrogen medication.DESIGN: Completely randomized design and controlled experiment.SETTING: End ocrinology Department, General Hospital of Beijing Military Area Command of Chinese PLA.MATERIALS: This experiment was conducted at the animal laboratory of the Institute of Basic Theory Research of Traditional Chinese Medicine between March 2002 and April 2003. Forty female unmated SD rats aged 6 months were included and randomized into 4 groups with 10 rats in each group: sham-operation group, estrogen medication group, propranolol treatment group, and placebo group.METHODS: ① Rats in estrogen group, propranolol treatment group and placebo group were anesthetized before the abdomen was opened and bilateral ovaries were excised. Rats in sham-operation group had their abdominal cavity opened and a piece of ovary surrounding fattytissue excised before closing the abdomen. ② Estrogen medication group: Rats were given hypodermic injection of grain oil dissolved 17 β-estradiol at a dose of 20 μg/(kg·d). Propranolol treatment group: Propranolol was used for gastric infusion at a dose of 18 mg/(kg·d). Placebo group and sham-op-eration group: The same volume of grain oil and/or distilled water was used instead of hypodermic injection or gastric infusion. Two treatment groups were given the same intervention as placebo group and sham-operation group during treatment; medication was carried out from postoperative week 1 for altogether 12 weeks. ③ Leica Qwin imaging analysis system was used for morphological measurement of bone tissues so as to calculate the volume percentage, active-surface formation percentage, mineralization rate, and formation rate of bone trabecula. ④ t-test was used for comparing the differences.MAIN OUTCOME MEASURES: Comparison of rat tibial morphological parameters between groups.RESULTS: Forty rats were divided into four groups with 10 rats in each and all entered the result analysis. ① Left tibial active-surface formation percentage and mineralization rate of bone trabecula: They were obviously lower in sham-operation group and estrogen group than in placebo group (P ＜ 0.01), but obviously higher in propranolol treatment group than placebo group (P ＜ 0.05). ② Formation rate of left tibial trabecula: It was obviously higher in propranolol treatment group than in placebo group (P ＜ 0.05). ③ The volume percentage of left tibial bone trabecula: It was obviously higher in sham-operation group and propranolol treat ment group than in placebo group (P ＜ 0.01), but obviously lower in pro pranolol treatment group than in sham-operation group and estrogen group (P ＜ 0.01). CONCLUSION: Propranolol can increase bone mass, reduce bone loss, and promote bone formation in osteoporotic rats following ovariectomy, thus displaying obvious preventive and therapeutic effects on osteoperesis in rats.

Objective To investigate the glycemic fluctuation and endothelial function in patients of coronary heart disease complicated with type 2 diabetes mellitus (T2DM).Methods Fifty eight patients with coronary heart disease were enrolled in the study,including 40 cases complicated with T2DM (group A) and 18 cases without T2DM (group B).All subjects underwent continuous glucose monitoring system (CGMS) and high-resolution ultrasound detection on brachial artery for endothelium-dependent flowmediated dilatation (FMD).According to the results of CGMS,patients with 3 times of standard deviation of blood glucose (SDBG) less than a mean blood glucose in group A were classified as low glucose excursion group (group A1 ),others were classified as high glucose excursion group (group A2 ).The association of glucose fluctuation with FMD in group A was analyzed.Results Compared to group B,the levels of mean amplitude of glycemic excursions (MAGE),the largest amplitude of glycemic excursions (LAGE) and mean postprandial glucose excursion (MPPGE) were elevated and the levels of FMD were lower in group A1 and A2 (P ＜0.05).Compared to group A1 the levels of MAGE,LAGE,MPPGE and absolute means of daily differences were significantly higher [(5.4 ±0.9) vs.(3.7±0.4),(6.3 ± 1.8) vs.(4.6 ±0.8),(4.7±1.0) vs.(3.5±1.2),(2.45 ±0.75) vs.(1.81 ±0.66)mmol/L,respectively]and the FMD levels were lower [ (3.2 ± 1.0) vs.(5.2 ± 1.2) ％ ]in group A2 ( all P ＜ 0.05 ).All CGMS parameters were significantly correlated with FMD in group A2 (P ＜ 0.05 ).Multiple stepwise regression analysis showed that MAGE,systolic blood pressure were the independent impact factors of FMD.Conclusions Patients of coronary heart disease complicated with T2DM have prominent glycemic fluctuation and decreased FMD and the glycemic fluctuation may be associated with the impairment of FMD.

Objective To study the relationship between menstrual disorder and ovarian morphology of adolescent women in order to provide basis for diagnosis of adolescent polycystic ovary syndrome (PCOS).Methods We analyzed the clinical data of 212 patients with adolescent menstrual disorders 2 years after menstruation collected from the Department of Gynecology and Women's Health of First Affiliated Hospital of Xi'an Jiaotong University between September 2014 and September 2015.Results ① Oligomenorrhea was the most common in the 212 adolescent women (33.96 ％),followed by amenorrhea (16.51％).There was a significant difference in F-G score and acne score among patients with different types of menstrual disorder (F=1.39,1.77,all P＜0.05),the highest in those with oligomenorrhea.② The volume of the ovary,number of sinusoidal follicles,maximum area of the ovary in women with oligomenorrhea were significantly higher than those in non-oligomenorrhea women (t =2.89,5.76,6.23,all P＜ 0.05).③ Clinical manifestations differed significantly among normal ovarian group,MFO group and PCO group (x2=43.25,P＜0.05).Incidence rate of oligomenorrhea ranked the top in polycystic ovary group (49.30％),followed by multiple ovarian follicles group (42.59％),and there were significant differences in blood LH,T,and LH/FSH (F=3.45,2.43,2.76,all P＜0.05) was found in PCO group.There was significant difference in diagnosis of puberty PCOS (x2=26.58,P＜0.05).④ Among these 212 adolescent women,45 ones had puberty PCOS (21.23％).The ovary volume,number of sinus follicles,and the largest area in the obese patients were significantly higher than those in non-obese group (t =3.42,7.89,4.02,all P＜0.05);HOMA IR was also significantly higher than that in non-obese group (t =8.89,10.62,all P ＜ 0.05).Conclusion Oligomenorrhea is the most common menstrual disorder in adolescent women.Ovarian morphological abnormalities occur in most women with oligomenorrhea and obesity,who should be followed up regularly.

BACKGROUND: Ischemic femoral head necrosis is caused by local vascular injury and blood-supply insufficiency. There exists no optimal treatment for the ischemic femoral head necrosis. Thus, the improvement of the blood supply to the femoral head seems to be a key point for the treatment. OBJECTIVE: To verify the curative effects of autologous bone marrow mesenchymal stem cell transplantation induced vascular regeneration on the improvement of ischemic femoral head necrosis via animal experiments and clinical observations. DESIGN: Contrast animal experiment and self-controlled clinical observation.SETTING: Cell Therapy Center, the 463 Hospital of Chinese PLA.MATERIALS AND PARTICIPANTS: ① Animals: Twenty Japanese white rabbits in either gender and weighing 3.0-4.0 kg were purchased from Animal Experimental Center, General Hospital of Shenyang Military Area Command of Chinese PLA. The animal experiments were coincident with the ethical standards. ② Participants: 188 patients with ischemic femoral head necrosis (335 hips) having whole following-up data were selected from Cell Therapy Center, the 463 Hospital of Chinese PLA from July 2004 to July 2007. There were 113 males and 75 females, and their ages ranged from 18 to 72 years. Diagnosis was done by using X-ray photographs, nuclide scanning, MRI and CT examinations. All patients provided the informed consent, and the study was approved by the local research ethics committee. METHODS: ① Animal experiments: The experiment was carried out at the Animal Experiment Center, General Hospital of Shenyang Military Area Command of Chinese PLA from January to June 2004. Ischemic femoral head necrosis models were established at both hindlimbs by using liquid-nitrogen refrigeration. The right side was regarded as transplantation group and the left one as control group. Mononuclear cells extracted from bone marrow were poured in the right femoral artery, while saline was poured in the left femoral artery. ②Clinical observations: Mononuclear cells were separated from autologous bone marrow of patients with ischemic femoral head necrosis after density gradient centrifugation. MAIN OUTCOME MEASURES: ①Four weeks later, angiogenesis at both femoral arteries was observed by arteriography by using digital subtraction anglography (DSA). Moreover, bilateral femoral head samples underwent pathological sections to observe bone regeneration and repair of femoral head 4 and 12 weeks later. ②Items including hip pain, walking distance and gait, abduction and internal rotation function changes of hip joint were observed in 3, 6, 12 and 24 months after stem cell transplantation in media femoral circum flex artery, lateral femoral circum flex artery and obturator artery. In 6 months after stem cell transplantation, angiogenesis and blood supply of femoral head were observed by using arteriography. In 6, 12 and 24 months after stem cell transplantation, morphological and ischemic changes of femoral head were observed by using CT, X-ray and MRI examinations. Harris scores were used to evaluate function of hip joint before and in 3, 6, 12 and 24 months after stem cell transplantation.RESULTS: Animal experiment: Twenty rabbits were involved in the final analysis. ① DSA-arteriography results: In 4 weeks after transplantation, blood-supply arteries in femoral head of right hindlimb in the transplantation group were more than those in the control group. ② Pathological results: In 12 weeks after transplantation, cartilage, lamellar bone and bone trabecula in the left femoral head were repaired remarkably, but left femoral head necrosis was not improved. Clinical observations: 188 patients were involved in the final analysis. ① Improvement of symptoms: Among 188 patients, 164 (87.3%) had remission of hip pain, 147 (78.4%) had function improvement, and 150 (80.0%) had elongation of walking distance. ② Imaging changes: At 6 months after transplantation, DSA-arteriography in 12 patients demonstrated that blood-supply arteries in femoral head were increased and thickened remarkably as compared with those before transplantation, and the blood flow was rapid. At 12-24 months after transplantation, lesion of bone matrix in 24 patients was improved under the X-ray, CT and MRI examinations. ③ Harris scores of hip joint: The scores at 6, 12 and 24 months after transplantation were significantly higher than those before transplantation (t= -3.423, -6.714, -9.039, P < 0.01).CONCLUSION: Autologous bone marrow mesenchymal stem cell transplantation can effectively improve and treat ischemic femoral head necrosis.

Objective:To observe the change of periphery and centra lymphocyte subsets at the crest-time of MOG_(35-55) induced EAE disease in mice,and to explore the alteration of cellular immunity and humoral immunity in the invasion process in EAE.Methods:MOG_(35-55) was used to establish EAE model in femina C57BL/6 mice.The behavioral changes and the histological scores were recorded after the mice were immuned .The changes of CD3~+CD4~+,CD3~+CD8~+,CD4~+CD25~+ and B220~+ on periphery and centra lymphocytes in spleen,brain and spinal cord were analyzed by flow cytometry.Results:The CD3~+CD4~+,CD3~+CD8~+,CD4~+CD25~+ and B220~+ lymphocytes were detected in the brain and spinal cord of EAE group mice,but they were not detected in CFA control group.The CD3~+CD4~+ and CD3+CD8+lymphocytes in the spleen of EAE crest-time group were lower than those in CFA control group(P＜0.05).The B220~+ lymphocytes were obviously higher than in the CFA control group (P＜0.01).And CD4~+CD25~+ lymphocytes were slight higher than the CFA control group.Conclusion:At the crest-time during EAE,the CD3~+CD4~+,CD3~+CD8~+lymphocytes of spleen reduced obviously,B220~+ lymphocytes increased markedly,and the CD4~+CD25~+ lymphocytes just have the increasing trend.It indicates that cellular immunity and humoral immunity coregulated the patho-process at the crest-time of EAE,T lymphocytes and B lymphocytes all played important roles in the pathogenesy of EAE.

Objective To analyze the bacterial distribution and resistance in upper urinary tract stone patients, then choose suitable antibiotics and reduce infectious complications accordingly.Methods Middle flow urine, infectious stone and the end of kidney drainage tube were taken for culture in 148 patients who underwent percutaneous nephrolithotomy between January 2009 to September 2010. Antibiotics were used according to the culture results and the complications secondary to infection were analyzed. Results Urinary pathogens presented in 38 (25.7%) patients before operation.There were 112 strains of bacteria. The predominant strains included: Escherichia coli (17 cases,11.5%), Staphylococcus epidermidis (4 cases) and Proteus mirabillis (4 cases). Escherichia coli and Proteus mirabillis were common in stone culture. Staphylococcus epidermidis (5 cases),Pseudomonas aeruginosa (5 cases) and Staphylococcus haemolytcus (5 cases) were found in renal drainage tube culture which were positive in 25 patients. Imipenem, cefepime, vacomycin, nitrofurinton were sensitive and commonly used antibiotics. Forty-one patients (27.7 %) had fever postoperatively, including 10 positive for middle urine culture and 9 positive for drainage tube culture. One infective shock was diagnosed postoperatively. Conclusions Gram-negative bacilli are predominant in the upper urinary tract stone patients preoperatively. Gram-positive ones are common postoperatively.Suitable antibiotics, based on middle flow urine culture, could reduce urinary infective complications.

1263 patients with choledocholithiasis were treated with endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (EST) from January 2005 to December 2008, with 1235 (97.8%) cases successfully treated. One-time ERCP removal of the stones was successful in 982 patients, with two times in 129 patients and three times in 124. 1130 patients (89. 5% ) underwent endoscopic nasal biliary drainage (ENBD) after the procedure. 56 patients with refractory stone were treated with intrabiliary plastic stent, among whom 42 were cured through endoscopic retrograde biliary drainage (ERBD) of 1 -3 times. Complications occurred in 29 patients (2. 3% ) with hemorrhage in 8 patients,acute pancreatitis in 17 and perforations in 4. Mortality rate was 0. We concluded that the majority cases of choledocholithiasis can be successfully treated by ERCP, while intrahepatic cholelithiasis and refractory common bile duct stone remained therapeutic challenges. It is also mandatory to evaluate long-term efficacy and complications of ERCP.

Objective To explore the strategies for diagnosis and treatment of anomalous junction of pancreaticobiliary duct (AJPBD) complicated by acute pancreatitis. Methods The clinical dataof 22 patients with abnormal pancreaticobiliary junction were analyzed retrospectively. Results The incidence of acute pancreatitis in this series was 31.8 % (7/22), thereinto, 5 cases(71.4%) in C-Ptype (the common bile duct joining the pancreatic duct) and 2(28.6%) in P-C type (the pancreatic duct joining the common bile duct). Seven patients underwent ERCP+ EST+ ENBD. Two patients with common bile duct stones were treated with stone basket and cholecystectomy was performed in two cases with gallstone. All patients were successfully treated. The follow-up for l year showed that there was no recurrence of pancreatitis. Conclusion Acute pancreatitis usually occurs in patients with AJPBD, especially in C-P type or with gallbladder stone or common bile duct stone. ERCP+EST+ENBD and prophylactic cholecystectomy are effective to prevent and treat acute pancreatitis.