Strengthening medical ethics education in clinical practice of internal medicine / 上海预防医学

With rapid society development and the constant changes in people's thinking， the medical ethics issue has become more prominent. Medical interns are often facing ethical problems in clinical practice. Due to the lack of understanding of the experience in medical ethics， they often handle the problems poorly， which leads to intensified disputes between doctors and patients. The paper discusses some ethical problems that often appear in the clinical practice of internal medicine， and suggests several methods to improve the medical ethics education of interns in the clinical process.

Therapeutic effects of hydrogen saturated saline on rat diabetic model and insulin resistant model via reduction of oxidative stress / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Molecular hydrogen, as a novel antioxidant, has been proven effective in treating many diseases. This study aimed to evaluate the therapeutic effects of hydrogen saturated saline in treatment of a rat model of diabetes mellitus and a rat model of insulin resistant.</p><p><b>METHODS</b>A rat diabetes mellitus model was established by feeding a high fat/high carbohydrate diet followed by injection of a small dose of streptozotocin, and an insulin resistant model was induced with a high glucose and high fat diet. Hydrogen saturated saline was administered to rats with both models conditions on a daily basis for eight weeks. A pioglitazone-treated group and normal saline-treated group served as positive and negative controls. The general condition, body weight, blood glucose, blood lipids, and serum insulin levels of rats were examined at the 8th week after treatment. The oxidative stress indices, including serum superoxide dismutase (SOD), glutathione (GSH) and malondialdehyde (MDA) were also evaluated after eight weeks of treatment using the commercial kits.</p><p><b>RESULTS</b>Hydrogen saturated saline showed great efficiency in improving the insulin sensitivity and lowering blood glucose and lipids. Meanwhile, the therapeutic effects of hydrogen saturated saline were superior to those of pioglitazone. Hydrogen saturated saline markedly attenuated the MDA level and elevated the levels of antioxidants SOD and GSH.</p><p><b>CONCLUSION</b>Hydrogen saturated saline may improve the insulin resistance and alleviate the symptoms of diabetes mellitus by reducing the oxidative stress and enhancing the anti-oxidant system.</p>

Effect of rosiglitazone on expression of CD36 in peripheral monocytes in patients with type 2 diabetes / 第二军医大学学报

Objective: To observe the expression of CD36 in peripheral monocytes in patients with Type 2 diabetes, and to study the influence of rosiglitazone on CD36 expression and the related the mechanism. Methods: The expression of CD36 in the peripheral monocytes of patients with Type 2 diabetes was measured by flow cytometry before and after rosiglitazone treatment; the correlation between monocytes CD36 expression and metabolic index was analyzed. Results: Flow cytometry showed that the mean fluorescence intensity (MFI) of monocyte CD36 in Type 2 diabetes was significantly higher than that in the healthy controls(745.9±281.3 vs 406.3±80.2, P<0.01). CD36 MFI in patients with Type 2 diabetes atherosclerosis was significantly higher than that in patients with Type 2 diabetes non-atherosclerosis (878.2 ± 296.1 vs 584.2 ± 148.3, P<0.01). Besides, we also found that CD36 expression, fasting blood glucose(FBG), post-prandial blood glucose(PBG), hemoglobin A1c(HbA1c), FIN, PIN, and HOMA-IR were all significantly decreased after rosiglitazone intervention compared with those before rosiglitazone intervetion and placebo group(P<0.05 or P<0.01). There was a positive correlation between monocyte CD36 expression with FBG(r=0.55, P<0.05), HbA1c(r=0.62, P<0.01), and HOMA-IR(r=0.64, P<0.01); but the expression was not correlated with PBG, FIN, or PIN. Conclusion: The increased expression of CD36 in monocytes of patients with Type 2 diabetes may be one of the mechanisms for accelerated atherosclerosis in diabetic patients. Rosiglitazone can decrease CD36 expression in monocytes through effectively controlling the blood glucose and decreasing insulin resistance.

Intensive glycemic control and macrovascular events in type 2 diabetes mellitus: a meta-analysis of randomized controlled trials / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>There is no agreement as to whether intensive glucose control in type 2 diabetes can reduce the incidence of macrovascular events in these patients. We performed a meta-analysis comparing intensive glucose control or conventional glucose control in randomized controlled trials.</p><p><b>METHODS</b>Databases including MEDLINE, EMBASE, and Cochrane controlled trials register, the Cochrane Library, and Science Citation Index were searched to find relevant trials. Outcome measures were the incidence of major macrovascular events.</p><p><b>RESULTS</b>Six trials involving 28 065 patients were included. Analysis suggested that there was an obviously decreased incidence of major macrovascular events in patients having intensive glucose treatment vs. controls (RR 0.92; 95%CI 0.87, 0.98; P = 0.005). However, intensive glycemia control strategies in type 2 diabetes showed no significant impact on the incidence of death from any cause compared with conventional glycemia control strategies, intensive 14.7%, controls 12.0% (RR 0.95; 95%CI 0.80, 1.12; P = 0.55), as well as on the incidence of cardiovascular death, intensive 3.7%, controls 3.6% (RR 1.10, 95%CI 0.79, 1.53; P = 0.57).</p><p><b>CONCLUSIONS</b>Control of glycemia to normal (or near normal levels) in type 2 diabetes appears to be effective in reducing the incidence of major macrovascular events, but there were no significant differences of either the mortality from any cause or from cardiovascular death between the two glycemia-control strategies.</p>