Metabolic syndrome is a complex group of metabolic disorders with an increasing global incidence rate,posing a serious threat to human health.Sodium-glucose linked transporter 2(SGLT2)inhibitors are a new type of oral hypoglycemic drug.SGLT2 inhibitors not only lower blood glucose level in a non-insulin-dependent manner by inhibiting glucose reabsorption by renal proximal convoluted tubular epithelial cell to promote urinary glucose excretion,but also by improving islet β cell function,reducing inflammatory responses,and inhibiting oxidative stress.In addition,SGLT2 inhibitors can reduce body weight through osmotic diuresis and increase fat metabolism;reduce blood pressure by inhibiting excessive activation of sympathetic nervous system and by improving vascular function.They can also improve blood lipids by increasing degradation of triacylglycerol;reduce blood uric acid by promoting uric acid excretion in kidney and intestine,and by reducing uric acid synthesis.This article reviews the effects and mechanisms of SGLT2 inhibitors on multiple metabolic disorders in metabolic syndrome and explores their potential application in metabolic syndrome treatment.

【Objective】 To investigate the prevalence of hepatitis D virus in Dalian blood donors. 【Methods】 The samples reactive to HBV in blood screening were selected with the following confirmed results: 1)HBsAg+ &HBV DNA+ ; 2)HBsAg+ & HBV DNA-; 3)HBsAg-&HBV DNA+ ; 4)NAT-yield uncertain. Qualified samples in routine blood screening were additionally tested with anti-HBc+ and anti-HBs+. All samples selected were tested HDV IgG further. Initial reactive samples would be tested by another HDV IgG assay and HDV IgM assay. HDV IgG positive was confirmed when samples were reactive to two HDV IgG assays. 【Results】 None HDV antibodies were detected among 1 344 unqualified samples (507 HBsAg+ &HBV DNA+, 33 HBsAg+ &HBV DNA-, 477 HBsAg-&HBV DNA+ and 327 NAT-yield uncertain samples) or 766 qualified samples (397 anti-HBc+ and 369 anti-HBs samples) in blood screening. 【Conclusion】 The prevalence of HDV infections among Dalian blood donors eligible in pre-donation screening seemed extremely low. However, for areas with high HBV prevalence, the risk of blood safety caused by OBI co-infection with HDV should not be ignored.

【Objective】 To investigate the serological and molecular characteristics of HBsAg+ /HBV DNA non-reactive (NR) infections. 【Methods】 Samples tested as HBsAg+ and HBV DNA NR were confirmed by individual NAT repeat testing, viral particle concentration by PEG precipitation combined with in-house nested PCR and real-time quantitative PCR, anti-HBc testing, and HBsAg quantification. HBV sequences were compared with those from donors with chronic and occult infection as controls. 【Results】 A total of 792 195 samples were screened between January 2011 and December 2020, of which 53 (1: 14 947) were confirmed HBsAg+ /HBV DNA NR. HBV DNA was detected further in five (9.4%) samples; three S sequences and four Pre Core/Core sequences were obtained. Unique amino acid substitutions (P130T, P135Q/S, R151Q, G153S and S155F) were found in the Core protein that may affect virus packaging and replication. 【Conclusion】 Extremely low HBV DNA level was detected in plasmas of HBsAg+ /HBV DNA NR donors. Barely detectable HBV DNA might be associated with unusual mutations in the Pre Core/Core protein affecting viral replication. More sensitive HBV DNA and/or HBsAg assays may be considered to further reduce the potential HBV transfusion-transmission residual risk.

BACKGROUND:Accumulative evidence supports that co-culture technology can be applied to construct the tissue-engineered cartilage with excellent biological characters. OBJECTIVE:To elaborate the co-culture concept and conclude and analyze seed cell sources, cel mixed ratio, spatial y-defined co-culture models and biomaterials in co-culture systems to conclude and analyze the biological characters of tissue-engineered cartilage, and to prospect progression of co-culture systems in cartilage tissue engineering. METHODS:The first author retrieved the databases of PubMed, Web of Science, and CNKI for relative papers published from January 1976 to May 2016 using the keywords ofco-culture, co-culture systems;articular cartilage, chondrocytes, mesenchymal stem cells;tissue engineering, articular cartilage tissue engineeringin English and Chinese, respectively. Finally 60 literatures were included in result analysis, including 1 Chinese and 59 English articles. RESULTS AND CONCLUSION:Co-culture technology emphasizes the role of microenvironment in terms of various physical, chemical and biological factors in the cell processing. In cartilage tissue engineering, co-culture systems contribute to maintain the viability and natural cell phenotype of chondrocytes and induce cartilage differentiation of mesenchymal stem cells. In addition, co-culture technology provides a novel way for cartilage tissue engineering to overcome the shortage of chondrocytes and repair injury to the cartilage-subchondral bone. However, the mechanisms of cell-cell interaction in co-culture systems still need to be explored in depth, so as to optimize the co-culturing conditions and construct perfect tissue-engineered cartilage.

Objective To explore the expression of interleukin -17A(IL-17A),interleukin-10(IL-10), interleukin-6 ( IL-6 ) in the maternal plasma , umbilical plasma , neonatal plasma from the pregnant women who accepted the Telbivudine for the prevention of perinatal transmission of hepatitis B virus infection .Methods 85 preg-nant women who were delivered in the hospital were chosen [ Telbivudine group 25 cases,HBVDNA high viral level group,HBVDNA negative group,non-infection group(health pregnant),each group included 20 cases].The level of the serum of IL-17A,IL-10,IL-6 in the maternal plasma,umbilical plasma,neonatal plasma from the different group was prospectively analyzed by the CBA method .Results The levels of IL-17A in the maternal plasma,um-bilical plasma,neonatal plasma of the Telbivudine group [(15.29 ±4.80)pg/mL,(19.45 ±4.80)pg/mL,(17.32 ± 4.18)pg/mL]were lower than the HBVDNA high viral level group [(26.03 ±4.88)pg/mL,(34.07 ±5.59)pg/mL, (24.12 ±4.76)pg/mL],there were significant differences(P=0.000,0.001,0.019);The level of IL -10 in the maternal plasma,umbilical plasma,neonatal plasma of the Telbivudine group [(6.08 ±1.32) pg/mL,(2.33 ± 0.68)pg/mL,(3.74 ±0.61)pg/mL]were higher than the HBVDNA high viral level group [(3.95 ±1.21)pg/mL, (1.71 ±0.53)pg/mL,(2.22 ±0.55)pg/mL],there were significant differences(P=0.023,0.015,0.012);The level of IL-6 in the maternal plasma ,umbilical plasma ,neonatal plasma of the Telbivudine group were lower than the HBVDNA high viral level group,there were significant differences (all P <0.05).Conclusion Telbivudine can cause the inhibition of the replication of HBV virus , partially reverse the immunologic dissonance of the pregnant women with HBV virus ,which is conducive to maintaining pregnancy .

Objective To evaluate the efficacy of a two-step infusion therapy with meropenem against noso-comial multi-drug resistant Pseudomonas aeruginosa infections in elderly patients with chronic obstructive pulmonary disease.Methods 112 elderly patients with nosocomial multi-drug resistant Pseudomonas aeruginosa infections and chronic obstructive pulmonary disease were randomized into two groups:two-step infusion therapy group ( rapid first-step infusion in 30 minutes and slow second-step infusion in 2.5 hours) and traditional 30 minutes infusion therapy group.The antibiotic clinical efficacy and bacteriological efficacy were observed between two groups .Results The clinical efficacy of observation group and control group were 82.2%(46/56) vs 57.1%(32/56).The difference was statistically significant(χ2 =10.185,P<0.05);The bacteriological efficacy of observation group and control group were 75.0%(42/56) vs 46.4%(26/56),The difference was statistically significant (χ2 =10.265,P<0.05). Conclusion The clinical efficacy and bacteriological efficacy of two-step infusion therapy with meropenem against nosocomial multi-drug resistant Pseudomonas aeruginosa infections in elderly patients with chronic obstructive pulmo -nary disease were superior to the traditional therapy .

Objective To evaluate the clinical outcome of mono-segment transpedicular fixation of type B thoracolumbar fracture.Methods A retrospective analysis was conducted on 40 cases suffering from type B thoracolumbar fracture treated with mono-segment transpedicular fixation from May 2003 to October 2012.According to the AO classification,13 cases were identified with type B1.1,11 type B1.2,11 type B2.2,2 type B3.1,2 type B3.2,and 1 type B3.3.Radiological results were evaluated by measuring compression rate of the fractured vertebra and Cobb' s angle of the vertebra adjacent to the fractured segment.Clinical results were assessed using Frankel classification for spinal cord injury and visual analogue scale (VAS) for pain.Results Mean operation time was 71 minutes and mean intrao perative blood loss was 105 ml.Mean period of follow-up was 47.5 months (range,24-82 months).Mean Cobb' s angle of the vertebra adjacent to the fractured segment and compression rate of the fractured vertebra revealed great correction at one week post-operation compared with preoperative ones (6.2° vs 20.1° and 10.1％ vs 38.9％ respectively,P ＜0.05) and there was no significant correction loss at the last follow-up (6.9° and 10.8％ respectively,P ＞ 0.05).Mean VAS was 8.6 points before operation,but mean VAS was 2.4 points at final follow-up (P ＜ 0.05).Neurological performance improved in 37 cases (93％).No cases experienced neurological deterioration.Conclusions Mono-segment transpedicular fixation has small incision,short operation time,few bleeding and decreased motor function loss.The procedure is indicated for most type B thoracolumbar fracture and clinical results are satisfactory.

Objective To investigate the feasibility of mono-segment pedicle instrumentation (MSPI)in management of thoracolumbar fracture (AO classification,A1 and A3) by being compared with short-segment(two-segment) pedicle instrumentation(SSPI).Methods Overall 141 patients with tape A1 or A3 thoracolumbar fractures,aged from 20 to 60 years (average,40.5 years),were enrolled in this prospective study.According to a simple randomized method,35 patients with type A1 fracture and 41 patients with type A3fracture were treated with MSPI,while 26 with type A1 fracture and 39 with type A3 fracture were treated with SSPI.Low back outcome score (LBOS) and ASIA2000 were used to evaluate clinical outcome.Eighteenth month postoperatively was assigned as the last follow up period.Wedge index (WI) and sagittal index (SI) of the affected vertebrae on radiography were measured and compared preoperatively,one week postoperatively and at the final follow-up.Results All patients were followed up successfully.The blood loss and duration of operation of MSPI group were significantly less than that of SSPI group,respectively.However,there were no significant differences of clinical outcome between two groups.For type A1 fracture,correction rate and correction loss of WI in MSPI group were better than those in SSPI group.For type A3 fracture,there were no significant differences of correction rate and correction loss of WI and SI between MSPI group and SSPI group; however,the failure rate of MSPI group was significantly higher than that of SSPI group.Conclusion For type A1 and partial type A3 thoracolumbar fractures,MSPI can provide the same or better fixation with less blood loss and operative duration than SSPI.Since MSPI for type A3.2 thoracolumbar fracture has a higher failure rate,the surgical indication should be strictly controlled.

Objective To analyze the prognostic factors and causes of death of patients with systemic lupus erythematosus (SLE).Methods A database with 319 patients were developed.They were newly diagnosed SLE in the Department of Rheumatology and Immunology,Affiliated Drum Tower Hospital of Nanjing University Medical School from 1999 to 2009.Normal distribution of measurement data was presented using mean±standard deviation.The skewed distribution of data was described by median(interquartile range).Using the rate or proportions,the character of classification data was also stated.Survival rate of SLE patients over time was studied by the Kaplan-Meier method,and prognostic factors were analyzed by COX proportional hazards model.Results The 5 year and 10-year survival rates was 96.2%, 88.7%, respectively Prognostic factors affecting survival included duration from onset to diagnosis, anemia, white blood cells in urine, low serum albumin,low C4 level,abnormal ECG and ultrasound echocardiography, pulmonary arterial hypertension (PAH) and systemic lupus erythematosus disease activity index (SLEDAI). However, PAH,duration from onset to diagnosis, low serum albumin were the independent poor prognostic factors and the relative risk and 95% confidence interval were 2.419 (1.052-5.564), 1.162 (1.043-1.294), 0.924 (0.873-0.978), respectively. Renal failure, pulmonary hypertension and infection were the main causes of death,followed by multiple organ failure and lupus encephalopathy. Conclusion PAH, duration from onset to diagnosis, low serum albumin are the important factors predicting poor prognosis. Early diagnosis, timely treatment of SLE organ damages and preventing complications are the key factors to improve the prognosis of patients with SLE.

ObjectiveTo compare the clinical effect of posterior circumferential fusion with versus without intertransverse process fusion on lumbar instability in aged patients. MethodsThe elderly with lumbar instability were treated with the posterior instrumented circumferential fusion technique in 80 cases. Among 58 patients followed up for at least 2 years, 28 cases (group A)underwent posterior circumferential fusion with intertransverse process, while 30 cases (group B)without intertransverse process. X-ray examination was used before and 1, 3, 6, 12 and 24 months after operation to evaluate the fusion condition of the bone graft, and visul analogue scale (VAS) and Oswestry disability index (ODI) questionnaire were applied to assess the pain of center back and leg,and the conventional activity.ResultsThe operation time and blood loss were more in group A[(185.3±56.6) min and (376.3±92.9) m1] than in group B [(146.4±46.3) min and (234.3±64.5)ml (t=12.37, 37.49, P＜0.01)]. All the 58 cases were followed for at least 2 years. The 27 cases (96.4％) of group A and 28 cases (93.3％) of group B got bone fusion (x2 =0.004, P＞0.05).There were marked differences in the VAS of center back at 1 and 3 months after operation between the 2 groups (t=3.178, 2.158, both P＜0.05), while no difference at the other 3 time point. VAS about the leg pain and the ODI showed no differences between group A and B after operation (all P＞0.05). ConclusionsFor the lumbar instability in the elderly, the posterior circumferential fusion with or without intertransverse process fusion can achieve a similar high rate of fusion and satisfactory clinical results,andtheposteriorcircumferentialfusionwithoutintertranaverseprocess is recommended for less trauma.