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The evidence regarding the impact of the scores on healthy eating indices on the risk of cardiovascular events among patients with type 2 diabetes (T2D) is limited. As such, in this study, we examined the associations of adherence to the Chinese and American dietary guidelines and the risk of cardiovascular disease (CVD) among Chinese individuals with T2D. We conducted a 1:1 age- and sex-matched case–control study based on a Chinese population. We used a structured questionnaire and a validated 79-item food-frequency questionnaire to collect general information and dietary intake information, and calculated the Chinese Healthy Eating Index (CHEI) and the Healthy Eating Index-2015 (HEI-2015). As participants, we enrolled a total of 419 pairs of hospital-based CVD cases and controls, all of whom had T2D. We found a significant inverse association between diet quality scores on the CHEI and HEI-2015 and the risk of CVD. The adjusted odds ratios (95% confidence interval) per five-score increment were 0.68 (0.61, 0.76) in the CHEI and 0.60 (0.52, 0.70) in the HEI-2015. In stratified analyses, the protective associations remained significant in the subgroups of sex, BMI, smoking status, tea-drinking, hypertension state, dyslipidemia state, T2D duration, and medical nutrition therapy knowledge (all p < 0.05). These findings suggest that a higher CHEI or HEI-2015 score, representing a higher-quality diet relative to the most recent Chinese or American dietary guidelines, was associated with a decreased risk of CVD among Chinese patients with T2D.

Cardiovascular diseases (CVDs) are the leading cause of death worldwide. Previous studies have shown that inflammatory chemokines are involved in the physiological functions of cytoskeletal reorganization, cell migration, adhesion and immune responses. However, in the past decade, there have been studies showing that inflammatory chemokines play a key role in CVD. Importantly, CXC motif chemokine ligand 2 (CXCL2) has been shown to be involved in the pathogenesis of cardiovascular disease. CXCL2 exerts its effects on the cardiovascular system by mediating inflammatory responses, but the specific signaling pathways by which CXCL2 exerts its effects in CVD remain unknown and need to be further investigated. This review aims to investigate the expression changes of CXCL2 in acute myocardial infarction (AMI), atherosclerosis (AS), obesity, diabetes and ischemic stroke (IS) and its potential key role in cardiovascular disease in order to provide new ideas for the prevention and treatment of cardiovascular diseases.

Streptococcus pneumoniae is an important human pathogen that causes invasive infections in adults and children. Accurate serotyping is important to study its epidemiological distribution and to assess vaccine efficacy.Invasive S. pneumoniae isolates (n = 300) from 27 teaching hospitals in China were studied. The Quellung reaction was used as the gold standard to identify the S. pneumoniae serotypes. Subsequently, multiplex PCR and cpsB gene-based sequetyping methods were used to identify the serotypes.Based on the Quellung reaction, 299 S. pneumoniae isolates were accurately identified to the serotype level and 40 different serotypes were detected. Only one strain was non-typeable, and five most common serotypes were identified: 23F (43, 14.3%), 19A (41, 13.7%), 19F (41, 13.7%), 3 (31, 10.3%), and 14 (27, 9.0%). Overall, the multiplex PCR method identified 73.3 and 20.7% of the isolates to the serotype and cluster levels, respectively, with 1.7% of the isolates misidentified. In contrast, the cpsB sequetyping method identified 59.0 and 30.3% of the isolates to the serotype and cluster levels, respectively, and 7% were misidentified.The cpsB gene sequetyping method combined with multiplex PCR, can greatly improve the accuracy and efficiency of serotyping, besides reducing the associated costs.

To investigate the correlation between FOXP3, CD11c protein expression and the prognosis of patients with diffuse large B-cell lymphoma (DLBCL).This study included 48 patients with DLBCL who were admitted to Jiujiang No.1 People's Hospital and TCM-Integrated Hospital of Southern Medical University from January 2015 to January 2019. The DLBCL tissues removed during the operation were collected as test specimens. The expression of FOXP3 and CD11c protein were detected by immunohistochemistry. The deadline for postoperative follow-up was December 31, 2019, and the patient's short-term efficacy (complete remission, partial remission) and progression-free survival were recorded.FOXP3 protein was positively expressed in the nucleus, mostly focally or diffusely distributed, the FOXP3In some patients with DLBCL, FOXP3 and CD11c expresse positively, and the positive expression rate is related to the clinical stage and international prognostic index score. The positive expression of FOXP3 and CD11c indicate a good prognosis.FOXP3、CD11c蛋白表达与弥漫性大B细胞淋巴瘤患者预后的相关性.探讨FOXP3、CD11c蛋白表达与弥漫性大B细胞淋巴瘤（DLBCL）患者预后的相关性.本研究纳入2015年1月至2019年1月九江市第一人民医院和南方医科大学中西医结合医院收治的48例DLBCL患者，收集患者术中切除的DLBCL组织作为检测标本，采用免疫组织化学法检测组织中FOXP3、CD11c蛋白的表达，术后随访截止日期为2019年12月31日，记录患者的近期疗效（完全缓解、部分缓解）和无进展生存期.FOXP3蛋白为核阳性表达，多以局灶性或弥漫性分布，FOXP3阳性率为54.17%（26/48）；CD11c蛋白为细胞膜阳性表达，多以弥漫性分布，CD11c阳性率为60.47%（29/48）。FOXP3、CD11c蛋白表达与DLBCL患者的年龄、性别、累及部位及乳酸脱氢酶水平无明显相关性，但与临床分期和国际预后指数评分存在明显相关性，差异有统计学意义（P0.05），即DLBCL患者临床分期越低、国际预后指数评分越低，则FOXP3、CD11c蛋白阳性表达率越高（r=0.637，r=0.709）。术后1年，FOXP3阳性表达或CD11c阳性表达的DLBCL患者的总有效率明显高于FOXP3阴性表达或CD11c阴性表达患者（P0.05）；至随访结束，FOXP3阳性表达或CD11c阳性表达的DLBCL患者的中位无进展生存期也明显长于FOXP3阴性表达或CD11c阴性表达患者（P0.05）.在部分DLBCL患者组织中FOXP3、CD11c阳性表达，且阳性表达率与临床分期及国际预后指数评分相关，FOXP3和CD11c蛋白阳性表达提示预后良好.

Spinal tuberculosis (TB) accounts for 1%-5% of all TB infections. Host genetic variation influences susceptibility to Mycobacterium tuberculosis (MTB). P2X7 receptor (P2X7R) expressed on cells has been identified as a regulatory molecule in cell death/apoptosis, killing of intercellular pathogens, and bone turnover. This study investigated the P2X7 gene polymorphisms and protein levels in spinal TB. P2X7 gene -762C>T and 489C>T polymorphisms were genotyped. The expression of P2X7R in bone or intervertebral disc (ID) tissues was analyzed by Western blot assay. The -762C>T and 489C>T polymorphisms were associated with susceptibility to spinal TB. Having the -762CC genotype and -762C allele increased the risk of developing spinal TB (CC vs. TT: P=0.031, OR [95%CI]=1.865 [1.053-3.304]; C vs. T: P=0.028, OR [95%CI]=1.355 [1.034-1.775]). The presence of the 489T allele was associated with an increased risk of developing spinal TB (TT vs. CC: P=0.004, OR [95%CI]=2.248 [1.283-3.939]; CT vs. CC: P=0.044, OR [95%CI]=1.755 [1.011-3.047]; T vs. C: P=0.004, OR [95%CI]=1.482 [1.134-1.936]; TT+CT vs. CC: P=0.010, OR [95%CI]=1.967 [1.171-3.304]; TT vs. CT+CC: P=0.037, OR [95%CI]=1.489 [1.023-2.167]). The expression of P2X7R in TB-induced bone lesions increased significantly among spinal TB patients (t=0.011). Carrying the P2X7 -762CC genotype and 489T allele is associated with an increased risk of developing spinal TB in a Southern Chinese Han population.

Hypertriglyceridaemia is a very rare disorder caused by the mutations of LPL gene, with an autosomal recessive mode of inheritance. Here, we identified two unrelated Chinese patients manifested with severe hypertriglyceridaemia and acute pancreatitis. The clinical symptoms of proband 1 are more severe than proband 2. Whole exome sequencing and Sanger sequencing were performed. Functional analysis of the identified mutations has been done. Whole exome sequencing identified two pairs of variants in LPL gene in the proband 1 (c.162C>A and c.1322+1G>A) and proband 2 (c.835C>G and c.1322+1G>A). The substitution (c.162C>A) leads to the formation of a truncated (p.Cys54*) LPL protein. The substitution (c.835C>G) leads to the replacement of leucine to valine (p.Leu279Val). The splice donor site mutation (c.1322+1G>A) leads to the formation of alternative transcripts with the loss of 134 bp in exon 8 of the LPL gene. The proband 1 and his younger son also harbouring a heterozygous variant (c.553G>T; p.Gly185Cys) in APOA5 gene. The relative expression level of the mutated LPL mRNA (c.162C>A, c.835C>G and c.1322+1G>A) showed significant differences compared to wild-type LPL mRNA, suggesting that all these three mutations affect the transcription of LPL mRNA. These three mutations (c.162C>A, c.835C>G and c.1322+1G>A) showed noticeably decreased LPL activity in cell culture medium but not in cell lysates. Here, we identified three mutations in LPL gene which causes severe hypertriglyceridaemia with acute pancreatitis in Chinese patients. We also described the significance of whole exome sequencing for identifying the candidate gene and disease-causing mutation in patients with severe hypertriglyceridaemia and acute pancreatitis.

Background Although enhanced recovery after surgery (ERAS) has made great progress in the field of surgery, the guidelines point to the lack of high-quality evidence in upper gastrointestinal surgery. Methods Randomized controlled trials in four electronic databases that involved ERAS protocols for upper gastrointestinal surgery were searched through December 12, 2018. The primary endpoints were lung infection, urinary tract infection, surgical site infection, postoperative anastomotic leakage and ileus. The secondary endpoints were postoperative length of stay, the time from end of surgery to first flatus and defecation, and readmission rates. Subgroup analysis was performed based on the type of surgery. Results A total of 17 studies were included. The results of the meta-analysis indicate that there was a decrease in rates of lung infection (RR = 0.50, 95%CI: 0.33 to 0.75), postoperative length of stay (MD = -2.53, 95%CI: − 3.42 to − 1.65), time until first postoperative flatus (MD = -0.64, 95%CI: − 0.84 to − 0.45) and time until first postoperative defecation (MD = -1.10, 95%CI: − 1.74 to − 0.47) in patients who received ERAS, compared to conventional care. However, other outcomes were not significant difference. There was no significant difference between ERAS and conventional care in rates of urinary tract infection (P = 0.10), surgical site infection (P = 0.42), postoperative anastomotic leakage (P = 0.45), readmissions (P = 0.31) and ileus (P = 0.25). Conclusions ERAS protocols can reduce the risk of postoperative lung infection and accelerating patient recovery time. Nevertheless, we should also consider further research ERAS should be performed undergoing gastrectomy and esophagectomy.

To investigate the relationship between melanocortin-3 receptor (MC3R) gene polymorphism and tuberculosis (TB) susceptibility in Han population in southern China.A total of 341 patients with TB (173 with pulmonary TB and 168 with multifocal TB) and 359 healthy controls were enrolled. Genotyping was performed by PCR and DNA sequencing, and detection of protein was performed by western blot.The distributions of genotype and allele frequencies of rs6127698 differed significantly between the pulmonary and multifocal TB groups, and between the multifocal TB and control groups. The GG genotype was significantly more common among multifocal TB patients than among pulmonary TB patients (P = .009) and those in the control group (P = .001) under the recessive model. GG+GT genotype was more common in multifocal TB than in pulmonary TB (P .01) and control group (P .01) under the dominant model. G allele was more common in multifocal TB than in pulmonary TB (P .0167) and control group (P .0167). Patients with multifocal TB had an increased expression of MC3R protein than healthy controls (P .05).In the southern Chinese Han population, the MC3R rs6127698 polymorphism, which accompanying an increased expression of MC3R protein,was associated with susceptibility to multifocal TB. Presence of the G allele increased the risk of developing multifocal TB.

To evaluate S1AI-S4AI screw channels with three-dimensional digital technology simulation analysis and to study the feasibility and applicable features of sacral alar-iliac screw fixation in adults.Forty (20 men and 20 women) normal adult's pelvic CT scan data sets were selected to reconstruct the three-dimensional pelvic model. The ideal S1AI-S4AI screw channels were simulated, followed by precise measurement of their parameters.The results showed that there were no significant differences in the transverse angles, sagittal angles, radiuses of the maximal inscribed circles, or lengths of the screw channels in S1AI-S2AI screws between genders (P 0.05). In contrast, the radiuses of the maximal inscribed circles on the left and right, respectively, were 5.93 ± 1.02 mm and 5.92 ± 1.04 mm in males and 4.64 ± 0.98 mm and 4.59 ± 0.95 mm in females, and there was a significant difference in S3AI screws between genders (P 0.05). With a radius of 2.50 mm considered to be standard, there were 25 cases (62.5%) with an S4AI screw channel radius ≤ 2.50 mm in 40 adults, and 15 cases (37.5%; 9 males and 6 females) with a radius 2.50 mm. Furthermore, the transverse angles, the sagittal angles, the lengths of the screw channels, and the radiuses of the maximal inscribed circles were significantly different between genders in 15 cases (P 0.05).Only one maximum ideal screw can be placed on one side at a time. With a radius of 2.50 mm considered to be standard, it is feasible to place S1AI-S3AI screws with a radius 2.50 mm in the entire adult population and S4AI screws with a radius 2.50 mm in some of the adult population. Furthermore, preoperative three-dimensional reconstruction and three-matic research software can effectively simulate the sacral alar-iliac screw channels, and they can provide accurate data for clinical applications.

OBJECTIVE: To explore the role of the interaction between glycogen synthase kinase- 3β (GSK- 3β) and endoplasmic reticulum stress (ERS) in the high glucose (HG)-induced injury in human umbilical vein endothelial cells (HUVECs). METHODS: HUVECs treated with 40 mmol/L glucose for 24 h were examined for expression levels of GSK-3β, GRP78, CHOP and cleaved caspase-3 protein using Western blotting. The cell viability was examined using CCK-8 assay and cell apoptosis was detected with Hoechst 33258 nuclear staining and photofluorography. The intracellular level of reactive oxygen species (ROS) was measured with dichlorfluoresein staining and photofluorography. Mitochondrial membrane potential (MMP) was tested by rhodamine 123 (Rh123) staining and photofluorography. RESULTS: Treatment of HUVECs with 40 μmol/L glucose for 3-24 h activated GSK-3β in a time-dependent manner, leading to significantly down-regulated expression of phosphorylated (p)-GSK- 3β (P < 0.05). HG exposure of the cells for 1-24 h induced ERS, evidenced by time-dependently up-regulated expression of GRP78 and CHOP (P < 0.05). LiCl, an inhibitor of GSK-3β, attenuated HG-induced ERS and significantly lowered the expression levels of GRP78 and CHOP (P < 0.01). 4-PBA, an inhibitor of ERS, obviously ameliorated the activation of GSK-3β by HG as shown by the increase in p-GSK-3β expression level (P < 0.01). HG exposure for 24 h induced obvious injuries in HUVECs, which exhibited decreased cell viability, increased cell apoptosis, increased expression of cleaved caspase-3 and ROS generation, and loss of MMP. Pretreatment of the cells with LiCl or 4-PBA for 60 min before HG exposure significantly lessened the cell injuries (P < 0.01). CONCLUSION: Interactions between GSK-3β and ERS occur in HUVECs exposed to HG and participate in HG-induced cell injuries.

To compare the level of testosterone between type-2 diabetes mellitus (T2DM) patients and healthy controls and to investigate the status of hypogonadism and the influence of hypopgonadism on the quality of life.We collected serum total testosterone (TT), free testosterone (FT), sex hormone-binding globulin (SHBG), and other clinical data from 166 T2DM patients aged over 30 years and 186 age-matched healthy controls. We investigated the quality of life (QoL) of the two groups of subjects using the questionnaires of Androgen Deficiency in Aging Males (ADAM), Aging Male Symptoms (AMS), 36-Item Short-Form Health Survey (SF-36), and Special Quality of Life for Diabetes Mellitus (DSQL).The level of calculated FT (cFT) was remarkably lower in the T2DM patients than in the healthy controls (P0.05), but no statistically significant differences were observed between the two groups in the levels of TT, bio-available testosterone (Bio-T), and SHBG. The T2DM males with hypogonadism showed significant differences from those without in age, height, systolic blood pressure, and creatinine (P0.05). Based on the criteria of cFT0.3 nmol/L and AMS score ≥27, the incidence rate of hypogonadism was 51.81% in the T2DM patients, 31.58% in the 30－39 yr group, 32.50% in the 40－49 yr group, 50% in the 50－59 yr group, 69.23% in the 60－69 yr group, and 77.27% in the ≥70 yr group, elevated by 77.4% with the increase of 10 years of age (OR = 1.774, P0.001). The AMS score was significantly correlated with the scores of DSQL (r = 0.557, P0.001) and SF-36 (r = －0.739, P0.001) in the T2DM patients.T2DM patients have lower levels of cFT than healthy men, accompanied with a higher incidence of hypogonadism. Age is a main risk factor of hypogonadism. Severer testosterone deficiency symptoms are associated with lower scores of QoL in T2DM males.目的： 比较2型糖尿病男性（T2DMM）与健康男性的雄激素水平，分析T2DMM性腺功能减退的状况以及性腺功能减退与生活质量的关系。方法： 选取166例30岁以上的T2DMM患者，收集血清总睾酮、游离睾酮等全面的临床资料，采用ADAM量表、AMS量表、SF-36量表、糖尿病患者生存质量特异性量表（DSQL）研究。选择186例年龄匹配的健康男性作为对照组，比较雄激素水平。结果: 在所有T2DMM患者，血清游离睾酮（cFT）水平明显低于各个同年龄组的健康男性对照(P0.05)，总睾酮水平(TT)、生物活性睾酮(Bio-T）和性激素结合球蛋白（SHBG）在两组间无统计学差异。T2DMM伴有性腺功能减退与不伴性腺功能减退患者相比，年龄、身高、收缩压、肌酐有统计学差异(P0.05)。以AMS问卷异常（得分≥27分）同时cFT低于0.3 nmol/L为性腺功能减退的诊断标准时，T2DMM伴发性腺功能减退达51.81%,且随年龄增长伴发率上升（30~39岁,31.58%; 40~49岁,32.5%; 50~59岁,50%; 60~69岁,69.23%; ≥70岁,77.27%）。年龄是性腺功能减退的危险因素，每增加10岁，性腺功能减退风险增加77.4%（OR=1.774, P0.001）。T2DMM患者AMS量表与SF-36量表（r= －0.7393, P0.001）、DSQL量表（r=0.557,P0.001）评分之间存在显著相关性。结论： T2DMM的游离睾酮低于健康男性，性腺功能减退的伴发率较高，年龄是性腺功能减退的主要危险因素。雄激素缺乏症状程度越严重，生活质量各个维度的评分越差。.

Spinal tuberculosis (STB) is an extrapulmonary form of tuberculosis (TB) caused by Mycobacterium tuberculosis (Mtb), which accounts for around 2% of all TB cases and can lead to spine degeneration. It is widely accepted that host genetic factors participate in the pathogenesis of active TB, but the factors controlling which TB form will manifest after Mtb infection remain unknown. We hypothesized that a genetic difference may exist between the development of STB and pulmonary tuberculosis (PTB). Here, three single nucleotide polymorphisms (SNPs) in the IFNG gene (rs2069718), IRGM gene (rs10065172), and MBL2 gene (rs11003125) were genotyped among 183 PTB patients, 177 STB patients, and 360 healthy controls from the Chinese Han population. We found that rs2069718 genotypes were significantly associated with PTB (TT, p = 0.007; CT, p = 0.008) but not STB, and the TT genotype (p = 0.046) of rs2069718 were less common in PTB than in STB. In contrast, neither PTB nor STB were found to be associated with rs10065172 and rs11003125. Overall, we found a difference in the rs2069718 genetic distribution between the STB and PTB patients in a Chinese Han population. The rs2069718 TT genotype was associated with a protective role in PTB but not STB development during active Mtb infection.

Diabetic retinopathy (DR) is a common chronic microvascular diabetic complication. The presence of DR may indicate microcirculatory dysfunction in other organ systems besides visual morbidity. The objective of this study was to develop a simple diabetic retinopathy risk score to identify DR in Chinese overweight/obese patients with type 2 diabetes mellitus (T2DM).A multicentre hospital-based cross-sectional study was carried out in Guangdong Province between August 2011 and March 2012. The evaluated 2699 patients included 1263 males and 1436 females, with an average age of 59.4 ± 13.0 years.The diabetic retinopathy risk score was conducted by age, duration of DM, history of antihypertensive drug treatment, and waist circumference. The area under the receiver operating characteristics curve for DR was 0.700 (95% CI 0.671-0.729). Comparing Youden's index of different values, the optimal cut-off point was 20 to predict DR. The odds ratio for one unit increase in the diabetic retinopathy risk score associated with the risk of DR was 1.104 (95% CI 1.089-1.120).Our data suggest that the diabetic retinopathy risk score could be a reliable primary screening tool for the presence of DR in Chinese overweight/obese patients with T2DM.

Objective. To investigate the association of single-nucleotide polymorphisms (SNPs) in SP110 gene and TNF-α gene among pulmonary TB (PTB) and spinal TB (STB) patients. Methods. In a total of 190 PTB patients, 183 STB patients were enrolled as the case group and 362 healthy individuals at the same geographical region as the control group. The SP110 SNPs (rs722555 and rs1135791) and the promoter -308G>A (rs1800629) and -238G>A (rs361525) polymorphisms in TNF-α were genotyped. Results. TNF-α -238G>A polymorphism was involved in susceptibility to STB, but not to PTB. The TNF-α -238 A allele was a protective factor against STB (A versus G: OR [95% CI] = 0.331 [0.113–0.972], P=0.044). Furthermore, the presence of the -238 A allele was considered a trend to decrease the risk of STB (AG versus GG: P=0.062, OR [95% CI] = 0.352 [0.118–1.053]; AA + AG versus GG: P=0.050, OR [95CI%] = 0.335 [0.113–0.999]). However, SP110 SNPs (rs722555 and rs1135791) and TNF-α -308G>A (rs1800629) showed no association with PTB and STB in all genetic models. Conclusion. The TNF-α -238 A allele appeared a protective effect against STB, whereas the SP110 SNPs (rs722555 and rs1135791) and TNF-α -308G>A (rs1800629) showed no association with susceptibility to PTB and STB patients in southern China.

The aim of this meta-analysis was to comprehensively compare the safety and efficacy of robotic-assisted rectal cancer surgery (RRCS) and open rectal cancer surgery (ORCS). Electronic database (PubMed, EMBASE, Web of Knowledge and the Cochrane Library) searches were conducted for all relevant studies that compared the short-term and long-term outcomes between RRCS and ORCS. Odds ratios (ORs), mean differences and hazard ratios were calculated. Seven studies involving 1074 patients with rectal cancer were identified for this meta-analysis. Compared with ORCS, RRCS is associated with a lower estimated blood loss (mean difference [MD]: −139.98, 95% confidence interval [CI]: −159.11 to −120.86; P P = 0.003), lower intraoperative transfusion requirements (OR: 0.52, 95% CI: 0.28 to 0.99, P = 0.05), shorter time to flatus passage (MD: −0.97, 95% CI = −1.06 to −0.88, P P = 0.04). There were no significant differences in surgery-related complications, oncologic clearance, disease-free survival and overall survival between the two groups. However, RRCS was associated with a longer operative time. RRCS is safe and effective.

Percutaneous cervical pedicle screw fixation has been proven to be an effective method of cervical screw instrumentation, which has the advantages of less invasiveness and low blood loss. Emerging evidence has indicated that the cervical spinous process plays an important role in percutaneous spine surgery. However, there is a limited amount of information on the fundamental research of pedicle and its associated imaging parameter measurement. The purpose of this study was to measure the anatomic data of the pedicle screw channel (PSC) using reverse engineering and three-dimensional reconstruction, and also to discuss the three-dimensional relationship between the cervical spinous process and the pedicle screw channel.Twenty adult subjects (10 males, 10 females, age range 19-46 years) were studied using the method of three-dimensional CT reconstruction and reverse engineering. The centrum was divided into 10 equal parts from front to back. The bisectors were defined as borderline depths of the centrum, from front to back, 100%, 90%, 80%, 70%, 60%, 50%, 40%, 30%, 20%, 10%, 0% of borderline depths were presented. Then, a 3D coordinate system was constructed to measure all the data, including the radius of the inscribed circle, the length of the PSC, the insertion angle, the distances from entry point to cervical spinous process and skin depth. All the indexes were measured from 70% to 90% borderline depth.The radius of the inscribed circles from CThe measurements of this study could provide detailed information for percutaneous cervical screw fixation. The data of the relationship between the cervical spinous process and the pedicle screw channel present valuable technical information for the design, optimization and clinical application of the aiming device for percutaneous cervical pedicle screw fixation. Copyright © 2016 John WileySons, Ltd.

A nanometer silicon membrane sandwich cup system was self-designed. It could concentrate the bacilli via 0.45-μm microporous filter membrane and semi-automate the acid-fast bacilli (AFB) by a bacteria-staining machine. The aim of the study was to assess the clinical value of our self-designed system for diagnosing tuberculosis (TB).A total of 1993 sputum specimens obtained from patients with confirmed or suspected TB were subjected to direct or concentrated specimens smear at XiangYa Hospital, Central South University between May 2012 and February 2013. In addition, all the specimens were also inoculated into Lowenstein-Jensen (L-J) media, and culture results were considered as the gold standard for calculating sensitivity and specificity.Compared with direct smear examination, an increased density of red stained bacilli was observed in the self-designed nanometer silicon membrane sandwich cup analysis under the microscope. The positive rate of the self-designed analysis was significantly higher than that of direct AFB smear [10.9% (217/1993) vs 6.2% (123/1993), P 0.05]. The sensitivity of the self-designed system increased (97.3% vs 55.2%, P 0.05) without a loss of specificity (100% vs 100%) for identifying positive TB cases compared with the direct smear method.The self-designed nanometer silicon membrane sandwich cup and semi-automatic bacteria-staining machine could more efficiently and rapidly detect the AFB in respiratory specimens than direct microscopy. This is a novel and safe examination, and it may replace direct smear examination for the diagnosis of patients with TB.

To explore the prevalence and risk factors for dyslipidemia in diabetics with overweight or obesity.Diabetics with overweight or obesity were recruited from 62 tertiary and secondary hospitals in Guangdong Province between August 2011 and March 2012. Dyslipidemia was diagnosed as total cholesterol (TC) ≥ 5.7 mmol/L or triglycerides (TG) ≥ 1.7 mmol/L or low-density-lipoprotein cholesterol (LDL-C) ≥ 3.6 mmol/L or high-density-lipoprotein cholesterol (HDL-C)1.29 mmol/L in females or HDL-C1.03 mmol/L in males. Binary Logistic regression was used to assess the associations between dyslipidemia and associated risk factors.Dyslipidemia was detected in 3160/3593 (87.9%) diabetics with overweight or obesity. And the prevalence of hypertriglyceridemia, low blood HDL-C, hypercholesterolemia and high blood LDL-C was 52.5% (1888/3593) , 54.1% (1945/3593), 33.1% (1188/3593) and 27.4% (985/3593) respectively. Among those with dyslipidemia, patients with simple and mixed dyslipidemia accounted for 34.1% and 53.9% respectively. In binary Logistic regression analysis, the presence of dyslipidemia were associated with female gender (OR = 1.593, 95%CI 1.233-2.057), hemoglobinA1c(HbA1c) (OR = 1.120, 95%CI 1.054-1.191), body mass index (OR = 1.084, 95%CI 1.022-1.150), hypertension (OR = 1.331, 95%CI 1.033-1.714), history of diabetes (OR = 1.586, 95%CI 1.186-2.120) and hyperuricacidemia (OR = 2.270, 95%CI 1.642-3.138).The prevalence of dyslipidemia is quite high in diabetics with overweight or obesity. The controls of blood pressure, serum uric acid level, blood glucose and body weight may reduce the prevalence of dyslipidemia, prevent and delay the development of cardiovascular complications and reduce the mortality of diabetics with overweight or obesity.

This study investigated the prevalence and determinants of hyperuricemia in Chinese type 2 diabetes mellitus (T2DM) patients with central obesity. A multicentric hospital-based cross-sectional study was carried out in Guangdong Province between August 2011 and March 2012. At each hospital, Chinese T2DM patients with central obesity who were aged over 20 years, whose serum uric acid levels were measured, and who had lived in Guangdong Province for=1 year, were recruited. Hyperuricemia was defined as serum uric acid420 μmol/L in men and360 μmol/L in women. Binary logistic regression was used to assess associated risk factors for hyperu-ricemia. A total of 2,917 T2DM patients with central obesity took part. The overall prevalence of hyperuricemia was 32.6% (36.1% for women, 28.4% for men). Binary logistic regression analyses demonstrated that women (OR: 1.576; 95% confidence interval (CI): 1.231, 2.018), high BMI (OR: 1.228; 95% CI: 1.094, 1.379), waist cir-cumference (OR: 1.135; 95% CI: 1.009, 1.276), hypertension (OR: 1.603; 95% CI: 1.263, 2.035), high total cho-lesterol (OR: 1.133; 95% CI: 1.002, 1.281), triglycerides (OR: 1.134; 95% CI: 1.069, 1.203), low HDL-cholesterol (OR: 0.820; 95% CI: 0.677, 0.995) and low estimated glomerular filtration rate (OR: 0.840; 95% CI: 0.815, 0.866) were risk factors associated with hyperuricemia. Hyperuricemia is prevalent in Chinese T2DM patients with central obesity and is significantly positively associated with women, cardiovascular risk factors such as obesity, hypertension and dyslipidemia, and low eGFR.本研究旨在探讨高尿酸血症在中国2 型糖尿病合并腹型肥胖患者中的患病率，并 分析其相关危险因素。2011 年8 月至2012 年3 月期间，在广东省内进行多中 心、以医院为基础的横断面调查。在广东省内居住满一年且年龄在20 岁以上， 确诊2 型糖尿病合并腹型肥胖且检测血尿酸水平的患者纳入本研究。高尿酸血症 定义：男性血尿酸420 μmol/L 或女性血尿酸360 μmol/L。采用二分类logistic 回归分析高尿酸血症的危险因素。共2917 名2 型糖尿病合并腹型肥胖的患者纳 入本研究。高尿酸血症的患病率为32.6%(女性为36.1%，男性为28.4%)。二分 类logistic 回归分析显示，女性、高体重指数和腰围、高血压、高总胆固醇和甘 油三酯、低高密度脂蛋白胆固醇和低肾小球滤过率是高尿酸血症的危险因素。 高尿酸血症在中国2 型糖尿病合并腹型肥胖患者中盛行，与女性、心血管危险因 素如肥胖、高血压、血脂異常症和低肾小球滤过率呈显著相关。

To explore the glycemic control status and related risk factors of overweight or obesity patients with type 2 diabetes mellitus (T2DM) in Guangdong province.The medical records of overweight or obesity patients with T2DM from 60 tertiary and secondary hospitals in Guangdong Province were collected by questionnaire and physical examination. And the clinical data were analyzed to explore the influencing factors of glycemic control. The HbA1c level was used to assess glycemic control. HbA1c7.0% indicated that glycemic control was up to standard.From August 2011 to March 2012, 5241 T2DM patients were recruited. The scope of current analysis was restricted to 4768 subjects with true data and deficiency no more than 5%. There were 2252 males and 2516 females. The age range was from 16 to 90 years, a median age 59.0 (50.0 - 69.0) years, onset age of diabetes 52.0 (44.0 - 60.0) years; a range of disease duration from 1 day to 42 years and a median of 5.0 (2.0 - 11.0) years. The median body mass index was 26.33(24.88 - 28.34) kg/m(2) and median waist circumference 93.0 (88.0 - 100.0) cm. Median HbA1c was 8.1% (6.9% - 10.1%) and only 26.2% patients reached the target level of HbA1c7.0%. Influencing factors of poor glycemic control were central obesity, high levels of resting heart rate, concurrent fatty liver and high intensity of treatment. And influencing factors of good glycemic control were regular exercises, smoking cessation, regular glycemic monitoring and good control of total cholesterol/triglyceride.A majority of Guangdong type 2 diabetics fail to achieve target values for glycemic control. There is an urgent need for comprehensive management for improving glycemic control.

AIM: To investigate the perinatal complications and risk of thyroid dysfunction at early childhood of Graves' disease (GD) mothers with euthyroidism (EU) or subclinical hyperthyroidism (sHT) during pregnancy. METHOD: One hundred and twenty-three pregnant women with GD were recruited. They were all in euthyroidism with treatment of anti-thyroid drugs (ATDs) before pregnancy. All the pregnant GD women maintained EU (n=55) or sHT (n=68) by using ATDs. Sixty randomly selected, age-matched healthy pregnant women (non-GD control) were included. The prenatal and newborn data were collected and analyzed. Toddlers of GD mothers (n=45) and non-GD healthy mothers (n=36) were also recruited for thyroid function and growth assessments. RESULTS: Newborns of mothers with GD had significantly higher complications than those of non-GD mothers. The percent of perinatal complications were 5.0%, 30.9% and 32.3% in the control, EU (vs. control, p

BACKGROUND: Spinal tuberculosis is the most common form of musculoskeletal tuberculosis. The expression of matrix metalloproteinase‐1 (MMP‐1) is increased in cells with Mycobacterium tuberculosis infection. MMP‐1 plays a curial role in extracellular matrix degradation during the progression of tuberculosis. Although the 1G/2G polymorphism in MMP‐1‐1607 influences its transcription, its role in spinal tuberculosis remains unknown. METHODS: Healthy controls and patients with spinal tuberculosis of Han ethnicity were recruited between January 2010 and May 2016. The MMP‐1‐1607 1G/2G polymorphism was genotyped using the Sequenom mass Array polymorphism analysis system. RESULTS: The genotypes of 1G/1G, 1G/2G, and 2G/2G were found in 13.7%, 53.6%, and 32.8% of patients, and 12.2%, 37.4%, and 50.4% of controls, respectively. The 1G/2G genotype were more common in cases than in controls (P=2.05E‐04). The 1G allele showed an association with an increased risk for spinal tuberculosis when compared to 2G allele (P=.004). 1G genotypes, having at least one 1G allele, were associated with the risk of developing spinal tuberculosis (1G/1G+1G/2G vs 2G/2G: OR=2.084, 95%CI=1.401‐3.100, P=2.65E‐04). CONCLUSION: 1G genotypes of the MMP‐1‐1607 may be associated with susceptibility to spinal tuberculosis in Southern Chinese Han population.

To characterize the baseline status of Chinese diabetic patients based on data derived from Chinese cohort from SOLVE(TM) study.Patients with type 2 diabetes initiating basal insulin detemir at the decision of the physician were eligible for the study. Data on demographics, medical history, glycemic profile and treatment regimen at baseline were collected by physicians.A total of 3272 patients [female 42%, male 58%, mean age (56.2 ± 10.8) years] were included in the study. Their BMI was (25.3 ± 3.3) kg/m(2). The duration of diabetes was 4.0 (0.1 - 27.0) years, and the duration of treatment with oral antidiabetic drugs (OADs) was 3.0 (0.0 - 20.2) years. The proportions of subjects with diabetic macro- and micro-vascular complications were 15.8% (515 cases) and 27.1% (866 cases), respectively. The hemoglobin A1c (HbA1c) at baseline was (8.33 ± 1.70)%, and the fasting blood glucose (FPG) was (9.5 ± 2.6) mmol/L.A large proportion of patients with type 2 diabetes remain in poor glycemic control, and the prevalence of diabetic complications is high, which requires optimal therapeutic strategy for the patients with suboptimal glycemic control.

To identify the novel species 'Mycobacterium fukienense' sp. nov of Mycobacterium chelonae/abscessus complex from tuberculosis patients in Fujian Province, China.Five of 27 clinical Mycobacterium isolates (Cls) were previously identified as M. chelonae/abscessus complex by sequencing the hsp65, rpoB, 16S-23S rRNA internal transcribed spacer region (its), recA and sodA house-keeping genes commonly used to describe the molecular characteristics of Mycobacterium. Clinical Mycobacterium isolates were classified according to the gene sequence using a clustering analysis program. Sequence similarity within clusters and diversity between clusters were analyzed.The 5 isolates were identified with distinct sequences exhibiting 99.8% homology in the hsp65 gene. However, a complete lack of homology was observed among the sequences of the rpoB, 16S-23S rRNA internal transcribed spacer region (its), sodA, and recA genes as compared with the M. abscessus. Furthermore, no match for rpoB, sodA, and recA genes was identified among the published sequences.The novel species, Mycobacterium fukienense, is identified from tuberculosis patients in Fujian Province, China, which does not belong to any existing subspecies of M. chelonea/abscessus complex.

A previously reported female diagnosed with type A insulin resistance syndrome bearing a heterozygous missense mutation of R1174W in the insulin receptor gene was followed for 7 years since the age of 16 years.Five-hour oral glucose tolerance tests (OGTT) were done on baseline, the 3(rd), 6(th) and 7(th) year respectively, with serum insulin and C-peptide measured at the same time points. Areas under of curve (AUC) of glucose, insulin and C-peptide were compared between the years. Acute insulin response (AIR) was determined at baseline and the 7(th) year. The dose response were insulin secretion rates at each time point during OGTT being plotted over the corresponding glucose levels, and the slopes of which quantified the insulin secretion responding to glucose.The follow up data showed that the glucose metabolism of the subject did not deteriorate over time with yearly glycosylated hemoglobin A1c (HbA1c) being normal (4.6% - 5.5%), and hyperinsulinemic hypoglycemia was a persistent phenomenon observed at 4 - 5 hours post-load. The fasting and AUCs of serum insulin and C-peptide tended to decline without simultaneously increase of those of plasma glucose. The AIR decreased by 56% as compared to baseline. The dose response curves shifted downward as years went by.It supports that with the alleviation of physiological insulin resistance after puberty, the gross hyperinsulinemia tends to ameliorate, and β-cell secretion does not deteriorate over time as glucose homeostasis maintains.

To investigate the effects of early intensive therapy on beta cell function and long-term glycemic control in newly diagnosed type 2 diabetic patients with different recruiting fasting plasma glucose (FPG) levels.A total of 382 newly diagnosed type 2 diabetic patients with FPG 7.0 - 16.7 mmol/L were randomly assigned to therapy with insulin in the form of continuous subcutaneous insulin infusion (CSII) or multiple daily injection (MDI) or oral hypoglycemic agents (OHA, by using gliclazide and/or metformin) for initial rapid correction of hyperglycemia. The treatments were stopped after euglycemia had been maintained for 2 weeks. The patients were followed longitudinally on diet alone for 1 year. Intravenous glucose tolerances tests (IVGTTs) were performed and blood glucose, insulin and proinsulin were measured before and after therapy as well as at 1-year follow-up. Homeostasis model assessment (HOMA) of beta cell function and insulin resistance index (HOMA-beta and HOMA-IR) were calculated. All the patients were stratified on the recruiting FPG: stratum A (7.0 mmol/L/= FPG11.1 mmol/L), stratum B (11.1 mmol/L/= FPG/= 16.7 mmol/L).More patients in stratum A achieved target glycemic control (94.4% vs 89.8%) and in shorter time [(5.9 +/- 3.8) d vs (6.9 +/- 3.6) d, P0.05] as compared with those in stratum B. beta cell function represented by HOMA-beta and acute insulin response (AIR) improved significantly after intensive interventions in both stratum A and B patients. However, the remission rate at 1 year was significantly higher in stratum A patients (47.8%) than those in stratum B (35.7%, P0.05). The patients treated with insulin (especially with CSII) had higher remission rates and better improvement of AIR at 1 year follow-up irrespective of the recruiting FPG (CSII or MDI vs OHA: 57.1%, 51.8% vs 32.8% in stratum A, P0.05; 44.4%, 38.7% vs 18.6% in stratum B, P0.05).Compared with OHA, early short time intensive insulin treatment had more favorable outcomes on maintaining AIR and prolonged glycemic remission in newly diagnosed type 2 diabetic patients irrespective of the recruiting FPG levels.

To set up the reference value of serum glycated albumin (GA) in Chinese for using in clinical practice through a multi-center clinical trial.Three hundred and eighty individuals with normal weight and normal glucose regulation, including 183 males and 197 females ranging from 20 to 69 years, were recruited from 10 hospitals in China Serum GA levels were measured with liquid enzymatic method.(1) The GA level of the 380 subjects was (14.5 +/- 1.9)%. When dividing these subjects by age into 3 subgroups, there was no difference in the GA levels among the 3 subgroups (P0.05). Compared with the women, the men had higher GA level in the first subgroup aging from 20 to 39 (P = 0.028). However, no significant difference was detected after adjusting with BMI as confounder. (2) When dividing those subjects by BMI into 3 subgroups, with BMI ranging from 18.5-20.9 kg/m2 21.0-22.9 kg/m2 and 23.0-24.9 kg/m2 respectively, we came to the following results: for men, there was no difference in the GA levels among the 3 subgroups (P0.05), but for women, the GA level of the first subgroup was higher than that of the second subgroup (P = 0.024). (3) The level of GA in the 2.5th to 97.5th percentile was 10.8%-17.1%. (4) Sixty normal subjects were chosen to repeat evaluation of GA levels after 2-3 weeks and the GA levels were of no difference (P0.05).The normal range of serum GA for the Chinese population could be suggested at 11%-17%.

Early intensive insulin therapies in newly diagnosed type 2 diabetic patients may improve beta-cell function and yield prolonged glycemic remissions. This study was performed to evaluate the relationship between the glycemic remission and beta-cell function and assess the variables predictive of long-term near-normoglycemic remission.Eighty-four newly diagnosed type 2 diabetic patients were treated with 2-week continuous subcutaneous insulin infusion (CSII) and followed up longitudinally. Intravenous glucose tolerance tests (IVGTTs) were performed, and blood glucose, hemoglobin A1c (HbA1c) and insulin were measured at baseline, after CSII and at 2-year visit. The patients who maintained glycemic control for two years were defined as the remission group and those who relapsed before the 2-year visit were the non-remission group.The duration to be diagnosed of the patients (from the time that patients began to have diabetic symptoms until diagnosis) in the remission group was shorter than that in the non-remission group (1.00 month vs 4.38 months, P = 0.040). The increase of the acute insulin response (AIR) was maintained after 2 years in the remission group compared with AIR measured immediately after intervention (413.05 pmol*L(-1)*min(-1) vs 408.99 pmol*L(-1)*min(-1), P = 0.820). While AIR in the non-remission group significantly declined (74.71 pmol*L(-1)*min(-1) vs 335.64 pmol*L(-1)*min(-1), P = 0.030). Cox model showed that a shorter duration to be diagnosed positively affected the duration of near-nomoglycemic remission with an odds ratio (OR) 1.019, P = 0.038, while fasting plasma glucose (FPG) and post-breakfast plasma glucose (PPG) after CSII were the risk factors (OR 1.397, P = 0.024 and OR 1.187, P = 0.035, respectively).The near-normoglycemic remission is closely associated with long-term maintenance of beta-cell function and occurs more commonly in patients with shorter duration to be diagnosed and better glycemic control during CSII.

To provide a new method in the fixation of sacral fracture by means of three-dimensional reconstruction and reverse engineering technique.Pelvis image data were obtained from three-dimensional CT scan in patients with sacral fracture. The data were transferred into a computer workstation. The three-dimensional models of pelvis were reconstructed using Amira 3.1 software and saved in STL format. Then the three-dimensional fracture models were imported into Imageware 9.0 software. Different situations of reduction (total reduction, half reduction and non-reduction) were simulated using Imageware 9.0 software. The best direction and location of extract iliosacral lag screws were defined using reverse engineering according to these three situations and navigation templates were designed according to the anatomic features of the postero-iliac part and the channel. The exact navigational template was made by rapid prototyping. Drill guides were sterilized and used intraoperatively to assist in surgical navigation and the placement of iliosacral lag screws.Accurate screw placement was confirmed with postoperative X-ray and CT scanning. The navigation template was found to be highly accurate.The navigation template may be a useful method in minimal-invasive fixation of sacroiliac joint fracture.

To observe the primary clinical result of digital template as navigation to the upper cervical pedicle instrumentation.CT scan of upper cervical vertebrae was performed. 3-D model of upper cervical vertebrae was reconstructed by software Amira 3.1 and was preserved in STL format. Then 3-D model was run in software UG Imageware 12.0, the best pedicle channel was extracted according to the reverse engineering principle. A virtual navigational template was established according to he lamina anatomic trait, and the best pedicle channel. The virtual vertebrae and navigational template were manufactured using rapid prototyping. The navigational template was sterilized and used intra operative to assist with the placement of pedicle screw. The Accuracy of screw placement was confirmed with postoperative X-ray and CT scanning.The digital navigational template had been established and used in the 3 cases, the good trajectory of cervical pedicle had been showed by the CT scan of post operation. There were not complications of related pedicle screw insertion.A novel method of upper cervical pedicle location using Reverse Engineering and rapid prototyping has been developed; the navigational template is found to be highly accuracy and has great expectation.

To analyzed the role of genetic factors in pathogenesis of acute intermittent porphyria (AIP).Peripheral blood sample was collected from a Chinese female AIP patients, aged 36, to undergo direct sequencing to analyze all the exons and flanking introns of the porphobilinogen deaminase (PBGD) and protoporphyrinogen oxidase (PPOX) genes. The sequencing results were compared with the established human PBGD and PPOX sequences (GenBank Accession No. M95623; NC_000001.9).Direct sequencing showed three kinds of single nucleotide polymorphism (SNP) in the PBGD gene. No mutation was found in the coding regions of either PBGD or PPOX gene.The three SNPs may underlie the genetic defects of AIP in Chinese. SNP may serve as genetic markers for linkage analysis to track presymptomatic carriers in AIP families.

Developments in the field of digitalized technique and three-dimensional (3D) reconstruction methods allowed a precise description of anatomy structures. With the development of Visible Human Project (1989) and Virtual Chinese Human (VCH) techniques, we could get more precise anatomic images. Digitized visible models of these structures can be a useful tool in clinical training. Combining modern radiology and VCH techniques, we designed a method to establish digitized visible models of anterolateral thigh (ALT) flap and arteria dorsalis pedis (ADP) flap from adult fresh cadaver specimens perfused with lead oxide-gelatine mixture and VCH Male III dataset. The 3D reconstructed visible models established from these datasets perfectly displayed the anatomic structures of ALT flap and ADP flap. This is the first report on the ACFL and ADP structures which were reconstructed digitally.

To investigate the function of islet beta cells in subjects with normal glucose tolerance (NGT), impaired glucose regulation (IGR), and type 2 diabetes mellitus (T2DM). Different indexes of insulin secretion, including DeltaI30/DeltaG30, AIR or HOMAbeta, were compared.178 subjects without overt diabetes were classified into three groups according to the results of 75 g oral glucose tolerance test (OGTT): NGT group (n = 68), IGR group (n = 75), and T2DM group (n = 35). Intravenous glucose tolerance test (IVGTT) was carried out 1 approximately 3 days later in all participants, with measurement of plasma insulin. The ratio of insulin-to-glucose levels increment during the first 30 min of OGTT (DeltaI30/DeltaG30) and the acute insulin response (AIR) in IVGTT were used as indexes of early insulin secretion. Homeostasis model assessment of insulin secretion (HOMAbeta) was another indicator of insulin secretion. The fasting plasma proinsulin level (FPI) was measured and the ratio fasting proinsulin to fasting insulin (PI/I) was calculated. HOMA insulin resistance index (HOMA IR) was used to assess the insulin resistance.The DeltaI30/DeltaG30 and AIR of the IGR group, adjusted by age, sex, and BMI, were both significantly lower than those of the NGT group. But the HOMAbeta of the IGR group was only slightly lower than that of the NGT group. Compared with the NGT subjects, the T2DM patients had a very severe islet beta cell dysfunction (84% decrease in AIR, 70% decrease in DeltaI30/DeltaG30 and 62% decrease in HOMA beta). When the DeltaI30/DeltaG30 was adjusted by HOMR IR, the extent of impairment in early insulin response was similar to that of AIR (87% versus 84% lower than that of the NGT group). The FPI and ratio of proinsulin to insulin were higher in the T2DM subjects compared with the NGT subjects (24.4 pmol/L +/- 18.0 pmol/L vs 10.9 pmol/L +/- 6.7 pmol/L; and 14.7% +/- 10.5% vs. 10.0% +/- 6.5%, both P0.05). There was a significantly positive correlation between DeltaI30/DeltaG30 and AIR (r = 0.75, P0.001).In the stage of IGR, an evident deficit in phasic insulin secretion after glucose load and a decreasing HOMAbeta are exhibited. In addition to this, qualitative decrease of insulin secretion appears in the DM stage. AIR is a reliable index of isletbeta cell function. DeltaI30/DeltaG30 is an alternative one in the subjects with NGT and IGR. But it should be adjusted by IR in diabetic patients.

Developments in the field of digitalized technique and three-dimensional (3D) reconstruction methods allowed a precise description of anatomy structures. With the development of computer reconstructive techniques, we could get more precise anatomic images. Digitized visible models of these structures can be as a useful tool in clinical training. The purpose of this study was to observe the anatomy of arteria circumflexa femoris lateralis (ACFL) flap and to discuss the methods in the visualization of anterolateral thigh (ATL) flap by digitalized technique.Six adults volunteer underwent contrast-enhanced CT angiography of pelvic and lower limbs utilizing a 64-row multi-slice spiral CT after median cubital vein injection with Ultravist (3.5 ml/s). 2D images from these data in Dicom format were transformed into computer. Next two adult fresh cadaver specimens, one male and one female, were subject to radiographic CT scanning before and after perfused with lead oxide-gelatine mixture, whose collimation are 0.5 mm (120 kV, 110 mA, 512 x 512 matrix). Through Amira 3.1 (TGS) software, the 2D images in Dicom format were transformed into the 3D models of the entire region. The structures of arteria circumflexa femoris lateralis (ACFL) were observed and the digitized visible models of ALT flap were established through 3D computerized reconstructions methods from these data using Amira 3.1 software. Then merging volume rendering with surface rendered reconstruction from lead oxide-gelatine mixture perfusion database.The 3D reconstructed visible models established from these datasets perfectly displayed the characteristic of ACFL and ALT flap anatomy.The digitized models could offer the anatomy of ALT flap perfectly, and the reconstructed methods may be used in other flap reconstruction with 3D demonstration.

To investigate the characteristics of the dysfunction of islet beta-cell in newly diagnosed type 2 diabetic patients.Intravenous glucose tolerance test (IVGTT) was carried out on 352 newly diagnosed type 2 diabetic patients and 48 subjects with normal glucose tolerance (NGT) and then blood samples were collected 1, 2, 4, 6, and 10 minutes later to measure the plasma glucose and insulin to calculate the acute insulin response (AIR) and the area under the curve of insulin (AUC of insulin), homeostasis model assessment beta-cell (Homabeta), and Homa IR (insulin resistance).The median AIR of the type 2 diabetic patients was -33.7 pmol/L, significantly lower than that of the NGT subjects (6962.0 pmol/L, P0.001). The median AUC of the type 2 diabetic patients was 834.2 pmol/L, significantly lower than that of the NGT subjects (7934.7 pmol/L, P0.001). When the fasting plasma glucose (FPG) of the type 2 diabetic patients was above 7.0 mmol/L, the AIR value was remarkably reduced with a median level of 317.3 pmol/L, and then subsequently disappeared when the FPG was above 9.0 mmol/L. After adjustment of the insulin resistance assessed by HOMA IR, the Homabeta of the type 2 diabetic patients was reduced to be 30% that of the NGT subjects (3.7 +/- 0.9 vs 5.9 +/- 0.9, P0.001). Both the fasting proinsulin concentration and the ratio of fasting proinsulin to fasting insulin of the type 2 diabetic patients were significantly higher those of the NGT subjects (22.6 pmol/L +/- 14.7 pmol/L vs 11.5 pmol/L +/- 7.1 pmol/L, P0.001; and 30.1% +/- 20.5% vs. 12.1% +/- 9.6%, P0.001).The dysfunction of islet beta-cell in newly diagnosed type 2 diabetic patients is mainly represented by the disappearance of AIR and the evident decline of AUC and HOMA B, and the decrease of quality of insulin secretion.

To compare the efficacy of insulin aspart and human soluble insulin used in insulin pump therapy on the islets beta cell function in newly diagnosed type 2 diabetic patients.Fifty-nine hospitalized newly diagnosed type 2 diabetic patients, 35 males and 24 females, aged 51 +/- 12, were and randomly divided into 2 groups to undergo insulin pump therapy with insulin aspart (aspart group, n = 30) or human soluble insulin (human insulin group, n = 29) for 2 weeks. The targets of glycemic control included fasting blood glucose (FBG)6.1 mmol/L and 2 h postprandial blood glucose (PBG)8.0 mmol/L. The changes of blood glucose, and the time and the doses of insulin needed for good glycemic control were compared between the two groups. The frequency of hypoglycemia and pump-related side effects were recorded.On the 2nd day of insulin pump therapy, FBG and 3 meals PBG levels were significantly reduced in both groups while the post-breakfast and post-dinner blood glucose levels were far more decreased in the aspart group than in the human insulin group (8.4 mmol/L +/- 2.8 mmol/L vs 11.3 mmol/L +/- 3.8 mmol/L, and 9.0 mmol/L +/- 2.4 mmol/L vs 10.7 mmol/L +/- 2.8 mmol/L, both P0.05). The FBG and 3 meals PBG were significantly lowered in the aspart group than in the human insulin group on the 7th day and after the stopping of insulin pump therapy. The time of good glycemic control of the aspart group was 2.0 d, significantly shorter than that of the human insulin group (6.0 d, P0.01). The mean dose of insulin used during insulin pump therapy in the aspart group was 0.6 U/kg, significantly less than that in the human insulin group (0.8 U/kg, P = 0.002). There was no significant difference in the AIR, mean area under the curve (AUC) of insulin and C peptide during IVGTT, HOMA-beta and proinsulin between the two groups before and after insulin pump therapy. No pump-related side effects were observed in both groups.In newly diagnosed type 2 diabetic patients with short term insulin pump therapy, the use of insulin aspart was more effective and faster with less doses of insulin in acquiring good glucose control compared with humulin R.

To investigate the effects of short-term continuous subcutaneous insulin infusion (CSII) on newly diagnosed type 2 diabetes and to identify the influencing factors for the curative effects of CSII.138 newly diagnosed type 2 diabetic patients with fasting plasma glucose11.1 mmol/L were treated with CSII for 2 weeks. Intravenous glucose tolerance test (IVGTT) was performed before and after CSII. The target of glycemic control were fasting blood glucose6.1 mmol/L and postprandial blood glucose (PBG)8.0 mmol/L. The age, body mass index (BMI), fasting and postprandial plasma glucose, hemoglobin A(1C) (GHbA(1C)), Homa beta, Homa IR, area under the curve of insulin (AUC) during IVGTT were compared between the good glycemic control group and the inadequate glycemic control group.After 2 weeks' CSII treatment, good glycemic control was achieved in 126 patients (group A) but not in the remaining 12 patients (group B). There were no differences in age, BMI, postprandial plasma glucose, GHbA(1C), and Homa IR between the two groups before and after CSII treatment. But the fasting plasma glucose was higher and Homa B was lower in group B than in group A before CSII treatment. The DeltaAUC (AUC after CSII subtracted from that before CSII) representing the recovery of beta-cell function was much greater in group A than in group B. The insulin dose of group B was significantly higher than that of the good glycemic control group.More severe hyperglycemia and relative beta-cell function deficiency may be the main reasons responsible for not achieving good glycemic control in newly diagnosed type 2 diabetic patients with short-term intensive CSII treatment.