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Penispidins A-C (1-3), new aromatic sesquiterpenoids with two classes of rare carbon skeletons, were isolated from the endophytic fungus Penicillium virgatum HL-110. 1 represents the first example of a dunniane-type aromatic sesquiterpenoid, possessing a novel 4/6/6 tricyclic system, while (±)-2 and 3 have a 7,12-cyclized bisabolene skeleton, featuring a 3,4-benzo-fused 2-oxabicyclo[3.3.1]nonane central framework. Their structures were elucidated on the basis of spectroscopic methods, single-crystal X-ray diffraction, and ECD calculations. 1 inhibited hepatic lipid accumulation in HepG2 cells.

Two new polyketides, lasobutone A(1) and lasobutone B(2), along with three known compounds, guignardianone C(3), guignardic acid(4), and 4-hydroxy-17R-methylincisterol(5), were isolated from the endophytic fungi Xylaria sp. by silica gel, MCI, and preparative HPLC, which was separated from the Chinese medicinal material Coptis chinensis and cultivated through solid fermentation with rice. Their structures were elucidated on the basis of spectroscopic methods, such as MS, NMR, IR, UV, and ECD. Compounds 2 and 4 showed inhibitory activities against the nitric oxide(NO) production in the LPS-induced macrophage RAW264.7 with IC_(50) values of 58.7 and 42.5 μmol·L~(-1) respectively, while compound 5 exhibited cytotoxic activities against HT-29 with IC_(50) value of 14.3 μmol·L~(-1).

A new polyketide, coptaspin A(1), along with two known compounds 4-acetyl-3,4-dihydro-6,8-dihydroxy-3-methoxy-5-methylisocoumarin(2), and cytochalasin Z_(12)(3), was isolated from the endophytic fungi Aspergillus sp. ZJ-58, which was isolated from the genuine medicinal plant Coptis chinensis in Chongqing after solid-state fermentation on rice and silica gel, MCI, and HPLC-based separation. Their structures were elucidated by MS, NMR, IR, UV, and ECD. The newly isolated compound 1 showed moderate inhibitory activities against LPS-induced NO production in RAW264.7 macrophages with the IC_(50) value of 58.7 μmol·L~(-1), suggesting its potential anti-inflammatory activity.

To explore the relationship between heart rate-corrected QT (QTc) interval and diabetic peripheral neuropathy (DPN), and whether QTc interval has diagnostic utility for DPN beyond nerve conduction velocity.A total of 965 patients with diabetes, including 473 patients with DPN and 492 patients without DPN, underwent standard 12-lead electrocardiography and detailed assessments of peripheral neuropathy.Patients with DPN had longer QTc intervals than those without. Among participants, from the first to fourth quartile of QTc interval, the proportion of patients with DPN appreciably increased and the nerve conduction velocity obviously decreased (P for trend0.001). The univariate and multivariate analyses showed that prolonged QTc interval was closely associated with increased risk of DPN (univariable odds ratio 1.112, 95% confidence interval 1.097-1.127, P 0.001; multivariable odds ratio 1.118, 95% confidence interval 1.099-1.137, P 0.001). Receiver operating characteristic analysis for the diagnosis of DPN showed a greater area under the curve for QTc interval of 0.894 than the median nerve motor conduction velocity of 0.691, median nerve sensory conduction velocity of 0.664 and peroneal nerve motor conduction velocity of 0.692. The optimal cut-off point of QTc interval for DPN was 428.5 ms with sensitivity of 0.715 and specificity of 0.920 (P 0.001). The combination of QTc interval and nerve conduction testing increased the area under the curve for the diagnosis of DPN (from 0.736 to 0.916; P 0.001).QTc interval with 428.5 ms has more reliable diagnostic utility for DPN than nerve conduction velocity, and prolonged QTc interval is closely associated with an increased risk of DPN.

Penispidins A-C (

Three undescribed 3(2H)-furanone derivatives, asperfuranones A-C (1-3), along with one known compound (4) were isolated from the Aspergillus sp. strain obtained from the intestines of centipede. Their structures were determined by NMR and MS spectroscopic analyses, and the absolute configurations were established by the Snatzke's sector rules, modified Mosher's method and electronic circular dichroism (ECD) calculation. Meanwhile, the application of the sector rules led to the reassignment of the absolute configurations of 4 and other seventeen previously reported analogues (5-21).

Objective: In this study, we aimed to investigate the function of microRNA-373-3p (miR-373-3p) in the pathogenesis of cervical cancer. Methods: Human and mouse cervical cancer cell lines were transfected with miR-373-3p mimic and inhibitor. Cell proliferation and viability were evaluated with Cell Counting Kit-8 (CCK-8) assay and Lactate Dehydrogenase (LDH) assay, respectively. The AKT1-targeting role of miR-373-3p was analyzed by qPCR and Western blot. Finally, a mouse xenograft cervical tumor model was adopted to study the in vivo effect of miR-373-3p on tumor growth and the expression of AKT1. Results: Over-expression of miR-373-3p significantly reduced the proliferation of cervical carcinoma cell line in vitro. In addition, miR-373-3p overexpression also inhibited cervical cancer growth in tumor-bearing mice. Mechanistically, we found that AKT1 gene can be targeted by miR-373-3p. MiR-373-3p mimic decreased the mRNA and protein expression of AKT1, while the miR-373-3p inhibitor increased the level of AKT1 in cervical cancer cells. AKT1 overexpression rescued the proliferation of cervical cancer cells transfected with miR-373-3p. Conclusion: MiR-373-3p can serve as a novel anti-tumor microRNA in cervical cancer by targeting AKT1.

Two new 14-membered resorcylic acid lactone derivatives, ascarpins A (1) and B (2), together with three related known compounds (3–5) were isolated from the fungus Aspergillus sp. ZJ-65, obtaining from the intestine of grass carp. These structures were elucidated on the basis of extensive spectroscopic methods, chemical conversion, and comparison with literature. All isolates were tested for their inhibitory activity against LPS-induced NO production in RAW 264.7 macrophages. Among them, compounds 1–4 exhibited potential anti-inflammatory activity with IC50 values ranging from 7.6 to 48.3 μM.

Aureochaeglobosins A–C (1–3), three novel [4 + 2] cycloaddition heterodimers of chaetoglobosin and aureonitol derivatives, were obtained from the culture of endophytic fungus Chaetomium globosum, representing the first adduct examples of chaetoglobosins. Their structures were elucidated by extensive spectroscopic analyses, single-crystal X-ray diffraction, and a modified Mosher’s method. Compounds 2 and 3 showed significant cytotoxicities against human MDA-MB-231 cancer cells with IC50 values of 7.6 and 10.8 μM, respectively.

Asperones A–E (1–5), five dimeric polyketides with two distinct skeletons generated by the crucial [3 + 2] and [3 + 3] cycloadditions, were isolated from fungal metabolites of an Aspergillus sp. Their structures were established by spectroscopic data, chemical derivatization, single-crystal X-ray diffraction, and electronic circular dichroism calculations. Compounds 2–4 showed significant nitric oxide (NO) inhibition in lipopolysaccharide (LPS)-induced RAW 264.7 macrophage cells, and exhibited IC50 values of 16.0, 13.2, and 6.0 μM, respectively.

It is unknown whether YOD (young onset diabetes) and LOD (late onset diabetes) require similar insulin doses for intensive insulin therapy with a metformin add-on to achieve glycemic control. We analyzed data from our two previously performed randomized, controlled open-label trials. Patients were randomized to receive either continuous subcutaneous insulin infusion (CSII) therapy or CSII combined with metformin therapy for 4 weeks. The studies concentrated on the differences in the insulin doses used for the two groups. We included 36 YOD (age 40 yrs) patients. YOD patients who received metformin combined with CSII therapy required significantly lower insulin doses to maintain euglycemic control compared to patients with LOD. A multivariate analysis, controlled for gender and the fasting blood concentration, was performed to determine the significance of the differences between groups, particularly with respect to the total and basal insulin doses. There was a trend toward improvement in β-cell function and insulin resistance in terms of ΔHOMA-B and ΔHOMA-IR in patients with YOD compared to those with LOD. Newly diagnosed T2D patients with YOD required significantly lower insulin doses, particularly basal insulin doses, to maintain glycemic control compared to the LOD patients.

Citrifurans A–D (1–4), metabolized by an Aspergillus sp., are unusual dimers of azaphilone and furanone derivatives. Michael addition was thought to be the pivotal procedure in their biosynthesis, and different addition sites generated two new different carbon skeletons. Their structures were elucidated on the basis of spectroscopic methods, single-crystal X-ray diffraction, chemical conversion, and electronic circular dichroism analyses. Compounds 1–3 showed moderate inhibitory activities against LPS-induced NO production in RAW 264.7 macrophages with IC50 values of 18.3, 22.6, and 25.3 μM, respectively.

Nine new phenalenone derivatives (1-9), along with two known analogues (10-11) have been isolated from the solid cultures of an endophytic fungus Aspergillus sp. which was obtained from Pinellia ternate. Their structures were established through interpretations of spectroscopic evidence, and some of their absolute configurations were determined by electronic circular dichroism (ECD) and Mo2(OCOCH3)4 induced ECD. All of the phenalenones are unusual acyclic diterpenoid adducts, which are diversely oxidized and partly epoxidized to form different heterocycles. In addition, compound 10 exhibited significant antimicrobial activity against Pseudomonas aeruginosa, Staphylococcus aureus, and Bacillus subtilis with MIC50 values of 1.87, 2.77, and 4.80μg/mL, respectively.

To determine the clinical non-inferiority of recombinant glargine-Basalin vs glargine-Lantus, in treatment of type 2 diabetes mellitus (T2DM) using continuous glucose monitoring system (CGMS). One hundred patients with T2DM were recruited. They were either regularly taking Basalin (Basalin group) or Lantus (Lantus group) (n = 50 each). CGMS was employed to real-time monitor blood glucose profile for 4 days (from day 1 to day 5). To exclude the effect of patient background, the study design was to have a blinded crossover from glargine-Basalin to glargine-Lantus on day 3, and vice versa. 24-hour mean blood glucose (24hMBG), 24-hour standard deviation of blood glucose (24hSDBG), 24-hour mean amplitude of glycemic excursion (24hMAGE), and number of glycemic excursion (NGE) every 24 h (24hNGE) were calculated for each glargine from 100 patients. No significant difference of 24hMBG, 24hSDBG, 24hMAGE, and 24hNGE (p > 0.05 for all) was found between Basalin and Lantus treatments. The glucose area under the curve and time when blood glucose was below 3.9 mmol/L, between 3.9 and 10.0 mmol/L, or above 10.0 mmol/L were similar between Basalin and Lantus treatment. The frequency of hypoglycemic episodes was also similar. However, the mean cost of Basalin was only 72% of Lantus’s in one treatment course. Glargine-Basalin is non-inferior in clinical efficacy compared to glargine-Lantus. In view of the large difference in the cost of glargine-Basalin, it would be much more cost-effective for our patients.

Wenyujindiol A (1), a new sesquiterpene possessing a skeleton with a rare 4/8 ring system, together with the known compound (4S,5S)-germacrone-4,5-epoxide (2), were isolated from the rhizomes of Curcuma wenyujin. The structure of 1 was elucidated using spectroscopic measurements and single-crystal X-ray diffraction experiments. A plausible biogenetic pathway was also proposed for the biosynthesis of 1 from farnesyl diphosphate (FPP). Biological evaluation indicated that 1 exhibited moderate antitumor activity on the human breast cancer cell line MCF-7.

Objective. To evaluate the effects of once-weekly dulaglutide injection and once-daily glimepiride on glucose fluctuation in patients with type 2 diabetes mellitus (T2DM) using the Continuous Glucose Monitoring System (CGMS). Methods. A total of 23 patients with T2DM were randomly assigned into two groups for 26 weeks: the dulaglutide group (n=13) and the glimepiride group (n=10). 72-hour CGMS was applied to all patients: before and after the treatment. General clinical data were collected and measured, such as fasting blood glucose (FBG), glycosylated hemoglobin (HbA1c), tumor necrosis factor-α (TNF-α), 8-iso-prostaglandin F2α (8-iso-PGF2α), and interleukin-6 (IL-6). Results. HbA1c of the dulaglutide group was reduced from 8.38±0.93% to 6.68±0.73% after the treatment (P<0.05); similarly, it was reduced from 7.91±0.98% to 6.67±0.74% (P<0.05) in the glimepiride group. The levels of serum 8-iso-PGF2α, TNF-α, and IL-6 all decreased significantly in both groups after treatment, and there was no significant difference found between the two groups (P>0.05). The Mean Blood Glucose (MBG) of the two groups declined significantly after therapy (P<0.05). However, the Standard Deviation of Blood Glucose (SDBG) decreased significantly only in the dulaglutide group (from 2.57±0.74 mmol/L to 1.98±0.74 mmol/L, P<0.05). There were no significant changes of Mean Amplitude of Glycemic Excursion (MAGE) and Absolute Means of Daily Difference (MODD) after treatment in both groups. Furthermore, no statistically significant difference was found between the two groups in MBG, SDBG, MAGE, and MODD (P>0.05). The percentage time (PT) (>10 mmol/L and 3.9-10 mmol/L) of the two groups was significantly changed after the treatment (P<0.05). However, this was not seen in the PT<3.9 mmol/L after the treatment (P>0.05). Conclusion. Once-weekly dulaglutide injection has the same effectiveness as daily glimepiride on lowering blood glucose and decreasing oxidation stress and inflammation and is more effective in controlling glucose fluctuation as compared with glimepiride. This trial is registered with ClinicalTrials.gov NCT01644500.

To investigate whether metformin add-on to the continuous subcutaneous insulin infusion (Met + CSII) therapy leads to a significant reduction in insulin doses required by type 2 diabetes (T2D) patients to maintain glycemic control, and an improvement in glycemic variation (GV) compared to CSII only therapy. We analyzed data from our two randomized, controlled open-label trials. Newly diagnoses T2D patients were randomized assigned to receive either CSII therapy or Met + CSII therapy for 4 weeks. Subjects were subjected to a 4-day continuous glucose monitoring (CGM) at the endpoint. Insulin doses and GV profiles were analyzed. The primary endpoint was differences in insulin doses and GV between the two groups. A total of 188 subjects were admitted as inpatients. Subjects in metformin add-on therapy required significantly lower total, basal and bolus insulin doses than those of control group. CGM data showed that patients in Met + CSII group exhibited significant reduction in the 24-hr mean amplitude of glycemic excursions (MAGE), the standard deviation, and the coefficient of variation compared to those of control group. Our data suggest that metformin add-on to CSII therapy leads to a significant reduction in insulin doses required by T2D patients to control glycemic variations.

To characterize blood glucose fluctuation during hemodialysis in patients with end stage diabetic nephropathy (ESDN) by a continuous glucose monitoring system (CGMS), and aim to improve blood glucose control in this patient population.Forty-six patients with or without type 2 diabetes mellitus (T2DM), receiving hemodialysis, were recruited in this study. Thirty-six patients had end stage diabetic nephropathy (ESDN group), the other ten patients had end stage renal disease without diabetes (ESRD group). A continuous glucose monitoring system (CGMS) was employed to monitor glycemic fluctuation for 72 hours. Blood samples were collected and analyzed.Mean, standard deviation (SD), maximum, and mean amplitude glycemic excursion (MAGE) of blood glucose and the ratio of blood glucose readings that was greater than 13.9 mmol/L of ESDN group, were significantly greater than those of ESRD group (p0.01 for all) during 72 hours of observation. The mean blood glucose was significantly lower, while SD and MAGE were significantly higher in ESDN group on hemodialysis day than on days off hemodialysis (p0.05), while these were not been observed in ESRD group. Though mean, SD, and MAGE of blood glucose during hemodialysis were significantly lower than those of peri-hemodialysis in both groups (p0.01 or p0.05, respectively), they were significantly higher in ESDN group than that in ESRD group (p0.05). The mean blood glucose value calculated from HbA1c did not reflect the actual mean blood glucose measured by CGM in both groups, and gave an inaccurate impression of a significantly lower mean glucose.ESDN patients had larger glycemic fluctuations as compared with ESRD patients. Hemodialysis caused reduction in mean, SD, and MAGE, which in turn caused bigger glycemic fluctuations on hemodialysis day. The HbA1c in ESDN patients gave an inaccurate value, which did not truly reflect blood glucose status for a prolonged period.

Five new isocoumarin derivatives, pestalactone A-C (1-3) and pestapyrone D-E (4-5), together with two known compounds (6-7) were isolated from the solid cultures of the endophytic fungus Pestalotiopsis sp. obtained from Photinia frasery. Their structures were mainly determined by extensive spectroscopic analysis, Mo2(OCOCH3)4-induced electronic circular dichroism (ECD), and ECD calculation. Compounds 1 and 2 were rare isocoumarin derivatives and derived from distinctive polyketide pathways. Compound 3 exhibited potent antifungal activity against Candida glabrata (ATCC 90030) with an MIC50 value of 3.49±0.21μg/mL.

Three new guaiane sesquiterpene lactones (4S)-4-hydroxy-gweicurculactone (1), zedoalactone G (2), and (1R, 4R, 5S, 10S)-zedoalactone B (3), and three known guaiane sesquiterpene lactones, including zedoarolide B (4), zedoalactone B (5), and a new natural product (+)-zedoalactone A (6), were isolated from the rhizomes of Curcuma wenyujin Y.H. Chen et C. Ling. The structures were elucidated by spectroscopic methods including 1D and 2D NMR and HR-ESI-MS. The absolute configuration of 2 was determined via the calculated electronic circular dichroism (ECD), whereas the absolute configurations of 1 and 3 were determined via the ECD data of the [Rh2(OCOCF3)4] complex and [Mo2(OAc)4] complex, respectively. The inhibitory effects of compounds 1-6 on nitric oxide production in lipopolysaccharide-activated macrophages were evaluated. All of them exhibited weak anti-inflammatory activity.

In this experiment acetylated corn starch was taken as the raw material and its filming property was studied through single-factor experiments and orthogonal experiment. The results showed that the different concentrations of acetylated corn starch, glycerol, polyvinyl alcohol (PVA) and glutaraldehyde had significant effects on the properties of the acetylated corn starch/PVA films. And the optimum film-forming conditions were 4.5% acetylated corn starch, 4.5% PVA, 4.0% glycerol and 0.4% glutaraldehyde for the coating liquid of film-forming, among which the most important factor was the glycerol concentration; the following factors were the acetylated corn starch concentration, the polyvinyl alcohol concentration and the glutaraldehyde concentration.

Simple gas chromatography –mass spectrometry (GC–MS) and highperformance liquid chromatography (HPLC) methods were developed for quantifying eight volatile compounds and 10 sesquiterpenoids, respectively. GC–MS analysis was performed on an HP-5MS capillary column (30 m30.25 mm i.d.) coated with 0.25 mm film 5% phenyl – 95% methylpolysiloxane and selected ion monitoring was used for quantification. Four volatile and previously unquantified monoterpenoids were determined. HPLC analysis was performed on a C18 column with water and acetonitrile as mobile phase. The proposed method, determined 10 non-polar and polar sesquiterpenoids simultaneously, which covered a wider polar range of analytes and had a more perfect resolution. Among them, five sesquiterpenoids were not determined before and some specific components, (4S,5S)germacrone-4,5-epoxide, curcumenone and dehydrocurdione were completely separated for the first time. Both methods were validated for linearity, limit of detection and quantification, precision, accuracy, recovery and system suitability. The methods were simple, effective, reliable and successfully applied to global detection and analysis of volatile and non-volatile components of steamed and non-steamed rhizomes of Curcuma wenyujin (Wen-E-Zhu (WEZ) and Pian-JiangHuang (PJH)). Multivariate statistical analysis was employed to distinguish PJH and WEZ and seven chemical components, including (4S,5S)-germacrone-4,5-epoxide, curcumenone, b-elemene, curzerene, borneol, isoborneol and camphor, were screened as chemical markers. The present study provided a promising method for accurate discrimination of the herbal medicines with the same origin.

On the basis of a sysmatic survey on literatures, this essay summarized the studies on chemical constituents and pharmacological activity of Curcuma wenyujin. According to statistics, the reports for chemical constituents of the plant were mainly concentrated between 2007 and 2010. So far, totally 82 compounds were reported, including 57 sesquiterpenoids, 6 diterpenoids, 6 monoterpenes and 10 other components. Particularly, 23 compounds were new. Studies on its pharmacological activity covered antitumor, anti-inflammatory, analgesic, hepatoprotective, antioxidant, antithrombotic and antithrombosis. This essay summarized its chemical constituents and pharmacological activity, in order to facilitate its studies, development and utilization.

It is believed that defects in upper airway neuromuscular control play a role in sleep apnea pathogenesis. Currently, there is no simple and non-invasive method for evaluating neuromuscular activity for the purpose of screening in patients with obstructive sleep apnea. This study was designed to assess the validity of chin surface electromyography of routine polysomnography in evaluating the neuromuscular activity of obstructive sleep apnea subjects and probe the neuromuscular contribution in the pathogenesis of the condition.The chin surface electromyography of routine polysomnography during normal breathing and obstructive apnea were quantified in 36 male patients with obstructive sleep apnea. The change of chin surface electromyography from normal breathing to obstructive apnea was expressed as the percent compensated electromyography value, where the percent compensated electromyography value = (normal breath surface electromyography - apnea surface electromyography)/normal breath surface electromyography, and the percent compensated electromyography values among subjects were compared. The relationship between sleep apnea related parameters and the percent compensated electromyography value was examined.The percent compensated electromyography value of the subjects varied from 1% to 90% and had a significant positive correlation with apnea hypopnea index (R(2) = 0.382, P0.001).Recording and analyzing chin surface electromyography by routine polysomnography is a valid way of screening the neuromuscular activity in patients with obstructive sleep apnea. The neuromuscular contribution is different among subjects with obstructive sleep apnea.

ObjectiveIntrathyroid injection of dexamethasone (DEX) has been used to treat Graves' disease (GD); however, the mechanism of this treatment remains poorly understood. The objective of this study was to investigate the effects of DEX on the function of regulatory T (Treg) cells (CD4+CD25+T cells) in patients with GD.MethodsPeripheral blood was obtained from 20 patients with GD, and peripheral blood mononuclear cells (PBMCs) were isolated by Ficoll–Hypaque density gradient separation. CD4+CD25–/CD4+CD25+T cells were isolated by immunomagnetic selection and DEX was co-cultured with PBMCs or isolated T-cells for 72 h. Treg cell function was analyzed using the proliferation rate of CD4+CD25–T cells.ResultsThe proportion of Treg cells and the transcription factor forkhead box P3 (FOXP3) mRNA expression in PBMCs decreased in GD patients compared with healthy subjects, and Treg cell function was impaired in patients with GD. Although the proportion of Treg cells and FOXP3 mRNA expression in PBMCs did not increase, the function of Treg cells improved after the treatment with DEX. Moreover, the proportion of T-helper 2 (Th2) cells was decreased by the DEX treatment.ConclusionsDEX could effectively improve the function of Treg cells and set up a new balance of Th1/Th2 in GD patients. This study might help to further understand the immune mechanism of the intrathyroid injection of DEX in the treatment of GD and facilitate the potential use of this therapy.

Antithyroid drugs are widely used in the treatment of Graves' disease (GD), but the relapse rate is very high after therapy withdrawal. We evaluated the reduction effects of intrathyroid injection of dexamethasone (IID) on the relapse rate of hyperthyroidism in patients with newly diagnosed GD.A total of 191 patients with GD completed the study. After 6 months of treatment with methimazole (MMI), the patients were randomly assigned to receive either MMI (96 patients) alone or MMI combined with IID (MMI+IID; 95 patients) treatment for 3 months, followed by continuing a dose of MMI that would maintain euthyroidism for the next 9 months in all of the patients. After withdrawal of the medical therapy, patients were followed for 24 months, and the relapse rate of hyperthyroidism was evaluated.No statistical difference was observed in the levels of serum FT(4), TSH, or TSH receptor antibodies (TR-Ab), the thyroid volume, or the TR-Ab positive rate between the two groups at month 6. After the next 3 months of treatment with MMI+IID or MMI alone, the levels of TSH increased significantly, and the levels of serum TR-Ab, the TR-Ab positive rate, and thyroid volume decreased significantly in the MMI+IID group compared with the MMI group. Seven patients (7.4%) experienced a relapse of overt hyperthyroidism in the MMI+IID group and 49 patients (51%) in MMI group during the 2-yr follow-up period (P0.001).MMI+IID treatment is helpful to prevent relapse of hyperthyroidism in GD after medical therapy withdrawal.

To assess the accuracy of pulse transit time (PTT) in classification of apnea events, and collect data for clinical application reference.Thirty-two obstructive sleep apnea-hypopnea syndrome (OSAHS) patients included in the research had Polysomnography (PSG), and 10 305 apnea events were recorded. All the events were analyzed by PTT and esophageal pressure (Pes) respectively. The results were analyzed to assess the accuracy of PTT and compare the accuracy of pulse transit time between REM stage and NREM stage, and analyze the correlation between age, body mass index (BMI), apnea hypopnea index (AHI) and concordance rate in every patient.The total concordance rate between PTT and Pes in classification of apnea was 96.7% (9970/10305). The sensitivities of PTT in detecting central, mixed and obstructive apnea were 88.0%, 91.3% and 97.8% respectively and the specificities were 99.8%, 97.8% and 92.8% respectively. The false determinations of apnea events mainly concentrated on the false determinations between the obstructive and mixed apnea. There was no statistical significant between the accuracy of PTT in different sleep stages. There was a negative relationship between the age, BMI, Lowest SaO2, AHI and the concordance rate.There was good concordance between PTT and Pes in classification of apnea. PTT had very high sensitivity and specificity in detecting all kinds of apnea. This study showed that PTT can detect respiratory drive noninvasively with high accuracy.

Background Although insulin has been reported to have an anti-inflammatory effect, whether this effect is independent of its property to reduce blood glucose with insulin treatment in type 2 diabetes has not been investigated in detail. The purpose of this study was to evaluate the independent anti-inflammatory effect of insulin in patients with newly diagnosed type 2 diabetes. Research design and methods An 8-week, randomized, parallel-group study that enrolled 90 patients with newly diagnosed type 2 diabetes, who were randomly assigned to receive either insulin or metformin, was carried out. The doses of insulin and metformin were titrated according to fasting plasma glucose (FPG) and postprandial plasma glucose (PPG) during the 4 weeks; the target of FPG was 126 mg/dL and that of PPG was 160 mg/dL. The blood glucose levels were kept stabilized till the end of the study. The serum concentrations of high-sensitive C-reactive protein (hsCRP) and interleukin (IL)-6 were measured before starting the study and 4 and 8 weeks after initiation of insulin or metformin therapy. Results After 4 weeks of dose titration, the levels of FPG were reduced in the two groups compared to baseline (p 0.05). During the next 4 weeks' treatment, the levels of FPG were stable, but the serum concentration of hsCRP and IL-6 was markedly reduced in the insulin-treated group compared with that in the metformin-treated group (p < 0.001). Conclusions Our data suggest that insulin has an anti-inflammatory effect that is independent of the reduction it causes in blood glucose. Copyright © 2009 John Wiley & Sons, Ltd.

Investigate the response of the patients with obstructive sleep apnea hypopnea syndrome (OSAHS) patients to combination of transpalatal advancement pharyngoplasty and uvulopalatopharyngoplasty.Thirty two patients with OSAHS, age ranged from 27 to 54, mean value (x +/- s) 39.1 +/- 7.8, male, body mass index (BMI) ranged from 22.9 to 36. 7 kg/m2, mean value (29.0 +/- 3.6) kg/m2, preoperative apnea and hypopnea index (AHI) was 11.7/h to 113.7/h, mean value (61.8 +/- 21.9)/h, the lowest blood oxygen saturation was 0.10 to 0.85, mean value 0.64 +/- 0. 13. With preoperative endoscopic technique, bony nasopharynx cavity narrowing were present, 14 patients had concomitant tonge-base obstruction. Cephalometric result, SNA ranged from 72.9 degrees to 87.0 degrees, mean value (80.7 +/- 4.1) degrees; SNB 69.50 to 85.0 degrees, mean value (76.8 +/- 4.5) degrees; PAS 0.5 cm to 2.1 cm, mean value (1.2 +/- 0.5) cm; MP-H: ranged from 1.2 cm to 3.5 cm, mean value (2.2 +/- 0.7) cm; PNS ranged from 2.4 cm to 3.5 cm, mean value (2.8 +/- 0.4) cm. All the patients had H-UPPP and concomitant transpalatal advancement pharyngoplasty. Fourteen patients with tonge-base obstruction had chin advancement. Results Six months after the operations, the patients were evaluated the response to the operations using Epworth sleep scale, OSAHS filtration questionnaire scale and polysomnography (PSG). There were 27 patients with the decrease percent of AHI reaching or more than 25% and 22 patients with the decrease percent of AHI reaching or more than 50% including 8 patients with AHI less than 5. The other 5 patients were ineffective. After operation, the Epworth sleep scale decreased from (9.2 +/- 4.5) to (4.7 +/- 2. 8) and OSAHS filtration questionnaire scale decreased form (56.0 +/- 15.3) to (17.5 +/- 11.5). Both of the differences were obvious (P0.01).Combination of transpalatal advancement pharyngoplasty and H-UPPP can improve the efficacity and in some patients with pure retropalatal airway narrowing, the cure rate can be improved.

The distribution of upper airway obstruction sites can be identified quantitatively and dynamically with continuous airway pressure measurements in obstructive sleep apnea hypopnea syndrome ( OSAHS) patients. Its value as a clinical predictor for the outcome of revised uvulopalatopharyngoplasty was evaluated.The upper airway obstruction sites (transpalatal level, tongue base or hypolarynx level) were determined preoperatively with overnight upper airway pressure monitoring and concurrent polysomnography (PSG). Of one's total amount of obstructive events, the proportion of apnea/hypopnea events located at Transpalatal level was quantified as contribution of transpalatal obstruction. Of all OSAHS patients, 26 males and 1 female underwent revised uvulopalatopharyngoplasty (2 had same stage transpalatal advancement pharyngoplasty) and had follow-up PSG 6. 33 +/- 0.84 months after surgery. The relationship of transpalatal obstruction proportion, age, tonsil size and body mass index (BMI) and the reduction in apnoea hypopnea index (AHI) was analyzed.The AHI (times/hr) of 27 subjects decreased from 63.9 +/- 20.7 to 28.4 +/- 25.4. The response rate was 51.9% (defined as AHI reduction over 50%). Correlation between the transpalatal obstruction proportion and the AHI reduction percentage was significant (r = 0.609), so was the degree of the tonsil size (r = 0.511). The proportion of tongue base level obstruction showed a negative correlation for the AHI reduction. Patients with oropharynx obstruction percentageor = 70% had a success rate of 90% and all patients with oropharynx obstruction percentage60% responded poorly to the operation. The regression model showed distribution of obstructive sites, along with tonsil size and other PSG parameters could predict 66.7% of the postoperative AHI of transpalatal level surgery (F = 6.701, P = 0.001) .Contribution of transpalatal level obstruction has significant predictive value to the outcome of transpalatal level surgery in OSAHS patients.

To understand how sleep stage and position influence the mechanisms for pharyngeal collapse in different levels of upper airway (UA), overnight state-related changes and postural variation in obstructive sites in obstructive sleep apnea hypopnea syndrome (OSAHS) patients were studied.Fifty four OSAHS patients underwent overnight upper airway pressure monitoring during polysomnography. The lower limits of the UA obstruction were determined and their relationship with sleep stage, position, age, body mass index and apnea hypopnea index (AHI) were investigated.All 54 patients had oropharynx (14 837 of the 23 172 analyzed events) and tongue base obstruction (5605/23,172), 2532 events were located at the oropharynx with extension to tongue base. Twenty nine patients has hypopharynx obstruction (105/23 172). Of the total amount of apnea hypopnea, the portions of obstruction located at tongue base level increased (t = 8.790, P = 0.000) in rapid eye movement (REM) sleep while those located at oropharynx decreased (t = -6.846, P = 0.000). Indexes of the apnea hypopnea caused by tongue base obstruction raised (t = 6.189, P = 0.000). Although the overall AHI in supine position was higher than in lateral position (t = 4.000, P = 0.000), increases in indexes of both the apnea hypopnea caused by tongue base (supine, 17.1 +/- 13.8 vs. lateral, 13.9 +/- 14.6) and oropharynx obstruction (44.3 +/- 20.3 vs. 37.2 +/- 25.9) were without significance (P0.05). Distribution of obstructive site varied little with different position (P0.05).Upper airway obstruction involves more than one specific site of the upper airway and the oropharynx is the most common collapse site. Obstructive sites are likely to extend to lower levels during REM sleep. Sleep position has little effect on the distribution of obstructive site.

To find out the polysomnography (PSG) indexes that reflex the degree of pathology of obstructive sleep apnea hypopnea syndrome (OSAHS).Six hundred and twenty-one male OSAHS patients, aged over 21, underwent measurement of weight, height, and neck circumference. Polysomnography was conducted to detect the apnea and hypopnea index (AHI), apnea and hypopnea time (AHT), and apnea and hypopnea time index (AHTI). A questionnaire survey based on Epworth sleep scaling (ESS) was conducted among 392 patients to assess the symptoms, such as excessive daytime sleepiness. 324 patients with an AHTI of 68.4 +/- 17.16 events/hour were regarded as severe group, and those with an AHTIor= 7 events/hr were regarded as very severer group. The relationship among clinical characteristics and polysomnographic parameters were analyzed.The AHI, AHTI, and lowest SaO(2) of the patients were significantly correlated with the ESS7 scores, morning mouth dryness, daytime fatigue (all P0.01), and significantly correlated with sour regurgitation, and heartburn, (all P0.05). AHTI was significantly correlated (r = 0.317), morning mouth dryness (r = 0.239); and sour regurgitation, and heartburn (r = 0.137). AHT was significantly correlated (r = 0.344), morning mouth dryness (r = 0.261); and sour regurgitation, and heartburn (r = 0.138). Very significant differences existed in morning mouth dryness, sour regurgitation and heartburn, and ESS7 scores between the severe and very severe patients (all P0.01).Among the PSG indexes, AHTI is better associated with sleepiness and other clinical symptoms than AHI. In severe OSAHS patients, there are significant differences in their clinical symptoms between the AHI70 events/hr group and AHIor= 70 events/hr group.