Guidance of critical thinking of clinical medical students in disease-centered PBL integrated course: taking diabetes as example / 中华医学教育探索杂志

Disease-centered problem-based learning (PBL) integrated course inspires the thinking of medical students in the case scenario to stimulate students' motivation of active learning. In this paper, the study of diabetes cases was taken as an example. Through the design of PBL cases, the scenario was reconstructed and information was provided step by step, so as to induce the students to discuss and learn the related knowledge of glucose metabolism and understand the predisposing factors of diabetes. Furthermore, students' critical thinking could be inspired through the information of the misdiagnose and mistreatment to recognize the clinical presentation and inducement of diabetic ketoacidosis. This teaching model is conducive to the cultivation of medical students' questioning spirit and critical thinking, laying a foundation for the cultivation of innovative medical talents.

Malnutrition in early life and metabolic diseases in adulthood / 中华内分泌代谢杂志

The prevalence of metabolic diseases, such as type 2 diabetes mellitus and obesity, is increasing all over the world. Metabolic diseases have become a major public health problem in China, and primary prevention is particularly important and urgent. According to the theory of DOHaD (Developmental Origin of Health and Diseases), negative environmental factors in early life, such as malnutrition, may increase the risk of some non-communicable diseases, especially metabolic diseases in adulthood. Due to regional economic development disparities in China, life cycle nutrition imbalance (such as malnutrition in early life and overnutrition in adults) is still a common problem. Recently, many scholars have made comprehensive and in-depth studies on the relationship between malnutrition in early life and the development of metabolic diseases in adulthood. This paper summarizes the recent results in this field and puts forward a metabolic model of undernutrition in early life and overnutrition in adulthood (double burden theory). These studies will provide related evidence for the prevention of metabolic diseases in rapidly developing countries such as China and India.

The use of antidiabetic medications in community-dwelling diabetic patients in Shanghai in 2018 / 中华内分泌代谢杂志

Objective@#To investigate the use of diabetes medications and their effects on the community diabetic patients in Shanghai, China, and provide the evidence for the use of antidiabetic drugs in diabetic patients in the region.@*Methods@#The data were from a database of a 2018 Survey on Community Diabetes Mellitus in Shanghai, China. There were 4 612 subjects included in this cross-sectional study in 2018. According to the use of antidiabetic drugs, the population was divided into untreated group, single drug group, double drugs combination group and multi-drugs combination group, to compare the fasting blood glucose, glycosylated hemoglobin, BMI and prevalence of diabetic complications in different groups.@*Results@#About 70.9% of the 4 612 patients used hypoglycemic agents, 34.8% used metformin, 35.1% used sulfonylureas, 22.9% used alpha glycosidase inhibitors, and 13.8% used insulin. The prevalence of diabetic nephropathy, retinopathy, neuropathy, stroke, and diabetic foot was higher in the combination than in the untreated and single-drug users (P<0.01). Only 41.3% subjects had HbA1C<7%. The fasting blood glucose and HbA1C values were lower in the untreated group than in other three medication groups, and the rate of the HbA1C reaching target in the untreated group was higher than the other medication groups (P<0.01). As the types of drug increased, HbA1C was less likely to reach the target (P<0.01). There were 42.2% of patients with BMI<24 kg/m2, and there was no significant difference in the proportion of BMI reaching target among the four groups (P>0.05).@*Conclusion@#The most common used antidiabetic drugs in diabetic patients in Shanghai are metformin, sulfonylureas, α-glycosides inbibitor, and insulin. The blood glucose control in diabetic patients in Shanghai community is not good enough. Patients with a longer duration of diabetes, a lower rate of HbA1C at goal, and a higher prevalence of diabetic complications may be more prone to use multiple hypoglycemic drugs.

Changes of immunoglobulins and CD series in patients with Graves′ orbitopathy treated with high-dose methylprednisolone / 中华内分泌代谢杂志

Objective@#To study the effect of high-dose methylprednisolone intravenous pulse therapy on immunoglobulins and CD series in patients with active moderate-to-severe Graves′ orbitopathy.@*Methods@#Twenty-seven patients with active moderate-to-severe Graves′ orbitopathy were enrolled in this study. All the patients received iv methylprednisolone pulse therapy for 12 weeks according to the 2016 European Thyroid Association/European Group on Graves′Orbitopathy(EUGOGO) Guidelines. Serum thyroidal autoantibodies, such as thyroid-stimulating hormone receptor antibody (TRAb), anti-thyroperoxidase antibody (TPOAb), and serum immunoglobulins, such as IgG, IgE, IgA, IgM were evaluated at the baseline, at the end of 4th and 12th week. Percentages of CD3+ T cells, CD4+ T cells, CD8+ T cells and CD19+ B cells, CD16+ or CD56+ NK cells were also evaluated at each time point.@*Results@#TRAb, TPOA and IgE, IgG, IgA were significantly decreased both after 4th week and after 12th week (all P<0.05). Percentages of CD3+ T cells, CD4+ T cells and CD4+ /CD8+ ratio were gradually decreased after treatment. However, change of CD8+ T cells was not significant (P>0.05).@*Conclusion@#High-dose methylprednisolone may exert an immunosuppressive effect not only by modifying humoral and cellular immune functions, but also by decreasing serum immunoglobulins.

Changes of immunoglobulins and CD series in patients with Graves' orbitopathy treated with high-dose methylprednisolone / 中华内分泌代谢杂志

Objective To study the effect of high-dose methylprednisolone intravenous pulse therapy on immunoglobulins and CD series in patients with active moderate-to-severe Graves' orbitopathy. Methods Twenty-seven patients with active moderate-to-severe Graves' orbitopathy were enrolled in this study. All the patients received iv methylprednisolone pulse therapy for 12 weeks according to the 2016 European Thyroid Association/European Group on Graves'Orbitopathy(EUGOGO) Guidelines. Serum thyroidal autoantibodies, such as thyroid-stimulating hormone receptor antibody ( TRAb) , anti-thyroperoxidase antibody ( TPOAb) , and serum immunoglobulins, such as IgG, IgE, IgA, IgM were evaluated at the baseline, at the end of 4th and 12th week. Percentages of CD3+ T cells, CD4+ T cells, CD8+T cells and CD19+ B cells, CD16+ or CD56+ NK cells were also evaluated at each time point. Results TRAb, TPOA and IgE, IgG, IgA were significantly decreased both after 4th week and after 12th week (all P<0.05). Percentages of CD3+ T cells, CD4+ T cells and CD4+/CD8+ ratio were gradually decreased after treatment. However, change of CD8+T cells was not significant (P>0.05). Conclusion High-dose methylprednisolone may exert an immunosuppressive effect not only by modifying humoral and cellular immune functions, but also by decreasing serum immunoglobulins.

Effect of sex hormone levels on macrovascular complications in community-dwelling male patients with diabetes mellitus in Shanghai / 中华内分泌代谢杂志

Objective We aimed to investigate whether sex hormone levels including total testosterone, estradiol, estradiol/total testosterone, and dehydroepiandrosterone ( DHEA ) were associated with macrovascular complications among Shanghai community-dwelling diabetic men. Methods Relying on the Environmental Pollutant Exposure and Metabolic Diseases in Shanghai (METAL) study (ChiCTR1800017573, www.chictr.org.cn), 2147 male diabetic participants were recruited from 10 communities. Carotid plaques and common carotid artery ( CCA) diameters were detected by carotid ultrasound. Cardiovascular disease ( CVD) was defined as a self-reported diagnosis of CVD, including coronary heart disease, myocardial infarction, or stroke. Results ( 1) The prevalence of CVD in this study was 36. 0％, and patients with CVD had higher rates of hypertension and dyslipidemia than those without CVD. ( 2) After controlling for multiple factors, serum DHEA levels were negatively correlated with the prevalence of CVD while estradiol levels were positively correlated with both the prevalences of CVD and carotid plaque, estradiol/total testosterone ratio was also positively correlated with the prevalence of CVD. ( 3) In subgroup with unilateral/bilateral CCA plaque, and after controlling for multiple factors, total serum testosterone was negatively associated with the mean CCA diameter. Conclusion The incidence of macrovascular complications was lower in male diabetic patients with higher serum total testosterone and DHEA levels and lower estradiol levels, suggesting that sex hormone levels may be a window for the diagnosis and treatment of diabetic macrovascular complications.

Age-related natural change trend of important hormones in Chinese population / 中华内分泌代谢杂志

Objective@#To reclarify the natural change trend of several hormones with age in Chinese population.@*Methods@#A cross-sectional survey was performed including 5 935 healthy individuals (2 286 males and 3 649 females) in the final statistical analysis. All participants received questionnaire survey, anthropometric index and laboratory tests including sex-related hormones, insulin, thyroid hormones, and 25-hydroxyvitamin D [25(OH)D]. Kruskal-Wallis test or One-way ANOVA analysis was used to compare hormone levels in different age groups. Spearman analysis was used to explore the correlation between age and hormone levels.@*Results@#(1) Follicle stimulating hormone (FSH) and luteinizing hormone (LH) concentrations increased with age from 40 years in both males and females, and stabilized at high levels after the age of 60 in females and 80 in males. Estradiol level in females started to decrease since 40 years old, then stabilized around 70 years. Sex hormone binding globulin level increased significantly with age in males, but decreased in postmenopausal females. (2) Fasting serum insulin gradually decreased with age in males until 60 years, but without obvious change in females. Fasting plasma glucose and HbA1C increased with age in both males and females. (3) Thyroid stimulating hormone (TSH) increased slowly with age in both males and females. (4) 25(OH)D increased with age in both males and females overall, especially more obvious in males. (5) During 41-60 years, FSH and LH levels in menopausal females were much higher than those in premenopausal females, while estradiol level in menopausal females was much lower. Compared with premenopausal females aged 41-50 years, estradiol level in premenopausal females was much lower in 51-60 years.@*Conclusion@#The levels of several important hormones are related with age, revealing a natural change trend as aging in Chinese population. (Chin J Endocrinol Metab, 2018, 34: 555-562)

Serum vitamin D levels of the natural population in eastern China / 中华内分泌代谢杂志

Objective To assess vitamin D levels in eastern China by a standard measurement. Methods The data were from a 2014 Survey on the Prevalence in East China for Metabolic Diseases and Risk Factors-China data base. There were 12662 subjects included in this cross-sectional study from February 2014 to June 2016. We assessed the vitamin D levels of natural population by a standard classification in which serum 25-hydroxy vitamin D (25-OHD)<50 nmol/ L was defined as vitamin D deficiency. Results The average serum 25-OHD level was (40. 5 ± 12. 5)nmol/ L, and there were 80. 3% subjects who would be classified as vitamin D deficiency; The average serum 25-OHD level of women was significantly lower than that of men (P< 0. 05); The serum 25-OHD concentrations of the <30, 30-39, 40-49, 50-59, 60-69, ≥70 age groups were 37. 81(31. 98-43. 52)nmol/ L, 39. 46(33. 87-45. 72) nmol/ L, 41. 17(34. 10-48. 65) nmol/ L, 40. 67(34. 20-49. 02) nmol/ L, 44. 00 (35. 67-53. 93) nmol/ L, 44. 14 (34. 61-55. 85)nmol/ L for males, and 36. 86 (30. 52-43. 75) nmol/ L, 37. 11 (31. 68-43. 23) nmol/ L, 36. 94 (30. 72-43. 71) nmol/ L, 38. 42(32. 08-46. 41) nmol/ L, 38. 58(31. 04-46. 21) nmol/ L, 37. 31(29. 34-47. 17) nmol/ L for females in corresponding subgroups. Conclusion The prevalence of vitamin D deficiency of natural population in eastern China was common, the levels of vitamin D in women were lower than those of men. However, the vitamin D levels were tended to be increasing with the advance of age.

Effects of 4-week Hypoxic Exercises on the Temporal Changes of Autophagy-related Factors in Skeletal Muscles of Healthy Obese Rats / 中国运动医学杂志

Objective To determine the effect of hypoxia conditions on the expression of autophagyrelated genes including P62,LC3 and Beclin-1 in the gastrocnemius muscles of rats with alimentary obesity and the possible mechanism of cellular autophagy induced by hypoxia exercises.Methods The model of rats with alimentary obesity was induced in Sprague-Dawley rats using high-fat diet.Then the obese rats were randomly divided into a control(C) group,a hypoxia-exercises-for-1-week(E1) group,a hypoxia-exercises-for-2-weeks (E2) group,a hypoxia-exercises-for-3-weeks (E3) group and a hypoxia-exercises-for-4-weeks(E4) group,each of 10.The rats were exposed to the environment where the simulated hypoxia was of about 13.6％ oxygen concentration(about the oxygen concentration at an actual altitude of 3,500 m),and underwent treadmill running with the speed at 20 m/min on a slope of 0 gradient every day,five days a week.After the last training,the rats were killed and sampled.The RT-PCR was used to detect the level of P62,LC3 and Beclin-1 mRNA and Western Blotting was conducted to examine the changes of protein P62 and LC3 before and after the intervention.Results Compared with group C,the expression of Beclin-1 mRNA in group E1,E2 and E3 increased significantly(P＜0.05),while the expression of protein Beclin-1 decreased significantly in group E2.The expression of protein Beclin-1 of group E2 and E3 was significantly lower than that of group E4,but there were no significant differences between group E2 and E3.Compared with group C,the relative expression of P62 mRNA in group E1 and E2 increased significantly(P＜0.05,P＜0.01),with that of group E2 significantly higher than group E1 (P＜0.05).Moreover,the relative expression of P62 mRNA in group E3 was significantly lower than that of E2(P＜0.01),and that of group E4 was significantly higher than group C,E1 and E3(P＜0.01).The relative expression of protein P62 in the obese rats in group E3 was significantly higher than that of group E2(P＜0.05).The relative expression of LC3 mRNA in group E2,E3 and E4 was significantly higher than that of group C(P＜0.01).Moreover,there were no significant differences in LC3-Ⅱ/LC3-Ⅰ protein among the five groups.Conclusion Hypoxia exercise can significantly enhance the relative expression of autophagy genes,and promote,to some extent,the autophagy.However,the transcription of autophagy genes does not happen synchronically with the synthesis of autophagy proteins.Moreover,an increase in autophagy in the skeletal muscle can be seen in the first two weeks of hypoxia exercises,followed by a gradual decrease with time prolonged,which may be the result of the gradual adaptation to hypoxia stimulation of the body.

Serum vitamin D levels of the natural population in eastern China / 中华内分泌代谢杂志

Objective To assess vitamin D levels in eastern China by a standard measurement. Methods The data were from a 2014 Survey on the Prevalence in East China for Metabolic Diseases and Risk Factors-China data base. There were 12662 subjects included in this cross-sectional study from February 2014 to June 2016. We assessed the vitamin D levels of natural population by a standard classification in which serum 25-hydroxy vitamin D (25-OHD)<50 nmol/ L was defined as vitamin D deficiency. Results The average serum 25-OHD level was (40. 5 ± 12. 5)nmol/ L, and there were 80. 3% subjects who would be classified as vitamin D deficiency; The average serum 25-OHD level of women was significantly lower than that of men (P< 0. 05); The serum 25-OHD concentrations of the <30, 30-39, 40-49, 50-59, 60-69, ≥70 age groups were 37. 81(31. 98-43. 52)nmol/ L, 39. 46(33. 87-45. 72) nmol/ L, 41. 17(34. 10-48. 65) nmol/ L, 40. 67(34. 20-49. 02) nmol/ L, 44. 00 (35. 67-53. 93) nmol/ L, 44. 14 (34. 61-55. 85)nmol/ L for males, and 36. 86 (30. 52-43. 75) nmol/ L, 37. 11 (31. 68-43. 23) nmol/ L, 36. 94 (30. 72-43. 71) nmol/ L, 38. 42(32. 08-46. 41) nmol/ L, 38. 58(31. 04-46. 21) nmol/ L, 37. 31(29. 34-47. 17) nmol/ L for females in corresponding subgroups. Conclusion The prevalence of vitamin D deficiency of natural population in eastern China was common, the levels of vitamin D in women were lower than those of men. However, the vitamin D levels were tended to be increasing with the advance of age.

The relationship of hypersensitive C reactive protein with carotid atherosclerosis and serum calcium and phosphorus in elderly patients with type 2 diabetes mellitus with hypertension and increased homocysteine / 中国糖尿病杂志

Objective To investigate the relationship of hypersensitive C reactive protein with carotid atherosclerosis and serum calcium and phosphorus in elderly patients with type 2 diabetes mellitus plus hypertension and increased homocysteine . Methods A total of 105 subjects were enrolled .Carotid intima-media thickness(CIMT) was determined by doppler ultrasound .All the participants were divided into three groups :control group (n=30 ,CIMT0.05).The levels of lipoproteins (LP) and HbA1 c were significantly higher in common carotid sclerosis group and common carotid plaque group than in the control group (P<0.05).The TC was higher in common carotid plaque group than in the control group[(4.32 ± 1.10) vs (3.69 ± 0.67)mmol/L , P<0.05].Pearson correlation analysis showed than CIM T was positively associated with hsC‐RP and Hcy (r=0.560 ,0.452 ,P<0.01). Logistic regression analysis showed that CIMT is independently associated with hsC‐RP and Hcy(OR=1.501 ,1.523 ,P<0.01). Conclusion The levels of serum hsC‐RP and Hcy were not only independent risk factors for carotid artery atherosclerosis but also related to the stability of atherosclerosis plaque in the patients with type 2 diabetes mellitus with hypertension .

Trace glucose fluxes in individuals with prediabetes using stable isotopes / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The glucose fluxes of individuals with prediabetes in Chinese population are not clear. This study was to determine whether the endogenous glucose production (EGP), oral glucose rate of appearance (Ra) and glucose rate of disappearance (Rd) were different in Chinese individuals with prediabetes under fasting conditions and following an oral glucose challenge.</p><p><b>METHODS</b>Five subjects with type 2 diabetes, 5 subjects with prediabetes and 5 non-diabetic subjects matched for age, weight, fat free mass and body mass index underwent a 180 minute stable glucose isotope tracing ([6, 6-(2)H2] glucose, [1-(13)C] glucose, and [U-(13)C] glucose) study under fasting and after ingestion of a 75 g oral glucose load. Isotope glucose enrichment was measured by gas chromatography-mass spectrometry. Insulin sensitivity was estimated using the oral glucose tolerance test (OGTT)-derived insulin sensitivity index, β cell function was determined by the insulinogenic index (δI30/δG30).</p><p><b>RESULTS</b>The insulin sensitivity index (P = 0.043) and insulinogenic index (P = 0.021) were decreased in subjects with prediabetes compared with non-diabetes. Fasting EGP was slightly higher (P = 0.29) and postprandial EGP was comparable in subjects with prediabetes and non-diabetes during 120 minutes after glucose ingestion, but nadir EGP occurred later in prediabetic than non-diabetic subjects. Ra did not differ among the three groups. Rd was substantially lower in subjects with prediabetes than non-diabetes after glucose intake (P = 0.013).</p><p><b>CONCLUSION</b>The mild hyperglycemia observed among individuals with prediabetes may result from decreased Rd during the postprandial state.</p>

Mitochondrial apoptosis of lymphocyte is induced in type 2 diabetes / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Lymphocyte function and homeostasis is associated with immune defence to infection. Apoptosis of lymphocytes might be a considerably important component which has an impact on immunity to infections in people with hyperglycemia. The aim of this study was to explore the mitochondrial apoptosis pathway of lymphocyte in diabetic patients.</p><p><b>METHODS</b>Sixty patients with type 2 diabetes mellitus and fifty healthy volunteers were included in this study. Annexin V and propidiumiodide (PI) were joined in the isolated lymphocytes and the rate of lymphocyte apoptosis was calculated with flow cytometry. Observation of the lymphocytes was done using transmission electron microscopy; mitochondria had been extracted and then mitochondrial membrane potential (MMP) was detected to assess mitochondrial function; the mRNA level of Bcl-2, cytochrome c (Cyt-C), caspase-9 and caspase-3 were analyzed by real-time reverse transcription-polymerase chain reaction (RT-PCR).</p><p><b>RESULTS</b>Apoptosis rate of lymphocyte was significantly higher in diabetic group than that in normal control group (P < 0.05). Transmission electron microscopy showed lymphocyte shrinkage and breakage, chromatin condensation and less mitochondria; a fall in MMP levels was also evident; Bcl-2 concentration was reduced and the expressions of caspase-9, caspase-3 and Cyt-C were elevated (P < 0.05) in diabetic patients.</p><p><b>CONCLUSIONS</b>The rate of lymphocyte apoptosis was significantly higher in type 2 diabetic patients than that in normal population. Mitochondrial apoptosis pathway may play a very important role in decreasing function of lymphocyte in diabetes.</p>

Impact of drug intervention on cardiomyopathy in STZ-induced type 1 diabetic rats / 中国综合临床

Objective To investigate the pathological changes of myocardium in diabetic rats and the effect of aspirin, perindopril, prednisone on the pathological changes of myocardium in type 1 diabetic rats. Methods Thirty SD rats were randomly divided into the following groups: ( 1 ) diabetes mellitus (DM)group ( n = 20): treated with intraperitoneal injection of streptozocin (STZ) 60 mg/kg at one time, diluted in sodium citrate buffer. (2) normal control group (n = 10): intraperitoneal injection of sodium citrate buffer. The blood glucose and the weight were measured regularly for 8 weeks. The 20 diabetic model rats were randomly divided into four groups (n = 5 individually), from the 4th day, the rats were given normal saline dissolved aspirin, perindopril, prednisone gavage respectively, and the normal control group and diabetic group were given an equal volume of saline daily gavage. After 8 weeks, the pathological changes in the cardiac muscle tissue were observed under light microscope and electron microscope. Results Three days after the injection of STZ, the blood glucose in the DM group was higher than 16. 7 mmol/L,20 rats were all modeling successfully. The model rats suffered from polydipsia, polyphagia, polyuria and weight loss significantly. HE staining showed diabetic myocardial cell swell, hypertrophy, degeneration and significant nuclear enlargement; the myocardial fiber fractured,dissolved, contraction wavy and disorganized fibre infiltrated by inflammatory cells. Under electron microscope, diabetic myocardial muscle fibers arranged irregularly, fractured and dissolved; the glycogen between the muscle fiber accumulated, mitochondria swelled, most of the ridges in mitochondria were not clear, cell plate widened. Compared with the diabetic group, the above-mentioned pathological changes reduced in the drug intervention group,and the changes in perindopril group was most significant. Conclusion Injection of STZ 60 mg/kg could successfully induce diabetic in rats and held stable blood glucose level. After 8 weeks, diabetes could cause servere damages in myocardium in the rats, but aspirin, perindopril, prednisone could reduce the cardiomyopathy in diabetic rats,in which perindopril had more positive effect.

Analysis of influencing factors of hemoglobin A1c in type 2 diabetic patients / 中国医师进修杂志

Objective To analyze the influencing factors of hemoglobin A1c in type 2 diabetic patients,including blood glucose,anti-diabetic therapeutic regiments,disease course,age,diabetic education,degree-educated,self-monitoring blood glucose.Methods Seventy-eight type 2 diabetic patients were divided into two groups by different degree of blood glucose,anti-diabetic therapeutic regiments,disease course,age,diabetic education,degree-educated,self-monitoring blood glucose.The levels of hemoglobin A1c in two groups were compared.Results There were significant changes in the levels of hemoglobin A1c between fasting blood glucose (FBG) ≤ 6.1 mmol/L group (30 cases) and FBG ＞ 6.1 mmol/L group (48cases),2 h postprandial blood glucose (2hBG) ≤8.0 mmol/L group (32 cases) and 2hBG ＞ 8.0 mmol/L group (46 cases ),insulin treatment group (27 cases) and no-insulin treatment group ( 51 cases ),combined drugs treatment group ( 36 cases ) and single drug treatment group ( 15 cases),age ≤ 65 years old group (41cases) and age ＞65 years old group (37 cases),disease course≤ 10 years group (39 cases) and disease course ＞ 10 years group( 39 cases),degree-educated above high grade group( 34 cases) and degree-educated below high grade group (44 cases),diabetic education ≥2 times/month group (20 cases) and diabetic education ＜ 2 times/month group (58 cases),self-monitoring blood glucose≥2 times/week group ( 19 cases)and self-monitoring blood glucose ＜ 2 times/week group (59 cases)[ (6.7 ± 1.5 )％ vs.(7.9 ± 1.3 )％,(6.8 ±1.1)％ vs.(7.8 ± 1.2)％,(6.7 ± 1.5)％ vs.(8.1 ± 1.4)％,(6.8 ± l.0)％vs.(8.0 ± 1.6)％,(6.9 ± 1.7)％ vs.(7.4 ± 1.6)％,(6.5 ± 1.2)％ vs.(8.2 ± 1.3)％,(6.9 ± 1.0)％ vs.(7.6 ± 1.4)％,(6.1 ± 1.7)％ vs.(8.0 ±1.1 ) ％,(6.7 ± 1.1 )％ vs.(7.6 ± 1.2)％ ] (P ＜ 0.01 or ＜ 0.05 ).Conclusion Blood glucose,anti-diabetic therapeutic regiments,disease course,diabetic,degree-educated,self-monitoring blood glucose are the important factors influencing hemoglobin A1c.

Changes of glucagon and somatostatin levels during oral glucose tolerance test in patients with type 2 diabetes mellitus / 中华内分泌代谢杂志

The fasting and 2 h levels of glucagon, somatostatin ( SS), and C-peptide during 75 g oral glucose tolerance test in 60 patients with type 2 diabetes and 34 normal subjects were determined. Compared with control group, the fasting levels of glucagon and SS and 2 h levels of SS after glucose loading significantly decreased,while the fasting and 2 h levels of C-peptide increased in diabetes group. The 2 h levels of these hormones were significantly higher than the fasting levels in two groups. Compared with control group, the increased folds of glucagon ( 1.40±0.48 vs 1.20±0. 30, P＜0. 05 ) and SS( 2.79±2. 17 vs 1.14±0. 22, P＜0. 01 ) levels after glucose loading were higher and that of C-peptide level ( 3.58 ±3. 10 vs 8. 33 ± 6. 99, P＜0. 01 ) was lower in diabetes group. The levels of fasting glucagon were positively correlated with that of fasting SS in two groups( both P＜0. 01 ). These results suggest that disturbance exists in hormones from α and δ cells besides the dysfunction of β cells in patients with type 2 diabetes.

Genetic diagnosis and weight loss surgery of a case of Prader-Willi syndrome / 中华内分泌代谢杂志

To investigate the clinical features, genetic diagnosis, and treatment of a patient with Prader-Willi syndrome(PWS). For a case with clinically suspected PWS, methylation specific PCR(MSPCR)amplification was applied to CpG islands of SNRPN(exon α)gene locus in the 15q11-q13. Furthermore, the diagnosis was comfirmed by the method of bisulfite sequencing PCR(BSPCR). Metabolic status before and after the operation of sleeve gastrectomy were compared. Absence of amplification of paternal allele on chromosome 15q11-q13 was detected in the case by MSPCR, different from the normal control. Results of BSPCR further proved a full methylation of CpG islands in the SNRPN gene locus. Four months after sleeve gastrectomy, systemic metabolic status and ventricular function were improved. MSPCR and BSPCR were both consistent with genetic diagnosis of PWS. Weight loss surgery is expected to be a major therapy of this disease.

Effects of metformin on thyrotropin: A preliminary study / 中华内分泌代谢杂志

Objective To evaluate the effects of metformin on thyrotropin(TSH)levels. Methods From the patients with type 2 diabetes mellitus or metabolic syndrome, 48 patients with primary hypothyroidism were enrolled and grouped. 17 patients were treated only with metformin(group A), 19 patients with metformin and stable L-T4substitution(group B), and the remaining 12 patients with antidiabetic drugs(other than metformin)and L-T4(group C). Meanwhile, 20 euthyroid patients with other thyroid abnormalities(group D)and 30 patients without thyroid diseases(group E)served as control. TSH, FT3, FT4, TT3, TT4, and blood glucose were determined regularly in all these subjects. Results After administration of metformin for 12 months, serum TSH were decreased in group A [(5.05±1.07 vs 2.61±0.91)mU/L, P＜0.01] and group B [(2.67±1.03 vs 1.35±0.74)mU/L, P＜0.01]. No difference was found in FT3and FT4in both groups. TSH levels were raised from(1.30±0.71)to(2.58±1.02)mU/L(P＜0.01)within 8～12 weeks in 13 out of 15 patients after metformin withdrawal. Serum TSH and thyroid hormones in the other 3 groups were not significantly changed. Conclusion Administration of metformin may lead to reduction of serum TSH level.

The function of hepatic oval cells under high glucose condition in vivo / 中华内分泌代谢杂志

Rat hepatic oval cell model was induced by hyperglycemia and streptozotocin in vivo. Expression of insulin and mRNA expression of pancreatic transcription factors(Nkx6.1, PDX-1) were carried out. It showed that under high glucose, liver tissues were positive for insulin staining, the expression of Nkx6.1 and Pdx-1mRNA was significantly enhanced, and insulin-1mRNA was found to be expressed. The result suggests that under high glucose, hepatic oval cells can differentiate into insulin-producing cells.

Identification of steroid biosynthetic defects in genotype-proven heterozygote individuals with 17α-hydroxylase/17,20-lyase deficiency / 中华内分泌代谢杂志

Objective To investigate the adrenal steroidogenic function in genotype-proven heterozygotes carrying mutations in CYP17A1 gene in vivo. Methods Eight patients and 14 family members from 5 families with 17-hydroxylase/17,20-lyase deficiency (17OHD) were recruited. The mutations of the CYP17A1 gene in these individuals were screened by direct sequencing of PCR products. The hormonal response to ACTH was evaluated in the 14 genotype-proven carriers and 45 age- and sex-matched normal subjects. Results Three mutations were found in 5 unrelated families. 14 carriers with CYP17A1 mutation were identified, including 7 heterozygotes with D487_F489del, 6 with Y329fs, and 1 for H373L. Compared to the normal subjects, the carriers exhibited lower basal and ACTH-stimulated cortisol levels, but higher ACTH-stimulated corticosterone level. The ratios of corticosterone to cortisol in the genotype-proven heterozygotes were higher than those of normal individuals at baseline and following ACTH-stimulation. Similarly, progesterone level and ratios of progesterone to 17-hydroxyprogesterone in the male heterozygotes were also higher than that of normal individuals before and after stimulation. No significant differences were observed in the hormone levels between two genotypes (D487_F489del vs Y329fs). Conclusions Genotype-proven carriers of 17OHD without apparent clinical symptoms exhibit decreased enzyme activity,analogous to mildly impaired adrenal 21-hydroxylase activity in the carriers of CYP21 A2 gene mutation.