Effects of glucose and insulin on the H9c2 （2-1） cell proliferation may be mediated through regulating glucose transporter 4 expression

Background The change of glucose transporter 4 （GLUT4） expression could influence glucose uptake in the myocardial cells and then effect myocardial metabolism, which maybe one of the factor for the diabetes cardiovascular disease. This study aimed to explore the influence of glucose and insulin at different concentrations on H9c2 （2-1） cell proliferation and its GLUT4 expression in vitro, and evaluate the correlation between myocardial cells proliferation and GLUT4 expression. This might be helpful for understanding the relationship between glucose metabolism and cardiovascular disease. Methods According to glucose concentrations in culture medium, cultured H9c2 rat myocardial cells were divided into five groups： control group （NC, glucose concentration 5.0 mmol/L）, low glucose group （LG, glucose concentration 0.1 mmol/L）, high glucose group 1 （HG1, glucose concentration 10 mmol/L）, high glucose group 2 （HG2, glucose concentration 15 mmol/L）, high glucose group 3 （HG3, glucose concentration 20 mmol/L）. Then according to different insulin concentrations in culture medium, each group was further divided into two subgroups： normal insulin subgroup （INSc, insulin concentration 3.8 mU/L）, high insulin subgroup （INSh, insulin concentration 7.6 mU/L）. H9c2 （2-1） cells were cultured for 1, 2, 3 days, the proliferation of cells were assayed by cell counting Kit-8 assay, the expressions of GLUT4 mRNA and protein were detected with RT-PCR and Western Blotting technique, and the relation between myocardial cells proliferation and GLUT4 expression was evaluated.     

Effect of Tang No.1 granule (糖1号方) in treating patients with impaired glucose tolerance

Objective： To observe the therapeutic effect of Tang No.1 granule （糖1号方, T1G） in treating patients with impaired glucose tolerance （IGT）. Methods： One hundred and forty patients with IGT and with Pi （脾）-Wei （胃） dampness-heat syndrome type were assigned randomly according to their visiting sequence into two equal groups. The control group received only general knowledge about IGT, but to the treated group, based on current knowledge available, T1G was given additionally for 6 months. Changes in related laboratory indexes, including fasting plasma glucose and insulin （FPG and FINS）, plasma glucose 2 h after meal （2hPG）, glycosylated hemoglobin （HbAlc）, serum triglyceride （TG）, low density lipoprotein cholesterol （LDL） and insulin resistance index （HOMA-IR）, were observed. Results： The levels of FPG, 2hPG, HbAlc, FINS, TG and HOMA-IR were significantly decreased after treatment in the treated group, showing a significant difference compared to the control group （P〈0.01）. Among them, HbAlc decreased from 7.08±1.41% to 6.56±1.29% in the treated group, while in the control group, it decreased from 7.02±1.37% to 6.93±1.31%. The level of LDL was also reduced in the treated group after treatment （P〈0.05）. In the treated group, 13 out of 68 patients （19.12%） had their glucose tolerance reversed to normal, while in the control group, only 2/64 （3.1%） got it reverse; a comparison between the two groups in terms of reversion rate showed a significant difference （P〈0.01）. No severe adverse reaction was found in the therapeutic course. Conclusions： T1G has good clinical effect as a treatment intervention for IGT, as it could improve glycometabolism, significantly depress the levels of post-prandial blood sugar and blood lipids, alleviate clinical symptoms of patients, and effectively cut-off and reverse the yielding and development of diabetes mellitus.     

Prognostic puzzle： which strategy in determining prognosis of patients with acutecoronary syndrome？

To the editor： We read with great interest an article by Zhang et al.The soluble ST2 level was shown to be increased in the earlyperiod and an independent predictor of prognosis, They additionallyproposed that it might contribute to the predictive value of GRACEscore and N-terminal prohormone B-type natriuretic peptide （NT-proBNP） level.     

Relationship between the level of fasting plasma glucose and beta cell functions in Chinese with or without diabetes

Background Type 2 diabetes is a chronic disease characterized by a progressive loss of beta cell functions. However, the evaluation of beta cell functions is either expensive or inconvenient for clinical practice. We aimed to elucidate the association between the changes of insulin responsiveness and the fasting plasma glucose （FPG） during the development of diabetes.
Methods A total of 1192 Chinese individuals with normal blood glucose or hyperglycemia were enrolled for the analysis. The early insulinogenic index （△I30/△G30）, the area under the curve of insulin （AUC-Ⅰ）, and homeostasis model assessment were applied to evaluate the early phase secretion, total insulin secretion, and insulin resistance respectively. Polynomial regression analysis was performed to estimate the fluctuation of beta cell functions. Results The △I30/△G30 decreased much more rapidly than the AUC-Ⅰ accompanying with the elevation of FPG. At the FPG of 110 mg/dl （a pre-diabetic stage）, the AI30/AG30 lost 50% of its maximum while the AUC-Ⅰ was still at a compensated normal level. The AUC-Ⅰ exhibited abnormal and decreased gradually at the FPG of from 130 mg/dl to higher （overt diabetes）, while the △I30/△G30 almost remained at 25% of its maximum value. When hyperglycemia continuously existed at 〉 180 mg/dl, both the AI30/AG30 and AUC-Ⅰ were totally lost.
Conclusion The increased fasting plasma glucose reflects progressive decompensation of beta cell functions, and could be used to guide the strategy of clinical treatments.     

The influence of α_1 adrenoceptor for glucose transporting in different blood supply states myocardium

1 IntroductionDuring ischemia ,glucose becomes the preferredsubstrate as glycolysis switches fromaerobic to anaer-obic conditions . Glucose transport into myocardialcellsis mediated by the glucose transporter (GLUT)isoforms GLUT4 and GLUT1[1]. GLUT4 ,whichpredominates in heart tissue ,was shown to be local-ized mainly on intracellular membrane vesicles (I M)in the basal state and to translocate to the plasmamembrane in response to sti muli such asischemia andhypoxia ,or anoxia . GLUT1 …     

Leopard skin-like fundus oculi induced by LASIK？

A 24-year-old man was presented to Department of Ophthalmology in November 2011 with an approximately l-month history of blurred vision and ophthalnlocopia. There was no ophthalmalgia, photophobia, or lacrimation. Visual acuity was examined at first, revealing 1.0 for the left eye and 0.6 lbr the right eye. However,     

Can moxibustion,an ancient treatment modality,be evaluated in a double-blind randomized controlled trial？ A narrative review

For thousands of years, moxibustion has been used for various diseases in China and other Asian countries. Despite the recent surge in Chinese herbal studies, few randomized controlled trials have been conducted on this modality, possibly due to the lacking of suitable double blinding methodology. This is a review of extant sham moxa devices and an introduction to a recently developed device that needs further validation.     

葡萄糖酸锌片辅助治疗小儿急性腹泻的疗效观察

目的:评价葡萄糖酸锌片辅助治疗小儿急性腹泻的效果。方法:回顾性分析88例急性腹泻患儿,随机分为对照组和试验组。对照组45例,实施常规治疗,试验组43例,在对照组基础上增加口服葡萄糖酸锌片,比较两组患儿治疗的总有效率和临床症状消失的时间。结果:试验组治疗总有效率高于对照组(97.7%vs 80.0%,χ~2=5.178,P=0.023),两组患儿在大便次数、大便性状恢复正常、呕吐症状消失的时间差异有统计学意义(P<0.05),在腹痛症状消失和体温降至正常的时间差异无统计学意义(P>0.05)。结论:葡萄糖酸锌片辅助治疗小儿急性腹泻效果满意,并且简单易行,值得临床中推广应用。     

Normal blood D-dimer concentrations： do they exclude pulmonary embolism？

Background Although pulmonary embolism （PE） with normal blood D-dimer （DD） concentrations is considered rare,in practice the incidence may be greater than is generally believed.Overlooking PE is potentially dangerous.The aim of this study was to explore the incidence and clinical features of PE with normal DD concentrations.Methods We retrospectively analyzed the records of 29 patients with PE and normal DD concentrations from the past seven years.We here compare relevant clinical characteristics of these patients with those of patients with PE and abnormal DD concentrations.We evaluated the probabilities of differences by computing pretest probability scores （Wells score and revised Geneva score）.Results The frequency of normal DD concentrations in patients with PE was 4％.Previous episode（s） of PE were more common in patients with normal DD concentrations than in those with abnormal DD concentrations （P=0.001）.Fever,tachycardia,and tachypnea occurred less frequently in the former group （P＜0.05） and time between onset of symptoms and DD testing was longer （P=0.001）.The diagnosis of PE was delayed in 22 of the 29 cases.Nineteen and seven cases with normal DD concentrations were classified according to pretest scores as intermediate and low risk,respectively.Conclusions PE with normal DD concentrations is uncommon.Although most diagnoses of PE are ruled out by normal DD values,a small number of cases with PE are missed.A combination of pretest probability score and normal DD concentration increases the probability of making the correct diagnosis,but cannot completely exclude patients with suspected PE.When the clinical manifestations cannot be otherwise explained,clinicians should be alert to the possibility of PE with normal DD concentrations in patients with previous episode（s） of PE or a long interval between onset of symptoms and DD testing.     

Can transthoracic Doppler echocardiography be used to detect coronary slow flow phenomenon?

Background Coronary slow flow phenomenon （CSFP） is an important, angiographic clinical entity but is lacking non-invasive detecting techniques. This study aimed to elucidate the value of transthoracic Doppler echocardiography （TTDE） in the diagnosis and monitoring of coronary slow flow in left anterior descending （LAD） coronary artery.Methods We consecutively enrolled 27 patients with CSFP in LAD detected by coronary arteriography from August 2009 to April 2010. Thirty-eight patients with angiographically normal coronary flow served as control. Corrected thrombolysis in myocardial infarction （TIMI） frame count （CTFC） was used to document coronary flow velocities. All subjects underwent TTDE within 24 hours after coronary angiography. LAD flow was detected and the coronary diastolic peak velocities （DPV） and diastolic mean velocities （DMV） were calculated.Results Sixty of 65 （92.3%） subjects successfully underwent TTDE. Baseline clinical characteristics were similar between the two groups. Coronary DPV and DMV of LAD were significantly lower in the CSFP group than in the control group （（0.228±0.029） m/s vs. （0.302±0.065） m/s, P=0.000; （0.176±0.028） m/s vs. （0.226±0.052） m/s, P=0.000,respectively）. There was a high inverse correlation between CTFC and coronary DPV and DMV （r=-0.727, P=0.000;r=-0.671, P=0.000, respectively）. Receiver operating characteristic （ROC） curve showed that the area under the curve （AUC） was less than one half for coronary DPV （AUC=0.104） and DMV （AUC=0.204）, respectively.Conclusions In patients with CSFP, there is a high inverse correlation between CTFC and coronary diastolic flow velocities in the LAD coronary artery, as measured by TTDE. The value of TTDE in the monitoring and evaluation of coronary flow in patients with CSFP deserves further investigation.     

临床VS科研,孰轻孰重？

＂先有蛋,还是先有鸡＂,这是个问题就医学发展而言,到底是先有临床还是先有科研？这就像＂先有蛋还是先有鸡＂的问题一样,是个亘古不变的哲学问题.医学首先是救死扶伤,这便是临床;但是医学同时还是一门科学,又离不开科研.临床的进步离不开科研的指导,而科研的成果又离不开临床的积累.     

什么是循证物理诊断学？

当前循证医学方法已成为临床研究的主流。循证医学强调临床决策应依赖客观证据而不是个人经验或专家意见,强调用科学实证的态度寻找临床问题的最佳解决方案。循证医学的发展有利于临床诊疗的规范化和科学化进程,然而目前循证研究多集中于探讨特定疾病的诊断和治疗,评估症状和体征诊断意义的研究相对较少。物理诊断学也因此难以获得严格的循证医学评价。     

Bocavirus infection in children： what should be the next to do？

Since human bocavirus （HBoV） was first described in 2005 by Allander et al,1 a considerable number （atleast nine） of original articles on this virus were published by authors from China, including two from the Hong Kong Special Administrative Region, within a relatively short period of time. These studies conducted in China cover basically the clinical aspects of children infected with the virus and genomic characteristics, mostly nucleic acid sequence analyses and comparisons with the results of studies reported from other countries, especially with those of the prototype strains. Two of the nine papers included the development and application of techniques for determination of antibodies against HBoV. These studies added some important information to the world＇s literature on HBoV regarding its existence in different regions in China, the relationship of the genomic sequences of the strains of the virus found in this country and the clinical manifestations of the Chinese patients infected with this virus.     

Reconstruction of bilateral axillary post burn contracture in a 3 year old： A case report

A2 year old male child was admitted with history of accidental pouring by boiling water all over the body resulting in 51%surface area burns involving the pos-terior and lateral thoracic region,both the upper limbs in the proximal regions near the shoulder,anterior and posterior abdomen and pubic region with second andthird degree severe burns.     

Can we early diagnose metabolic syndrome using brachial-ankle pulse wave velocity in community population？

Background The prevalence of metabolic syndrome （MetS） increased recently and there was still not a screening index to predict MetS.The aim of this study was to estimate whether brachial-ankle pulse wave velocity （baPVVV）,a novel marker for systemic arterial stiffness,could predict MetS in Chinese community population.Methods A total of 2 191 participants were recruited and underwent medical examination including 1 455 men and 756 women from June 2011 to January 2012.MetS was diagnosed according to the criteria of the International Diabetes Federation （IDF）.Multiple Logistic regressions were conducted to explore the risk factors of MetS.Receiver operating characteristic （ROC） curve was performed to estimate the ideal diagnostic cutoff point of baPWV to predict MetS.Results The mean age was （45.35±8.27） years old.In multiple Logistic regression analysis,the gender,baPWV and smoking status were risk factors to MetS after adjusting age,gender,baPWV,walk time and sleeping time.The prevalence of MetS was 17.48% in 30-year age population in Shanghai.There were significant differences （Х^2=96.46,P 〈0.05） between male and female participants on MetS prevalence.According to the ROC analyses,the ideal cutoff point of baPWV was 1 358.50 cm/s （AUC=60.20%） to predict MetS among male group and 1 350.00 cm/s （AUC=70.90%） among female group.Conclusion BaPWV may be considered as a screening marker to predict MetS in community Chinese population and the diagnostic value of 1 350.00 cm/s was more significant for the female group.     

Effects of salivae miltiorrhizae liguspyragine hydrochloride and glucose injection (参芎葡萄糖注射液) on the levels of main platelet thrombin receptors in chronic haemodialysis patients

Objective:To investigate the effects of Salvia Miltiorrhiza Liguspyragine Hydrochloride and Glucose Injection(参芎葡萄糖注射液,SLGI) on the expression of platelet membrane receptors proteinase-activated receptor-1(PAR1) and proteinase-activated receptor-4(PAR4) in end-stage renal disease(ESRD) patients on chronic haemodialysis(HD).Methods:Eighty-six ESRD patients on HD(treated group) were treated with SLGI,7 days as one therapeutic course,for two successive courses.The previous therapies were unchanged.Flow cytometry was used to assess the expression of platelet PAR1 and PAR4 in the patients,and turbidity method was used to determine the platelet maximum aggregation rate(MAR).Meanwhile,renal function was measured.The final data were compared with those before treatment and with those in the normal control group(54 healthy subjects).Results:Compared with the normal control group,the expressions of PAR1 and PAR4 and platelet MAR in ESRD patients on HD was significantly higher before treatment(P=0.001,P=0.006, and P=0.008);after treatment with SLGI,the above indices in patients were remarkably decreased(P=0.036 and P=0.046),except PAR4(P=0.067),but still higher than those in the normal control group,however,it was not statistically significant.Conclusions:(1) The overexpression of PAR1 and PAR4 might lead to increased platelet aggregation and this could be one of the reasons for the thrombotic events in ESRD patients on HD.(2) SLGI was able to down-regulate the expression of PAR1 in ESRD patients on HD,improve platelet function,and regulate platelet activation.     

高血压合理选药的前提有哪些要点值得注意？

1）明确诊断,科学评估病情的危险程度、治疗的效/险和效/价比值,在循证医学临床指南的指导下,同时结合病人的意向性,形成指南-医患之间的互动,制定与施行合理的临床决策。     

羟氯喹联合多西环素和医学保湿剂治疗红斑期玫瑰痤疮的临床效果及安全性评价

目的 探讨羟氯喹联合多西环素和医学保湿剂治疗玫瑰痤疮的临床效果及安全性评价。方法 回顾性分析2018 年12 月～2020 年6 月我院门诊治疗的玫瑰痤疮患者108 例,按照治疗方法不同进行分组,分为对照组（n=54）和研究组（n=54）,其中对照组患者采用羟氯喹联合多西环素治疗,研究组患者采用羟氯喹联合多西环素和医学保湿剂治疗,比较两组患者临床症状好转时间、玫瑰痤疮症状积分、HAMA 评分、HAMD 评分、治疗效果及不良反应发生率。结果 研究组患者临床症状好转时间明显短于对照组,玫瑰痤疮症状积分低于对照组,HAMA评分、HAMD 评分低于对照组,治疗总有效率高于对照组,差异均有统计学意义（P＜0.05）;不良反应发生率为3.70%（2/54）,低于对照组的5.55%（3/54）,但差异无统计学意义（P＞0.05）。结论 玫瑰痤疮患者采用羟氯喹联合多西环素和医学保湿剂进行治疗,治疗效果显著,安全性较高,有助于患者病情恢复。     

Controversy of the prostate-specific antigen test era： should prostate cancer be detected and treated in all patients？

The United States Food and Drug Administration approved the prostate-specific antigen (PSA) test in 1986 for monitoring the progression of prostate cancer;in 1994,the test was approved for the early detection of prostate cancer.1 The application of the PSA test has significantly increased the detection rate of prostate cancer.     

介入医生应重视对比剂肾病

日前,中华医学会心血管病学分会委员、北京安贞医院周玉杰教授在接受记者采访时指出,目前我国对比剂肾病（CIN）发病形势严峻,必须以循证医学证据为依据,借鉴国外的成熟经验,形成我国临床CIN的诊疗方案,更好地指导临床工作中对CIN的预防。