Breed difference and regulatory role of CRTC3 in porcine intramuscular adipocyte.

The cAMP responsive element binding protein (CREB)-regulated transcription coactivator 3 (CRTC3) is a member of the CRTC protein family and plays an important role in energy metabolism. The aim of this study was to determine if the expression of porcine CRTC3 is related to intramuscular fat (IMF) deposition and meat quality in Heigai pigs (a local fatty breed in China) and Duroc × Landrace × Yorkshire (DLY) pigs (a lean crossbred pig widely cultured in China). In addition, the effect of ectopic expression of CRTC3 on gene expression in porcine IMF adipocytes was also examined. Our results showed that Heigai pigs had lower lean percentage, thicker back fat thickness and smaller loin muscle area than DLY pigs. Compared with DLY pigs, Heigai pigs had higher marbling scores, better meat color and higher IMF contents and triglyceride concentrations. Higher levels of oxidative metabolic enzyme and expression of the slow oxidative muscle fiber-related genes were observed in longissimus dorsi muscle and psoas major muscle (P < 0.05) from Heigai pigs. Notably, CRTC3 and adipocyte-specific marker genes were highly expressed in muscle tissues of Heigai pigs. The expression of lipolysis-related genes ATGL and HSL were lower in Heigai muscles. Moreover, forced expression of CRTC3 promoted lipid accumulation and increased the expression of PPARγ, C/EBPα, leptin and FABP4 (P < 0.05), whereas it decreased the expression of ATGL and HSL in IMF adipocytes. These results suggest that CRTC3 expression is associated with lipid accumulation and IMF deposition in pigs.

Tacrolimus induced nephrotoxicity and pulmonary toxicity in Wistar rats.

Transplantation has evolved into an accepted treatment for end-stage organ failure. The major limitation for solid organ transplantation is organ rejection, which is an adaptive immune response caused by the activation of T-cells. Immunosuppressant drugs are used to overcome this problem. Tacrolimus is a powerful immunosuppressive drug which is used to minimize the risk of organ rejection. The present study was designed to find the toxic effects of tacrolimus on lungs and kidneys. Wistar rats were divided into 4 experimental groups and one control group (n=9). Each rat of the experimental group was orally given the aqueous suspension of tacrolimus powder (3mg/ml) and dissected after 6, 12, 24 and 48 hours of tacrolimus suspension dose. Lungs and kidneys were excised and processed for histopathological and histochemical alterations. Kidney tissues presented signs of toxic potential on tissue architecture such as increased interstitial spaces, necrosis, especially acute tubular necrosis, glomerular shrinkage, dilated blood vessels and enlargement of Bowman’s capsule. Lung sections also confirmed the toxic potential, characterized by bronchiolar wall thickening, alveolar cells necrosis, collapsing of alveolar spaces and interstitial round cell infiltrate. Results of Prussian blue iron staining showed no iron deposition in kidney architecture while in lung sections, iron accumulation was evident. Taken together from these observations we can conclude that tacrolimus may induce toxicity to a certain extent with structural distortion of the kidneys and lungs.

[Expression and clinical significance of long non-coding RNA CCAT1 in gastric cancer].

Objective: To investigate the expression and clinical significance of long non-coding RNA colon cancer associated transcript-1 (CCAT1) in gastric cancer (GC), and to further explore the effect of CCAT1 on cell proliferation of GC. Methods: The mRNA expressions of CCAT1 in GC tissues and matched adjacent normal tissues from 62 patients who received resection for gastric carcinoma between January 2013 and May 2015 in Nanjing Medical University Affiliated Wuxi Second Hospital and expressions in GC cell lines were assessed by quantitative real-time PCR (qRT-PCR). The clinical significance of CCAT1 expression was then analyzed. The expressions of CCAT1 in MGC-803 and SGC-7901 cells were inhibited by small interfering RNA (siRNA) transfection. The effect of CCAT1 on cell proliferation was studied by cell counting kit (CCK)-8 assay. Results: The expressions of CCAT1 mRNA in GC tissues were significantly higher than in the normal tissues (3.39±2.37 vs 1.28±0.74, P<0.05). Compared with immortalized human gastric epithelial cell line (GES-1), the expressions of CCAT1 mRNA were significantly higher in GC cell lines MGC-803 and SGC-7901 (3.07±0.69, 2.23±0.32 vs 1.01±0.12, both P<0.05). Besides, the expression of CCAT1 varied significantly among patients with different TNM stage, depth of invasion, and lymph node metastasis (χ(2) =5.199, 5.395, 9.239, all P<0.05). The results of CCK-8 assay showed that down-regulation of CCAT1 in MGC-803 and SGC-7901 cells significantly inhibited the cell proliferation (both P<0.05). Conclusions: CCAT1 is up-regulated in GC and may be significantly correlated with the progression of GC. Decreased expression of CCAT1 can suppress the proliferation of GC cells. CCAT1 might be used as a novel target for GC early diagnosis and treatment.

[Genome structure and origin of nontoxigenic strains of Vibrio cholerae of El Tor biovar with different epidemiological significance].

Intraspecies genetic differentiation of nontoxigenic strains of Vibrio cholerae of El Tor biovar containing one of the key pathogenicity genes, tcpA, is studied along with the phylogenetic relationships between these strains and toxigenic isolates. Comparative analysis of the whole genome nucleotide sequences demonstrates for the first time that ctxA ­ tcpA + strains vary considerably and can be clustered into two separate groups, the CTXφ­RS1φ +VPI+VSP+/CTXφ­RS1φ­VPI+VSP+ isolates and the CTXφ­RS1φ­VPI+VSP­ isolates, differing in their epidemiological significance. In the course of model experiments, it is established that nontoxigenic potentially epidemic CTXφ­RS1φ +VPI+VSP+/CTXφ­RS1φ­VPI+VSP+ isolates are derivatives of toxigenic strains. The results of whole genome SNP analysis of 35 Vibrio cholerae strains confirm these data and indicate genetic remoteness of nontoxigenic CTXφ­RS1φ­VPI+VSP­ strains both from the potentially epidemic strains and from the toxigenic isolates. It is found that the genomes of the CTXφ­RS1φ­VPI+VSP­ strains contain unique SNPs which are characteristic of them alone. The new data on the structure of the genome of nontoxigenic strains with different epidemiological significance may be further used for their genetic differentiation.

Genetic variability of DNA repair mechanisms in chemotherapy treatment outcome of gastric cancer patients.

We investigate whether three common polymorphisms in ERCC1 and ERCC2 are predictor factors for the chemotherapy response, as well as the clinic outcome of patients with gastric cancer. Between May 2011 and May 2013, 263 patients with gastric cancer who were newly diagnosed by histopathology were enrolled in our study. Genotyping of the ERCC1 rs11615 and rs3212986, and ERCC2 rs1799793 polymorphisms were conducted by the polymerase chain reaction-restriction fragment length polymorphism assay. Patients carrying the TT genotype and TT+CT genotype of ERCC1 rs11615 were associated with poorer response to chemotherapy and shorter survival times when compared with the CC genotype. In conclusion, our results suggested that the ERCC1 rs11615 polymorphism in the DNA repair pathways can be used as predictive factors to the clinical outcome of patients with gastric cancer.

[Microevolution of cholera agent in the modern period].

AIM: To carry out comparative molecular genetic analysis of highly pathogenic atypical Vibrio cholerae strains biovar El Tor, isolated in the territory of RF, in order to determine micro-evolutionary alterations of cholera agent in the modern period. MATERIALS AND METHODS: 38 clinical strains have been examined by means of polymerase chain reaction, sequencing and MLVA-analysis. The selected strains were isolated at different periods of time during cholera epidemic complications and differed between each other in virulence. RESULTS: It is demonstrated that new variants have emerged in the course of short-term microevolution. Their genome structure and function differ from those of all previously known strains. The genome alterations have been caused by point mutations in ctxB u tcpA genes associated with virulence and located in CTXΦ prophage and pathogenicity island VPI-1 respectively, as well as by the extended deletion in pandemicity island VSP-II. Presented is the dynamics of genome structure and function alterations in modern strains. CONCLUSION: The discovered genomic alterations in the new variants of the agent evolved in the process of microevolution are indicative of their epidemic potential enhancement and probability of virulence potentiation.

Application of the concept of fast-track surgery in pediatric ophthalmic surgery.

PURPOSE: To explore the effects of the fast-track surgery (FTS) approach during the perioperative period of ophthalmic surgery in pediatric patients. METHODS: A bidirectional cohort design was applied in this study. The traditional nursing mode was followed in relation to 40 pediatric patients admitted for ophthalmic surgery in March 2018 (control group), whereas the FTS mode was followed with regard to 40 pediatric patients admitted for ophthalmic surgery in April 2018 (observation group). The effects of the FTS mode were determined by comparing the postoperative pain score, restlessness score, and the incidence of postoperative nausea and vomiting between the two groups. RESULTS: The pain and restlessness scores of the patients at 4hours after surgery in the observation group were significantly decreased compared with those in the control group (P<0.01). The incidence of postoperative nausea and vomiting in the observation group was also slightly lower than that in the control group (P>0.05). CONCLUSION: A perioperative FTS-based nursing mode can effectively alleviate the postoperative pain and restlessness of pediatric patients without increasing their stress response.

Retention of Intrafibrillar Minerals Improves Resin-Dentin Bond Durability.

The concept of extrafibrillar demineralization involves selective removal of apatite crystallites from the extrafibrillar spaces of mineralized dentin without disturbing the intrafibrillar minerals within collagen. This helps avoiding activation of endogenous proteases and enables air-drying of partially demineralized dentin without causing collapse of completely demineralized collagen matrix that adversely affects resin infiltration. The objective of the present study was to evaluate the potential of quaternized carboxymethyl chitosan (QCMC)-based extrafibrillar demineralization in improving resin-dentin bond durability. Isothermal titration calorimetry indicated that QCMC synthesized by quaternization of O-carboxymethyl chitosan had moderate affinity for Ca2+ (binding constant: 8.9 × 104 M-1). Wet and dry bonding with the QCMC-based demineralization produced tensile bond strengths equivalent to the phosphoric acid (H3PO4)-based etch-and-rinse technique. Those bond strengths were maintained after thermocycling. Amide I and PO43- mappings of QCMC-conditioned dentin were performed with atomic force microscope-infrared spectroscopy (AFM-IR). Whereas H3PO4-etched dentin exhibited an extensive reduction in PO43- signals corresponding to apatite depletion, QCMC-conditioned dentin showed scattered dark areas and bright PO43- streak signals. The latter were consistent with areas identified as collagen fibrils in the amide I mapping and were suggestive of the presence of intrafibrillar minerals in QCMC-conditioned dentin. Young's modulus mapping of QCMC-demineralized dentin obtained by AFM-based amplitude modulation-frequency modulation recorded moduli that were the same order of magnitude as those in mineralized dentin and at least 1 order higher than H3PO4-etched dentin. In situ zymography of the gelatinolytic activity within hybrid layers created with QCMC conditioning revealed extremely low signals before and after thermocycling, compared with H3PO4-etched dentin for both wet and dry bonding. Confocal laser scanning microscopy identified the antibacterial potential of QCMC against Streptococcus mutans and Enterococcus faecalis biofilms. Taken together, the QCMC-based demineralization retains intrafibrillar minerals, preserves the elastic modulus of collagen fibrils, reduces endogenous proteolytic activity, and inhibits bacteria biofilms to extend dentin bond durability.

Isolation and characterization of canine astrovirus in China.

In this study, we first investigated the prevalence of astrovirus in stools of dogs with and without diarrhea in Shanghai, China. Of all the specimens, 22 (12.02%) from the 183 dogs with diarrhea and none (0%) from the 138 healthy controls were positive for astrovirus. Furthermore, we cloned partial sequences of ORF1b (442 bp) and the entire sequences of ORF2 (2475 bp). Phylogenetic analysis showed that the new isolates were belonged to genus Mamastrovirus and most closely clustered with the Italy strain, based on the ORF2 sequences available. However, the new isolates and the Italy strain were divided into two different clusters. The new isolates may be a new strain of canine astrovirus.

PPARα agonist prevented the apoptosis induced by glucose and fatty acid in neonatal cardiomyocytes.

OBJECTIVE: We investigated the effect of peroxisome proliferator activator receptors α (PPARα) on cardiomyocyte apoptosis induced by glucose and fatty acid, and if high glucose levels could increase fatty acid-induced apoptosis. METHODS: Cardiomyocytes were maintained in Dulbecco's Modified Eagle Medium and divided into 5 groups: Group N (control Group); Group G (exposed to 25.5 mmol/l glucose); Group L (exposed to 5 mmol/l glucose, fatty acid); Group H (exposed to 25.5 mmol/l glucose and fatty acid); Group I (exposed to 25.5 mmol/l glucose, fatty acid and Wy14643). Apoptosis was detected by terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling. Immunocytochemistry staining detected PPARα's expressing, and western blotting detected PPARα and nuclear factor κB's (NF-κB) protein level. RESULTS: Exposure to fatty acid resulted in a significant increase of cardiomyocytes apoptosis, with the extension of NF-κB formation, whereas exposure to 25.5 mmol/l glucose had no influence on the apoptosis rate. However, combination with fatty acid and high glucose concentration had induced more apoptosis with the up-regulation of NF-κB formation. The fatty acid and glucose-induced effects were improved by Wy14643, with down-regulation of NF-κB formation. CONCLUSION: These results suggested that in neonatal cardiomyocytes, fatty acid and glucose in combination with fatty acid induced apoptosis via NF-κB formation and activation of apoptosis pathways; glucose in combination with fatty acid induce more apoptosis rate for the more NF- κB formation, activation of the PPARα can reverse such apoptosis effect. The results also suggest that gluco-lipotoxicity may play a central role in the development of diabetic cardiomyopathy, and PPARα-agonist may be an effective drug in treating the diabetic cardiomyopathy.

Sequence analyses of the representative Chinese-prevalent strain of avian nephritis virus in healthy chicken flocks.

Avian nephritis virus (ANV), which belongs to the Astroviridae family, has been associated with acute nephritis in chickens. Cases of ANV infection have been recorded in Japan and in several European countries. However, related studies have never been performed in China. Thus, this study isolated ANV in Chinese chicken flocks. ANV RNA was detected by reverse transcription-PCR in stool samples collected from healthy layer chickens in the Sichuan Province of China in 2009. Of the 192 stool specimens collected, 32.3% (62/192) were positive for ANV infection. The whole genome of ANV-Sichuan54, the first representative Chinese strain, was 6941 nucleotides in length, including the 5' untranslated region, three open reading frames (ORFs), a 3' UTR, and a poly-(A) tail. Comparative and phylogenetic analyses based on partial RNA-dependent RNA polymerase (ORF1b) demonstrated that the majority of ANV investigations were more closely related to the U.S. ANV strain (DQ324827-324836) than to the G-4260 (AB033998).

Application of Artificial Intelligence in Dentistry.

Artificial intelligence (AI) is a technology that utilizes machines to mimic intelligent human behavior. To appreciate human-technology interaction in the clinical setting, augmented intelligence has been proposed as a cognitive extension of AI in health care, emphasizing its assistive and supplementary role to medical professionals. While truly autonomous medical robotic systems are still beyond reach, the virtual component of AI, known as software-type algorithms, is the main component used in dentistry. Because of their powerful capabilities in data analysis, these virtual algorithms are expected to improve the accuracy and efficacy of dental diagnosis, provide visualized anatomic guidance for treatment, simulate and evaluate prospective results, and project the occurrence and prognosis of oral diseases. Potential obstacles in contemporary algorithms that prevent routine implementation of AI include the lack of data curation, sharing, and readability; the inability to illustrate the inner decision-making process; the insufficient power of classical computing; and the neglect of ethical principles in the design of AI frameworks. It is necessary to maintain a proactive attitude toward AI to ensure its affirmative development and promote human-technology rapport to revolutionize dental practice. The present review outlines the progress and potential dental applications of AI in medical-aided diagnosis, treatment, and disease prediction and discusses their data limitations, interpretability, computing power, and ethical considerations, as well as their impact on dentists, with the objective of creating a backdrop for future research in this rapidly expanding arena.

Human parechovirus infections in monkeys with diarrhea, China.

Information about human parechovirus (HPeV) infection in animals is scant. Using 5' untranslated region reverse transcription-PCR, we detected HPeV in feces of monkeys with diarrhea and sequenced the complete genome of 1 isolate (SH6). Monkeys may serve as reservoirs for zoonotic HPeV transmissions and as models for studies of HPeV pathogenesis.

Sequence analysis of an isolate of minute virus of canines in China reveals the closed association with bocavirus.

In the present study, we have cloned and sequenced the nearly-full-length genome of minute virus of canines (MVC), SH26, in China. The genome of MVC, 5,132 nucleotides (nts) in length, contains three open reading frames (ORFs), which are 2,325-bp of NS1, 561-bp of NP1 and 2,112-bp of VP1/VP2 encoding three proteins of 774, 186 and 703 residues, respectively. Predicted amino acids sequence of NS1 of MVC has 44% identity with human bocavirus (HBoV) and human boacvirus 2 (HBoV2), NP1 has 48 and 45% identity with HBoV and HBoV2, VP1/VP2 has 45 and 46% identity with HBoV and HBoV2, respectively. Phylogenetic analysis showed that the present Chinese MVC strain was also closely clustered with the previous American and Japanese MVC isolates, and MVCs formed a different branch together with bovine parvovirus and HBoVs from other parvoviruses classified into Parvovirinae.

Partial molecular cloning, characterization, and analysis of the subcellular localization and expression patterns of the porcine OTUB1 gene.

The product of the OTUB1 gene is a member of the OTU superfamily of predicted cysteine proteases and inhibits cytokine gene transcription via its interaction with a ubiquitin protease and E3 ubiquitin ligase. To further understand the functions of the porcine OTUB1 gene, the subcellular localization of porcine OTUB1 protein was analyzed. We first cloned a partial DNA sequence of porcine OTUB1 which contained an 816 bp ORF encoding 271 amino acids. The deduced protein product was found to contain an OTU domain. The corresponding porcine OTUB1 protein was subsequently demonstrated to localize predominantly in the nucleus by confocal fluorescence microscopy. By spatial expression analysis, we further found that OTUB1 is highly expressed in the brain, liver, spleen, lung, kidney, large intestine, small intestine, stomach, ovary, uterus and thymus. In contrast, only low levels of this gene were evident in the heart, dorsal muscles and leg muscle of the pig. This is the first report to show the subcellular localization of porcine OTUB1, and our current data provides us with an important basis for conducting further studies on the functions and regulatory mechanisms underlying the role of OTUB1 gene in the immune system.

Breed difference and regulation of the porcine adipose triglyceride lipase and hormone sensitive lipase by TNFalpha.

Adipose triglyceride lipase (ATGL) and hormone sensitive lipase (HSL) are major novel triglyceride lipases in animals. The aim of this study was to determine if there are differences in the porcine ATGL (pATGL) and HSL genes between Jinhua pigs (a fatty breed) and Landrace pigs (a leaner breed). In addition, the effect of TNFalpha and pATGL-specific siRNA (pATGL-siRNA) on the expression of pATGL and HSL in porcine adipocytes was also examined. Compared with Landrace pigs, the body weight (BW) of Jinhua pigs was lower (P < 0.01), while intramuscular fat content (in the longissimus dorsi muscle), as well as the back fat thickness and body fat content were higher (P < 0.01). The expression of pATGL and HSL mRNA in Jinhua pigs was lower (P < 0.01) in subcutaneous adipose tissue, and greater (P < 0.01) in longissimus dorsi muscle compared with Landrace pigs. In vitro treatment of porcine adipocytes with TNFalpha decreased (P < 0.01) the glycerol release and the gene expression of pATGL, HSL and PPARgamma in porcine adipocytes. Furthermore, transfection with pATGL-siRNA significantly decreased (P < 0.01) the expression of pATGL, while it had no effect on the expression of HSL. Treatment with 25 ng/ml TNFalpha in conjunction with pATGL-siRNA significantly decreased (P < 0.01) the expression of pATGL and HSL in cultured porcine adipocytes. These results provide useful information to further the understanding of the function of pATGL and HSL in porcine lipid metabolism, which should be applicable to the regulation of fat deposition and improvement of meat quality.

Increases in serum macrophage migration inhibitory factor in patients with severe sepsis predict early mortality.

This prospective study aimed to delineate the association between the serum levels of macrophage migration inhibitory factor (MIF) and the risks of early mortality in 112 patients who presented with clinically severe sepsis. Previous studies showed that elevated serum MIF levels on the first day are associated with an increased risk of 28-day mortality. Nonsurvivors may be the sickest population on arrival. Not all patients with severe sepsis follow the same clinical pathway, however, and the sequential change in MIF might be an important predictor of mortality. We hypothesized that, for septic patients, in addition to serum MIF levels on day 1, the percentage of change in MIF between days 1 and 2 after arriving in the emergency department predicts the probability of early mortality. Serum MIF levels were measured on days 1 (emergency department arrival) and 2 (24 h after arrival). Patients with a high percentage of increase between MIF levels on days 1 and 2 had higher 3-day (odds ratio, 1.8; 95% confidence interval, 1.2-2.6; P = 0.003) and 7-day mortalities (odds ratio, 1.4; 95% confidence interval, 1.0-1.9; P = 0.03) after adjusting for age and day-1 serum MIF levels. In conclusion, an increase in serum MIF from the first to second day of admission in patients with severe sepsis indicates a higher risk of early mortality; therefore, these patients need more aggressive therapeutic intervention.

Effects of lactose and glucose on production of itaconic acid and lovastatin by Aspergillus terreus ATCC 20542.

Fermentation products of Aspergillus terreus ATCC 20542 (a parent strain for lovastatin production) were collected, and the coexistence of itaconic acid (IA) with lovastatin was confirmed in this study. Using a lactose-based medium (LBM), lovastatin production was 873 mg/l on day 10, but IA production was only 22-28 mg/l during the cultures. When lactose in LBM was simply replaced with glucose, IA production was markedly enhanced by 20-fold (491 mg/l on day 5), which showed a growth-associated pattern. The findings indicated that the carbon source used (glucose or lactose) controlled the biosynthetic pathway. The net yield of lovastatin production when using lactose was calculated to be 25.1 mg/g (5.1-fold) in comparison with when using glucose in the cultures. Furthermore, lovastatin production was further increased by 9.2% when IA (0.5 g/l) was added to LBM. When IA was added at 5 g/l, the fermentation broth turned dark-brown, and lovastatin production was reduced by 18.0%. Hence, these two metabolites (IA and lovastatin) produced by the fungus might be related.

[Prophage CTXphi genome variability and its role in alteration of Vibrio cholerae El Tor virulence characteristics].

Comparative analysis of CTXphi prophage genome of 366 V. cholerae El Tor strains isolated from infected people and water was carried out using the polymerase chain reaction. Four groups of vibrios, which carry different combinations of ctxA, zot, and ace genes from core region of CTXphi prophage coding key (cholera enterotoxin) and accessory (Zot and Ace toxins) pathogenicity factors, were determined: ctxA(+) zot(-) ace(+), ctxA(-) zot(+) ace(+), ctxA(-) zot(+) ace(-), ctxA(-) zot(-) ace(+). Vibrios that had lost all tested genes were also revealed. Genomic rearrangements occurring in water environment in virulent V. cholerae strains, which acquired foreign pathogenicity genes necessary for their existence in human organism, were proposed as one of the mechanisms of formation of clones with an incomplete or no prophage. Infection process in model animals challenged with wild and isogenic strains of V. cholerae differing in the set of the phage genes (ctxA, zot, and ace) was comparatively analyzed. It was shown that variability of CTXphi prophage genome was an important factor of modification of cholera vibrios virulent characteristics. Obtained data point to usefulness of ctxA, zot, and ace phage genes detection in wild V. cholerae isolates as it could permit evaluation of their virulent potential determining the severity of the infection.

The Therapeutic Effect of Pancreatic Kininogenase on Treatment of Diabetic Peripheral Neuropathy in Patients with Type 2 Diabetes.

Background: To determine the therapeutic efficacy and cost-effective of pancreatic kininogenase (PKase) on treatment of diabetic peripheral neuropathy (DPN) compared with Prostaglandin E1 (PGE1) in patients with type 2 diabetes. Methods: 104 patients with DPN receiving standard glucose control therapy were randomly assigned into 3 groups: Group-A received PKase treatment, Group-B received PGE1 treatment, and Group-C received only standard glucose control therapy. Michigan neuropathy screening instrument (MNSI) score, neurophysiology examination, and nerve conduction velocity were measured. Results: Standard glucose control therapy significantly reduced hyperglycemia to a similar level in all groups. Questionnaire grading and neurophysiology examination both indicated that no significant difference was found at the end of treatment between Groups -A and -B. Except for the ulnar nerve sensory conduction velocity that was significantly improved in Group-B, the remaining nerve conduction velocity (regardless of sensory or motor nerve conduction velocities) was improved to a similar level in Groups -A and -B. Group-A had significantly reduced questionnaire grading and better improvement in motor nerve conduction velocity of the common peroneal nerve, ulnar nerve, and sensory nerve conduction velocity of the sural nerve as compared with Group-C. However, the medical cost of PKase was only 18.9% of that of PGE1 during one course of treatment. Conclusions: PKase has the similar therapeutic efficacy as PGE1 on treatment of DPN in patients with type 2 diabetes. However, the medical cost of PKase is one fifth of that of PGE1. Thus, PKase is a cost-effective drug for treatment of DPN.