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1.
Endocrinology and Metabolism ; : 778-789, 2021.
Article in English | WPRIM | ID: wpr-898203

ABSTRACT

Background@#Subclinical hypothyroidism (SCH) is the most common thyroid dysfunction, and its relationship with blood pressure (BP) has been controversial. The aim of the study was to analyze the association between SCH and newly-diagnosed hypertension. @*Methods@#Based on data from the Thyroid disease, Iodine nutrition and Diabetes Epidemiology (TIDE) study, 49,433 euthyroid individuals and 7,719 SCH patients aged ≥18 years were enrolled. Patients with a history of hypertension or thyroid disease were excluded. SCH was determined by manufacturer reference range. Overall hypertension and stage 1 and 2 hypertension were diagnosed according to the guidelines issued by the American College of Cardiology/American Heart Association in 2017. @*Results@#The prevalence of overall hypertension (48.7%), including stage 1 (28.9%) and 2 (19.8%) hypertension, increased significantly in SCH patients compared with euthyroid subjects. With elevated serum thyroid stimulating hormone (TSH) level, the hypertension prevalence also increased significantly from the euthyroid to different SCH subgroups, which was more profound in females or subjects aged <65 years. The age- and sex-specific regression analysis further demonstrated the same trends in the general population and in the 1:1 propensity matched population. Similarly, several BP components (i.e., systolic, diastolic, and mean arterial BP) were positively associated with TSH elevation, and regression analysis also confirmed that all BP components were closely related with SCH in female subjects aged <65 years. @*Conclusion@#The prevalence of hypertension increases for patients with SCH. SCH tends to be associated with hypertension and BP components in females younger than 65 years.

2.
Endocrinology and Metabolism ; : 778-789, 2021.
Article in English | WPRIM | ID: wpr-890499

ABSTRACT

Background@#Subclinical hypothyroidism (SCH) is the most common thyroid dysfunction, and its relationship with blood pressure (BP) has been controversial. The aim of the study was to analyze the association between SCH and newly-diagnosed hypertension. @*Methods@#Based on data from the Thyroid disease, Iodine nutrition and Diabetes Epidemiology (TIDE) study, 49,433 euthyroid individuals and 7,719 SCH patients aged ≥18 years were enrolled. Patients with a history of hypertension or thyroid disease were excluded. SCH was determined by manufacturer reference range. Overall hypertension and stage 1 and 2 hypertension were diagnosed according to the guidelines issued by the American College of Cardiology/American Heart Association in 2017. @*Results@#The prevalence of overall hypertension (48.7%), including stage 1 (28.9%) and 2 (19.8%) hypertension, increased significantly in SCH patients compared with euthyroid subjects. With elevated serum thyroid stimulating hormone (TSH) level, the hypertension prevalence also increased significantly from the euthyroid to different SCH subgroups, which was more profound in females or subjects aged <65 years. The age- and sex-specific regression analysis further demonstrated the same trends in the general population and in the 1:1 propensity matched population. Similarly, several BP components (i.e., systolic, diastolic, and mean arterial BP) were positively associated with TSH elevation, and regression analysis also confirmed that all BP components were closely related with SCH in female subjects aged <65 years. @*Conclusion@#The prevalence of hypertension increases for patients with SCH. SCH tends to be associated with hypertension and BP components in females younger than 65 years.

3.
Acta Universitatis Medicinalis Anhui ; (6): 1361-1365, 2017.
Article in Chinese | WPRIM | ID: wpr-668066

ABSTRACT

Objective To study the changes of serum lipoprotein cholesterol subclass in patients with primary hypothyroidism).Methods 38 cases of primary hypothyroidism were divided into clinical hypothyroidism group (hypothyroidism group,20 cases) and subclinical hypothyroidism group (subclinical hypothyroidism group,18 cases),Another 20 healthy persons (control group) were selected as control group.5 ml of fasting venous blood was extracted,the serum was separated and preserved at-80 ℃.Configuration of density liquid and ultracentrifugation under different background densities was done.Cholesterol oxidase method was used to determine the serum cholesterol,levels of small and low density lipoprotein (sdLDL),high density lipoprotein 2 (HDL2),and HDL3.At the same time,levels of serum triiodothyronine (T3),thyroxine (T4) and thyroid stimulating hormone (TSH) were checked.Statistical analysis of the correlation between the thyroid relevant hormone mentioned above and serum lipoprotein cholesterol subclass was done.Results ① The total cholesterol,triglycerideand LDL cholesterol levels in hypothyroidism group and subclinical hypothyroidism group were higher than that in the control group,However,the HDL level was significantly lower than the control group (P < 0.05);② SdLDL-C in hypothyroidism group and subclinical hypothyroidism group was significantly higher than that in the control group (P < 0.05);serum HDL2-C in hypothyroidism and subclinical hypothyroidism group was significantly lower than that in the control group (P <0.05);while the significance of HDL3 was not reached;sdLDL-C,HDL2-C,HDL3-C in hypothyroidism and subclinical hypothyroidism group had no statistical significance;(Primary thyroid dysfunction occurs,the level of sdLDL-C was positively correlated with TSH (r =0.287,P =0.026),and negatively correlated with T4 (r =-0.267,P =0.039);and no correlation with T3;HDL2-C and T3,T4 were positively correlated (r =0.271,0.270,P =0.036,0.037);no significant correlation between HDL3-C and TSH,T3 T4.Conclusion The changes of clinical lipid profile and lipoprotein cholesterol subclass in patients with hypothyroidism are correlated with thyroid function.

4.
Acta Universitatis Medicinalis Anhui ; (6): 678-681, 2016.
Article in Chinese | WPRIM | ID: wpr-492484

ABSTRACT

Objective To investigate the association between serum Klotho and oxidative stress in metabolically healthy obese individuals. Methods 180 physicalexamination subjects were investigated. They were devided into 3 groups:60 cases of normal weight and metabolic normality,60 cases of metabolically healthy but obese( MHO) ,60 cases of obesity with metabolic syndrome. Fasting blood glucose(FBG),2 h blood glucose(2 hBG),triglyceride ( TG) ,high densitylipoprotein cholesterol( HDL-C) , systolic blood pressure, diastolic blood pressure,body height, body weight,waist circumference,body mass index( BMI) were recorded. Malondialdehyde( MDA) ,superoxide dis-mutase( SOD) ,total antioxidation capacity( TAOC) ,Klotho were detected by ELISA. The difference of clinical pa-rameters,metabolic parameters,oxidative stress and Klotho among these three groups was compared by the methods of covariance analysis. Regression analysis and pearson correlation were used to evaluate the relationship of Klotho with oxidative stress. Results Compared with the control group, TAOC, SOD, Klotho were decreased significantly while MDA elevated significantly in both MHO group and obesity with metabolic syndrome group(P<0. 05). Com-pared with MHO group, TAOC, Klotho were significantly lower in obesity with metabolic syndrome ( P<0. 05 ) . Klotho protein was significantly positively associated with SOD, TAOC, negatively associated with waist circumfer-ence,BMI,FBG,2 hBG(r= -0. 182,-0. 225,-0. 221,-0. 202,-0. 188,P<0. 05). SOD,TAOC were deter-minants for Klotho. Conclusion The balancebetween oxidative and antioxidative system is disturbed in subjects with MHO. Klotho protein may maintain the normal metabolism of thebody by regulating the oxidative stress.

5.
Acta Universitatis Medicinalis Anhui ; (6): 198-201, 2015.
Article in Chinese | WPRIM | ID: wpr-462100

ABSTRACT

Objective To explore the effect of smoking on the triglyceride ( TG ) , cholesterol ( TC ) , high density lipoprotein-cholesterol(HDL-C) and low density lipoprotein-cholesterol(LDL-C) with the male type 2 diabetes. Methods Selected 144 male patients with type 2 diabetes, then divided them into four groups, including non-smokers, former smokers,current mild(≤20 per day) smokers and current heavy ( >20 per day) smokers. All of them were investigated about the age, diabetes pathogenesis, exercise, diet, smoking, lipid-lowering drugs used and checked with TG, TC, HDL-C, LDL-C and so on. The difference of TG, TC, HDL-C, LDL-C among these four groups was compared by the methods of covariance analysis, regression analysis and partial correlation to evalu-ate the relationships of smoking with blood lipid. Results TG of heavy smokers was higher than the non-smokers and HDL-C was lower after correcting the effects of other possibly relative factors(P<0. 05). HDL-C of the former smokers was higher than smokers and TG was lower than heavy smokers(P<0. 05). Smoking was an independent risk factor for HDL-C ( P<0. 05 ,β= -0. 213 ) , and there was a significantly negative relationship between daily cigarette consumption and HDL-C ( r= -0. 223 , P<0. 05 ) . Conclusion Smoking is an important risk factor for the diabetic male patients’ metabolism of the TG and HDL-C,independent of age, body mass index, blood pres-sure,exercise,diabetes pathogenesis, percentage of body fat and blood glucose. Smoking promotes the type 2 diabet-ics’ disorder of blood lipid and smoking cessation is of significance for the diabetics’ regulation of blood lipids.

6.
The Journal of Practical Medicine ; (24): 3765-3768, 2014.
Article in Chinese | WPRIM | ID: wpr-461728

ABSTRACT

Objective To examine the association between one-hour plasma glucose (1-hPG) level during an oral glucose tolerance test (OGTT) and serum lipid profiles in individuals with NGT. Methods 6 402 individuals with NGT who underwent a 75 g OGTT were screened from four communities of Hefei suburban areas, aged over 40 years. Then 1 291 cases of NGT were randomly selected as the object of this research by random data table method. They were divided into NGT-1 group (1-h PG < 8.6 mmol/L, n = 597)and NGT-2 group(1-h PG≥8.6 mmol/L, n = 694). Pearson correlation analysis and multivariate linear regression analyses were performed to assess correlations between 1-h PG levels and lipid profiles. Results (1) The average values of body mass index were 24.3 kg/m2 in NGT-1 group, and 24.5 kg/m2 in NGT-2 group. (2) Compared with individuals in NGT-1 group , fasting plasma glucose , two-hour plasma glucose during OGTT , HbA1c , triglyceride (TG), and high-density lipoprotein-cholesterol(HDL-c) levels, TG/HDL-c ratios, and total cholesterol(TCH)/HDL-c ratios were significantly higher in individuals than in NGT-2 group. By contranst, body mass index, blood pressure , TCH and low-density lipoprotein-cholesterol levels were not significantly different between NGT-1 group and NGT-2 group. (3) The multiple linear regression analyses showed that 1 h PG levels positively correlated with TG in individuals in both NGT-1 group and NGT-2 group (P < 0.01). In addition, 1-h PG levels negatively correlated with HDL-c ratio in both groups (P < 0.01). Conclusion 1-h PG levels during OGTT in overweight individuals with NGT closely correlate with HDL-c and TG levels.

7.
Chinese Journal of Endocrinology and Metabolism ; (12): 584-588, 2012.
Article in Chinese | WPRIM | ID: wpr-427259

ABSTRACT

Objective To investigate the oxidative stress status and cardiac myocyte apoptosis in rats with propylthiouracil-induced hypothyroidism and to examine the effect of levothyroxine ( LT4 ),vitamin E ( VitE ),and both supplementation on this experimental model.Methods Male Sprague Dawley rats were divided into normal control group( NC),propylthiouracil group( PTU ),LT4 treatment group( PTU + LT4 ),VitE treatment group ( PTU +VitE),LT4 and VitE combination therapy group (PTU + LT4 + VitE).Serum T3,T4,TSH levels,serum and myocardial superoxide dismutase ( SOD ) activity and malondialdehyde ( MDA ) content were determined.Cardiac myocyte apoptotic index was made with TUNEL.Results ( 1 ) Compared with NC group,T3 and T4 levels were significantly lower and TSH level was significantly higher in PTU group and PTU+VitE groups( P<0.05 ).Compared with PTU group,T3 and T4 levels were significantly higher and TSH level was significantly lower in PTU + LT4 group and PTU + LT4 + VitE group( P<0.05 ).There were no statistical differences in T3,T4,and TSH levels between PTU group and PTU + VitE group( P>0.05 ).( 2 ) Compared to NC group,serum and myocardial MDA levels in PTU group increased significantly( P<0.05 ),serum SOD activity decreased significantly ( P<0.05 ),while myocardial SOD activity showed no significant difference( P>0.05 ).( 3 ) Compared with NC group,myocardial apoptosis index was significantly higher in PTU and PTU + VitE groups( P<0.05 ).Compared with PTU group,myocardial apoptosis index was significantly lower in PTU + LT4 group and PTU + LT4 + VitE group( P<0.05 ).Conclusion LT4,VitE,and their combined treatment of hypothyroidism in rats reduce the myocardial cells apoptosis,which may be related to the improvement of thyroid function and amelioration of oxidative stress.

8.
Chinese Journal of Endocrinology and Metabolism ; (12): 578-583, 2012.
Article in Chinese | WPRIM | ID: wpr-426842

ABSTRACT

Objective To explore whether adiponectin activates AMP-activated protein kinase(AMPK) via LKB1 pathway or not in skeletal muscle and liver tissues.Methods Male Sprague-Dawley rats ( n =28 ) were divided into normal control diet( NC,n =15 ) and high-fat diet( HF,n =13 ) groups.After 16 weeks feeding,fasting blood free fatty acids( FFA ),triglyceride( TG ),total cholesterol( TC ),fasting plasma glucose( FPG ),fasting insulin(FINS),and adiponectin were determined.The protein levels of AMPKα,phosphorylated AMPKα ( p-AMPK ),and LKB1 in the skeletal muscle and liver tissues were analyzed with Western blot.Cultured primary skeletal muscle cells and hepatic cells were incubated with aditonectin and radicicol.The expression of AMPKα,p-AMPKα,and LKB1 inthese cells were analyzed with immunofluorescence method.Results Compared with NC group,body weight,FFA,TG,FPG,and FINS in rats of HF group were significantly higher( all P<0.05 ) while serum adiponeetin level was lower( P<0.05 ).The levels of AMPKα phosphorylation and LKB1 expression in the skeletal muscle and liver tissues of HF group were lower than those in NC group. In primary skeletal muscle cells and hepatic cells,adiponectin significantly increased the levels of AMPKα phosphorylation and LKB1 expression ( all P< 0.05 ),which were decreased by radicicol ( P<0.05 ).Conclusion Adiponectin may activate AMPK via LKB1 pathway in skeletal muscle and liver tissues of rats.

9.
Chinese Journal of Endocrinology and Metabolism ; (12): 293-294, 2012.
Article in Chinese | WPRIM | ID: wpr-418575

ABSTRACT

The data collected from 34 type 2 diabetic patients receiving intensive insulin therapy for six years showed that the yearly mean HbA1C was less than 7.0%,and none of the patients showed severe hypoglycemia,occurrence or evident progression of retinopathy or nephropathy,and the islet β cell function gained improvement.The DQOL score,used to evaluate the quality of patients' life had no significant change during the observation ( P >0.05 ).It is satisfactory and safe to maintain long-term glycemic control with prolonged intensive insulin therapy in patients with type 2 diabetes,and that such therapy does not induce untoward influence on the quality of diabetic patients life.

10.
Chinese Journal of Endocrinology and Metabolism ; (12): 967-971, 2011.
Article in Chinese | WPRIM | ID: wpr-417530

ABSTRACT

ObjectiveTo investigate the relationship of HLA-DRB1 allele polymorphism and antineutropil cytoplasmic antibody ( ANCA ) with the susceptibility to antithyroid drug ( ATD ) -induced leucocytopenia in the patients with Graves' disease (GD) in Anhui Han Chinese.MethodsThe HLA-DRB1 * 08032,DRB1 * 1501,and DRB1 * 0901 allele frequencies were determined by the polymerase chain reaction-based sequence-specific primer (PCR-SSP) method in 76 patients with Graves' disease who had ATD-induced leucocytopenia and 98 patients with Graves' disease treated with ATD,who were free from leucocytopenia.The other230 healthy subjects served as controls.Indirect immunofluorescence assay (IIF) was used to detect ANCA positive rate.Result( 1 ) Compared with the controls and the GD patients without leucocytopenia,the allele frequencies ofDRB1 * 08032 and DRB1 * 1501 in patients with ATD-induced leucocytopenia were significantly increased ( OR were 3.06,1.77,4.03,and 2.28,all P<0.05),while that of HLA-DRB1 * 0901 was decreased ( OR were 0.33 and 0.43,both P<0.05 ).(2)The ANCA frequencies were significantly increased in the GD patients with methimazole-induced leucocytopenia compared with those without leucocytopenia (x2 =4.878,P<0.05 ).( 3 ) Compared with the GD patients not carrying DRB1 * 08032,DRB1 * 1501,and DRB1 * 0901 alleles,the ANCA positive rates were significantly increased in the GD patients carrying these alleles(x2 were 5.682,5.429,4.009,and 4.549,all P<0.05).ConclusionsThe DRB1 * 08032 and HLA-DRB1 * 1501 alleles may be susceptible to ATD-induced leucocytopenia in Anhui Hans,while HLA-DRB1 * 0901 alleles may be protective or resistant gene.Immune response may be involved in the development of leucocytopenia.The occurrence of immune response is based on the genetic susceptibility.

11.
Chinese Journal of Endocrinology and Metabolism ; (12): 676-678, 2010.
Article in Chinese | WPRIM | ID: wpr-387950

ABSTRACT

To explore the association between polymorphisms of transcription factor 7-like 2 gene (TCF7L2) and type 2 diabetes mellitus in Hefei district. The results suggest that the genetic variation DG10S478 in the TCF7L2 gene was not associated with type 2 diabetes mellitus in Hefei district ( P>0.05 ). However, its attribution to the susceptibility of type 2 diabetes mellitus in Hefei is not important.

12.
Chinese Journal of Endocrinology and Metabolism ; (12): 868-870, 2010.
Article in Chinese | WPRIM | ID: wpr-386302

ABSTRACT

One-hundred and sixty-nine women with polycystic ovarian syndrome (PCOS)and 95 healthy women were enrolled. All subjects were genotyped for rs290487 ( transcription factor 7-like 2 gene) by TaqManMGB probe hybridization assay. The results showed that polymorphism rs290487 had association with PCOS in Han people in Anhui area. The allele C was associated with the risk of PCOS. Genotype CC seems to be the risk factor of insulin resistance in PCOS patients.

13.
Chinese Journal of Endocrinology and Metabolism ; (12): 394-396, 2008.
Article in Chinese | WPRIM | ID: wpr-398963

ABSTRACT

Objective To explore the impact of waist-to-hip ratio (WHR) in type 2 diabetic probands on the phenotype of insulin resistance and β-cell function in normoglycemic first-degree relatives. Methods One hundred and eighty-six type 2 diabetic probands and 489 normoglycemic first-degree relatives were selected from 186 type 2 diabetes core families. 115 first-degree relatives (FDR1 group) of probands with low WHR (1st quartile: <0.86 for males and <0.84 for females) and 106 first-degree relatives (FDR2 group) of probands with high WHR (4th quartile: >0.92 for males and >0.89 for females) were identified to intensively study from 489 normoglycemic first-degree relatives. The homeostasis model assessment of insulin resistance (HOMA-IR) was used to estimate insulin sensitivity, and β-cell function was quantified as the ratio of the incremental insulin to glucose responses over the first 30 min (△I30/△G30) during the oral glucose tolerance test. The latter measure was also adjusted for the assay of insulin sensitivity as it modulated β-cell function (△I,,30>·△G-1,30·HOMA-IR-1). Results The body mass index, the waist circumference and waist-to-height ratio in female first-degree relatives, systolic blood pressure, triglyceride and HOMA-1R were significantly higher in FDR2 group than those in FDR1 group andhigh density lipoprotein cholesterol,△I30/△G30, △I-130·HOMA-IR-1were significantly lower in FDR2 group than those in FDRI group (P < 0.05 or P < 0.O1). The waist circumference and waist-to-height ratio in relatives of probands with low and high WHR were positively correlated with the HOMA-IR. However, the least square regression analysis showed that the slope from regression in FDR2 group were significantly steeper than thatin FDR1 group(both P <0.01). Conclusion The normoglycemic first-degree relatives of the type 2 diabetic probands with high WHR had much more evident phenotype of insulin resistance and decreased β-cell function, and a slight increase in abdominal obesity had a greater impact on insulin resistance.

14.
Chinese Journal of Postgraduates of Medicine ; (36)2006.
Article in Chinese | WPRIM | ID: wpr-528441

ABSTRACT

Objective To compare the effect of treating hyperglycemia on insulin pump therapy in newly diagnosed type 2 diabetes mellitus(T2DM) and the patients with failure to oral antidiabetic therapy. Methods Selecting 32 patients with newly diagnosed T2DM(NDM group)and 64 T2DM patients with failure to oral antidiabetic therapy(ODM group),which were treated by insulin pump,having no significant difference of the level of blood glucose,body mass index(BMI),age,proportion of sex between NDM group and ODM group. Results (1)The mean time and the maximal dosage of insulin for blood glucose to be targeted in NDM group were all lower than those in ODM group(P all

15.
Chinese Journal of Practical Internal Medicine ; (12)2001.
Article in Chinese | WPRIM | ID: wpr-561206

ABSTRACT

Objective To study the change of B-cell function after reduction in plasma free fatty acid(FFA)concentration.Methods All 38 normoglycemic first-degree relatives of type 2 diabetes received a 75 g oral glucose tolerance test(OGTT),before and after acipimox,250 mg orally tid for 5 days.Results Acipimox significantly reduced fasting plasma FFA,HOMA-IR,the incremental glucose area under the curve(AUCg)and the incremental FFA area under the curve(AUCf)during OGTT(P0.05).The increment in ?I30/?G30、?I30??G30-1?HOMA-IR-1 correlated negatively with the decrement in fasting FFA,AUCf(r=-0.39~-0.49,P

16.
Chinese Journal of Diabetes ; (12)1995.
Article in Chinese | WPRIM | ID: wpr-587158

ABSTRACT

0.05). Obesity group showed the higher levels of TG,VLDL-C,FIns, TNF-? and FFA than did normal controls (P

17.
Chinese Journal of Diabetes ; (12)1994.
Article in Chinese | WPRIM | ID: wpr-585934

ABSTRACT

Objective To explore the relationships of serum levels of leptin,TNF-?,FFA and resistin with IR and between themselves. Methods 48 T2DM patients and 47 non-diabetic controls were selected.Levels of leptin,TNF-?,FFA and resistin were measured.FPG,insulin,blood lipid,blood pressure,BMI and WHR were measured.Results The levels of leptin,TNF-?,FFA and resistin were correlated positively with HOMA-IR(P

18.
Chinese Pharmacological Bulletin ; (12)1987.
Article in Chinese | WPRIM | ID: wpr-563049

ABSTRACT

Aim To investigate the relationship between nonalcoholic fatty liver disease(NAFLD)and levels of serum adiponectin and tumor necrosis factor-?(TNF-?)in diet-induced obese rats and the effects of pioglitazone.Methods 45 SD male rats were randomly divided into three groups:pioglitazone group(P),high-fat diet group(HF),normal control group(NC),15 rats in each group.Rats in NC group were fed with standard food and the others with high-fat diet.After 12 weeks,rats in P group were treated with pioglitazone 10mg/kg ig daily for 4 weeks.Accordingly,HF and NC groups were administrated with homologous solvent.Serum adiponectin,TNF-?,free fatty acid(FFA),and biochemical data were observed,and Lee's index,HOMA-IR and liver index were calculated.Pathologic histology and HE stain of rat livers were observed.Results Compared with HF group with NC group,body weight,liver index,levels of serum glucose,insulin,FFA,ALT,HOMA-IR and TNF-? increased significantly,and serum adiponectin decreased(P

19.
Chinese Journal of Endocrinology and Metabolism ; (12)1986.
Article in Chinese | WPRIM | ID: wpr-538118

ABSTRACT

Objective To observe the effect of leptin on glucose oxidation with increased mRNA expression of complete length long intracellular domain of leptin receptor ( OBRb) in primary cultured skeletal muscle cells. Methods Skeletal muscle cells were isolated from SD sucking rat and cultured in four groups (recombinant transfection, empty plasmid transfection, non-transfection and control).The recombinant with complete length OBRb cDNA or the empty plasmid were introduced into skeletal muscle cells by clonfectin when the cultured cells were 70% conlluency, leptin and regular insulin were applied into wells and incubated for 1 h, then D-[ U-I4C]-glucose was added into wells and incubated for 2 h. The radioactivity of collected 14CO2 was assayed by scintillation. Expression level of OBRb mRNA in transfected cells was assayed by RT-PCR. Results The ratios of OBRb intraceUular domain mRNA and p-actin mRNA in cells transfected with recombinant, transiected with empty plasimd, and non-transfected were 1.22?0.10,0.41?0.08 and 0.49?0.09, respectively.The expression of OBRb intraceUular domain mRNA in cells transfected with recombinants was significantly increased as compared to the other groups of cells (P

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