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Objective:To explore the application effect of clinical path teaching method (CPTM) and case-based learning (CBL) in the standardized residency training in the department of endocrinology.Methods:A total of 120 residents who participated in the standardized residency training in the Department of Endocrinology in The First Affiliated Hospital of University of Science and Technology of China from June 2020 to June 2021 were selected as subjects. They were randomly divided into the control group (30 cases) who received traditional teaching mode, CPTM group (30 cases), CBL group (30 cases) and the experimental group (30 cases) who received CPTM + CBL combination teaching mode. The graduation examination results, usual performances and the teaching satisfaction among the four groups were compared.Results:The students in experimental group had higher score in learning methods, task completion, clinical thinking ability and operational assessment than the rest three groups. In addition, the students in experimental group were more enthusiastic to learn than the control group and CPTM group, and the difference was statistically significant ( P<0.05). The students in experimental group had better performance in graduation examination (55.97±5.58) than the control group (51.97±4.54), CPTM group (53.48±3.37) and CBL group (51.36±3.72).The teaching satisfaction of the students in experimental group was higher than that of the rest three groups. Furthermore, the teaching experience of teachers in experimental group was better. Conclusion:CPTM combined with CBL teaching method can improve the thinking skills and learning initiative, which is beneficial to cultivate the clinical ability of residents in the standardized residency training of endocrinology.
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Objective:To verify the efficacy and safety of daily oral minodronate in postmenopausal women with established osteoporosis.Methods:In this randomized, double-blinded, placebo-controlled trial, 262 postmenopausal women were enrolled. Patients were randomized to receive daily oral minodronate 1 mg with supplements of 500 mg calcium and 200 U vitamin D 3 ( n=130) or placebo ( n=132) with daily supplements of 500 mg calcium and 200 U vitamin D 3, for 48 weeks. The primary endpoint was the average bone mineral density (BMD) change in the lumbar vertebrae 48 weeks post-treatment. Secondary outcome measures was the incidence of vertebral fractures. Safety assessments included the rate of adverse events. Results:At the end of 48 weeks treatment, the average BMD change rate from baseline were: full analysis set results: (3.52±4.82)% in the minodronate group and (2.00±5.74)% in the placebo group; per-protocol set results: (3.99±5.05)% in the minodronate group and (2.07±6.20)% in the placebo group; the differences were all significant (all P<0.05). Vertebral fracture occured in 3 patients (2.3%, 3/132) in the placebo group, and 1 case (0.8%, 1/130) in the minodronate group ( P>0.05). The incidence of adverse events was 71.5% (93/130) in the minodronate group and 78.0% (103/132) in the placebo group ( P>0.05). Conclusion:Minodronate is effective and safe in the treatment of postmenopausal osteoporosis without severe side effects.
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Objective:To explore the related influencing factors of carotid atherosclerosis(AS)plaque formation and stability in the patients with type 2 diabetes mellitus(T2DM),and to provide scientific evidence for early prevention and treatment.Methods:A total of 249 cases of simple T2DM patients were selected.According to the results of carotid artery color Doppler ultrasound,they were divided into AS group,stable plaque group and unstable plaque group.The differences in physicochemical indexes and life style of the patients were compared between three groups;univariate analysis and Logistic regression analysis were used to screen the related influencing factors of carotid AS plaque formation and stability of the T2DM patients.Results:The univariate analysis showed that age,fasting blood glucose(FBG),glycosylated hemoglobin(HbA1c),non-high density lipoprotein cholesterol (NHDL-C),monocyte/ high density lipoprotein ratio(MHR),smoking ratio(Smoking%),T2DM disease course,high density lipoprotein protein cholesterol(HDL-C)had significant differences between AS group and plague group(P<0.05).There were significant differences in the values of postprandial blood glucose(PBG), systolic blood pressure(SBP),low density lipoprotein cholesterol(LDL-C),HbA1c,MHR,Smoking% and HDL-C of the patients in stable plaque group and unstable plaque group(P<0.05).The Logistic regression analysis showed that high age,HbA1c,NHDL-C,MHR and smoking were the risk factors of the plaque formation and high HDL-C was a protective factor of plaque formation(Age:OR=1.62,P=0.011;HbA1c:OR=1.25, P=0.027;HDL-C:OR=0.65,P=0.009;MHR:OR=3.50,P=0.000;Smoking:OR=2.28,P=0.009;NHDL-C:OR=1.39,P=0.028).High SBP,LDL-C,MHR and smoking were the risk factors of unstable plaque formation,and high HDL-C was a protective factor of unstable plaque formation(SBP:OR=1.5 7,P=0.003;LDL-C:OR=1.99,P=0.000;MHR:OR=3.88,P=0.000;Smoking:OR=2.01,P=0.001;HDL-C:OR=0.53,P=0.001).Conclusion:For the patients with simple T2DM and carotid AS plaque,blood lipid,blood pressure and smoking cessation should be emphasized and HDL-C level should be increased,which can effectively prevent the formation of AS plaque and stabilize the plaque.
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Objective To investigate the relationship among retinol binding protein 4(RBP-4), 25-hydroxy vitamin D [25(OH)D]concerntrations and lower extremity arterial disease (LEAD)in type 2 diabetes mellitus (T2DM) patients. Methods A total of 197 T2DM patients and 80 healthy subjects were recruited in this study.The diabetic patients were assigned to group without complications (non-LEAD)and group complicated with LEAD (LEAD).Biochemical indications,serum RBP4 and 25(OH)D concentrations were measured. Results Serum RBP4 levels in LEAD group[(39.14 ± 2.14) μg/ml] increased as compared with that in group non-LEAD [(30.01 ± 2.09)μg/ml]and NC group [(14.09 ± 1.88)μg/ml](P<0.01).Serum 25(OH)D concentrations in LEAD group [(11.63 ± 6.83)ng/ml]were lower than that in Non-LEAD group [(18.02 ± 6.42)ng/ml]and NC group[(23.39 ± 4.68)ng/ml](P<0.05).Serum RBP-4 was positively associated with triglycerides (TG),low density lipoprotein cholesterol (LDL-C),homeostasis model assessment for insulin resistance (HOMA-IR),body mass index (BMI), waist-hip ratio (WHR)and negatively associated with 25(OH)D and high density lipoprotein cholesterol (HDL-C).Serum 25(OH)D had a negative correlation with RBP-4,HbA1c,fasting plasma glucose(FPG),HOMA-IR and duration.Logistic regression analysis showed that HDL-C and 25(OH)D were protective factors of LEAD. Conclusion Increased serum RBP-4 levels and reduced 25(OH)D concentrations are significantly associated with the occurrence of LEAD in patients with T 2DM.
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Aims To observe the influences of met-formin ( MET ) on the expression of renal tissue ad-vanced glyclation end-products( AGEs) protein and its receptor mRNA ( RAGE mRNA ) in type 2 diabetes mellitus (T2DM) model rats, and to discuss the mech-anism of the MET in the treatment of diabetic nephrop-athy ( DN ) . Methods The rat model of T2 DM was established by fed with high-fat diet and intraperitoneal injection of low-dose of streptozotocin ( STZ ) . All rats were randomly divided into metformin group( MET,300 mg·kg-1 ·d-1 ) , glyburide group( GLY,5 mg·kg-1 ·d-1),T2DM model group(T2DM) and normal con-trol group ( NC ) . After 8 weeks ’ observation, blood glucose ( BG ) , glycated hemoglobin ( HbA1 c ) , blood urea nitrogen(BUN), urinary albumin,urinary AGEs and urine creatinine were detected. The expression of renal tissue AGEs was detected by immunohistochemis-try assay, and the expression of RAGE mRNA was measured by real-time PCR. Results The levels of BG, HbA1c , urinary albumin/urine creatinine ( UACR ) , glomerular basement membrane thickness ( GBMT ) in MET group and GLY group were signifi-cantly lower than those of T2DM group, while higher than those of NC group(P0. 05 ) . The urinary AGEs/urine creatinine( UGCR) , the expressions of re-nal tissue AGEs and RAGE mRNA in MET group and GLY group were significantly decreased compared with those of T2 DM group ( P < 0. 05 ) , but higher than those of NC group ( P <0. 05 ) . The UGCR, the ex-pressions of AGEs and RAGE mRNA in MET group were lower than those of GLY group(P<0. 05). Con-clusion MET can reduce the accumulation of AGEs in the renal tissue,and down-regulate the over-expres-sion of RAGE mRNA in T2DM rats.
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Dipeptydil-peptidase-4 (DPP-4) inhibitors are designed as oral anti-hyperglycemic drugs for the treatment of type 2 diabetes owing to their effects on the incretin system through sparing incretin hormones including glucagon-like peptide-1 (GLP-1) from rapid degradation by DPP-4.It has been shown that GLP-1 signaling may exert beneficial effects on cardiovascular system.In addition to GLP-1,DPP-4 physiologically cleaves cytokines,chemokines,and neuropeptides involved in inflammation,immunity,and vascular function.It means that DPP-4 inhibitors hold promise for cardiovascular protection independent of GLP-1.And its modulation of endothelial progenitor cells,infiammatory pathway,ischemic response,and lipid metabolism emerges as the major cardiovascular target of DPP-4 inhibitors.
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Objective To observe the effects of metformin on expression of Adenosine 5'-monophosphate (AMP)-activated protein kinase (AMPK),nuclear factor-κB (NF-κB) and transforming growth factor β1 (TGF-β1) in cultured rat glomerular mesangial cells (MCs),and explore its renoprotective mechanisms.Methods MCs were cultured in the medium with normal glucose (group NG,5.6 mmol/L),high glucose (group HG,25mmol/L) and different concentrations of metformin (group M1,M2,M3).After 48 h exposure,the supernatants and MCs were collected.The expression of NF-κB and TGF-β1 mRNA was analyzed by real time-PCR.Total-AMPK,phospho-Thr-172 AMPK (p-AMPK),NF -κB p65 and TGF-β1 were visualized by Western blot.Results The real time-PCR and Western blot result showed MCs could express AMPK,NF-κB and TGF-β1 mRNA and protein.After stimulated by HG,the levels of intracellular NF-κB and TGF-β1 expressions were significantly increased compared with group NG (P ＜ 0.05); The levels of NF-κB and TGF-β1 were significantly decreased in group M1,M2 and group M3 compared with group HG in a dose-dependent manner.After stimulated by HG,the level of intracellular p-AMPK were down-regulated compared with group NG(all P ＜ 0.05); The expression of p-AMPK increased with the rising of metformin concentration,presenting the opposite trend (P ＜ 0.05),while the level of total-AMPK protein was unchanged with exposure to HG or different concentrations of mefformin(P ＞ 0.05).Conclusion Metformin can suppress the expression of NF-κB and TGF-β1 of glomerular MCs induced by HG via AMPK activation,which may partly contribute to its reno-protection.
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<p><b>BACKGROUND</b>The renoprotective mechanisms of adenosine monophosphate (AMP)-activated protein kinase (AMPK) agonist - metformin have not been stated clearly. We hypothesized that metformin may ameliorate inflammation via AMPK interaction with critical inflammatory cytokines. The aim of this study was to observe the effects of metformin on expression of nuclear factor-κB (NF-κB), monocyte chemoattractant protein-1 (MCP-1), intercellular adhesion molecule-1 (ICAM-1) and transforming growth factor-beta 1 (TGF-β1) induced by high glucose (HG) in cultured rat glomerular mesangial cells (MCs).</p><p><b>METHODS</b>MCs were cultured in the medium with normal concentration glucose (group NG, 5.6 mmol/L), high concentration glucose (group HG, 25 mmol/L) and different concentrations of metformin (group M1, M2, M3). After 48-hour exposure, the supernatants and MCs were collected. The expression of NF-κB, MCP-1, ICAM-1, and TGF-β1 mRNA was analyzed by real time polymerase chain reaction. Western blotting was used to detect the expression of AMPK, phospho-Thr-172 AMPK (p-AMPK), NF-κB p65, MCP-1, ICAM-1, and TGF-β1 protein.</p><p><b>RESULTS</b>After stimulated by HG, the expression of NF-κB, MCP-1, ICAM-1, TGF-β1 mRNA and protein of MCs in group HG increased significantly compared with group NG (P < 0.05). Both genes and protein expression of NF-κB, MCP-1, ICAM-1, TGF-β1 of MCs induced by high glucose were markedly reduced after metformin treatment in a dose-dependent manner (P < 0.05). The expression of p-AMPK increased with the rising of metformin concentration, presenting the opposite trend, while the level of total-AMPK protein was unchanged with exposure to HG or metformin. Conlusion Metformin can suppress the expression of NF-κB, MCP-1, ICAM-1 and TGF-β1 of glomerular MCs induced by high glucose via AMPK activation, which may partly contribute to its reno-protection.</p>
Subject(s)
Animals , Rats , AMP-Activated Protein Kinases , Metabolism , Cells, Cultured , Glomerular Mesangium , Cell Biology , Glucose , Pharmacology , Mesangial Cells , Metabolism , Metformin , Pharmacology , NF-kappa B , MetabolismABSTRACT
Objective To investigate the prevalence and risk factors of metabolic obesity with normal weight (MON W) in Han nationality adult population,and to identify the cut-off points of body fat percentage (％ BF) by dualenergy X-ray absorptiometry(DXA) for defining MONW.Methods Six hundred and sixty subjects (403 men and 257 women) with body mass index(BMI) ranged from 18.5 to 23.9 kg/m2 were recruited into this study.Waist circumference(WC),blood pressure (BP),BM1,and ％ BF were measured.Serum concentrations of glucose,triglycerides(TG),total cholesterol (TC),high-density lipoprotein-cholesterol (HDL-C),low-density lipoproteincholesterol(LDL-C),serum insulin,and high-sensitivity C-reactive protein (hsCRP) were tested.Those within the highest quartile in the homeostasis model assessment of insulin resistance (HOMA-IR) with a normal BM1 between 18.5 and 23.9 kg/m2 were classified as MONW.Results The prevalence of MONW was 11.34％ for men and 16.34％ for women amongst normal-weight subjects,there was no significant different between men and women in the prevalence(P＞0.05).Multivariable Logistic regression analysis showed that TG(OR =5.92,P=0.001),LDLC (OR =13.65,P =0.009),hsCRP (OR =2.09,P =0.011),WC (OR =2.35,P ＜ 0.01),％ BF (total,OR =3.65,P＜0.01) and ％ BF(abdominal,OR =26.07,P＜0.01) were the risk factors of MONW amongst men.For women,TG (OR =9.12,P＜0.01),LDL-C (OR =2.64,P =0.005),HDL-C (OR =0.020,P＜ 0.01),hsCRP (OR =2.15,P =0.039),WC (OR =1.32,P =0.045),％ BF(total,OR =1.73,P＜0.01) and ％ BF(abdominal,OR =8.43,P＜0.01) were the risk factors of MONW.The cut-off points of ％ BF for diagnosing MONW by ROC were ％ BF≥25％ for men,％ BF ≥35.0％ for women.Conclusion MONW is quite common in Han nationality adult population;.％ BF,WC,hsCRP and lipid profiles were independently associated with MONW ％ BF ≥25 ％ for men,％ BF≥35.0％ for women can be used as reference cut-off.point for diagnosing MONW.
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Objective To discuss the effects of the changes of sex hormone levels on quality of life and nutritional status in middle-aged and elderly hospitalized men.Methods A total of 150 male patients (aged 45-90 years) were divided into 3 groups according to age:45-59-year (the middle-aged group),60-79 year (the elderly group),and over 80 year (the old old group) (n=50,each group).Levels of serum testosterone,follicle stimulating hormone (FSH),and luteinizing hormone (LH)were detected.The questionnaire (SF-36) and micro-nutrient assessment table (MNA) were conducted.Results Serum testosterone level was significantly lower in the old old group than in the elderly group and middle-aged group [(10.5±2.5) pmol/L vs.(13.1±2.0) pmol/L and (15.6±3.2) pmol/L,respectively,P＜ 0.05].Levels of FSH and LH were significantly higher in the old old group than in the elderly group and middle-aged group [(15.5±7.7)U/L vs.(12.7±5.1)U/L and (9.5±2.9)U/L,(9.8±3.7)U/L vs.(7.8±3.2)U/L and (5.4±2.0) U/L,respectively,P＜0.05].The 8 health latitude scores of SF-36 scale and nutritional status scores were significantly lower in the old old group than in the elderly group and middle-aged group (all P＜0.05).Relation analysis sho wed that age had a negative correlation with serum testocterone level (r=-0.389,P＜0.05),and had positive correlations with the levels of serum FSH and LH (r=0.427,r=0.520,both P＜0.05).After adjusting for age,serum testocterone level was positively correlated with physical functioning,role of physical activity,body pain,general health,vitality,mental health and nutritional status in SF-36 health scale (all P＜0.05),and had no obvious correlation with social function and emotional function health dimensions (all P＞0.05).Conclusions The sex hormone levels are changed with age,which can seriously affect the health state in middle-aged and elderly hospitalized men.
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Objective To study the changes of circulating triglyceride (TG) in the obese elderly, and to investigate the effect of hypertriglyceridemia on the development of insulin resistance. Methods A total of 82 subjects were divided into simple obesity group, obesity with IGT group, obesity with T2DM group and normal control group. The body height, body weight, blood pressure, fasting plasma glucose (FPG) and insulin(FPI), circulating TG and total cholesterol (TC) were measured. The homeostasis model assessment-insulin resistance (HOMA-IR) was calculated. Results The levels of serum TG were significantly higher in the simple obesity group ( 1.3 ± 0. 6) mmol/L, obesity with IGT group (1.9 ± 0.9)mmol/L and obesity with T2DM group (2.1±0.7) mmol/L than in the normal controls [(1.0±0.2)mmol/L, all P<0. 05], Furthermore, the levels of TG, FPG, FPI, HOMA-IR and systolic pressure were significantly higher(all P<0. 05) in obesity with IGT group and obesity with T2DM group than in simple obesity group. There were significantly positive correlations between TG and body mass index (BMI), FPG, HOMA-IR, TC, systolic pressure respectively (all P < 0.05). Multiple linear regression analysis indicated that FPG and HOMA-IR were the independent factors affecting TG (both P < 0. 05 ). Conclusions Hypertriglyceridemia may play an important role in the development of insulin resistance.
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Objective To observe the correlation between 1-hour postload plasma glucose and carotid intima-media thickness (IMT) in elderly male patients with hypertension.Methods One hundred and twenty six elderly male patients with hypertension were enrolled and divided into four groups: normal glucose tolerance with normal 1 h plasma glucose (1 hPG) group (low-NGT, n=42); normal glucose tolerance with high lh plasma glucose group (high-NGT, n=23);impaired glucose tolerance group (IGT, n=27) and diabetic group (n=84). The differences of blood pressure, blood glucose, blood lipid and intimia-media thickness among groups were analyzed.Results OGTT 1 hPG in high-NGT group was similar with IGT group[(12.0±1.1)mmol/L vs. (11.1±1.8)mrnol/L, P>0. 053 ,but significantly higher than that in Iow-NGT group ((12.0±1.1)mmol/L vs. (9. 1±1.4) mmol/L, P<0.01]. The value of IMT was gradually increased in four groups (P<0.05) and it was (1.02±0. 12) mm in high-NGT group. OGTT 1 hPG was the independent risk factor for IMT(P< 0.01).Conclusions OC-TT 1h plasma glucose is associated with atherosclerosis in elderly male hypertensive people.
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Objective To observe the distribution proportion of insulin resistance(IR) and non -insulin resistant(NIR) in aged subjects with impaired glucose tolerance (IGT)and to evaluate their states of metabolic syndrome and atherosclerosis. Methods Some indexes were detected in elderly subjects with IGT such as body mass index(BMI),waist-to-hip ratio(WHR), cholesterol(TC),triglyceride(TG), low density lipoprotein cholesterol(LDL-C) and high density lipoprotein cholesterol(HDL-C), systolic blood pressure (SBP), diastolic pressure (DBP), insulin,insulin area under curve(InsAUC) , inflammation markers(hsCRP,Fg), proinsulin and proinsulin area under curve(PIAUC),IMT and carotid artery atheromatous plaque were also examined in some people. Subjects were divided into insulin resistance group(IR group) and non-IR group(NIR group) according to HOMA-IR. Results (1)156 subjects with IGT, the rates of IR and NIR were 75.6% and 24.4% respectively.(2)BMI, TG,TC,LDL-C,hsCRP, Fg, SBP, DBP,HOMA-IR, InsAUC, PIAUC in IR group\[(26.8?2.1) kg/m2,0.96?0.23,(2.9?1.3)mmol/L,(5.4?1.8)mmol/L,(3.9?1.5)mmol/L,(154?12)mm Hg,(96?7) mm Hg,(239?71)mU/L,(170?42)pmol/L,(7.5?1.2)mg/L,(4.5?1.4) g/L \] were higher than those in NIR group\[(22.8?2.5) kg/m2, 0.80?0.2,(1.7?1.2) mmol/L,(4.5?1.5)mmol/L, 3.0?0.8 mmol/L,(133?10)mm Hg,(83?1)mm Hg,(180?66)mU/L,(109?25) pmol/L,(4.3?0.8)mg/L,(3.8?1.5 )g/L\], but HDL-C in IR group was lower than that in NIR group(1.0?0.4)mmol/L (P
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Aim To study the effect of rosiglitazone(RGZ)on expression and excretion of connective tissue growth factor(CTGF) in renal tissue and urinary of diabetic nephropathy rats.Methods Three groups of rats were studied:normal control group(n=8),STZ-induced diabetic model group(n=8),diabetes RGZ-treatment group(n=8).Urinary CTGF was measured at the 1 st,4 th,6 th and 8 th week,as well as the expressions of CTGF protein(by histochemical staining)at the 8 th week by ELISA.Results The urinary excretion rates of CTGF at 4 th、6 th、8 th weeks and the expressions of CTGF protein in renal cortex at 8th weeks significantly increased in STZ-induced model group compared with those in normal group(P
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Aim ① To observe the relationship between TGF?_1 and diabetic nephropathy in experimental rats;② To explore the effects of ACEI-fosinopril and ATRA-losartan on renal TGF?_1 in diabetic rats and their renoprotective mechanism. Method Four groups of rats were studied, A group:normal control rats;B group: strephtozotocin induced diabetic rats;C group:diabetic rats treated with fosinopril;D group: diabetic rats treated with losartan.Blood glucose, urinary excretion rates of albumin, TGF?_1,as well as the expressions of TGF?_1 protein and TGF?_1 mRNA in renal cortex and the relative kidney were measured. Result ① The urinary excretion rates of albumin and TGF?_1 in B,C ,D groups were significant higher than those in A group, fosinopril and losartan can decrease the urinary excretion rates of the two proteins but can’t make the rate normal. ② The expressions of TGF?_1 protein in renal cortex in B group was much higher than that in other 3 groups, fosinopril and losartan can inhibit the expression of TGF?_1. ③ The expressions of TGF?_1 mRNA in renal cortex increased greatest in B group, fosinopril and losartan can low the expression. Conclusion The overexpression of TGF?_1 protein and mRNA in renal cortex of diabetic rats may be one of the mechanisms of diabetic nephropathy. Fosinopril and losartan can suppress the expressions of TGF?_1 protein and mRNA in renal cortex, decrease the urinary excretion rates of TGF?_1. So alleviate the patholochanges in kidney.
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411 subjects were divided into six groups according to their FPG levels.And OGTT was carried out.Result showed that along with the FPG increasing, HOMA ?-cell index and ?I30 /?G30 were decreased progressively, and the fasting serum proinsulin level and ratio of proinsulin /insulin were increased markedly.The area under insulin curve decreased gradually when FPG was above 8 mmol/L. In conclusion, FPG is a reflection of islet ? cell function.
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Proinsulin(PI)_(AUC) increased,and insulin action index,HOMA-? and △I_(30)/△G_(30) decreased progressively from NGT(n=131) to IGT(n=120) to T2DM(n=107).Obese group had higher HOMA?,Ins_(AUC),C-P_(AUC) and PI_(AUC) than did the non-obese group.