Insulin aspart: a novel rapid-acting human insulin analogue

In order to improve therapy and increase the quality of life for diabetic patients, it has been of significant interest to develop rapid-acting insulin preparations that mimic the physiological meal-time profile of insulin more closely than soluble human insulin. Insulin aspart (B28Asp human insulin) is a novel rapid-acting insulin analogue that fulfils this criterion. The B28Asp modification weakens the self-association of the insulin molecule and provides a more rapid absorption from the sc. injection site. The preclinical evaluation in vitro and in vivo demonstrates that apart from the more rapid absorption, insulin aspart is equivalent to human insulin. Thus, insulin aspart is equivalent to human insulin on key in vitro parameters such as insulin receptor affinity, insulin receptor dissociation rate, insulin receptor tyrosine kinase activation, IGF-I receptor binding affinity, metabolic and mitogenic potency. In accordance with the equivalent in vitro profiles, the toxico-pharmacological properties of insulin aspart and human insulin are also identical. The available data for insulin aspart and other rapid-acting insulin analogues supports that in vitro assays are sensitive and valuable in the preclinical evaluation of insulin analogues. Clinical studies demonstrate that insulin aspart has a pharmacokinetic and pharmacodynamic profile superior to that of soluble human insulin. In Type 1 diabetic patients on a basal-bolus injection regimen, insulin aspart given immediately before the meals provides an improved postprandial glycaemic control and an improved long-term metabolic control, as compared to soluble human insulin given 30 min before the meals, without increasing the risk of hypoglycaemia. Taken together, the data support the hope that insulin aspart will allow the diabetic patient to combine a more flexible lifestyle with better glycaemic control, without any increased safety risk.     

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??Cathepsin-D and nm23 provide the predictive value of response to anthracycline-based neoadjuvant chemotherapy in breast cancer CHEN Yi-zuo*, CHEN Can-ming, FEI Fei, et al. *Department of Breast Surgery?? Cancer Hospital??Fudan University.Department of Oncology, Shanghai Medical College, Fudan University,Shanghai 200032??China Corresponding author: WU Jiong, E-mail: wujiong1122@vip.sina.com Abstract Objective To investigate the predictive value of biological markers for responsiveness to anthracyline-based regimen in neoadjuvant systemic therapy. Methods Post-operative paraffin-embedded tumor samples from 173 breast cancer patients were examined for expression of ER??PR??Her-2/neu??and other 15 markers by immunohistochemistry, to analyze the predictive value of these biological markers for response to neoadjuvant chemotherapy. Results For the primary tumor, the clinical objective response was 66.47%?? 29.48%SD,and 4.05% PD. Pathological complete response was found in 3 cases(1.73%).Negative nm23, and loss of Cathepsin-D were significantly predictive for an effective response to anthracycline-based neoadjuvant chemotherapy. In multivariate logistic regression analysis, only the Cathepsin-D status was found for independent predictive value. Conclusion Loss of Cathepsin-D independently predicts the response to anthracycline-based regimen.     

袋形术与正畸治疗促进含牙囊肿内阻生牙萌出

 含牙囊肿是口腔内常见的颌骨囊性病变之一，通常伴有阻生牙。刮除术虽能根除病变，但易造成牙列缺损、神经损伤、邻牙损伤或牙髓活力丧失等。近年来临床上常用的袋形术，可减少邻近结构的创伤及提高囊内阻生牙的存留率，对于位置深或无法自行萌出的阻生牙配合正畸牵引可取得满意的效果。文章简要介绍含牙囊肿的形成、袋形术的适应证以及囊肿内阻生牙的正畸牵引等临床问题。     

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??Effect of perioperative restrictive fluid treatment on postoperative complication in elder patients YU rui-dong*, LU Xiao-chuan, SONG Xiao-hua, et al. *Department of SICU, Huadong Hospital Fudan University, Shanghai 200040, China
Corresponding author: SONG Xiao-hua,E-mail: songxiaohua1963@126.com
Abstract Objective To compare the outcome of restricted or standard intravenous fluid regimen in perioperative elder patients. Methods This study was designed as a prospective and randomized controlled trial. After informed consent was obtained, patients were allocated to either restricted or standard fluid regimen group. The primary end point was postoperative complications, including intestinal, heart, renal?? and respiratory function, and the death rate, hospital stay and cost were also observed. Results A total of 65 patients were assigned to restricted group(n=33) or standard group(n=32). The total fluid volume, total postoperative complications, hospital stay and cost were significantly reduced in restricted group when compared with those in standard group. However, there were no significant differences on the incidence of heart failure, lung infection, incision infection ??and intestinal recover time between two groups. Conclusion For elder patients who undergo elective surgery, perioperative restrictive fluid management may be more beneficial, because it would reduce total postoperative complications and decrease hospital stay and expenses.     

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??Effect of laparoscopic surgery CO2 pneumoperitoneum for colorectal cancer on femoral venous hemodynamics WANG Yu*??WANG Yan-ting??JIANG Yan-yan??et al.*Department of General Surgery??Fuzhou General Hospital of Nanjing Military Command??Fuzhou 350025??China Corresponding author:ZOU Zhong-dong,E-mail: fzptwk@21cn.com Abstract Objective To study the effect of the special surgical position and CO2 pneumoperitoneum on femoral venous hemodynamics during laparoscopic surgery for colorectal cancer.Methods Color Doppler ultrasound was adopted to evaluate the diameter??blood velocity and volum of the blood flow in the lower extremity with 30 patients undergoing laparoscopic surgery for colorectal cancer in Fuzhou General Hospital of Nanjing Military Command between August 2007 to June 2008,with different pressure of pneumoperitoneum??6mmHg??8mmHg??10mmHg??12mmHg??and that during the laparoscopic surgery for colorectal cancer with 12mmHgCO2 pneumoperitoneum and head-down tilt position. Results Compared with the stage before the pneumoperitoneum, no change was obserbed with the hemodynamics indexes after the establishment of 6mmHgCO2 pneumoperitoneum??when the pressure of pneumoperitoneum increases to 8mmHg, the femoral vein diameter increases?? the velocity and the amount of blood flow decrease by degrees (P<0.05) with the accrescence of pneumoperitoneum pressure. During the operation, the femoral vein diameter decreased??the velocity and the volum of blood flow increased with the head-down tilt position,but still less than the level before pneumoperitoneum, compared with the stage of prostration after pneumoperitoneum,;At the end of operation without the exhaust of CO2 gas,the femoral vein diameter returned to the level of the prostration after pneumoperitoneum, while the velocity and the volum of blood flow was still higher than that, but significantly lower than that of feet-down tilt position with pneumoperitoneum; At the end of operation with prostration and the exhaust of CO2 gas , the femoral vein diameter decreased,but still thicker than prostration without pneumoperitoneum,and the velocity and the volum of blood flow returned to the level before pneumoperitoneum. Conclusion The CO2 pneumoperitoneum can interfere the recirculation of blood??positive correlated to the pressure,witch will increase the risk of venous thrombosis ,so we should take the lower-grade of pneumoperitoneum pressure as far as possible . Besides, the head-down tilt position is conducive for the blood to recirculate ,which can improve but not fully offset the poor blood returning conducted by CO2 pneumoperitoneum .The vein stasis exists objectively in the perioperation of laparoscopic colorectal cancer operation, which will increase the risk of venous thrombosis ,and taking the active preventive measures is requisite.     

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??Intrahepatic Glissonian approach for mesohepatectomy in the management of primary hepatic tumors HU Ji-xiong??DAI Wei-dong??MIAO Xiong-ying??et al. Department of Hepatobiliary Surgery, the Second Xiangya Hospital of Central South University, Changsha 410011, China Corresponding author??DAI Wei-dong??E-mail:daiweidong@medmail.com.cn Abstract Objective To evalualte intrahepatic Glissonian approach for mesohepatectomy in the management of primary hepatic tumors. Methods The clinical data of 24 cirrhotic patients with primary liver tumor admitted from May 2005 to December 2007 at the Second Xiangya Hospital of Central South University were analyzed retrospectively. Results Mesohepatectomy was feasible with the proposed technique in all patients. No patients experienced massive bleeding during the operation. The estimated intraoperative mean amount of blood loss was 300mL (range 200 to 1200mL). The mean operating time was ??258±60?? minutes and only 2 patients required blood transfusion for 2U. Minor postoperative complications included bile leakage in 3 cases, subphrenic infection in 2 cases and resolved with conservative management. No hospital mortality occurred. Conclusion Intrahepatic Glissonian access for mesohepatectomy in cirrhotic patients is safe and effective. It may reduce intraoperative blood loss and the need for the pringle maneuver.     

微酸性次氯酸水用于口腔综合治疗台水路消毒的研究

 目的　检测不同浓度微酸性次氯酸水（slightly acidic hypochlorite water，SAHW）应用于口腔综合治疗台水路（dental unit waterlines，DUWLs）的消毒效果。方法    选取32台口腔综合治疗台（dental chair unit，DCU），随机均分为4组（1个对照组和3个实验组，每组8台DCU）。首先，采集高速手机和三用枪基础水样行细菌培养、菌落计数；然后，实验组分别用有效氯含量8 ~ 12 mg/L（实验1组）、18 ~ 22 mg/L（实验2组）、28 ~ 32 mg/L（实验3组）的SAHW供水DUWLs，连续7 d采集高速手机和三用枪水样行细菌培养、菌落计数。第8 d始改用无菌蒸馏水（distilled water，DW）供水DUWLs后采集水样菌落培养计数；对照组用DW替代消毒水，同样程序流动冲洗DUWLs后收集高速手机和三用枪水样菌培养后菌落计数。数据采用SPSS 20.0软件进行统计分析。结果    与基础水样比较，SAHW消毒1 d，3个实验组的高速手机和三用枪水样菌落计数均显著下降（P < 0.05）；SAHW消毒2 d，实验3组高速手机和三用枪水样菌落计数均小于消毒合格水样上限值（100 CFU/mL）；SAHW消毒3 d开始，实验3组菌落计数为0 CFU/mL，实验1组和2组菌落计数均显著小于100 CFU/mL。更换为DW供水后1 ~ 2 d，3个实验组的高速手机和三用枪水样菌落计数维持小于100 CFU/mL，组间差异无统计学意义（P > 0.05）；3 ~ 7 d，3个实验组的高速手机和三用枪水样菌落计数持续增加（149 ~ 1014 CFU/mL），实验1、2、3组的组内不同时间点检测数据比较差异均有统计学意义（均P < 0.05），且均明显大于合格水样上限值（P < 0.05）。结论    高有效氯含量较低有效氯含量的SAHW消毒效果更稳定；低有效氯含量8 ~ 12 mg/L的SAHW持续作用于DUWLs内环境亦可有效控制菌落计数，消毒效果明显。