[Iodine Nutritional Status and Prevalence of Thyroid Disorders among Adults in Chengdu].

Objective: To investigate the prevalence of thyroid disorders, iodine nutritional status and relevant risk factors among adults in Chengdu city on the basis of two population-based surveys, one conducted between 2016 and 2017 and the other, between 2019 and 2020, and to provide references for making health-related administrative decisions. Methods: Two population-based sampling surveys were conducted. The first one was done between October 2016 and December 2017, using stratified cluster random sampling to select subjects from 2 urban and 2 rural communities in Chengdu. Then, between December 2019 and February 2020, sequential cluster sampling was used to select subjects from communities in the peripheral regions of Longquanyi District, Chengdu. Both surveys covered natural populations of people who were 18 or older and who met the inclusion criteria. In the first survey, questionnaires, physical examination, thyroid ultrasound, and examinations of serum thyroid biochemical markers and urine iodine were performed, while in the second survey, only questionnaire concerning thyroid disorders and physical examination were performed. Statistical analysis of the nutritional status of iodine, the prevalence of thyroid disorders, and potential risk factor was conducted. Results: A total of 1859 subjects were enrolled for the first survey and 16152 for the second. According to the results of the first survey, the median urine iodine concentration was 172.10 µg/L, and the group with adequate or more than adequate iodine accounted for more than 60% of the surveyed population. The prevalence of thyroid disorders was found to be 0.48% for overt hyperthyroidism, 0.43% for subclinical hyperthyroidism, 0.43% for Grave's disease, 1.34% for overt hypothyroidism, 16.62% for subclinical hypothyroidism, 16.73% for positive thyroid antibody, 12.96% for TPOAb positive, 10.06% for TGAb positive, 0.81% for goiter, 14.85% for single nodule, 14.42% for multi-nodules, and 29.26% for thyroid nodules. Excess iodine is a risk factor for subclinical hypothyroidism ( OR=1.50, 95% confidence interval [ CI]: 1.07-2.10, P<0.05), and iodine deficiency is a risk factor for multiple thyroid nodules ( OR=1.45, 95% CI: 1.02-2.05, P<0.05). The total prevalence of hyperthyroidism, hypothyroidism and Hashimoto's thyroiditis in the two surveys was 6.58% and 5.95%, respectively, showing no significant difference. The second survey lacked accurate data on thyroid nodules. Conclusion: The iodine nutritional status of adults in Chengdu in recent years was appropriate. The total prevalence of hyperthyroidism, hypothyroidism and Hashimoto's thyroiditis remained stable, while that of thyroid nodule increased in recent years. We should continue with the implementation of the universal salt iodization policy and reinforce efforts in monitoring. Furthermore, we should make an active effort to look into the etiology of thyroid nodules.

Efficacy and Safety of Dulaglutide Monotherapy Compared to Glimepiride in Oral Antihyperglycemic Medication-Naïve Chinese patients with Type 2 Diabetes: A Post Hoc Analysis of AWARD-CHN1.

INTRODUCTION: Glucagon-like peptide (GLP)-1 receptor agonists are glucose-lowering agents associated with weight loss, cardiovascular benefits, and low hypoglycemic risk and are recommended by recent guidelines as first-line therapy for some patients with type 2 diabetes (T2D). This post hoc analysis of the AWARD-CHN1 study compared the efficacy and safety of once-weekly dulaglutide with glimepiride in oral antihyperglycemic medication (OAM)-naïve Chinese patients with T2D. METHODS: AWARD-CHN1 was a phase 3, double-blind study with 737 patients randomized 1:1:1 to once-weekly dulaglutide (1.5 or 0.75 mg) or glimepiride (1-3 mg/day). This is a post hoc analysis of AWARD-CHN1 based on mixed-model repeated measures using a modified intent-to-treat analysis set with only the OAM-naïve Chinese population. RESULTS: There were 264 OAM-naïve Chinese patients included in this analysis (dulaglutide 1.5 mg, n = 87; dulaglutide 0.75 mg, n = 90; glimepiride, n = 87). A greater glycated hemoglobin (HbA1c) reduction from baseline was observed with dulaglutide 1.5 mg and 0.75 mg compared to glimepiride (- 2.02% and - 1.84% vs - 1.37%, respectively; both P < 0.001). Significantly more patients in dulaglutide 1.5 mg and 0.75 mg groups achieved HbA1c targets < 7.0% compared to glimepiride (86.2% and 81.1% vs 65.5%; P = 0.002 and P = 0.026, respectively). Beta cell function was significantly increased for dulaglutide groups compared to glimepiride. Mean body weight was significantly reduced for dulaglutide 1.5 mg and 0.75 mg compared to glimepiride (- 1.40 kg and - 0.96 kg vs + 0.73 kg, respectively; both P < 0.001). Through 26 weeks, 7.9%, 4.2%, and 18.2% of patients reported hypoglycemia, and 40.4%, 23.2%, and 8.0% of patients reported at least one gastrointestinal treatment emergent adverse event, in dulaglutide 1.5 mg, 0.75 mg, and glimepiride groups, respectively. CONCLUSIONS: In this post hoc analysis, dulaglutide was effective in reducing both HbA1c and weight with favorable tolerability and safety profile, which is consistent with results seen in larger international dulaglutide monotherapy studies. TRIAL REGISTRATION: ClinicalTrials.gov NCT01644500.

[Epidemiology Study and Risk Factors Analysis of Hyperuricemia in Tibetan Monks of Sichuan Province].

OBJECTIVE: To investigate the prevalence and risk factors of hyperuricemia (HUA) in Tibetan monks of Sichuan province. METHODS: 755 adult Tibetan monks (more than 18 years old) in Ganzi Tibetan Autonomous Prefecture of Sichuan Province were included in this study for health examination. Residents of Kangding City who received health examination were selected as controls. We measured the height, body mass, waist circumference, hip circumference, blood pressure and detected liver and renal function, serum lipid and blood routine exam. Then HUA prevalence in different genders and ages, and risk factors of HUA were analyzed. RESULTS: The serum uric acid (SUA) level of Tibetan monks was (318. 03±107. 70) µmol/L with the total HUA prevalence of 21. 46%. The prevalence of male was higher than that of female (25. 44% vs. 19. 02%, P<0. 05). The overall HUA prevalence of residents in Kangding City was 30. 70%, which was higher than that of the monks (P<0. 01). Prevalence of HUA in male monks was lower than the entire male population (25. 44% vs. 41. 65%) and male Tibetan ones (25. 44% vs. 32. 23%) in Kangding city. Among female population, however, we found that the HUA prevalence of monk (19. 02%) was higher than that of overall female population (14. 07%) and Tibetan residents (14. 72%) in Kangding (P<0. 05). Peak prevalence of HUA in Tibetan monks was between 30 and 40 years old. Gender, waist circumference, waist-to-height ratio (WHtR), fasting plasma glucose (FPG), serum creatinine (SCr), hemoglobin (Hb) levels and the consumption of meat were all independent risk factors for the occurrence of HUA in Tibetan monks according to Logistic regression analysis. CONCLUSION: The prevalence of HUA in male Tibetan monks is lower than that of local urban Tibetan population, but the result in female monks is opposite. Gender, waist circumference, WHtR, FPG, SCr, Hb levels and the consumption of meat were all independent risk factors for HUA.

The association between thyroid autoantibodies in serum and abnormal function and structure of the thyroid.

OBJECTIVES: To evaluate the association between thyroid autoantibodies and abnormalities in thyroid function and structure, and to investigate any risk factors. METHODS: A cross-sectional survey was undertaken in Chengdu residents ≥ 18 years with no previous thyroid disease. The study participants provided demographic and clinical data. Thyroid function and serum concentrations of the thyroid autoantibodies antithyroperoxidase antibody (TPOAb) and antithyroglobulin antibody (TgAb) were measured. RESULTS: A total of 1334 subjects were included in this study. The prevalence of TPOAb and TgAb positivity was significantly higher in female than in male subjects. The prevalence of thyroid autoantibodies in those with subclinical hypothyroidism and clinical hyper- and hypothyroidism was significantly greater than in euthyroid subjects. The concentration of TPOAb and TgAb in subjects with both TPOAb and TgAb was significantly higher than in those who exhibited only one type of thyroid autoantibody. Using multivariate logistic regression analysis, female sex, thyroid volume, thyroid hypo- and heteroechogenicity were found to be risk factors for the presence of autoantibodies. CONCLUSIONS: Thyroid autoantibodies were common in the general population. Women with thyroid enlargement, hypoechogenicity and heteroechogenicity might benefit from routine screening for thyroid autoantibodies and thyroid function.

Randomized, double blinded, placebo-controlled trial to evaluate the efficacy and safety of tolvaptan in Chinese patients with hyponatremia caused by SIADH.

To study the effect of tolvaptan on non-acute, non-hypovolemic hyponatremia in inappropriate secretion of antidiuretic hormone (SIADH) syndrome in Chinese patients. Hyponatremic SIADH patients received placebo (N = 18) or tolvaptan (N = 19) at an initial dose of 15 mg/day with further titration to 30 mg/day and 60 mg/day based on serum sodium concentrations. Randomized, double-blind, placebo-controlled trial. Primary endpoint was the change of the serum sodium from baseline to days 4 and 7. Analysis of covariance (ANCOVA) was used for statistical analysis. At day 4, average daily changes in serum sodium levels from baseline was 1.9 ± 2.9 mmol/L (1.9 ± 2.9 mEq/L) in the placebo group and 8.1 ± 3.6 mmol/L (8.1 ± 3.6 mEq/L) in the tolvaptan group; at day 7, the values were 2.5 ± 3.9 mmol/L (2.5 ± 3.9 mEq/L) and 8.6 ± 3.9 mmol/L (8.6 ± 3.9 mmEq/L) for the placebo and tolvaptan groups (ANCOVA, P < 0.001). At days 4 and 7, daily urine output and proportions of patients with normalized serum sodium were significantly superior in the tolvaptan group. The most common adverse events occurring in the tolvaptan group were dry mouth and thirst. Tolvaptan demonstrated superiority to placebo in the treatment of Chinese SIADH patients with hyponatremia by elevating serum sodium concentration with acceptable safety profile.

Interpretation of Chinese Society of Endocrinology consensus statement on hyperglycemia management target in adult inpatients in China.

Hyperglycemia of inpatients will increase the incidence of complications, mortality and medical cost, meanwhile prolong the course of hospitalization. A consensus on hyperglycemia management target in adult inpatients is proposed by experts of the Chinese Society of Endocrinology in order to control hyperglycemia of inpatients safely and effectively. Individualization is emphasized in this consensus. Different stratified glycemic targets should be established according to different patients and conditions. Target blood glucose control is unnecessary for diabetic patients during hospital stay. Glycemic decrement should generally not be quick. Hypoglycemia should be avoided as much as possible, and for overweight and obesity individuals, weight gain should be avoided as much as possible also. At the same time, the risks of infection and hyperglycemic crisis must also be avoided due to loose glycemic control.

Stratifying and tailoring HbA1c control targets for adults with Type 2 diabetes: interpretation of the consensus proposed by the Chinese Society of Endocrinology.

Glycemic control is an important goal of treatment to delay the progression of and complications associated with diabetes, but controversies exist regarding individual HbA1c control targets for different patients. With the aim of optimizing outcomes and minimizing adverse events, a preliminary consensus on HbA1c control targets for adults with Type 2 diabetes has been proposed by the Chinese Society of Endocrinology (CSE). Instead of recommending a general standard value for all patients, the CSE suggests that a relatively reasonable stratified and tailored target for individual patients should take into consideration both clinical status and social factors. Principles governing the establishment of a glycemic control target include safety, feasibility, scientific evidence, and customized care, of which the most important factor is safety. In addition to controlling plasma glucose, equal consideration should be given to other vascular disease risk factors.

Activation of PPARδ promotes mitochondrial energy metabolism and decreases basal insulin secretion in palmitate-treated ß-cells.

The peroxisome proliferator-activated receptor δ (PPARδ) regulates the expression of genes involved in cellular lipid and cell energy metabolism in many metabolically active tissues, such as liver, muscle, and fat, and plays a role in the cellular response to stress and environmental stimuli. The particular role of PPARδ in insulin-secreting ß-cells, however, is not well understood; we recently identified the cell-specific role of PPARδ on mitochondrial energy metabolism and insulin secretion in lipotoxic ß-cells. After treatment of HIT-T15 cells, a syrian hamster pancreatic ß-cell line, with high concentrations of palmitate and/or the specific PPARδ agonist GW501516, we detected the gene expression changes for transcripts, such as peroxisome proliferator-activated receptor gamma co-activator 1 (PGC-1α), nuclear respiratory factor 1 (NRF-1), mitochondrial transcription factor A (mtTFA), the protein levels of the mitochondria uncoupling protein 2 (UCP2), mitochondrial morphology, the insulin secretion capacity and ATP/ADP ratio. Our results show that GW501516 treatment promoted generation of mitochondrial ATP, as well as expression levels of PGC-1α, NRF-1 and mtTFA, decreased basal insulin secretion, but had no effect on glucose-stimulated insulin secretion (GSIS), increased amounts of UCP2 and changed ATP-to-ADP ratio, improved mitochondrial morphology in palmitate-treated ß-cells. GW501516-induced activation of PPARδ enhanced mitochondrial energy metabolism, but also promoted a concomitant mitochondrial uncoupling and resulted in decreased basal insulin secretion and restricted GSIS; this observation indicated the possible action of a protective mechanism responding to the alleviation of excessive lipid load and basal insulin secretion in lipotoxic ß-cells.

Severe insulin allergy after percutaneous transluminal coronary angioplasty.

BACKGROUND: Insulin therapy is essential for type 1 and inadequately controlled type 2 diabetic patients. Insulin allergies have become less common since the introduction of highly purified human recombinant insulin. There are rare reports of severe insulin allergic reactions after percutaneous transluminal coronary angioplasty (PTCA) in patients with type 2 diabetes who had no previous allergic reactions. To better understand the causes and presentation of this rare acute reaction, we present the following observed case. CASE SUMMARY: A 63-year-old Chinese man (height, 172 cm; weight, 68.5 kg) with a 17-year history of type 2 diabetes and hypertension was first admitted to the West China Hospital, Sichuan University, Sichuan, People's Republic of China, for uncontrolled type 2 diabetes. He used regular human insulin, neutral protamine Hagedorn insulin, or premixed insulin without any allergic reactions. Four months later, PTCA was performed because of an acute myocardial infarction. The patient was administered 50 mg of protamine after active abdominal bleeding due to a right external iliac artery rupture. Three months later, recurrent raised, pruritic erythema occurred at the insulin injection site immediately after injection. Four weeks later, he experienced an attack of generalized urticaria at multiple previous injection sites (abdomen, upper arms, thighs) after injecting premixed insulin. It was accompanied by dizziness and palpitations. During the following 3 months, the symptoms recurred 3 times; one time, the patient reported losing consciousness for 2 to 3 minutes. The results of a skin prick test found that he was allergic to human recombinant insulin and insulin lispro. The allergy was resolved by changing his treatment regimen from insulin to oral hypoglycemic agents. A Naranjo score of 10 suggested a definite relationship (score >or=9) between the adverse drug reaction and the insulin administration. CONCLUSIONS: We present a definite case of allergy associated with insulin and insulin lispro administration. The patient had not experienced anaphylactic reactions prior to PTCA and protamine administration.

[Isolation, purification and primary culture of rat pancreatic beta-cells].

OBJECTIVE: To isolate and purify rat pancreatic beta-cells and to explore the best conditions for the primary culture of the pancreatic beta-cells in vitro. METHODS: The pancreas of Norman Wistar rats were digested by collagenase V. The islets were purified by mesh sieve. The activity of the islets was stimulated by different concentrations of glucose and detected by dithizone dye. The purified islets were put into RPMI-1640 nutritive medium for culture overnight. The cultured islets were digested again with trypsin and DNAase to obtain the suspension containing single pancreatic cells. The beta-cells were separated and purified in a fluorescence-activated cell sorter (FACS) in the medium containing 2.8 mmol/L glucose. The purified beta-cells were identified by immunohistochemistry and glucose stimulating test. Ham's F-10 with different concentrations of glucose and 3-Isobutyl-1-methylxanthine (IBMX) were used as nutritive medium for the primary cell culture for 24 hours. The best conditions for the culture were identified. RESULTS: An average of 550 +/- 90 islets with fine activities were obtained per rat. The purification with FACS obtained about 5688 beta-cells per rat, with a recovery rate of (93.69 +/- 1.26)% and a purity of (85.5 +/- 1.24)%. A concentration of 10.0 mmol/L and 16.0 mmol/L glucose in primary culture for 24 hours produced the highest survival rates of beta-cells, but IBMX did not increase the survival rates of beta-cells. CONCLUSION: FACS is effective in purifying pancreatic beta-cells from the suspension with a medium containing 2.8 mmol/L glucose. Pancreatic beta-cells maintain relatively high activities in Ham's F-10 medium containing 10.0-16.0 mmol/L glucose in primary culture.

[The effect of metformin on insulin receptor protein tyrosine kinase activity of HIT-T15 cell exposed to high concentration glucose and free fatty acid].

OBJECTIVE: To study the effect of metformin on insulin receptor (IRc) protein tyrosine kinase (PTK) activity of HIT-T15 cell exposed to high glucose and free fatty acid (FFA) concentration, and to explore the mechanism of metformin (MF) improving beta cell insulin resistance. METHODS: HIT-T15 cells were incubated for 48 h in a medium containing 5.5-16.7 mmol/L glucose and 0.5 mmol/L palmitic acid respectively. The cells were re-incubated for another 24 h with or without 2.5 microg/mL MF. The PTK activities of IRc were measured by radioactive enzyme assay. RESULTS: The enzymatic activities of IRc PTK were significantly decreased to HIT-T15 cells having the exposure to high glucose or high FFA concentration, when compared to control [(52.5 +/- 18.6) or (54.6 +/- 14.0) vs. (119.4 +/- 29.1) pmol/(min x microg), P < 0.01 respectively. The enzymatic activities of IRc PTK in HIT-T15 cells reincubated with 2.5 microg/mL MF for an additional 24 h were significantly increased vs MF free group [(113.0 +/- 29.8) vs. (52.5 +/- 18.6) pmol/(min x microg), x 98.6 +/- 26.1) vs. (54.6 +/- 14.0) pmol/(min x microg), P < 0.01 respectively], and were no significant difference in comparison with control group (P > 0.05). CONCLUSION: The enzymatic activities of IRc PTK are significantly decreased in HIT-T15 cells chronically exposed to elevated glucose or free fatty acids levels. Metformin can restore approximately normal enzymatic activities of PTK of HIT-T15 cells, of which the PTK activities have been impaired by chronic exposure to high glucose or free fatty acids levels.

[Effects of sibutramine on blood glucose and lipids, body fat mass and insulin resistance in obese patients: a multi-center clinical trial].

OBJECTIVE: To evaluate the effects of sibutramine on body weight, body fat mass, metabolism of plasma glucose and serum lipids, and insulin resistance (IR) in primary obesity patients. METHODS: A double-blind, double-placebo, randomized controlled, multi-center clinical trial was conducted. 359 voluntary obese subjects, whose body mass index (BMI) > or = 27 kg/m(2), without hypertension and diabetes, were enrolled. They were randomly divided into group A, B and C respectively. Sibutramine tablets or capsules were administered 10-20 mg/day for 24 weeks to the test groups and placebo to a control group. CT scan was used to measure the intra or subcutaneous-abdominal fat areas (IAFA, SAFA) at L(4)-L(5) level. Dual energy X-ray absorptiometry (DEXA) was used to measure total body fat mass (TBFM). RESULTS: 315 subjects continued to be followed for 24 weeks. After opening the blind, it was shown that group A received sibutramine tablet (n = 107), group B placebo (n = 104) and group C was capsule (n = 104). In group A and C body weight loss was 4.86 kg (6.42%) and 4.68 kg (6.38%), TBFM reduction was 4.07 kg (13.94%) and 4.09 kg (15.02%), SAFA decreased 7.30% and 7.45%, IAFA decreased 19.21% and 16. 98% respectively. Fasting plasma glucose decreased from 5.69 to 4.83 mmol/L and from 5.38 to 4.69 mmol/L in group A and C respectively. Fasting serum insulin decreased from 20.98 to 14.75 mU/L and from 21.11 to 14.68 mU/L, 2 h insulin decreased from 70.91 to 44.11 mU/L and from 73.13 to 41.93 mU/L in group A and C respectively. Serum triglyceride decreased from 1.98 to 1.73 mmol/L and 1.84 to 1.67 mmol/L, total cholesterol decreased from 5.08 to 4.75 mmol/L and from 5.06 to 4.46 mmol/L, high-density lipoprotein cholesterol increased from 1.13 to 1.28 mmol/L and 1.10 to 1.31 mmol/L in group A and C respectively, HOMA-IR index decreased from 5.32 to 3.32, and from 5.09 to 3.12 respectively in group A and C. Adverse drug reaction was 32.41%, 13.47% and 31.20% in group A, B and C. CONCLUSIONS: Sibutramine tablet or capsule decreases comparably body weight and TBFM, especially IAFA regulates plasma glucose and serum lipid metabolism and also decreases IR. Sibutramine is well tolerated in most of the subjects.

[In vitro study of the effects of pioglitazone on endothelial cell functions of human umbilical vein and the mechanisms involved].

OBJECTIVE: To determine whether pioglitazone (PIO) has effects on human umbilical vein endothelial cells (HUVECs) in vitro and to clarify the possible mechanisms therein involved. METHODS: The HUVECs were selected to be a model, which was cultured with 5.5 mmol/L glucose (control group), 30 mmol/L glucose (high glucose group), and 30 mmol/L glucose+PIO at 10(-9), 10(-7), 10(-5) mol/L respectively (PIO+high glucose groups). The effects of the drugs on the endothelial dysfunction induced by high glucose were studied. The role of protein kinase C (PKC) alpha and delta in the endothelial dysfunction induced by high glucose and the effects of PIO were assessed. The translocation of PKCdelta or PKCalpha in a single HUVEC was observed by Laser-Scanning Confocal Microscope, and the expression analysis was conducted quantificationally by Western blotting. RESULTS: High glucose could induce HUVECs apoptosis; the concentration of NO reduced and the level of sICAM-1 increased in high glucose group. PIO could inhibit the increasing apoptosis peaks induced by high glucose and could reverse the concentration of NO and sICAM-1 to normal level. PIO could inhibit the translocation of PKCa from plasm to nucleus in HUVECs induced by high glucose; it also could inhibit the translocation of PKCdelta from nucleus to plasm and membrane in HUVECs. PIO could inhibit the increasing expression of PKCdelta in HUVECs induced by high glucose. The expression level of PKCalpha in the high glucose group was not significantly different from that in the control. CONCLUSION: PIO could correct the endothelial cell dysfunction induced by high glucose, and this drug action of PIO may be effected via the inhibition of PKCalpha and PKCdelta.

[A case of Gitelman's syndrome presenting with severe hypocalcaemia and hypokalemic periodic paralysis].

HISTORY AND CLINICAL FINDINGS: A 63-year-old woman was admitted with fatigue, general malaise, paraesthesiae, muscle cramping and weakness of the limbs. Since the age of 13, she had suffered from a transient lower extremities paralysis 3 times. Past history was unremarkable. There was no family history of disease. In addition, she denied any form of self-medication, surreptitious diuretic and laxative abuse, persistent vomiting and diarrhea. The blood pressure was 120/70 mmHg, BMI = 23.0 kg/m2, WHR = 0.84. A little anxious. The results of physical examinations were unnoticeable. The cranial-nerve functions were intact. Manual muscle tests revealed her extremities in normal condition. Sensation was normal in all modalities. The deep tendon reflexes were present but decreased mildly. INVESTIGATIONS: Laboratory tests showed moderate to severe hypokalemia with a serum potassium concentration of 2.77 to 3.17 mmol/L, hypomagnesemia (0.31-0.35 mmol/L), hypocalcaemia (1.79-1.99 mmol/L), hypocalciuria (0.12-1.10 mmol/24 h), and metabolic alkalosis. The patient had elevated plasma renin activity and normoaldosteronism; her parathyroid hormone level was normal. Urinary calcium to creatinine ratio was (5.17-23.57) x 10(-3) mg/mg Cr. The renal clearance studies in this patient using furosemide or hydrochlorothiazide disclosed that urine volume and chloride clearance (CCL) were increased after furosemide administration, but there was no obvious change after the administration of hydrochlorothiazide. Furthermore, the distal fractional chloride reabsorption [CH2O/(CH2O+CCI)] was dramatically decreased by furosemide administration, whereas thiazide had little effect on it. These findings pointed to the presence of a non-functional thiazide-sensitive sodium/chloride cotransporter in the distal convoluted tubule, so the diagnosis of Gitelman's syndrome (GS) was made. TREATMENT: The patient was treated with indomethacin 50 mg, tid; after 3 days, the potassium increased, but calcium and magnesium serum levels failed to improve. So triamterene 50 mg, tid was also administrated. After 4 days, the serum levels of potassium, calcium were normalized, and the serum levels of magnesium increased from 0.35 mmol/L to 0.52 mmol/L; weakness and fatigue improved markedly, the clinical symptoms disappeared. The 18-month-follow-up study found the magnesium serum level normal. CONCLUSION: GS may be present with severe hypocalcaemia and hypokalemic periodic paralysis; the renal clearance studies by diuretic administration may be of help in diagnosing Gitelman's syndrome, and the combined use of indomethacin with triamterene has good therapeutic effect.

[Effects of L-threonate on bone resorption by osteoclasts in vitro].

OBJECTIVE: To clarify if calcium L-threonate and sodium L-threonate have inhibitory effects on the bone resorption of rabbit's osteoclasts in vitro. METHODS: This study contained a total of 16 culture groups, including one group as control and 5 groups treated by 5 drugs (calcium D-threonate, sodium L-threonate, alendronate, 17beta-estradiol and calcium gluconate) each at the final concentrations of 10(-9) mol/L, 10(-7) mol/L, 10(-5) mol/L respectively. After 7 days, eight bone slices of every group were stained with toluidine blue and the areas of resorptive pits were analyzed under light microscope; the concentrations of C-telopeptide of type I collagen (CTx or Crosslaps) in culture supernatants were measured by ELISA. RESULTS: (1) The resorption area and the CTx concentration of the Calcium L-threonate groups were reduced significantly as compared with those of control and of Calcium gluconate groups respectively. The resorption area and CTx level of the Sodium L-threonate groups were significantly reduced when compared with those of the control, but the effects of Calcium gluconate groups were not so. (2) The reduction in the resorption area and CTx concentration of Calcium L-threonate group was more than that of Sodium L-threonate group. (3) The reductive effect of the high concentration (10(-5)) group of Calcium L-threonate on the area and CTx level was corresponding to that of 17beta-estradiol at a concentration between 10(-7) and 10(-9). (4) The resorption area was related to the CTx concentration (r=0.876). (5) The CTX level was much more sensitive, precise and stable than the concentration. CONCLUSION: L-threonate, especially calcium L-threonate could inhibit the bone resorption of osteoclasts in vitro, and its effect might be related to the radical of L-threonic acid. The CTx concentration in culture supernatants might be an effective marker quantitatively reflecting the bone resorption by osteoclasts in vitro.

[Body fat distribution: its characteristics and relationship to cardiovascular risk factors in obese Chinese].

OBJECTIVE: To investigate the distribution of body fat and analyze its characteristics and relationship with metabolic variables in obese Chinese. METHODS: In this observational, cross sectional study, the total body fat mass was measured using body mass index (BMI), and as an index of intra-abdominal fat accumulation, the ratio of the visceral (VA) to abdominal subcutaneous (SA) adipose area (VSR) was determined using a computed tomography (CT) scans made at the level of L4/L5 in 309 obese human subjects (male 88; female 221). Blood pressure (BP), fasting serum lipids such as triglycerides (TG), total cholesterol (TC), high density lipoprotein(HDL-c), low density lipoprotein (LDL-c), and serum uric acid (UA) were also determined. RESULTS: (1) There were no differences between the male and the female subjects in regard to age, BMI, SBP, LDL-c and HDL-c. SA was significantly greater in women, whereas VA and VSR were significantly greater in men; DBP, UA, TC and TG were significantly higher in men than in women. (2) In both men and women, VSR was significantly higher in obese Chinese than in obese European and Americans. Age, TG and LDL-c were higher in subjects with visceral fat obesity (VFO) than in those with subcutaneous fat obesity (SFO). In males, TC,UA were significantly higher in VFO than in SFO. (3) 57 paired cases of male and female subjects matched for VSR were studied, and significant higher levels of serum UA and TG were noted in the male than in the female subjects. (4) After being adjusted for age and BMI, the analyses of partial correlation showed that in both men and women, VSR was positively correlated with TG and LDL-c, and SA was negatively correlated with LDL-c. In men, VA was positively correlated with SBP, and SA was negatively correlated with TG. In women, VA was positively correlated with TG, LDL-c; SA was negatively with LDL-c, but it was positively correlated with HDL-c and UA. (5) Stepwise multiple regression analysis showed that SA, VA, VSR were independent predictor for TG and LDL-c, SBP, and TC respectively (adjusting R2=0.079, 0.193, 0.122, 0.072, P=0.005, 0.000, 0.001, 0.007, respectively) in males. In females. VSR was an independent predictor for TG and LDL-c (adjusting R2=0.024, 0.113, P=0.012, 0.000 respectively); both BMI and SA were important predictors for UA and HDL-c, and SA was an important predictor for SBP. CONCLUSION: The above data suggest that in obese Chinese, the body fat distribution is characterized by central obesity, the cardiovascular risk factors are not only associated with general obesity but more closely associated with regional body fat distribution (VFO), and the relationships between regional body fat distribution and metabolic variables vary with gender.