Essence interpretation and hot debates of American Diabetes Association(ADA)Scientific Sessions in 2020 / 中华内分泌代谢杂志

The 80th American Diabetes Association(ADA)Scientific Sessions was held online from June 12 to 16, 2020. There was some hot debates on the topics of diabetes related complications in the annual meeting of ADA. Endocrinologists and cardiologists debated and presented different perspectives. This paper will summarize the debates on the following five topics: (1)Microvascular and macrovascular complications of diabetes are distinct pathophysiologic entities.(2)Guideline recommendations for cardiovascular risk and disease management in type 2 diabetes.(3)Drawing the line between primary and secondary prevention—necessary or too simplistic? (4)Should metformin be considered first-line therapy for individuals with type 2 diabetes with established arteriosclerotic cardiovascular disease(ASCVD)or at high risk for ASCVD? (5)Primary cardiovascular prevention with sodium-glucose co-transporter 2(SGLT2)inhibitors or glucagon-like peptide-1(GLP-1)receptor agonists.

Precision Therapy in Acromegaly Caused by Pituitary Tumors: How Close Is It to Reality?

Acromegaly presents with an enigmatic range of symptoms and comorbidities caused by chronic and progressive growth hormone elevations, commonly due to endocrinologic hypersecretion from a pituitary gland tumor. Comprehensive national acromegaly databases have been appearing over the years, allowing for international comparisons of data, although still presenting varying prevalence and incidence rates. Lack of large-scale analysis in geographical and ethnic differences in clinical presentation and management requires further research. Assessment of current and novel predictors of responsiveness to distinct therapy can lead to multilevel categorization of patients, allowing integration into new clinical guidelines and reduction of increased morbidity and mortality associated with acromegaly. This review compares current data from epidemiological studies and assesses the present-day application of prognostic factors in medical practice, the reality of precision therapy, as well as its future prospects in acromegaly, with a special focus on its relevance to the South Korean population.

Lineage conversion of mouse fibroblasts to pancreatic α-cells

α-cells, which synthesize glucagon, also support β-cell survival and have the capacity to transdifferentiate into β-cells. However, the role of α-cells in pathological conditions and their putative clinical applications remain elusive due in large part to the lack of mature α-cells. Here, we present a new technique to generate functional α-like cells. α-like cells (iAlpha cells) were generated from mouse fibroblasts by transduction of transcription factors, including Hhex, Foxa3, Gata4, Pdx1 and Pax4, which induce α-cell-specific gene expression and glucagon secretion in response to KCl and Arg stimulation. The cell functions in vivo and in vitro were evaluated. Lineage-specific and functional-related gene expression was tested by realtime PCR, insulin tolerance test (ITT), glucose tolerance test (GTT), Ki67 and glucagon immunohistochemistry analysis were done in iAlpha cells transplanted nude mice. iAlpha cells possess α-cell function in vitro and alter blood glucose levels in vivo. Transplantation of iAlpha cells into nude mice resulted in insulin resistance and increased β-cell proliferation. Taken together, we present a novel strategy to generate functional α-like cells for the purposes of disease modeling and regenerative medicine.

"High detective rate of""metabolic inflammatory syndrome""in patients with type 2 diabetes" / 中华内分泌代谢杂志

Objective Metabolites produced by metabolic imbalance such as free fatty acids and lipopolysaccharides can result in a state of chronic low-grade inflammation, or metabolic inflammation, which plays an important role in the pathogenesis of atherosclerosis, type 2 diabetes, non-alcoholic fatty liver disease, and obesity. The above metabolic disorders are closely related with the metabolic inflammation, which always coexist. Therefore, we proposed the concept ofmetabolic inflammatory syndrome ( MIS). According to our study, patients with two or more metabolic disorders above could be diagnosed as MIS. The current research is aimed to investigate the prevalence of MIS and its components, and to compare the clinical values of MIS and metabolic syndrome ( MS) . Methods 2 001 in patients with type 2 diabetes from 6 hospitals in Shanghai were recruited in the current multi-center cross-sectional study. The diagnostic rates of MIS and MS and their components of both syndromes were compared. Results In the patients with type 2 diabetes, the detective rate of MIS was 96. 2%, which was higher than that of MS (71. 3%). Among 4 components of MIS, atherosclerosis showed the highest detective rate (75.6%). MIS[OR=2.252(95%CI1.026-4.942),P=0.043],atherosclerosis[OR=2.726(95% CI1.953-3. 804),P<0. 001], and MS[OR=1. 915 (95%CI 1. 444-2. 540),P<0. 01] were the risk factors of coronary heart disease. Conclusion With atherosclerosis, type 2 diabetes mellitus, non-alcoholic fatty liver disease, and obesity as its 4 components, MIS has a high detective rate in patients with metabolic disorders, and seems to be more sensitive than MS to distinguish inflammation-related metabolic diseases. The concept of MIS will promote the screening and prevention of atherosclerosis in its early stage.

Hyperthyroid-associated EMA syndrome:four cases report and review of literature / 中华内分泌代谢杂志

[Summary] Four patients with hyperthyroid-associated exophthalmos, myxedema, acropachy ( EMA ) syndrome, including three male patients and one female patient were diagnosed with Graves′diseases and treated by 131 I therapy. Complaints of thyrotoxicosis were presented at the onset. Tibia myxedema and acropathy appeared, and eye symptoms aggravated in two patients after anti-thyroid drug therapy and 131 I therapy. Four cases were all given clobetasol propionate, miconazole nitrate, neomycin sulfate and urea cream alone or in combination with compound betamethasone local injection treatment, and three cases were given low-dose oral prednisone treatment. Complaints of tibia myxedema and eye symptoms were significantly improved after the treatment. Therefore, we should be wary of the occurrence of hyperthyroid-associated EMA syndrome after 131 I therapy. Corticosteroid might be the effective therapy for myxedema and eye symptoms of EMA syndrome.

A Meta-analysis of carotid intima-media thickness and subclinical hypothyroidism / 中国组织工程研究

BACKGROUND:Recently, subclinical hypothyroidism has been associated with increased carotid intima-media thickness, but it is controversial. OBJECTIVE:To assess whether carotid intima-media thickness in patients with subclinical hypothyroidism differs from that in euthyroid subjects. METHODS:We searched published studies concerning the carotid intima-media thickness of patients with subclinical hypothyroidism in comparison with euthyroid subjects. Then, we evaluated each potential study for eligibility, assessed the methodological quality, and extracted the data for a Meta-analysis. RESULTS:Eight observational studies with 3 602 cases met the eligibility criteria. In patients with subclinical hypothyroidism, the pooled estimate of the weighted mean difference (WMD) of increased carotid intima-media thickness was 0.056 [95%CI (0.020, 0.092)]. Sensitivity analysis using a pooled result of the seven higher-quality studies demonstrated higher carotid intima-media thickness level in patients with subclinical hypothyroidism than in euthyroid subjects [WMD=0.064, 95%CI(0.024, 0.105)]. In a subgroup analysis, subclinical hypothyroidism was even more significantly associated with the carotid intima-media thickness in patients with a mean thyrotropin level > 10.0 mU/L [WMD=0.082, 95%CI (0.049, 0.116)]. Subclinical hypothyroidism was also associated with a significant increase in systolic blood pressure, triglyceride levels, total cholesterol levels, low-density lipoprotein levels and with a decrease in fasting plasma glucose. This meta-analysis indicates that subclinical hypothyroidism is associated with an increased carotid carotid intima-media thickness, which may be due to elevated thyrotropin, dyslipidemia and hypertension. Despite the obvious individual differences, a prospective large-sample study is necessary to further assess the conclusions of this observation.

Genetic diagnosis for a Chinese Han family with primary hypertrophic osteoarthropathy / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To identify the genetic cause for a Chinese Han family affected with primary hypertrophic osteoarthropathy.</p><p><b>METHODS</b>Whole blood and urine samples were collected from a patient and 7 unaffected relatives of the family. The coding sequences and intron/exon boundaries of HPGD and SLCO2A1 genes of the patient were amplified with polymerase chain reaction and sequenced. The genotypes of relatives were subsequently verified. Urinary prostaglandin level was measured with enzyme-linked immunosorbent assay (ELISA).</p><p><b>RESULTS</b>A homozygous 2-bp deletion in HPGD gene (c.310_311delCT, or p.L104AfsX3) was detected in the patient, and 5 heterozygous carriers were identified in the relatives. The urinary prostaglandin E2 (PGE2) level was significantly elevated (P<0.01), while PGE-M was significantly reduced (P<0.01) in the patient.</p><p><b>CONCLUSION</b>Primary hypertrophic osteoarthropathy in this family is caused by a homozygous mutation (c.310_311delCT) in the HPGD gene.</p>

Ezscan: A new non-invasive technology to evidence cardiac autonomic neuropathy in diabetes / 中华内分泌代谢杂志

Objective To assess the efficacy of Ezscan in evaluating the risk of cardiac autonomic neuropathy (CAN) in diabetes. Methods This study included 144 patients with diabetes. Their serum lipid profile and HbA1c were determined. The heart rate variability was assessed by Holter, and the cardiac autonomic neuropathy by classic experiments. Meanwhile, Ezscan was carried out. Results There was a positive correlation between low frequency (LF) measurements by Holter and Ezscan score( r=0. 39, P＜0. 01 ), so did LF/HF and Ezscan score( r=0. 28, P＜0. 01 ). Correlations between Ezscan score and other Holter parameters were weaker. There was no correlation between HbA1c and LF measurements. In patients with positive classic experiments, the sensitivity and specificity of Ezscan were 58. 3% and 57.8% respectively. Conclusions Ezscan test is a valuable screening procedure for detecting diabetic complications. It is more facilitative and takes shorter time than does the classical autonomic function assessment.