Assessment of diabetes care and the healthcare system in economically and transport underdeveloped rural mountain areas of western China: A cross-sectional survey.

BACKGROUND: The aim of the present study was to assess the quality of diabetes care and characteristics of the healthcare system in underdeveloped rural mountain areas of western China. METHODS: Questionnaires were used to collect data from 288 diabetic patients with a multistage cluster sampling method in Zhongjiang County (Sichuan Province) between October 2009 and April 2010. Sixty-two village clinics, 23 town health centers, and a county central hospital were included to assess the availability of diabetes-related medical resources, in addition to diabetes-related medical insurance, reimbursement policies, and manpower. RESULTS: Of 288 patients, 38.2 % monitored their blood glucose regularly. Targets for fasting blood glucose (≤7 mmol/L) and blood pressure (≤130/80 mmHg) were achieved by 7.6 % and 9.7 % of patients, respectively. On average, each patient paid US$120 out of pocket annually for out-patient diabetes care, with a maximum US$86 reimbursed. The county central hospital was the only healthcare facility in the county that could provide all essential diabetes-related drugs and process-of-care measures and tests, except measures of HbA1c and the urinary albumin: creatinine ratio. Insulin was not available at village clinics, and only 29 % of village clinics had glucometers. "Certified" doctors were not available to provide primary care in village clinics. CONCLUSIONS: The quality of diabetes care was quite poor in underdeveloped rural mountain areas of western China. Recommendations for further intervention research to improve diabetes healthcare include increasing investment in medical infrastructure, improving the availability of essential drugs and process measures, organizing regular diabetes patient education, and recruiting village doctors.

Chinese herbal medicines for hypothyroidism.

BACKGROUND: The reduced production of thyroid hormones is the main feature of the clinical state termed hypothyroidism. In Chinese philosophical and medical theory, it results from Yang deficiency. Chinese herbal medicines (CHM) are thought to restore Yang and have been used in China to treat hypothyroidism for many years. OBJECTIVES: To assess the effects of CHM for hypothyroidism. SEARCH METHODS: We searched The Cochrane Library, MEDLINE, EMBASE, the Chinese Biomedical Literature Database on Disc, and the China National Knowledge Infrastructure for randomised clinical trials (RCTs). The date of the last search was September 2014 for all databases. We also searched for ongoing trials in trial registers. SELECTION CRITERIA: We considered RCTs of CHM alone or combined with thyroid hormone therapy compared with no treatment, placebo or thyroid hormone therapy. We also planned to compare different formulae of CHM with each other, alone or combined with thyroid hormone therapy. Hypothyroid individuals had to be diagnosed by the standard criteria valid at the time of the beginning of the trial regardless of the cause of hypothyroidism. DATA COLLECTION AND ANALYSIS: Data extraction and risk of bias assessment were not performed because no study could be included. MAIN RESULTS: We found no RCTs and therefore could not establish the effects of CHM on hypothyroidism. AUTHORS' CONCLUSIONS: Currently, there is no evidence available from RCTs on CHM for the treatment of hypothyroidism. We also did not find any ongoing registered trial.

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.

Activation of PPARdelta up-regulates fatty acid oxidation and energy uncoupling genes of mitochondria and reduces palmitate-induced apoptosis in pancreatic beta-cells.

Recent evidence indicates that decreased oxidative capacity, lipotoxicity, and mitochondrial aberrations contribute to the development of insulin resistance and type 2 diabetes. The goal of this study was to investigate the effects of peroxisome proliferator-activated receptor delta (PPARdelta) activation on lipid oxidation, mitochondrial function, and insulin secretion in pancreatic beta-cells. After HIT-T15 cells (a beta-cell line) were exposed to high concentrations of palmitate and GW501516 (GW; a selective agonist of PPARdelta), we found that administration of GW increased the expression of PPARdelta mRNA. GW-induced activation of PPARdelta up-regulated carnitine palmitoyltransferase 1 (CPT1), long-chain acyl-CoA dehydrogenase (LCAD), pyruvate dehydrogenase kinase 4 (PDK4), and uncoupling protein 2 (UCP2); alleviated mitochondrial swelling; attenuated apoptosis; and reduced basal insulin secretion induced by increased palmitate in HIT cells. These results suggest that activation of PPARdelta plays an important role in protecting pancreatic beta-cells against aberrations caused by lipotoxicity in metabolic syndrome and diabetes.

Danazol for uterine fibroids.

BACKGROUND: Uterine fibroids (myomas, fibromyomas, leiomyomas) are the most common benign tumours of the female genital tract. Danazol, a synthetic isoxazole derivative chemically related to 17-ethinyl testosterone, has been used for many years for the treatment of women with uterine fibroids. OBJECTIVES: To evaluate the effectiveness and safety of danazol in women with uterine fibroids. SEARCH STRATEGY: We searched the Cochrane Menstrual Disorders and Subfertility Review Group Specialised Register; Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2008, Issue 4); MEDLINE; EMBASE; Chinese Biomedical Disc; and the China National Knowledge Infrastructure for relevant trials (to December 2008). Attempts were made to identify trials from references in published studies. We also searched for ongoing trials in the five major clinical trials registries. SELECTION CRITERIA: Randomised controlled trials of danazol versus placebo or any other medical therapy in women with uterine fibroids confirmed by medical procedures, regardless of the women's symptoms or age. Women with malignancies were excluded. DATA COLLECTION AND ANALYSIS: Data extraction and risk of bias assessment were not been performed because there were no identified studies. MAIN RESULTS: We did not identify any studies which met our full inclusion criteria. AUTHORS' CONCLUSIONS: There is no reliable evidence available from randomised controlled trials regarding the benefits and or harms of the use of danazol for treating uterine fibroids.