Objective To compare the clinical use of continuous glucose monitoring system (CGMS) and self-monitoring blood glucose (SMBG) when monitoring blood glucose level of patients with gestational diabetes mellitus (GDM) or type 2 diabetes mellitus (DM) complicated with pregnancy.Methods A total of 99 patients with GDM (n=70) and type 2 DM complicated with pregnancy (n=29) that whether hospitalized or in clinical of Peking University First Hospital were recruited from Aug 2012 to Apr 2013.The CGMS was used to monitor their blood glucose level during the 72-hour time period,while the SMBG was also taken seven times daily.The correlation between these blood glucose levels and their glycosylated hemoglobin (HbA1c) levels were analyzed by comparing the average value,the maximum and the minimum value of blood glucose,and the appeared time of these extremum values in these two monitoring methods,and the amount of insulin usage was recorded as well.Results (1) The maximum,minimum and the average blood glucose value in the GDM group were (8.7± 1.2),(4.5 ±0.6) and (6.3 ± 0.6) mmol/L of SMBG vs.(10.1±1.7),(3.1±0.7),(6.0±0.6) mmol/L of CGMS.These values in DM group were (10.1±2.2),(4.5±1.0),(6.9±1.1) mmol/L of SMBG vs.(12.2±2.6),(2.8±0.8),(6.6±1.1) mmol/L of CGMS.By using the two methods,the maximum and the average value of the two groups showed significant differences (P＜0.01) while the minimum value showed no significant differences (P＞0.05).(2) In the GDM group,the average blood glucose values of CGMS and SMBG were significantly correlated (r=0.864,P＜0.01).The maximum values presented the same result (r=0.734,P＜0.01).Correlation was not found in the minimum values of CGMS and SMBG (r=0.138,P＞0.05).In the DM group,the average valves of two methods were significantly correlated (r=0.962,P＜0.01),the maximum values showed the same result (r=0.831,P＜0.01).It can also be observed in the minimum values (r=0.460,P＜0.05).(3) There was significant correlation between the average value of CGMS and HbA1c level (r=0.400,P＜0.01),and the average value of SMBG and HbA1c level were correlated (r=0.031,P＜0.05) in the GDM group; the average values of CGMS (r=0.695,P＜0.01) and SMBG (r=0.673,P＜0.01) were both significantly correlated with the HbA1c level in the DM group.(4) In the GDM group,37％ (26/70) of the minimum values of SMBG appeared 30 minutes before breakfast,while 34％(24/70) of them appeared 30 minutes before lunch; 86％(60/70) of the maximum values of SMBG were evenly distributed 2 hours after each of the three meals.In the DM group,41％(12/29) of the minimum values of SMBG presented 30 minutes before lunch,while 21％(6/29) and 14％(4/29) of them were showed 30 minutes before breakfast and dinner respectively; about 30％ of the maximum values of SMBG appeared 2 hours after each of the three meals.(5) In the GDM group,23％(16/70) of the minimum values of CGMS occurred between 0:00-2:59 am.,and most of the other minimum values of CGMS were evenly distributed in the rest of the day,except for 3％(2/70) of them were found during 18:00-20:59 pm.43％(30/70) of the maximum values of CGMS appeared during 6:00-8:59 am.,only 1％(1/70) and 3％(2/70) of them presented during 0:00-2:59 am.and 21:00-23:59 pm.,and the rest were evenly distributed for the other times of the day.In the DM group,34％(10/29) of the minimum values of CGMS were found during 0:00-2:59 am.,14％(4/29) of them appeared during 9:00-11:59 am.and 15:00-17:59 pm.,45％(13/29) of the maximum values of the CGMS presented during 6:00-8:59 am.,none was found during 21:00-23:59 pm.,0:00-2:59 am.and 3:00-5:59 am.,and the rest were evenly distributed for the other times of the day.(6) 64％(45/70) of the patients in the GDM group did not require for insulin treatment,while 36％(25/70) of them did.For those patients who received insulin treatment,after CGMS,64％(16/25) of them adjusted the insulin dosage according to their blood glucose levels.In the DM group,14％(4/29) of them did not receive insulin treatment,while for the others who did(86％,25/29); 60％ (15/25) of them adjusted the insulin dosage according to their blood glucose levels after CGMS.Conclusions Both CGMS and SMBG could correctly reflect patients' blood glucose levels.It was more difficult to control the blood glucose levels in patients with type 2 DM complicated with pregnancy than the GDM patients.Compared with SMBG,CGMS could detect postprandial hyperglycemia and nocturnal hypoglycemia more effectively.

As one of the important indexes for the diagnosis and treatment of cardiovascular diseases, cardiac output can reflect the state of cardiovascular system timely, and can play a guiding role in the treatment of related diseases. In recent years detection technology of cardiac output has caused great attention, especially minimally invasive and non-invasive methods. In this paper, the principle of non-invasive detection methods and their recent developments are described, and various detection methods are also analyzed.
Cardiac Output ; Cardiovascular Diseases ; diagnosis ; Cardiovascular Physiological Phenomena ; Humans

Objective:To estimate the safety and feasibility of flexible laryngeal mask airway (FLMA) for lumbar vertebral surgery in prone position.Methods: In the study,120 adult patients scheduled for lumbar vertebral surgery under intravenous general anesthesia were divided into group FLMA and reinforced tracheal tube (RTT) group at random.Heart rate (HR),systolic blood pressure (SBP) and diastolic blood pressure (DBP) were recorded at the beginning of anesthesia induction (T0) and on the time of artificial airway intubation (T1),1 min after intubation (T2),extubation (T3),1 min after extubation (T4) as well.The number and time required for intubation were recorded.Peak airway pressure (PPEAK),airway sealing pressure (PAS) in group FLMA and fiberoptic bronchoscopy scale (FBS) were recorded after artificial airway intubation,turned over into prone position and after the operation started,as well as on the time of 1 hour after the operation started,2 hours after operation started and when the operation stopped.Finally,respiratory complications after extubation,including hypoxemia,laryngospasm,coughing,vomiting,hoarseness,and pharyngalgia,were observed and whether there was blood or sewage inside and outside the artificial airway was recorded.Results: There was no difference in the number and time required for intubation between the two groups (P>0.05).There was no difference in PPEAK and FBS between the two groups,and also the same at the different time points in each group (P>0.05).PAS in group FLMA was the same at the diverse time points during anesthesia (P>0.05) and always higher than PPEAK in the perioperative period.In group FLMA,there was no difference in HR,SBP and DBP between the time points of T2 and T1,also of T4 and T3 (P>0.05).In group RTT,HR,SBP and DBP were significantly higher between the time points of T2 and T1 (P<0.01);SBP was significantly higher between the time points of T4 and T3 (P<0.01),DBP and HR were higher between the time points of T4 and T3 (P<0.05).SBP in group FLMA was significantly lower than in group RTT at T2 (P<0.01),HR and DBP were lower than those in group RTT simultaneously (P<0.05).On the time point of T4,SBP,DBP and HR in group FLMA were lower than those in group RTT (P<0.05).The incidence of coughing and pharyngalgia after extubation was significantly lower in group FLMA than in group RTT (P<0.01),with the incidence of hoarseness was lower in group FLMA than in group RTT (P<0.05).There was no difference in the incidence of hypoxemia,vomiting and blood seen outside the cuff between the two groups (P>0.05) while no laryngospasm and sewage seen outside the artificial airway in each group.Conclusion: For suitable patients,FLMA can be used in mechanical ventilation forlumbar vertebral surgery in prone position with more stable circulation and less respiratory complications than RTT.Further clinical validation is needed for the safety of FLMA.

[Objective]To explore the operative method through the trans-upper-sternal approach in the treatment of the cervicothoracic spinal lesions and evaluate its clinical effects.[Method]From August 1999 to February 2006,11 cervicothoracic patients,8 males and 3 females,age ranged from 17 to 77 years with a mean of 41.5 years underwent the trans-uppersternal approach surgical treatment.There were four traumatic lesions,six tumors and one tuberculosis.The lesions were located at T3,C7~T1 and T1、2 in 1 case respectively,C7 and C6~T1 in 2 cases respectively,T1 in 4 cases.The combined cervicothoracic incision and upper sternotomy were performed for the exposure of the vertebral bodies,then tumor or vertebral body was resected,the spinal cord was decompressed,the spinal column was reconstructed and fixed.Neurologic status was assessed using the Frankel classification.[Result]The duration of follow-up ranged from 10 to 56 months with an average of 31 months.One patient developed chyle leakage of 50 ml one day after surgery and the leakage stopped 2 days after continuous drainage.One patient had transient vocal cord paresis which recovered in 3 months.All patients had their neurological improvement at different level.Nonunion or instrument-related complications were not observed,and the vertebral column had good stability.[Conclusion]The trans-upper-sternal approach gives an excellent exposure of the cervicothoracic junction.It is a technically simple,safe and effective method for anterior decompression,maintenance of anatomic alignment,fusion with bone graft and internal fixation with less complications and trauma.Attention should be paid to avoid injury of the recurrent laryngeal nerve and the thoracic duct.

Objective To explore the long term effects of gestational diabetes mellitus (GDM)on offsprings of affected women.Methods One hundred and twenty-four singleton pregnant women with GDM,who delivered in Department of Obstetrics and Gynecology,Peking University First Hospital from June 14,2006 to December 31,2007,were enrolled as the study group.Ninety-eight singleton pregnant women with normal glucose metabolism who delivered at the corresponding period were enrolled as the control group.The follow-up study was performed from November 6,2010 to January 31,2011 on their offsprings.Anthropometry indexes,including height,weight,waist circumference,systolic and diastolic blood pressure (DBP),triceps skin fold (TSF) and sub-scapular skin fold (SSF) were measured.According to the development standard of children less than five years old issued by World Health Organization in 2006,there were six detailed evaluation indicators including length/height for age z-score (HAZ),weight for age z-score (WAZ),weight for length/ height z score (WHZ),body mass index (BMI) for age z-score (BAZ),triceps skin folds for agez-score (TSFZ) and sub-scapular skin folds for age z-score (SSFZ).Chi-square,t-test or variance analysis were applied.Results (1) No statistical difference on age,birth weight,sex,height,weight,BMI,waist circumference,blood pressure,TSF and SSF was found between offsprings of study and control group (P＞0.05).(2) Offsprings in both groups were further divided into macrosomia and non-microsomia subgroups,i.e.GDM macrosomic subgroup (n =15),GDM nonmacrosomic subgroup (n=109),control macrosomia subgroup (n=6) and control non-macrosomia subgroup (n=92).Significant difference was shown amont the four subgroups in weight [(19.8±3.9),(17.0±1.9),(17.7±1.7)and (17.2±1.7) kg,F=6.238,P＜0.001],BMI (17.6±2.6,16.0±1.2,16.6±1.1 and 16.2±1.1,F=5.901,P＜0.001),waist circumference [(53.6±5.3),(49.9±2.7),(50.9±3.3) and (50.4±0.9) cm,F=5.307,P＜0.001],WHZ (1.40±1.44,0.45±0.81,0.88±0.75 and 0,60±0.87,F=5.269,P=0.002),HAZ (1.22±0.78,0.47±0.82,0.98±0.74 and 0.50±1.00,F=3.668,P=0.013),WAZ (1.68±1.23,0.58±0.79,1.15±0.85and 0.71±0.93,F=7.361,P＜0.001) and BAZ (1.41±1.52,0.42±0.84,0.81±0.76 and 0.60±0.90,F=5.210,P =0.002).While comparing between each two subgroups,there was statistical difference between GDM macrosomia subgroup and GDM non macrosomia subgroup,and between GDM marosomia subgroup and control non-macrosomia group.(3) While comparing GDM macrosomia and GDM non-macrosomia subgroup with control group [weight (17.2±2.5) kg,BMI (16.2± 1.4),waist circumference (50.5 ± 3.6) cm,DBP (55.2 ± 6.9)mm Hg,SSF(6.1 ± 1.8) mm,WHZ (0.62±0.87),HAZ (0.53±0.99),WAZ (0.73±0.92),BAZ(0.61±0.89)],the weight (F=9.283,P＜0.001),BMI (F=8.707,P＜0.001),waist circumference (F=7.934,P＜0.001),DBP(F=3.123,P=0.046),SSF (F=3.499,P=0.032),WHZ (F=7.639,P＜0.001),HAZ(F=4.709,P=0.010),WAZ (F=10.302,P＜0.001) and BAZ (F=7.689,P＜0.001) was higher in GDM group than the control group.(4) The proportions of overweight and obesity were higher in GDM macrosomia subgroup than in GDM non-macrosomia and control groups [overweight:9/15 vs24.8％ (27/109) and 24.5％ (24/98),x2 =8.870,P=0.012; obesity:5/15 vs 7.3％(8/109) and 9.2％(9/98),x2=10.083,P=0.006].If all subjects were divided into macrosomia and non-macrosomia group,then the proportion of overweight and obesity was higher in the former group [overweight:52.4％ (11/21) vs24.4％(49/201),x2=7.560,P=0.006; obesity:28.6％ (6/21)vs 7.9％(16/201),x2 =9.047,P=0.003].Conclusions GDM may have long term adverse effect on the development of offsprings at three-four-year-old with higher incidence of obesity or high diastolic blood pressure in macrosomic babies of GDM mothers than in non macrosomic babies of GDM mothers or babies of non GDM mothers.

Objective To observe the pathology in temporal lobe cortexes and hippocampus in protopathic intractable temporal lobe epileptics.Methods The cortexes of spike foci in temporal lobe and hippocampus were obtained from 9 cases with protopathic intractable temporal lobe epilepsy who accepted operation.The samples were observed under the transmission electron microscope.Results The ultrastructure changes in spike focus of temporal lobe cortexes are similar to those in hippocampus.It is common that neurons were pycnotic and decreased.Astrocytes were hydropic and degenerative.Gliosis were found in some cases.The number of synapses increased or decreased in different cases and positions.Blood-brain barriers were destroyed because foot processes of astrocytes around capillaries were edematous.Conclusion Neuronal loss,gliosis and synaptic reorganization which occur in epileptic hippocampus and maybe also in epileptic temporal lobe cortexes destroy the balance between excitatory and inhibitory neurotransmission.The abnormalities probably associate with protopathic intractable temporal lobe epileptic seizures.

High extracellular potassium can induce spreading depression-like depolarizations, elevations of extracellular glutamate and even neuronal death in normal brain. To investigate the contribution of high potassium in vivo, a microelectrode arrays ( MEAs ) probe integrated with recording sites for glutamate concentration (50í150 μm) and local field potential ( LFP) ( diameter=15 μm) was fabricated by Micro-electro-mechanical-systems ( MEMS) technologies. We implanted the MEA probe acutely in the rat brain and exposed the brain to a high potassium solution. During these multi-modal recordings, it was observed that high potassium elevated extracellular glutamate while suppressing the LFP irreversibly. This is one of the first studies in which a dual mode MEA probes is applied in vivo for neuronal death, and it is concluded that our MEA probes are capable of examining specific spatiotemporal relationships between electrical and chemical signaling in the brain.

The nano-structure TiN was modified on the laboratory self-made planar microelectrode array pMEA by magnetron sputtering method. The performance of modified pMEA was investigated. Research on neuroelectrical and neurochemical recording was studied in vitro. The impedance of the modified pMEA was decreased almost one order of magnitude, and the background noise level was reduced to ±6 μV. In the same testing environment, the signal-to-noise ratio (SNR) of modified electrodes was 1. 7 times of bare electrodes. The SNR of neuroelectrical recording on the brain slice of SD rats reached 10:1 , and the weak signal such as ±12 μV was separated easily. For neuroelectrical recordings, the detection limit of dopamine ( DA) solution reached 50 nmol/L with the 2:1 (S/N). During the concentration range of 0. 05-100 μmol/L, the linearly correlation coefficient of the DA oxidation currents was 0 . 998 . The modification of nano-structure TiN on pMEA reduced pMEA impedance and background noise level, meanwhile the SNR was increased. The weak signals of neuroelectrical and neurochemical recording were successfully recorded.

BACKGROUND:Lipoic acid, with a closed circle structure composed by sulphur and carbon atoms, exerts strong anti-oxidation, and has been extensively applied in the prevention and treatment of oxidative stress, diabetic cataract, diabetic neuropathy and cardiovascular diseases. OBJECTIVE:To investigate the protective effect of lipoic acid on peripheral nerve function during peripheral nerve ischemia/reperfusion injury. METHODS:Models of peripheral nerve ischemia/reperfusion injury were established in rabbits, and then rabbit models were then allotted to treatment and non-treatment groups. The treatment group was subdivided into experimental (injection of lippoic acid) and control groups according to the use of lipoic acid at 1, 3 and 6 hours after ischemia and before reperfusion. The ultrastructural changes of the sciatic nerve were observed under electron microscope, and the electrophysiological changes of the sciatic nerve were detected using evoked potential instrument. RESULTS AND CONCLUSION:With the ischemic time increasing, the number of vacuoles in the axon increased gradually, accompanied by axonal atrophy, and Waller's degeneration in the aggregated microfilaments. The myelin sheath thickening and dissolving were visible. All above phenomena became severest at 6 hours after ischemia. Compared with the control groups, lipoic acid reduced the number of the vacuoles in the axon and all eviated axonal atrophy, Waller's degeneration and demyelination. As the ischemic time increasing, the latency of sciatic nerve was significantly increased, and peaked at 6 hours of ischemia;while the amplitude was significantly decreased, and reached a minimum at 6 hours of ischemia. Compared with the control groups, in the experimental groups, the latency of sciatic nerve was significantly decreased, but the amplitude was significantly increased. These results suggest that lipoic acid provides neuroprotection against peripheral nerve ischemia/reperfusion injury.

Subthalamic nucleus (STN) deep brain stimulation (DBS) has become an important surgical treatment of Parkinson disease, but its exact mechanism is still unclear.In this study, a 16-channel implantable microelectrode array (MEA) was prepared by micro-electromechanical system (MEMS) technique and later modified with platinum black/reduced Graphene Oxide/Nafion (Pt/RGO/Nafion) nanocomposites.Extracellular dopamine (DA) content and spike of dorsal striatum neurons were synchronously recorded before and after STN stimulation.The results showed that the dopamine content began to increase within 20 s after electrical stimulation and dropped to normal level after about 50 s, with the highest rising concentration of 1.72 μmol/L.At the same time, there was an increased spike activity of interneurons in the dopamine ascending phase, and the spike firing rate of medium spiny projection neurons (MSNs) was high when the concentration of DA was higher than the normal level.The MEA sensor can simultaneously record dopamine flux and physiological signals in situ, thus providing an ideal tool for neural information detection.