Objective To observe the effect of insulin increasing-sensitivity agent- rosiglitazone on impaired glucose tolerance. Methods One hundred and forty cases of impaired glucose tolerence(IGT)were divided into two groups randomly. Eighty cases was intervented with physical activity, diet control and rosiglitazone in the treatment group ,60 cases were intervened with physical activity and diet control in the control group for 24 weeks. Clinical characteristics, including BMI, blood pressure, blood glucose, lipids profiles, insulin, C-peptide and urinary microalbumin excretion were compared between two groups. Results In the treatment group, fasting glucose and 2 h glucose significantly decreased from (5.7 ±0.9) mmol/L and (9. 6 ± 1.8) mmol/L at the baseline to (4.6 ±0.8)mmol/L and (7. 6 ± 1.2) mmol/L(P ＜0.01). In the treatment group,the urinary micro-albumin excretion,insulin resistance,triglyceride, fasting glucose and 2 h glucose were (246 ± 16)mg/24 h,2. 024 ± 0.427, (1.6 ± 0.8)mmol/L, (4. 6 ± 0.8) mmol/L and (7. 6 ± 1.2) mmol/L, which was significantly lower than those of (280 ± 12)mg/24 h ,3. 328 ± 0.462, (2. 5 ± 0.9) mmol/L, (5.5 ± 0.7) mmol/L and (8. 9 ± 1.3) mmol/L in the control group (P ＜0.01). The treatment significantly improved the insulin sensitivity from 80 ± 1 at the baseline to 198 ±8. In the treatment, the FINS and C-peptide were significantly decreased from (32 ± 9) mU/L and (3. 58 ± 1.60) g/L at the baseline to (21 ± 8) mU/L and (2. 52 ± 1.20) g/L(P ＜ 0.01). The blood pressure deceased significantly at the 24th week, and signfiantly different from those in the conrol group (P ＜ 0.05). After 48 weeks, 1 of the patients in the treatment group developed into type 2 diabetes mellitus,whereas 8 patients developed into type 2 diabetes mellitus in the control group,which was significantly higher than that in the treatment group (P ＜0.05). The rate of side effects in the treatment group was similar with that in the control group, no liver function impair etc has been observed. Conclusions Rosiglitazone has significant effect on decreasing the blood sugar and decreasing the fasting insulin and C-peptide in patients with impaired glucose tolerancem improving the insuhn sensitivity of the circumference tissue, and can prevent or postpone the progression of IGT to type 2 diabetes mellitus in patients at risk of developing the disease.

Objective To observe the efficacy,feasibility and safety of continous intravenous infusion of furosemide,dopamine combined with Shenmai on treatment of refractory heart failure. Methods Fifty-six patients with diuretic resistance and refractory heart failure were divided into control group(28 patients)and treatment group(28 patients)by random digits table. Conventional diuretics and other anti-heart failure treatment were used in two groups, meanwhile, continuous intravenous infusion of furosemide,dopamine and Shenmai were used in treatment group for 5-7 days. The clinical symptoms and signs, pulmonary edema in chest X-ray and the improvements of pulmonary congestion were observed before and after treatment. Results In treatment group, 10 patients were markedly effective, 14 patients were effective, and 4 patients were unfruitful. The total effective rate was 85.7%(24/28). In control group, 3 patients were markedly effective, 10 patients were effective, and 15 patients were unfruitful. The total effective rate was 46.4%(13/28). There was significant difference in total effective rate between two groups (P ＜ 0.05). The indexes of left ventricular end-diastolic dimension, fractional shortening, left ventricular ejection fraction and cardiac index were significantly improved in treatment group(P ＜ 0.05), but was not significantly improved in control group(P ＞ 0.05). After treatment,2 patients emerged hypokalemia and hyponatremia, after symptomatic treatment,they all recovered. Conclusion Conventional treatment combined with continuous intravenous infusion of furosemide,dopamine and Shenmai in patients with refractory heart failure is markedly effective, feasible and safe.

The diagnosis of nonparasitic hepatic cysts has been significantly improved with the development of imaging techniques,however,the successful differential diagnosis depends on more careful consideration.The differential diagnosis of multiple hepatic cysts and polycystic liver disease depends on the family heredity,number of cysts,combination of polycystic kidney,division and the results of B ultrasound.The differential diagnosis of hepatic cyst and hepatic cystic adenocarcinoma depends on the imaging features and results of histopathological examination.Recently,laparoscopic surgery has been widespread-ly used in the management of hepatic cystic disease,while it still cannot replace open surgery.The individualized and various treatment should be selected according to the condition of the patients.

Urethral reconstruction is required in congenital abnormalities such as hypospadia and urethral stricture caused by trauma or infection. The development of tissue engineering has brought new hope to the field of urethral reconstruction. Much progress has been made in the experimental and clinical research of using tissue engineering for urethral reconstruction as well as the research of the scaffold materials. This review focuses on the recent progress in this field.

The development of tissue engineering has provided new methods for organ replacement and disease treatment.The research of seed cells includes cell selection,culture,transplantation,tracing and so on.The tracing technique of seed cells involves molecular biology,molecular immunology,molecular imaging and many other subjects,making it difficult to select a label for seed cells.This review summarizes the recent research progress in the tracing technique of seed cells.

Objective To investigate the role of hexosamine biosynthesis pathway (HBP) in the functionalalterationofmesangialcellstransinfectedwith glucose transporter 1 (GLUT1) gene. Methods Rat mesangial cells were transinfected with the human GLUT1 gene (MCGT1) by retrovirus vector. Mesangial cells transinfected with bacterial ?-galactosidase (MCLacZ) were used as control. Glucose uptake was detected with 2-deoxy-〔 3H〕-D-glucose (2-DG). Cell size, RNA/DNA ratio, protein/DNA ratio and the synthesis of fibronectin were evaluated by flow cytometry. The activity of glutamine: fructose-6-P aminotransferase (GFAT), which is the key enzyme of HBP, was assayed by spectrophotometry. The expression of GFAT gene was analyzed by RT-PCR. Results MCGT1 demonstrated higher 2-DG uptake than MCLacZ 〔(741.0?60.5)dpm/?g protein vs (92.2?9.0)dpm/?g protein,P

Objective To investigate the pulmonary microvascular responsiveness of diabetic animals to sepsis and the potential mechanism of NO system.Methods Sixty-four Wistar rats of clean grade were randomly (random number) divided into 4 groups,namely normal control group (group A,n =16),diabetes group (group B,n =16),sepsis group (group C,n =16),diabetes and sepsis group (group D,n =16).Diabetic mellitus model was made in rats with injection of streptozotocin,STZ (65 mg/kg).Successful model was defined as the blood glucose value≥ 16.67 mmol/L 48 hours after injection of STZ.All animals were fed 4 weeks before initiation of next experiment.The sepsis model was established by intravenous injection of LPS (10 mg/kg) in rats.RT-PCR was used to determine the mRNA expression of Tie-2 in rats'blood.The ratio of dry/wet of lung tissue and the extravasation of Evans blue dye into the lung were detected.Quantitation of NO in lung tissue and serum was measured by using Griess method.RT-PCR was also used for determination of iNOS,eNOS,DDAH2 mRNA expressions in lung tissue.Data were analyzed with ANONA and LSD method for comparison between groups,and P ＜ 0.05 was considered statistically significant.Results Compared with septic group.,the diabetic rats with sepsis group demonstrated higher expression of Tie-2 mRNA in blood (19.72 ± 0.70) vs.(3.99 ± 0.92),P =0.00,lower ratio of dry/wet in lung tissue (0.19 ±0.01) vs.(0.22 ±0.01),P =0.000,higher permeability of Evans blue dye into lung tissue (3.76 ± 0.77) vs.(1.74 ± 0.24),P =0.000.Serum NO level was lower in group D than that in group C (123.13 ±4.24) vs.(188.30 ±5.18),P =0.000,however,NO levels in lung tissue of both group D and group C were higher than that in control group (53.62 ± 6.70),(23.63± 3.92) vs.(10.37 ± 1.29),P =0.00,and NO level in group D was higher in 2 times than that in group C (P =0.00).However,there were no differences in eNOS expression among groups A,B and C,but the difference in eNOS expression was present between group D with lower expression and group A,that lower in group D (0.07 ±0.02) vs.(0.38 ±0.05),P=0.017.Compared with group C,the expression of iNOS was higher in group D (80.23 ±2.49),(32.48±5.37) vs.(1.74±0.23),P=0.00),and the expression of DDAH2 was lower in group D (0.49 ±0.13),(7.26 ±0.50) vs.(11.96 ±0.55).Conclusions Diabetic rats with sepsis enhanced endothelial cell damages.Diabetes deteriorates the regulatory activity of NO system,suggesting the potential mechanism of the worsened damages of EC in diabetic sepsis host.

Objective To evaluate the prevalence and clinical significance of IgG,IgA and IgM isotypes of anti-peptidylarginine deiminase 4 (anti-PAD4) antibodies in early rheumatoid arthritis (RA).Methods IgG,IgA and IgM isotypes of anti-PAD4 antibodies were measured in the sera of 88 RA patients with disease duration less than 2 years,62 patients with other rheumatic diseases and 57 healthy subjects.The diagnostic performance of IgG,IgA and IgM isotypes of anti-PAD4 antibodies and their relationship with disease duration,DAS28,ESR,CRP,anti-CCP antibodies and rheumatoid factor (RF) were evaluated.Data analysis were performed using t test,U test and Spearman's association analysis.Results ① The sensitivities of IgG,IgA,and IgM isotypes for early RA were 28.41％,36.36％ and 9.09％ respectively.The specificities of IgG,IgA and IgM isotypes were 94.12％,93.28％ and 95.80％ respectively.② IgA isotype was positively correlated with age (r=0.234,P=0.028),DAS28 (r=0.309,P=0.007),ESR (r=0.382,P=0.000) and CRP (r=0.291,P=0.008),while negatively correlated with disease duration (r=-0.295,P=0.006).③ IgA isotype was positively correlated with IgG isotype (r=0.451,P＜0.01).In the IgG negative patients,the positivity of IgA isotype was 29％(18/63),which indicated that the IgA isotype might be helpful in diagnosing RA in IgG isotype negative patients.Conclusion Anti-PAD4 antibodies can be detected in early RA,primarily with IgA and IgG isotypes.IgA isotype has negative correlation with disease duration,indicating that IgA isotype of anti-PAD4 antibody may play a role in the very early stage RA.

Objective To study the application of standardized patients practice and agent physician system in digestion medical clinical practice. Methods One hundred and fifty five-year-clinical medical students who began digestion medical clinical practice from 2008 to 2009 were selected and randomly divided into teaching reform group and control group, each group containing 75 people. According to teaching reform group students' willingness and through the selection, 69 were identified as agent physician. Standardized patients and agent physician simulation clinical training were applied in the teaching reform group while conventional teaching methods were used in the control group. Sta-tistical analysis of the experimental data was conducted using SPSS 11.0 statistical package. Measure-ment data use independent-samples t test and rank sum test was used for heterogeneity of variance. Results Teaching reform group students' inquiry contents and skills scores for each project were higher than those of control group and the score difference was statistically significant (P<0.05) in chronological order, the transition language, interrogation schedule, repeated questions, summary records, citing verification, instrumentation courtesy, friendly behavior, praise and encouragement, eliciting the patient's views, concerns about the effects of disease, care and support and assistance aspects. After the end of the third internship, two groups were compared in operation results, reform history collection, physical examination skills group score and the excellent and good rate being higher (P=0.002, 0.001). After three times' practice, teaching group students' scoring pass rate in medical ethics demeanor, interrogation techniques and physical examination skills, case analysis is higher than that of the control group students, and the difference was statistically significant(P<0.05). Conclusion Application of standardized patients and implementing agency resident simulation clinical training in the guide teaching of digestion department of internal medicine has achieved good effect.

Objective To investigate changes of esophagogastric varicosis,and portal hemodynamics in cirrhotic portal hypertensive patients after Hassab surgical operation. Method The changes of esophageal varicosis and gastric varices incidences at different phases of cirrhotic patients after the Hassab surgical operation were examined by electric endoscope.Hemodynamics of portal vein system was measured by Doppler color imaging and color Doppler ultrasound after operation. Results Mild esophageal varicosis incidences on the 6th,12th and 18th month after the Hassab surgical operation were respectively 44.1%,34.7% and 28.4%,higher than that before operation (7.5%) (P＜0.05).Severe esophageal varicosis incidences on the 6th,12th and 18th month were respectively 25.1%,30.0% and 35.0%,lower than that before operation (65.2%) (P ＜ 0.05).Mild esophageal varicosis with gastric varices incidences on the 6th,12th,18th and 24th month before and after operation were respectively 16.6%,and 7.4%,9.2%,9.1%,10.3% respectively.Severe esophageal varicosis with gastric varices incidences in the 6th,12th,18th and 24th month were respectively 43.8%,and 45.8%,45.2%,47.4%,48.8% (P＜0.05).Inner diameter of portal vein and the right branch of portal vein on the 6th and 12th month before and after operation were respectively (13.5±1.7) mm,(9.8±2.0) mm,(10.5±2.2) mm,(11.2±1.2) mm,(8.1 ± 1.3) mm and (8.2 ± 2.2) mm (P ＜ 0.05).Maximum flow rate and blood flow of portal vein,velocity of the left of portal vein in the 6th and 12th month were respectively (13.6 ±2.6) cm/s,(1095 ±290) ml/min,(13.3±2.6) cm/s,(11.5 ±1.6) cm/s,(11.8 ±1.8) cm/s,(847 ±249) ml/min,(907 ± 310) ml/min,(11.0 ± 1.9) cm/s and 11.1 ± 1.9 cm/s (P ＜ 0.05).Velocity of the right of portal vein in the sixth month were (11.6 ± 2.6) cm/s,which was significantly slower than preoperative level of (13.2 ± 2.9) cm/s. Conclusion After the Hassab surgical operation the degree of esophageal varices lightens during 18 months and aggravates after 18 months.There is obvious relation between gastric varices and the degree of esophageal varices.Velocity of portal blood flow becomes slow,blood flow diminishes and inner diameter reduces after the Hassab surgical operation.