"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.

Evaluation of desmopressin stimulated bilateral inferior petrosal sinus sampling in diagnosing Cushing′s disease / 中华内分泌代谢杂志

Objective To evaluate desmopressin stimulated inferior petrosal sinus sampling in diagnosing Cushing′s disease.Methods Sixteen ACTH-dependent Cushing′s disease patients underwent bilateral desmopressin stimulated inferior petrosal sinus ( IPS ) sampling because of negative or equivocal magnetic resonance imaging.Cortisol response to high-dose dexamethasone suppression test was also evaluated.ACTH sampling was taken from a peripheral vein and bilateral IPS before and both 5 and 10 min after injection of desmopressin.Diagnosis was based on the ratio of ACTH level in between IPS to peripheral vein by desmopressin test.Diagnosis was confirmed after surgery.Results High-dose dexamethasone suppression test showed suppressible in 9 of 16 patients with Cushing′s disease.An IPS gradient ＞2 was found in 14 of the 16 cases (87.5％ )with Cushing′s disease after desmopressin injection,while before injection the respective figure was 12 of 16 (75.0％).No severe adverse effects were observed during or after the procedure.Conclusion Desmopressin test during bilateral IPS sampling is a safe and effective diagnostic procedure in Cushing′s disease.

Plasma levels of N-terminal pro-B-type natriuretic peptide in patients with metabolic syndrome / 中华全科医师杂志

A retrospective analysis was made on clinical data of 230 cases of metabolic syndrome (MS) and 239 cases of non-MS admitted to department of cardiology and endocrinology of Huashan Hospital from July 2005 to August 2009.Multiple linear regression analysis was performed to assess the association between levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and potential influencing factors.Covariance analysis was used for group comparison.Multiple linear regression analysis demonstrated that age,body mass index,systolic blood pressure,diastolic blood pressure,insulin resistance index,triglyceride,low density lipoprotein-cholesterol,creatine,left atrial diameter,left ventricular posterior wall dimensions,left ventricular ejection fraction were independent predictors for plasma levels of NT-proBNP in those subjects(P ＜ 0.05).Covariance analysis showed that plasma levels of NT-proBNP in MS group were significantly lower than those in non-MS group ( P ＜ 0.05).Further analysis found that plasma levels of NT-proBNP in MS patients with high triglyceride and body mass index,but normal systolic and diastolic blood pressure,normal fasting plasma glucose were significantly lower than those in non-MS group ( P ＜ 0.05 ).The results indicate that decreased plasma levels of NT-proBNP might be related to lipids disorder and obesity of MS patients.

Evaluation of vibration perception thresholds test in screening diabetic peripheral neuropathy in type 2 diabetic patients / 复旦学报（医学版）

Objective To investigate the correlation between vibration perception thresholds test (VPT) and simple screening tests for peripheral neuropathy in the diabetes clinic in type 2 diabetic patients. Methods VPT and three simple screening tests including 10 g Semmes-Weinstein monofilament examination (SWME), vibration test by 128 Hz tuning fork, and temperature sensation test by Tip-Therm were completed in 487 Chinese patients diagnosed with type 2 diabetes aged over 30. The relationships between these simple screening tests and VPT were evaluated by Spearman correlation and observed agreement rate. Results Abnormal VPT was significantly associated with aging and fasting plasma glucose by binary logistic regression analysis. VPT was significantly correlated with SWME, temperature sensation test, vibration test by 128 Hz tuning fork, and the correlation coefficient was 0.176, 0.152 and 0.240, respectively (P<0.01);Observed agreement between VPT and three simple screening tests including SWME, temperature sensation test, vibration test by 128 Hz tuning fork was 49.5%, 59.8% and 51.1%, respectively. The percentage of abnormal results by SWME or vibration test by 128 Hz tuning fork with normal result by VPT was very low, only 2.7% and 1.2% respectively. Conclusions VPT should also be considered as a first-choice screening test for diabetic peripheral neuropathy.

Ghrelin inhibits apoptosis induced by high glucose and sodium palmitate in adult rat cardiomyocytes through the PI3K-Akt signaling pathway.

OBJECTIVE: Ghrelin is a gastric acyl-peptide that has been identified as an endogenous ligand for the growth hormone secretagogue receptor. It has been reported to have cardioprotective activities independent of growth hormone release. We investigated the effect of ghrelin on apoptosis induced by high glucose and sodium palmitate and the mechanisms underlying the cardioprotective activities of ghrelin. RESEARCH DESIGN AND METHODS: Cardiomyocytes were isolated from hearts of adult rats and cultured in serum-free MEM. High glucose (30 mM) or sodium palmitate (0.5 mM) were used to induce apoptosis. Apoptosis was detected using an annexin V-FITC/PI binding assay and a caspase 3 activity assay. Reactive oxygen species were detected using a DCFH-DA fluorescent probe. Phospho-Akt, phospho-ERK, and NF kappaB levels were determined using ELISA. The transcription of genes was analyzed using real-time PCR. RESULTS: Ghrelin can inhibit apoptosis induced by oxidative stress in cardiomyocytes from adult rats through the activation of the PI3K-Akt signaling pathway. In addition, ghrelin does not decrease intracellular oxidative stress. Activation of the MEK-ERK1/2 signaling pathway has no influence on the inhibition of apoptosis. Finally, ghrelin activates NF kappaB and subsequently increases the transcription of survival genes such as Bcl-2, Bcl-xL, c-iap, and c-fos. CONCLUSION: Our research provides evidence that ghrelin may act as a survival factor under oxidative stress in cardiomyocytes. This may provide a clue for therapy for myocardial disease in diabetes mellitus.

Clinical diagnosis of 5 cases of pituitary stalk interruption syndrome / 中华内分泌代谢杂志

Objective To raise the level of clinical diagnosis for the patients with pituitary stalk interruption syndrome (PSIS). Methods Five patients (4 males) with PSIS were retrospectively analyzed with respects to the clinical features, endocrine status and image characteristics. Magnetic resonance imaging (MRI) scan was performed at hypothalamic-pituitary region. Results The clinical manifestations of all patients consisted of growth retardation and delayed puberty without polyuria. Deficiency of multiple anterior pituitary hormones was revealed in all patients by the evaluation of endocrine status. The features of MRI included a lack of visible pituitary stalk, absence of posterior lobe hypersignal in the sella turcica and a hyperintense spot in the region of the thalamus opticus. Conclusion The clinical characteristics of patients with PSIS are growth retardation and delayed puberty. The evaluation of anterior pituitary function is necessary. The detection of an anatomical abnormality around hypothalamic-pituitary region by MRI is important diagnostic evidence.

Patient preference for Shexiang Baoxin Pill versus extended release Isosorbide 5-Mononitrate in elderly diabetic patients with angina pectoris / 中成药

AIM: To gain an insight into preference for elderly diabetic patients with angina pectoris between Shexiang Baoxin Pill (SXBXP) (Moschus, Radix Ginseng, Calculus Bovis, etc.) and Extended Release Isosorbide 5-Mononitrate (ERIM). METHODS: Followed a two-week run-in, 56 elderly patients were randomized to take SXBXP 2 pills tid or ERIM 60 mg qd for 4 weeks; then followed a two-week wash-out, patients crossed over to the complementary therapy for another 4 weeks. Daily diary cards were used to record the side effects, the frequency of angina pectoris attacks and use of rescue medication. At the end of the study, participants were asked to complete a 3-item scale questionary to assess their angina pectoris treatment in terms of convenience, side effects and overall preference. RESULTS: No treatment difference in the frequency of angina pectoris attacks and use of rescue medication was found; 71.4% of patients thought use of SXBXP was the same convenient as that of ERIM; patients felt SXBXP had side effects fewer than ERIM and overall 75% of patients preferred SXBXP. CONCLUSION: Elderly diabetic patients with angina pectoris prefer SXBXP to ERIM.

Protectiv eeffect of Shexiang Baoxin Pills on the heart function and cardiac pathologic changes of STZ rats / 中成药

AIM:To observe the effect of Shexiang Baoxin Pills on pathologic changes and heart function of streptozotocin(STZ)-induced diabetic rats. METHODS:The rats were randomly divided into the control group,Shexiang Baoxin Pill group and STZ group.The rats in Shexiang Baoxin Pill group took Shexiang Baoxin Pill(50 mg/kg) to perfuse the stomach every day.The cardiac functions in 8 weeksafter treatment were determined.Meantime,the cardiac pathologic changes were observed through electron microscope and immunohistochemistry. RESULTS: Shexiang Baoxin Pills could reduce the interstitial fibrosis of myocardium in STZ rats.it could obviously improve the cardiac contraction and diastolic functions in STZ rats. CONCLUSION: Shexiang Baoxin Pills can(amendment) cardiac pathologic changes and improve cardiac function in STZ rats.