The practice and application of the PBL-English-clinical rounds teaching in medical undergraduate education / 中华医学教育探索杂志

Teaching rounds is an important part of clinical teaching but it is difficult to implement in place for a variety of reasons. To endocrine and metabolic section as an example, Lack of enthusiasm, inadequate preparation and other issues result that teaching rounds is difficult to achieve the desired effect in the teaching rounds, especially in the English teaching rounds. In view of the above situation, based on the concept of PBL to carry out teaching rounds in English is not only an important method to cultivate the clinical thinking of medical students, but also an important measure to improve teachers' and students' English proficiency, as well as to cultivate medical students' clinical thinking. The last but not the least, carrying out teaching rounds in English is an important measure for medical education reform and improve-ment. Facts have proved that carrying out teaching rounds in English has a high practicality and feasibility in clinical practice.

Reform of endocrinology and metabolism course integration based on organ-system based learning / 中华医学教育探索杂志

Systems-based integrated course is the core and hot spot in current advanced medical education reform.An integrated organ-system oriented curriculum system of endocrinology and metabolism was applied in eight year clinical medicine and five year excellent doctor education.The teaching contents of endocrinology and metabolism from traditional Basic Medicine,Internal Medicine and Surgery were integrated and optimized to compile the integrated syllabus and teaching cases.Curriculum integration oriented PBL teaching and comprehensive morphology experimental teaching were implemented into the integrated endocrinology and metabolism system curriculum.This endocrinology and metabolism course integration based on organ-system based learning is conducive to establishing the organic connection between Basic Medicine and Clinical Medicine,and cultivating high-quality medical talents.

Association between Circulating Betatrophin Levels and Metabolic Parameters in Non-alcoholic Fatty Liver Disease Patients / 实用医学杂志

Objective To investigate circulating betatrophin levels in non-alcoholic fatty liver disease patients (NAFLD). To explore its association with various metabolic parameters in Chinese subjects. Methods From August 2014 to April 2015 , 58 patients with NAFLD and 41 non-NAFLD control subjects with age and sex matched were enrolled in the Department of Endocrinology of Zhujiang Hospital. Results In NAFLD group, serum betatrophin concentrations significantly increased (781.96 vs. 431.89 pg/mL, P < 0.05) and associated only with HDL-cholesterol level. In normal group, betetrophin levels are associated with multiple metabolic parameters, such as fasting glucose, insulin, C peptide, HOMA-IR, QUICK index and HDL-C levels. Conclusions Serum betatrophin concentration significantly elevated in non-alcoholic fatty liver disease patients and was negatively correlated with HDL-C level (r = -0.479, P < 0.001).

Related factors of obstructive sleep apnea sysdrome in type 2 diabetes patients / 实用医学杂志

Objective To analyze the related factors of obstructive sleep apnea syndrome (OSAS) in type 2 diabetes mellitus (T2DM) patients. Methods 289 participants were enrolled and 254 people finished the whole process. Portable sleep monitor was used to detect the breath situation during sleep , and related factors were also analyzed. Finally , 183 subjects were diagnosed as OSAS and 71 subjects were not. Results 254 T2DM subjects were enrolled, with 108 males (59%) and 183 participants were diagnosed as OSAS (72%). OSAS group had a higher diabetic duration,body mass index, 2 h plasma glucose,fasting insulin, C peptide level, systolic blood pressure, triglyceride, low density lipoprotein cholesterol, and homocysteine levels(P<0.01). The prevalences of dyslipidemia , hyperuricemia , high blood pressure , non-alcoholic fatty liver disease and metabolic syndromein OSAS group were also higher than that in compared groups. Logistic regression analysis showed that body mass index, dyslipidemia and high homocysteine level were independent risk factors of OSAS. Conclusions The prevalence of OSAS in T2DM was higher. Blood glucose level , body mass index and multiple metabolic parameters in OSAS patients elevated significantly. Obesity and insulin resistance were major factors during the process of the disease.

Protection of Saxagliptin for liver inflammatory injury in rat model of diabetes complicating with nonalcoholic fatty liver disease and its mechanism / 中华内分泌代谢杂志

[Summary] Thirty-two SD rats were randomly divided into noraml control group(NC, n = 10) and high fat diet group(HF, n=22). 10 weeks later, the HF group rats were injected STZ(30 mg/ kg) to set up the model of diabetes complicating with nonalcoholic fatty liver disease (NAFLD). Then, HF group were randomly divided into model control group(MC, n = 8) and Saxagliptin intervene group( M + S, n = 8). The M + S group were made an intervention with Saxagliptin(10 mg·kg-1 ·d-1 ) for 8 weeks. At the end of 18 weeks, the fasting blood glucose, serum insulin, liver function, liver weight, tumor necrosis factor alpha, and interleukin 6 were measured. HOMA-IR was calculated. Western bolt was used to determine the expression of NF-κB in hepatic tissue. The level of the indexes above increased in the MC group than in the NC group. But the indexes above mentioned in M + S group were ameliorated. The expression of NF-κB was significantly up regulated in MC group as compared with the NC group, and significantly reduced in the M+S group than in the MC group. The results of correlation analysis revealed that TNF-αand IL-6 were positive correlated with HOMR-IR, respectively. Saxagliptin can effectively reduce the blood glucose level and alleviate insulin resistance, then further relieve the inflammation of liver injury, and finally to alleviate the condition of T2DM with NAFLD. It may play a protective role in the damaged hepatic cells.

Triple combination therapy using saxagliptin/metformin/rosiglitazone versus intensive insulin therapy in the treatment of newly-diagnosed type 2 diabetes:Effects on glycaemic control andα/β-cell function / 中华内分泌代谢杂志

[Summary] Drug naive, newly diagnosed type 2 diabetic subjects were randomized to Saxagliptin/Metformin / Rosiglitazone(Triple Therapy, n=23) or insulin 70 30 mix group(Intensive Insulin Therapy) (n=21) for 24 weeks. How did the 2 therapies influence fasting blood glucose, fasting insulin, C-peptide, and glucagon levels and the change of body weight were compared. This study was aimed to explore the comparative glycemic efficacy and impact on α/ β-cell function of two different antidiabetic therapies, triple combination therapy using saxagliptin/metformin/ rosiglitazone and intensive insulin therapy, for newly diagnosed type 2 diabetes mellitus. The results indicated that fasting blood glucose, HbA1C , insulin resistance index 2(HOMA 2-IR), glucagon and body mass index level were significantly decreased, and insulin secretion index 2 ( HOMA 2-% β) was increased significantly( P <0. 05) in triple therapy group, and the decreasing extent of HOMA 2-IR, glucagon, and body mass index were significantly greater than that in the intensive insulin group(P<0. 05). Triple therapy group has a stronger effect of reducing insulin resistance, as well as on inhibiting glucagon and promoting weight loss.

Therapeutic effect of saxagliptin in rat models of nonalcoholic fatty liver and type 2 diabetes / 南方医科大学学报

<p><b>OBJECTIVE</b>To observe the therapeutic effect of saxagliptin in a rat model of nonalcoholic fatty liver and type 2 diabetes and investigate the possible mechanism.</p><p><b>METHODS</b>Rats models of nonalcoholic fatty liver and type 2 diabetes established by feeding on a high glucose and fat diet and streptozotocin injection were treated with saxagliptin (daily dose of 10 mg/kg) gavage for 8 weeks, using saline as the control. After the treatment, fasting blood glucose, serum insulin, blood lipids, liver function, liver oxidative indices, and hepatic pathologies were evaluated in all the rats, and the expressions of Bcl-2 and Bax in the liver tissue were detected with immunohistochemistry and Western blotting.</p><p><b>RESULTS</b>Compared with the model group, saxagliptin intervention significantly reduced blood glucose and HOMA-IR, improved the liver function and SOD activity (P<0.01), lowered the liver weight, liver index (P<0.01) and MDA level (P<0.05), and slightly lowered the body weight and blood lipids (P>0.05); AST level was similar between the normal control group and saxagliptin intervention group (P>0.05). HE and oil red staining showed obvious hepatic pathologies in the model group, and saxagliptin intervention significantly reduced lipid droplets in the hepatocytes and improved the structural damage of the liver. Hepatic Bax expression significantly increased and Bcl-2 expression decreased in the model group, and these changes were reversed by saxagliptin.</p><p><b>CONCLUSION</b>Saxagliptin shows good therapeutic effect in rat models of nonalcoholic fatty liver and type 2 diabetes possibly by controlling blood glucose, lowering insulin resistance, alleviating hepatic oxidative stress and hepatocyte damage, and regulating the expression of apoptosis-related proteins.</p>

Estimated glomerular filtration rate and associated risk factors in overweight or obese patients with type 2diabetes and normal urine microalbumin level / 中华内分泌代谢杂志

From August 2011 to March 2012,5 241 type 2 diabetic patients with body mass index ≥ 24kg/m2 were enrolled from 60 hospitals in Guangdong Province.According to estimated glomerular filtration rate (eGFR),a total of 2 631 subjects with norml urine microalbumin level (＜30 ng/L) were divided into normal eGRF group and decreased eGRF group.Binary logistic regression was used to analyze the associations between eGFR and its related risk factors.The results showed that age,blood uric acid,blood urea nitrogen,history of hypertension and coronary heart disease,family history of diabetes,and hyperuricemia were positively related to lowering of eGFR (P＜ 0.05 or P＜0.01).HbA1C＜7％,regular glucose monitoring,and regular physical activity were negatively related to eGFR decrease (all P＜ 0.01).These results suggest that urine microalbumin and eGFR should be applied to overweight or obese patients with type 2 diabetes in order to screen diabetic nephropathy.Furthermore,intensive control of blood glucose,uric acid,and blood pressure is beneficial to lowering the risk of diabetic nephropathy.

Role of TRB3 in the inhibitory effect of fenofibrate against high glucose-induced proliferation of glomerular mesangial cells / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the role of TRB3 in the inhibitory effect of fenofibrate against the proliferation of glomerular mesangial cell induced by high glucose.</p><p><b>METHODS</b>Rat glomerular mesangial cells (MCs) were cultured in the presence of 5.5 mmol/L glucose (normal control), 25 mmol/L glucose (high glucose group), or high glucose along with 10, 50, or 100 µmol/L fenofibrate. Cell counting kit-8 (CCK-8) assay was used to evaluate cell proliferation, and Hoechst 33258 staining was employed to determine chromatin distribution in the MCs. Flow cytometry was performed to analyze the cell cycle changes in different groups. The expressions of TRB3 and P-AKT in different groups were detected using immunocytochemistry and Western blotting.</p><p><b>RESULTS</b>High glucose induced obvious proliferation of the MCs (P<0.001), which was significantly inhibited by fenofibrate in a concentration-dependent manner (P<0.001). The MCs exposed to fenofibrate presented with typical apoptotic morphologies and cell cycle arrest at G1/S phase. Low levels of TRB3 expression was detected in the normal control and high glucose groups, whereas in the 3 fenofibrate groups, TRB3 expression increased and P-AKT expression decreased as fenofibrate concentration increased.</p><p><b>CONCLUSION</b>Fenofibrate can promote TRB3 expression in rat MCs. TRB3 causes cell cycle arrest at G1/S phase by inhibiting AKT phosphorylation to result in suppressed proliferation of the MCs.</p>

Effect of pretreatment with apoptotic donor spleen cells on spleen lymphocyte function of recipient rats after islet transplantation / 南方医科大学学报

<p><b>OBJECTIVE</b>To study the effect of pretreatment with apoptotic donor spleen cells on spleen lymphocyte function of recipient rats undergoing islet transplantation to explore new approaches to prolong islet graft survival.</p><p><b>METHODS</b>Apoptotic spleen cells from donor rats were obtained by exposure to γ-ray irradiation from (60)Co. Diabetic SD rat models were randomly divided into 4 groups to receive tail vein injections with saline (group A), normal cells (group B), apoptotic donor cells (group C), or necrotic donor cells (group D). One week later, orthotopic transplantation of islets under the renal capsule was performed. Before and at 1 and 2 weeks after islet transplantation, the recipient rats were examined for proliferative activity of spleen lymphocytes with CFSE cell staining and for IL-2 and IL-10 expressions in the cells using ELISA.</p><p><b>RESULTS</b>Pretreatment with donor apoptotic cells significantly suppressed the proliferative activity of recipient spleen lymphocytes before and at 1 and 2 weeks after islet transplantation as compared with the other three groups (P<0.05). The level of IL-2 was significantly decreased while IL-10 increased in apoptotic donor cell pretreatment group compared with those in the other 3 groups at each time point of observation.</p><p><b>CONCLUSION</b>The effect of pretreatment with apoptotic donor cells on recipient spleen lymphocytes suggest an important role of apoptotic donor spleen cells in immune tolerance of grafts.</p>

Role of PPARγ signaling pathway in osteogenic differentiation of rat bone marrow- derived mesenchymal stem cells in simulated microgravity / 南方医科大学学报

<p><b>OBJECTIVE</b>To explore the role of peroxisome proliferator-activated receptor γ (PPARγ) signaling pathway in osteo- blast differentiation of rat bone marrow mesenchymal stem cells (BMSCs) cultured in simulated microgravity.</p><p><b>METHODS</b>Rat BMSCs were cultured in simulated microgravity (by rotating clinostat) in the presence of 10 µmol/L pioglitazone, 10 µmol/L GW9662, or both pioglitazone and GW9662, with the cells cultured in normal gravity as the control group. After osteogenic induction for 14 days, the cells were stained with alizarin red for the bone nodules and with oil red-O for the fat cells, and the fat rate was calculated. ALP activity in the cells was determined in each group, and RT-PCR was performed to detect cellular expressions of PPARγ mRNA.</p><p><b>RESULTS</b>Pioglitazone significantly inhibited osteoblast differentiation of the BMSCs, whereas GW9662 promoted the cell differentiation by suppressing the activation of PPARγ.</p><p><b>CONCLUSION</b>We hypothesize that the activation of PPARγ signaling pathway is one of the main mechanisms for inhibited osteoblast differentiation of rat BMSCs in simulated microgravity, and inhibiting PPARγ pathway activation can effectively prevent and treat microgravity-induced osteoporosis.</p>

Generation and identification of pluripotent stem cells from NOD mouse / 中华内分泌代谢杂志

Three factors ( Oct4,Sox2,and Klf4) were introduced into tail tip-derived fibroblasts of NOD mouse by retrovirus infection.The induced pluripotent stem cells ( iPSCs ) generated from this method were analyzed in several aspects,including surface antigens,gene expression,alkaline phosphatase activity,and teratoma formation assays.The NOD mouse iPSCs generated from this study had ES-like characters,expressed ES-specific surface antigens,and possessed the ability to differentiate into 3-germ layers.Such NOD mouse-iPSCs should be useful in tyre 1 dialectic disease modeling,as well as for cell replacement therapy.

Effect of intermittent high glucose on INS-1 cell proliferation and the expression of skp2-p27 / 中华内分泌代谢杂志

Objective To investigate the effect of intermittent high glucose on proliferation, apoptosis, and cell cycle progression of INS-1 cells, and the possible intracellular pathways activated by intermittent high glucose. Methods Cell viability was evaluated by cell counting kit, the cell cycle was determined by flow cytometry,Annexin-V/PI double-labeled cell apoptosis detection kit was used to monitor cell apoptosis. Cell cycle related protein Skp2 and p27 expressions were detected by Western blot. Results ( 1 ) Both intermittent and constant high glucose significantly inhibited the growth of INS-1 cells, and the former effect was more significant. ( 2 ) Intermittent and constant high glucose levels significantly increased apoptosis in INS-1 cells, and the former effect was more significant. (3) Intermittent and constant high glucose levels significantly inhibited the cell process, the G0/G1 cell cycle arrest also was induced by intermittent high glucose, resulting in lowered proportion of the G2/M phase and S phase of INS-1 cells. (4) Intermittent and constant high glucose significantly decreased the level of protein Skp2 and increased the level of cell cycle related protein p27. Conclusion Intermittent high glucose levels affect INS-1 cell growth and proliferation, as well as induce cell apoptosis, probably by decreasing the level of protein Skp2 and increasing the level of p27 in the cells, resulting in arrest of progression through the G1 phase to the S phase of INS1 cells, and thus impairment of cell proliferation.

Relationship between HbA1C and microvascular complications in high-risk populations of diabetes / 中华内分泌代谢杂志

Objective To explore the association of HbA1C with microvascular complications,and to evaluate the diagnostic value of HbA1C in diabetes mellitus in high-risk populations of Guangzhou.Methods HbA1C,blood glucose,fundus photography,and microalbuminuria were detected in 208 permanent residents with high-risk factors of diabetes.The receiver operating characteristiC(ROC)curves were used to estimate the area of HbA1C,fasting plasma glucose(FPG),postprandial 2 h plasma glucose(2hPG)under the curve for discriminating microvascular complications.Results There were 14.9% adults suffering from diabetic retinopathy and 12% microalbuminuria in high risk populations of diabetes.The optimal cutoff points of HbA1C,FPG,and 2hPG in detecting retinopathy were 5.8%,7.0 mmol/L,and 10.9 mmol/L respectively.The thresholds for increasing prevalence of microalbuminuria were5.8% for HbA1C,6.4 mmol/L for FPG,and 10.7 mmol/L for 2hPG.Conclusions The prevalence of diabetic microvascular complications increases dramatically at the concentration of HbA1C 5.8%.As a diagnostic value for microvascular complications,there is no significant difference between HbA1C and 2hPG.

Exploration of ways to improve young teachers'teaching ability in teaching hospital / 中华医学教育探索杂志

The teacher training of medical colleges has become a pressing task force.Young doctors should systematically study the educational theory,make positive observation,conduct teaching rounds and share experience,use the Internet,read the literature and pay attention to academic practice to improve clinical teaching ability.