2008年·第121卷第08期

As is well known,diabetes is becoming a significant burden for public health in China.Diabetes mellitus has become an epidemic in recent years in China.Studies indicate that the prevalence of diabetes has increasedrapidly in many difierent areas of China。

Abstract：Background Diabetes mellitus has become epidemic in recent years in China.We investigated the prevalence of hyperglycaemia and inadequate glycaemic control among type 2 diabetic inpatients from ten university teaching hospitals in Guangdong Province,China. Methods Inadequate glycaemic control in diabetic patients was defined as HbA1c(≥)6.5%.Therapeutic regimens included no-intervention,lifestyle only,oral antiglycemic agents(OA),insulin plus OA(insulin+OA),or insulin only. Antidiabetic managements included monotherapy,double therapy,triple or quadruple therapy. Results Among 493 diabetic inpatients with known history,75%had HbA1c≥6.5%.Inadequate glucose control rates were more frequently seen in patients on insulin+OA regimen(97%) than on OA regimen(71%)(P＜O.001),and more frequent in patients on combination therapy(81%-96%)than monotherapy(75%)(P＜0.05).Patients on insulin differed significantly from patients on OA by mean HbA1c,glycemic control rate,diabetes duration,microvascular complications,and BMI(P＜0.01). Conclusions This study showed that glycaemic control of type 2 diabetic patients deteriorated for patients who received insulin and initiation time of insulin was usually delayed.It is up to clinicians to move from the traditional stepwise therapy to a more active and early combination antidiabetic therapy to provide better glucose control。

Abstract：Background Numerous mitochondrial DNA mutations are significantly correlated with development of diabetes. This study investigated mitochondrial gene, point mutations in patients with type 2 diabetes and their families. Methods Unrelated patients with type 2 diabetes(n=826)were randomly recruited; unrelated and nondiabetic subjects (n=637)served as controls. The clinical and biochemical data of the participants were collected. Total genome was extracted from peripheral leucocytes. Polymerase chain reaction, restriction fragment length polymorphism (PCR-RFLP)and clonig techniques were used to screen mitochondrial genes including np3316,np3394 and np3426 in the ND1 region and np3243 in the tRNALeu (UUR). Results In 39 diabetics with one or more mitochondrial gene point mutations, the prevalence(4.7%,39/826)of mtDNA mutations was higher than that(0.7%,5/637)in the controls. The identical mutation was found in 23 of 43 tested members from three pedigrees. Affected family members presented with variable clinical features ranging from normal glucose tolerance to impaired glucose tolerance (IGT)(n=2),impaired fasting glucose(IFG)(n=1)to type 2 diabetes (n=13)with 3 family members suffering from hearing loss. Conclusions Type 2 diabetes in China is associated with several mitochondrial gene mutations. Aged patients with diabetic family history had a higher prevalence of mutation and various clinical pictures. Mitochondrial gene mutation might be one of the genetic factors contributing to diabetic familial clustering。

Abstract：Background Controlling plasma glucose levels, blood pressure and lipid levels is proven to reduce the risk of vascular complications in patients with type 2 diabetes mellitus. This has prompted intensive multitherapy targeted at several macrovascular risk factors.Carotid intima-media thickness(cIMT)is a reliable measure of early atherosclerosis. We sought to determine whether a 6-month intensive mutiltherapy program resulted in better goal attainment than usual care and its effect on the development of cIMT among patients with newly diagnosed type 2 diabetes mellitus. Methods The study randomly assigned 220 patients with newly diagnosed type 2 diabetes mellitus to intensive or traditional therapy groups. The clinical parameters, such as fasting plasma glucose, total cholesterol, triglyceride, blood pressure, body weight and insulin were assessed at the baseline and after the 6-month therapy. cIMT of the patients wasalso obtained. Results The average levels of fasting plasma glucose, hemoglobin A1c, total cholesterol (TC)and low-density lipoprotein cholesterol (LDL-C)in the intensive group were significantly lower than those in the control group at the end of 6-month treatment. By 6 months, a higher proportion of patients in the intensive therapy group than in the control group attained goals for fasting plasma glucose(FPG), TC, LDL-C and hemoglobin A1c.With intensive multherapy the level of carotid intima-media thickness in the intensive therapy group was lower than that in the control group((0.88±0.26)mm vs(0.96±0.22)mm, P＜0.01).Conclusions The evidence from this clinical trial demonstrates that intensive glucose. lipid and blood pressure control in patients with newly diagnosed type 2 diabetes is associated with diabetic macrovascular benefits. Intensive multitherapy allows more patients to achieve aims of control and may reduce macrovascular complications and delay disease progression。

Abstract：Background This prospective, randomized, controlled study was designed to investigate the effects of a diabetes specific formula (Diason low energy:313.8 kJ/100 ml),compared with a standard formula, on insulin sensitivity, serum C peptide, serum lipids and free fatty acid(FFA)in type 2 diabetics. Methods In total of 71 type 2 diabetics completed the study. Enteral formulas were given orally as the sole source of nutrition to the subjects for 6 days. Venous blood samples(0.5,1,2,3 hours)were collected at day-7 after a 75 g oral glucose tolerance test(OGTT),day 1 after a standard test meal(1673.6 kJ)and after 6 days of either the test diabetes specific formula or a standard formula. Plasma glucose,serum insulin, C peptide and lipids were. measured. Results After the intervention period, the diabetes specific formula resulted in a significantly lower postprandial rise in blood glucose concentrations at 0.5 hour(P＜0.05)and 1 hour(P＜0.01);significantly lower peak height of plasma glucose(P=0.05);significantly lower plasma insulin concentrations at 0.5 hour(P＜0.01),1 hour(P＜0.01)and 2 hours(P＜0.01);and a significantly lower plasma insulin peak compared to controls; both OGTT and a standard test meal(P＜0.05).The glucose and insulin area under the curve after the diabetes specific formula compared to the standard formula were significantly lower. The C peptide level was lower after 6 days of both nutrition formulas compare to 75 g OGTT, but not different from the standard mixed meal. Both formulas were well toleraled. Conclusions In summary the diabetes specific formula with a relatively high monounsaturated fatty acid and high multi fiber proportion significantly improved glycemic control. On top of this,the insulin sensitivity(HOMA-IS)was significantly improved and may therefore directly improve the impact on long term complications. The disease specific formula should therefore be the preferred option to be used by diabetic and hyperglycemic patients in need of nutritional support。

Abstract：Background Women with a history of gestational diabetes mellitus(GDM)are at higher risk of future development of diabetes. This study investigated the risk factors associated with early postpartum abnormal glucose regulation (AGR) among Chinese women with a history of GDM. Methods A total of 186 women with a history of GDM were screened for early postpartum AGR at 6-8 weeks after delivery. Those with AGR were given lifestyle intervention therapy and reevaluated in 6-12 months. The demographic, anthropometric, prenatal and delivery data were recorded. The plasma high-sensitivity C-reactive protein (HsCRP)and lipid concentration were measured, and insulin secretion were analyzed. Insulinogenic index △ins30'/△BG30', the homeostasis model assessment index(HOMA)-B, and HOMA-IR were calculated. Multiple regression analysis was performed to identify the risk factors. Results of the GDM women 28. O%(52/186)had AGR at 6-8 weeks after delivery;45. 2% (17/40) of these AGR women reminded abnormal after 6-12 month lifestyle intervention. Compared to the women who reverted to normal, women with consistent AGR showed significantly lower fasting insulin concentration, lower △ins30'/△BG30'as well aslower HOMA-B. No significant differences in age, body mass index(BMI), waist circumference, blood pressure, lipid level, HsCRP and HOMA-IR were observed between the two groups. Pre-pregnancy BMI＞25 kg/m2. fasting glucose level≥5. 6 mmol/L and/or 75 g oral glucose tolerance test (OGTT)2 hours glucose level≥11. 1 mmol/L during pregnancy were predictors for the AGR at 6-8 weeks after delivery. △ins30'/△BG30≤1.05 was a significant risk contributor to the consistent early postpartum AGR. Conclusion There is a high incidence of early postpartum AGR among Chinese woman with prior GDM. Beta-cell dysfunction, rather than insulin resistance or inflammation, is the predominant contributor to the early onset and consistent AGR after delivery。

Abstract：Background Many cytokines have been found to increase the insulin resistance during pregnancy complicated by glucose metabolism disorder. This study aimed to investigate which comes first, the changes of some cytokines or the abnormal glucose metabolism. Methods This nested case-control study was undertaken from January 2004 to March 2005. Twenty-two women with gestational diabetes mellitus(GDM), 10 with gestational impaired glucose tolerance(GIGT), and 20 healthy pregnant women were chosen from the women who had visited the antenatal clinics and had blood samples prospectively taken and kept during their visit. The levels of tumor necrosis factor-α(TNF-α), leptin and adiponectin were determined. One-way ANOVA analysis and bivariate correlation analysis were used to assess the laboratory results and their relationship with body mass index(BMI). Results Women with GDM have the highest values of TNF-α and leptin and the lowest value of adiponectin compared with those with GIGT and the healthy controls(P＜0.01)at 14-20 weeks of gestation. This was also found when these women progressed to 24-32 weeks. The significantly increased levels of TNF-α and leptin and the decreased level of adiponectin were found at the different periods of gestation within the same group. Positive correlation was shown between the levels of TNF-α and leptin at the two periods of gestation with the BMI at 14-20 weeks. while adiponectin was negatively correlated (P＜0.05). Conclusions The concentrations of TNF-α. leptin and adiponectin may change before the appearance of the abnormal glucose level during pregnancy. Further studies are required to verify the mechanism of this alteration and whether the three cytokines can be predictors for GDM at an early stage of pregnancy。

Abstract：Background Berberine is one of the main constituents of Coptidis rhizoma (CR) and Cortex phellodendri, In this study, we investigated the beneficial effects of berberine on renal function and its possible mechanisms in rats with diabetic nephropathy(DN). Methods Male Wistar rats were divided into three groups: normal, diabetic model, and berberine treatment groups. Rats in the diabetic model and berberine treatment groups were induced to diabetes by intraperitonal injection with streptozotocin(STZ). Glomerular area, glomerular volume, fasting blood glucose(FBG), blood urea nitrogen(BUN), serum creatinine (Cr)and urine protein for 24 hours(UP24h) were measured using commercially available kits. Meanwhile, the activity of superoxide dismutase (SOD), content of malondialdehyde (MDA) in serum, activity of aldose reductase (AR)and the expression of AR mRNA and protein in kidney were detected by different methods. Results The result showed that oral administration of berberine (200mg·kg-1·d-1) significantly ameliorated the ratio of kidney weight to body weight. Glomerular area, glomerular volume, FBG, BUN, Cr and UP24h were significantly decreased in the berberine treatment group compared with the diabetic model group(P＜0.05). Berberine treatment significantly increased serum SOD activity and decreased the content of MDA compared with diabetic model group(P＜0.05). AR activity as well as the expression of AR mRNA and protein in the kidney was markedly decreased in the berberine treatment group compared with diabetic model group (P＜0.05). Conclusion These results suggested that berberine could ameliorate renal dysfunction in DN rats through controlling blood glucose, reduction of oxidative stress and inhibition of the activation of the polyol pathway。

Abstract：Background The paralimbic system, which is composed of three parts, is an important functional unit. Gliomas located in the region remain a challenge for clinical treatment. However, the dynamic change of gliomas in the area has not been well documented. The purpose of this study was to identify the growth tendency of gliomas located in the paralimbic system and to obtain some suggestions for clinical treatment. Methods Eleven cases of gliomas located in the paralimbic system were recruited in the study. All of them were proven by pathology. Analysis of the serial radiological examinations in each patient was performed from the initial to the final examination, taking into consideration the following items: initial tumor location, final location and the growth tendency. Results In the initial and final examinations the ratios of insula involvement were 64% and 100%, respectively. On the other hand, the ratios of gliomas located in two or more partS of paralimbic system increased from 64%to 100%during the dynamic examination. Conclusions Even though the paralimbic system is composed of three independent anatomical parts, gliomas tend to involve all three pans, especially the insula. Therapeutic plans should aim at the whole region of the system, even during the early stages of gliomas。

Abstract：Background Hydrogen sulfide(H2S)plays an important role in the smooth muscle cell relaxation and thereby participates in the development of hypertension. Cystathionine γ-lyase is the key enzyme in the endogenous production of H2S. Up to now, the reports on the relationship between the polymorphisms of cystathionine γ-lyase gene (CTH) and essential hypertension(EH)are limited. This study was designed to assess their underlying relationship. Methods A total of 503 hypertensive patients and 490 age-, gender-and area-matched normotensive controls were enrolled in this study. Based on the FASTSNP, a web server to identify putative functional single nucleotide polymorphisms (SNPs) of genes, we selected two SNPs, rs482843 and rs1021737, in the CTH gene for genotyping. Genotyping was performed by the polymerase chain reaction and restriction fragment length polymorphism method (PCR-RFLP). The frequencies of the alleles and genotypes between cases and controls were compared by the chi-square test. The program Haplo. stats was used to investigate the relationship between the haplotypes and EH. Results These two SNPs were in Hardy-Weinberg Equilibrium in both cases and controls. The genotype distribution and allele frequencies of them did not significantly differ between cases and controls(all P＞0.05). In the stepwise logistic regression analysis we failed to observe their association with hypertension. In addition, none of the four estimated haplotypes or diplotypes significantly increased or decreased the risk of hypertension before or after adjustment for several known risk factors. Conclusions The present study suggests that the SNPs rs482843 and rs1021737 of the CTH gene were not associated with essential hypertension in the Northern Chinese Han population. However, replications in other populations and further functional studies are still necessary to clarify the role of the CTH gene in the pathogenesis of EH。

Abstract：Background Anomalous origin of coronary artery from the pulmonary artery is a rare congenial cardiac malformation with a mortality rate of up to 90% within the first year of life without surgical intervention. Direct implantation of the anomalous coronary artery (ACA)into the aorta is successful in early life, but it may have increased surgical difficulty and risk with age. This retrospective study summarized our operative experience in direct implantation for treatment of this coronary anomaly in pediatric and adult patients. Methods From August 2000 to January 2003. 4 consecutive patients aged from 9 months to 41 years underwent dual coronary repair. Among them, two children and one infant with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA)and one adult was anomalous origin of right coronary artery from the pulmonary artery(ARCAPA). Coronary arteries were directly implanted into the ascending aorta in 4 patients. In a boy with ALCAPA associated with moderate mitral insufficiency(MI), whose ACA arose remotely from the ascending aorta, we created a tube-shaped graft using part of the pulmonary arterial wall in continuity with the origin of the left coronary artery (LCA). Concomitant moderate MI was repaired in 2 patients, including this boy, after a dual-coronary repair. Results All patients survived. There were no hospital or late deaths and no major complications as well. Echocardiography revealed that the left ventricular (LV)function including LV end-diastolic dimension(EDD)and ejection fraction(EF)was markedly improved at hospital discharge. At 3-6 years follow-up after surgery all patients were asymptomatic and currently in NYHA class I. Conclusions The best results are achieved with direct implantation of the ACA into the ascending aorta and simultaneous mitral valve repair if needed. Direct implantation is feasible in pediatric and adult patients with ALCAPA or ARCAPA including the coronary artery in a location remote from the ascending aorta. It is a good procedure to lengthen the ACA by creating a tube-shape graft using part of the pulmonary arterial wall in continuity with the origin of ACA。

Abstract：Background Hematopoietic growth factor(HGF)is indispensable to hematopoiesis in the body. The proliferation and differentiation of hematopoietic cells must rely on the existence and stimulation of HGE. This study investigated the effect of catechin, an active component extracted from Spatholobus suberectus Dunn (SSD), on bioactivity of granulocyte-macrophage colony-stimulating activity(GM-CSA), burst-promoting activity(BPA)and megakaryocyte colony-stimulating activity(MK-CSA)in spleen condition medium(SPCM)of mice to clarify the hematopoietic mechanism of catechin and SSD. Methods Spleen cells of mice were separated and spleen condition medium (SPCM)was prepared from spleen cell culture. Bone marrow cells of mice were separated and cultured in a culture system including 10%(v/v)SPCM(induced by catechin in vivo or ex vivo)for 6 days. Granulocyte-macrophage colony forming units(CFU-GM), erythrocyte burst-colony-forming units(BFU-E)and megakaryocyte colony-forming units(CFU-Meg)formation were employed to assay the effects of different treatment on the bioactivity of GM-CSA, BPA and MK-CSA in SPCM. Results SPCM induced by 1 00 mg/L catechin ex vivo could promote the growth of CFU-GM, BFU-E and CFU-Meg, which indicated that catechin could stimulate the production of GM-CSA, BPA and MK-CSA in SPCM. SPCM prepared at the fourth day of spleen cell culture showed the best stimulating activity. The bioactivity of GM-CSA, BPA and MK-CSA in the SPCM prepared after intraperitoneally injecting catechin into mice was also increased. The number of CFU-GM, BFU-E and CFU-Meg gradually increased as the dose of catechin increased and the time of administration prolonged. CFU-GM, BFU-E and CFU-Meg of the high-dose catechin group were significantly higher than those of the control group (P＜0.01)and reached the maximum at the seventh day after administration. Conclusions This study suggests that catechin extracted from the active acetic ether part of Spatholobus suberectus Dunn can regulate hematopoiesis by inducing bioactivity of GM-CSA, BPA and MK-CSA in SPCM of mice. This may be one of the mechanisms for the hematopoietic-supportive effect of catechin and Spatholobus suberectus Dunn。

Abstract：Purpose To review the current progress in epidemiology, etiology, clinical manifestation, and pathophysiology of severe cutaneous adverse drug reactions(SCADRs). Data sources Data were acquired by using Blackwell-Synergy, PubMed, original articles published in the main Chinese journals and related medical textbooks materials. Study-selection and date extraction Throughout the literature review 49 articles were selected. Results SCADRs cases are rare, however, the implication is life threatening with significant mortatity rates. Epidemiology studies have shown various incidences from different regions, gender, age, race and concurrent illness. There are typical signs and symptoms for each type of SCADRs, but this is not always so. Drugs associated with inducing SCADRs are anticonvulsants, antibiotics, NSAIDs and antirheumatic drugs. In some countries, especially in Asia, traditional drugs are offen the cause of SCADRs. Genetic polymorphisms and viral infections are predisposition factors of SCADRs. Patients with certain genetic alleles and underlying diseases are vulnerable to SCADRs. The exact pathogenesis of SCADRs is not well defined. Nonetheless, recent study showed that reactive metabolites and immunological processes have a significant role in SCADRs. Conclusions The different SCADRs reactions are attributed by different intrinsic factors, such as genetic polymorphisms, gender, age and race as well as extrinsic factors, such as underlying diseases. Different regions and culprit drugs also play a role in the various types of SCADRs。

TBX5, as a member of the T-box-containing transcription factor family, encodes a protein of 518 amino acids and is expressed in the embryonic heart and developing limb tissues.1 The coding region of TBX5 cDNA is 1.5 kb with eight exons including the N-terminal portion, the DNA binding domain and C-terminal region. We reported that the abnormality in transcription level of the TbX5 gene might be the mechanism underlying human simple congenital heart disease in the absence of TBX5 mutations。

In 1991. Delaitre and Maignien1 performed the first splenectomy with a laparoscope. Laparoscopic splenectomy (LS) is now an accepted alternative to open splenectomy, but questions still remain, such as the appropriate manner in which to position the patient, the best means of assuring hemostasis, and whether LS can be performed in cases of splenomegaly. 2 From the perspective of a developing nation, such as China, the Endo-stapler and commercial extraction bags have inhibited the use of LS for reasons of expense. 3 Here, we report our 12-year experience in performing LS on 87 patients to determine the most optimal approach。