Thiazolidinediones (TZDs) are currently the only recognized insulin sensitizers available for the clinical treatment of type 2 diabetes. Although their advantages are recognized, the profiles of numerous adverse effects hinder the continued use of these drugs. Peroxisome proliferator-activated receptor γ (PPARγ) is known as a receptor for TZDs, and its underlying mechanisms of pharmacological actions and adverse effects have been deeply explored. To maximally preserve the PPARγ-mediated insulin sensitizing effects and reduce the occurrence of related adverse effects, the concept of "selective PPARγ modulators (SPPARMs)" has been proposed and developed, guiding the development of new drugs. In this review, we summarize the recent research progress in the definition of SPPARMs, the candidate classification and the molecular underpinnings, as well as present the discovery of the YR series compounds as an example, and discuss the potential application prospects of SPPARMs.

Objective:To explore the feasibility of fetal intelligent navigation echocardiography (FINE) in automatic quantitation of cardiac axis (CA).Methods:A total of 62 pregnant women of which 2 with twins′ pregnancy in the second and third trimesters from May to June 2020 in Sir Run Run Shaw Hospital Zhejiang University College of Medicine were enrolled in this non-selective and prospective study. After excluding those who could not be analyzed, they were assigned into four groups according to their CA measuring methods: ①Group with manual measuring CA in systole (CAS); ②Group with manual measuring CA in diastole(CAD); ③Group with CA measured by FINE in three-steps; ④Group with CA measured by FINE in seven-steps. The CAS among groups were compared in order to analyze the consistency and correlation of CAS achieved by different methods, meanwhile, the intra-observer and inter-observer consistency and repeatability were also evaluated.Results:A total of 64 fetuses with 187 volume data were collected, of which 60 cases of fetal data can be included in the study, 57 cases of normal CA, 3 cases of abnormal CA, a total of 158 volume data can be used for data analysis, the success rate was about 84.5%. Because of the small number of abnormal CA cases (3 cases), only 57 cases of normal CA were statistically analyzed in this study. Three-step and seven-step FINE automatic quantitative CA showed significantly different from those obtained with manual measurements of CAD ( P=0.005, P<0.001). There were no significant differences in quantitative analysis of CA between three-step or seven-step FINE and manual measurements of CAS ( P=0.458, 0.883), however, there was no correlation between CA using three-step FINE and manual measurement of CAS ( rs=0.056, P=0.679), but there was a positive correlation between CA using seven-step FINE and manual measurement of CAS ( rs=0.599, P<0.001). The linear regression equation was constructed as follows: Y=10.96+ 0.73 X ( R2=0.431, P<0.001). There was no correlation between three-step method and seven-step method for automatic quantitative CA ( rs=0.158, P=0.241). There was significant difference( P<0.001), but strong correlation between manual measurement of CAS and manual measurement of CAD ( rs=0.973, P<0.001), the average difference was ΔCA=(4.5± 3.8)°. The linear regression equation was constructed as follows: Y=-2.94+ 0.96 X ( R2=0.950, P<0.001). Intra-observer and inter-observer measurements had shown no significant difference in consistency and repeatability (all P>0.05). Conclusions:The measurement of fetal CA by seven-step FINE is superior to the three-step FINE when the fetal CA is in normal range. This may be considered a promising aspect that seven-step FINE automatic quantitation of fetal CA can replace the manual measurement of CAS. Future research is needed to deliminate the reliability of automatic quantification of fetal CA by seven-step FINE with the CA in abnormal range.

Objective To study the relationship between hepatic arterial buffer response (HABR),recovery of liver function,early biliary complications and small-for-size syndrome (SFSS).Methods Early hepatic hemodynamic parameters (including hepatic arterial flow (HAF),portal venous flow (PVF) were measured using duplex Doppler sonography in 34 patients who received living donor liver transplantation (preoperatively n＝26,intraoperatively n=26) and on postoperative days 1,2,3,and 7.Alanine aminotransferase (ALT),aspartate aminotransferase (AST) and total bilirubin (TBIL) level were measured preoperatively and on postoperative days 1,2,3,7,14,21,and 28.If TBIL level was elevated,we used B ultrasonography or CT and even ERCP to diagnose early biliary complications.The days taken for AST,AI T and TBIL to recover and the number of patients with early (＜60 days) biliary complications (bile leakage or bile stricture) and with small-for-size syndrome (SFSS) were recorded.Results Passive hepatic artery buffer response (HABR) was present in 11 patients early after living donor liver transplantation (group 1) and it disappeared in 23 patients (group 2).The recovery in days taken for normalization of AST (10.6± 8.8),AIT (11.6±9.0) and TBlL (average of 29) in group 1 were shorter than in group 2.However,the differences did not reach statistics difference (P＞0.05).The overall incidences of early biliary complications and small-for-size syndrome (SFSS) in group 1 were significantly lower than in group 2 (P=0.04).The survival rate in group 1 was 82 ％,compared with 74 ％ in group 2.Conclusions Passive hepatic arterial buffer response (HABR) disappeared in some patients early after living donor liver transplantation.There were high incidences of early biliary complications and small-for-size syndrome (SFSS) in these patients.Measurcment of hepatic buffer response in the early stage after living donor liver tranaplanta tion is valuable for predition of early biliary complications and small-for-size syndrome (SFSS),thus helping to prevent failure in transplantation.

Objective To investigate the protective effect of polymyxin B (PMB) to the liver graft after liver transplantation and the underlying mechanism in rats.Methods Male SD rats were selected as the donors and recipients.Non-artery whole liver transplantation model was established in rats according to Kamada's two-cuff method.The rats were divided into two groups by the way of random number table method:control group (normal saline,0.5 ml) and PMB group (PMB,1 mg/ml,0.4 mg/kg+ normal saline 0.5 ml).The levels of portal vein plasma endtotoxin (EU/ml)were determined by endotoxin-analyzing machine of BET-24A. ALT,BUN,and TNF-α,IL-6 in serum were measured by using machine of Automatic Analyzer and ELISA,respectively.The CD14,TLR4,NFκB and AP-1 in the grafts were measured by RT-PCR and Western blotting,and pathological changes were observed. Results PMB decreased the levels of portal vein plasma endotoxin 1 h after reperfusion in PMB group as compared with control group (P＜0.05),and the levels of portal vein plasma endotoxin returned to the normal levels 6 h after reperfusion in both two groups (P＞0.05).After operation,the levels of ALT,TNFα and IL-6 in serum were significantly reduced (P＜0.05),the expression of CD14 and TLR4 mRNA in the grafts was significantly decreased (P＜0.05),the expression of Hsp60 protein and mRNA,and NF-κB and AP1 proteins in the grafts were reduced (P＜0.05),and the pathological damage to the grafts was significantly alleviated in PMB group as compared with control group.Conclusion PMB reduced the levels of portal vein plasma endotoxin after reperfusion in liver transplantation in rats.PMB improved liver function,reduced the injury of inflammatory response,decreased the levels of endotoxin signal pathway markers and alleviated the pathological damage to the grafts.

Objective To investigate the complications of deep brain stimulation (DBS) internal pulse generator (IPG) replacement procedures and discuss the reasons,preventive measures and treatments.Methods From 2012 to 2016,285 procedures (according to the number of replacement IPG) were performed for 211 patients in our hospital.Among them,178 patients were with Parkinson's disease,29 patients were with dystonia,3 patients were with tic disorder,and one with essential tremor.Thirty-two patients previously used Medtronic replaced with local DBS with brand of PINC and Sceneray,and the other 179 patients remained the use of Medtronic brand.Furthermore,36 patients got extension cable reimplantation along with IPG replacements.Results Replacement surgeries were divided into 3 types:IPG replacement in situ;bilateral side single-channel IPG was replaced by double-channel IPG or double-channel IPG was replaced by bilateral single-channel IPG;extended cables and IPG replacement were carried out simultaneously.The follow up period was from one to 6 years for these 211 patients,and 15 got surgical-and hardware-related complications:6 with sack hemorrhage,2 with skin erosion,one with IPG rejection,3 with adaptor fracture,and 3 with impedance abnormality were recorded;no infection was noted.Twenty-six patients got significant improvement after new IPG replacement.Conclusions DBS IPG replacement operations is a regular surgery with certain safety.Personalized surgical procedures,rigorous intraoperative operation and correct postoperative management can effectively reduce and prevent the complications of IPG replacement surgery.

OBJECTIVETo explore the clinical effects of Stoppa approach and posterior percutaneous plate in treating type C pelvic fracture.

METHODSFrom June 2009 to July 2011,16 patients with type C pelvic fracture were treated with reconstruction plate fixation in Stoppa approach for anterior lesions combined with posterior percutaneous plate fixation for posterior lesions.There were 11 males and 5 females,with an average age of 38.8 years (ranged, 22 to 59 years). According to the Tile classification,10 cases belonged to C1,4 belonged to C2,2 belonged to C3. Tometta and Majeed score standards were used to evaluate clinical results.

RESULTSSixteen patients were followed up from 4 to 13 months with an average of 7.3 months. Operative time was from 80 to 140 min with an average of 100 min;blood loss volume was from 200 to 500 ml with an average of 280 ml; and the healing time of fracture was from 12 to 16 months with an average of 14 months. According to the Tometta score classification, 9 cases got excellent results, 6 good, 1 fair. According to the Majeed score classification, 9 cases obtained excellent results, 5 good, 2 fair.

CONCLUSIONReconstruction plate fixation in Stoppa approach for anterior lesions combined with posterior percutaneous plate fixation for posterior lesions is an ideal minimally invasive operation in treaing type C pelvic fracture. It can early exercise and has the advandages of small trauma, safe operaton,less complication, stable fixation.

Adult ; Bone Plates ; Female ; Fracture Fixation, Internal ; adverse effects ; methods ; Fractures, Bone ; surgery ; Humans ; Male ; Middle Aged ; Pelvic Bones ; injuries ; surgery

OBJECTIVETo investigate the feasibility and clinical effects of titanium elastic nails (TEN) for adolescent clavicular fracture.

METHODSFrom October 2008 to November 2009, 17 adolescent patients with clavicular fracture were treated with internal fixation, including 11 males and 5 females who ranged in age from 12 to 18 years (mean 15.3 years). The mean time from injury to surgery was 3.5 days (2-7 days). Constant function score before surgery and that 3 months after surgery and shoulder ROM before surgery and that 2 months after surgery were compared. Fracture reduction and healing were followed up by X-rays to analyze internal fixation with the TEN technique.

RESULTSAll patients were followed up for a mean of 6.5 months (range 3-8 months), during which no infection, TEN fracture or skin bursting was observed. The Constant score rose from preoperative (45.3 +/- 6.1) to (85.6 +/- 4.3) at 3-month follow up (t = 22.164, P < 0.01),and the shoulder activity degree at 2-week follow up was improved obviosly from preoperative (P < 0.01). X-ray at 12-16 weeks after surgery showed good bone healing and recovery of shoulder function.

CONCLUSIONInternal fixation with TEN in the treatment of adolescent clavicular fracture is safe, minimally invasive,reliable and cosmetic. This technique provides a liable ption for the treatment of adolescent clavicular fractire

Adolescent ; Bone Nails ; Child ; Clavicle ; injuries ; surgery ; Female ; Follow-Up Studies ; Fracture Fixation, Internal ; methods ; Fractures, Bone ; surgery ; Humans ; Male ; Range of Motion, Articular

OBJECTIVETo compare the curative effects of newly suture anchors and traditional steel wire for the reconstruction of near distal tendo achillis rupture.

METHODSThe clinical data of 56 patients with near distal tendo achillis rupture from June 2007 to February 2011 were retrospectively analyzed. Among 31 patients receiving reconstruction by suture anchors, 22 patients were male and 9 patients were female, with a mean age of 35.5 years (ranging from 16 to 52 years ). Among 25 patients treated with traditional steel wire, 19 patients were male and 6 patients were female, with a mean age of 37.6 years (ranging from 22 to 53 years). The different rehabilitation was conducted for every patient at different times after operation. The position of suture anchor and steel wire were recorded. The clinical data such as operative time, complications of the surgery and the function of stendo achillis were analyzed. The healing of stendo achillis and functional recovery were assessed by Arner-Lindholm standard.

RESULTSAll the patients were followed up with an average during of 24.2 months. There were no intraoperative injuries on blood vessels, nerve and tendon. The average operative time and postoperative complications of suture anchors were lower than there of the traditional steel wire (t = 8.75, P = 0.00; Chi2 = 5.42, P = 0.02). The functional recovery of tendo achillis repaired by suture anchors was better than that in the group of traditional steel wire (Chi2 = 7.65, P = 0.02).

CONCLUSIONCompared to the traditional steel wire, suture anchor demonstrate the superior performance on repairing rupture of the near distal tendo achillis, which is a reliable and effective treatment methods.

Achilles Tendon ; diagnostic imaging ; injuries ; surgery ; Adolescent ; Adult ; Bone Wires ; Case-Control Studies ; Female ; Humans ; Male ; Middle Aged ; Radiography ; Reconstructive Surgical Procedures ; methods ; Retrospective Studies ; Rupture ; surgery ; Suture Anchors

OBJECTIVETo investigate the feasibility and clinical effects of titanium elastic nail (TEN) for treatment of proximal radius epiphyseal injuries of O'Brien type III.

METHODSFrom October 2008 to November 2009,19 patients with proximal radius epiphyseal injuries of O'Brien type III were treated with internal fixation, including 13 males and 5 females with an average age of 8.3 years old ranging from 6 to 12 years. The average time from injury to surgery was 3.5 days (2 to 7 days). The reduction situation after operation was assessed by Métaizeau criteria, and the elbow function after operation were evaluated by Broberg-Morrey elbow score.

RESULTSAll patients were followed-up for 8.7 months in average (ranged 6 to 12 months). No infection, TEN brokage, skin bursting and other complications occurrenced. According to Métaizeau criteria, the results were excellent in 7 cases, good in 10 cases and fair in 2 cases. The Broberg-Morrey score rose from preoperative (47.3 +/- 5.1) to (86.6 +/- 6.3) at 3 months followed-up (t=139.17, P=0.0002); the outcome was excellent in 7 cases, good in 9 cases, and fair in 3 cases.

CONCLUSIONInternal fixation with TEN in treatment of proximal radius epiphyseal injuries of O'Brien type III has a limited invasion, cosmetic beauty, safety and reliability advantages. This technique provides a reliable alternative in proximal radius epiphyseal injuries of O'Brien type III.

Bone Nails ; Child ; Elasticity ; Epiphyses ; injuries ; surgery ; Female ; Fracture Fixation, Internal ; instrumentation ; Humans ; Male ; Radius Fractures ; surgery ; Titanium ; Treatment Outcome

OBJECTIVETo compare post-operative long-term complications and quality of life of two digestive reconstruction procedures after total gastrectomy.

METHODSA total of 109 gastric cancer patients in Tianjin Medical University Cancer Hospital from March 2012 to February 2013 were prospectively enrolled and randomly divided into functional jejunal interposition (FJI) group (52 cases) and Roux-en-Y (R-Y) group (57 cases). The post-operative complications, nutritional status, and the quality of life were compared between two groups.

RESULTSOne, 3 and 6 months after operation, the incidence of R-S syndrome in FJI group was lower as compared to R-Y group[13% (6/45) vs. 37% (18/49), 3% (1/30) vs. 42% (14/33), 5% (1/21) vs. 48% (11/23), all P<0.01], while 3 months after operation, the incidence of reflux and heartburn in FJI group was higher[53% (16/30) vs. 21% (7/33), P<0.01; 37% (11/30) vs. 12% (4/33), P<0.05]. There were no significant differences in quality of life questionnaire QLQ-C30 between R-Y and FJI groups. QLQ-STO22 stomach module revealed in FJI group, the eating score was better, but reflux score was worse as compared to R-Y group 3 months after operation (all P<0.01).

CONCLUSIONSFunctional jejunal interposition keeps intestinal continuity preserving and food duodenal passing, which is a reasonable digestive reconstruction procedure.

Anastomosis, Roux-en-Y ; Female ; Gastrectomy ; Humans ; Male ; Middle Aged ; Prospective Studies ; Quality of Life ; Reconstructive Surgical Procedures