Objective To analyze the hospitalization rates of diabetic patients in different departments in different years and compare the differences in hospitalization costs, length of stay, and mortality between diabetic and non-diabetic patients. Methods The clinical data of hospitalized patients from 1995 to 2009 in different departments of Peking Union Medical College Hospital were retrospectively analyzed. Patients were divided into three groups by calendar period (every five years) and into four groups by ages. Results A total of 500 523 patients were enrolled in this study. From 1995 to 2009, the hospitalization rates of diabetic patients increased from 2.85% to 7.65% , especially among patients who were treated in the departments of cardiology, ophthalmology,and vascular surgery. In 2009, the hospitalization rates of diabetic patients in the three departments were 29.36% , 24. 51% , and 21.25 % , respectively. The length of hospital stay was significantly longer among diabetic patients than among non-diabetic patients (P ＜ 0. 001). The total hospital costs were also significantly higher among diabetic patients than among non-diabetic patients in all the period and age groups (P ＜ 0.01 or P ＜0.001)except in 2000-2004 group and 2005 - 2009 group in 0 - 18 years group (P ＞0. 05). The hospital cost per day in diabetic patients was significantly lower than that in non-diabetic patients in all the period and age groups (P ＜ 0. 05, P ＜ 0. 01 or P ＜ 0. 001)except in 1995-1999 group in over 65 years group (P ＞ 0.05). The mortality rate of diabetic patients in the 1995-2004 in 0-18 years group was zero, and the mortality rates were not significantly different between diabetic patients and non-diabetic patients in 2005 -2009 group in 0-18 years group (P ＞0.05), and were significantly higher in diabetic patients than in non-diabetic patients in all other period and age groups (P ＜0.01 or P ＜ 0. 001). Conclusions Diabetic inpatients tend to have a longer hospital stay, higher hospitalization rate, higher hospital costs, and higher mortality rates. A hospital-wide diabetes management mode should be developed to optimize its treatment.

Objective To observe the effect of acupuncture at lumbar Jiaji (EX-B 2) points plus botulinum toxin injection on the seated function of patients with spastic cerebral palsy.Method Sixty patients aged 1-4 years old with spastic cerebral palsy were randomized into a treatment group and a control group, 30 in each group. The treatment group was intervened by acupuncture at lumbar Jiaji (EX-B 2) points plus botulinum toxin injection, while the control group was by conventional acupuncture plus botulinum toxin injection. After 3 treatment courses, the seated function zone (zone B) of Gross Motor Function Measure (GMFM) was used for evaluation, and the clinical efficacies were compared.Result Respectively after 1, 2, and 3 treatment courses, the total effective rates were 46.7%, 73.3% and 83.3% in the treatment group, versus 33.3%, 46.7% and 60.0%. There were significant differences in comparing the total effective rate between the two groups after 2 and 3 courses (P<0.05). After the first treatment course, the seated function score of GMFM was significantly changed in both groups (P<0.01). After the second course, the seated function score was significantly different from that after the first course in both groups (P<0.01). After the third course, the seated function score was significantly different from that after the second course in both groups (P<0.01). There was a significant between-group difference in comparing the changes of the seated function score during the second treatment course (P<0.01). There was a significant between-group difference in comparing the changes of the seated function score during the second treatment course (P<0.05). Conclusion Acupuncture at lumbar Jiaji (EX-B 2) points plus botulinum toxin injection can produce a more significant efficacy in improving the seated function of patients with spastic cerebral palsy.

Cephalosporins are widely used antibiotics owing to their broad activity spectra and low toxicity. Many of these medically important compounds are made chemically from 7-aminodeacetoxycephalosporanic acid. At present, this intermediate is made by synthetic ring-expansion of the inexpensive penicillin G to form G-7-ADCA, followed by enzymatic removal of the side chain to obtain 7-ADCA. The chemical synthetic process is expensive, complicated and environmentally unfriendly. Environmentally compatible enzymatic process is favorable compared with chemical synthesis. In our previous research, metabolic engineered Escherichia coli strain (H7/PG15) was constructed and used as whole-cell biocatalyst for the production of G-7-ADC with penicillin G as substrate. The whole-cell biocatalysis was studied by single factor experiment, including the composition of substrates and the conversion conditions (OD600, pH, concentration of penicillin G, MOPS, glucose, time and FeSO4). After optimization, 15 mmol/L of G-7-ADCA was obtained. The process is convenient, efficient and economic. This work would facilitate the industrial manufacturing and further product research.
Anti-Bacterial Agents ; biosynthesis ; Biocatalysis ; Cephalosporins ; biosynthesis ; Escherichia coli ; metabolism ; Metabolic Engineering

Objective To evaluate the value of continuous glucose monitoring system (CGMS) in the gestational patients with impaired glucose regulation. Methods The glucose level in the subcutaneous tissue was monitored by CGMS for 3 days in 6 patients with gestational diabetes mellitus (GDM) and 6 patients with gestational impaired glucose tolerance (GIGT). The fluctuation coefficient of blood glucose, percentage of hyperglycemic time, and percentage of hypoglycemic time were calculated. Results As shown by CGMS, the fluctuation coefficient of blood glucose, mean glucose level, percentage of hyperglycemic time, percentage of hypoglycemic time, mean fasting blood glucose, and mean postprandial blood glucose (PBG) levels were not significantly different between GDM group and GIGT group (P ＞ 0. 05). The time for reaching the peak PBG level ranged 90-120minutes in both two groups (P ＞ 0. 05). No sensor-related adverse events were noted. Conclusions It is safe to apply CGMS sensor in pregnant women. The blood glucose profiles are comparable between GDM and GIGT patients by CGMS; therefore, control of blood glucose should be equally strict in patients with GIGT as those with GDM.

Objective:To observe the clinical effect of acupuncture combined with low-frequency electric stimulation on scissor gait in children with spastic cerebral palsy. Methods:A total of 60 spastic cerebral palsy kids were allocated into two groups by random number table, 30 in each group. Cases in the control group were treated with physical exercise therapy, massage and hydrotherapy. Based on the therapies given to the control group, cases in the observation group were supplemented with acupuncture combined with low-frequency electric stimulation. Selected points included Zusanli (ST 36), Sanyinjiao (SP 6), Yanglingquan (GB 34), Jiexi (ST 41), Chengshan (BL 57), Naoqing [Extra, locates at 2 cun directly above Jiexi (ST 41)] and Genping (Extra, locates at the midpoint of the line connecting medial and lateral malleolus). The treatment was done once every other day and 10 d made up a treatment course. The low-frequency electric stimulation was applied to anterior tibia, 6 times a week and 20 times made up a treatment course. Cases were treated for a total of 3 courses and there was a 15-20 d interval between two courses. The low limb functions were assessed before and after treatment using the modified Ashworth scale (MAS) and composite spasticity scale (CSS). In addition, the ankle dorsiflexion angles were measured before and after treatment. Results:After treatment, the ankle dorsiflexion angles and CSS scores in the observation group were better than those in the control group, showing statistical significances (P<0.05); the effective rate in the observation group calculated by MAS and ankle dorsiflexion angle were both higher than that in the control group, showing a statistical significance (P<0.05). Conclusion:Rehabilitation training combined with acupuncture and low-frequency electric stimulation can achieve better effect than rehabilitation training alone in improving scissor gait in kids with spastic cerebral palsy.

Objective To study the difference of body weight gain in the first and second trimesters between pregnant women with abnormal gestational glucose metabolism and those with normal gestational glucose metabolism.Methods We retrospectively analyzed the data of pregnant women visited the obstetric clinic of Peking Union Medical College Hospital from January 2010 to May 2011,with or without abnormal glucose metabolism.The data of body weight gain in the first and second trimesters,body mass index (BMI) before pregnancy,BMI in the end of second trimester,age,obesity history,diabetes family history,insulin level in the oral glucose tolerance test (OGTT),and lipid profile of these women were collected.Results Altogether 216 pregnant women with abnormal glucose metabolism (case group) and 230 pregnant women with normal glucose metabolism (control group) were included in this study.In the case group,the increment of body weight in the first and second trimesters was 10.0 (8.1,12.5) kg,and the increment of BMI was (4.01 ± 1.43) kg/m2,BMI in the end of the second trimester was (25.84 ± 3.14) kg/m2;in comparison,the increments of body weight and BMI in the first and second trimesters were 9.5 (7.0,11.5) kg and (3.60 ± 1.43) kg/m2,respectively,BMI in the end of the second trimester was (25.1 ± 3.00) kg/m2 in the control group,all significantly lower than in the case group (all P ＜ 0.05).The BMI before pregnancy was higher in the case group than in the control group [(21.84 ±2.99) kg/m2 vs.(21.50 ±2.82) kg/m2],but with no statistical significance (P＞0.05).Compare with the control group,the case group had older age [(33.17 ±3.65) years vs.(31.68±3.36) years],higher fasting insulin level [11.2 (7.1,16.3) mU/Lvs.8.9 (6.5,13.7) mU/L],higher peak insulin level in OGTT [135.3 (99.7,208.0) mU/L vs.104.9 (75.6,144.4) mU/L],higher homeostasis model assessment for insulin resistance (HOMA-IR) [2.40 (1.49,3.47) vs.1.82 (1.28,2.71)],and triglyceride [2.62 (2.04,3.31) mmol/L vs.2.18 (1.81,2.81) mmol/L],all with significant differences (all P ＜ 0.05).There were no significant differences in obesity history,family history of diabetes and history of menstrual disorder between the two groups (all P ＞ 0.05).Conclusions The body weight gain is higher in the pregnant women with abnormal glucose metabolism than in those with normal glucose metabolism in the first and second trimesters.Large increment of body weight is likely to be a risk factor for abnormal gestational glucose metabolism.

Objective To study the pharmacokinetics and pharmacodynamics of recombinant human insulin preparations SciLin TM R and Humulin (R) R,and to evaluate their bioequivalence in Chinese healthy volunteers.Methods In this positive control,single dose,open label,randomized cross-over study,20 male healthy volunteers were recruited from March to October 2007,and tested on two experimental days with an interval of 7-14 days.The volunteers were divided into two groups with a random number table,one group was injected with SciLin TMR for the first time and Humulin (R) R for the second time,the other group was injected with the opposite.The pharmacokinetics and pharmacodynamic properties were evaluated by euglycemic glucose clamp study.Results Time to peak concentration [Tmax,(105.8 ± 19.1) minutes vs.(103.5 ± 18.1) minutes,P =0.389) and time to maximum glucose infusion rate [TGIRmax,(132.8 ± 16.8) minutes vs.(132.8 ± 18.6) minutes,P =0.697] for SciLin TMR and Humulin(R) R were similar.The relative bioavailability of SciLin TMR was (102.2 ± 7.6) ％,and the relative biological effectiveness was (107.4 ± 18.8) ％.The 90％ confidence interval(CI) of peak concentration(Cmax) and area under the curve of blood glucose concentration at 0-10 hours (AUCIns 0-10) of SciLin TM R were 99.32 ％-102.62 ％ (equivalent range 70％-143 ％) and 98.98 ％-104.99 ％ (equivalent range 80％-125％),respectively;90％ CI of the maximum glucose infusion rate (GIRmax) and AUCGIR0-10 were 97.36％ ～ 103.49％ (equivalent range 70％-143％) and 98.72％-113.54％ (equivalent range 80％-125％),respectively,indicating that SciLin TMR and Humulin (R) R was bioequivalent.There was no clinically significant abnormalities in the safety indexes before and after the tests.During the trial,no hypoglycemic events,allergic reactions,or local injection adverse reaction occurred.Conclusion The studied recombinant human insulin preparation SciLin TMR may be bioequivalent as Humulin (R) R.

Objective To study the pharmacokinetics and pharmacodynamics of the 40/60 premixed recombinant human insulin injection preparation,and to compare with 30/70 preparation,regular insulin,and neutral protamine Hagedorn (NPH).Methods In this positive control,single dose,open label,Latin square crossover study,20 male healthy volunteers were recruited from May 2006 to March 2007,and divided into four groups.On 4 test days,40/60 preparation,30/70 preparation,regular insulin,and NPH were administered to each of the 4 groups,the interval was 7-70 days before 2 test days.The pharmacokinetics and pharmacodynamics were evaluated by euglycemic glucose clamp technique.Results According to the analysis of variance,there were statistically significant differences in pharmacokinetics and pharmacodynamics of the 4 insulin formulations between the 4 groups (all P ＜ 0.05).For the 40/60 premixed recombinant human insulin,the pharmacokinetic parameter time to peak (Tmax) and mean retention time (MRT) were (105.00 ±24.33) minutes and (321.77 ± 56.29) minutes,respectively;the glucose-lowering effects reflected by the pharmacodynamic parameter Tmax and MRT were (167.75 ± 26.48) minutes and (248.33 ± 14.96) minutes,respectively.Compared with 30/70 premixed recombinant human insulin,40/60 preparation showed no significant differences in the pharmacokinetics parameters of blood insulin concentration,including peak concentration [(91.67 ± 13.03) mU/L vs.(84.96 ± 14.75) mU/L,P =0.119],Tmax [(105.00 ± 24.33) minutes vs.(122.25 ± 39.35) minutes,P =0.128],MRT [(321.77 ± 56.29) minutes vs.(332.12 ± 49.20) minutes,P =0.645] and area under the curve in 0-16 hours [AUCIns 0-16,(24 918 ± 6 610)h · mU/L vs.(26 768 ± 8 032)h· mU/L,P=0.084];however,statistically significant differences were observed in AUCIns0-4 [(16 991 ± 3 673) h · mU/L vs.(12 407 ± 3 441) h · mU/L,P =0.042] and AUCIns 0-8 [(23 283 ± 4 939) h · mU/L vs.(19 397 ±5 314)h · mU/L,P =0.046].Pharmacodynamic parameters showed no statistically significant differences (all P ＞ 0.05).Compared with 30/70 premixed insulin,the relative bioavailability of 40/60 premixed insulin was (118.9 ± 35.9) ％,and the relative biological effectiveness was (106.6 ± 35.2) ％.There was no clinically significant abnormalities in the safety indexes before and after the tests.No hypoglycemic events,allergic reactions,or local injection adverse reaction occurred in this trial.Conclusions The 40/60 premixed recombinant human insulin preparation demonstrated different properties in insulin absorption in 8 hours after injection compared with the 30/70 preparation,mainly because of the difference in proportions of short-and intermediate-acting insulin in the mixture.This new premixed insulin may provide a new option for personalized diabetes management.

Objective:To clone the RC-RNase gene and prepare its recombinant prokaryotic construct, and then to express RC-RNase protein using Escherichia coli system. Methods: RC-RNase cDNA was obtained by RT-PCR from liver of Rana catesbeiana, and cloned into pUCm-T plasmid for nucleotide sequencing. Its expression construct was prepared using the 6?His vector pRSET-A, and induced to express by IPTG in Escherichia coli BL21(DE3). Western blotting identified the expression product. Results: A 380 bp long cDNA was obtained from liver of Rana catesbeiana, restriction sites and sequence being consistent to those reported for RC-RNase. After introducing the gene into Escherichia coli and through the induction by IPTG, it was observed a new peptide at the expected position (Mr 16000) on SDS-PAGE gel. This product was proved to be the target protein via Western blotting. It existed in a form of inclusion body and its efficiency reached 12.5% of total bacterial proteins. Conclusion: RC-RNase gene was cloned and expressed in Escherichia coli. The protein could be used for characterizing the biological activities and function of RC-RNase.

BACKGROUND: Previous studies have proved platelet-rich fibrin (PRF) with osteoinduction ability, and the centrifugal speed and time to prepare rabbit advanced PRF (A-PRF) with the most similar structure to that of human PRF have been determined.OBJECTIVE: To observe the histological changes during A-PRF-induced osteogenesis.METHODS: Thirty Japanese white rabbits were randomly divided into A-PRF and blank control groups (n=15 per group).The full-thickness defect models were established on the rabbit parietal bone, followed by implanted with A-PRF or nothing, respectively. The model rabbits were killed immediately, at 2, 4, 8 and 12 weeks after modeling, to grossly observe the bone formation, and the histological changes in the defect region were observed through hematoxylin-eosin staining, Masson staining and immunohistochemistry.RESULTS AND CONCLUSION: Unhealed defects were observed in the blank control group. Gross and histological observations showed that the speed, amount and maturity of bone formation in the A-PRF group were significantly better than those in the blank control group immediately, 4, 8 and 12 weeks after modeling (P < 0.05). Our findings suggest that the rabbit skull bone defect is successfully established. A-PRF can induce osteogenesis, and more mature newly born bones appear with time. Additionally, osteoclasts can act with osteoblasts synergically under the A-PRF induction to promote the bone formation.